Abstract P4-02-13: Breast ultrasound surveillance with image fusion technique in a short-interval follow-up for BI-RADS category 3 mass lesions

PURPOSE: Breast ultrasound (US) is a diagnostic imaging modality that is now widely used as an adjunct to mammography for evaluation of breast abnormalities. In the Breast Imaging-Reporting and Data System (BI-RADS) lexicon, a solid mass with an oval shape, well-circumscribed margins and parallel orientation is classified as category 3 (BI-RADS category 3 mass lesions) . This mass should have a risk of malignancy of < 2%. Surveillance breast US in short-interval follow-up for BI-RADS category 3 mass lesions is an acceptable alternative to biopsy. The surveillance US is recommended 6 month after initial lesion identification and then every year for at least 2 y. However, inconsistent reproducibility for US due to operator dependence is still a clinical issue. The aim of our study was to verify the utility of US using real-time virtual sonography (RVS) - to coordinate present US images with past US images reconstructed from previously acquired US volume data using magnetic tracking system – in a short-interval follow--up for BI-RADS category 3 mass lesions.

METHOD AND MATERIALS: We enrolled 20 women (23 lesions) with more than 24 months of follow-up after classification as BI-RADS category 3 during initial US. US surveillance was scheduled at 6, 12 and 24 months. Three-dimensional assessment of morphologic features was performed while serially checking past US volume data corresponding to the present US probe position. Measurement of the target lesion diameter was performed after the probe was adjusted to include the maximum diameter of a past US image at each visit.

RESULTS: RVS was technically successful in 100% of patients. All target lesions were detected, including two iso-echoic lesions. The mean target lesion diameters at baseline and at 6, 12 and 24 months were 8.2+4.2, 8.4+4.5, 8.1+4.5 and 8.3+5.0 mm, respectively . Statistical analysis using a Friedman test with multiple comparisons revealed no significant difference between the diameters at each time point (p = 0.785). RVS was used to directly compare the US morphologic characteristics and sized of lesions. Furthermore, the RVS data can be reproduced in their entirety for independent review at a later date by using stored US volume data.

CONCLUSION:Our results suggest that RVS is reproducible, operator-independent technique for comparison of US images of BI-RADS category 3 mass lesions obtained at different time points.

Citation Format: Nakano S, Fujii K, Kousaka J, Mouri Y, Ando T. Breast ultrasound surveillance with image fusion technique in a short-interval follow-up for BI-RADS category 3 mass lesions [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-02-13.

Clinical features and endoscopic findings in patients with actively bleeding colonic angiodysplasia

Colonic angiodysplasia (AGD) is an important cause of lower gastrointestinal bleeding. However, most episodes of bleeding from colonic AGD stop spontaneously. To date, few data are available regarding the endoscopic findings of bleeding colonic AGD. In order to clarify the clinical features and endoscopic findings of actively bleeding colonic AGD, we conducted a retrospective study of patients treated with colonoscopy at our hospital. From November 2006 to March 2013 inclusive, 32,586 colonoscopies were performed at this hospital, among which 13 patients with bleeding colonic AGD were enrolled in the current study. The mean age was 84 years (range: 69-90 years). All patients had chronic heart disease and were currently using anticoagulant and/or antiplatelet drugs. Sites of bleeding AGD were localized in the left colon in two patients (15 %) and in the right colon in the remaining patients (85 %). A total of 77 % of the lesions (10/13) were 1-2 mm in size and two lesions were 4 mm in size; only one lesion was larger than 5 mm. Endoscopic treatment resulted in a therapeutic success rate of 100 %, and no recurrence of bleeding was observed in 85 % of the patients (11/13) after treatment. During the study period, two patients presented with bleeding from residual AGD and underwent endoscopic treatment. In the present study, most sites of bleeding colonic AGD were very small, termed "micro-angiodysplasia", and targeted endoscopic treatment for actively bleeding AGD was found to be effective and safe. It is essential that physicians consider the potential for actively bleeding colonic AGD, especially "micro-angiodysplasia", when performing colonoscopy in elderly patients with a history of cardiovascular disease and/or treatment with anticoagulant or antiplatelet therapy.

