乳癌検診の過剰診断について―避けるための対応策―

乳癌検診の過剰診断について―避けるための対応策―

Journal of Japan Association of Breast Cancer Screening


In order to reduce over-diagnoses in breast cancer screening

乳がん検診の過剰診断を避けるために

日本がん検診・診断学会誌

日本がん検診・診断学会誌


Promotion of quality-controlled mammography alone as a screening modality in Japan.

BACKGROUND: The rate of breast cancer screening in Japan has not increased, and it is thought that one of the reasons is the principle that mammography (MMG) and clinical breast examination (CBE) be carried out in combination. Nationwide, there is a shortage of physicians qualified to perform CBE, and in some regions mass-screening is performed by MMG alone out of a mobile MMG bus. In Shikoku, MMG is performed alone as a screening examination in Kochi and Ehime Prefectures. METHODS: A comparative analysis of the data generated by MMG alone in breast cancer screening in the four prefectures of Shikoku during the 2005-2009 period was performed. RESULTS: The overall attendance rates, recall, cancer detection, early-stage cancer detection, and the positive predictive value (PPV) were 16.8-24.5, 6.0-12.8, 0.26-0.37, 63.1-79.7, and 2.8-4.3 %, respectively. Almost no differences were seen between the results for MMG alone and combined MMG/CBE screening. In addition, the cancer detection rates based on the Japan Cancer Society's nationwide data were 0.25 % with combined MMG/CBE screening and 0.21 % with MMG alone, showing almost no difference. CONCLUSIONS: No differences were seen between the results (i.e., recall rate, cancer detection rate, early-stage cancer detection rate, PPV) for MMG alone and MMG/CBE screening in the four prefectures of Shikoku compared with the Japan Cancer Society's nationwide data. In order to improve the mammographic screening rate in Japan, quality-controlled mammography as a stand-alone examination should be promoted, and performed biennially for women aged 50-74 years.


Basic study of a diagnostic modality employing a new electrical impedance tomography (EIT) method for noninvasive measurement in localized tissue

The objective of this study is to develop a device for noninvasive local tissue electrical impedance tomography (EIT) using divided electrodes with guard electrodes and to validate its effectiveness using bioequivalent phantoms. For this purpose, we prepared a measurement device and bioequivalent phantoms, measured the electrical characteristics of the phantoms, and validated the method using the phantoms. Monolayer phantoms mimicking the brain and muscle and bilayer phantoms consisting of muscle and brain layers were prepared. The relative differences between the measured electrical conductivities of the monolayer brain and muscle phantoms and the true values determined by the 4-electrode method were both less than 10%. The relative differences between the measured and true values in the bilayer phantoms were less than 20% in both layers. The biological impedance measurement device that we developed was confirmed to be effective for impedance measurement in bilayer phantoms with different electrical impedances. To develop a device for the early diagnosis of breast diseases, the development of a multi-layer phantom and demonstration of the effectiveness of the device for its examination are necessary. If the device that we developed makes impedance measurement in breast tumors possible, it may be used as a new diagnostic modality for breast diseases.

The Journal of Medical Investigation : JMI


乳房縮小・再建術を行った若年性乳腺肥大症の2例

乳房縮小・再建術を行った若年性乳腺肥大症の2例

Journal of Japan Society of Plastic and Reconstructive Surgery


False-positive in fine-needle aspiration cytology of breast disease can be reduced with p63 immunostaining- A preliminary report

Myoepithelial cells of the mammary gland are considered to be a key to distinguishing benign from malignant disease in fine-needle aspiration (FNA) cytology. However, identification of these cells with Papanicolaou staining is not easy. The identification of myoepithelial cells was investigated using p63 antibodies to carry out immunostaining of FNA specimens that had been used at the time of Papanicolaou staining for 37 patients who yielded false-positives in FNA. Positively-stained cells were observed in overlying cell clusters or the background in 67.6% of the patients. There is a possibility that over-diagnosis could have been avoided by performing p63 staining for these patients. The controls consisted of stamp samples of fresh specimens obtained from 23 patients at the time of surgery for invasive carcinoma and the results of p63 immunostaining did not reveal any positive staining of tumor cells. Accordingly, these results indicate that there is a strong likelihood that there is no invasive carcinoma when many p63-positive cells are observed in the tumor cell population or the background and that p63 immunostaining has the potential to aid in reducing false-positives at the time of FNA diagnosis of breast disease.


Evaluation of safety and efficacy for bi-weekly Docetaxel and 5'-DFUR combination therapy in patients with advanced or recurrent breast cancer--Phase I study

進行・再発乳癌に対するBi‐weekly Docetaxelと5′‐DFURの併用化学療法における安全性と効果の検討—第I相試験—

BACKGROUND: A clinical trial of Docetaxel was performed by tri-weekly administration in patients with advanced or recurrent breast cancer. However, careful observation is necessary for outpatients because serious neutropenia often occurs during the therapy. A bi-weekly schedule is recommended since weekly administration requires more visits to the hospital. Docetaxel is proved to express synergistic efficacy in combination with 5'-DFUR by induced dThdPase in vivo. But there are no clinical trials to evaluate efficacy of bi-weekly Docetaxel and 5'-DFUR combination therapy. PURPOSE: To evaluate safety, the recommended dose of Docetaxel and the efficacy of biweekly Docetaxel and 5'-DFUR combination therapy. PATIENTS AND METHODS: Patients with advanced or recurrent breast cancer within 1 regimen of prior chemotherapy and without prior use of both Docetaxel and 5'-DFUR were enrolled. 5'-DFUR was orally administered by 600 mg/day. Docetaxel was intravenously given for at least 2 cycles (8 weeks) by 30 mg/m(2) for level 1, 40 mg/m(2) for level 2 and 50 mg/m(2) for level 3. At each level with 3 cases enrolled,the maximum tolerated dose (MTD) level was defined as that in which 2 or 3 cases showed dose limiting toxicity (DLT). The recommended dose was defined as the dose before MTD level. Therapeutic safety was evaluated by analyses of adverse events with the recommended dose. RESULTS: MTD was in level 3 and the recommended dose of Docetaxel was 40 mg/m(2) of level 2. No DLT was observed in level 2, and this combination therapy seemed safe and feasible for outpatients. In addition, all 6 cases for whom therapeutic efficacy was evaluated expressed a clinical response.

Japanese Journal of Cancer and Chemotherapy


A Theoretical Study about Parameter Estimation of Space Distributed Local Tissue Impedance

空間分布する局所組織インピーダンスのパラメータ推定に関する理論的検討

In this paper, a new configuration of the electrodes, called divided electrode, is proposed for a short time measurement of bio-impedance in a cross section of a local tissue. Its capability is examined by computer simulations, where a distributed equivalent circuit is used as a model of the tissue. Estimation of impedance parameters is carried out by use of the Gauss-Newton Method. As a result of them, usefulness of the proposed method is confirmed by computer simulations using a typical layered tissue model.

IEEJ Transactions on Electronics, Information and Systems

電気学会論文誌C (電子，情報，システム部門誌)


Accuracy of tissue thickness of the rectus femoris region as measured by ultrasound

In order to verify the accuracy of the thickness of the rectus femoris muscle and overlying subcutaneous fat as assessed by ultrasound, experiments were conducted on 10 healthy subjects aged over 30 years to assess the following: 1) concordance of measurements made by two different observers; 2) concordance of repeated measurements made by the same observer ; and 3) concordance of repeated measurements made by the same observer with and without an imaging aid(ultrasound gel block). Between two observers with varying experience in ultrasound, no significant difference in measured muscle thickness was observed ; however, there was a significant difference in subcutaneous fat thickness. When measurements were made by the same observer on two separate days, a significant positive correlation was evident for muscle and subcutaneous fat thickness between the first and second tests. While use of the imaging aid was associated with higher concordance of measurements between the first and second tests, the measurements themselves were affected. Although ultrasonic measurement of tissue thickness requires further investigation to minimize intra-observer error and examine correlations with other imaging techniques, the accuracy of the measurements in the present study suggests that clinical application may be possible.

