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Although pathological diagnosis is essential for managing malignant lymphoma, intraabdominal lesions are generally difficult to approach due to the invasiveness of abdominal surgery. Here, we report the use of percutaneous image-guided coaxial core-needle biopsy (CNB) to obtain intraabdominal specimens for diagnosing intraabdominal lymphomas, which typically requires histopathological and immunohistochemical evaluation. We retrospectively reviewed consecutive cases involving computed tomography (CT)- or ultrasonography (US)-guided CNB to obtain pathological specimens for intraabdominal lesions from 1999 to 2011. Liver, spleen, kidney, and inguinal node biopsies were excluded. We compared CNBs with laparotomic biopsies. A total of 66 CNBs were performed for 59 patients (32 males, 27 females; median age, 63.5), including second or third repeat procedures. Overall diagnostic rate was 88.5%. None of the patients required additional surgical biopsies. Notably, the median interval between recognition of an intraabdominal mass and biopsy was only 1 day. Forty-five procedures were performed for hematological malignancies. Adequate specimens were obtained for histopathological diagnosis in 86% of cases. Flow cytometry detected lymphoma cells in 79.5% of cases. Twelve patients (nine males, three females; median age, 60) were eligible for surgical biopsy. While every postoperative course was satisfactory, median duration from lesion recognition to therapy initiation for lymphoma cases was significantly shorter for CNB than for surgical biopsy (14 vs. 35 days). While one-fourth of the patients were not eligible for the procedures, CNB is safe and highly effective for diagnosis of intraabdominal lymphomas. This method significantly improves sampling and potentially helps attain immunohistological distinction, allowing for more timely therapy initiation.

To improve the quality of radiation oncology in Japan, Patterns of Care Study (PCS), a widely known quality assurance (QA) program in the USA, was introduced. The feasibility was tested by collecting nationwide data by extramural audit for cervix cancer.From July 1996 through February 1997, PCS audits were performed for 29 institutions nationwide. On the basis of the facility survey by Tsunemoto, 13 institutions were classified as A1 (university hospital/cancer center), 10 as B1 (other institutions treating120 patients/year) and six as B2 (other institutions treating120 patients/year). Medical charts for the patients treated for cervix cancer between 1992 and 1994 were reviewed based on the data format of the US PCS. The total number of patients surveyed was 432.Simulation was used for90% of the patients in both A1 and B1-2 institutions. However, in B1-2, planning for 5% of the patients was performed with only a clinical set-up (p = 0.0287). A daily fraction with a size of 200 cGy was given to65% of patients in A1 and to47% in B1-2. On the other hand,50% of those in B1-2 were treated with daily fractions of 180 cGy and less compared with 25% in A1 institutions (p0.0001). Brachytherapy was utilized more frequently for patients in Stages II (p = 0.0365), III (p = 0.0015) and IV (p = 0.0483) in A1 than in B1-2. As for external beam equipment, linear accelerators with 10 MV or more were used for 83% of the patients in A1. However, in B1-2 institutions, machines with lower energy were used for 38% of the patients (p0.0001). The median number of full-time-equivalent (FTE) radiation oncologists was 2.7 in A1, 0.65 in B1 and 0.2 in B2.Institutional stratification, including equipment and personnel, was found to affect significantly the patterns of care for cervix cancer. Therefore, to improve the quality of radiation therapy nationwide, improvements in equipment and in supply of FTE personnel are extremely important. PCS was found to have great potential for a practical evaluation of how much improvement will be required in Japan.

症例1: 67歳, 男性. 右下葉の原発性肺癌 (扁平上皮癌, T4N2M0, IIIB期) にて, cisplatin, etoposideによる化学療法を2クール (効果判定はPartial Response), 胸部放射線療法 (総線量54Gy) を施行したが, 胸部X線写真上, 両側性間質影が出現し, ステロイド剤の投与にても改善なく呼吸不全のため永眠した. 症例2: 74歳, 男性. 左下葉の原発性肺癌 (腺癌, T3N2M0, IIIA期) にて胸部放射線療法を施行したが, 総線量56Gyの照射にて胸部X線写真上, 両側性間質影が出現し, ステロイド剤の投与にても改善せず呼吸不全のため永眠した. 2例とも死後, 開胸下に照射野対側の肺の一部を採取した. 病理学的には硝子膜の形成を伴う肺胞壁の肥厚がみられ, 細菌やウイルスの感染および癌性リンパ管症の所見はなく, 放射線治療に関連した急性間質性肺炎と考えられた. 発症の予測は困難であったが, 発熱は重要な所見と思われた.

