Andy Shau-Bin Chou

Factors Affecting Diagnostic Accuracy of CTguided Coaxial Cutting Needle Lung Biopsy: Retrospective Analysis of 631 Procedures

PURPOSE To analyze variables affecting diagnostic accuracy of computed tomography (CT)-guided percutaneous coaxial cutting needle biopsy of lung lesions. MATERIALS AND METHODS A retrospective analysis of factors affecting diagnostic accuracy of CT-guided percutaneous coaxial cutting needle lung biopsy was performed in 631 consecutive procedures with confirmed final diagnoses. Benign and malignant needle biopsy results were cross-examined with correct and incorrect final outcomes to determine diagnostic accuracy. Factors affecting diagnostic accuracy were determined by multivariate logistic regression analysis of variables thought to affect diagnostic accuracy. A P value less than 0.05 was interpreted as statistically significant. RESULTS The overall diagnostic accuracy of CT-guided percutaneous coaxial cutting needle biopsy of lung lesions was 95% (95% CI: 92.7%-96.2%). Sensitivity was 93%, specificity 98%, negative predictive value 6%, positive predictive value 99%, false-positive rate 0.7%, and false-negative rate 15%. The factors affecting diagnostic accuracy were final diagnoses (benign, 86%; malignant, 99%; chi(2) test, P < 0.001) and lesion size (lesions <1.5 cm, 84%; lesions 1.5-5.0 cm, 96%; lesions >5 cm, 93%; chi(2) test, P = 0.06). CONCLUSION Benign lung lesions, lung lesions smaller than 1.5 cm (which pose technical difficulty), and lung lesions larger than 5 cm (which are associated with a higher necrosis rate) affect diagnostic accuracy of CT-guided percutaneous coaxial cutting needle biopsy of lung lesions.

Computed Tomography Findings of Gossypiboma

Gossypiboma is composed of non-absorbable surgical material with a cotton matrix. Gossypiboma is usually under-reported and is a severe medicolegal issue. Thus, we describe the computed tomography (CT) findings of gossypiboma in our institution. From January 2003 to June 2006, gossypibomas diagnosed in our institution and their data regarding sex, age, previous operation, location, the interval between the operation and the diagnosis of gossypiboma, clinical presentation, indication of CT, CT findings and further management were collected. There were 6 cases of gossypiboma, 4 men and 2 women. Three of our cases had previous chest surgery and the other 3 cases had previous abdominal surgery. The locations of 3 (50%) cases were in the left anterior subphrenic space. The mean interval between original operation and diagnosis was 24.6 +/- 33.4 months (range, 17 days to 8 years). With regard to CT findings, 3 (50%) cases had an isodense mass and 3 (50%) had a typical mass containing curvilinear opaque structures. The mean size of the gossypibomas was 62 x 62 x 67 mm. Because gossypiboma is due solely to human factors and is a severe medicolegal issue, continuous education should be considered.

Diagnosis and staging of gallbladder carcinoma:Evaluation with dynamic MR imaging

The purpose of this study is to determine the ability of dynamic magnetic resonance imaging (MRI) in the diagnosis and staging of gallbladder cancer (GBC). Images of dynamic MRI of hepatobiliary system combined with MR cholangiography (MRC) of 18 patients with pathologically proved gallbladder cancer were correlated with pathological and operative findings. Focal or diffuse wall thickening was present in 10 patients. In five patients, the tumor appeared as a fungating or intramural mass. A tumor replacing the gallbladder was found in two patients and a small cancer in cystic duct in one patient. The tumor featured early and irregular enhancement, which persisted throughout the dynamic study. Metastatic nodes were found by surgicopathology in 13 patients and were depicted by the dynamic MRI in 11 patients. Local invasion to liver was found by surgery in 12 patients and correctly detected by MRI in 11 patients. MRI detected duodenum invasion in three out of six patients and none of the three cases with omental metastasis. In conclusion, dynamic MRI is useful and reliable in staging of advanced gallbladder cancer. MRI combined with MRC is sensitive in detection of obstructive jaundice, liver invasion as well as liver and lymph nodes metastasis. It is more difficult to delineate the invasion to duodenum and omental metastasis by MRI.

Marjolin's ulcer : MR appearance

1All authors: Department of Medical Imaging, Buddhist Tzu Chi Medical Center, Hualien, No. 707, Section 3, Chung Yang Rd., Hualien, Taiwan 886. Address correspondence to P.-Y. Chang. alignant degeneration of untreated chronic wounds is a well-known complication. These rare, aggressive tumors that originate in chronically nonhealing wounds are called Marjolin’s ulcer [1]. A multidisciplinary approach is necessary in these patients. Here we report a case of Marjolin’s ulcer and the MRI findings.

Induction of metastatic cancer stem cells from the NK/LAK-resistant floating, but not adherent, subset of the UP-LN1 carcinoma cell line by IFN-γ.

