RESUMEN
BACKGROUND: Recently, the numbers of patients with breast cancer have increased rapidly in Japan, and about 40,000 people contract the disease annually today. Therefore, secondary prevention by breast cancer screening has become an important issue. Presently, mammography is used frequently for the diagnosis of breast cancer, but the reading of mammograms is difficult, and physicians must attend training classes specified by the Central Committee on Quality Control of Mammographic Screening and obtain a license to perform screening. Assessment categories are used for the evaluation of mammograms. Although they provide a scale for the diagnosis of breast cancer, the interpretation of mammograms is dependent on the physician's subjective judgment, and the advent of an objective evaluation method is awaited. METHODS: We scored the size, shape, density, margin, border, and internal structure of mammographic images and evaluated the relationships of these scores with lesion categorization. RESULTS: Since lesions could not be categorized by the analysis of any single item of mammographic images, the items were paired, and a new diagnostic system for breast cancer was prepared. When this system was applied, the diagnostic accuracy was very satisfactory, with a sensitivity of 100% (37/37) and a specificity of 92.9% (65/70) for category 5; 83.6% (51/61) and 97.8% (45/46), respectively, for category 4; and 88.9% (8/9) and 94.9% (93/98), respectively, for category 3. CONCLUSION: In this study, findings concerning the margin and internal structure were important for the discrimination of category 5, and those concerning the size, shape, and density made major contributions to the discrimination of category 3.
Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/patología , Mama/patología , Mamografía , Adulto , Anciano , Anciano de 80 o más Años , Detección Precoz del Cáncer , Femenino , Humanos , Japón , Persona de Mediana Edad , Pronóstico , Sensibilidad y EspecificidadRESUMEN
Objective: Based on data from a national survey of primary biliary cirrhosis (PBC), the pathology and prognosis of PBC in Japan were clarified. In particular, we tried to perform multivariate analysis of factors useful in determining prognosis of asymptomatic PBC (a-PBC). Methods: The survey was performed 10 times. Responses from 3778 of 4361 registered patients (416 institutions) were investigated (survey period: January 1968-December 1998). At the time of diagnosis, patients were classified as a-PBC or symptomatic PBC (s1-PBC; pruritus only, s2-PBC; jaundice and serum bilirubin level above 2 mg/dl). The survival rate was obtained by the Kaplan-Meier method. Logistic regression analysis was used in multivariate analysis of prognostic factors of a-PBC. Results: There were no significant differences in clinical findings from those in previous reports. The 5-year survival rates of patients with a-PBC, s1-PBC, and s2-PBC at the time of diagnosis were 97, 88, and 53%, respectively. Patients with a-PBC at the time of diagnosis were divided into groups: those in whom the disease progressed to s2-PBC (8%) and did not progress to s2-PBC (92%) at the final examination, and the prognosis was compared between groups. The prognosis was significantly poorer in the s2-PBC progression group. As a result of multivariate analysis for prediction of prognosis, levels at diagnosis of total serum bilirubin (T-Bil), albumin (Alb), total cholesterol (T-Cho), histological stage, and presence or absence of ursodeoxycholic acid (UDCA) administration were selected as significant factors (P<0.00001). Conclusion: Serum T-Bil, Alb, T-Cho, and histological stage at the time of diagnosis and presence or absence of UDCA administration were considered useful early prognostic indicators in patients diagnosed as having a-PBC whose prognosis may deteriorate with progression to s2-PBC.