Publications by authors named "Kazunori Kubota"

66 Publications

Relationship between Prognostic Stage in Breast Cancer and Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography.

J Clin Med 2021 Jul 19;10(14). Epub 2021 Jul 19.

Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.

This retrospective study examined the relationship between the standardized uptake value max (SUVmax) of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) and the prognostic stage of breast cancer. We examined 358 breast cancers in 334 patients who underwent F-FDG PET/CT for initial staging between January 2016 and December 2019. We extracted data including SUVmax of F-FDG PET and pathological biomarkers, including estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and nuclear grade. Anatomical and prognostic stages were determined per the American Joint Committee on Cancer (eighth edition). We examined whether there were statistical differences in SUVmax between each prognostic stage. The mean SUVmax values for clinical prognostic stages were as follow: stage 0, 2.2 ± 1.4; stage IA, 2.6 ± 2.1; stage IB, 4.2 ± 3.5; stage IIA, 5.2 ± 2.8; stage IIB, 7.7 ± 6.7; and stage III + IV, 7.0 ± 4.5. The SUVmax values for pathological prognostic stages were as follows: stage 0, 2.2 ± 1.4; stage IA, 2.8 ± 2.2; stage IB, 5.4 ± 3.6; stage IIA, 6.3 ± 3.1; stage IIB, 9.2 ± 7.5, and stage III + IV, 6.2 ± 5.2. There were significant differences in mean SUVmax between clinical prognostic stage 0 and ≥II ( < 0.001) and I and ≥II ( < 0.001). There were also significant differences in mean SUVmax between pathological prognostic stage 0 and ≥II ( < 0.001) and I and ≥II ( < 0.001). In conclusion, mean SUVmax increased with all stages up to prognostic stage IIB, and there were significant differences between several stages. The SUVmax of F-FDG PET/CT may contribute to prognostic stage stratification, particularly in early cases of breast cancers.
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http://dx.doi.org/10.3390/jcm10143173DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8307215PMC
July 2021

A Rare Case of Primary Breast Osteosarcoma Evaluated with Multiple Modalities.

Diagnostics (Basel) 2021 Jun 28;11(7). Epub 2021 Jun 28.

Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo 113-8510, Japan.

Primary breast osteosarcoma (PBO) is very rare. This report presents a case of POB that was evaluated by multiple modalities. A woman in her 70s presented with a mass of increasing size in her right breast. A mammogram and an ultrasound visualized a lobulated mass containing coarse calcification in the right breast. Magnetic resonance imaging showed a strong enhancement effect and high signal on diffusion-weighted imaging. Further imaging on 18F-fluorodeoxyglucose positron-emission tomography and computed tomography exhibited a high uptake. A right total mastectomy was performed. Histologic examination revealed abundant periosteal formation, areas of calcification and moderately pleomorphic oval to spindle-shaped stromal cells, leading to the diagnosis of PBO. The presence of calcified breast tumors exhibiting aggressive growth indicates that PBO should be added to the differential diagnosis.
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http://dx.doi.org/10.3390/diagnostics11071170DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8305560PMC
June 2021

Active Herpes Zoster Mimicking Worsening of Axillary Lymph Node Metastases of Breast Cancer after Chemotherapy on 18F-Fluorodeoxyglucose Positron-Emission Tomography/Computed Tomography.

Diagnostics (Basel) 2021 Jun 14;11(6). Epub 2021 Jun 14.

Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.

A woman in her 60s presented to our hospital with a left breast mass that was diagnosed as breast cancer. 18F-Fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT) revealed intense, hot uptake in the cancerous mass and left axillary lymph node metastasis. After chemotherapy, another PET/CT scan was performed. Although the mass and left axillary lymph nodes shrank and FDG uptake decreased, enlarged lymph nodes with high FDG uptake appeared in the right axilla. The patient had a painful vesicular eruption on the front to the back of the right upper hemithorax, which was diagnosed as active herpes zoster. Active herpes zoster mimics a worsening axillary lymph node metastasis on the PET/CT scan.
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http://dx.doi.org/10.3390/diagnostics11061085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8232124PMC
June 2021

Clinical usefulness of the fast protocol of breast diffusion-weighted imaging using 3T magnetic resonance imaging with a 16-channel breast coil.

Clin Imaging 2021 Apr 30;78:217-222. Epub 2021 Apr 30.

Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113 - 8510, Japan.

We aimed to evaluate the usefulness of a fast protocol of diffusion-weighted imaging (DWI) with one excitation using 3T magnetic resonance imaging (MRI) and a 16-channel breast coil. We analyzed 30 lesions from 27 women between February 2020 and June 2020. The visibility score (from 1 = extremely poor to 5 = excellent) and apparent diffusion coefficient (ADC) value between one and four excitations were evaluated by two readers. The image acquisition time was 40 s for one excitation and 1 min 52 s for four excitations. The visibility scores were 4.630 ± 0.718 and 4.267 ± 1.015 for one excitation and 4.730 ± 0.691 and 4.200 ± 1.000 for four excitations by the two readers. There was no significant difference in the visibility (P = 0.184 and P = 0.423), mean ADC value (P = 0.918 and P = 0.417), and minimum ADC value (P = 0.936 and P = 0.443) between one and four excitations by the two readers. Despite the short acquisition time, the visibility score and ADC values of one-excitation DWI were comparable to that with four excitations. Our fast DWI protocol could provide reproducible visibility and ADC value, potentially helping radiologists to efficiently diagnose patients.
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http://dx.doi.org/10.1016/j.clinimag.2021.04.022DOI Listing
April 2021

Breast ultrasound in the age of advanced technology and artificial intelligence.

