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男性乳癌は全乳癌の1％以下であり，さらに男性乳房Paget病は全乳癌の約0.5％ときわめてまれな疾患である1)．また近年センチネルリンパ節生検が一般臨床に急速に普及してきた．今回われわれは男性乳房Paget病の症例に対して，センチネルリンパ節生検により腋窩リンパ節郭清を省略しえた症例を経験したので，若干の文献的考察を含めて報告する．

We applied quantitative parameters in three-dimensional ultrasonic images to distinguish benign from malignant breast tumors in 29 benign cases including 8 cysts and 21 fibroadenomas, and 32 malignant cases including 23 ductal carcinomas, 2 special types of carcinoma, 1 malignant lymphoma and 6 others. This procedure involved simultaneously acquiring video data from real-time ultrasonic images and recording the original position and orientation of the probe. Both sets of data were fed directly into a desktop computer. Fuzzy reasoning and relaxation techniques were use to automatedly extract the shape of the tumor and render it in three dimensions. We then evaluated three parameters: 2D-D/W, the so-called depth-width ratio measured in B-mode images: 3D-D/W; and the S/V index ([surface area](3)/36π [volume](2)) calculated from the three-dimensional volume extracted with this system. All three parameters were significantly higher in the malignant group (averages: 0.81, 0.64, and 11.3, respectively) than in the benign group (averages: 0.62, 0.47, and 3.78, respectively). All three parameters were thus found to be useful in differentiating the two groups.

We are developing a new method of breast cancer screening that we call Automated Breast Cancer Diagnosis (ABCD). This system uses computerized three-dimensional (3D) imaging techniques and statistical analysis to base diagnosis on data obtained from ultrasound images. Here we use this system to investigate ten parameters and their effectiveness in determining the malignancy of tumors. Twenty-nine benign tumors and 32 malignant tumors were studied. The benign tumors comprised 8 cysts and 21 fibroadenomas; the malignant tumors were 23 ductal carcinomas, 2 special carcinomas, 1 malignant lymphoma, and 6 other types of lesions. The procedure requires the simultaneous acquisition of both the ultrasonic image data and the position and orientation of the probe for each slice. This data is transferred to a computer, where the tumor surface is determined using fuzzy reasoning and relaxation techniques. The extracted tumor image is then rendered in 3D, allowing interactive manipulation and observation. A significant distinction between benign (0.57±0.25, 2.08±0.12, 0.76±0.25) and malignant tumors (0.78±0.33, 2.22±0.16, 0.58±0.29) was obtained for all three parameters (Sz/Sxy, M-D, and Vei/V). A malignancy probability expression is calculated using multivariate logistic regression analysis in combination with the five parameters (Sz/Sxy, M-D, Vei/V, 3D-D/W, and S/Vindex). Satisfactiorily results were obtained when this method was applied to newly prepared external data that consist of three benign and two malignant tumors additional tumors.

The purpose of our study was to verify in animals the possibility of using albumin-enhanced ultrasonography as a modality for sentinel node detection. The nine pigs were injected subcutaneously in the neck with albumin, five with 5% solution and four with 25% solution, and then the regional lymph nodes were observed over time. It was found that, where the 5% solution had been injected, the lymph nodes showed no change, but where the 25% solution had been used, a high echo 1 to 5 mm in size was seen at the hilus of the nearest lymph node. Examination of the excised pathologic specimens of lymph nodes demonstrated that this echo was due to albumin accumulated in the efferent lymphatics. This finding suggested that this technique of ultrasonography using albumin as a contrast agent was an effective new method of identifying sentinel nodes.