Hyunjong Lee

Postoperative nomogram predicting risk of recurrence after radical hysterectomy for early-stage cervical cancer.

Objective: The aim of this study was to develop a nomogram for predicting the 5-year disease-free survival (DFS) after radical hysterectomy for early-stage cervical cancer. Patients and Methods: An institutional database of 275 consecutive patients treated at Seoul National University Hospital for stage I to stage IIA cervical cancer was used to develop a nomogram based on Cox proportional hazards regression model. The developed nomogram was internally validated with bootstrapping, and performance was assessed by concordance index and a calibration curve. External validation was also performed using an independent data set of patients from Asan Medical Center. Results: From Cox regression analysis, disease stage, number of positive lymph nodes, parametrial involvement, and depth of invasion were identified as independent risk factors for disease recurrence (P < 0.05). The nomogram incorporating these factors appeared to be accurate and predicted the outcomes better than the International Federation of Gynecology and Obstetrics stage alone (concordance index, 0.858 compared with 0.719; P = 0.001). When applied to a separate validation set, the nomogram also showed similar predictive accuracy (concordance index, 0.879). Conclusion: We have developed a nomogram that can predict the recurrence risk in patients with early-stage cervical cancer after surgery, which was internally and externally validated.

Epidermal growth factor 61 A/G polymorphism and uterine cervical cancer

Cervical cancer, the second most common malignancy in women worldwide, is almost invariably associated with infection by human papillomavirus (HPV). However, although many women are infected with high-risk types of HPV, only a subset of infected women will ever develop cervical cancer. Therefore, host genetic factor may play a role in cervical carcinogenesis. Alterations in epidermal growth factor receptor (EGFR) are common events in cervical cancer. Therefore, we hypothesized that a functional polymorphism in the 5′ untranslated region of the epidermal growth factor (EGF) gene, a natural ligand of the EGFR, may play a role in the cervical carcinogenesis and tumor invasiveness. We assessed the possible association between EGF +61 A/G polymorphism and cervical cancer risk in a hospital-based case–control study among 337 Korean women (168 cases, 169 age-matched controls). The frequencies of EGF +61 allele and genotype were not different between cases and controls. We observed increasing trend of lymph node metastasis from A/A homozygous genotype toward G/G homozygous genotype. We did not find any evidence that EGF +61 A/G polymorphism was associated with individual susceptibility of cervical cancer. However, although it was not statistically significant, the increasing trend of lymph node metastasis according to EGF genotype suggests the possibility that individual variance of EGF expression may be associated with cervical cancer invasiveness. We also confirmed that there exists striking ethnic heterogeneity of EGF genotype between Caucasian and East Asian population

Impact of diagnostic laparoscopy on the management of chronic pelvic pain

BackgroundDiagnostic laparoscopy is a useful tool, especially when there is no definite anatomical abnormality visible on imaging modalities. We assess the role and clinical impact of diagnostic laparoscopy in the management of women with chronic pelvic pain.MethodsClinical data of 3,068 cases of diagnostic laparoscopy performed for chronic pelvic pain from June 1994 to August 2005 were analyzed. We compared the diagnoses after diagnostic laparoscopy and those after pelvic examination and imaging modalities such as ultrasound or computed tomography (CT), and we then checked the final pathologic diagnoses after operation.ResultsPelvic endometriosis was the most common (60.2%) laparoscopic finding in patients with chronic pelvic pain in this study, followed by normal pelvic findings (21.2%) and pelvic congestion (13.0%). Diagnostic laparoscopy had an influence on correcting previous plans based on imaging modalities in 42.7% of patients such as discarding unnecessary procedures or introducing new diagnostic or therapeutic plans. There were 3 cases of major complications requiring immediate correction.ConclusionsDiagnostic laparoscopy is a useful diagnostic tool for of women with chronic pelvic pain and can be used as a guideline for individualized treatment.

