Tokiko Endo

Sensitivity and specificity of mammography and adjunctive ultrasonography to screen for breast cancer in the Japan Strategic Anti-cancer Randomized Trial (J-START): a randomised controlled trial

BACKGROUND Mammography is the only proven method for breast cancer screening that reduces mortality, although it is inaccurate in young women or women with dense breasts. We investigated the efficacy of adjunctive ultrasonography. METHODS Between July, 2007, and March, 2011, we enrolled asymptomatic women aged 40-49 years at 42 study sites in 23 prefectures into the Japan Strategic Anti-cancer Randomized Trial (J-START). Eligible women had no history of any cancer in the previous 5 years and were expected to live for more than 5 years. Randomisation was done centrally by the Japan Clinical Research Support Unit. Participants were randomly assigned in 1:1 ratio to undergo mammography and ultrasonography (intervention group) or mammography alone (control group) twice in 2 years. The primary outcome was sensitivity, specificity, cancer detection rate, and stage distribution at the first round of screening. Analysis was by intention to treat. This study is registered, number UMIN000000757. FINDINGS Of 72,998 women enrolled, 36,859 were assigned to the intervention group and 36,139 to the control group. Sensitivity was significantly higher in the intervention group than in the control group (91·1%, 95% CI 87·2-95·0 vs 77·0%, 70·3-83·7; p=0·0004), whereas specificity was significantly lower (87·7%, 87·3-88·0 vs 91·4%, 91·1-91·7; p<0·0001). More cancers were detected in the intervention group than in the control group (184 [0·50%] vs 117 [0·32%], p=0·0003) and were more frequently stage 0 and I (144 [71·3%] vs 79 [52·0%], p=0·0194). 18 (0·05%) interval cancers were detected in the intervention group compared with 35 (0·10%) in the control group (p=0·034). INTERPRETATION Adjunctive ultrasonography increases sensitivity and detection rate of early cancers. FUNDING Ministry of Health, Labour and Welfare of Japan.

CT findings in groove pancreatitis: correlation with histopathological findings

Objective To clarify the CT characteristics of groove pancreatitis, which is a segmental form of chronic pancreatitis. Materials and Methods The CT findings in four patients with proved groove pancreatitis were reviewed retrospectively. The examinations consisted of plain CT, dynamic CT, and high dose enhancement CT in each patient. Correlation between the CT findings and the resected specimens was performed in three patients. Results In every patient a mass was detected in the head of the pancreas that involved the duodenum. Dynamic CT demonstrated a poorly enhancing lesion extending between the pancreatic head and the duodenum. Cysts in the duodenal wall and/or the groove and duodenal stenosis due to wall thickening were seen in four and three patients, respectively. These CT findings reflect the histological characteristics of this disease. Conclusion Computed tomography, including dynamic study, can demonstrate the characteristic findings of groove pancreatitis and suggest the diagnosis.

Thyroid nodules : evaluation with color Doppler ultrasonography

Forty‐seven patients with thyroid nodules (13 papillary carcinomas, 14 adenomas, and 20 adenomatous goiters) underwent color Doppler sonography with a 7.5 MHz transducer. Perinodular or intranodular color flow signals were depicted in 10 of 13 papillary carcinomas, in 10 of 14 follicular adenomas, and in 14 of 20 adenomatous goiters. No correlation existed between the presence of color signals and pathology, whereas the detection rate of color signals had a dependence on the size of the lesions. No specific flow pattern for malignancy could be found. Color Doppler sonography would not improve the ability to differentiate benign from malignant nodules significantly.

Development of a fully automatic scheme for detection of masses in whole breast ultrasound images.

Ultrasonography has been used for breast cancer screening in Japan. Screening using a conventional hand-held probe is operator dependent and thus it is possible that some areas of the breast may not be scanned. To overcome such problems, a mechanical whole breast ultrasound (US) scanner has been proposed and developed for screening purposes. However, another issue is that radiologists might tire while interpreting all images in a large-volume screening; this increases the likelihood that masses may remain undetected. Therefore, the aim of this study is to develop a fully automatic scheme for the detection of masses in whole breast US images in order to assist the interpretations of radiologists and potentially improve the screening accuracy. The authors database comprised 109 whole breast US imagoes, which include 36 masses (16 malignant masses, 5 fibroadenomas, and 15 cysts). A whole breast US image with 84 slice images (interval between two slice images: 2 mm) was obtained by the ASU-1004 US scanner (ALOKA Co., Ltd., Japan). The feature based on the edge directions in each slice and a method for subtracting between the slice images were used for the detection of masses in the authors proposed scheme. The Canny edge detector was applied to detect edges in US images; these edges were classified as near-vertical edges or near-horizontal edges using a morphological method. The positions of mass candidates were located using the near-vertical edges as a cue. Then, the located positions were segmented by the watershed algorithm and mass candidate regions were detected using the segmented regions and the low-density regions extracted by the slice subtraction method. For the removal of false positives (FPs), rule-based schemes and a quadratic discriminant analysis were applied for the distribution between masses and FPs. As a result, the sensitivity of the authors scheme for the detection of masses was 80.6% (29/36) with 3.8 FPs per whole breast image. The authors scheme for a computer-aided detection may be useful in improving the screening performance and efficiency.

