Objective: Focal asymmetric densities (FAD) observed in mammography (MMG) are also seen in normal breasts so their positive predictive value (PPV) is low and the false positive (FP) rate is high, making accuracy management difficult for health check-up facilities. In examinees deemed to require more detailed examination due to FAD in screening MMG, we clarified the extent to which combined evaluation by breast ultrasonography (US) raised the PPV of FAD in order to determine the effectiveness of such combined evaluation as a way of reducing excessive judgments of “requiring more detailed examination” due to FAD.
Methods: We focused on 204 persons told that they required more detailed examination on the basis of undergoing population-based or opportunistic MMG screening at our facility from January to December 2013. The subjects of this study were the 171 persons who actually underwent such examination. We obtained PPV from their medical records.
Results: Lesions were found in US conducted at the location of FAD for 73 subjects (42.7%), and biopsies were required for 13 of them. Breast cancer was determined in 6 of these subjects. The PPV for FAD by MMG alone was 3.5%. Additional judgment by means of US raised the PPV to 46.2%.
Conclusion: The use of US for additional evaluation of FAD findings in MMG can raise the PPV for FAD, enabling the FP rate to be reduced and the amount of excessive further detailed examination due to FAD to be reduced. Examinees are affected psychologically by a FP result and this impact could also be reduced.

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Objective: Generally, cancer screening using only tumor markers is considered insufficient because cancer often goes undetected in the early stage, and they sometimes produce false-positive results. The aim of this study was to evaluate the positive predictive value (PPV) of serum CA19-9 and perform analysis on patients with high CA19-9 levels.
Methods: Of the 32,508 patients whose serum CA19-9 was first measured from January 2006 to June 2013 in our center, 790 patients (0.024%) had high levels (> 37.0 U/mL). The subjects of our analysis were 320 patients among them whose serum CA19-9 was measured twice or more after the first measurement.
Results: Among the eight patients diagnosed with cancer, 4 had pancreatic cancer, 2 had duodenal cancer, 1 cystic duct carcinoma and 1 colon cancer. The median serum CA19-9 level of the 8 patients was 198.2 U/mL (Range 46.4 - 2,968 U/mL). The positive predictive value (PPV) was 2.5%.
Conclusion: Since the PPV of CA19-9 was only 2.5%, further examination of all patients with high levels may not be cost-effective. The use of the novel cancer detection method using organ-specific microRNA in combination with conventional tumor markers may be promising.

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Objective: In order to raise awareness of smoking cessation and recommend it to more people, it was felt necessary to provide more information on its effectiveness. For this purpose, we examined the usefulness of smoking cessation therapy through measurements of BMI, blood pressure and expired CO concentration, the pulmonary function test, the d-ROMs (diacron reactive oxygen metabolites) test, hs-CRP levels and blood tests, for a period of 12 weeks following its introduction.
Methods: The subjects were 66 patients undergoing smoking cessation therapy at our clinic. We monitored changes in all test parameters over the period from the initial measurements at week 1 to the final measurements at week 12, paying particular attention to the d-ROMs test (marker of oxidative stress), and conducted a comparative analysis.
Results: Significant differences were observed for expired CO concentration and d-ROMs test over the period. In the latter there was an improvement as early as week 4 from starting therapy and the improvement was maintained at week 12 (p<0.01). Also, an assessment to see whether there was a variation in temporal changes in the d-ROMs test with differing degrees of pulmonary function (FEV₁/FVC) at week 0 demonstrated that when FEV₁/FVC was 70% or greater at week 0, there was a significant drop in the d-ROMs test result (p<0.01).
Conclusion: In the present study, improvement was observed in the oxidative stress status, an indicator of the effectiveness of smoking cessation. It also demonstrated that smoking cessation therapy was particularly effective when FEV₁/FVC was 70% or greater at its beginning and that the d-ROMs test could be a useful means of knowing the short-term effectiveness of smoking cessation.

