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In Japan, government support for human papillomavirus (HPV) vaccination began in November 2010. However, the mass media repeatedly reported on severe adverse events. The Japanese Ministry of Health, Labor and Welfare suspended proactive recommendations for HPV vaccines in June 2013. Japan’s HPV vaccination rate dropped from 70% to less than 1% in 2017. We examined cervical cancer screening results in terms of abnormal cytology, histology, and HPV vaccination status among 11,903 women aged 20 to 25 y in the fiscal year 2015. The overall rate of HPV vaccination was 26.1% (3,112/11,903). Regarding cytology, the rate of atypical squamous cells of undetermined significance (ASC-US) or worse was 3.3% (103/3,112) in women who received HPV vaccination (vaccine (+) women) and 5.6% (496/8,791) in women who did not (vaccine (-) women). The rate of high-grade squamous intraepithelial lesion (HSIL) or worse was 0.26% (8/3,112) in vaccine (+) women and 0.81% (72/8,791) in vaccine (-) women. Regarding histology, the rate of cervical intraepithelial neoplasia 1 or worse (CIN1+) was 1.4% (42/3,112) in vaccine (+) women and 2.1% (178/8,791) in vaccine (-) women. The rates of CIN2+ and CIN3+ were similar regardless of vaccination. We found a significantly lower incidence of CIN in vaccine (+) women. These results suggest that the resumption of recommending HPV vaccination as primary prevention for cervical cancer is needed in Japan.

OBJECTIVE In Japan, no region has introduced primary HPV testing for cervical cancer screening. We assessed the diagnostic value and possible harm of HPV testing in Japan. METHODS This cross-sectional study with historical controls used cytology-based screening and co-testing data in Japan. As surrogate indicators of possible harm, colposcopy referral rate and cervical intraepithelial neoplasm (CIN) 1 detection rates were calculated. As surrogate indicators with diagnostic values, the detection rates of CIN2 or greater (CIN2+) and CIN3+ were calculated. RESULTS The data of 297 970 women (182 697 for cytology-based, 115 273 for co-testing) were examined. The detection rates of CIN1, CIN2+, and CIN3+ were significantly higher in the co-testing group than in the cytology-based group (P

Cervical cancer screening has been shifting from primary cytology to primary HPV testing worldwide as primary HPV testing is more sensitive than primary cytology. To the best of our knowledge, the current study is the first in Japan to examine the feasibility of primary HPV testing. One of the disadvantages of this shift is that hrHPV-/≥LSIL/CIN2+ (high-risk HPV negative cancers or pre-cancerous lesions with abnormal cytology results) can be missed. The objectives of the present study are to clarify in detail CIN2+ missed by this shift and to evaluate the feasibility of primary HPV testing in Japan. Data from 115,273 women who underwent co-testing with cytology and HPV testing in cancer screening were used in the current study. The cases with hrHPV-/≥LSIL (‘hrHPV-/≥L-SIL’ include CIN2-, in contrast, ‘hrHPV-/≥L-SIL/CIN2+’ doesn't include CIN2-) were analysed in detail. Women with hrHPV-/≥LSIL comprised 0.3% of the total. The prevalence of CIN2, CIN3, SCC or cervical adenocarcinomas in the lesions with HPV-/≥LSIL was 0.03% in the cancer screening group. Only one case of 14 cervical adenocarcinomas in ≥LSIL was hrHPV-. The prevalence of cancer missed by the shift in patients >50 years of age was significantly higher compared with patients younger than 49 years. In conclusion, the prevalence of CIN2+, which might be missed by the shift from primary cytology to primary HPV testing, was remarkably low in this Japanese cancer screening. The data indicated that primary HPV testing, which was more sensitive for CIN2+ than primary cytology, was a feasible method that can be used in Japan. In particular, primary HPV testing should be introduced for women

