[in Japanese]

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[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

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[in Japanese]

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[in Japanese]

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The purpose of this study was to evaluate the clinicopathological characteristics and most appropriate treatment for cases of atypical ductal hyperplasia（ADH）of the breast diagnosed by stereotactic vacuum―assisted breast biopsy（ST―VAB）. We reviewed the medical records of ７０ patients with ADH among１，１５３patients who underwent ST―VAB between２００３and ２０１１ in our hospital. All of the patients were women rangin age from３１ to ７９ years（mean age ４８．７ years）. The chief complaints, clinical course, mammography findings, and final or clinical diagnosis were studied. Sixty―three patients visited our hospital for further examinations after breast cancer screening. Six patients were examined for incidental findings during follow―up examinations for other reasons and１patient was examined because of abnormal nipple discharge. In all cases, mammography findings showed only calcifications. Among the ７０ cases, ５０ were classified as category ３, １９ as category ４, and１as category ５. In１７ cases, sequential excision or resection revealed breast cancer. There were１４cases of non―comedo―type DCIS, ２ cases of comedo―type DCIS, and １ invasive ductal carcinoma（invasive luminal type, ４ mm in size, no lymph node metastasis）. Benign lesions were found by excision in ２ patients, and ５３ patients were judged to have non―malignant lesions because of no change in clinical manifestations or imaging findings（median observation period ２６ months）. From these findings, we conclude that such atypical cases that require long―term follow―up would be found at a uniform rate once mammographic breast screening has become widespread. If malignancy is found in some patients during the follow―up period, it will be low―grade DCIS if US examination has been negative for malignancy. Therefore we will be able to follow such ADH cases using breast imaging without additional excision.

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Evaluation of mammograms has been done using films or hard copy. In Japan, there has been a rapid shift to soft―copy diagnosis, and facilities for this approach are necessary. Digital mammography has high resolution and a large matrix size. When a monitor displays the mammogram, the image is either displayed partially by １：１ pixel mapping or is narrowed to fit the monitor, resulting in loss of image quality. We have developed the digital phantom used for every mammographic detector sold in Japan. This phantom resembles the Contrast Detail Phantom and comprises group of １２ different shapes and group of eight different brightnesses. One group consists of９signals, and each signal is located at the prime number coordinate from a central signal coordinate. This phantom is able to evaluate the display system including the reduction function and monitor resolution, etc. This phantom is also useful for education and quality control.

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We followed women who had undergone initial breast cancer screening using a free screening coupon issued by the Cancer Screening for Women―Specific Cancer Program. Subjects: A total of９７７women who underwent initial breast cancer screening in Suita, Japan, in fiscal２００９. Methods: The percentage of women who continued to attend routine breast cancer screening was analyzed as the cumulative rate of adherence. Results: The cumulative rate of adherence was１７.９％ for the second year of follow―up and ３２.３％ for the third year. When subjects were divided into one of two groups based on whether the screening age on the coupon matched the screening age at the screening location, adherence differed between groups in the second year（２７.５％ vs.１３.６％, P ＜０.０５）but not in the third year（３２.４％ vs.３２.３％）. Discussion: The lack of difference between groups in the third year was likely because many women in the non―matching group waited three years before their next screening, which is longer than recommended. Overall, ４４.６％ of subjects who had another routine screen waited three years, which is an issue that should be addressed. To ensure that first―time participants adhere to the routine screening schedule, the screening ages for the Cancer Screening for Women―Specific Cancer Program should be matched to the ages at the routine screenings. Furthermore, other measures will be necessary, such as improving the content of the screening handbook provided with the coupon, using the handbook for outreach, educating new participants in person, and sending reminders.

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A26-year-old woman was screened by physical and ultrasound examinations for a mass in the upper outer area in the left breast. Ultrasonography showed a heterogeneous mass shadow with an unclear boundary. However, mammography revealed no tumor because of dense fibroglandular tissue, showing only some small round calcifications. Ultrasound―guided fine―needle aspiration cytology with a large amount of cells revealed suspicious malignancy. To confirm the diagnosis, we also performed core needle biopsy, but pathological examination revealed only benign breast tissue. Since there was discordance between cytology and pathology, surgical removal of the tumor using a hook wire was performed. The final diagnosis was mastopathy showing various morphological changes and proliferation of ductal epithelial cells.

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