JNI : The Journal of Nursing Investigation


Changes in the thickness of leg muscles before and after laparotomy

広島保健学学会 特別講演In order to establish an objective and convenient technique to assess postoperative recovery following laparotomy, in particular activities of daily living, we measured the thickness of muscle tissues by ultrasound sonography. In the present study, the following four muscular compartments were selected: rectus femoris, biceps femoris, extensor digitorum longus, and soleus. These account for a large portion of the systemic skeletal musculature and are important for locomotion. Subjects were 28 patients who underwent moderately invasive surgery for stomach or colon cancer. The results showed that muscle thickness decreased significantly in all four compartments. Rectus femoris exhibited the greatest reduction in thickness and was most affected by short-term or long-term recumbency. Furthermore, for soleus, the tendency was that the longer the recumbency, the greater the wasting. These findings suggest that, of the four areas of the lower limb, rectus femoris is most affected by short-term recumbency and is most suited for objectively assessing postoperative recovery. The results of the present study suggest that it would be effective to design a recovery program focused on maintaining the femoral extensor muscles, which are most affected by short-term recumbency following laparotomy.

Journal of Health Sciences, Hiroshima University


Content analysis of nursing students' learning though clinical practices with individuals with diabetes mellitus

臨地実習で糖尿病患者を受け持った学生の学びの分析

学士課程3年次での成人看護学実習で，糖尿病患者を受け持った看護学生(以下，学生)34名の学びの内容について検討することを目的に，学生の記述したレポート内容を質的帰納的に分析した．その結果，4カテゴリー(「療養行動が主体的に実践できるための具体的な支援方法」「学生が感じた困難感や達成感」「療養生活支援のために必要な看護技術」「療養生活を送る対象の理解」)と17サブカテゴリーが抽出された．学生は糖尿病患者を理解し，療養生活行動が主体的に行えるための支援方法を考えていた．そして，患者の行動変容を目指した介入の難しさを実感しながら，患者が主体的に療養行動を実践できるように支援することの大切さについて考え，学生としての立場での看護実践の喜びを感じていた．今後は，学生の学びについて，個々の事例ごとの確認を丁寧に行いながら，学びの内容を卒業時の到達目標と照らし合わせて確認する方法を考案することの必要性が示唆された．


甲状腺髄様癌術後肝転移に対し肝動脈化学塞栓療法が有効であった1例

甲状腺髄様癌術後肝転移に対し肝動脈化学塞栓療法が有効であった1例


Literature review of nursing interventions and evaluations for the persons with diabetes mellitus in Japan --- ―国内での文献検討から―

糖尿病を有する人に対する看護介入とその評価の現状 --- ―国内での文献検討から―

医学中央雑誌Web版(Ver．3)を用いて，1994年から2004年の過去10年間に，糖尿病を有する人を対象に，看護師が行った教育や指導などの看護介入行為のうち，その効果が患者の持つ問題の解決に有効であると報告されている研究論文の分析を行い，以下の結果が得られた． 1．対象となった論文は16編あった． 2．介入内容は食に関連するものが11編あった．看護師は，患者の持つ問題の明確化，その具体的な対応，到達目標の設定に対して，患者が主体的に取り組むことができるように，患者の情緒面も含めて援助していた． 3．介入内容の評価を看護師が行っていたものは13編あった．評価項目は糖尿病の血糖コントロール指標としてのHbA1cがすべての文献で用いられていた． 以上のことより，今後は，患者の自己管理を支援するために，患者が一貫して主体的に取り組めるような介入方法を開発することが必要である．また，介入結果の評価においては，血糖コントロール指標に加えて，患者の行動や心理の変化を適切に評価できる評価方法や評価指標を開発する必要があると考えられた．


施設画像評価委員会の現状と再評価施設における成果

施設画像評価委員会の現状と再評価施設における成果

Journal of Japan Association of Breast Cancer Screening


臨地実習での学習内容に対する学生自己評価の変化-成人看護学臨地実習で興味·関心のあるテーマを課題学習に導入した場合と導入しなかった場合の比較から-

臨地実習での学びを効果的にするために，3年課程3年次学生を対象に臨地実習固有の学習内容を用いた学生自己評価を継続しているが，自己評価得点は，実習開始前から中期にかけて上昇しても，中期から終了時には上昇しない傾向が続いた．そのため，成人看護学臨地実習(急性期)では，2003年度後期に学生の興味・関心のあるテーマを課題学習として導入することを試みた．課題学習を導入した2003年度後期(36人)と導入しなかった2001年度後期(34人)の自己評価得点の差を統計的に検定することにより，課題学習の効果を検討した．その結果，以下の結果が得られた． ① 課題学習のテーマを決定する過程において，学生は，自己の学習状況を振り返り，整理することができた． ② 終了時の自己評価では，課題学習を導入しなかった2001年度では4．0点以上の高得点の項目が20項目であったのに対し，課題学習を導入した2003年度では40項目もあり，学生は学習内容に到達したと高く評価していた． これらのことより，興味・関心のあるテーマを課題学習として導入することは，学生の自発性を高め，学習内容に対する学生の到達度の認識を高める可能性があると考えられた．


Basic study of new diagnostic modality according to non-invasive measurement of the electrical conductivity of tissues

The purposes of this study were to estimate the electrical conductivity of tissues by non-invasively measuring the electrical bio-impedance, to develop a new method for tissue diagnosis, i.e., electrical impedance tomography (EIT). Tissue models were first designed taking into consideration the distribution of the fat tissue, muscle and bone in the human forearm, and then the intra-tissue distributions of electrical potential and field, and the electrical impedance in the models was theoretically analyzed by the three-dimensional finite element method. The electrical impedance of both forearms was measured in healthy human subjects, and estimated the electrical conductivity of individual local tissues. The results of the analysis showed that the distributions of electrical potential and field were affected by the presence of fat tissue but not by the presence or absence of bone. In addition, as a result of calculation of the electrical resistance of the extracellular fluid (Re) in each model, it was found that the value of bio-impedance was influenced by the presence of fat tissue, and the value of bio-impedance was increased by the intervention of a fat layer. The electrical conductivity estimated by fitting the observed values to the values obtained by finite element analysis was 0.40 S/m and 0.15 S/m for male muscle and fat tissue, and 0.35 S/m and 0.11 S/m for female muscle and fat tissue, respectively. The sex difference in the slope of linear approximation in the estimation of electrical conductivity of the males and females was thought to be due to sex differences in the properties and structure of fat tissue. These results suggest that local tissues can be diagnosed differentially and electrically by percutaneous measurement of local bio-impedance and subsequent estimation of the electrical conductivity of each tissue.

The Journal of Medical Investigation : JMI


Self-evaluation Study of Nursing Students' Recognition of Their Degree of Achievement of Educational Goals in Clinical Practice --- -臨地実習開始前，中，後における自己評価の変化の分析から-

臨地実習における学習内容に対する学生の到達度の認識 --- -臨地実習開始前，中，後における自己評価の変化の分析から-

Objective: The purpose of this study was to :assess the nursing students' recognition of their achievement of their educational goals in clinical practice ;and discuss the clinical teaching interventions of nursing education by means of self-evaluation for the students at a 3-year nursing junior college. Methods: We used the self-evaluation questionnaire (62 questions). Self-evaluation was performed three times: the first was before clinical practice (hereinafter first evaluation), at the middle point of clinical practice (middle evaluation) and after the clinical practice (final evaluation). Results: 1. There ware 2patterns in self-evaluation scores. One was rise, and the other was not rise by comparison between first evaluation and final evaluation. 2. Only 7 scores were improved among 62 questions.They were classified cognitive domain, and they were recognized by the nursing students to be achieved of their educational goals. 3. In the final evaluation there were 14 items for which they had not achieved their educational goals. They were the following items: comparing their clinical practice experience with nursing theory, performing clinical practice while thinking about the nature of nursing and using communication skills, and the process of nursing diagnosis. Conclusions: Nursing students need educational intervention. That is, they need teachers to teach them, or to think with them, how to use the nursing process to overcome patients' problems in each clinical situation by means of communication skills. It is also important to make effective use of conferences at school to so that student's can shore experiences.