Authors:
Kazunori Kubota

J Med Ultrason (2001) 2021 Apr 28;48(2):113-114. Epub 2021 Apr 28.

Department of Radiology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan.

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http://dx.doi.org/10.1007/s10396-021-01091-5DOI Listing
April 2021

Effects of gadobutrol on background parenchymal enhancement and differential diagnosis between benign and malignant lesions in dynamic magnetic resonance imaging of the breast.

Breast Cancer 2021 Jul 24;28(4):927-936. Epub 2021 Feb 24.

Department of Radiology, Sagara Hospital Miyazaki, 2-112-1 Maruyama, Miyazaki City, Miyazaki, 880-0052, Japan.

Background: The high concentration of gadolinium in gadobutrol, which is widely used in Japan, helps visualize signal enhancement of neoplastic lesions, however, there was concern that high T1 relaxivity could decrease the contrast between the lesion and the background mammary gland. We evaluate the effect of gadobutrol on background parenchymal enhancement (BPE) and differential diagnosis between benign and malignant lesions in dynamic MRI of the breast.

Methods: Ninety-nine patients were enrolled prospectively. Measurements of the following signal intensities (SIs) were obtained: breast tissue on a pre-contrast image (SI) and an early-phase image (SI); and the SIs of breast cancer on a pre-contrast image (SI) and an early-phase image (SI). We calculated the BPE ratio, i.e., (SI - SI)/SI and the cancer/BPE ratio, i.e., (SI - SI)/(SI on the affected side - SI on the affected side). These quantitative assessments were compared with the data from the recently published multicenter study (reference study without use of gadobutrol). In addition, two radiologists reinterpreted each of the MR images, and a third radiologist set the ROIs in the lesions and performed kinetic analysis as a Reader 3.

Results: While there was no significant difference in the SI of breast cancer in the premenopausal patients between the two studies, that in postmenopausal patients was significantly higher in the present study than in the reference study (p = 0.002). Although there was no significant difference in the cancer/BPE ratio in the postmenopausal patients between the two studies, the cancer/BPE ratio in the premenopausal patients was significantly higher in the reference study than in the present study (p = 0.028). For differentiation between benign and malignant masses, the mass margin was found to be the most important term (p < 0.001). According to the data of Reader 3, visual washout was observed in all 18 patients in whom the interpretation was changed from "plateau" to "washout".

Conclusions: Gadobutrol may decrease the contrast between breast cancer and background parenchyma in premenopausal patients, and it may have a characteristic that "washout" does not easily occur, leading to "plateau" in patients with breast cancer.
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http://dx.doi.org/10.1007/s12282-021-01229-wDOI Listing
July 2021

Investigating the Image Quality and Utility of Synthetic MRI in the Breast.

Magn Reson Med Sci 2021 Feb 2. Epub 2021 Feb 2.

Department of Diagnostic Radiology, Tokyo Medical and Dental University.

Purpose: Synthetic MRI reconstructs multiple sequences in a single acquisition. In the present study, we aimed to compare the image quality and utility of synthetic MRI with that of conventional MRI in the breast.

Methods: We retrospectively collected the imaging data of 37 women (mean age: 55.1 years; range: 20-78 years) who had undergone both synthetic and conventional MRI of T2-weighted, T1-weighted, and fat-suppressed (FS)-T2-weighted images. Two independent breast radiologists evaluated the overall image quality, anatomical sharpness, contrast between tissues, image homogeneity, and presence of artifacts of synthetic and conventional MRI on a 5-point scale (5 = very good to 1 = very poor). The interobserver agreement between the radiologists was evaluated using weighted kappa.

Results: For synthetic MRI, the acquisition time was 3 min 28 s. On the 5-point scale evaluation of overall image quality, although the scores of synthetic FS-T2-weighted images (4.01 ± 0.56) were lower than that of conventional images (4.95 ± 0.23; P < 0.001), the scores of synthetic T1- and T2-weighted images (4.95 ± 0.23 and 4.97 ± 0.16) were comparable with those of conventional images (4.92 ± 0.27 and 4.97 ± 0.16; P = 0.484 and 1.000, respectively). The kappa coefficient of conventional MRI was fair (0.53; P < 0.001), and that of conventional MRI was fair (0.46; P < 0.001).

Conclusion: The image quality of synthetic T1- and T2-weighted images was similar to that of conventional images and diagnostically acceptable, whereas the quality of synthetic T2-weighted FS images was inferior to conventional images. Although synthetic MRI images of the breast have the potential to provide efficient image diagnosis, further validation and improvement are required for clinical application.
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http://dx.doi.org/10.2463/mrms.mp.2020-0132DOI Listing
February 2021

Clinical practice guidelines for high-resolution breast PET, 2019 edition.

Ann Nucl Med 2021 Mar 25;35(3):406-414. Epub 2021 Jan 25.

