Sachiko Tanaka

Effectiveness of periodic checkup by ultrasonography for the early diagnosis of hepatocellular carcinoma.

Periodic checkup by ultrasonography was conducted on patients with chronic liver diseases for early detection of hepatocellular carcinoma. in 19 months, a total of 2004 examinations were performed on a total of 660 cases (179 cases with liver cirrhosis in the compensatory stage, younger than 70 years; 481 cases with chronic hepatitis, aged 40 to 70 years for men and 50 to 70 years for women). of the 660 cases, 22 HCC cases (3.3%) were detected and finally diagnosed by angiography and/or histologic examination. Four of those cases (18%) had a single nodule smaller than 1 cm in diameter, and 11 cases (50%) had a single nodule smaller than 2 cm. Surgical resection was performed on 12 cases (55%). in comparison with the control group (83 HCC cases not receiving any periodic checkup), the frequency of small liver cancer and the surgical resection rate in the study group were significantly higher. This examination system by periodic ultrasonography checkup of patients with chronic hepatic diseases was effective for early detection and permitted aggressive therapy of hepatocellular carcinoma.

Recent advances in ultrasonographic diagnosis of hepatocellular carcinoma

The diagnostic accuracy of ultrasonography (US) for hepatocellular carcinoma (HCC) was estimated by checking against the regional cancer registry, and also the clinical features, major therapy, and prognosis of HCC cases diagnosed by initial US were examined for the two periods of 1980 and 1984. The number of patients with HCC was 83 of 4442 in 1980 and 86/3393 in 1984. As for the detectability of the tumor, the sensitivity improved from 94.0% to 96.5%. Regarding the ability to confirm the detected tumor to be HCC, the sensitivity improved from 53.0% to 68.6% without decrease in the specificity of 99.9%. The size and number of nodules were more accurately diagnosed in 1984, and cases with small (⩽4 cm) single nodule increased from 2% to 9%. Active therapy was performed in more cases and the 2‐year survival rate increased from 9% to 20%. The remarkable improvement was achieved in the diagnostic accuracy of US for HCC during 4 years from 1980 to 1984.

Diagnostic accuracy of ultrasonography for hepatocellular carcinoma

Accuracy of ultrasonography for the diagnosis of hepatocellular carcinoma (HCC) was examined. The subjects were 5339 patients who underwent ultrasonography of the upper abdomen, during the year 1980 at our hospital. Out of 5339, 113 cases were found to be hepatocellular carcinoma by a 3‐year follow‐up study, checking against the records of regional cancer registry. Diagnostic accuracy based on 6 months of follow‐up was as follows: for identification of liver tumors, sensitivity, specificity, and overall accuracy were 94.9%, 98.7%, and 98.9% respectively; for diagnosis of HCC, sensitivity, specificity, and overall accuracy were 58.9%, 99.9%, and 99.3% respectively. In conclusion, the ability of ultrasonography to detect hepatocellular carcinoma is adequately high, and thus, ultrasonography can be employed as a diagnostic procedure for mass screening. Cancer 58:344–347, 1986.

Serum lipase response to cerulein secretin stimulation test in patients with pancreas-associated diseases as measured by sensitive colorimetric assay (a BALB-DTNB method)

We have compared responsiveness of serum lipase and amylase activity to the pancreatic exocrine stimulation with cerulein and secretin (CS test) in normal subjects and patients with pancreas-related and other diseases. The lipase and amylase activities were measured by a sensitive colorimetric method, the BALB-DTNB method and the Caraway method, respectively. The percentage of positive lipase and amylase response cases was as follows: confirmed chronic pancreatitis (N=22), 27 and 14%; suspected chronic pancreatitis (N=37), 46 and 32%; pancreatic cancer (N=16), 44 and 25%; biliary tract diseases (N=11), 14 and 14%; miscellaneous (N=11), 0 and 18%; normal subjects (N=13), and partial pancreatectomy (N=5), 0 and 0%, respectively. The serum lipase response cannot be regarded as specific for pancreatic diseases because the lipase response cases were found in biliary tract diseases as well. However, in view of frequent, fast, and intense responsiveness to the CS test, the serum lipase activity measured by the BALB-DTNB method may be more useful than the serum amylase as an auxilliary diagnostic aid for suspected pancreatitis which might develop into confirmed chronic pancreatitis or cancer of the head or body of the pancreas.

Hookwire localizer as an aid for ultrasonic detection of small liver nodules

We applied a V-shaped localizer and evaluated its clinical usefulness in nine patients with small hepatic nodules less than 2 cm in diameter. A small hepatic nodule was punctured with a 21-gauge localization needle under ultrasonic guidance, and the V-shaped localizer was pushed into the nodule with a wire. The localizer could be observed as a strong echo line by ultrasonography and as a highdensity bar by computed tomography (CT). By this method, it was possible to precisely localize the nodule. Intraoperative ultrasonography became less time-consuming, and resection of the nodules could be confirmed with low-kilovoltage radiography.

Adenomatous hyperplasia in cirrhotic liver detected by Lipiodol CT. A case report.

肝動脈内Lipiodol注入後のCTで明瞭なLipiodolの停滞を示した肝腺腫様過形成の1例を報告した.症例は46歳男性,慢性肝炎の経過中,腹部超音波検査で肝右葉に直径2cmの腫瘤を指摘された.血管造影上濃染像は明らかではなかったが,肝動脈内Lipiodol注入7日後のCTで明瞭な腫瘍内Lipiodol停滞がみられた.しかし,大部分のLipiodolが1ヵ月後には流出していた.肝細胞癌を疑い手術を施行した.腫瘤は数個の偽小葉により形成され,胆管を含む門脈域が認められた.核にも異型はなく組織学的に腺腫様過形成と診断した.腫瘤内にはLipiodol残存部に一致して完全壊死を示す小結節がみられ,腺腫様過形成内部に発生した小肝細胞癌が肝動脈塞栓術により壊死に陥ったものと考えられた.