臨地実習指導における教育的な介入への示唆を得ることを目的に，3年課程短期大学3年次学生を対象に，臨地実習開始前·中期·終了後に，国立大学医療技術短期大学部看護学科協議会臨地実習委員会Aグループが作成した「臨地実習固有の学習内容」を用いて，学生の臨地実習固有の学習内容に対する到達度の認識について，調査を行った．その結果，以下の結果が得られた． ① 自己評価得点は，実習開始前と比べて終了時に自己評価が有意に上昇したもの(以下上昇群)と，上昇しなかったもの(非上昇群)の2群に大きく分類できた． ② 上昇群のうち，段階的に評価が上昇した項目は7項目であった． ③ 学生は，認知領域は高く自己評価し，学習内容に到達したと認識していた． ④ 学生は14項目は終了時に至っても，到達レベルに達していないと自己評価しており，それらの項目は，コミュニケーションや看護過程，理論との照合など看護を深める取り組みに関する内容であった． 以上のことから，教育的な介入として，学生がコミュニケーション技術を有効に用いながら，看護過程を展開し，看護実践を深めることができるように，カンファレンスを有効に活用し，場面を捉えて，学生の学習状況にあわせて，丁寧に指導を行うことが必要であると考えられた．学年進行に伴う到達レベルの詳細な明示など，学生の成長を長期的な視点に立って支援することの必要性が示唆された．


Relationship between mammary gland structures during pregnancy and breast-feeding

Study Purpose Diagnostic indices for prediction of breast milk production and assessment of care necessary for mammary gland structure during the pregnancy period were investigated. Methods Development of mammary gland during the pregnancy period was examined via ultrasound methodology. Each subject underwent three measurements once per trimester. Quantity of post-partum breast milk production was also measured ; furthermore, the relationship between mammary gland image and production quantity was evaluated. Results and conclusion As previously reported, mammary gland reaches a certain level of development during the course of pregnancy. Four distinct types of developmental pattern were observed. Mammary gland exhibited remarkable development up to the 15th week of pregnancy in comparison with non-pregnant adult females in type 1. In type 2, mammary gland displayed significant development from the 16th to the 35th week of pregnancy. In types 3 and 4, mammary gland tissue development, which was apparent from 35 weeks, was characterized by gland thickness of > 20 mm and < 20 mm, respectively. Among these four types, type 1 mammary gland demonstrated the largest level of breast milk production. Therefore, we suggest that understanding with respect to mammary gland structure during pregnancy contributes toward individual support in breast-feeding following childbirth.

JNI : The Journal of Nursing Investigation


Analysis of cases applying shiatsu massage for nursing care

指圧を看護ケアに取り入れた事例の文献検討

Shiatsu massage is one of the common therapeutic methods in oriental medicine, and is considered to be useful for supporting conventional medicine. However, there has been little evidence for its effects. In this report, papers dealing with the application of shiatsu massage to nursing care are extracted from literature, in order to clarify the effects and problems of this method as a nursing care. Papers containing studies of shiatsu massage by nurses as a nursing care were extracted from literature by using the Japan Centra Revuo Medicina (WEB issue, version 3), and those published during 10 years from 1993 to 2003 were analyzed. It was found that the relaxation effects by shiatsu massage were reported for various symptoms. Among these, 10 papers were analyzed in detail, which described the effects on relief of the following symptoms; dysphasia (constipation) (5 papers), nausea and vomiting at cancer chemotherapy (3 papers), pain from cancer (1 paper), and edema generated after lymphadenectomy (1 paper). It was found from these papers that shiatsu massage is effective for patients who have positive thinking to this therapy. On the other hand, the necessity of further experiments was indicated because of the lack of common methods and effects in this therapy; for example, position, force, frequency, etc., should be optimized.

東洋医学の1つの手法である指圧を看護ケアに取り入れた論文の検討を行ない，その効果と問題点を明らかにすることを目的に，『医学中央雑誌』(WEB版ver.3)を使用して1993年から2003年まで10年間に，看護師による指圧の影響が明らかにできた論文を抽出した．その結果10論文が得られた．10論文の内訳は排便障害(便秘)の軽減および排ガスの促進5件，癌化学療法実施時の副作用(嘔気·嘔吐等)の軽減3件，癌性疼痛の軽減1件，リンパ節郭清後に発生した浮腫の軽減1件であった．それぞれの論文に共通して言えることは，患者が指圧について肯定的に捉える場合は，その効果が非常に大きいことであった．さらに指圧の圧迫部位，圧迫の強さ，頻度など，まだ一定の手技と効果が得られていないため，追試験を重ねる必要性が示唆された．

JNI : The Journal of Nursing Investigation


Study on the difference in observation points between students before and after experiencing related nursing practice --- On the observations of vital signs and oxygen inhalation by use of an acute stage dummy

看護学生の実習開始前と終了後の観察の相違に関する検討 --- 術後急性状況のモデル人形を用いたバイタルサインと酸素吸入療法の観察に注目して

The difference in observation points for postoperative patients between two groups of nursing students was analyzed in terms of the students' experience of related training for the purpose of improving the training tutorial. The object was 72 students before starting adult nursing training (nursing of the acute stage patient) and 45 students after the training termination. The students were allowed to observe an acute stage dummy for 10 minutes and to write down the observation results of the 'drains and tubes', 'fluid therapy', and 'vital signs'. The descriptions about these three items were analyzed by classifying them into 'correct', 'mistaken', and 'no description'. The main results are as follows. The percentage of nursing students who correctly reported the 'heart rate on the monitor' was lower in the group after training termination comparing to the other group. As for the 'oxygen flow rate', many mistakes were found in the both groups, indicating the technical problem on the monitoring of the oxygen flow meter. In the both groups, no student described 'core temperature on the monitor' and 'oxygen concentration'. These results suggest the necessity of developing tutorial method to improve the students' observation ability for postoperative patients. The use of an acute stage dummy would be helpful for the practice of observations. It is also necessary for the teachers to check the observation behaviors of students during the exercises and practices in order to make the observations correct.

本研究は術後急性期の状況を設定したモデル人形を用い，実習開始前と実習終了後の学生が行なった術後患者に対する観察のちがいを分析し，今後の実習指導に生かすことを目的に行った． 対象は成人看護実習(急性期患者の看護)の実習開始前の学生72名と実習終了後の学生45名であった． 方法は実習室でモデル人形を用いて，10分間学生に自由に観察させた．この時の観察用紙に記入された記入項目を分析対象とした．分析方法は「ドレーン·チューブについて」「輸液について」「バイタルサインについて」を自由に記載してもらい，筆者らが『観察できた』『誤認』『記入なし』の3つに分類した． その結果，「モニター上に表示:心拍数」は実習終了後の学生の方が観察できていなかった．「酸素流量」は，『誤認』がどちらの学生も他の項目より多く，酸素流量計の見方を正確に把握していないことがわかった．「モニター上に表示:深部体温」，「酸素濃度」に関してはどちらの学生も『記入なし』であった．今後は学生の術後患者に対する観察能力が，より向上するように指導を行なっていく必要性が示唆された．そのためには急性期モデル人形を活用することで観察の機会を多くして練習を重ねるとともに，演習時および実習時において観察が的確になされているかを教員が確認する必要が示唆された．


マンモグラフィ 検診の精度管理に及ぼす読影講習会企画の意義

マンモグラフィ 検診の精度管理に及ぼす読影講習会企画の意義


A New Method for Noninvasive Measurement of Multilayer Tissue Conductivity and Structure Using Divided Electrodes

This paper outlines a new method for measuring multilayer tissue conductivity and structure by using divided electrodes, in which current electrodes are divided into several parts. Our purpose is to estimate the multilayer tissue structure and the conductivity distribution in a cross section of the local tissue by using bioresistance data measured noninvasively. The effect of the new method is assessed by computer simulations using a typical two-dimensional (2-D) model. In this paper, the conductivity distribution in the model is analyzed based on a finite difference method (FDM) and a steepest descent method (SDM). Simulation results show that the conductivity values of skin, fat, and muscle layers can be estimated with an error of less than 0.1%. When random noise at various levels is added to the measured resistance values, estimates of the conductivity values for skin, fat, and muscle layers are still reasonably precise: their root mean square errors are about 1.06%, 1.39%, and 1.61% for 10% noise. In a 2-D model, increasing the number of divided electrodes permits simultaneous estimates of tissue structure and conductivity distribution. Optimal configuration for divided electrodes is examined in terms of dividing pattern.