Health Insurance Committee, Japanese Society of Nuclear Medicine, Tokyo, Japan.

Breast positron emission tomography (PET) has had insurance coverage when performed with conventional whole-body PET in Japan since 2013. Together with whole-body PET, accurate examination of breast cancer and diagnosis of metastatic disease are possible, and are expected to contribute significantly to its treatment planning. To facilitate a safer, smoother, and more appropriate examination, the Japanese Society of Nuclear Medicine published the first edition of practice guidelines for high-resolution breast PET in 2013. Subsequently, new types of breast PET have been developed and their clinical usefulness clarified. Therefore, the guidelines for breast PET were revised in 2019. This article updates readers as to what is new in the second edition. This edition supports two different types of breast PET depending on the placement of the detector: the opposite-type (positron emission mammography; PEM) and the ring-shaped type (dedicated breast PET; dbPET), providing an overview of these scanners and appropriate imaging methods, their clinical applications, and future prospects. The name "dedicated breast PET" from the first edition is widely used to refer to ring-shaped type breast PET. In this edition, "breast PET" has been defined as a term that refers to both opposite- and ring-shaped devices. Up-to-date breast PET practice guidelines would help provide useful information for evidence-based breast imaging.
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http://dx.doi.org/10.1007/s12149-021-01582-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902575PMC
March 2021

Peritoneal dissemination of breast cancer diagnosed by laparoscopy.

Int Cancer Conf J 2021 Jan 14;10(1):91-94. Epub 2020 Nov 14.

Department of Breast Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyou-ku, Tokyo, 113-8519 Japan.

The accuracy of modern imaging techniques for the diagnosis of peritoneal carcinomatosis is poor. A breast cancer patient with a high serum CA15-3 level did not receive a definitive diagnosis of peritoneal dissemination by imaging examination and then underwent laparoscopy. Pathological examination showed peritoneal dissemination of breast cancer, but the biological markers were different from the primary lesion: ER(-), PgR(-), and Her2:3 +. T-DM1 therapy was very effective, and her systemic symptoms disappeared. Since biomarkers of metastatic lesions may sometimes change, laparoscopic biopsy is very important and useful.
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http://dx.doi.org/10.1007/s13691-020-00456-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797395PMC
January 2021

The Utility of Deep Learning in Breast Ultrasonic Imaging: A Review.

Diagnostics (Basel) 2020 Dec 6;10(12). Epub 2020 Dec 6.

Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo 113-8510, Japan.

Breast cancer is the most frequently diagnosed cancer in women; it poses a serious threat to women's health. Thus, early detection and proper treatment can improve patient prognosis. Breast ultrasound is one of the most commonly used modalities for diagnosing and detecting breast cancer in clinical practice. Deep learning technology has made significant progress in data extraction and analysis for medical images in recent years. Therefore, the use of deep learning for breast ultrasonic imaging in clinical practice is extremely important, as it saves time, reduces radiologist fatigue, and compensates for a lack of experience and skills in some cases. This review article discusses the basic technical knowledge and algorithms of deep learning for breast ultrasound and the application of deep learning technology in image classification, object detection, segmentation, and image synthesis. Finally, we discuss the current issues and future perspectives of deep learning technology in breast ultrasound.
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http://dx.doi.org/10.3390/diagnostics10121055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7762151PMC
December 2020

Association between skin flap necrosis and sarcopenia in patients who underwent total mastectomy.

Asian J Surg 2021 Feb 20;44(2):465-470. Epub 2020 Nov 20.

Department of Specialized Surgeries, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.

Background: Sarcopenia is associated with postoperative complications in patients undergoing digestive surgery. In this study, we investigated the impact of preoperative sarcopenia on postoperative complications in breast cancer patients who underwent total mastectomy.

Methods: Patients with breast cancer who underwent total mastectomy were included in the analysis. The relationship between the presence of sarcopenia and postoperative complications (e.g., skin flap necrosis and seroma) and between the incidence of these complications as well as preoperative and surgical factors was investigated. Moreover, the effects of sarcopenia on recurrence-free survival and overall survival were evaluated. The psoas muscle index calculated using values measured on preoperative computed tomography images was used to diagnose sarcopenia.

Results: In total, 43 (49%) of 88 patients presented with sarcopenia. The number of patients with a Geriatric Nutritional Risk Index score <91 was higher in the sarcopenia group than in the non-sarcopenia group (p = 0.011). Seroma was observed in 32 (36.4%) patients, and no significant difference was observed between the patients with and without sarcopenia (16 [35.6%] in the non-sarcopenia group vs 16 [37.2%] in the sarcopenia group). By contrast, skin flap necrosis was observed in 20 (22.7%) patients, and the number of patients with this complication was higher in the sarcopenia group than in the non-sarcopenia group (15 [34.9%] vs 5 [11.1%]).

Conclusion: Sarcopenia is a risk factor for skin flap necrosis and may be an important factor for preoperative evaluation in patients who will undergo total mastectomy.
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http://dx.doi.org/10.1016/j.asjsur.2020.11.001DOI Listing
February 2021

Deep-learning approach with convolutional neural network for classification of maximum intensity projections of dynamic contrast-enhanced breast magnetic resonance imaging.

Magn Reson Imaging 2021 01 10;75:1-8. Epub 2020 Oct 10.

Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan.

Purpose: We aimed to evaluate deep learning approach with convolutional neural networks (CNNs) to discriminate between benign and malignant lesions on maximum intensity projections of dynamic contrast-enhanced breast magnetic resonance imaging (MRI).

Methods: We retrospectively gathered maximum intensity projections of dynamic contrast-enhanced breast MRI of 106 benign (including 22 normal) and 180 malignant cases for training and validation data. CNN models were constructed to calculate the probability of malignancy using CNN architectures (DenseNet121, DenseNet169, InceptionResNetV2, InceptionV3, NasNetMobile, and Xception) with 500 epochs and analyzed that of 25 benign (including 12 normal) and 47 malignant cases for test data. Two human readers also interpreted these test data and scored the probability of malignancy for each case using Breast Imaging Reporting and Data System. Sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC) were calculated.

Results: The CNN models showed a mean AUC of 0.830 (range, 0.750-0.895). The best model was InceptionResNetV2. This model, Reader 1, and Reader 2 had sensitivities of 74.5%, 72.3%, and 78.7%; specificities of 96.0%, 88.0%, and 80.0%; and AUCs of 0.895, 0.823, and 0.849, respectively. No significant difference arose between the CNN models and human readers (p > 0.125).

Conclusion: Our CNN models showed comparable diagnostic performance in differentiating between benign and malignant lesions to human readers on maximum intensity projection of dynamic contrast-enhanced breast MRI.
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http://dx.doi.org/10.1016/j.mri.2020.10.003DOI Listing
January 2021

Feasibility of ultrafast dynamic magnetic resonance imaging for the diagnosis of axillary lymph node metastasis: A case report.

Eur J Radiol Open 2020 3;7:100261. Epub 2020 Sep 3.

Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113 - 8510, Japan.

A 74 year old Japanese woman was diagnosed with invasive breast carcinoma. Her axillary lymph node was slightly swollen and had a short-axis diameter of 8 mm, but fine-needle aspiration did not lead to the diagnosis of metastasis. Subsequent 18F-fluorodeoxyglucose positron emission tomography/computed tomography showed no abnormal accumulation on the lymph node. Ultrafast dynamic magnetic resonance imaging yielded a very fast contrast enhancement like that of the primary lesion based on which we suspected lymph node metastasis. To our knowledge, this is the first report that shows that ultrafast imaging has contributed to the diagnosis of axillary lymph node metastasis.
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http://dx.doi.org/10.1016/j.ejro.2020.100261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7481530PMC
September 2020

Efficient Anomaly Detection with Generative Adversarial Network for Breast Ultrasound Imaging.

Diagnostics (Basel) 2020 Jul 4;10(7). Epub 2020 Jul 4.

Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.

We aimed to use generative adversarial network (GAN)-based anomaly detection to diagnose images of normal tissue, benign masses, or malignant masses on breast ultrasound. We retrospectively collected 531 normal breast ultrasound images from 69 patients. Data augmentation was performed and 6372 (531 × 12) images were available for training. Efficient GAN-based anomaly detection was used to construct a computational model to detect anomalous lesions in images and calculate abnormalities as an anomaly score. Images of 51 normal tissues, 48 benign masses, and 72 malignant masses were analyzed for the test data. The sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of this anomaly detection model were calculated. Malignant masses had significantly higher anomaly scores than benign masses ( < 0.001), and benign masses had significantly higher scores than normal tissues ( < 0.001). Our anomaly detection model had high sensitivities, specificities, and AUC values for distinguishing normal tissues from benign and malignant masses, with even greater values for distinguishing normal tissues from malignant masses. GAN-based anomaly detection shows high performance for the detection and diagnosis of anomalous lesions in breast ultrasound images.
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http://dx.doi.org/10.3390/diagnostics10070456DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7400007PMC
July 2020

Feasibility of new fat suppression for breast MRI using pix2pix.

Jpn J Radiol 2020 Nov 1;38(11):1075-1081. Epub 2020 Jul 1.

Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.

Purpose: To generate and evaluate fat-saturated T1-weighted (FST1W) image synthesis of breast magnetic resonance imaging (MRI) using pix2pix.

Materials And Methods: We collected pairs of noncontrast-enhanced T1-weighted an FST1W images of breast MRI for training data (2112 pairs from 15 patients), validation data (428 pairs from three patients), and test data (90 pairs from 30 patients). From the original images, 90 synthetic images were generated with 50, 100, and 200 epochs using pix2pix. Two breast radiologists evaluated the synthetic images (from 1 = excellent to 5 = very poor) for quality of fat suppression, anatomic structures, artifacts, etc. The average score was analyzed for each epoch and breast density.

Results: The synthetic images were scored from 2.95 to 3.60; the best was reduction in artifacts when using 100 epochs. The average overall quality scores for fat suppression were 3.63 at 50 epochs, 3.24 at 100 epochs, and 3.12 at 200 epochs. In the analysis for breast density, each score was significantly better for nondense breasts than for dense breasts; the average score was 2.88-3.18 for nondense breasts and 3.03-3.42 for dense breasts (P = 0.000-0.042).