As an advanced status of cancer stem cells (CSCs), metastatic CSCs (mCSCs) have been proposed to be the essential seeds that initiate tumor metastasis. However, the biology of mCSCs is poorly understood. In this study, we used a lymph node (LN) metastatic CEA-producing carcinoma cell line, UP-LN1, characterized by the persistent appearance of adherent (A) and floating (F) cells in culture, to determine the distribution of CSCs and mechanisms for the induction of mCSCs. F and A cells displayed distinct phenotypes, CD44high/CD24low and CD44low/CD24high, respectively. The CSC-rich nature of F cells was typified by stronger expression of multiple drug resistance genes and a 7.8-fold higher frequency of tumor-initiating cells in NOD/SCID mice when compared with A cells. F cells showed a greater depression in HLA class I expression and an extreme resistance to NK/LAK-mediated cytolysis. Moreover, the NK/LAK-resistant F cells were highly susceptible to IFN-γ-mediated induction of surface CXCR4, with concomitant downregulation of cytoplasmic CXCL12 expression, whereas these two parameters remained essentially unchanged in NK/LAK-sensitive A cells. Following the induction of surface CXCR4, enhanced migratory/invasive potential of F cells was demonstrated by in vitro assays. Confocal immunofluorescence microscopy showed the two distinct phenotypes of F and A cells could be correspondingly identified in monodispersed and compact tumor cell areas within the patients LN tumor lesion. In response to IFN-γ or activated NK/LAK cells, the CXCR4+ mCSCs could be only induced from the CSCs, which were harbored in the highly tumorigenic CD44high/CD24low F subset. Our results revealed the complexity and heterogeneity of the CSC of this cell line/tumor and the differential immunomodulatory roles of F and A cells. A better understanding of the interactions among different classes of CSCs and their niches may assist us in eradicating the CSCs/mCSCs through targeted immunotherapy, chemotherapy, or both.

Differential baseline and response profile to IFN-γ gene transduction of IL-6/IL-6 receptor-α secretion discriminate primary tumors versus bone marrow metastases of nasopharyngeal carcinomas in culture

BackgroundUnderstanding of immunobiology of bone marrow metastases (designated BM-NPC) versus primary tumors (P-NPC) of the nasopharynx is far from complete. The aim of this study was to determine if there would be differences between cultured P-NPCs and BM-NPCs with respect to (i) constitutive IL-6 and the IL-6 receptor gp80 subunit (IL-6Rα) levels in the spent media of nontransduced cells, and (ii) IL-6 and IL-6Rα levels in the spent media of cells transduced with a retroviral vector containing the IFN-γ gene.MethodsA panel of NPC cell lines were transduced with the IFN-γ gene through a retroviral vector. Four clonal sublines were isolated via limiting dilution methods. Cytofluorometric analysis was performed for the detection of cell surface antigens of HLA class I, HLA class II and ICAM-1. ELISA was used to assay for IFN-γ, IL-6 and IL-6Rα in the spent media of cultured cell lines.ResultsOur results showed that in day 3 culture supernatants, low levels of soluble IL-6 were detected in 5/5 cultured tumors derived from P-NPCs, while much higher constitutive levels of IL-6 were detected in 3/3 metastasis-derived NPC cell lines including one originated from ascites; the difference was significant (p = 0.025). An inverse relationship was found between IL-6Rα and IL-6 in their release levels in cultured P-NPCs and metastasis-derived NPCs. In IFN-γ-transduced-P-NPCs, IL-6 production increased and yet IL-6Rα decreased substantially, as compared to nontransduced counterparts. At variance with P-NPC cells, the respective ongoing IL-6 and IL-6Rα release patterns of BM-NPC cells were not impeded as much following IFN-γ transduction. These observations were confirmed by extended kinetic studies with representative NPC cell lines and clonal sublines. The latter observation with the clonal sublines also indicates that selection for high IL-6 or low IL-6Rα producing subpopulations did not occur as a result of IFN-γ-transduction process. P-NPCs, which secreted constitutively only marginal levels of IFN-γ (8.4 ~ 10.5 pg/ml), could be enhanced to produce higher levels of IFN-γ (6.8- to 10.3-fold increase) after IFN-γ transduction. Unlike P-NPCs, BM-NPCs spontaneously released IFN-γ at moderate levels (83.8 ~ 100.7 pg/ml), which were enhanced by 1.3- to 2.2-fold in the spent media of their IFN-γ-transduced counterparts.ConclusionOur results showed that cultured P-NPCs and BM-NPCs could be distinguished from one another on the basis of their differential baseline secretion pattern of IFN-γ, IL-6 and IL-6Rα, and their differential response profiles to IFN-γ gene transfer of the production of these three soluble molecules. These results suggest that the IL-6 and IFN-γ pathways in a background of genetic instability be involved in the acquisition of metastatic behaviour in BM-NPCs.