IEEE Transactions on Biomedical Engineering


3-Dimensional Computed Tomography Lymphography-Guided Identification of Sentinel lymph Nodes in Breast Cancer Patients Using Subcutaneous Injection of Nonionic Contrast Medium :A clinical Trial

Simple and reliable identification methods for sentinel lymph nodes (SLNs) which do not use radioisotope are essential for early breast cancer patients in community hospitals in Japan. The purpose of this paper is to demonstrate the feasibility and efficacy of computed tomography (CT) lymphography for SLN detection. The study included 15 cases with T1 or T2 breast cancer. After subcutaneous injection of 1 mL of iopamidol in 1 subareolar area of the affected breast, CT scanning was carried out and 3-dimensional (3D) CT images were created. SLNs predicted from images and CT values were assessed as to whether they were identical to those identified by the dye method. An enhanced lymph vessel draining into SLN was demonstrated in 11 cases (73%) and an enhanced SLN in 10 cases (67%). 3D images clearly revealed the anatomic relationship between lymph vessels, SLN, and the surrounding structures. In addition, SLN could be predicted by the change of CT value in the time-course in another case. In total, SLN in 13 cases (87%) could be predicted. All SLNs suggested from CT lymphography were identified by the dye method. No significant adverse effect was noted in any case. The present clinical trial indicated that subcutaneous injection of nonionic contrast medium with CT scanning seems to be a promising method for the demonstration of a draining lymph vessel and SLN. The CT value time-course may also provide some important information. Further trials will be needed for the successful establishment of this CT lymphography-guided method for SLN identification.


Evaluation of a new rehabilitation program for postoperative patients with breast cancer

The purpose of the present study was to evaluate the efficacy of a newly designed rehabilitation program for postoperative patients with breast cancer. This was achieved through examinations to clarify the range of motion (ROM) of the shoulder joint, postoperative pain and recovery of activities of daily living (ADL). The ROM of the shoulder joint was evaluated with respect to five items and determinations were carried out five times. Patients were orally questioned four times regarding their pain after surgery, movement-associated chest pain, pain at night and operative wound pain. Evaluation of the ADL after discharge was conducted using a three-level rating method at postoperative week 4 and week 12. A total of 72 patients were studied, comprising 39 who underwent pectoral muscle-conserving mastectomy and 33 who underwent breast-conserving surgery. The arm movement of forward raising showed the greatest decline, followed by lateral raising of the arm. Postoperative time-course changes in internal/external arm rotation, as well as backward arm raising were slight. Comparison of the operative procedures revealed differences only for lateral arm raising at postoperative week 4, while there were no differences in any of the shoulder joint movements. Lowering of the ROM of the shoulder joint was more marked at an earlier time (week 1 to week 2) after surgery, but it was not statistically significant. Pain at night and operative wound pain were prolonged over the period, and reported in postoperative week 1 to week 12 by 3-15% of patients. All ADL items became almost normal in approximately 90% of patients at postoperative week 4. The efficacy of the present rehabilitation program early after surgery was demonstrated in terms of recovery of ADL as well as the ROM of the arm on the affected side.


乳癌術後患者の早期機能回復訓練実施による肩関節可動域の評価

乳癌術後患者の早期機能回復訓練実施による肩関節可動域の評価

日本リハビリテーション看護学会学術大会誌第1集

日本リハビリテーション看護学会学術大会誌第1集


アンケート調査によるマンモグラフイ読影講習会の精度管理(6)

アンケート調査によるマンモグラフイ読影講習会の精度管理(6)

Journal of Japan Association of Breast Cancer Screening


乳癌縮小手術を受けた患者の術後回復過程に関する研究(1) --- 肩関節可動域の回復遅延に関わる要因の分析

本研究は，乳癌で胸筋切除を伴わない縮小手術を受けた患者の肩関節の可動域の回復遅延ケースにおける，回復遅延に関わる要因を明らかにし，術後の機能回復訓練時の患者指導に活かすことを目的とした．対象は乳房温存術や胸筋温存乳房切除術を受けた乳癌術後患者39名で，機能回復訓練を術後12週間縦断的に観察しえたケースにおいて，肩関節可動域の回復状態を良好群と遅延群の2群にわけ，その2群間の比較を，肩関節可動域や疼痛・日常生活動作から観察した．その結果，遅延群ケースから肩関節可動域の回復に関わる主要因として，創部の動作時の疼痛が考えられ，2つめの要因としてこの動作時の疼痛の発生により術後必要とされる運動を行わないことで，さらに回復を遅延させていることが考えられた．よって，動作時の疼痛を訴え，肩関節可動域の回復の遅れを認める例には，機能回復訓練状態の観察と術後12週目までの継続的な運動の必要性の指導のほかに，肩関節可動域訓練を看護師が患者とともに一緒に行うという確実な実施が，肩関節の可動域の回復遅延の予防となると考えられた．


乳癌縮小手術(乳房温存術,胸筋温存乳房切除術)を受けた患者の術後回復過程に関する研究(2) --- 患者の術式選択時の情報提供のための術式別回復過程の比較

成人で手術後リハビリテーションの必要な患者の看護ケアの開発·改善の一助にすることを目的に，温存術と切除術を受けた乳癌患者39名の術式別回復状態の比較を行った．切除術の1週目に握力が，有意に低下し，運動プログラムに，等尺性運動を取り入れることが示唆された．

JNI : The Journal of Nursing Investigation


マンモグラフィ読影講習会の精度管理の現状と改善策の検討

マンモグラフィ読影講習会の精度管理の現状と改善策の検討


Randomized Controlled Trial Comparing Oral Doxifluridine Plus Oral Cyclophosphamide With Doxifluridine Alone in Women With Node-Positive Breast Cancer After Primary Surgery

We compared the therapeutic usefulness of doxifluridine (5'-DFUR) alone and a combination of 5'-DFUR plus cyclophosphamide (CPM), both of which are considered effective against advanced and recurrent breast cancer, to determine which treatment is more beneficial as postoperative adjuvant chemotherapy. A total of 1,131 women with node-positive primary breast cancer were randomly assigned after primary surgery to receive 5'-DFUR alone or 5'-DFUR plus CPM. All patients initially received 5'-DFUR in an oral dose of 1,200 mg/d for 4 weeks, starting 4 weeks after surgery. Chemotherapy was then not given for 2 weeks. Patients in the 5'-DFUR group subsequently received five 4-week cycles of treatment consisting of oral 5'-DFUR (1,200 mg/d) for the first 2 weeks and no chemotherapy for the next 2 weeks. Those assigned to the 5'-DFUR plus CPM group also received oral CPM 100 mg/d for the first 2 weeks and no chemotherapy for the next 2 weeks. Women 50 years or older concurrently received 20 mg/d of tamoxifen for 2 years in both groups. Of the 1,088 eligible women, 546 were assigned to receive 5'-DFUR alone and 542 were assigned to receive 5'-DFUR plus CPM. Overall disease-free survival was significantly better in women who received 5'-DFUR plus CPM than in those who received 5'-DFUR alone (log-rank test, P =.021). Toxic effects occurred in 20.0% of patients (109 of 546) in the 5'-DFUR group and 32.3% of patients (175 of 542) in the 5'-DFUR plus CPM group (chi(2) test, P <.001). Combination therapy with 5'-DFUR plus CPM is more effective in preventing recurrence than 5'-DFUR alone.