Conclusion: Pix2pix had the potential to generate FST1W synthesis for breast MRI.
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http://dx.doi.org/10.1007/s11604-020-01012-5DOI Listing
November 2020

Virtual Interpolation Images of Tumor Development and Growth on Breast Ultrasound Image Synthesis With Deep Convolutional Generative Adversarial Networks.

J Ultrasound Med 2021 Jan 27;40(1):61-69. Epub 2020 Jun 27.

Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan.

Objectives: We sought to generate realistic synthetic breast ultrasound images and express virtual interpolation images of tumors using a deep convolutional generative adversarial network (DCGAN).

Methods: After retrospective selection of breast ultrasound images of 528 benign masses, 529 malignant masses, and 583 normal breasts, 20 synthesized images of each were generated by the DCGAN. Fifteen virtual interpolation images of tumors were generated by changing the value of the input vector. A total of 60 synthesized images and 20 virtual interpolation images were evaluated by 2 readers, who scored them on a 5-point scale (1, very good; to 5, very poor) and then answered whether the synthesized image was benign, malignant, or normal.

Results: The mean score of overall quality for synthesized images was 3.05, and that of the reality of virtual interpolation images was 2.53. The readers classified the generated images with a correct answer rate of 92.5%.

Conclusions: A DCGAN can generate high-quality synthetic breast ultrasound images of each pathologic tissue and has the potential to create realistic virtual interpolation images of tumor development.
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http://dx.doi.org/10.1002/jum.15376DOI Listing
January 2021

Classification of Breast Masses on Ultrasound Shear Wave Elastography using Convolutional Neural Networks.

Ultrason Imaging 2020 Jul-Sep;42(4-5):213-220. Epub 2020 Jun 5.

Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan.

We aimed to use deep learning with convolutional neural networks (CNNs) to discriminate images of benign and malignant breast masses on ultrasound shear wave elastography (SWE). We retrospectively gathered 158 images of benign masses and 146 images of malignant masses as training data for SWE. A deep learning model was constructed using several CNN architectures (Xception, InceptionV3, InceptionResNetV2, DenseNet121, DenseNet169, and NASNetMobile) with 50, 100, and 200 epochs. We analyzed SWE images of 38 benign masses and 35 malignant masses as test data. Two radiologists interpreted these test data through a consensus reading using a 5-point visual color assessment (SWEc) and the mean elasticity value (in kPa) (SWEe). Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated. The best CNN model (which was DenseNet169 with 100 epochs), SWEc, and SWEe had a sensitivity of 0.857, 0.829, and 0.914 and a specificity of 0.789, 0.737, and 0.763 respectively. The CNNs exhibited a mean AUC of 0.870 (range, 0.844-0.898), and SWEc and SWEe had an AUC of 0.821 and 0.855. The CNNs had an equal or better diagnostic performance compared with radiologist readings. DenseNet169 with 100 epochs, Xception with 50 epochs, and Xception with 100 epochs had a better diagnostic performance compared with SWEc ( = 0.018-0.037). Deep learning with CNNs exhibited equal or higher AUC compared with radiologists when discriminating benign from malignant breast masses on ultrasound SWE.
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http://dx.doi.org/10.1177/0161734620932609DOI Listing
June 2020

Predictors for upstaging of ductal carcinoma (DCIS) to invasive carcinoma in non-mass-type DCIS.

Mol Clin Oncol 2020 Jul 27;13(1):67-72. Epub 2020 Apr 27.

Department of Surgical Specialties, Tokyo Medical and Dental University, Graduate School of Medicine and Dentistry, Bunkyo-ku, Tokyo 113-8519, Japan.

Preoperatively diagnosed ductal carcinoma (DCIS) is sometimes upstaged to invasive cancer by postoperative pathological examination. Various preoperative factors associated with upstaging to invasive cancer have been reported; however, this subject remains to be clarified. DCIS takes various forms on imaging, but many cases show non-mass-type lesions. In non-mass-type DCIS, recognizing the presence of invasion is difficult. To investigate predictors associated with upstaging to invasive cancer more precisely, we examined only non-mass-type DCIS. The present study retrospectively analyzed 101 patients diagnosed with non-mass-type DCIS preoperatively on breast biopsy at our institution between 2007 and 2017. Data were analyzed using Fisher's exact probability test and two-sample t-tests. Multivariate analysis was performed using logistic regression. The results showed that 27 patients (27%) were finally diagnosed with invasive cancer. Univariate analysis revealed abnormal result of palpation on breast examination (P=0.05), comedo necrosis (P=0.05), and HER2 status (P=0.02) as significant predictors. Multivariate analysis revealed an abnormal result of palpation as an independent predictor of invasive cancer underestimation (odds ratio 4.76; confidence interval 1.44-15.7; P=0.01). In conclusion, preoperatively diagnosed non-mass-type DCIS represented an underestimation in approximately 27% of cases. In particular, the presence of a clinically abnormal palpation increases the chance of upstaging to invasive cancer.
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http://dx.doi.org/10.3892/mco.2020.2036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7243301PMC
July 2020

Detection and Diagnosis of Breast Cancer Using Artificial Intelligence Based assessment of Maximum Intensity Projection Dynamic Contrast-Enhanced Magnetic Resonance Images.

Diagnostics (Basel) 2020 May 20;10(5). Epub 2020 May 20.

Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo 113-8510, Japan.

