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Masakuni Noguchi

Publications and source records attributed to Masakuni Noguchi.

11 recordsLinked to original sources
PubMed2006

Radiofrequency ablation of small breast cancer followed by surgical resection.

BACKGROUND: With the growing demand from patients for less-invasive procedures, the shift from surgical extirpation to ablative local control of breast tumors is an emerging focus in breast cancer care. This study was performed to determine the feasibility and safety of treating small breast cancer with radiofrequency (RF) ablation. METHODS: Patients with biopsy-proven invasive or non-invasive breast cancer underwent RF ablation under general anesthesia. Before RF ablation, all patients were confirmed to have a localized lesion using imaging modalities. Wide excision or total mastectomy with sentinel lymph node biopsy or axillary lymph node dissection was performed. The resected tumor was examined histologically with hematoxylin-eosin (H&E) and nicotinamide adenine dinucleotide-diaphorase (NADH) staining. RESULTS: Ten patients completed the treatment without RF ablation-related complications. The mean tumor size was 1.1 cm (range: 0.5-2.0 cm). Histological evaluation of the ablated tissue using H&E staining revealed a spectrum of changes ranging from complete coagulation necrosis of tumor cells to normal-appearing tumor cells. However, NADH-diaphorase showed no staining of viable tumor cells in the RF-ablated region in all of the patients. CONCLUSIONS: RF ablation is promising as a minimally invasive ablation technique in the local treatment of invasive or non-invasive breast cancer. However, further study is necessary before RF ablation can replace conventional breast conservation therapy for patients with small breast cancer.

Adult↗
PubMed2004

Current controversies concerning sentinel lymph node biopsy for breast cancer.

BACKGROUND AND METHODS: The objectives of this article are to review existing controversies regarding sentinel lymph node (SLN) biopsy and to identify potential areas of consensus in order to eliminate routine axillary lymph node dissection (ALND). RESULTS: A combination of peritumoral injection with radioisotopes and subdermal or subareolar injection with blue dye may result in enhanced success rates of SLN identification. Preoperative lymphoscintigraphy is most useful for detecting an internal mammary SLN, but the practicability of internal mammary SLN biopsy is still in the investigative stage. Intraoperative diagnosis of SLN is useful because patients with SLN metastases may be treated immediately with ALND, but it is unreasonable to expect that either examination of frozen sections or imprint cytology will detect every metastatic disease. SLN micrometastases may be of prognostic importance and these can be identified with H and E staining on permanent sections of 200 micro m intervals. While ALND is preferable for patients even with a small tumor (T1) and SLN micrometastases, radiation therapy is an acceptable alternative. SLN biopsy may be indicated for patients with DCIS detected as a palpable mass or those with large calcification areas in the breast. The accuracy of SLN biopsy after neoadjuvant chemotherapy is considered to be unproven. CONCLUSION: Since SLN biopsy has been adopted by surgeons around the world, consistency of technique and case selection has attained great significance.

Axilla↗
PubMed2004

[Controversial issues surrounding sentinel lymph node biopsy in breast cancer].

UNLABELLED: This article discusses controversies regarding sentinel lymph node (SLN) biopsy and offers the following CONCLUSION: 1. Combination of radioisotopes and blue dye, and of peritumoral and subdermal injections, may enhance the success rates of SLN identification. 2. Preoperative lymphoscintigraphy is the most useful for detecting an internal mammary SLN. However, the practicability of internal mammary SLN biopsy remains in the investigative stage. 3. Intraoperative diagnosis of SLN is necessary because patients with SLN metastases may be treated immediately with axillary lymph node dissection (ALND), but both frozen sections and imprint cytology have limitations for detecting micrometastases. 4. SLN micrometastases (0.2-2.0 mm) may be of prognostic importance and these can be histologically diagnosed on permanent sections of 200 microns intervals. 5. SLN biopsy may be indicated for patients with large or high-risk DCIS. 6. The accuracy of SLN biopsy after preoperative chemotherapy is still considered unproven.

