Seung Joon Choi

Palpable Breast Masses with Probably Benign Morphology at Sonography: Can Biopsy be Deferred?

Background: When a palpable breast mass is detected, a biopsy is usually performed even if the mass reveals probably benign morphologic features on imaging, as there is relatively little data reporting the outcome of such breast masses. Purpose: To determine the negative predictive value for sonographic evaluation of palpable breast masses with probably benign morphology, and to assess whether follow-up may be an acceptable alternative to immediate biopsy. Material and Methods: Of the 1399 sonograms of palpable masses from January 2004 to September 2005, there were 397 patients with masses of probably benign morphology. This study included 274 of these patients (age range 12–64 years, mean age 34 years) with 312 palpable masses that were pathologically confirmed by fine-needle aspiration (n=7), ultrasound (US)-guided core needle biopsy (n=180), or surgical biopsy (n=125). The false-negative rate, negative predictive value (NPV), and 95% confidence interval (CI) were calculated using the SPSS statistical software package for Windows, version 12.0. A P value <0.05 was considered statistically significant. Results: Of the 312 masses, there were 310 benign lesions and two malignancies, resulting in a false-negative rate of 0.6% (NPV 99.4%, P value=0.0432, 95% CI 0.0–1.5%). Conclusion: The negative predictive value of sonography for palpable breast masses with probably benign morphology is high (99.4%). Therefore, short-term imaging follow-up can be an acceptable alternative to immediate biopsy, similar to the management of nonpalpable probably benign lesions (BI-RADS category 3).

Validity of interferon-γ-release assays for the diagnosis of latent tuberculosis in haemodialysis patients

Haemodialysis patients are at higher risk of developing active tuberculosis (TB) infection. However, tuberculin skin tests (TST) have limitations and the diagnostic usefulness of interferon-γ-release assays (IGRAs) remains unclear in immunocompromised hosts including haemodialysis patients. Haemodialysis patients were enrolled from a dialysis centre in Korea, an intermediate TB-burden country with a high bacille Calmette-Guérin (BCG) vaccination rate. The QuantiFERON-Gold TB In tube test (QFT) and the T-SPOT TB test (TSPOT) were performed, along with the TST. We stratified patients to low- and high-risk groups, according to the risk factors for latent TB. Association between each of the three diagnostic tests and the risk of latent TB was analysed. One hundred and sixty-seven patients were enrolled. The positive rates for the TST, the QFT and TSPOT were 23.5, 45.9 and 60.4%, respectively. Previous BCG vaccination increased the TST-positive rate in the low-risk group (OR 4.438), whereas it affected neither QFT nor TSPOT. The positive QFT rates were 41.2 and 62.5% in the low- and high-risk groups, respectively. The QFT was associated with the high-risk group (OR 2.578), whereas the TST was not. The positive TSPOT rates were 58.9 and 65.7% in the low- and high-risk groups, respectively. The frequency of indeterminate results was higher for the QFT (12.6%) compared with the TSPOT (4.8%). In conclusion, the IGRAs can be useful for the diagnosis of latent TB infection in haemodialysis patients.

Multidetector CT and radiographic findings of lung injuries secondary to cardiopulmonary resuscitation

OBJECTIVES Lung injury is one of the complications of cardiopulmonary resuscitation (CPR). This is the first study to describe the MDCT and radiographic findings of lung injuries secondary to CPR. METHODS A total of 44 patients who underwent CPR for a non-traumatic cause of cardiac arrest were retrospectively included in this study. We evaluated the presence of lung injuries in the initial chest radiograph and MDCT performed immediately after CPR and described the MDCT and radiographic findings of the CPR-associated lung injuries. Finally, we evaluated the temporal pattern of lung injury on the follow-up radiographies. RESULTS Chest CT demonstrated lung injury in 54 lungs of 35 patients, while initial chest radiography detected lung abnormality in 37 lungs of 28 patients. The most common patterns of lung injuries on chest CT were bilateral (n=19), ground-glass opacity (n=30) and consolidation (n=26), distributed along the bronchovascular bundles (n=13). Most of the abnormalities were located in the posterior part of both upper lobes and both lower lobes (n=29). Among seven patients who did not have abnormalities in the initial chest radiograph, lung abnormalities were detected on the follow-up radiographies (mean follow-up duration=1.6 days, range=1-3 days) in five patients, and 28 patients who had lung abnormalities on initial radiograph were improved (n=19) or aggravated (n=8) on the follow-up radiographies. CONCLUSIONS Lung injuries are frequent complications in patients who underwent CPR. Compared with radiography, MDCT has benefits for the detection and characterisation of CPR-associated lung injuries. The most common findings of lung injuries after CPR were bilateral ground glass opacity and consolidation, usually in the dependent area of both lungs.

A Pilot Study of Intralymphatic Immunotherapy for House Dust Mite, Cat, and Dog Allergies.

