[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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Breast changes with microcalcifications detected by mamography or other imaging studies are diverse. Sometimes, we hesitate to decide what work―up to perform. In this study, to evaluate the indications for future testing, we compared imaging and pathological findings of calcified lesions that were indicated for stereotactic mammotome biopsy and diagnosed. We report our study results, with a review of the literature. Ninety―four women were studied who had undergone stereotactic mammotome biopsies in our hospital between January 2008 and December 2013. Of these patients, 43（44.7％）had breast cancer, and 37（86.0％）of them had DCIS. Mammographically, 37 calcified lesions were minute and round, 44 were amorphous, and 13 were pleomorphic. Breast cancer accounted for 45.9, 34.0, and 92.3％ of the respective lesions, and the majority of the minute and round and amorphous lesions were benign. Although stereotactic mammotome biopsy is useful for the detection of early―stage cancer, it is important to determine the indications to avoid overdiagnosing calcified lesions. In category 3 calcifications, amorphous calcifications were observed significantly less frequently in cancers. The background breast tissue density in category 3 calcifications was significantly higher or heterogeneously higher in patients who were indicated for testing. These results suggest that, when the density of calcifications is very low, further follow―up should be considered, and that, when the breast tissue density is high or heterogeneously high, care should be taken to avoid overdiagnosing breast cancer, keeping in mind that mammographic findings associated with breast calcifications are difficult to interpret, thereby narrowing down the indications for stereotactic mammotome biopsy.

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Introduction: In Japan, breast cancer screening is categorized according to whether clinical breast examination and mammography are performed at the same facility（System A）or at different facilities（System B）. At our clinic, we have developed the world’s smallest and first battery―powered mammography screening vehicle by remodeling a ２―ton truck（L＝４.９２m）. Unlike conventional mobile clinic buses, our vehicle can be dispatched anywhere without road restrictions and requires only one parking space. Taking advantage of these features, we visit clinics to offer mammography as in System A. To evaluate the field screening service’s efficacy, we switched from System B to A at our clinic, using our vehicle in an operational demonstration. Subjects and Methods: The subjects were patients undergoing routine health screening and patients undergoing breast cancer screening. We retrospectively compared breast cancer screening participation rates before and after incorporation of the mobile clinic vehicle（System B, May ― October ２００７, n＝５８; System A, May― October ２００８ during the operational demonstration, n＝５７）. Statistical analysis was performed using Fisher’s exact test, with significance set at P ＜０.０５. Results: In non―elderly adults （＜６５ years old）, participation rates before and after incorporation were not significantly different（６４.９％ vs. ７８.２％, respectively）. In elderly adults （≧６５ years old）, however, the participation rate increased significantly from １９.０％ before incorporation to６１.８％ after. Conclusion: Among elderly individuals, the higher screening rate is presumably due to convenience, particularly when undergoing screening at a familiar clinic. Our vehicle offering System A screening seems useful for increasing participation in breast cancer screening among the elderly.

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The majority of abnormal findings of screening mammography are microcalcifications with no clinical symptoms. Here we present a case of DCIS that showed rapid progression of microcalcifications on screening mammography. A５５―year―old woman was recalled for further examination of pleomorphic, widely extended and segmental microcalcifications in region C of the right breast. Ultrasound showed an extended low―echoic area with some high―echoic spots in the same area. Mammography in the previous year had also indicated small microcalcifications. A core needle biopsy revealed ductal breast cancer. The patient underwent total mastectomy with the nipple and areola complex of the right breast due to spread of the microcalcifications to the nipple. Sentinel axillary node biopsy confirmed no metastasis. Pathology of the surgical specimen revealed extended DCIS（comedo type）, with a profile of ER（―）, PgR（―）, HER２（３＋）, Ki―６７（＞３０％）and Nuclear grade ３. Mammoplasty of the right breast is scheduled. It is important to detect high―risk DCIS in screening mammography.

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A 71―year―old woman was admitted to our department with suspected bilateral breast cancer due to positive findings of 18F―FDG PET/CT（PET/CT）scan imaging. The standard uptake value （SUVmax）of 18F―FDG on the breast nodules was 4.9 and 5.0, respectively. The suspected bilateral breast tumors were larger than 3cm. Since the patient had undergone augmentation mammoplasty in her twenties and some foreign material might have been injected, we suspected foreign body granuloma. Dynamic magnetic resonance imaging（MRI）showed a slow―persist pattern in the bilateral breast tumors. Diffusion―weighted MRI images showed low breast signals, suggesting a benign profile. Pathological examination of core needle biopsy specimens revealed accumulation of foamy cells that were positively stained for CD 68 and negative for S 100 protein. The breast tumors were diagnosed as lipogranuloma due to silicone injection. Periodical examinations for more than 4 years have revealed no pathological changes in either breast. For diagnosis of breast silicone granuloma it is important to obtain any details of foreign body injection performed in the past. The fact that silicone granuloma due to injection often exists in the retro―mammary space or the pectoralis muscles is helpful for differential diagnosis. Positive PET/CT scan images due to silicone granuloma have been rarely reported. Although it may not be easy to distinguish breast cancer from silicone granuloma after augmentation mammoplasty, the present case and some reports suggests that dynamic MRI could be useful for this purpose, although needle biopsy might be necessary for definitive diagnosis.

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