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Objective:Our objective was to establish optimal method and criteria for the detection of moderate-severe gastric mucosal atrophy, for which the risk of developing gastric cancer is high, by investigating associations between pepsinogen (PG) levels and Helicobacter pylori (Hp) antibody (Ab) titers measured in gastric cancer risk screening (stratified according to ABC classification) and gastric mucosal atrophy observed in esophagogastroduodenoscopy (EGD).
Methods: Our subjects were 175 persons subjected to the ABC classification for the first time at our facility and who replied that they had no history of Hp eradication therapy, selected from 308 persons who underwent the ABC classification and EGD on the same day in the period from April 2011 - March 2014. An association with PG or HpAb was analyzed for those determined to have moderate-severe gastric mucosal atrophy, which was considered to be C-3 and above in the Kimura-Takemoto classification.
Results: By the current ABC classification, 15.2% of moderate-severe mucosal atrophy was contaminated in the A group. The optimal point for distinguishing moderate-severe gastric mucosal atrophy was PG I/II 4.7 or less and HpAb 4 - 5 U/mL or greater. In ROC analysis, PG I/II was the most favorable, however there was no significant difference regarding HpAb for distinguishing moderate-severe gastric mucosal atrophy.
Conclusion: By the current ABC classification, 15.2% of moderate-severe gastric mucosal atrophy was contaminated in the A group. Defining a tentative ABC classification with cut off points set at 4.7 for PG I/II and 5 U/mL for HpAb could reduce the proportion of moderate-severe gastric mucosal atrophy in Group A to about half (7.8%) without significantly raising the positive rate.

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Objective: In patients diagnosed with nonalcoholic fatty liver disease (NAFLD) an appropriate method of identifying those with advanced fibrosis is required. It has been reported that diabetes is involved in the progression of fibrosis in NAFLD and that the FIB-4 index is useful in predicting fibrosis progression in the liver. Clarifying associations with glucose intolerance and other factors in cases of NAFLD found in health check-ups was therefore made the objective of the present study.
Methods:The subjects were 1,638 persons diagnosed with NAFLD and they were assigned to 4 groups (A-D) depending on the degree of glucose intolerance based on FBS and HbA1c as follows: A Group - FBS < 100 mg/dL and HbA1c ≤5.5%; B Group - FBS 100 - 109mg/dL or HbA1c 5.6 - 5.9%; C Group - FBS 110 - 125 mg/dL or HbA1c 6.0 - 6.4%; D Group - FBS ≥126 mg/dL or HbA1c ≥ 6.5%. The groups were compared with regard to age, gender, abdominal circumference, blood pressure, dyslipidemia, platelets, liver function and FIB-4 index.
Results: Age and FIB-4 index in the B, C and D Groups were significantly higher as compared with the A Group and there was a significant difference in liver function between the A and D Group. Regarding presence of metabolic syndrome factors, there were significant differences in blood pressure among all groups, between the A Group and D Group regarding abdominal circumference and between the A Group and C and D Groups regarding dyslipidemia.
Conclusion: The results suggested that presence of metabolic syndrome factors was correlated with degree of glucose intolerance. They also suggested an association between a high FIB-4 index or low platelets and progression of liver fibrosis. The use of glucose intolerance and the FIB-4 index were therefore considered to be in important in identifying persons with advanced NAFLD in health check-ups.

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Objective: The objective of the present study was to perform locomotion checks (“loco-checks”) and standing tests on examinees of our health check-up facility and study the findings and actions required to conduct exercise therapy, a strategy against metabolic syndrome (“metabo”), more safely.
Methods: We performed a loco-check, physical constitution/body composition measurements and the standing test, a test of the functional strength of the lower limbs, on 723 persons who underwent a health check-up at our facility from March 13 to November 30 2012. The subjects were divided into a Loco-check (+) Group, a Metabo Group, an Overlap (Metabo and Loco-check (+)) Group and a Healthy Group and we compared subject percentages, physical constitution and body composition measurements, and standing test results among them.
Results: Of the total number of subjects, 20.9% were assigned to the Loco-check (+) group, 12.3% to the Metabo Group, 7.5% to the Overlap Group and 59.3% to the Healthy Group. In males, the results obtained in the standing test were lower in subjects in their 50s in the Overlap Group and in subjects in their 60s in the Loco-check (+) Group than those in the same age groups in the Healthy Group. Regarding the physical constitution and body composition indicators of BMI, body fat percentage (% fat) and lean body mass/height (LBM/m), there were no differences between the Loco-check (+) Group and Healthy Group.
Conclusion: Among subjects coming under the metabo category, there were those who also came under the loco-check (+) category and the functional strength of the lower limbs was lower in such subjects. By the physical constitution and body composition measurements currently conducted in health check-ups, it is difficult to identify loco-check (+) subjects. Therefore, in order to screen for problems with the motor system at an early date and conduct exercise therapy safely as a metabo strategy, it is necessary to match exercise prescriptions to individual motor functions by conducting loco-checks and tests of lower limb functional strength.