Abstract P4-03-08: A new real-time image fusion technique, a coordinated sonography and MRI using magnetic position tracking system, improves the sonographic identification of enhancing lesions in breast MRI

Breast magnetic resonance imaging (MRI) is a method that can detect clinically and mammographically occult cancer foci. For lesions suspected to be malignant on the basis of breast MRI, targeted sonography can help determine whether the lesion is amenable to tissue biopsy using sonographic guidance. However, the reproducibility of sonography as well as interexaminer reliability in targeted sonography is still a clinical issue. Recently, we have developed real-time virtual sonography (RVS) that can coordinate a sonographic image and a MRI multiplanar reconstruction (MRI-MPR) of the same section in real time. Although RVS has been reported to be useful for breast cancers, only a few studies have investigated the size and positioning error between a real-time sonographic image and a MRI-MPR image. The purpose of this study was to evaluate the accuracy of RVS to sonographically identify enhancing lesions by breast MRI. Between December 2008 and May 2009, RVS was performed in 51 consecutive patients with 63 enhancing lesions. MRI was performed with the patients in the supine position using a 1.5-T imager with a body surface coil to achieve the same position as with sonography. To assess the accuracy of the RVS, the following three issues were analyzed: (i) The sonographic detection rate of enhancing lesions, (ii) the comparison of the tumor size measured by sonography and the MRI-MPR and (iii) the positioning errors as the distance from the actual sonographic position to the expected MRI position in 3-D. Among the 63 enhancing lesions, 42 (67%) lesions were identified by conventional B-mode, whereas the remaining 21 (33%) initial conventional B-mode occult lesions were identified by RVS alone. The sonographic size of the lesions detected by RVS alone was significantly smaller than that of lesions detected by conventional B-mode (p < 0.001). The mean tumor size provided by RVS was 12.3 mm for real-time sonography and 14.1 mm for MRI-MPR (r = 0.848, p < 0.001). The mean positioning errors for the transverse and sagittal planes and the depth from the skin were 7.7, 6.9 and 2.8 mm, respectively. The overall mean 3D positioning error was 12.0 mm. Our results suggest that RVS has good targeting accuracy to directly compare a sonographic image with MRI results without operator dependence.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-03-08.

Abstract P2-02-12: Utility of Targeted Sonography Using Real-Time Virtual Sonography (RVS) for Breast Lesions That Were Suspicious on MRI

PURPOSE : MRI-detected suspicious breast lesions that are not expected from previous MMG or sonography, are detectable initially on MRI in 48% maximum. Therefore, biopsy is required for definitive diagnosis of MRI-detected lesions. Although MRI-guided biopsy is often necessary, sonographically guided biopsy after targeted sonography is more broadly available and less time-consuming and costly. The aim of this study was to verify the utility of targeted sonography using Real-time Virtual Sonography (RVS) for the identification of MRI-detected suspicious lesions.

METHOD AND MATERIALS : From 196 breast MRI examinations, all MRI-detected suspicious lesions and subsequent biopsy were identified between February 2006 and December 2009. All patients were examined using MMG, sonography, MRI and RVS that could synchronize a sonography image and the MRI cutaway images of the same site to be displayed in real time using magnetic navigation system. Following the conventional dynamic enhanced image, MRI was obtained on a 1.5-T imager in the supine position using a flexible body surface coil in order to achieve the same position as in sonography. We searched all cases for MRI-detected suspicious lesions and investigated targeted sonography with or without RVS in identifying the lesions.