Intraportal endovascular ultrasonography in the diagnosis of portal vein invasion by pancreatobiliary carcinoma.

ObjectiveThe purpose of this study was to determine the value of intraportal endovascular ultrasonography (IPEUS) in the diagnosis of portal vein invasion by pancreatobiary carcinoma. The authors reported their experiences with this new technique and compared it with conventional imaging technologies, such as portography and computed tomography (CT). Summary Background DataPancreatobiliary carcinoma often invades the portal vein. Observation of the echogente band of the portal vein wall by means of a high-frequency, high-resolution intravascular ultrasound catheter allows for the accurate diagnosis of the portal vein invasion. MethodsA prospective study of 30 consecutive patients with pancreatobiliary carcinoma (16 pancreatic carcinomas, 8 bile duct carcinomas and 6 gallbladder carcinomas) was performed. In 23 cases IPEUS was performed intraoperatively from the superior mesenteric venous route with an 8 French, 20 MHz intravascular ultrasound catheter. In 7 cases IPEUS was performed before surgery from the percutaneous transhepatic route with a 6 French, 20 MHz intravascular ultrasound catheter. The finding of IPEUS was confirmed by pathologic examination of resected specimens and surgical exploration. The results of IPEUS were compared to those of portography and CT. ResultsIntraportal endovascular ultrasonography visualized the portal vein wall as an echogenic band with a thickness of 0.5 mm to 1.0 mm. The diagnostic criterion of portal vein invasion was destruction of this echogenic band. Portal vein invasion was found in 15 of 30 cases. Vascular invasion was confirmed by pathologic examination of resected specimens in 10 patients and operative findings in 5. The sensitivity, specificity, and overall accuracy of IPEUS for diagnosis of portal vein invasion was 100%, 93.3%, and 96.7%, respectively. The values were 80%, 67.7%, and 73.3% for portography and 53.3%, 80%, and 66.7%, respectively, for CT. ConclusionsIntraportal endovascular ultrasonography provided precise information about the relationship between the pancreatobiliary tumor and the portal vein wall. It was capable of accurately detecting or excluding early invasion of the portal vein wall by pancreatobiliary carcinoma.

The Role of Contrast-Enhanced MR Mammography for Determining Candidates for Breast Conservation Surgery

PurposeThe aim of this study was to assess the impact of preoperative magnetic resonance mammography (MRM) on the surgical determination of breast conservation treatment for breast cancer patients.MethodsFrom September 1997 to March 2000, 57 consecutive breast conservation treatment candidates were prospectively evaluated with conventional imaging studies (mammography and ultrasonography) and preoperative MRM.ResultsIn 47 of 54 (87%) breast cancer patients breast conservation surgery (BCS) was indicated on the basis of mammography (MMG) and ultrasonography (US). However in 40 of the 54 (74%) patients BCS was indicated on the basis of MRM. Thirty-eight of the 40 patients ultimately underwent BCS and only 1 showed a positive margin. There were 7 patients whose MRM findings suggested that more aggressive treatment than BCS was needed but for whom US/MMG suggested that BCS was appropriate. Five of the 7 patients underwent mastectomy rather than BCS based on the MRM findings, which were justified by post-surgical histological findings. Of the 2 remaining patients who underwent BCS, one had a positive histological margin and one had recurrence, both of which resulted in salvage mastectomy.ConclusionOur study suggests that high resolution preoperative MRM provides more accurate information compared with US and MMG for selecting candidates for BCS. Using MRM as a routine staging tool may reduce unnecessary repeated excisions. A larger study will be required to confirm these findings and to define the patients most likely to benefit from breast MR imaging.

X-ray phase imaging: from synchrotron to hospital.