We aimed to evaluate an artificial intelligence (AI) system that can detect and diagnose lesions of maximum intensity projection (MIP) in dynamic contrast-enhanced (DCE) breast magnetic resonance imaging (MRI). We retrospectively gathered MIPs of DCE breast MRI for training and validation data from 30 and 7 normal individuals, 49 and 20 benign cases, and 135 and 45 malignant cases, respectively. Breast lesions were indicated with a bounding box and labeled as benign or malignant by a radiologist, while the AI system was trained to detect and calculate possibilities of malignancy using RetinaNet. The AI system was analyzed using test sets of 13 normal, 20 benign, and 52 malignant cases. Four human readers also scored these test data with and without the assistance of the AI system for the possibility of a malignancy in each breast. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were 0.926, 0.828, and 0.925 for the AI system; 0.847, 0.841, and 0.884 for human readers without AI; and 0.889, 0.823, and 0.899 for human readers with AI using a cutoff value of 2%, respectively. The AI system showed better diagnostic performance compared to the human readers ( = 0.002), and because of the increased performance of human readers with the assistance of the AI system, the AUC of human readers was significantly higher with than without the AI system ( = 0.039). Our AI system showed a high performance ability in detecting and diagnosing lesions in MIPs of DCE breast MRI and increased the diagnostic performance of human readers.
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http://dx.doi.org/10.3390/diagnostics10050330DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7277981PMC
May 2020

[A Case of Axillary Accessory Breast Cancer Treated via Latissimus Dorsi Musculocutaneous Flap Reconstruction].

Gan To Kagaku Ryoho 2020 Feb;47(2):343-345

Dept. of Breast Surgery, Tokyo Medical and Dental University.

A 46-year-old woman visited our hospital with the chief complaint of left axillary mass enlargement, which she had been aware of for 8 years. Palpation revealed that the mass was 15mm in size. Redness and gathering of the skin were also observed. Mammographic imaging of the left axilla revealed an irregular mass with skin infiltration. Breast ultrasonography revealed a low echo mass in the left axilla, which was continuous from the skin. Core needle biopsy was used to diagnose the tumor as an invasive ductal carcinoma. No other lesions were observed in the breast, and primary lesions were not found in any other organs. The patient was diagnosed with axillary accessory breast cancer and underwent local extensive resection and axillary lymph node dissection. Because the skin defect was widespread, we performed axillary reconstruction using the latissimus dorsi musculocutaneous flap to prevent upper limb contracture. At present, she can move her upper limbs and lymphedema has not been observed. In cases of axillary accessory breast cancer with skin infiltration, reconstruction using the latissimus dorsi musculocutaneous flap can be a useful procedure.
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February 2020

[A Case of Breast Cancer Complicated with Castleman's Disease].

Gan To Kagaku Ryoho 2019 Dec;46(13):2455-2457

Dept. of Specialized Surgeries, Tokyo Medical and Dental University Graduate School.

The patient was a 57-year-old woman with Castleman's disease. The follow-up CT scans obtained during the treatment of Castleman's disease, detected a 15mm nodule in the right breast AC area, and the patient was diagnosed with breast cancer. Lymphadenopathy was noted on both sides of the axilla; however, it was considered to be due to Catsleman's disease. Mastectomy and sentinel lymph node biopsy were performed with preoperative diagnosis of cT1cN0M0, cStage Ⅰ. Rapid diagnosis of the sentinel lymph node during the operation showed a metastatic tumor measuring 3mm and axillary dissection was performed. However, no metastasis was found in the dissected lymph node, which was, therefore, considered as an enlargement due to Castleman's disease.
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December 2019

Correlation between F-FDG uptake on PET/MRI and the level of tumor-infiltrating lymphocytes (TILs) in triple-negative and HER2-positive breast cancer.

Eur J Radiol 2020 Feb 23;123:108773. Epub 2019 Dec 23.

Department of Radiology, Sagara Hospital Affiliated Breast Center, 3-28 Tenokuchi-cho, Kagoshima City, Kagoshima, Japan.

Purpose: The tumor microenvironment is related to the metabolism of cancer cells and local immune reactions. Previous studies have established TILs could be a significant prognostic factor, especially for triple-negative breast cancers (TNBC) and human epithelial growth factor receptor 2 (HER2)-positive breast cancers. We explore the association between metabolic information on PET/MRI with TILs in TNBC and HER2-positive breast cancer.

Method: We retrospectively reviewed the cases of 55 women with triple-negative or HER2-positive invasive ductal carcinomas who had undergone F-FDG PET/MRI without neo-adjuvant treatment for pre-operative evaluation. FDG uptake was quantified as standardized uptake value (SUV) max. The existence of peritumoral edema on PET/MRI was also recorded. The TIL score of the breast cancers was defined histologically on the basis of the proportion of the area infiltrated by lymphocytes, and classified as low (<10 %), intermediate (10-50 %), and high (>50 %). The association between PET/MRI findings and TILs was assessed using Kruskal-Wallis test and Wilcoxon signed-rank test.

Results: There were 14 high TIL, 20 intermediate TIL and 21 low TIL lesions. Higher values of SUVmax were found in the high and intermediate TIL group as compared to the low TIL group (P = 0.013). On the other hand, the lesions with peritumoral edema in the low TIL group tended to show high SUVmax (P = 0.014).