Association of cyclin D1 G870A polymorphism with uterine leiomyoma in women whose body mass index values are above 25 kg/m2

BACKGROUND Many studies have shown that a polymorphism (G870A) in cyclin D1 (CCND1) is associated with carcinogenesis in a variety of cancers. Our aim was to determine if an association exists between the CCND1 G870A polymorphism and uterine leiomyoma in Korean women. METHODS Blood samples of 331 cases and 204 controls aged 47.4 +/- 7.6 and 46.8 +/- 10.4 years (mean +/- SD), respectively, were collected. CCND1 genotyping was determined by PCR and restriction fragment length polymorphism. RESULTS Allelic frequencies of cases (A, 0.53; G, 0.47) were not significantly different from those of controls (A, 0.49; G, 0.51) (P = 0.22). After adjustment for menarche age and BMI, multivariate logistic regression analysis showed that the AA genotype was not associated with increased risk for uterine leiomyoma [odds ratio (OR) = 1.38, 95% confidence interval (CI); 0.85-2.26, P = 0.19]. However, in stratification analysis of cases and controls with BMI >25 kg/m(2), allelic frequencies of cases (A, 0.56; G, 0.44) were significantly different from controls (A, 0.36; G, 0.64) (P = 0.005), and the AA genotype was associated with increased risk for uterine leiomyoma (OR = 3.61, 95% CI; 1.02-12.73, P = 0.046). Furthermore, the OR for AA compared with combined GG and AG genotypes was 3.16 (95% CI 1.01-9.92, P = 0.048). CONCLUSIONS The A allele and AA genotype of CCND1 G870A polymorphism have a significant association with an increased risk of the uterine leiomyoma in obese Korean women.

Assessing clinical performance of gynecology residents : sonographic evaluation of adnexal masses based on morphological scoring systems

To assess the performance of inexperienced gynecology residents in the evaluation of adnexal masses using sonographic scoring systems.

Quantitative single-photon emission computed tomography/computed tomography for technetium pertechnetate thyroid uptake measurement.

Objectives:Technetium pertechnetate (99mTcO4) is a radioactive tracer used to assess thyroid function by thyroid uptake system (TUS). However, the TUS often fails to deliver accurate measurements of the percent of thyroid uptake (%thyroid uptake) of 99mTcO4. Here, we investigated the usefulness of quantitative single-photon emission computed tomography/computed tomography (SPECT/CT) after injection of 99mTcO4 in detecting thyroid function abnormalities. Materials and methods:We retrospectively reviewed data from 50 patients (male:female = 15:35; age, 46.2 ± 16.3 years; 17 Graves disease, 13 thyroiditis, and 20 euthyroid). All patients underwent 99mTcO4 quantitative SPECT/CT (185 MBq = 5 mCi), which yielded %thyroid uptake and standardized uptake value (SUV). Twenty-one (10 Graves disease and 11 thyroiditis) of the 50 patients also underwent conventional %thyroid uptake measurements using a TUS. Results:Quantitative SPECT/CT parameters (%thyroid uptake, SUVmean, and SUVmax) were the highest in Graves disease, second highest in euthyroid, and lowest in thyroiditis (P < 0.0001, Kruskal–Wallis test). TUS significantly overestimated the %thyroid uptake compared with SPECT/CT (P < 0.0001, paired t test) because other 99mTcO4 sources in addition to thyroid, such as salivary glands and saliva, contributed to the %thyroid uptake result by TUS, whereas %thyroid uptake, SUVmean and SUVmax from the SPECT/CT were associated with the functional status of thyroid. Conclusions:Quantitative SPECT/CT is more accurate than conventional TUS for measuring 99mTcO4 %thyroid uptake. Quantitative measurements using SPECT/CT may facilitate more accurate assessment of thyroid tracer uptake.