RESULTS : Of the 196 patients, MRI-detected suspicious lesions were detected in 55 (28%) patients. A total of 67 suspicious lesions in 55 patients comprised this analysis. Of the study lesions, 24 (36%) were malignant and 43 (64%) were benign. Overall mean lesion size was 6.7mm. A total of 46 (69%) mass lesions were identified, compared with 16 (24%) foci and 5 (7%) nonmasslike lesions. 18 (27%) lesions were detected in targeted sonography without RVS and were revealed as cancers in eight, benign lesions in 10. In contrast, 60 (90%) lesions were detected in targeted sonography with RVS and were revealed as cancers in 21, benign lesions in 39. Although seven (10%) lesions were not detected with RVS, all lesions were able to project enhanced MRI information onto a body surface correctly as we checked ultrasound form images without the use of large-scale equipment.

CONCLUSION: The present results suggest that targeted sonography with RVS appears to be not time consuming technique which can identify a large part of MRI-detected suspicious lesions.

Impact of Virtual MRI Sonography with Magnetic Navigation on Detecting Residual Tumors in Patients with Breast Cancer Who Undergo Neoadjuvant Chemotherapy; Initial Experience

Objective: The accurate evaluation of the extent of residual disease after neoadjuvant chemotherapy (NAC) for breast cancer appears essential for successful clinical outcomes. However, there are limited date about the success of achieving negative margins in breast conservation therapy. Recently, we have developed virtual MRI sonography with magnetic navigation (real-time virtual sonography; RVS). RVS can overlay high-resolution structural image taken by sonography with functional image reflecting vascular permeability taken by MRI of the same site in real time. The objective of our study was to determine the relative accuracy of RVS in detecting residual tumors after NAC.Materials and Methods: Between April 2007 and May 2009, 96 breast conservation therapy were performed for invasive ductal carcinoma at our hospital. Fourteen patients with stage IIA-IIIB palpable invasive ductal carcinoma were enrolled in a study investigating the effects of NAC on tumor imaging. All patients underwent mammography, sonography, MRI, and RVS before and after NAC. MRI was performed with a 1.5-T scanner in the supine position using a flexible body surface coil to achieve the same position as that used in sonography. Based on MRI results, the absence or presence of residual tumors was used to classify treatment response into a clinically complete response (cCR) or non-cCR, respectively. Nine patients received lumpectomy, and 5 received mastectomy. The surgical resection area was determined by RVS. Detection rate was determined for residual tumors with or without RVS. The pathologically complete response (pCR) was defined as no invasive carcinoma.Results: All index tumors were detected by sonography and MRI before NAC. After NAC, a cCR was seen in 5 (5 of 14, 36%) patients. MRI correctly diagnosed pCR in 4 (4 of 5, 80%) patients. Detection rate for residual tumors was 9% (1 of 11) for mammography, 33% (3 of 9) for sonography alone, 78% (7 of 9) for MRI, and 89% (8 of 9) for RVS. It was noteworthy that 5 (5 of 5, 100%) cases with cCR were accurately localized onto the body surface with supplementation using RVS combined with pre- and post-NAC imaging while we were checking sonography. Although surgical excision was incomplete in 5 (5 of 9, 56%) patients, all positive surgical margins were ductal carcinoma in situ.Conclusions: By using RVS, two different forms of diagnostic imaging can be integrated in real time and thereby complement each other. The present results suggest that RVS is a useful imaging technique for detecting residual tumors that have been associated with local recurrence after NAC.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5024.

Heparin versus danaproid for prevention of venous thromboembolism after hip surgery

PURPOSE

To compare the prevalence of deep vein thrombosis (DVT), pulmonary thromboembolism (PTE), and bleeding complications in patients receiving heparin or danaproid after hemiarthroplasty or osteosynthesis for hip fractures.

METHODS

37 men and 138 women aged 47 to 100 (mean, 80) years underwent either hemiarthroplasty or osteosynthesis for hip fractures; 5 patients with dementia were excluded. All patients received preoperative elastic stocking and postoperative intermittent pneumatic compression. They were divided into 3 groups based on their admission period: controls (n=71), unfractionated heparin (n=44), and danaproid sodium (n=55). Drugs were administered from postoperative day 1 to 7. At day 7, all patients undertook radioisotope venography of the legs and lung perfusion scintigraphy.

