Shizuoka Cancer Center Hospital

Shizuoka-shi, Japan

Shizuoka Cancer Center Hospital

Shizuoka-shi, Japan
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Kiyohara Y.,Shizuoka Cancer Center Hospital | Yamazaki N.,National Cancer Center Hospital | Kishi A.,Toranomon Hospital
Journal of the American Academy of Dermatology | Year: 2013

Skin toxicities are the most common side effects associated with the epidermal growth factor receptor inhibitor erlotinib, occurring in most patients receiving the drug. Clinical trials evaluating erlotinib for the treatment of non-small cell lung cancer have reported a range of skin disorders, the most common being acneiform rash, xeroderma (dry skin), pruritus, and paronychia. Although in the majority of cases these effects are mild and transient, they can have a considerable impact on a patient's quality of life and, if particularly severe and persistent, may necessitate treatment interruption or cessation and compromise treatment outcome. This coupled with recent evidence to suggest a positive correlation between the incidence and severity of rash and clinical outcome among erlotinib-treated patients with advanced or metastatic non-small cell lung cancer highlights the importance of adequately managing epidermal growth factor receptor inhibitor-related skin disorders. Clear treatment strategies are therefore necessary to ensure the prevention and optimal management of erlotinib-related skin toxicities thereby enabling patients to continue erlotinib treatment. In this review we present a practical approach for the treatment of erlotinib-related cutaneous side effects in Japanese patients with advanced non-small cell lung cancer providing details of specific treatment interventions, according to symptom severity, for each of the common skin disorders. In addition, the importance of preventive skin care measures-namely maintaining cleanliness, moisturization, and protection from external stimuli-in preventing the development of serious skin disorders is discussed and guidelines for the practice of proper skin care are presented. © 2013 by the American Academy of Dermatology, Inc.

Uematsu T.,Shizuoka Cancer Center Hospital | Kasami M.,Shizuoka Cancer Center Hospital
American Journal of Roentgenology | Year: 2012

OBJECTIVE. The purpose of this study was to analyze the features of nonmasslike enhancement detected on 3-T MRI and to determine which of these features are significant predictors of malignancy. MATERIALS AND METHODS. Retrospective review was performed of 124 consecutive patients with nonmasslike enhancement detected on 3-T MRI after biopsy or surgery. We described nonmasslike enhancement using the descriptors in the BI-RADS MRI lexicon. In addition to the BI-RADS descriptors, whether clustered ring enhancement was present and whether surrounding high signal intensity (SI) was present on T2-weighted imaging were assessed. RESULTS. Cancer was identified in 85 lesions (69%). Of these lesions, ductal carcinoma in situ (DCIS) was found in 41 (48%) and invasive cancer in 44 (52%). The features found to be significant predictors of malignancy were segmental (p = 0.001), focal (p = 0.006), dendritic (p = 0.017), and clustered ring enhancement (p = 0.026) and surrounding high SI on T2-weighted imaging (p < 0.0001). The features found to be significant predictors of invasive cancer were dendritic enhancement (p < 0.0001) and surrounding high SI on T2-weighted imaging (p < 0.0001). There were no significant predictive features for DCIS. Homogeneous enhancement was found to be a significant predictor of benignancy (p = 0.001). Kinetic patterns were not significant predictors of malignancy. Nonmasslike enhancement of 1 cm or larger was more often malignant than lesions smaller than 1 cm (p < 0.0001). In multivariate analysis, a lesion size of 1 cm or larger was found to be the only significant predictor of malignancy for nonmasslike enhancement. CONCLUSION. Segmental, focal, dendritic, and clustered ring enhancement; surrounding high SI on T2-weighted imaging; and a lesion size of 1 cm or larger can act as predictors of malignancy for nonmasslike enhancement detected on 3-T MRI, but kinetic characteristics cannot. © American Roentgen Ray Society.

Uematsu T.,Shizuoka Cancer Center Hospital
Breast Cancer | Year: 2011

Little is known about the MR imaging features of triple-negative breast cancer (TNBC), but TNBC has a worse prognosis because it has no effective therapeutic targets, such as estrogen receptor for endocrine therapy and human epidermal growth factor receptor 2 (HER2) for anti-HER2 therapy. MR findings of a unifocal lesion, mass lesion type, smooth mass margin, rim heterogeneous enhancement, persistent enhancement pattern, and very high signal intensity on T2-weighted images are typical features of breast MR imaging associated with TNBC. Although TNBC can mimic a benign morphology, the early MR imaging recognition of TNBC could assist in both the pretreatment planning and the prognosis, as well as adding to our understanding of the biological behavior of TNBC. © The Japanese Breast Cancer Society 2010.

Uematsu T.,Shizuoka Cancer Center Hospital
Breast Cancer | Year: 2014

Breast ultrasonography (US) is an indispensable tool for diagnosis of palpable and non-palpable breast masses and can facilitate good patient care for breast cancer. However, it is of limited value in cases of isoechoic lesions surrounded by fat, heterogeneous echoic lesions surrounded by a heterogeneous background, deep lesions in huge breasts, subareolar lesions, and lesions caused by poor and underdeveloped operator skills. Some breast tumors such as ductal carcinoma in situ and invasive lobular carcinoma are easily missed on US because of the nature of the lesions. Recent studies have emphasized the use of tools complementary to B-mode US, including real-time elastography and Doppler imaging, in the evaluation of breast lesions missed on US. Radiologists can take a number of steps that will enhance the accuracy of US image interpretation and decrease the rate of false-negative findings. These steps include reviewing clinicopathological data, using mammography and MRI to help assess breast lesions missed on US, strictly adhering to positioning and technical requirements, being alert to subtle features of missed breast lesions, and judging a lesion by its most malignant feature. © 2013 The Japanese Breast Cancer Society.