Objective The aim of this study was to determine the value of human papillomavirus (HPV) testing for primary cervical cancer screening in Japan. Methods In total, 5065 women who underwent primary screening with cytology and HPV between January 2005 and December 2006 were enrolled. In the baseline phase, these women were stratified by age, and the rates of HPV-positive and abnormal cytology were compared between women younger than and older than 30 years. In the follow-up phase, women aged 20 to 69 years and cytology negative for intraepithelial lesions or malignancy at baseline were followed up until December 2011 (n = 2383). Progression to grade 2/3 cervical intraepithelial neoplasia or worse (CIN2+/CIN3+) was compared between the HPV-positive and HPV-negative groups. Results In the baseline phase, HPV-positive rates were significantly higher in women younger than 30 years at 20.7% (95% confidence interval [CI], 18.4–22.9; 255/1234) compared with women 30 years or older at 7.2% (95% CI, 6.4%–8.0%; 275/3831; P < 0.001). However, there was no statistical difference for high-grade squamous intraepithelial lesion or worse rates between them, at 2.7% (95% CI, 1.8%–3.6%; 33/1234) and 2.4% (95% CI, 1.9%–2.9%; 91/3831), respectively, P = 0.55. In the follow-up phase, the rate of progression to CIN2+/CIN3+ was significantly higher in the HPV-positive group than in the HPV-negative group (P < 0.001). Moreover, relative risk of progression to CIN2+ was 15.9 times higher in the HPV-positive group, and that of progression to CIN3+ was 16.1 times higher in the HPV-positive group. Conclusions Human papillomavirus testing is a useful test for predicting progression to CIN and is recommended as a primary screening tool. However, screening with cytology alone is still appropriate for younger women, younger than 30 years, because HPV testing yields more false-positive results in younger women.

Objective We conducted a prospective, multicentre study to compare the clinical performance of liquid-based endometrial cytology (LBEC) using SurePath™ with that of suction endometrial tissue biopsy (SETB). This study is officially advocated and reported by the Japan Association of Obstetricians and Gynecologists. By publishing our midterm data, we intend to disseminate the benefits of LBEC system, using the descriptive reporting format and algorithmic interpretational approach. Methods From April 2014 to December 2015, we consecutively assessed 1116 LBEC specimens and 1044 SETB specimens in our five outpatient clinics. Results The sensitivity of suction tissue biopsies was 85.2%, whereas the sensitivity of LBEC was 92.2%. The specificity of suction tissue biopsies was 98.9% and that of LBEC was 98.5%. The negative predictive value of LBEC (99.1%) was higher than that of SETB (98.1%), although the difference between these values was not significant. Conclusions The clinical performance of LBEC for detecting endometrial malignancies was almost identical to the performance of SETB. This indicates that LBEC was not inferior to SETB for the detection of endometrial cancer. The LBEC is appropriate for various clinical situations as the first-step detecting tool. In addition, it could be used for cancer surveillance for women with signs highly suggestive of endometrial malignancies and in Lynch syndrome patients, on a larger scale.

The first reported case of cerebellar metastasis from primary clear cell adenocarcinoma of the fallopian tube is presented. Initially diagnosed as stage Ia, the patient underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy, followed by cisplatin-based chemotherapy and whole pelvic irradiation. Thirty six months later multiple pulmonary metastases were detected that did not respond to chemotherapy. Later the patient presented with cerebellar metastasis. She received whole brain radiotherapy and steroids. The brain lesion partially responded and the patient's neurologic symptoms improved. Throughout there was no evidence of local recurrence. This case suggests that with the prolonged survival achieved by aggressive treatment occult brain metastases might become apparent.

The placental polyp has been defined as an intrauterine polypoid or even pedunculated mass of retained placental tissue from an abortion or term pregnancy. Most of the chorionic villi forming the placental polyp were necrotic or sclerotic and hyalinized. A blind intrauterine operation was performed once, leading to hemorrhaging and hysterectomy. We report three cases of placental polyp successfully treated by transcervical resection (TCR) after uerine artery embolization (UAE) or iliac artery occlusion.