Several recent clinical trials reported that intralymphatic immunotherapy (ILIT) for some allergens, such as cat dander and pollen, induce tolerance more rapidly than conventional subcutaneous or sublingual immunotherapy, have a comparable duration of effect after only 3 injections, and do not provoke serious local or systemic reactions. However, the efficacy and safety of ILIT are using Dermatophagoides farinae (Df), Dermatophagoides pteronyssinus (Dp), and dog, which are indoor allergens that are commonly found globally, need to be evaluated. Furthermore, use of multiple allergens in ILIT should be investigated. We assessed the clinical efficacy and adverse effects of ILIT using aqueous Df, Dp, dog, and cat allergens or mixtures thereof in patients with allergic rhinitis. A total of 11 subjects with AR sensitized to Df, Dp, cat, and/or dog allergens received 3 intralymphatic inguinal injections of sensitized allergen extract (HollisterStier, New Orleans, LA, USA). Clinical parameters were assessed before ILIT, and 4 months and 1 year after the first injection. Rhinitis symptoms were alleviated and quality of life was improved 4 months after ILIT (P=0.012 and P=0.007, respectively), and these improvements lasted for 1 year after ILIT (P=0.047 and P=0.009, respectively). However, we observed 2 cases of anaphylaxis, one case of a moderate-to-severe systemic hypersensitivity reaction and the other case of a severe local reaction at the injection site after ILIT. In conclusion, ILIT can rapidly improve allergy symptoms and quality of life, and this effect lasts for 1 year. In hypersensitized patients, however, ILIT can provoke severe systemic and/or local hypersensitivity reactions when performed using aqueous allergen extracts.

Sparganosis of the breast and lower extremities: sonographic appearance.

Sparganosis is a rare parasitic infection caused by larvae of the genus Spirometra. It can involve any part of the human body and usually manifests as a mass in various locations. We report a case of recurrent sparganosis in the breast and lower extremities. Our patient had recurrent subcutaneous masses in her breast and lower leg that showed characteristic ultrasonographic imaging findings of serpentine, tubular structures with surrounding increased echogenicity. These imaging findings are well correlated with pathologic findings. Worms were identified in resected specimens confirming sparganosis.

Parametric response mapping of dynamic CT for predicting intrahepatic recurrence of hepatocellular carcinoma after conventional transcatheter arterial chemoembolization

AbstractObjectivesThe aim of our study was to determine the diagnostic value of a novel image analysis method called parametric response mapping (PRM) for prediction of intrahepatic recurrence of hepatocellular carcinoma (HCC) treated with conventional transcatheter arterial chemoembolization (TACE).MethodsThis retrospective study was approved by the IRB. We recruited 55 HCC patients who achieved complete remission (CR) after TACE and received longitudinal multiphasic liver computed tomography (CT). The patients fell into two groups: the recurrent tumour group (n = 29) and the non-recurrent tumour group (n = 26). We applied the PRM analysis to see if this technique could distinguish between the two groups. The results of the PRM analysis were incorporated into a prediction algorithm. We retrospectively removed data from the last time point and attempted to predict the response to therapy of the removed data.ResultsThe PRM analysis was able to distinguish between the non-recurrent and recurrent groups successfully. The prediction algorithm detected response to therapy with an area under the curve (AUC) of 0.76, while the manual approach had AUC 0.64.ConclusionsAdopting PRM analysis can potentially distinguish between recurrent and non-recurrent HCCs and allow for prediction of response to therapy after TACE.Key Points• Parametric response mapping (PRM) could help assess patients with recurrent HCCs after TACE. • Parametric response mapping could direct patients to individualized therapy. • Longitudinal CT images were analyzed with advanced image analysis method.

Evaluation of the growth pattern of carcinoma of colon and rectum by MDCT.

Background Colorectal cancer is a leading cause of cancer morbidity and mortality worldwide. Knowledge of colorectal cancer tumor growth is of importance for basic understanding of tumor biology and for the clinical handling of the disease. Purpose To conduct a retrospective evaluation of the growth pattern of colorectal cancer by multidetector computed tomography (MDCT). Material and Methods Pathologically proven adenocarcinomas of the colon and rectum in 44 patients were examined by MDCT on at least two separate occasions with an interval of >1 month in patients not receiving therapy. Maximal longitudinal diameters, wall thicknesses, and volume changes, as determined by serial CT scans, were used in calculation of growth rates. Results Mean longitudinal diameters of tumors at initial and follow-up investigations were 3.8 cm (1.0–9.1 cm) and 5.4 cm (2.5–12.2 cm), respectively. The mean growth rate of longitudinal tumor diameter was 3.4 cm/year (0–13.8 cm/year). Mean axial wall thicknesses at initial and follow-up investigations were 1.4 cm (0.6–6.6 cm) and 1.9 cm (0.8–6.8 cm), respectively. Mean growth rate of tumor axial wall thickness was 1.0 cm/year (0–3.1 cm/year). Mean tumor volumes at initial and follow-up investigations were 1975 cm3 (172–9756 cm3; median, 1490) and 3545 cm3 (442–15211 cm3; median, 2846), respectively. Mean growth rate of tumor volume was 2912 cm3/year (216–12548 cm3/year; median, 1698), and volume doubling times varied from 0.05 to 7.1 years (mean, 1.2; median, 0.7). Significant correlations were observed between initial wall thickness and volume growth rate (p = 0.004). No significant difference was observed between other initial tumor size and growth rate. Conclusion The tumor growth doubling time of colorectal cancer has a very broad aspect. The initial wall thickness of the tumor on MDCT appears to be the most powerful parameter showing correlation with the volume growth rate.