Uematsu T.,Shizuoka Cancer Center Hospital | Kasami M.,Shizuoka Cancer Center Hospital | Watanabe J.,Shizuoka Cancer Center Hospital
European Radiology | Year: 2011

Objective: The purpose of this study was to assess the influence of background enhancement on the detection and staging of breast cancer using MRI as an adjunct to mammography or ultrasound. Methods: One hundred forty-six bilateral breast MRI examinations were evaluated to assess the extent of a known primary tumour and to problem solve after mammography or ultrasound without adjusting for the phase in the patients' menstrual cycle. The background enhancement was classified into four categories by visual evaluation: minimal, mild, moderate and marked. Results: In total, 131 histologically confirmed abnormal cases (104 malignant and 27 benign) and 15 normal cases were included in the analysis. There was no tumour size-related bias between the groups (p=0.522). For the primary index tumour, the sensitivities of MRI with minimal/mild and moderate/marked background enhancement were 100% and 76% (p=0.001), respectively. Thus, the degree of background enhancement did not affect the specificity. For evaluating tumour extent (n=104), the accuracy of MRI with moderate/marked background enhancement (52%) was significantly lower than that with minimal/mild background enhancement (84%; p=0.002). Conclusion: The degree of background enhancement affected the detection and staging of breast cancer using MRI. © 2011 European Society of Radiology.

This article describes a systematic approach to choosing needles and probes for ultrasonographically guided (US-guided) percutaneous breast biopsy under various circumstances. The accuracy of US-guided percutaneous breast biopsy depends upon both the method chosen and lesion characteristics. Target accuracy and proper procedures are essential for predicting the yield regardless of the method chosen. Considering accuracy and cost, vacuumassisted biopsy (VAB) should be offered only to appropriately selected patients. In particular, VAB should be the first choice for US-guided percutaneous breast biopsy of non-mass-like lesions. © 2011 The Japanese Breast Cancer Society.

Uematsu T.,Shizuoka Cancer Center Hospital
Breast Cancer | Year: 2012

This article reviews various non-mass-like ultrasonography (US) findings of the breast and the sonographic-pathologic correlation with Doppler techniques, elastography, and MRI. High-resolution US allows for identification of small, clinically occult non-mass-like US findings. Ductal carcinoma in situ and invasive lobular carcinoma usually manifest as a non-mass-like lesion on US. It is useful to classify non-mass-like lesions on US in a similar manner to the classification of non-mass-like enhancement on MRI. © 2012 The Japanese Breast Cancer Society.

Inflammatory breast carcinoma (IBC) is rare; however, it is the most aggressive variant of breast cancer with a very poor outcome. Locally advanced breast cancer and acute mastitis have a presentation similar to that of IBC. Therefore, the diagnosis of IBC remains a challenge in breast imaging. MRI can play a crucial role in the differential diagnosis by providing criteria indicative of IBC. Several MRI findings, especially T2-weighted images, are promising for more reliable and accurate interpretation of IBC. © 2012 The Japanese Breast Cancer Society.

Uematsu T.,Shizuoka Cancer Center Hospital
Breast Cancer | Year: 2013

Digital breast tomosynthesis (DBT) is a new modality that aids in breast cancer detection. It is a pseudo-three-dimensional digital mammography imaging system that produces a series of 1-mm-slice images with multiple very low-dose X-ray projections to reveal the inner architecture of the breast after eliminating interference from overlapping breast tissue. This review article provides an overview of the current and potential use of DBT. The illustrations and discussion are based on our experience with the Selenia Dimensions (Hologic, USA) DBT system approved by the US Food and Drug Administration. © 2013 The Japanese Breast Cancer Society.

Uesaka K.,Shizuoka Cancer Center Hospital
Journal of Hepato-Biliary-Pancreatic Sciences | Year: 2012

Purpose Although left-sided hepatectomy, such as a left hepatectomy or left trisectionectomy with resection of the caudate lobe and extrahepatic bile duct, is used to treat hilar cholangiocarcinoma predominantly involving the left side of the hepatic hilum, it is associated with several difficult technical points. The important points during leftsided hepatectomy are described here. Techniques There are anatomical variations of the sectional artery and bile duct. It is essential to understand the individual intrahepatic and hilar anatomy preoperatively. Surgical procedures consist of lymph node clearance, dissection of the distal bile duct, skeletonization resection of the hepatoduodenal ligament, mobilization of the liver and liver resection, dissection of the intrahepatic bile ducts, and biliary reconstruction. During lymph node dissection and skeletonization resection of the hepatoduodenal ligament, the nerve plexus around the hepatic artery is dissected, and its adventitia is exposed with great care to avoid injuring the hepatic artery. Mobilization of the caudate lobe is performed only from the left side. There is no clear landmark between the caudate lobe and the right posterior section during liver resection. In the final step of liver resection, it progresses toward the right edge of the inferior vena cava. When dividing intrahepatic bile ducts, extreme care should be used to avoid injury to the corresponding hepatic arteries, especially the anomalous supraportal posterior sectional artery. Conclusions Left-sided hepatectomy for hilar cholangiocarcinoma should be considered a more complicated and technically demanding procedure than right-sided hepatectomy. Surgeons need to pay close attention to anatomical variations in order to perform a left-sided hepatectomy safely and successfully. © 2011 Japanese Society of Hepato-Biliary-Pancreatic Surgery and Springer.

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