Conclusions: F-FDG uptake on PET/MRI correlated with TIL levels in patients with TNBC and HER2-positive breast cancer. This finding suggests that preoperative PET/MRI may be useful as a non-invasive tool for guiding the treatment plan.
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http://dx.doi.org/10.1016/j.ejrad.2019.108773DOI Listing
February 2020

[Clinical Utility of Comprehensive Genome Profiling Using FoundationOne CDx in Japanese Population(PROFILE-F Study)].

Gan To Kagaku Ryoho 2019 Nov;46(11):1715-1719

Dept. of Breast Surgery Tokyo Medical and Dental University, Medical Hospital.

Background: FoundationOne CDx is a cancer genome profiling test that has already been approved by the FDA, but its clinical utility in Japanese patients is unknown. In this study, we examined the clinical utility of FoundationOne CDx.

Methods: 46 samples from 43 Japanese pretreated patients with advanced solid tumors were tested with FoundationOne CDx between September 2018-January 2019.

Results: The median age of 43 patients was 63 years(ranged 18 to 82 years), and among them 24 were males and 19 females. Major cancer types were hepato-biliary and pancreatic(8 cases)and other digestive organs(8 cases). All 27 cases in which genome cancer board had been completed by January 17, 2019 were analyzable, and the number of detected gene mutations(except VUS)was an average of 4.3(ranged 0 to 14)per case. Of the 27 cases, one or more mutations were found in 26 cases(96%), and in all such 26 cases actionable mutations with candidates for therapeutic agents were found. In 4(15%)of them, the treatment corresponding to the gene mutation was performed. Among the cases in which target disease matched and clinical trials of the drug were being conducted in Japan, only one case participated in the trial. The most common reason for not participating in the trial was disease deterioration and PS reduction (33%).

Conclusions: The FoundationOne CDx test showed that it can detect gene mutations in various cancer types in Japanese patients.
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November 2019

The Japanese Breast Cancer Society Clinical Practice Guidelines for Breast Cancer Screening and Diagnosis, 2018 Edition.

Breast Cancer 2020 Jan 16;27(1):17-24. Epub 2019 Nov 16.

Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan.

This article updates readers as to what is new in the Japanese Breast Cancer Society Clinical Practice Guidelines for Breast Cancer Screening and Diagnosis, 2018 Edition. Breast cancer screening issues are covered, including matters of breast density and possible supplemental modalities, along with appropriate pre-operative/follow-up diagnostic breast imaging tests. Up-to-date clinical practice guidelines for breast cancer screening and diagnosis should help to provide patients and clinicians with not only evidence-based breast imaging options, but also accurate and balanced information about the benefits and harms of intervention, which ultimately enables shared decision making about imaging test plans.
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http://dx.doi.org/10.1007/s12282-019-01025-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8134289PMC
January 2020

Breast Ultrasound Image Synthesis using Deep Convolutional Generative Adversarial Networks.

Diagnostics (Basel) 2019 Nov 6;9(4). Epub 2019 Nov 6.

Department of Diagnostic Radiology, Tokyo Medical and Dental University Hospital 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8501, Japan.

Deep convolutional generative adversarial networks (DCGANs) are newly developed tools for generating synthesized images. To determine the clinical utility of synthesized images, we generated breast ultrasound images and assessed their quality and clinical value. After retrospectively collecting 528 images of 144 benign masses and 529 images of 216 malignant masses in the breasts, synthesized images were generated using a DCGAN with 50, 100, 200, 500, and 1000 epochs. The synthesized ( = 20) and original ( = 40) images were evaluated by two radiologists, who scored them for overall quality, definition of anatomic structures, and visualization of the masses on a five-point scale. They also scored the possibility of images being original. Although there was no significant difference between the images synthesized with 1000 and 500 epochs, the latter were evaluated as being of higher quality than all other images. Moreover, 2.5%, 0%, 12.5%, 37.5%, and 22.5% of the images synthesized with 50, 100, 200, 500, and 1000 epochs, respectively, and 14% of the original images were indistinguishable from one another. Interobserver agreement was very good (|| = 0.708-0.825, < 0.001). Therefore, DCGAN can generate high-quality and realistic synthesized breast ultrasound images that are indistinguishable from the original images.
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http://dx.doi.org/10.3390/diagnostics9040176DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6963542PMC
November 2019

Diagnostic performance of time-of-flight PET/CT for evaluating nodal metastasis of the axilla in breast cancer.

Nucl Med Commun 2019 Sep;40(9):958-964

Departments of Diagnostic Radiology.

Objective: The aim of this study was to evaluate the performance of preoperative axillary lymph node assessment in breast cancer using time-of-flight 18F-fluorodeoxyglucose PET/computed tomography (TOF [F-18]FDG-PET/CT).

Methods: Eighty-two women with breast cancer (mean age, 59.3 years; range, 30-84 years) underwent TOF [F-18]FDG-PET/CT scanning before surgery between January 2016 and June 2018 at our hospital. Visual analysis of FDG uptake and the maximum standardized uptake value (SUVmax) of axillary lymph nodes were compared with the pathological diagnoses.

