[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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The percentage of recalls following mammography at our institution is higher than the national average. We hypothesized that one reason for this could be poor utilization of comparative mammography methods. Currently, we use a picture archiving and communication system (PACS), which enables convenient comparison of images. We studied whether this system was functioning effectively by examining the records of 5,451 women who underwent mammography between April 2007 (when DR mammography was started here) and March 2012. The records were divided into two groups: before introduction of PACS when comparative examination was still inconvenient, and after introduction of PACS. The recall rates were then compared between the two periods. Under our system, cases are recalled when result from either one or both of the primary and secondary is found to be category 3 or higher. Therefore, we studied the details of women who were recalled because of positive findings from a single (primary or secondary) reading. There were no significant inter-or intra-observer differences in the annual recall rates,both before and after PACS. Abnormal findings characteristic for each individual film reading physician showed a significant decrease following the introduction of PACS. Comparative mammography is being utilized, but has not led to a decrease in recall rates. Our high recall rate is considered attributable to the accuracy of the film reading itself and the decision-making system employed.

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We examined eight cases of bilateral breast cancer detected by screening mammography between 2007 and 2012. Three of these cases showed bilateral abnormality on mammograms at the time of screening. We retrospectively examined the mammograms of the 5 cases that showed only unilateral abnormality, and found that one of them showed bilateral abnormality on the mammograms. Through close examination of these 5 cases, a craniocaudal view in addition to the mediolateral oblique view detected abnormality in one case, ultrasonography (US) did so in 2 cases, and magnetic resonance imaging (MRI) did so in 3 cases. Three of the 5 cases showing no abnormality by initial screening mammography were invasive ductal carcinoma histologically, and the remaining 2 cases were non-invasive ductal carcinoma. In cases that show only unilateral abnormality on initial screening mammograms, non-invasive carcinoma or small invasive carcinoma may exist on the contralateral side, and therefore examination of the contralateral side by US or MRI is recommended.

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Recently, both the incidence of breast cancer and associated mortality have been increasing in Japan, emphasizing the importance of increasing the rate of participation in breast cancer screening. Since 2009, we have been offering breast cancer screening involving only female staff, and performing the screening on public holidays, while informing the local community of this service through neighborhood associations. Immediately after this cancer screening service had been announced in local newspapers, our hospital received many applications from prospective participants. In one instance, a women who had clinical symptoms in her breast contacted us and visited our hospital immediately. A diagnosis of breast cancer was made and appropriate treatment was initiated. Questionnaires distributed to the examinees showed that many of them preferred being screened by female staff only, giving responses such as “Although I have always been reluctant to participate in breast cancer screening, I decided to participate this time because all of the stuff were female” and “I have always felt uncomfortable about breast palpation by male doctors, but I felt at ease during this screening, and I hope to participate again.” We also found that screening on public holidays was useful for participants who were unable to attend on weekdays. In order to increase the rate of participation in breast cancer screening, convenience,reduction of hesitation, and motivation are necessary. Our project involving only female staff was thus thought to be effective.

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We analysed the validity of diagnosis by comparing four cases of ductal carcinoma in situ (DCIS) and benign microcalcification. We diagnosed these four DCIS cases using stereotactic vacuum-assisted core needle biopsy or excisional biopsy, and in all of them ultrasonography demonstrated no evident changes, whereas mammography demonstrated amorphous microcalcification. None of the four patients had any symptoms, and were recommended to consult our hospital on the basis of breast cancer screening results alone. Although ultrasonography demonstrated no changes in these four cases, mammography revealed an increase in the number of microcalcifications and expansion of the affected area, reaching class 3 or a higher category within 6 to 12 months. During the course of observation, the microcalcification pattern in these four cases remained light and indistinct, and there was no progression to invasive ductal carcinoma. In comparison with cases of benign microcalcification diagnosed by stereotactic vacuum-assisted core needle biopsy, mammography showed no change in the microcalcification pattern or area of expansion. Our experience suggests that cases with a category of class 3 or higher showing amorphous microcalcification but no changes detectable by ultrasonography should be subject to reexamination using mammography within one year. Changes in microcalcification pattern in such cases may indicate malignancy.

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A 65-year-old woman was referred to us for detailed examination of focal FDG uptake in the inner lower area (B area) in the left breast that had been detected by screening FDG-PET. There was neither a palpable mass nor nipple discharge in the bilateral breast. Mammography showed a focal asymmetric density (FAD) classified as category 3 in the B area of the left breast. Ultrasonography showed no abnormal findings. Six months later, the patient noted a palpable lesion in the B area of the left breast. Mammography showed increasing FAD, and ultrasonography showed a geographic low-echo lesion in the same area. A core needle biopsy demonstrated ductal carcinoma. The patient underwent wide excision with sentinel lymph node biopsy. The pathological diagnosis was solid papillary carcinoma (SPC) with microinvasion. It appears that SPC, when not accompanied by invasive carcinoma, behaves in an indolent manner. In this case, however, physical examination and diagnostic imaging revealed obvious changes in during a six-month period. Because FDG-PET has high sensitivity for breast carcinoma, any lesion of the breast detected by FDG-PET should be treated carefully.

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