RESULTS

In the control, heparin, and danaproid groups respectively, the DVT rates were 31%, 9.1%, and 5.5%, and the PTE rates were 5.6%, 4.5%, and 1.8%. Only the DVT rate in the control group was significantly higher than that in the heparin and danaproid groups. In the heparin group, one patient had gastrointestinal bleeding, 5 developed wound haematomas, and one had leakage from the drain site for 2 weeks.

CONCLUSION

Danaproid sodium appeared more effective and safer than heparin, with no bleeding complications occurred.

The role of real-time virtual sonography in the management of enhancing breast lesions on contrast-enhanced MRI

Abstract #4001

[Purpose]
 The aim of this study was to evaluate the role of real-time virtual sonography (RVS) in the management of enhancing breast lesions visualized with contrast-enhanced MRI.
 [Materials]
 Between April 2006 and May 2008, 92 women underwent breast MRI at our hospital. Of these 92 patients, 55 underwent MRI for staging of known breast cancer, and the remaining 37 underwent MRI for problem solving, including abnormal findings at physical examination or on conventional images. All patients were examined using mammography, sonography, MRI and RVS. The RVS system is capable of superimposing a sonography image with the MRI image of the same section in real time using a position tracking system with a magnetic sensor. Breast MR images were obtained on a 1.5-T imager using a flexible body surface coil, with the patient in the supine position.
 [Results]
 Overall sensitivity for detecting primary breast cancer was 74% (43/58) for mammography, 93% (54/58) for sonography, 97% (56/58) for MRI, and 97% (56/58) for RVS. Incidental enhancing / suspicious lesions (IELs) which were not predicted by the previous conventional imaging techniques were found in 55% of the patients (51/92),. Of these, 59% (24/41) of IELs could be identified only on repeated sonography, but 85% (35/41) of them were identified easily using the RVS system (p<0.05). The RVS system was able to project enhanced MRI information onto a body surface correctly while checking sonography form images without the use of large-scale equipment. Histologically, 10% (4/41) of the IELs were invasive ductal carcinoma.
 [Conclusions]
 The present results suggest that the RVS system offers excellent accuracy for identification of enhancing breast lesions. RVS can accurately select the cases in which MR guided biopsies are required.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4001.

Photodissociation of p-Xylene in Polar and Nonpolar Solutions

The photodissociation of p-xylene at 266 nm in n-heptane and acetonitrile has been studied with use of nanosecond fluorescence and absorption spectroscopy. The p-methylbenzyl radical was identified in n-heptane and acetonitrile by its fluorescence, which was induced by excitation at 308 nm. The p-xylene radical cation was observed in acetonitrile by its absorption. In n-heptane, the decay rate of the S(1) state of p-xylene ((3.2 +/- 0.2) x 10(7) s(-1)) is equal to the growth rate of the p-methylbenzyl radical ((2.7 +/- 0.4) x 10(7) s(-1)), showing that the molecule dissociates via the S(1) state into the radical by C-H bond homolysis (quantum efficiency approximately 5.0 x 10(-3)). In acetonitrile, the formation of the p-xylene radical cation requires two 266 nm photons, and the decay rate of the radical cation ((1.6 +/- 0.2) x 10(6) s(-1)) equals the growth rate of the p-methylbenzyl radical ((2.0 +/- 0.2) x 10(6) s(-1)). This shows that the radical cation dissociates into the radical by deprotonation (quantum efficiency approximately 8.9 x 10(-2)).