Management of breast fibroadenomas by ultrasound-guided vacuum-assisted biopsy - Three years experience

Objective: Fibroadenoma is a common benign breast tumor occurring in young women. The management of fibroadenoma is still debatable. During the last decade, ultrasound-guided vacuum-assisted biopsy (UGVAB) has been widely used in the treatment of breast fibroadenoma. We wanted to evaluate the role of UGVAB in the diagnosis, treatment and complete excision of breast fibroadenoma. Materials and Methods: From July 2000 to July 2003, 113 consecutive patients, with radiographically or clinically suspected breast fibroadenomas 0.5 to 2 cm in size, were prospectively referred for UGVAB. The clinical outcome (complications, diagnostic rate and complete excision rate) of all patients were reviewed. Results: All 113 UGVAB tissues were sent to the pathology department for histological examination and all but one were diagnosed as fibroadenomas (99%). The exception was confirmed as lobular carcinoma in situ (LCIS). All tumors 0.5 cm to 1.5 cm in size were completely excised by UGVAB. However, the complete excision rate was only 67% for tumors 1.6 cm to 2 cm in size. Two patients had pneumothorax (1.76%) and 13 patients had severe ecchymosis (11.5%) after UGVAB. The average time for completion of the procedure was 48 minutes (range 20 to 150 minutes). There were no wound infections and all patients were satisfied with the cosmetic results. Conclusions: In our three-year experience, UGVAB is a fast and accurate method for breast tumor diagnosis. Moreover, tumors measuring 1.5 cm or less can be completely removed under UGVAB. Therefore, we believe that UGVAB is a safe and effective method of treatment for small fibroadenomas.

Percutaneous Retrieval of Dislodged Port-A Catheters by Loop Retriever

Objective: Port-A catheter fracture with embolization is a serious complication. The percutaneous retrieval of intravascular foreign bodies avoids the need for surgery in this high risk population. We report on 14 patients who underwent percutaneous retrieval of dislodged Port-A catheters by loop retriever. Materials and Methods: Fourteen patients who had undergone percutaneous foreign body retrieval between 2002 and 2007 were evaluated retrospectively. In all procedures, retrieval of foreign bodies was performed using a 6.3-F angled wire loop retriever. Results: The percutaneous retrieval procedure was successful in all 14 patients. Repositioning of the foreign body was done in seven cases using an RC1 catheter for the intracardiac Port-A catheter fragments. Additional surgery was not required. No further complications, such as damage to the vascular wall, were noted. Conclusion: With the increasing use of indwelling catheters and interventional devices, we are frequently confronted with the problem of dislodged catheters. The percutaneous approach should be considered as the first choice when trying to resolve the problem of an embolized catheter in the cardiovascular system.

Imaging in the Preoperative Assessment of Omphalopagus Conjoined Twins-A Case Report

A set of 9-month-old female conjoined twins from the Philippines were sent to our hospital in Taiwan in April 2003 for assessment and planning for possible surgical separation. This set of twins had been delivered by cesarean section after a 38-week gestation. On clinical examination, they were healthy looking and had good activity. Their bodies were oriented face to face and were externally fused from the lower chest to the upper abdomen in the ventral aspect. An out-pocket sac was noted at the inferior fusion part, which was thought to be an omphalocele. Serial preoperative imaging studies included cardiac and abdominal echograms, plain film of the body, whole-body computed tomography (CT), chest to abdomen magnetic resonance imaging (MRI), and upper gastrointestinal serial films (UGI series). Proper imaging to evaluate the condition of conjoined twins can accurately define anatomic fusion, vascular anomalies, and associated abnormalities. Such information is essential for surgical planning and prognostic estimation.

Tumor dormancy resulting from subcutaneous injection to SCID mice with cultured nasopharyngeal carcinoma cells is mediated via IFN-γ induction of a highly differentiated phenotype.

The mechanisms underlying tumor dormancy in human primary lesions and bone marrow metastases of nasopharyngeal carcinoma (NPC) are still not completely understood. The aim of this study was to determine differences in the fates of cultured primary NPC (P-NPC) cells, interferon-γ-transduced primary NPC (IFN-γ-P-NPC) cells, bone marrow metastatic NPC (BM-NPC), and IFN-γ-transduced BM-NPC (IFN-γ-BM-NPC) cells following xenotransplantation into these four groups of SCID mice through subcutaneous injection of 5×10(6) cells/site/animal (4 animals/group). The injected mice were monitored for tumor development at the sites of injection. In only the group injected with IFN-γ-P-NPC cells, the resulting nodules remained small throughout the 60-day observation period after injection, but gradually became palpably prickly. Histopathological examination revealed that these lesions invariably consisted of mostly structures of horny pearls and keratin bridges with occasional apoptotic and degenerative cells. In contrast, animals injected with nontransduced-P-NPC cells developed tumors progressively with occasional central necroses. In the two groups injected with IFN-γ-NPC-BM and NPC-BM cells, progressive growths of tumors were noted, with the latter being at slightly faster rates, whereas the xenografts of both groups showed a poorly differentiated phenotype with abundant vascularity. The study results highlight the high susceptibility of P-NPC but not BM-NPC following IFN-γ gene transfer to the induction of tumor dormancy, which is mediated via induced cell differentiation. Thus, induced cell differentiation could provide a new mechanism by which tumor dormancy is induced.