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Objective: Observation of the pancreatic duct is highly useful in the diagnosis of pancreatic diseases, and pancreatic duct dilatation is a high risk factor of pancreatic cancer. We investigated the results of follow-up examinations on examinees with pancreatic duct dilatation to clarify the need for such follow-up.
Methods: One hundred sixty-two examinees in whom pancreatic duct dilatation was detected in abdominal ultrasonographic (US) screening between April 1996 and March 2013 were the subjects of this study. They were divided into two groups as follows; Group A, consisting of 31 examinees in whom pancreatic duct dilatation was also observed in US performed one month after the initial screening US that detected pancreatic duct dilatation, and group B, consisting of 98 examinees in whom pancreatic duct dilatation was not observed in US performed one month after the initial screening US.
Results: Analysis of blood tests revealed no significant differences between groups A and B. Five cases of chronic pancreatitis, 3 cases of IPMN, 1 case of pancreas cyst and 1 case of pancreatic cancer were discovered in group A. In group B, 2 cases of pancreatic cysts and 1 case of IPMN without mucin-secretion were discovered 2 years and 8 years after the initial screening US, respectively.
Conclusion: We have to continue to follow-up of examinees with pancreatic duct dilatation for subsequent events, even if pancreatic duct dilatation disappears in follow-up US.

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Objective: We evaluated the introduction of transvaginal sonography and measuring endometrial thickness into cervical cancer screening and determined how frequently endometrial diseases, including endometrial cancer, were detected.
Methods: Among 4,794 postmenopausal, asymptomatic women undergoing cervical cancer screening, 37 with an endometrial thickness of 5 mm or more measured by transvaginal sonography, were selected for final diagnosis of endometrial diseases. Final diagnoses were achieved in 30 women, either by repeated transvaginal sonography, endometrial cytology, endometrial biopsy, hysteroscopy, magnetic resonance imaging or by serum estradiol measurement, depending on the judgment of the attending gynecologists.
Results: The diagnoses were: 1 case of endometrial cancer, 1 case of endometrial hypertrophy, 3 cases of endometrial polyp, 2 case of endometrial hypertrophy due to coexistent uterine fibroid, 1 case of hydrometra, 15 cases of negative endometrial cytology, and 7 cases of negative endometrial pathology. The responses of examinees to an anonymous questionnaire on the topics of pain, bleeding, time required, shortness and simplicity of explanation of sonograms obtained by transvaginal sonography, especially for elderly visitors, and acceptability of transvaginal sonography, were favorable.
Conclusion: The measurement of endometrial thickness in postmenopausal, asymptomatic women by means of transvaginal sonography is clinically useful because it provides a basis for the discovery of endometrial diseases.

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Objective: Isolated aneurysm of superior mesenteric artery (SMA) is a relatively rare condition, and there have been few studies on the use of ultrasonography for detecting SMA aneurysms. This study was conducted to examine ultrasonographic images of SMA aneurysms diagnosed in comprehensive health check-ups.
Methods: The records of seven patients in whom isolated asymptomatic dilatation of SMA was discovered for the first time in screening abdominal ultrasonography were reviewed.
Results: All subjects were men aged 59.9 ± 25.1 (range, 39-76), SMA diameter was 9.8 ± 1.2mm (8.6-10.3 mm), expanded range 26.6 ± 23.2 (17.2-50.1 mm), normal portion diameter 6.2 ± 1.7mm (4.8-6.9 mm), distance from aortic branch 24.0 ± 13.9mm (12.4-30.7 mm, n=5). In three cases flap-like lumen structures were observed.
Conclusion: SMA lesions are often reported as acute abdomen, and detection in health screening is rare. The reasons for this are considered to be: inability to notice dilatation, inability to visualize due to digestive tract gas, and non-inclusion in objects of examination. Asymptomatic SMA lesions should be kept in mind when we conduct screening ultrasonography as this may lead to the discovery of important diseases.

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