The concepts of made-to-order and low-invasiveness medicines are becoming widely accepted. A treatment for cancer, with minimum invasive surgery and without lymph nodes dissection based on sentinel lymph node (SN) navigation surgery, would adhere to these concepts. Dyes and/or radioisotopes are employed for SN detection in standard methods, however, each detection method has advantages and disadvantages. To make up for the disadvantages, we aimed at developing a new non-invasive method using fluorescent beads of uniform nano-size that could efficiently visualize SN from outside the body, and conducted experiments to determine the appropriate size and fluorescent wavelength. We examined various bead sizes and fluorescent wavelengths. The sizes were 20, 40, 100 and 200 nm. The fluorescent peak wavelengths of the beads were yellow-green (515 nm), dark red (680 nm), far red (720 nm) and infrared (755 nm). The beads were subcutaneously injected into the foot pad of the hind leg of a rat, and followed by laser scanning of the inguinal area for fluorescence observation. T he sentinel node (SN) is the first lymph node on the lymphatic drainage pathway from the cancerous tumor. In cases where the SN has a metastasis, there is the possibility of another positive node. When the SN is negative for metastasis, we can consider that there will be no other positive node and lymph node dissection (LND) is not necessary except for of the SN. This leads to the avoidance of functional or organic complication after LND. Preventive and systematic LND in cancer surgery has been accepted as a standard technique for over 100 years, however, the modern concept of minimizing the invasiveness of medical treatment is changing surgical procedures. This SN navigation surgery presents a new choice to patients as a made-to-order medical treatment. There are two major methods for detection of SN using tracer molecules: (i) a dye method in which iso-sulfan blue is used; and (ii) a radioisotope (RI) method in which 99m Tc with phytic acid is used. They are subcutaneously injected at the periphery of the tumor, and then the SN can be identified through tracer accumulation.(1-4) High sensitivity in the detection of an SN can be achieved using these two methods together. However, there are disadvantages for each method. The dye method requires some great skill, and cannot be detected without a skin incision. The RI method requires radioactive agents it, therefore, can only be performed at certain hospitals because of the regulations for handling these.To make up for the disadvantages, we designed fluorescent nano-sized beads as a new alternative tracer. There are many factors that might influence their movement in the lymphatic system when particles are subcutaneously administered in vivo. We noted the particle size as the most important factor. Small sized particles immediately move into lymphatic capillaries and pass through the interstices of the endothelial cells from the interstitial tissue. Large-sized particles are carried by macrophages after...

Lymphocyte‐predominant breast cancer (LPBC) defined by the density of stromal lymphocytes shows favorable behavior. However, considerable distribution heterogeneity of lymphocytes is a major problem. The present study defined LPBC by the proportion of lymphocyte‐rich stroma with the cut‐off values of 30, 50, and 75%, and clinicopathologically analyzed mainly LPBC (area > 30%) defined by the cut‐off value of 30%. LPBCs (area > 30%), 39 cases in total, were composed mainly of triple‐negative and HER2+/ER ‐ subtypes, without any luminal A‐like subtype. LPBCs were composed predominantly of histological grade 3 tumors, without any grade 1 lesions. Multivariate analyses on 477 consecutive tumors revealed that ER‐negativity and grade 3 status associated significantly with LPBC. LPBC (area > 30%) showed better disease‐free survival than grade‐matched controls, and it was a good indicator of complete pathological remission after pre‐operative chemotherapy. Patients with LPBC with the cut‐off value of 50% and that of 75% showed 100% disease‐free survival. These results demonstrated the validity of our definition of LPBC. Our data also suggest that de‐differentiated cancers without TILs could be regarded as high‐grade cancer without lymphocyte‐mediated responses. In conclusion, the definition of LPBC by the proportion of lymphoid stroma is useful for prognostication of high grade breast cancer in routine diagnosis.

To evaluate colorectal cancer screening with faecal occult blood testing (FOBT) in terms of prevention of advanced cancers, we conducted a case -control study in the areas where an annual screening programme with immunochemical FOBT has been offered to all inhabitants aged 40 years or over. Cases were 357 consecutive patients in the study areas clinically diagnosed as having advanced colorectal cancer or a tumour invading the muscularis propriae or deeper, that is, T 2 -T 4 in TNM classification. Three controls were selected for each case matched by gender, age, residential area and exposure status to screening within 1 year before case diagnosis. The odds ratios (ORs) of developing advanced cancer were calculated using conditional logistic regression analyses. The OR for those screened within 3 years before the diagnosis vs those not screened was 0.54 (95% confidence interval (CI) 0.29 -0.99). The ORs were lower for rectum than for colon (0.32 -0.73 and 0.84 -1.18 for rectum and colon, respectively). For those screened within the past 3 years, OR of developing advanced cancer in the rectum was 0.32 ( 95%CI: 0.12 -0.84). A screening programme with immunochemical FOBT can be effective for prevention of advanced colorectal cancer. Risk reduction appears to be larger for rectal than for colon cancer.

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Pseudoaneurysm of the cystic artery is a cause of hemobilia, and is extremely rare, with only eight cases having been reported in the world literature. We report a case of pseudoaneurysm of the cystic artery in a 72-year-old Japanese man. The patient experienced epigastric pain and melena, and was found to have jaundice and liver dysfunction. Repeated gastroendoscopy did not reveal the cause of the alimentary tract bleeding; however, color-Doppler ultrasonography detected an aneurysm of the cystic artery in the gallbladder. Selective hepatic arteriography demonstrated that the posterior branch of the cystic artery was markedly dilated and that an aneurysm had formed in the midst of the artery. We diagnosed hemobilia due to the pseudoaneurysm of the cystic artery, and associated gastrointestinal bleeding. Cholecystectomy was performed immediately. Pathologically, the gallbladder showed acute calculous cholecystitis. This case emphasizes the importance of including hemobilia in the differential diagnosis whenever gastrointestinal bleeding is associated with signs of biliary disorder; color-Doppler imaging is a favorable modality for the diagnosis of pseudoaneurysm of the cystic artery.

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