Background: Inflammatory pseudotumor is a tumor-like mass of inflammatory origin. It is most commonly found in the lung or the orbit, but occurrences have been reported at nearly every site in the body. These tumors most commonly appear in young and middle-aged patients.Case: A 37-year-old female presented with vaginal bleeding and anemia. Ultrasound and MRI showed a myoma like mass of 56 mm in maximum diameter at the posterior wall of the uterine body. Preoperative hormone therapy failed to shrink the mass. Histological examination of the mass following laparoscopic enucleation revealed spindle shaped mesenchymal cells with infiltration by inflammatory cells, consistent with inflammatory pseudotumor. Smooth muscle cells were seen scantily in the margins of the resected mass.Conclusion: A rare inflammatory pseudotumor of the uterus is diagnosed after laparoscopic surgery.

The aim of this study was to evaluate the efficacy of endometrial cytology using the Uterobrush in the collection of samples for the diagnosis of endometrial lesions. The preparation technique for endometrial brushing specimens was also demonstrated. In their earlier study, the authors described the cyto-architectural criteria that appear to be more useful for the cytological assessment of endometrial lesions. Therefore, for the application of the diagnostic criteria, endometrial cytological sampling will become more important. With regard to the cell sample collection, the authors used the Uterobrush because the insertion into the uterine cavity is easy and painless. The authors compared the Uterobrush with the Endocyte, since they thought that cell clumps using the former device tended to be smaller. The purpose of the current study was to improve and evaluate cell preparation methods using the Uterobrush. The authors investigated three methods [i.e., conventional and improved techniques ("flicked" method) with the Uterobrush and the Endocyte] of endometrial cell collection and preparation. Using conventional methods, a brush was rolled along a glass slide and the collected material spread and smeared. However, using the "flicked" method, a brush is strongly flicked with forceps, so that the cells are transferred to the slide and its position is moved along the slide little by little and smeared. The frequency by size of cell clumps with tube or sheet-shaped pattern was examined in the preparations. Cell block specimens with the Uterobrush were also investigated. Endometrial cytology from a total of 90 women was evaluated. Most were outpatients and all were older than 20 yr (ranging from 20 to 54, average 42.7 yr). Of these, 30 cases from each group were examined by three methods. Uterobrush samples prepared by the "flicked" method have a greater quantity of cell clumps than those using the Endocyte sampler, while the frequency-by-size of cell clumps was by degree the same as the Endocyte. The cell clumps obtained in the Uterobrush "flicked" method preparation was considered equivalent or superior as an aid to making a diagnosis of endometrial lesions and it became obvious that the same criteria were applicable to both of instruments. Our cytological examination may be a potent aid to making a diagnosis of endometrial lesions and these findings will be helpful in the standardization of criteria in direct intrauterine cell samples.

Our purpose was to describe interrelationships and contacts between twins in utero by use of three-dimensional ultrasonography with a specially developed abdominal three-dimensional transducer. Thirteen twin pregnancies (3 monochorionic and 10 dichorionic pairs) and one triplet pregnancy (trichorionic triplet) from 9 to 36 weeks of gestation were studied with a specially developed abdominal three-dimensional transducer (3.5 MHz). This imaging system can provide conventional two-dimensional ultrasonography images and can also generate within seconds high-quality three-dimensional images in the surface and transparent mode with no need for an external workstation. Interrelationships and contacts between twins or triplets are described. Various types of contacts (head/body/arm/leg) and interrelationships were clearly visualized. Crowding of in utero twin fetuses increased with advancing gestation. Sometimes two placentas and dividing membrane were beautifully depicted. In one triplet pregnancy, the interrelationships among 3 fetuses and dividing membranes were easily recognized. Three-dimensional ultrasonography provides a novel means of visualizing multiple pregnancies in utero. These results suggest that three-dimensional ultrasonography has the potential to be a supplement to two-dimensional ultrasonography and would be useful in evaluating the interhuman contacts and crowdings of twin and triplet fetuses in utero.