超音波検査法による開腹術後患者の下肢筋組織厚および皮下脂肪厚の評価

超音波検査法による開腹術後患者の下肢筋組織厚および皮下脂肪厚の評価

術後の健康回復の促進に向けた看護ケアの基礎的資料を得るため,超音波診断装置(周波数は7.5MHz)を用いて,開腹による胃あるいは大腸手術を受けた患者を対象に,手術経過に伴う下肢の筋組織厚および皮下脂肪厚の変化を明らかにした.術前,術後離床日,術後10日目,術後20日目の合計4回,下肢の大腿直筋上,大腿二頭筋上,長指伸筋上,ヒラメ筋上にプローブを当て,組織厚を測定した.開腹による胃または大腸手術を行なった患者のうち,合計4回の測定結果が得られた16名を分析対象とした.4箇所の測定部位の筋組織厚および皮下脂肪厚をそれぞれ合計し,筋組織厚総和および皮下脂肪厚総和を算出し,術前値との比較を行なった.その結果,下肢の筋組織厚総和は,術後離床日,術後10日目,術後20日目に有意な減少を認めた.一方,下肢の皮下脂肪厚総和は,術後には有意な減少を認めず,ほとんど変化しないことが明らかになった.胃手術群と大腸手術群の比較においては,胃手術群は,術後10日目から術後20日目にさらに減少し,回復の傾向を示さなかったが,大腸手術群は,術後10日目から術後20日目に下肢の筋組織厚が回復の傾向を示した.よって,開腹術後患者,特に胃手術患者に対して,より細やかな看護観察と栄養評価,および食事摂取量を増やす看護介入の必要性が示唆された.In order to obtain basic data for use in postoperative nursing care intended to promote the recovery of patients after surgery, the authors examined postoperative changes in lower limb muscular tissue thickness and subcutaneous fat thickness by ultrasonography (7.5 MHz) in patients who underwent open surgery of the stomach or large intestine. The ultrasound probe was placed on the skin above the following muscles: quadriceps femoris, biceps femoris muscle, extensor digitorum longus, and soleus. Measurements were taken on 4 occasions: before surgery, and on the 1st, 10th and 20th day after postoperative mobilization. Of all patients who underwent open surgery of the stomach or large intestine, 16 patients were selected for analysis and ultrasonic measurements. Muscular tissue and subcutaneous fat thicknesses at each of the four sites of measurement were totaled to yield measures of total muscular tissue and total subcutaneous fat. Postoperative and preoperative parameters were then compared. The total lower limb muscular tissue thickness at each of the 4 postoperative measurement points was significantly less than the preoperative thickness, whereas the total lower limb subcutaneous fat thickness showed no significant decrease after surgery and remained almost unchanged from the preoperative value. Comparing patients undergoing different types of surgery, leg muscular tissue thickness showed a tendency to recover on the 10th and 20th day after surgery in the colorectal surgery group, while the gastric surgery group showed further decreases in this parameter on the 10th and 20th day, with no trend towards recovery evident over the timeframe investigated. These results suggest the necessity of active nursing intervention for patients after open gastric surgery.G2

Journal of Health Sciences, Hiroshima University

広島大学保健学ジャーナル


マンモグラフィ検診精度管理中央委員会(精中委)·施設画像評価委員会の活動状況

マンモグラフィ検診精度管理中央委員会(精中委)·施設画像評価委員会の活動状況

日本がん検診·診断学会誌

日本がん検診·診断学会誌


Axillary 3D CT Imaging with Lymphoscintigraphy Is Useful for Sentinel Node Biopsy in Breast Cancer

This study examined whether 3D CT imaging with lymphoscintigraphy (LSG) is useful when performing sentinel node biopsy (SNB) in a community hospital where radioisotope with gamma-probe (RI method) is unavailable. From June to November 2002, 35 T1/T2 clinically node-negative breast cancer patients underwent LSG in a university nuclear medicine department. Skin areas above LSG hot spots were marked, helical CT scanning was performed and axillary 3D images were created in our hospital. The SLN predicted from the 3D images were examined for agreement with the dye method. SLNs were detected with dye in 32 out of 35 patients (91.4%). In 31 of those 32 (96.9%), the SLN predicted from 3D CT images was the same. Even in the 3 dye-negative patients, CT imaging predicted the SLN. SNB including sampling was successful in 34 patients (97.1%). 3D CT imaging with LSG enables SNB even if the RI method is impossible.


A New Method for Non-Invasive Measurement of Multi-layer Tissue Conductivity and Structure Using Divided Electrodes

IEEE Transactions on Biomedical Engineering


アンケート調査によるマンモグラフィ読影講習会の精度管理[5]

アンケート調査によるマンモグラフィ読影講習会の精度管理[5]


徳島トライアルの成績から見た49歳以下女性に対するマンモグラフィ併用乳癌検診

徳島トライアルの成績から見た49歳以下女性に対するマンモグラフィ併用乳癌検診


Estimation of Multi-Layer Tissue Conductivities from Non-invasively Measured Bioresistances Using Divided Electrodes

To estimate inner multi-layer tissue conductivity distribution in a cross section of the local tissue by using bioresistance data measured noninvasively on the surface of the tissue, a measurement method using divided electrodes is proposed, where a current electrode is divided into several parts. The method is evaluated by computer simulations using a three-dimension (3D) model and two two-dimension (2D) models. In this paper, conductivity distributions of the simplified (2D) model are analyzed based on a combination of a finite difference method (FDM) and a steepest descent method (SDM). Simulation results show that conductivity values for skin, fat and muscle layers can be estimated with an error less than 0.1%. Even though different strength random noise is added to measured resistance values, the conductivities are estimated with reasonable precise, e.g., the average error is about 4.25% for 10% noise. The configuration of the divided electrodes are examined in terms of dividing pattern and the size of surrounding guard electrodes to confine and control the input currents from the divided electrodes within a cross sectional area in the tissue.

IEICE Transactions on Information and Systems


An immunohistochemical evaluation of biomarkers and apoptotic cells in ductal carcinoma in situ of breast


アンケート調査によるマンモグラフィ読影講習会の精度管理[4]

アンケート調査によるマンモグラフィ読影講習会の精度管理[4]

Journal of Japan Association of Breast Cancer Screening


The effect of adjuvant 5'-deoxy-5-fluorouridine in early stage breast cancer patients: Results from a multicenter randomized controlled trial

To assess the efficacy of 5'-DFUR, an intermediate of capecitabine, for adjuvant treatment of early breast cancer, we conducted an open-labeled multi-center randomized controlled trial to compare postoperative 5'-DFUR treatment with surgery alone. We enrolled 1217 primary breast cancer patients and randomly assigned them into two treatment groups; one received six-month postoperative 5'-DFUR treatment by consecutive or intermittent administration, and the other surgery alone. Follow-up surveys were conducted once a year for all subjects simultaneously and examined their outcome/presence or absence of the cancer recurrence. The central study committee reviewed all follow-up data and judged the recurrence data to be used for the analysis. Eight-year follow-up data showed no significant differences in relapse-free and overall survival between the two groups, and 5'-DFUR treatment regimen showed an extremely high tolerance. Possible explanations are discussed for the finding of no significant survival difference between adjuvant 6-month 5'-DFUR monotherapy and surgery alone in early breast cancer.


Cases Report of Malignant Mucocele-like Lesions

Mucocele-like lesions (MLL) of the breast have been reported as extremely rare as well as benign, but now it is believed they can be both malignant and benign. This paper describes two cases of malignant MLL, both subjected to immunohistochemical staining. Case 1: A 42-year-old woman with multiple malignant MLLs without evidence of a mass at presentation to our hospital after biopsy, but whose ultrasonogram showed small multiple hypoechoic lesions. Case 2: A 70-year-old woman, whose left breast cancer was found on routine mammography after modified radical mastectomy for right breast cancer. Pathologically, MLL with intraductal carcinoma was diagnosed. Case 1 underwent two lumpectomies in 3 years, but even now new lesions have developed. However, the patient refused to have another operation. C-erbB2 was negative in both cases. When malignant MLL is histologically of low grade, excisional biopsy is sufficient for a single MLL with intraductal carcinoma, while it may be necessary to perform a subcutaneous mastectomy for multiple lesions.