An animal model of marginal zinc deficiency was tested in mice, and salt taste threshold and salt preference were investigated in the state of marginal zinc deficiency. Two experiments were conducted. In Experiment 1, four-week-old male ICR mice were fed diets of three different levels of zinc content (3.17, 9.27, or 48.13 micrograms Zn/g) for 60 days. Food intake, growth, zinc levels in tissues, hepatic metallothionein (MT) content, and activities of selected enzymes (hepatic and RBC delta-amino-levulinic acid dehydratase (ALAD) and plasma alkaline phosphatase (ALP] did not differ among the groups throughout the experiment, and no overt signs of zinc deficiency were manifested in any group. In Experiment 2, four-week-old male ICR mice were fed a zinc-deficient diet (1.98 micrograms Zn/g) or a zinc-adequate diet (49.14 micrograms Zn/g) for 56 days. Food intake and growth did not differ between the two groups, and no overt signs of zinc deficiency were observed throughout the experiment. Zinc levels in the plasma and femur--but not those in the brain, kidneys, liver, and red blood cell (RBC)--and plasma ALP activities were significantly lower on Day 42 and Day 56 of the experiment in the mice fed the zinc-deficient diet (ZnD group) than in those fed the zinc-adequate diet (ZnA group). Hepatic MT contents were lower in the ZnD group than in the ZnA group on Day 56 only. Salt taste threshold was 0.05% in the ZnA group, while it was 0.1% in the ZnD group, between Day 30 and Day 38, and between Day 44 and Day 52 of the experiment. Preference for 0.9% NaCl solution was no different in the two groups when tested between Day 38 and Day 40 or between Day 52 and Day 54, but that for 1.6% NaCl solution was significantly higher in the ZnD group than in the ZnA group between Day 40 and Day 42, and between Day 54 and Day 56.

We examined the role of metallothionein in the chemosensitivity of transplanted tumors in mice. The antitumor activities of cisplatin, adriamycin, bleomycin, peplomycin, cyclophosphamide, and melphalan were significantly suppressed when the concentration of metallothionein in the tumor was increased to only twice the control level. On the other hand, the antitumor activities of mitomycin C, 5-fluorouracil, and vinblastine were hardly affected by increases in the concentration of metallothionein in the tumors in mice. Moreover, all the antitumor drugs examined increased the concentration of metallothionein in transplanted tumors to a level that was high enough to suppress the antitumor activity of these drugs. These observations suggest that treatment of patients with certain antitumor drugs might result in the resistance of their tumors to multiple drugs.

Abstract 4214 Introduction: Although pathological diagnosis is an essential component of managing malignant lymphoma and other malignancies, intraabdominal lesions are generally difficult to approach due to the invasiveness of abdominal surgery. We report here the use of percutaneous image-guided coaxial core needle biopsy to obtain intraabdominal specimens. The coaxial method is associated with a lower risk of tumor cell dissemination and allows for repeated biopsies and thus improves the accuracy of pathological or immunohistological diagnosis. To the best of our knowledge, there have been no reports on the feasibility of this technique for diagnosing intraabdominal malignant lymphomas, which typically requires flow cytometry analysis as well as histopathological evaluation. Methods: We retrospectively reviewed consecutive cases involving percutaneous image-guided biopsy to obtain pathological specimens for intraabdominal mass lesions from April 1999 to March 2011 at Nagano Red Cross Hospital, Nagano, Japan. Liver, spleen, kidney, and inguinal node biopsies were excluded. Following local anesthesia, a certified interventional radiologist performed the procedures using a 16 coaxial guide needle (Cook) parallel to the anesthetic needle under computed tomography (CT) or ultrasonography (US). An 18 gauge core needle was inserted to obtain a pathological specimen, following aspiration with a 20 gauge needle for flow cytometry and cytological evaluation. Occlusion materials of the biopsy track were not used. Since laparotomic biopsy was performed for intraabdominal lesions when percutaneous needle biopsy was not indicated due to anatomical difficulties, we compared needle biopsies with simultaneously performed laparotomic biopsies, which led to a diagnosis of lymphoma. Results: During the 12-year period, we performed 66 procedures for 60 patients (32 males, 28 females; median age, 63.5; age range, 16–85). Six patients underwent second or third repeat procedures due to prior inappropriate samplings (5) or relapse (1). The overall diagnostic rate was 86.4% (57/66); there were 56 true positives, 1 true negative, 9 false negatives, and no false positives (sensitivity, 85.9%; specificity, 100%). No patients required additional surgical biopsies. CT and US were used in 51(76%) and 16 (24%) procedures, respectively. There was no statistically significant difference in accuracy between CT and US as an imaging modality. Notably, median interval between recognition of intraabdominal mass and biopsy was only one day (0–24). As for hematological malignancies, 39 patients had malignant lymphoma (diffuse large B cell lymphoma, 16; follicular lymphoma, 12; Hodgkin lymphoma, 3; peripheral T cell lymphoma, 3; small lymphocytic lymphoma, 3; Burkitt lymphoma, 1; extranodal NK/T cell lymphoma, nasal type, 1) including one case with relapse; 45 procedures were performed for these patients. Biopsies were submitted in 43 procedures, and adequate specimens were obtained for histopathological evaluation and diagnosis in 37 (86%). Flow cytometry was used in 39 procedures and detected lymphoma cells in 31 (79.5%). No major adverse events were observed. Twelve patients (9 males and 3 females; median age, 60; age range, 42–72) were eligible for laparotomic biopsy. While every postoperative course was satisfactory, median duration from lesion recognition to therapy initiation for lymphoma cases excluding those who chose watchful wait or refused therapy was significantly shorter for needle biopsies than laparotomy (14 versus 35 days, p Conclusions: This is the first report to show the clinical effectiveness of percutaneous image-guided intraabdominal needle biopsy with coaxial core needles for diagnosis of intraabdominal lymphomas. Although no difference was previously reported between coaxial and noncoaxial methods for liver or kidney biopsies (Hatfield et al. AJR 2008), they experienced seven (0.9%) major complications including one death. We identified no major complications using the Cook core needle system in the present study. This method significantly improves the collection of adequate specimens from intraabdominal lymphoma lesions and potentially helps attain immunohistological distinction, allowing for more timely therapy initiation. Disclosures: No relevant conflicts of interest to declare.