Background. Over the past 20 years, various methods have been suggested to determine the histopathologic stage and grade of cervical cancer for predicting biologic behavior during chemotherapy. However, none of these complicated techniques have proved consistently accurate enough to predict chemotherapeutic effects on locally advanced cervical cancer. Methods. Primary treatment with hypertensive intraarterial chemotherapy and, 4 weeks later, with radical hysterectomy were performed on 20 patients with locally advanced cancer of the uterine cervix (International Federation of Gynecology and Obstetrics [FIGO] Stages IIa-IVa). The vascular densities of biopsy specimens from pretreatment cancers stained by the Elastica-Goldner technique were measured semiquantitatively. Cytologic and histologic changes in the early stages after the intraarterial chemotherapy were simultaneously recorded. Patients were divided into two groups after analysis of the final histologic effects on operation materials in accordance with the criteria of the Japan Society for Cancer Therapy: (1) an effective group (≧ Grade 2; n = 7) or (2) a noneffective group (< Grade 2; n = 13). Results. The vascular densities of the effective and noneffective groups were 6.91 plus or minus 4.51/mm2 and 1.94 plus or minus 1.21/mm2, respectively. The vascular densities of biopsy specimens were significantly higher in the effective group (P < 0.05). The early cytologic and histologic changes 1 week after chemotherapy were significantly greater in the effective group (P < 0.05). Conclusions. These results indicate that the efficacy of intraarterial chemotherapy for cervical cancers depends on their individual vascular densities, which can be detected beforehand through the study of biopsy specimens. Furthermore, cytologic and histologic changes in the early stages would seem to reflect the overall histologic effect of the treatment as a whole.

Intraoperative and postoperative complications related to CO2 laser conization and cold knife conization were compared. From 1980 to 1984, 66 patients were hospitalized for cold knife conization. The mean operative time was 28.1 minutes, all patients had epidural anesthesia, and the mean time of admission was 6.8 days. Three percent of cases had infections, the mean intraoperative hemorrhage was 66 ml, and the rate of remaining foci of neoplasia was 18.2%. There were 116 patients hospitalized for CO2 laser conization from 1985 to 1987. The mean operative time was 15.6 minutes, 15.5% of patients had local anesthesia, and the mean time of admission was 0.6 days. No patients had infection or postoperative stenosis, the mean intraoperative hemorrhage was 75 ml, and 29.5% of patients had remaining foci of neoplasia. There was no significant difference in hemorrhage amounts at hysterectomy after conization using either method. In the 2 pregnant patients, CO2 laser conization could be performed safely and did not affect pregnancy or delivery. Thus in our experience, CO2 laser conization is more effective for clinical diagnosis and treating of cervical intraepithelial neoplasia.

老人保健法の検診対象になっている不正子宮出血のある症例から, 非腫瘍性内膜, 子宮内膜増殖症, 子宮内膜癌を細胞診により早期に, より正確に診断する目的で, 子宮内膜擦過細胞診所見をscore化して, scoringによるscreenigを試み検討したので報告する。1) retrospectiveに, 30歳以上の122例 (正常子宮内膜97例, 子宮内膜増殖症8例, 子宮内膜異型増殖症5例, 子宮内膜癌12例) の得点数のmean±2SDを算出した結果より, 0～6点を正常内膜, 7～12点を増殖症, 13～18点を内膜癌と推定することができた (18点満点).2) prospectiveにscoringした嚢胞性腺増殖症3例, 腺腫性増殖症9例, 異型増殖症9例, 子宮内膜癌 (G1) 11例, 子宮内膜癌 (G3) 3例の正診率は, 73.3%, 66.7%, 71.5%, 72.7%, 93.3%であり, 検出可能率 (7点以上の割合) はそれぞれ73.3%, 80.0%, 88.6%, 100%, 100%だった.3) scoring使用による子宮内膜増殖症以上 (含子宮内膜癌) のfalse negativeは6.2%, 子宮内膜癌だけのfalse negativeは0%であった. 一方正常子宮内膜のfalse positive (7点以上) は7.5%で, さらに13点以上で正常子宮内膜症例であったものは1.2%と低率であった.4) 従来におけるscoring未使用の細胞診結果は, 子宮内膜増殖症以上 (含子宮内膜癌) のfalse negativeは7.0%, false positiveは17.2%であった.嚢胞性腺増殖症・腺腫性増殖症の検出可能率は10%(1/10), 異型増殖症は50%(4/8), 子宮内膜癌は80%(16/20) であった.以上の結果より子宮内膜病変のscreeningにおいて, scoringによる細胞診が有効であることが示唆されたので報告する.