F-18 Sodium Fluoride Positron Emission Tomography/Computed Tomography for Detection of Thyroid Cancer Bone Metastasis Compared with Bone Scintigraphy

Objective The aim of the study was to compare the diagnostic performances of F-18 sodium fluoride positron emission tomography/computed tomography (bone PET/CT) and bone scintigraphy (BS) for the detection of thyroid cancer bone metastasis. Materials and Methods We retrospectively enrolled 6 thyroid cancer patients (age = 44.7 ± 9.8 years, M:F = 1:5, papillary:follicular = 2:4) with suspected bone metastatic lesions in the whole body iodine scintigraphy or BS, who subsequently underwent bone PET/CT. Pathologic diagnosis was conducted for 4 lesions of 4 patients. Results Of the 17 suspected bone lesions, 10 were metastatic and 7 benign. Compared to BS, bone PET/CT exhibited superior sensitivity (10/10 = 100% vs. 2/10 = 20%, p = 0.008), and accuracy (14/17 = 82.4% vs. 7/17 = 41.2%, p < 0.025). The specificity (4/7 = 57.1%) of bone PET/CT was not significantly different from that of BS (5/7 = 71.4%, p > 0.05). Conclusion Bone PET/CT may be more sensitive and accurate than BS for the detection of thyroid cancer bone metastasis.

18F-NaF PET/CT Findings in Fibrous Dysplasia.

A 43-year-old woman with breast cancer underwent Tc-hydroxymethylene diphosphonate bone scintigraphy for preoperative workup. An abnormal lesion with increased uptake was found in the right humeral shaft, and F-NaF bone PET/CT was performed for clarification. There was high uptake of F-NaF without cortical bone disruption in the right humeral shaft, corresponding to the site on bone scintigraphy. Upper arm MRI was performed subsequently, and metastasis was suggested as a differential diagnosis. However, this lesion was pathologically diagnosed as fibrous dysplasia after curettage surgery.

A Case Report of Tinnitus Occurred in the Sudden Sensory Neural Hearing Loss Treated with Korean Medical Treatments

Objectives : The purpose of this study is to show the clinical effect of Korean Medical Treatments for Tinnitus with Sudden Sensory Neural Hearing Loss. Methods : The patient was treated by Korean Medical Treatments for 10weeks. The effect of treatments on tinnitus was measured with Visual Analogue Scale(VAS) and Korean Tinnitus Handicap Inventory(K-THI). And the effect of treatments on sudden hearing loss was measured by VAS. Results : VAS of Tinnitus was decreased from 10 to 3 points and K-THI score was decreased from 70 to 26 points. VAS of hearing loss was decreased from 9 to 8 points. Conclusions : Korean Medical Treatments are effective on Tinnitus.

Appropriate margin thresholds for isocontour metabolic volumetry of fluorine-18 fluorodeoxyglucose PET in sarcoma: a hybrid PET/MRI study.

ObjectivesMetabolic volumetry and heterogeneity indexes are increasingly being used in fluorine-18 fluorodeoxyglucose (18F-FDG) PET, mostly using isocontour methods. However, there is no standard method to determine optimal margin thresholds for isocontour volume of interest (VOIiso). Here, VOIiso with various margin thresholds were compared with exact anatomical tumor volumes in sarcoma using a hybrid PET/MRI scanner. Patients and methods18F-FDG PET/MRI images were retrospectively analyzed for 36 lesions of soft tissue or bone sarcoma. VOIiso of tumors was drawn with varying margin thresholds; standardized uptake value (SUV) 1.0–4.0 with an increment of 0.5 and 30–70% of maximal SUV (SUVmax) with an increment of 10%. Exact anatomical tumor volumes (VOIMRI) were drawn manually on the basis of MRI. In each VOI, metabolic tumor volume, SUVmean, total lesion glycolysis, and SD were measured and compared between VOIiso and VOIMRI. ResultsSignificant correlations were observed between the indexes from VOIiso and VOIMRI. For metabolic tumor volume, no significant difference existed between VOIiso and VOIMRI with margin thresholds of 30 and 40% of SUVmax, and SUV 1.5. For SUVmean, no significant difference existed with 30% of SUVmax, and SUV 1.5. For total lesion glycolysis, no significant difference existed with 40% of SUVmax, SUV 1.5, and 2.0. For SD, no significant difference existed with 30% of SUVmax, SUV 1.5, and 2.0. ConclusionMargin thresholds of 30 or 40% of SUVmax and SUV 1.5 or 2.0 may be used for the VOIiso method in 18F-FDG PET images of sarcoma. VOIiso with these margin thresholds are expected to produce reliable metabolic, volumetric, and heterogeneity indexes on 18F-FDG PET images.