With the aim of clinical applications of X-ray phase imaging based on Talbot–Lau-type grating interferometry to joint diseases and breast cancer, machines employing a conventional X-ray generator have been developed and installed in hospitals. The machine operation especially for diagnosing rheumatoid arthritis is described, which relies on the fact that cartilage in finger joints can be depicted with a dose of several milligray. The palm of a volunteer observed with 19 s exposure (total scan time: 32 s) is reported with a depicted cartilage feature in joints. This machine is now dedicated for clinical research with patients.

Automated detection of clustered microcalcifications on mammograms: CAD system application to MIAS database

To investigate the detection performance of our automated detection scheme for clustered microcalcifications on mammograms, we applied our computer-aided diagnosis (CAD) system to the database of the Mammographic Image Analysis Society (MIAS) in the UK. Forty-three mammograms from this database were used in this study. In our scheme, the breast regions were firstly extracted by determining the skinline. Histograms of the original images were used to extract the high-density area within the breast region as the segmentation from the fatty area around the skinline. Then the contrast correction technique was employed. Gradient vectors of the image density were calculated on the contrast corrected images. To extract the specific features of the pattern of the microcalcifications, triple-ring filter analysis was employed. A variable-ring filter was used for more accurate detection after the triple-ring filter. The features of the detected candidate areas were then characterized by feature analysis. The areas which satisfied the characteristics and specific terms were classified and displayed as clusters. As a result, the sensitivity was 95.8% with the false-positive rate at 1.8 clusters per image. This demonstrates that the automated detection of clustered microcalcifications in our CAD system is reliable as an aid to radiologists.

Serous papillary adenocarcinoma of the female genital organs and invasive micropapillary carcinoma of the breast. Are WT1, CA125, and GCDFP-15 useful in differential diagnosis?

Serous papillary adenocarcinoma of the female genital organs and invasive micropapillary carcinoma of the breast have close histologic similarities. Thus, when these cancers occur synchronously or metachronously in the same patient, it is difficult to determine the primary site. We examined 23 serous papillary adenocarcinomas (16 ovarian, 5 endometrial, and 2 peritoneal) and 37 invasive micropapillary carcinomas of the breast (12 pure and 25 mixed types) on immunohistochemical expression of Wilms tumor antigen-1 (WT1), CA125, and gross cystic disease fluid protein-15 (GCDFP-15), which have been reported to be useful in the differential diagnosis of primary ovarian carcinomas versus metastatic breast cancer to the ovary. The positive rates of WT1, CA125, and GCDFP-15 in serous papillary adenocarcinomas were 78%, 78%, and 0%, respectively, and the corresponding rates in invasive micropapillary carcinomas were 3%, 40%, and 38%. The CA125-positive rate of invasive micropapillary carcinoma was higher than the rate reported for other types of breast carcinomas. We consider CA125 to be not always useful in the differential diagnosis of serous papillary adenocarcinoma and invasive micropapillary carcinoma. Although the positive rate of WT1 was significantly higher in serous papillary adenocarcinoma than in invasive micropapillary carcinoma, WT1 expression in endometrial serous papillary adenocarcinoma was infrequent (20%). WT1 and GCDFP-15 could be useful markers for the differential diagnosis of ovarian and peritoneal serous papillary adenocarcinoma versus breast invasive micropapillary adenocarcinoma. However, the availability of GCDFP-15 is limited because of the low positive rate of GCDFP-15 in invasive micropapillary carcinomas.

Automated detection methods for architectural distortions around skinline and within mammary gland on mammograms

Abstract The architectural distortion is a very important finding in interpreting breast cancers as well as microcalcification and mass on mammograms. However, it is more difficult for physicians to detect architectural distortion than microcalcification and mass. The purpose of this study is to develop two detection approaches for architectural distortions existing around skinline and within mammary glandular tissues. The detection methods for depressed areas around skinline consisted of three steps. The binarization technique was performed to extract the mammary gland region. In order to determine suspect areas, the top-hat processing was performed. The false positives were eliminated by the features of their sizes and positions. The distorted areas within mammary gland region were detected by the following steps. The structure of mammary gland was extracted by using curvature. The candidates were determined by concentration index. The false positives were eliminated by their isotropy indexes, sizes, pixel values and contrast. Our image database consisted of 17 cases with focal retraction areas around skinlines (case A) and 38 cases with architectural distortions within mammary glands (case B). As a result, the sensitivities were 94% and 84% in case A and case B, respectively. It was concluded that our methods were effective to detect architectural distortions.