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Minamimoto R.,National Center for Global Health | Minamimoto R.,Yokohama City University | Senda M.,Institute of Biomedical Research and Innovation | Jinnouchi S.,Atsuchi Memorial Institute of Radiology | And 3 more authors.
Clinical Breast Cancer | Year: 2015

Background The [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET) cancer screening program is defined as cancer screening for asymptomatic subjects using FDG-PET/computed tomography with or without combination of other screening tests. The aim of this study was to analyze the detection rate and effectiveness of the FDG-PET cancer screening program for breast cancer between 2006 and 2009 in Japan. Patients and Methods A total of 62,054 asymptomatic female subjects underwent FDG-PET cancer screening. We analyzed 473 cases with findings of possible breast cancer in any screening tests. Results Among 473 possible cases, 161 were verified as breast cancer. The relative sensitivity and positive predictive value (PPV) of FDG-PET for breast cancer were 83.9% and 41.7%, respectively. The relative sensitivity and PPV of mammography (MMG) for breast cancer was less than for FDG-PET; results for breast ultrasonography (US) were close to FDG-PET. The combination of FDG-PET with MMG and US might contribute to increased sensitivity but does not improve PPV. Most breast cancer cases (83.0%) detected using the FDG-PET cancer screening program were stage 0 or I based on the Union for International Cancer Control criteria. Conclusion The FDG-PET screening program in Japan detected breast cancer at an early stage. A combination of FDG-PET and MMG and/or breast US yields the best results for detecting breast cancer. The FDG-PET cancer-screening program alone cannot detect all breast cancers. © 2015 Elsevier Inc.

Hamada Y.,Clinical Center | Nagata N.,National Center for Global Health and Medicine | Shimbo T.,Japan National Institute of Information and Communications Technology | Igari T.,National Center for Global Health | And 13 more authors.
AIDS Patient Care and STDs | Year: 2013

We conducted a single-center prospective study to evaluate the utility of cytomegalovirus (CMV) antigenemia assay for the diagnosis of CMV-gastrointestinal disease (GID). The study subjects were HIV-infected patients with CD4 count ≤200 μL/cells who had undergone endoscopy. A definite diagnosis of CMV-GID was made by histological examination of endoscopic biopsied specimen. CMV antigenemia assay (C10/C11 monoclonal antibodies), CD4 count, HIV viral load, history of HAART, and gastrointestinal symptoms as measured by 7-point Likert scale, were assessed on the same day of endoscopy. One hundred cases were selected for analysis, which were derived from 110 cases assessed as at high-risk for CMV-GID after endoscopy screening of 423 patients. Twelve patients were diagnosed with CMV-GID. Among the gastrointestinal symptoms, mean bloody stool score was significantly higher in patients with CMV-GID than in those without (2.5 vs. 1.7, p=0.02). The area under the receiver-operating characteristic curve of antigenemia was 0.80 (95%CI 0.64-0.96). The sensitivity, specificity, positive likelihood ratio (LR), and negative LR of antigenemia were 75.0%, 79.5%, 3.7, and 0.31, respectively, when the cutoff value for antigenemia was ≥1 positive cell per 300,000 granulocytes, and 50%, 92.0%, 5.5, and 0.55, respectively, for ≥5 positive cells per 300,000 granulocytes. In conclusion, CMV antigenemia seems a useful diagnostic test for CMV-GID in patients with HIV infection. The use of ≥5 positive cells per 300,000 granulocytes as a cutoff value was associated with high specificity and high positive LR. Thus, a positive antigenemia assay with positive endoscopic findings should allow the diagnosis of CMV-GID without biopsy. © Copyright 2013, Mary Ann Liebert, Inc.

Ueda Y.,National Center for Global Health | Yamashita H.,National Center for Global Health | Takahashi Y.,National Center for Global Health | Kaneko H.,National Center for Global Health | And 2 more authors.
Clinical Rheumatology | Year: 2014

We experienced three patients with refractory or severe hemophagocytic syndrome associated with the activity of systemic lupus erythematosus, so-called acute lupus hemophagocytic syndrome (ALHS). All patients were successfully treated with intermittent intravenous injections of cyclophosphamide (IVCY). In each patient, hemophagocytosis was found during bone marrow examination, and infectious causes of hemophagocytic syndrome were carefully excluded. Patients 1 and 2 were refractory to combination therapy with a high-dose corticosteroid and rituximab or cyclosporine and were successfully treated with additive IVCY. Patient 3 had very severe ALHS that developed after cardiac surgery but was successfully treated with a high-dose corticosteroid and IVCY. We conducted a literature review of adult ALHS and analyzed 54 cases reported from 2006 to 2013. Although the clinical and laboratory features were diverse, fever, bicytopenia or pancytopenia, and hyperferritinemia were almost universal. Including our 3 patients, a total of 16 have reportedly been treated with IVCY-containing regimens, and ALHS was successfully controlled in most of them without switching or adding other therapies. We suggest that combination therapy with IVCY and corticosteroids may be useful to treat severe or refractory ALHS. © 2013 Clinical Rheumatology.

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