Breast Neoplasms↗
PubMed2003

Minimally invasive surgery for small breast cancer.

BACKGROUND AND METHODS: So-called minimally invasive techniques make percutaneous eradication of breast tumors possible, thus leading to breast-conserving treatment (BCT) without surgery. This paper reviews and discusses the feasibility of minimally invasive techniques for breast cancer. RESULTS: Although a wide variety of ablation techniques have been investigated for the treatment of primary breast cancer, radiofrequency ablation (RFA) remains one of the most promising and potentially useful tools. RFA therapy results in effective cell killing in a predictable volume of tissue with a low complication rate. On the other hand, ultrasonography is useful for guiding the needle within the tumor but cannot predict the extent of thermal ablation accurately. Early post-procedural magnetic resonance imaging (MRI) may be useful for assessing whether complete tumor ablation has been achieved by RFA. Whether adequate ablation of the tumor has been achieved can be confirmed by extensive core needle sampling of the treated area. However, validation of the margin status is also important and this needs to be tackled in further studies. CONCLUSIONS: There are many problems that remain before RFA therapy can be considered for conventional treatment. Further studies are needed to determine whether the use of RFA alone for local treatment of primary breast cancer will result in local recurrence and survival rates equivalent to those seen with BCT.

Breast Neoplasms↗
PubMed2003

Is it necessary to perform prospective randomized studies before sentinel node biopsy can replace routine axillary dissection?

BACKGROUND AND METHODS: Sentinel lymph node (SLN) biopsy is a useful way of assessing axillary nodal status in breast cancer patients. Recently, several surgeons have begun to abandon routine axillary dissection on the basis of negative SLN biopsy results. However, there is no long-term data comparing outcomes of SLN biopsy alone with those of axillary dissection. This paper reviews and discusses the significance of ongoing prospective randomized clinical trials aiming at the elimination of axillary dissection. RESULTS: SLN biopsy is known to have a false-negative rate. It can thus be assumed that SLN biopsy alone may fail to remove the disease completely from the axilla in some patients. As a result, it is not known whether SLN biopsy alone will increase the axillary recurrence rate, particularly in patients with a high risk of axillary lymph node metastasis. Recently, moreover, locoregional control appears to be important for enhancing survival in conjunction with adjuvant systemic therapy. It is therefore still unclear to what extent the benefits of SLN biopsy outweigh the risks and, if so, for which patient groups. CONCLUSION: Before SLN biopsy can replace routine axillary dissection, research using long-term regional controls and investigation of survival in a prospective randomized trial are essential. Except for clinical research studies, routine axillary dissection should not be abandoned until and unless there is documentation of extensive experience and a low false negative rate. Even with such evidence, however, patients undergoing SLN biopsy without concomitant axillary dissection should be informed of the risk of a false-negative result.

Axilla↗
PubMed2002

Spindle epithelial tumor with thymus-like differentiation (SETTLE) of the thyroid.

BACKGROUND: Tumors of the so-called intrathyroidal epithelial thymoma type are a rare group of thyroid neoplasm tumors. Of this type of tumor, spindle epithelial tumor with thymus like differentiation (SETTLE) has been reported only 17 times in English literature. METHODS: An 18-year-old woman was initially seen with a 6-cm left thyroid mass that was resected with a left thyroidectomy. Histopathologic features of the excised left thyroid tumor together with an immunohistochemistry and electron microscopy led us to a diagnosis of SETTLE. RESULTS: Most of the specimen was composed of highly cellular spindle cells that formed intersecting and streaming fascicles. The spindle cells showed both vimentin immunoreactivity and cytokeratin immunoreactivity but no immunoreactivity for thyroglobulin or calcitonin. Electron microscopic examination of the spindle cells demonstrated prominent cytoplasmic tonofilaments, desmosomes, and basal lamina consistent with epithelial cell origin. DNA content analysis by flow cytometry revealed DNA diploidy. CONCLUSIONS: SETTLE of thyroid gland is an extremely rare entity. A review of the literature reveals that SETTLE has distinctive morphologic features and an immunohistochemical profile.