Primary breast cancer patients treated with breast-conserving therapy and tamoxifen --- - Do they always require radiotherapy? -


アンケート調査によるマンモグラフィ読影講習会の精度管理[3]

アンケート調査によるマンモグラフィ読影講習会の精度管理[3]


アンケート調査によるマンモグラフィ読影講習会の精度管理[2]

アンケート調査によるマンモグラフィ読影講習会の精度管理[2]


Breast cancer screening with mammography in women aged under 50 years in Japan

BACKGROUND: The effectiveness of mammographic screening in women aged over 50 years has been confirmed in the United States and Europe, but its effectiveness in women aged from 40 to 49 years remains controversial. The optimum age for effective screening of subjects for breast cancer by mammography in Japan was studied based on the results of mammographic screening. METHOD: The benefit of breast cancer screening in women was examined by stratifying the results of mammographic screening in a Tokushima trial on the basis of age: under 50 years and 50 years or older. The results of conventional screening by physical examination alone, which we performed in a Zentsuji trial, were used as the control. RESULTS: The examinees numbered 13,982 and 18,619 in mammographic screening and screening by physical examination, respectively. Breast cancer was detected in 43 and 22 patients, respectively. The detection rate of breast cancer was 0.31% by mammographic screening, which is about 3 times higher than that (0.12%) by screening using physical examination. Mammographic screening thus showed significantly higher sensitivity (93.5% vs 73.3%, p = 0.015). The proportion of stage I cancer and the absence of nodal involvement were 67.4% and 79.1% by mammographic screening, compared with 31.8% and 59% by physical examination. Our results obtained with mammographic screening were equal to or higher than the results obtained in the United States and Europe. The clinical stage of the breast cancers detected by mammographic screening in the subjects aged under 50 years was stage 0 (DCIS) in one case and stage I in 10 cases, while the group aged 50 years or older showed stage 0 in 11 cases and stage I in 19 cases. There were three cases of false-negative; two false-negative cases were aged under 50 year, while one case was aged 50 years or older. The detection rates of cancer in the group under 50 years and that of 50 years or more were 0.19% and 0.39% by mammograpic screening and 0.09% and 0.15% by the physical examination. The sensitivities in the group under 50 years and that of 50 years or more were 84.6% and 97.0% by mammographic screening and 72.7% and 73.7% by physical examination, showing no significant difference. In the results of mammograms by Wolfe's classification with respect to the age groups, the proportion of DY (dense breast) pattern decreased significantly from 3.5% to 0.2% in women of 50 years or more and from 16.6% to 2.4% in those under 50 years when the values were compared between the period from 1992 to 1995 and the period from 1998 to 1999, respectively (p < 0.0001). CONCLUSION: The above findings suggested the possible effectiveness of mammographic screening not only in women aged 50 years or more but also in those aged under 50 years, in Japan. Therefore, introduction of mammography should be considered at an early date, even for women aged from 40 to 49 years.


Temperature effect of a disinfectant in operative field during surgery under local anesthesia


乳房温存術および胸筋温存乳房切除術に対する新しい術後機能回復訓練実施プログラムの評価


Neither gynecomastia nor galactorrhea is a common side effect of neuroleptics in male patients

OBJECTIVE: Gynecomastia is known to be a side effect of neuroleptics. The authors investigated the prevalence of gynecomastia and galactorrhea in a group of regularly neuroleptic-treated male patients. METHODS: Gynecomastia was defined as a palpable, discrete button of firm subareolar tissue measuring at least 2 cm in diameter. The subjects were 100 male patients who were taking neuroleptic treatment regularly. Each patient gave informed consent for the research involved in this study. RESULTS: (1) Palpable gynecomastia was present in 2% of the patient group, but not at all in the normal group. (2) Galactorrhea was not present in either patient or normal group. (3) The mean level of the serum prolactin in the group of patients without gynecomastia (n = 53) was significantly higher than that in the normal group (n = 35), but there was no significant difference in blood luteinizing hormone, follicle-stimulating hormone, testosterone (T), estradiol (E(2)) or T/E(2) ratio between the groups. (4) The mean level of the T/E(2) ratio in the patients with gynecomastia tended to be higher than that in the group of patients without gynecomastia. CONCLUSIONS: Overall, these results seem to indicate that (i) gynecomastia is not common in the Japanese population, and (ii) in male patients neither palpable gynecomastia nor galactorrhea is a common side effect of neuroleptics. To clarify the relation between gynecomastia and neuroleptic treatment, large prospective studies are required.


Noninvasive Measurement of the Electrical Bioimpedance of Breast Tumors

The purpose of this study was to evaluate the possibility of differential diagnosis of tumors, such as breast cancer, by measuring the mammary electrical bioimpedance via the skin surface noninvasively and by examining the relationship between the tissue structure of the breast and electrical bioimpedance. The mammary electrical bioimpedance was measured in 24 patients with breast cancer. Taking into account the measurement results and the distribution of the mammary glands and fatty tissue, a breast model with tumors was proposed. Based on this model, the distributions of the electric potential and electric field in the tissue were theoretically analyzed by the three-dimensional finite element method. In clinical cases, the Re values of the diseased breast were significantly larger than those of the contralateral healthy breast. In theoretical analysis based on the breast model, the Re value of mammary electrical bioimpedance varied due to the structure of the breast, that is, the ratio of fatty tissue to mammary gland and the presence of mammary tumors. The results of the measurement agreed with the theoretical analyses. These results suggest that differential diagnosis of breast tumors is possible by measuring the mammary electrical bioimpedance using noninvasive electrodes on the skin.


Human papillomavirus type 33 DNA in breast cancer in Chinese


HPV33 DNA in premalignant and malignant breast lesions in Chinese and Japanese populations.

The relationship between human papillomavirus (HPV) infection and breast cancer is controversial. In this study, paraffin-embedded tissue blocks prepared from 72 patients with benign, premalignant or malignant mammary lesions were randomly collected from the Shanghai region of China and Tokushima in Japan. DNA specimens extracted from all tissues were amplified by the polymerase chain reaction (PCR) using HPV16, 18 and 33 primers. Southern blot hybridization showed 19 cases to be positive for HPV33 DNA: The positive rate for HPV33 DNA in Chinese (41.7%) was significantly higher than in Japanese (11.1%) (P < 0.01): The positive rate for HPV33 DNA in invasive ductal carcinoma (34.1%) was higher than in benign or borderline mammary lesions (5%) (P < 0.02). There were no statistically significant difference among the relationship of the nuclear grade of breast cancers with HPV33 DNA-positivity. This is the first report of a positive correlation between HPV33 DNA and breast lesions in Chinese and Japanese populations. These results suggest that the infection by HPV33, but not HPV 16 or HPV 18, may be involved in breast hyperplastic lesions, especially breast cancer, in humans.


Characteristics of the Daily Lives of Elderly Women at Various facilities for the Aged: Analysis of their ADL and Degree of Satisfaction


Radiation Complications Following Breast Conserving Therapy


Value of mass screening for thyroid cancer

This study aims to clarify the presently uncertain value of mass screening for thyroid cancer, which has been performed by physical examination along with mass screening for breast cancer in Zentsuji, Japan since 1983. Among 18,619 subjects, 36 individuals with thyroid cancer (0.19%) were found. The detection rate was 0.40% at the initial screening and 0.10% during subsequent periodic screening. All thyroid cancers were confirmed histologically as well differentiated carcinoma. The tumor size in the mass-screening group (14 +/- 6 mm) was significantly smaller than in patients presenting at an outpatient clinic during the same period (19 +/- 13 mm) (p < 0.05). The incidence of nodal metastases in the mass-screening group (38%) was significantly lower than in the outpatient group (68%) (p < 0.05). Thus mass screening seemed to find thyroid cancers in a relatively early stage. Mass screening for thyroid cancer was economic in this instance because it was performed together with screening for other cancers, such as breast cancer. Thyroid cancer screening required less than one additional minute per subject. The ultimate aim of mass screening is to reduce mortality. No improvement in prognosis from enforced mass screening for thyroid cancer was detected in this study. It cannot be demonstrated that there is sufficient value of mass screening for thyroid cancer to perform it independently despite early cancer detection.


