島 宏彰, 近藤 裕太, 里見 蕗乃, 九冨 五郎, 竹政 伊知朗

Hiroaki SHIMA, Yuta KONDO, Fukino SATOMI, Goro KUTOMI, Ichiro TAKEMASA

札幌医科大学消化器・総合，乳腺・内分泌外科

Department of Surgery, Surgical Oncology and Science, Sapporo Medical University

キーワード : breast cancer, surgery, ultrasound, contrast-enhanced ultrasound, partial mastectomy, extent of resection

この項では乳癌診療の中で乳癌の診断と手術までの精査，手術直前の広がり診断に関して検査の流れについて解説する．そして，超音波検査の位置づけと，とくに造影超音波について取り上げる．造影超音波で用いる第2世代超音波造影剤ソナゾイドは，CTや乳房MRI検査の水溶性造影剤と異なり血管外へ漏出しない純粋な血管内造影剤であることが知られる．したがって，詳細な血流情報が得られることが期待され実地臨床にも応用されている．一般的に組織学的な乳癌の確定診断がなされた後，マンモグラフィ，超音波検査（エラストグラフィ，カラードプラ），乳房MRI検査の結果から総合的な広がり診断を行っていく．この過程で見つかった病変に対してはSecond-look USがなされ，個別に質的診断がなされる．これらをもとに総合的に評価して選択可能な術式を決定する．術式決定もさることながら部分切除を選択した場合は切除範囲決定のうえで，広がり診断が重要となる．各モダリティの意義に触れながら，造影超音波がどのような位置づけとなっているのか，どのような意義があるのかについて解説する．最後に実際の症例から具体的にどのような流れで手術に至るのかについても触れたい．

In this section, we describe the flow of examinations for diagnosis of breast cancer, including close examination leading to surgery, and evaluation of the extent of the breast cancer immediately before surgery. Also discussed is the methodology of ultrasonography tools, especially in contrast-enhanced ultrasound. It is well known that Sonazoid, a second-generation ultrasound contrast agent used in contrast-enhanced ultrasound, is a pure intravascular contrast agent that does not leak out of blood vessels, unlike the water-soluble contrast agents used in CT and breast MRI examinations. Therefore, it can be expected to provide detailed blood flow information and has in recent years been commonly applied in modern clinical practice. In general, after a definitive histological breast cancer is diagnosed, its extent is comprehensively assessed based on the results of mammography, ultrasonography (including elastography and color Doppler imaging), and breast MRI. Second-look US is performed for lesions found during this process, and a qualitative diagnosis is made on an individual basis. Based on these factors, a comprehensive evaluation is made to determine the surgical options. If a partial resection is selected along with the surgical technique, the evaluation of extent is important to determine the extent of resection. We describe the significance of each modality, as well as the role of contrast-enhanced ultrasound and what determines its significance. Finally, we will discuss actual cases and the specific processes leading up to surgery.