Adolescent↗
PubMed2002

Relevance and practicability of internal mammary sentinel node biopsy for breast cancer.

OBJECTIVES AND METHOD: Recent observations in breast cancer patients undergoing sentinel lymph node (SLN) mapping, in which drainage can be traced to the internal mammary node (IMN) chain, have renewed interest in the staging and treatment of the disease. This paper discusses the relevance of internal mammary SLN biopsy and suggests an optimal procedure for the identification of the SLN in the IMN chain. RESULTS: Axillary lymph node (AX) and IMN status have similar predictive relevance for survival, while the involvement of IMNs has prognostic value for AX-negative as well as AX-positive patients. Although parasternal recurrence is fortunately rare after modified radical mastectomy or breast conserving surgery, if left untreated it not infrequently develops as clinically evident disease in patients with histologic involvement of IMNs. "Hot" internal mammary SLNs can be identified by means of lymphoscintigraphy and gamma-detection probe after peritumoral injection of radioisotopes. A positive internal mammary SLN biopsy would be an indication for internal mammary radiotherapy as well as adjuvant systemic treatment. However, the reported incidence of positive internal mammary SLNs is still lower than expected because the spread of radioactivity does not necessarily coincide with nodal involvement. CONCLUSION: Internal mammary SLN biopsy has proven to be relevant but not yet fully practical because more data are needed on the collection of a "Hot" internal mammary SLN and on pathologic involvement. This means that internal mammary SLN biopsy should be regarded as still investigative.

Breast Neoplasms↗
PubMed2002

Does regional treatment improve the survival in patients with operable breast cancer?

BACKGROUND: The impact of regional therapy on survival of patients with invasive breast cancer remains controversial. Regional therapies discussed include axillary lymph node dissection (ALND), internal mammary node dissection, and locoregional radiotherapy. METHODS: Prospective randomized clinical studies of regional therapy were reviewed using, as a source, Medline, main review articles on the related topic, and statements from consensus conference. RESULTS: Although a number of randomized clinical studies have failed to demonstrate the benefits of regional treatment for survival, it is still a matter of debate whether ALND or regional radiotherapy alone can have a small but significant beneficial effect on the survival of breast cancer patients. However, recent studies have suggested that survival can be enhanced by interaction of postmastectomy locoregional radiotherapy with adjuvant systemic therapy. CONCLUSIONS: Locoregional control is important for enhancing survival in the presence of adjuvant systemic therapy. Although only a few randomized controlled trials show conclusively the survival benefit of local therapies, it is expected that in clinical practice, the node-positive or other high-risk breast cancer patients given systemic treatment will be more frequently treated with postmastectomy radiation.

Antineoplastic Agents↗
PubMedDate not supplied

Internal mammary sentinel node biopsy for breast cancer: is it practicable and relevant? (Review).

Sentinel lymph node (SLN) biopsy is a useful way of assessing axillary nodal status and obviates unnecessary axillary lymph node dissection for patients with node-negative breast cancer. However, SLN can also be located in the internal mammary lymph node (IMN) chain or elsewhere. The practicability and relevance of internal mammary SLN is reviewed and discussed. Axillary and IMN status have similar predictive value for survival, and the involvement of IMNs has prognostic value for both axillary node-negative and node-positive patients. Although parasternal recurrence is fortunately rare after modified radical mastectomy or breast conserving surgery, if left untreated it develops not infrequently as a clinically evident disease in patients with histologic involvement of IMNs. Internal mammary SLNs can be identified by means of lymphoscintigraphy and gamma-detection probe after peritumoral injection of radioisotopes. A positive internal mammary SLN biopsy would be an indication for internal mammary radiotherapy as well as adjuvant systemic treatment. However, the reported incidence of positive internal mammary SLNs is still lower than expected, because the spread of radioisotope activity is not synonymous with nodal positivity. Internal mammary SLN biopsy is considered to be still in the investigative stage. More data are needed on the correction of a internal mammary SLN and pathologic positivity, so that further clinical investigation is clearly warranted.

Breast↗