Fast in vivo measurements of local tissue impedances using needle electrodes

The objective of the research is to show an in vivo, fast method of measurement of local tissue bio-impedance in the beta dispersion region (0-200 kHz). A needle electrode is used for the purpose. The performances with respect to circuits, electrodes, measurement area and electrical representations are evaluated. A measurement example is shown, and the electrical representations are discussed and compared using it. The method discussed, although invasive, is considered to be useful for local tissue diagnoses concerning structures and physiological functions.

Medical and Biological Engineering and Computing


Effectiveness of mammographic screening for brest cancer in women aged over 50 years in Japan


Molecular epidemiology of breast cancers in northern and southern Japan: the frequency, clustering, and patterns of p53 gene mutations differ among these two low-risk populations

Comparison of acquired mutations in the p53 tumor suppressor gene can illuminate factors contributing to carcinogenesis among cancer cohorts. Japan has an ethnically homogeneous population with a low incidence of breast cancer. Previously we reported an unusual frequency, allelic status, and clustering of mutations in breast cancers from the northern part of the main Japanese island. To extend these findings, exons 2-11 and adjacent intronic sequences were analysed in tumors of women from northern (Hokkaido) and southern (Tokushima) Japan. The frequency of breast cancers with p53 gene mutations in the Hokkaido group is the highest reported (81%) while that in Tokushima (28%) is similar to most other populations. Thirteen of the 19 mutations (68.4%) in the Hokkaido cohort were heterozygous, an unusually high frequency for p53 mutations in any tumor type. There were three missense mutations at codon 175, a known hotspot for alterations in the p53 gene, and three missense mutations at codon 179, a rare site for p53 changes. In addition, the patterns of p53 gene mutation differed between the two Japanese cohorts (P=0.04). The multiple differences in acquired p53 mutations suggest unsuspected biological differences among breast cancers in northern and southern Japan. In addition, the high frequency of p53 mutations in breast cancers from Hokkaido predicted a poorer prognosis for this population which was confirmed on examination of mortality data.


Ductal Carcinoma In Situ of the Breast: Is Breast Conserving Treatment Feasible?


Postoperative adjuvant randomized trial comparing chemoendocrine therapy, chemotherapy and immunotherapy for patients with stageII breast cancer --- 5-year results from The Nishinihon cooperative study group of Adjuvant Chemoendocrine Therapy for Breast Cancer (ACETBC) of Japan

Between 1985 and 1988, the effect of using ftorafur (FT) or PSK (an immunotherapy agent) in combination with the conventional postoperative adjuvant therapy using mitomycin (MMC) plus tamoxifen (TAM) was assessed in stage II, oestrogen receptor-positive (ER+) breast cancer patients. Furthermore, in ER- breast cancer stage II patients, the effects of postoperative adjuvant therapy using MMC plus FT were compared with the effects of postoperative adjuvant therapy using MMC plus PSK. Patients had primary stage II breast cancer and had undergone total mastectomy plus axillary dissection or more radical surgery. On the day of surgery, MMC (13 mg/m2) was administered intravenously. Then, ER+ patients received one of three regimens of drug therapy, starting 2 weeks after surgery: regimen A (daily oral treatment with 30 mg of TAM), regimen B (daily oral treatment with 30 mg of TAM and 600 mg of FT) or regimen C (daily oral treatment with 30 mg of TAM and 3 g of PSK) [corrected]. ER- patients received either regimen D (daily oral treatment with 600 mg of FT) or regimen E (daily oral treatment with 3 g of PSK), starting 2 weeks after surgery. Of the 540 ER+ patients registered, 525 were evaluated. The 5-year overall survival rate for ER+ patients was higher for patients who received regimen B (94.2%) than for those who received regimen A (86.9%) or regimen C (89.9%) (P = 0.063). The 5-year relapse-free survival rate was higher for regimen B (88.9%) than for regimen A (78.6%) and regimen C (77.2%) (P = 0.010). Stratified analysis revealed better results with the FT-combined therapy in patients positive for lymph node metastasis and premenopausal patients. These results indicate the effectiveness of using FT in combination with TAM. Of the 376 ER- patients registered, 364 were evaluated. The 5-year overall and relapse-free survival rate for ER- patients did not differ significantly between patients who received regimen D and those who received regimen E.


carcinoma in situ of the breast --- Is breast conserving treatmart feasible ?


An experimental study of conductive heating using a concentric double-electrode applicator


Electrical properties of extracted rat liver tissue


High positive rate of pS2 expression in forefront intraductal cancerous area in breast cancer


Difference in thymidylate synthetase activity in involved nodes compared with primary tumor in breast cancer patients


A Malignant Phyllodes Tumor of the Breast in a 6-Year Old Girl


A Comparison of Mass Screening for Breast Cancer Using Mammography and Physical Examination Alone in Japan


High detection rate of breast cancer by mass screening using mammography in Japan


Application of electrical impedance analysis for diagnosis of a pulmonary mass


p53 alteration correlates with negative ER, negative PgR, and high histologic grade in breast cancer.

Seventy tumors of invasive ductal carcinoma of the breast were examined for p53 alteration by the RT-PCR-SSCP method. Sixty-five samples (92.9%) were investigated in the regions of codons 101-200 and 201-300. In total, 16 samples (24.6%) showed p53 gene alteration. We found that p53 gene alteration showed a correlation with (1) a negative ER status, (2) a negative PgR status, and (3) a high histologic grade (especially numerous mitotic figures) of the tumor. However, we found no correlation between p53 gene alteration and the lymph node status or clinical stage. Thus, p53 gene alteration in breast cancer may occur in highly malignant breast cancer other than advanced clinical stage cancer or node-positive cancer.


Significant Correlation between the Presence of Type W Collagen in the Duct Wall and the Development of Wide Intraductal Cancerous Extension in Breast Cancer


Five-year results of a randomized clinical trial comparing modified radical mastectomy and extended radical mastectomy for stage II breast cancer


Tumor progression accompanied by increase in proliferation rate in breast cancer: a preliminary report


Frequency of spontaneous p53 mutations (CpG site) in breast cancer in Japan.

Sixty-five tumors of invasive ductal carcinoma of the breast were examined for p53 alteration by the reverse transcription-polymerase chain reaction-single strand conformation polymorphism (RT-PCR-SSCP) method and sequencing analysis. In total, 16 samples (24.6%) showed p53 gene alteration. Sixteen of these alterations were evaluated by sequencing analysis, and 15 showed missense point mutations while one showed a 9-base pair deletion. In the 15 point mutations, G:C to A:T transitions constituted the majority (53%), and five tumors (33%) had a transition at the CpG site, which are mutational patterns not commonly found in breast tumors from Europe and America. On the other hand, there were no G:C to T:A transversions in our cases, which were frequently observed transversions in Europe and America. These p53 mutation patterns in breast cancer in Japan are not similar to those in Europe and America reported by Hollstein et al. and Coles et al.. These findings suggest that there are some differences between mechanisms of breast cancer in Japan and in Europe and America.


Immunohistochemical study of estrogen receptor and estradiol on papillary thyroid carcinoma in young patients


Incidence of ultrasonographically-detected thyroid nodules in healthy adults

The Tokushima Journal of Experimental Medicine


Effect of mass screening for breast cancer from the aspect of psychosocial assessment of the quality of life


A study of the electrical bioimpedance of tumors

A new system of impedance measurement over a frequency range of 0 to 200 kHz was developed by a three-electrode method. In this study, the electrical impedances of various tumors were measured in vivo in 54 patients with breast disease (31 breast cancers, 13 fibroadenomas, and 10 fibrocystic diseases) and 57 patients with pulmonary disease (44 lung cancers, 5 metastatic pulmonary tumors, 4 pulmonary tuberculoses, and 4 organized pneumonias). On the basis of those impedance measurements and the equivalent circuits in vivo, we calculated the extracellular resistance (Re), intracellular fluid resistance (Ri), and cell membrane capacitance (Cm) in tissues, all of which were compared among the various diseases. It was found that Re and Ri were significantly higher in breast cancers than in benign tumors and normal breast tissues and that Cm was significantly lower in breast cancers than in other tissues. On the other hand, Re and Ri were significantly higher, and Cm was significantly lower, in normal lung tissues than in pulmonary masses. Re and Ri were significantly higher, and Cm was significantly lower, in malignant tumors than in organized pneumonias. The results showed that these parameters (Re, Ri, and Cm) exhibit significant differences among various tissues and tumors, suggesting possible applications in tumor diagnosis.


