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The use of color Doppler ultrasound (CD) for distinguishing between benign and malignant breast lesions remains controversial. This study (JABTS BC-04 study) was aimed at confirming the usefulness of our CD diagnostic criteria. We evaluated ultrasound images of 1408 solid breast masses from 16 institutions in Japan (malignant: 839, benign: 569). Multivariate analysis indicated that vascularity (amount of blood flow), vascular flow pattern ("surrounding marginal flow" or "penetrating flow") and the incident angle of penetrating flow were significant findings for distinguishing between benign and malignant lesions. However, the sensitivity and specificity of B-mode alone did not improve significantly with CD addition (97.6% → 97.9%, 38.3% → 41.5%, respectively). We explored the causes of these negative results and found that age should have been considered when evaluating vascularity. Simulation experiments suggested that specificity is significantly improved when age is taken into consideration (38.3% → 46.0%, p0.001) and we thereby improved our diagnostic criteria.

A recent trend for less invasive surgery has increased consideration for a minimized scope of lymphadenectomy for submucosal cancer; however, feasibility criteria have not been precisely established.Patterns and sites of nodal involvement were retrospectively investigated in 294 patients with solitary submucosal gastric cancer in association with other clinicopathologic characteristics, including pre- and intraoperative evaluations of cancer depth (cT) and nodal involvement (cN).Among the early (cT1) and node-negative (cN0) cancer, intestinal (or =1.5 cm) and diffuse types (or =1.0 cm) of submucosal cancer showed low incidences of nodal involvement (3%) confined to the first tier. When the cancer exceeded these cutoff diameters, positive nodes of the second tier were confined to three priority stations (left gastric, common hepatic, and celiac arteries) at an incidence of 2.3%. Perigastric and preferential dissection of these three node stations (modified D2 dissection) showed survival benefits identical to those of a conventional D2 dissection.When submucosal cancer is evaluated as cT1cN0, a virtually sufficient minimized scope of lymphadenectomy is a D1 dissection for that within the cutoff diameter and a modified D2 dissection for that exceeding the cutoff diameter. These two types of dissection can even cover the infrequently observed node-positive stations and can realize no residual disease at surgery.

To improve the quality of breast cancer screening by ultrasonography, both effective training and evaluation of the performance of the examiners of breast ultrasound are essential. The Educational Committee of the Japan Association of Breast and Thyroid Sonology, an NPO, has established 2-day training programs on breast ultrasonography with tests at the end of the programs. The tests are performed using images to evaluate the ability of observers to detect and evaluate lesions on ultrasound. Ability to detect lesions was examined by using videos, and ability to evaluate lesions was examined by using still images. The results of tests taken by 422 physicians and 415 technologists were analyzed. In a comparison between physicians and technologists, the video specificity, the still image sensitivity, and the percentage of category agreement did not show any significant differences. The video sensitivity, the still image specificity, and the percentage of disease name agreement were significantly higher in technologists. Observers who had experienced

We have reported the Diagnostic Guidelines for Non-Mass Image-Forming Lesions. These have been discussed in the subcommittee of the Japan Association of Breast and Thyroid Sonology (JABTS) and the Japan Society of Ultrasonics in Medicine.

To make a standard diagnosis, it is important to have a standard lexicon. Although many kinds of expression are possible for the same feature of a breast tumor, a technical term must be a word that is seldom confused with another different concept. Especially, a halo or boundary high echo must be a word that is used to express a malignant sign.

Many aspects of internal echoes of mass image-forming breast lesions have been discussed. These points, as well as other themes, should be documented or corrected through further investigation in wide clinical practice.

In conclusion, endoscopic ultrasonography yielded valuable information on the deeper mucosal layers and blood flow in gastric cancer and wall. Endoscopic ultrasonography also allowed puncture under ultrasonic guidance. This technique may thus become indispensable for the diagnosis and treatment of gastric cancer.

Diabetic mastopathy is an unusual stromal fibrotic lesion, but typically occurs in long-standing insulin dependent and younger diabetic patients. We report a case of diabetic mastopathy in an older diabetic patient. The patient was a 76-year-old woman with a history of type 2 diabetes mellitus for 13 years and 3 years of insulin treatment. She developed a 3 cm, hard, mobile nodule in the left breast. Mammography revealed a dense mass. Ultrasonography showed an irregular-shaped hypoechoic lesion with an unclear boundary and acoustic shadowing. Since fine needle aspiration biopsy delivered insufficient material and core needle biopsy did not yield any specific findings for diagnosis, clinically diabetic mastopathy was the prime suspect but breast cancer could be completely ruled out. Surgical excision was thus performed and diabetic mastopathy was confirmed pathologically. We report on this rare case of diabetic mastopathy in a 76 year-old type 2 diabetic patient.

The unusual occurrence of an "inside-out" appendix reported here is a case of complete intussusception of the appendix of a 45-year-old woman with Peutz-Jeghers syndrome in whom the diagnosis of intussusception was made preoperatively. At laparotomy, the lead point of intussusceptum was revealed to be a Peutz-Jeghers syndrome polyp of the appendix. There was also a cystic lesion in the pancreas, and subsequent distal pancreatectomy revealed a cystadenocarcinoma of the pancreas. Two jejunal Peutz-Jeghers syndrome polyps and two duodenal Peutz-Jeghers syndrome polyps were found via intraoperative endoscopies. The duodenal polyps were endoscopically removed, whereas a jejunal wedge resection was performed for the adjoining jejunal polyps. One of the two duodenal polyps possessed an adenocarcinoma focus. To our knowledge, this is the first report of complete intussusception of the appendix caused by a Peutz-Jeghers syndrome polyp.