Results: There were 77 patients with invasive breast carcinoma (mean invasive long diameter, 18.5 mm; range, 2-90 mm) and five patients with noninvasive carcinoma. Axillary lymph node metastases were histologically confirmed in 13 of 82 patients (15.9%). SUVmax showed an area under a receiver operating characteristic curve of 0.916, and the cut-off value of 1.1 was appropriate. By visual assessment, there were 11 true positives, 15 false positives, 54 true negatives and two false negatives; the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 85%, 78%, 42%, 96% and 79%, respectively. SUVmax showed values of 69%, 99%, 90%, 94% and 94%, respectively.

Conclusions: The sensitivity of TOF [F-18]FDG-PET/CT was as high as 85% by visual analysis. SUVmax using TOF [F-18]FDG-PET/CT showed high diagnostic performance for N-staging in breast cancer patients, especially high negative predictive value. The specificity, positive predictive value and accuracy of SUVmax were higher than those of visual analysis.
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http://dx.doi.org/10.1097/MNM.0000000000001057DOI Listing
September 2019

Simultaneous comparison between strain and shear wave elastography of breast masses for the differentiation of benign and malignant lesions by qualitative and quantitative assessments.

Breast Cancer 2019 Nov 7;26(6):792-798. Epub 2019 Jun 7.

Department of Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.

Purpose: To compare the addition of diagnostic strain elastography (SE) and shear wave elastography (SWE) values to the conventional B-mode ultrasonography in differentiating between benign and malignant breast masses by qualitative and quantitative assessments.

Materials And Methods: B-mode ultrasound, SE, and SWE were simultaneously performed using one ultrasound system in 148 breast masses; 88 of them were malignant. The breast imaging reporting and data system category in the B-mode, Tsukuba score (SE), Fat-Lesion-Ratio (SE) in SE, and five-point color assessment (SWE) and elasticity values (SWE) in SWE were assessed. The results were compared using the area under the receiver-operating characteristic curve (AUC).

Result: The AUC for B-mode and each elastography were similar (B-mode, 0.889; SE, 0.885; SE, 0.875; SWE, 0.881; SWE, 0.885; P > 0.05). The combined sets between B-mode and either of the elastography technique showed good diagnostic performance (B-mode + SE, 0.903; B-mode + SE, 0.909; B-mode + SWE, 0.919; B-mode + SWE, 0.914). B-mode + SWE and B-mode + SWE showed a higher AUC than B-mode alone (P = 0.026 and 0.029), and B-mode + SE and B-mode + SE showed comparable AUC to B-mode alone (P = 0.196 and 0.085). There was no significant difference between qualitative and quantitative assessments for the combined sets of B-mode and elastography (P > 0.05).

Conclusion: The addition of both SE and SWE to B-mode ultrasound improved the diagnostic performance with increased AUC, and especially SWE was more useful than SE, and no significant difference was found between qualitative and quantitative assessments.
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http://dx.doi.org/10.1007/s12282-019-00985-0DOI Listing
November 2019

Extra-axial chordoma of the gingiva.

Auris Nasus Larynx 2020 Apr 21;47(2):299-304. Epub 2019 Mar 21.

Departments of Otolaryngology and Head and Neck Surgery, Graduate School of Biomedical & Health Sciences, and Applied Life Sciences, Japan.

Background: Extra-axial chordomas are exceedingly rare malignant tumours. Herein, we present the first case of an extra-axial chordoma in the gingivae.

Methods And Results: A 21-year-old man presented with a suspected chordoma in the upper right gingiva. Diagnosis was difficult; however, owing to strong expression of the chordoma marker brachyury, extra-axial chordoma was ultimately diagnosed. The tumour was completely resected without performing a facial incision. To ensure its safety and effectiveness, the surgical procedure was simulated several times before its performance using a three-dimensional (3D) model. Twenty-four months after surgery, the patient remains disease-free.

Conclusion: A diagnosis of extra-axial chordoma can be confirmed by immunohistochemical staining for brachyury.
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http://dx.doi.org/10.1016/j.anl.2019.03.005DOI Listing
April 2020

Distinction between benign and malignant breast masses at breast ultrasound using deep learning method with convolutional neural network.

Jpn J Radiol 2019 Jun 19;37(6):466-472. Epub 2019 Mar 19.

Department of Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.

Purpose: We aimed to use deep learning with convolutional neural network (CNN) to discriminate between benign and malignant breast mass images from ultrasound.

Materials And Methods: We retrospectively gathered 480 images of 96 benign masses and 467 images of 144 malignant masses for training data. Deep learning model was constructed using CNN architecture GoogLeNet and analyzed test data: 48 benign masses, 72 malignant masses. Three radiologists interpreted these test data. Sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC) were calculated.

Results: The CNN model and radiologists had a sensitivity of 0.958 and 0.583-0.917, specificity of 0.925 and 0.604-0.771, and accuracy of 0.925 and 0.658-0.792, respectively. The CNN model had equal or better diagnostic performance compared to radiologists (AUC = 0.913 and 0.728-0.845, p = 0.01-0.14).

Conclusion: Deep learning with CNN shows high diagnostic performance to discriminate between benign and malignant breast masses on ultrasound.
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http://dx.doi.org/10.1007/s11604-019-00831-5DOI Listing
June 2019
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