The coexistence of lobular carcinoma in a fibroadenoma with a malignant phyllodes tumor in the opposite breast: report of a case


Cancerous residue in breast-conserving surgery


Juvenile gigantomastia: report of a case


The quality of mass screening for breast cancer by physical examination


The characteristics of interval breast cancer in mass screening


Evaluation of an improved dot-immunobinding assay for carcinoembryonic antigen determination in nipple discharge in early breast cancer: results of a multicenter study

We have previously reported carcinoembryonic antigen (CEA) measurement in nipple discharge to be a useful adjunct in the diagnosis of non-palpable breast cancer. We have now developed a "microdot-immunobinding assay" using a specially constructed device to screen efficiently large numbers of patients with nipple discharge for non-palpable breast cancer. The method is as follows: a sample of nipple discharge is placed on a solid phase monoclonal anti-CEA antibody and, if CEA is present in the discharge, it will be detected by a second monoclonal anti-CEA antibody conjugated with alkaline phosphatase. The use of bromochloroindolyl phosphate as a chromogen results in a stable color reaction that can be semiquantitatively analyzed with the naked eye. CEA levels determined by this microdot assay correlated well with those determined using the earlier Elmotec assay. To determine the accuracy of the method, a collaborative study involving 11 institutes in Japan was organized. The CEA levels in nipple discharges from 77 patients undergoing surgery, 44 of whom were diagnosed as having breast cancer, were assayed. The results were that 17 of the 23 patients with palpable breast cancer, and 16 of the 21 patients with non-palpable breast cancer exhibited CEA values > 400 ng/ml, a cut-off value determined in a previous study. The overall accuracy (78%) of this test for diagnosing non-palpable breast cancer was higher than that obtained from ductography or cytology. The system may thus be of use in the screening of early breast cancer.


Randomized adjuvant trial to evaluate the addition of tamoxifen and PSK to chemotherapy in patients with primary breast cancer. 5-Year results from the Nishi-Nippon Group of the Adjuvant Chemoendocrine Therapy for Breast Cancer Organization


Estimated weight of the residual parathyroid gland after parathyroidectomy Surgery using plasma levels of parathyroid hormone


The effect of breast self-examination on early detection and survival


Thyroid carcinoma in patients with secondary hyperparathyroidism


Relative effect of steroid hormone receptors on the prognosis of patients with operable breast cancer. A univariate and multivariate analysis of 3089 Japanese patients with breast cancer from the Study Group for the Japanese Breast Cancer Society on Hormone Receptors and Prognosis in Breast Cancer


Primary adult T-cell lymphoma of the breast


A rare case of fibroadenoma in a tubular adenoma of the breast


Comparison of estrogen receptor and epidermal growth factor receptor content of primary and involved nodes in human breast cancer


Correlation between estrogen receptor status and histological malignancy in human breast cancer


The morphological feature of mucus leakage appearing in low papillary carcinoma of the breast

This report summarizes the clinicopathologic findings in 11 cases of low papillary carcinoma of the breast accompanied by the morphologic feature of mucus leakage into the mammary stroma. These cases were characterized by two morphologic findings. First, abundant mucus produced by the tumor cells filled the intraductal spaces where neoplastic epithelium formed very low papillary projections, ie, a feature of mucinous-producing low papillary carcinoma in situ. Second, there was expansive leakage of mucus into the mammary stroma occasionally accompanied by a few epithelial cells. All the cases showed a high level of mucus production and contained no elements of invasive ductal carcinoma or ordinary invasive mucinous carcinoma. These cases have no evidence of direct invasion of the mammary stroma by malignant cells. The average age of the 11 patients was 41 years. Foci of microcalcification were seen in some tumors (seven cases; 64%). There were no cases with lymph node metastases. All the patients underwent mastectomy with no adjuvant therapy, and they are currently alive and well.


The effect of mass screening for breast cancer: results of a multivariate analysis


Comparisons of interval breast cancers with other breast cancers detected through mass screening and in outpatient clinics in Japan

In a nation-wide collaborative study on mass screening for breast cancer, we collected 152 cases of interval breast cancer diagnosed at 35 hospitals or clinics distributed throughout Japan. The definition of interval breast cancer used in the present study is "breast cancer cases which were diagnosed as having 'no malignant findings' in a previous screening for breast cancer but subsequently diagnosed as 'breast cancer' at a hospital or medical clinic within two years of the previous screening." The clinical stages and prognoses of these interval cancer were analyzed and compared with those of other breast cancers detected through mass screening and in outpatient clinics. In the clinical staging of interval breast cancer, Tis (non infiltrating cancer) accounted for only 2.1%, compared to 8.0% in cases detected through mass screening. At stage I 43.4% were interval breast cancers compared to 32.9% breast cancers detected through mass screening and 25.4% diagnosed in outpatient clinics. The stage differences between interval breast cancers and breast cancers detected through mass screening were not statistically significant. Five-year survival rates were 85.6% for interval breast cancers, 91.7% for breast cancers detected through mass screening and 84.7% for breast cancers diagnosed in outpatient clinics. Ten-year survival rates were 75.9, 80.5 and 78.1%, respectively, suggesting the interval breast cancer cases to show a similar prognosis to that of breast cancer cases diagnosed in outpatient clinics. The differences in five- and 10-year survival rates among the three groups were not statistically significant. From the present study we were not able to confirm the general belief of interval cancer being more aggressive in nature and showing a poorer prognosis than cancer detected through periodic screening. The reasons for this are discussed.


Chemoendocrine therapy in DMBA-induced rat mammary carcinoma

The Tokushima Journal of Experimental Medicine


Sex hormone receptors in human thyroid tissues


Tumor growth rate and prognosis of breast cancer mainly detected by mass screening


Measurement of the electrical bio-impedance of breast tumors


Mass screening for breast cancer: comparison of the clinical stages and prognosis of breast cancer detected by mass screening and in out-patient clinics


Flexible bronchoscopy for foreign body in airway


Prognostic value of hormone receptors in breast cancer


Rapidly growing mature teratoma of the mediastinum: do sex hormones affect growth of the tumor?


Changes in the hormone dependency of DMBA-induced rat mammary tumors with reference to the effect of tamoxifen

Tamoxifen was administered over a period of 4 weeks to 19 female Sprague-Dawley rats bearing 20 DMBA-induced mammary tumors. Consequently, 13 tumors (65.0 per cent) regressed and showed a reduction in their estradiol receptor (ER) and progesterone receptor (PgR) concentrations. In spite of subsequent treatment given to the rats bearing the regressed tumors, 6 new tumors occurred. The ER and PgR concentrations of these tumors were lower than those of the tumors before tamoxifen therapy, and histochemical study showed these tumors to be composed mostly of ER-negative cells. These results suggest that: (a) the hormone dependency of breast cancer is reduced by tamoxifen therapy; (b) breast cancers recurring during tamoxifen therapy show reduced hormone dependency.


Mucinous carcinoma of the breast in Japan. A prognostic analysis based on morphologic features


Breast cancer detected by mass screening using physical examination alone


Involvement of nipple and areola in early breast cancer


Minor surgery for early cancer of the breast--from the clinicopathological study--


An evaluation of mass screening for breast cancer


Liposarcoma of the breast--fine structural and histochemical study of a case and review of 42 cases in the literature


Therapeutic value of mepitiostane in the treatment of advanced breast cancer


生活習慣と肥満尺度の関連性の検討

生活習慣と肥満尺度の関連性の検討


生体インピーダンス法(BIA法)，近赤外分光法および皮脂厚計による肥満測定

生体インピーダンス法(BIA法)，近赤外分光法および皮脂厚計による肥満測定

Bulletin of School of Medical Sciences, the University of Tokushima

徳島大学医療技術短期大学部紀要


Gynecomastia induced by treatment with tandospirone, a 5-HT1A agonist