The clinical courses including thyroid conditions of three infants born to a mother with primary hypothyroidism due to Hashimoto's thyroiditis were studied. The mother was positive for both TSH-binding inhibitor immunoglobulins (TBII) and thyroid stimulating-blocking antibodies (TSBAb) in her serum. The first infant died because of septic shock due to fistula formation between the large intestine and the bladder. Serum thyroid hormone levels during the first pregnancy were extremely low because of incomplete replacement therapy with levothyroxine. The second infant had almost normal thyroid function, so that the replacement therapy was not necessary. The third infant had transient and overt primary hypothyroidism. The replacement therapy was carried out for six months after birth. TSBAb activities in this mother were high in the third pregnancy. In general, these activities gradually increases with the clinical course in TSBAb-positive Hashimoto's patients. From these findings, it was suspected that the thyroid conditions in the second and the third infants reflected the natural course of TSBAb activities in this mother.

Intraperitoneal scintigraphy with Tc-99m MAA was performed in nine patients with carcinomatous peritonitis secondary to ovarian or tubal carcinoma. Tc-99m MAA (370 MBq) and NaCl was delivered through an implantable injection port. For patients with good diffusion on intraperitoneal scintigraphy, intraperitoneal chemotherapy was effective. However, for patients with only local diffusion, intraperitoneal chemotherapy was not effective. Intraperitoneal scintigraphy can predict the effectiveness Intraperitoneal scintigraphy can predict the effectiveness of chemotherapy through the implantable injection port.

Sialosyl-Tn (S-Tn) antigen, a cancer-related antigen, was expressed in 56.3% (36 of 64 cases) of the common epithelial carcinoma tissues. This antigen was moderately to strongly expressed in 83.3% (15 of 18 cases) of the mucinous adenocarcinomas. In contrast, it was weakly expressed in 31.3% (5 of 16 cases) of the serous adenocarcinomas. Expression of this antigen in ovarian mucinous tumors of borderline malignancy was 80% (4 of 5 cases), and the staining was moderately intense. S-Tn reactivity was found in 11.5% (3 of 26 cases) of benign ovarian neoplasms. The S-Tn antigen was not found in either normal ovarian tissues or the normal vaginal squamous epithelia. We conclude that the S-Tn antigen may be useful in the histological classification of ovarian carcinomas and in the determination of the malignant potential of such lesions. Moreover, because increases in serum S-Tn antigen were often accompanied by its positive expression in tumor tissues, the S-Tn antigen appears to be a tumor marker in sera with a high specificity for ovarian carcinoma, particularly mucinous adenocarcinoma.

A 31-year-old women with polycystic ovary syndrome underwent dilatation and curettage (D&C) as part of her infertility workup. Pathologic examination revealed endometrial morular metaplasia without malignant potential. Follow-up D&C had no evidence of endometrial hyperplasia or carcinoma. The diagnostic difficulties and pathogenesis are discussed.