[A case of infected subdural hematoma due to Campyrobacter fetus]

A 20-year-old male presented fever, nausea and headache 1 week after eating uncooked liver. On admission, it was revealed he had suffered a closed head injury 3 months before without unconsciousness. On admission, computed tomography scan showed a left chronic subdural hematoma. Gd-DTPA magnetic resonance images revealed unusual enhancement of the capsule and linear enhancement of the subarachnoid space. The patient underwent burr hole irrigation and drainage. The culture of the hematoma content showed Campylobacter fetus. Therefore, the diagnose was infected subdural hematoma. A drainage operation and administration of antibiotics were effective. Our case suggests that enhanced magnetic resonance images are useful for diagnosis and follow-up of infected subdural hematoma.

A low prevalence of coronary heart disease among subjects with increased high-density lipoprotein cholesterol levels, including those with plasma cholesteryl ester transfer protein deficiency

BACKGROUND

Use of genetic analysis may improve the predictive value of risk factors for disease. A high plasma level of high-density lipoprotein (HDL) cholesterol is a strong negative risk factor for coronary heart disease (CHD). Cholesteryl ester transfer protein (CETP) deficiency causes increased levels of HDL cholesterol. However, recent studies suggest that CETP deficiency is a risk factor for CHD despite elevated HDL cholesterol levels.

METHODS

Plasma lipid levels, CHD prevalence, resting electrocardiograms, and common CETP gene mutations were analyzed cross-sectionally in a population of 19,044 male and 29,487 female Japanese subjects (ages 45-79 years).

RESULTS

High HDL cholesterol levels (serum HDL cholesterol >/=80 mg/dl, >/=95th percentile) were found in 6 and 5% of Japanese men and women, respectively. In the group with HDL cholesterol >/=80 mg/dl, common CETP gene mutations were identified in 23-24% of men and 31-49% of women. The prevalence of CHD in the group with high HDL cholesterol (>/=80 mg/dl) was low among both men (1.0%) and women (1.3%). There was no difference in CHD prevalence between hyper-HDL-cholesterolemic subjects with and without CETP mutations.

CONCLUSIONS

Subjects with very high HDL levels (HDL cholesterol >/=80 mg/dl) as well as mild-to-moderate HDL elevations (60-79 mg/dl) appear to be protected against CHD, whether or not they have CETP deficiency, a genetic cause of elevated HDL.

An iridoid glucoside from dipsacus asperoides

A new iridoid glucoside, loganic acid-6'-O-beta-D-glucoside, has been isolated from the defatted root of Dipsacus asperoides. Its structure has been elucidated by spectroscopic means as 1S-(1 alpha,4a alpha,6 alpha,7 alpha,7a alpha)-1-[(6-O-beta-D- glucopyranosyl-beta-D-glucopyranosyl)oxyl]1,4a,5,6,7,7a-hexahydro-6-hydr oxy-7- methyl-cyclopenta[c]pyran-4-carboxylic acid.

Occurrence of acute megakaryoblastic leukemia in a patient with idiopathic growth hormone deficiency

We describe a case of a 15 year old boy who developed acute megakaryoblastic leukemia (AMKL) while receiving treatment with human growth hormone (hGH) for idiopathic growth hormone deficiency (GHD). He was diagnosed as having idiopathic GHD and given hGH from December 1991. The examination of his peripheral blood showed mild pancytopenia 2 months before the start of the hGH therapy. Since January 1992, paleness of the skin, general fatigue and fervescence progressed gradually. In February 1992, because of the occurrence of acute leukemia, administration of hGH was discontinued. Judging from the results of surface marker analysis of the blast cells, the patient was diagnosed as having AMKL. He was treated with chemotherapy for acute non-lymphoblastic leukemia from March 1992. A complete remission was obtained after 4 weeks of treatment. The chemotherapy was completed in July 1993. He remains in complete remission 26 months after diagnosis. This case suggests the importance of hematological examination and, when there is any abnormality which is not caused by GHD, such as pancytopenia, more detailed medical examinations (for example bone marrow examination) are necessary.

