Accurate detection of intrahepatic metastases, or daughter nodules, of primary hepatocellular carcinoma is of crucial importance. Due to the introduction of infusion hepatic angiography, computed tomography (CT) after Lipiodol (iodized oil) infusion, and intraoperative ultrasound (US), tumors less than 10 mm in diameter are now frequently found. We compared the diagnostic accuracy of these three modalities in the detection of nodules in 45 patients who had hepatocellular carcinoma (confirmed by biopsy). CT with Lipiodol was superior to hepatic angiography in demonstrating nodules when they were overlapped by the primary tumor or very small in size. Intraoperative US demonstrated nodules in four avascular or hypovascular hepatocellular carcinomas, which both hepatic angiography and CT failed to demonstrate. In cases associated with severe liver cirrhosis, differentiation of small nodules from regenerating cirrhotic nodules was sometimes difficult with intraoperative US. The combined use of these three modalities is indispensable for the accurate detection of small nodules of metastatic hepatocellular carcinoma.

Standard lymphadenectomy for prostate cancer is limited to the obturator lymph nodes (LNs), although the internal and external iliac LNs represent the primary landing zone for prostatic lymphatic drainage. We performed anatomically semi-extended pelvic lymph node dissection (PLND) to assess the incidence of LN metastasis in cases of clinically localized prostate cancer. A total of 730 consecutive patients underwent radical prostatectomy with either semi-extended PLND, comprising 6 selective fields, namely the external iliac, internal iliac and obturator LNs bilaterally, or standard LND (obturator LNs alone). A total of 131 patients undergoing semi-extended PLND were compared with 599 patients undergoing standard LND. The patients were stratified into high-risk [prostate-specific antigen (PSA)>20 ng/ml, Gleason score (GS)≥8], intermediate-risk (PSA 10-20 ng/ml, GS=4+3) and low-risk (PSA<10 ng/ml, GS≤3+4) subgroups. Following semi-extended LND, positive LNs were detected in 12/61 (20%) of the high-risk, 1/30 (3%) of the intermediate-risk and 0/40 (0%) of the low-risk cases. Following standard LND, positive LNs were detected in 13/182 (7%) of the high-risk, 1/164 (0.6%) of the intermediate-risk and 0/253 (0%) of the low-risk cases. In high-risk patients, the detection rate of LN metastasis was significantly higher following extended LND compared with standard LND (P<0.01). In 9 of 13 patients (69%), metastases were identified in the internal and external iliac regions, despite negative obturator LNs. There were no significant differences regarding intraoperative and postoperative complications or blood loss in the two groups. There was no lymphocele formation in patients undergoing either standard or semi-extended LND. Extended pelvic LND (PLND) is associated with a high rate of LN metastasis detection outside the fields of standard LND in cases with clinically localized prostate cancer. Therefore, LND including the internal and external iliac LNs should be performed in all patients with high-risk prostate cancer; however, in the low-risk group, PLND may be omitted.

BackgroundLiposarcoma is one of the most common soft tissue sarcomas found in adults. It has a predilection for retroperitoneal space. Renal cell carcinoma is the most common tumor of the kidney.Case presentationConcurrent retroperitoneal liposarcoma and renal cell carcinoma were found in a 34-year-old Japanese man. The renal tumor was first detected by ultrasonography, it was confirmed by computed tomography, which also identified a presumptive retroperitoneal liposarcoma, and the tumors were further assessed with magnetic resonance imaging. The patient was treated by surgical resection of retroperitoneal liposarcoma and left nephrectomy and has been disease-free for 10 years.ConclusionsThe concomitant occurrence of a renal tumor and a primary primary liposarcoma is rare. The major factors promoting a good prognosis in this case were the favorable histology and the small size of the tumors.

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Background: Surgical treatment could be omitted if we could predict pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) in primary breast cancer patients by radiological findings accurately. The aim of this study is to assess the accuracy of MRI and ultrasonography (US) in predicting pathologic complete response in breast cancer patients treated with NAC. Methods: Five hundred sixty nine primary breast cancer patients who underwent breast conserving surgery after NAC between 2004 and 2008 were reviewed. Sensitivity and specificity of clinical complete response (cCR) by MRI alone and in combination with US were retrospectively assessed. pCR in primary tumor was defined as no residual invasive carcinoma. Spotted, linear or trabecular lesions without vascularity detected by US and/or enhanced on late phase of MRI findings were suspected to be residual in situ carcinoma. Results: The median age of the 569 patients analyzed was 50 years (range, 26-76 years). Of the patients, 86 (15.1%) had pCR. Of 79 patients who were diagnosed cCR by MRI alone, 72 patients (91.1%) were accurately predicted. Of 490 patients who were diagnosed to have residual invasive carcinoma, 14 patients (2.9%) had pCR. Of 75 patients who were diagnosed cCR by MRI in combination with US, 68 patients (90.7%) was accurately predicted. Of the 494 patients who were diagnosed to have residual invasive carcinoma, 18 patients (3.6%) had pCR. The combination of MRI and US had a sensitivity of 79.1%, specificity of 98.6%. prediction of pCR by MRI alone and in combination with US MRI aloneMRI + US cCRnon-cCRcCRnon-cCR (n = 79)(n = 490)(n = 75)(n = 494)pCR72146818(n = 86)(91.1%)(2.9%)(90.6%)(3.6%)non-pCR74767476(n = 483)(8.9%)(97.1%)(9.4%)(96.4%) For 85 patients who were diagnosed cCR by MRI and/or US, positive predictive value was 89.4% in ER-positive breast cancer, 100% in ER-negative/HER2-positive breast cancer, and 81.5% in triple negative breast cancer. In terms of prediction of residual in situ carcinoma, of the 86 patients with pCR, 43 (50%) had residual in situ carcinoma. The median size of residual tumor was 2.0 cm (range, 0.01-8.0 cm). Twenty five of 37 patients (67.6%) who are diagnosed cCR without any residual in situ carcinoma by both MRI and US were accurately predicted. Twelve of the 37 patients (31.6%) had residual carcinoma (in situ carcinoma, n = 10, and invasive carcinoma, n = 2) on surgical specimen. Twenty one of 38 patients (55.3%) who are diagnosed cCR with residual in situ carcinoma by both MRI and US had pCR with residual in situ carcinoma accurately. Twelve of the 38 patients (31.6%) had pCR without any in situ carcinoma and 5 (13.2%) had residual invasive carcinoma on surgical specimen. Conclusions: Our results indicated that MRI in combination with US was highly useful to predict pCR in breast cancer patients treated with NAC, although it was hard to predict a presence of residual in situ carcinoma. Pathological intervention using a vacuum-assisted breast biopsy in addition to these radiological modalities is expected for higher accuracy of predicting pCR. We are going to conduct a prospective multi-institutional study to assess predictive value of the method. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-02-11.