A 40-year-old woman underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic/paraaortic lymphadenectomy, and omentectomy for Stage IA ovarian surface papillary tumor of borderline malignancy. Microscopic examination revealed endosalpingiosis of ovaries, the peritoneum of uterus, pelvic lymph nodes, and omentum. There was no evidence of disseminated peritoneal malignancy. The several proposed theories of the pathogenesis of endosalpingiosis are reviewed, but that involving metaplasia of the multipotential peritoneal cells is presented as the most acceptable.

The assay conditions needed for an immunoradiometric competitive inhibition assay of sera in healthy women were studied using the monoclonal antibody TKH2, which is known to recognize specifically sialosyl-alpha 2,6-GalNAc alpha 1-0-serine/threonine (S-Tn) antigen, a mucinous cancer-related antigen. Stable results were obtained with an incubation time of 1.5 hours at room temperature. The intra-assay and inter-assay coefficients of variation were 3.27% and 3.07%, respectively. The mean (+/- standard deviation [SD]) levels of serum S-Tn in 602 healthy women was 21.2 U/ml (+/- 8.4 U/ml). Values showed a normal logarithmic distribution. Although slightly higher levels were seen in postmenopausal compared with premenopausal women, the differences were not significant. The cutoff value of 41 U/ml was determined from data obtained in 602 healthy women; higher levels were observed in only 2%. Serum S-Tn levels were not strongly influenced by Lewis or ABO (H) blood type, smoking, pregnancy, parturition, or phase of menstrual cycle. The use of the S-Tn antigen as a tumor marker for various gynecologic cancers requires study.

The serum levels of sialosyl-alpha 2,6GalNAc alpha 1-0-serine/threonine (S-Tn) antigen and CA 125 antigen were measured in 205 patients with gynecologic tumors, including 48 ovarian cancers, 20 endometrial cancers, 29 cervical cancers, 57 benign ovarian tumors, 37 uterine leiomyomas, and 14 adenomyosis. Using a cutoff value of 41 U/ml for S-Tn and 35 U/ml for CA 125, positive findings were obtained in ovarian cancers in 31 of 48 (64.6%) patients with S-Tn antigen, and in 36 of 48 (75%) patients with CA 125. In uterine malignancies, positive findings were obtained in 11 of 49 (22.4%) patients and in 8 of 49 (16.3%) patients with the serum S-Tn and CA 125 antigens, respectively. In ovarian benign tumors, false-positive findings with CA 125 were observed in 16 of 57 (28.1%) patients, but with S-TN antigen in only 3 of 57 (5.3%) patients (P less than 0.01). For the ovarian tumors, excluding patients with recurrent disease, the specificity, positive predictive value, and accuracy of the serum S-Tn antigen level for detecting cancer exceeded that of the serum CA 125. The combined assay of serum S-Tn and CA 125 antigens gave positive results in 38 of 48 (79.2%) patients with ovarian cancers; most of the negative findings were obtained in Stage I disease. A significant decreases in serum S-Tn level was observed after cytoreductive surgery in 14 patients with ovarian cancer (P less than 0.01). Four patients with a subsequent recurrence showed a concomitant rise in serum S-Tn. The cyst fluid and ascitic fluid showed high levels of S-Tn antigen in patients with ovarian cancer, in contrast to findings in patients with benign ovarian tumors. In conclusion, serum S-Tn antigen has limited use in diagnosing early stage ovarian cancer and uterine malignancies, but it can detect with accuracy ovarian cancers when used in a combination assay with CA 125 and can monitor the status of disease after therapy.