[Analysis of prevalence over-estimates for tuberculosis in Okayama Prefecture]

In order to clarify the over-estimates in prevalence rates of tuberculosis, patients originally registered as having tuberculosis and later cancelled from the registration due to change of diagnosis were analyzed. The results were as follows: 1) The patients reclassified due to a change in diagnosis accounted for 6.3% of all reclassified patients. Of all the patients cancelled by the change of diagnosis, the proportion diagnosed as having atypical mycobacteriosis was largest. 2) The patients cancelled due to a change in diagnosis accounted for 6.0% of the patients newly registered as having tuberculosis. 3) The prevalences of all tuberculosis, pulmonary tuberculosis, infectious pulmonary tuberculosis and of bacteriologically positive pulmonary tuberculosis were significantly reduced by corrective adjustments. 4) Analysis for method by which diagnosis was obtained showed that there was a larger proportion of those patients who were reclassified due to change in diagnosis who were diagnosed by mass screening, compared to those reclassified due to correction of disease. The prevalence of cavities was less among the former group than the latter.

[Epidemiological study of atypical mycobacteriosis in Okayama prefecture]

In order to understand the epidemiology of atypical mycobacteriosis, patients who were cancelled from registration in tuberculosis surveillance and those who were diagnosed as having atypical mycobacteriosis were compared. The results were as follows in: 1) The proportion of female patients was greater for atypical mycobacteriosis than for tuberculosis. 2) No case of atypical mycobacteriosis resulting from contact infection was detected. Therefore, atypical mycobacteriosis dose not appear to be transmitted by direct person-to-person contact under ordinary conditions. 3) There were fewer cases of atypical mycobacteriosis with cavities than of tuberculosis. 4) There was no correlation between the incidence of atypical mycobacteriosis was higher to tuberculosis incidence. 5) The incidence of atypical mycobacteriosis was higher in the southern part of Okayama prefecture than in the northern part.

[A comparison of pancuronium and vecuronium used during the induction of high-dose fentanyl anesthesia]

Effects on hemodynamics and blood catecholamine levels of pancuronium and vecuronium used during the induction of anesthesia, were studied in patients undergoing coronary artery bypass grafting. Anesthesia was induced out with fentanyl, 70 micrograms.kg-1, and diazepam, 0.2 mg.kg-1, and either pancuronium or vecuronium was administered in a dose of 0.2 mg.kg-1. Control measurements were made before the induction of anesthesia. Hemodynamic parameters and blood levels of norepinephrine (NEP) and epinephrine (EP) were measured three minutes (S1) and ten minutes (S2) after tracheal intubation. The study showed that HR, AP, CI, and coronary perfusing pressure were more stable in the group of patients receiving pancuronium (group P) than in the group receiving vecuronium (group V) during the induction of anesthesia. LVSWI and RVSWI showed a comparable decline in both groups. While NEP was unaffected in group P during the induction of anesthesia, it decreased significantly at S1 and S2, compared with control (S0), in group V. On the other hand, EP decreased significantly at S1 and S2 during the induction of anesthesia in both groups, but group V showed a greater change. The results of this study suggest that pancuronium is more advantageous than vecuronium as a muscle relaxant used during the induction of high-dose fentanyl anesthesia.

Computed tomography in the assessment of pancreatic tumor response after intraoperative radiation therapy

Computed tomography was used in 7 patients given intraoperative electron beam therapy for advanced carcinoma of the pancreas. The local tumor response was studied quantitatively by defining the tumor contour in consecutive CT scans and then estimating the tumor volume. The maximum diameters of the tumor in 3 planes (X, Y and Z) were also estimated. There was evidence of initial tumor regression in all patients during the first few months after the treatment. No specific behaviour of the diameters in the X, Y and Z planes could be detected. Later on, regrowth of the tumor could sometimes be observed, preferably in one of the 3 planes. On the whole, CT was found to be a useful tool for assessing tumor response to this form of therapy.