Differentiating radiological features of rapid- and slow-growing renal cell carcinoma using multidetector computed tomography.

Purpose This study aimed to retrospectively evaluate the radiological features between rapid- and slow-growing renal cell carcinoma (RCC). Materials and Methods Twenty-five pathologically proven RCCs were reviewed with computed tomography (CT). Each tumor underwent at least 2 CT sessions. Growth rate was evaluated in terms of its maximal diameter and volume change with the serial CT scan. We reviewed 8 reports from 8 single-institution series in the world literature regarding growth rate of RCCs and determined mean growth rate. Slow- and rapid-growing RCCs were compared in relation to several radiological factors (tumor shape, initial size, initial volume, initial location, enhancement pattern, and cystic change). In addition, we evaluated differences in growth rate between asymptomatic and symptomatic RCCs. Results The mean diameter growth rate of RCC was determined as 0.49 cm/y (8 studies, 126 cases). There were 14 cases of rapid-growing RCCs (mean growth rate, 1.3 cm/y) and 11 cases of slow-growing RCCs (mean growth rate, 0.1 cm/y). The slow-growing tumors showed round shape, small initial size, small initial volume, and outer location of the kidney compared with the rapid-growing tumors. Sixteen patients (64%) were treated for incidental and 9 patients (36%) were treated for symptomatic RCCs. The asymptomatic RCCs grew at a slow rate both diametrically (P = 0.007) and volumetrically (P = 0.003). Conclusions Rapid- and slow-growing RCCs tend to show some different radiological features with respect to tumor shape, initial size, initial volume, and location. Radiological features may be helpful to predict growth rate.

Cumulative effective dose associated with computed tomography examinations in adolescent trauma patients.

Objectives The aims of this study were to analyze cumulative effective dose (cED) and to assess lifetime attributable risk (LAR) of cancer due to radiation exposure during computed tomography (CT) examinations in adolescent trauma patients. Methods Between January 2010 and May 2011, the adolescent patients with trauma were enrolled in this study. Numbers of CT examinations and body regions examined were collated, and cEDs were calculated using dose-length product values and conversion factors. Lifetime attributable risk for cancer incidence and cancer-associated mortality were quantified based on the studies of survivors of the atomic bombs on Japan. Data were stratified according to severity of trauma: minor trauma, injury severity score of less than 16; and major trauma, injury severity score of 16 or greater. Results A total of 698 CT scans were obtained on the following regions of 484 adolescent patients: head CT, n = 647; rest of the body, n = 41; and thorax, n = 10. Mean cED per patient was 3.4 mSv, and mean LARs for cancer incidence and mortality were 0.05% and 0.02%, respectively. The majority of patients (98.4%) experienced minor trauma, and their mean cED and LARs for cancer incidence and mortality (3.0 mSv and 0.04% and 0.02%, respectively) were significantly lower than those of patients with major trauma (24.3 mSv and 0.31% and 0.15%, respectively, all P values < 0.001). Conclusions The overall radiation-induced cancer risk due to CT examinations performed for the initial assessment of minor trauma was found to be relatively low in adolescent patients. However, adolescent patients with major trauma were exposed to a substantial amount of radiation during multiple CT examinations.

The Predictive Value of Tumor Size, Volume, and Markers During Radiation Therapy in Patients With Cervical Cancer.

Objectives We investigated the prognostic significance of changes in primary tumor volume and serum squamous cell carcinoma antigen (SCC-ag) levels during radiation therapy (RT) in patients with cervical cancer. Methods We conducted a review of 40 patients treated with RT. All patients received external beam RT and intracavitary brachytherapy. The primary tumor volume and squamous cell carcinoma antigen levels were measured pre-RT and mid-RT. Overall survival (OS) and progression free survival (PFS) were estimated, and possible prognostic factors for survival were analyzed. Results The correlation coefficient between primary tumor volume reduction rate (pTVRR) and serum squamous cell carcinoma antigen reduction rate in all patients was 0.550 (P < 0.001). In univariate analysis, stage more than II (P <0.001), pre-RT pTV of 55 cm3 or more (P = 0.05), mid-RT tumor size of 4 cm or more (P = 0.004), and pTVRR of 90% or less (P = 0.031) were significant unfavorable prognostic factors for PFS, whereas stage (P = 0.009) was the only significant prognostic factor for OS. Multivariable analysis revealed that none of these factors were independently associated with PFS or OS. Conclusions There was a significant correlation between pTVRR and squamous cell carcinoma antigen reduction rate. Our findings indicate that the tumor parameters such as pre-RT pTV, mid-RT tumor size, and pTVRR are associated with PFS in women with cervical cancer.