Sialyl SSEA-1 antigen (SLX) is a highly specific tumor marker composed of sugar chain antigens that have Lewis X at their terminals and bind to sialic acid. This antigen is rarely detected in normal tissues, and is present in adenocarcinoma and fetal tissues. We studied the clinical usefulness of SLX in gynecological patients and obtained the following results. (1) The antigen was frequently positive in patients with ovarian cancer with a mean of 89.5 +/- 48.3 U/ml (72.8%, 8/11) and in those with endometriosis with a mean of 39.8 +/- 10.3 U/ml (75.0%, 6/8). (2) Among the gynecological malignancies, the percent positivity was low in those with cervical cancer (20.0%, 5/25), endometrial cancer (33.3%, 1/3), and cancer of the fallopian tube (33.3%, 1/3). (3) The antigen was negative in 20 with myoma uteri, 20 normal pregnant women, and 9 nonpregnant healthy women during the follicular, luteal, or menstrual phase. It was negative in 8 of 9 patients with benign ovarian cyst. False negative results were rare. (4) The SLX level was higher in the ascites than in the serum in patients with ovarian cancer and in those with benign ovarian tumors. (5) The serum SLX in patients with ovarian cancer, which was positive before tumor resection, became negative 2 weeks postoperatively. These results suggest that SLX is a tumor marker with a high specificity to adenocarcinoma of the reproductive organs.

A total of 646 ultrasonic measurements of fetal liver size were made from 18 weeks of gestation through to term. After 29 weeks, size of the liver in the growth-retarded fetuses was significantly small as compared to findings in the control fetuses. The sensitivity and specificity for the detection of growth retardation were 0.86 and 0.89 at 33 weeks, 0.89 and 0.94 at 38 weeks and 0.89 at 40 weeks of gestation. Growth rate of the liver in the growth-retarded fetus was diminished as compared with findings in the control fetus. Also, a method of estimating fetal weight by ultrasonic measurement of the fetal liver size is described.

We used a combination assay of serum sialyl SSEA-1 antigen (SLX) and CA125 levels, and evaluated the clinical usefulness of this technique for a differential diagnosis of ovarian cancer, benign ovarian tumor and endometriosis. In 82 patients with ovarian tumors, the sera of 20 (64.5%) of 31 with ovarian cancer and 15 (48.4%) of the 31 with endometriosis (endometrial cyst) were positive for both SLX and CA125, but serum SLX level was 5 U/ml or less in these 14 SLX- and CA125-positive patients with endometriosis. The sera of 16 (80.0%) patients with benign ovarian tumor were negative for both tumor markers. The sera of 3 (9.7%) of 31 with ovarian cancer and the sera of 2 (6.5%) of 31 with endometriosis were negative for both markers. The diagnostic accuracy (true positive rate X true negative rate) of the combination assay for ovarian cancer was 49.0% when the cutoff value of the serum SLX was 38 U/ml but improved to 78.5% when the value was set at 50 U/ml. When the cutoff value of serum SLX was set at 50 U/ml and that of serum CA125 at 35 U/ml, 27 of 37 patients who were positive only for CA125 had endometriosis. From the above observations, a combination assay of serum SLX and CA125 is a promising method for the differential diagnosis of malignant and benign ovarian tumors. Our results also suggest that to improve the diagnostic accuracy, the cutoff value of the serum SLX level should be 50 U/ml for ovarian tumors alone.

A review of 40 clinical cases of proven intraperitoneal fluid was made to assess the accuracy of ultrasonography for diagnosing the nature or distribution of intraperitoneal fluid and for differentiation between fluid collection and other conditions. Since the distributions of intraperitoneal fluid depend on the action of gravity, capillary attraction, adhesion and so forth, localized fluid collection or unusual distribution of fluid poses a problem in differential diagnosis. An unusual or irregular collection of fluid may suggest a malignant ascites. Deviations from a homogenous, echo-free space suggest an inflammatory, mucinous or malignant fluid. The smallest amount of fluid identified by ultrasound was thought to be approximately 10 ml.

We report here Doppler color flow mapping carried out before and after chemotherapy for an invasive mole. This mapping revealed an abnormal color blood flow within the echo-free space in the uterine myometrium, and pulsed Doppler ultrasound showed a prominent arteriovenous shunt flow. Similar features were obtained by pelvic angiography (PAG). After 4 courses of chemotherapy, the area of abnormal colored flow was reduced and findings on the PAG were supportive. The patient is being closely followed, using Doppler color flow mapping.