Publications by authors named "Eun-Kyung Kim"

937 Publications

Deep Learning-Based Artificial Intelligence for Mammography.

Korean J Radiol 2021 May 4. Epub 2021 May 4.

Department of Radiology, Yongin Severance Hospital, Yonsei University, College of Medicine, Yongin, Korea.

During the past decade, researchers have investigated the use of computer-aided mammography interpretation. With the application of deep learning technology, artificial intelligence (AI)-based algorithms for mammography have shown promising results in the quantitative assessment of parenchymal density, detection and diagnosis of breast cancer, and prediction of breast cancer risk, enabling more precise patient management. AI-based algorithms may also enhance the efficiency of the interpretation workflow by reducing both the workload and interpretation time. However, more in-depth investigation is required to conclusively prove the effectiveness of AI-based algorithms. This review article discusses how AI algorithms can be applied to mammography interpretation as well as the current challenges in its implementation in real-world practice.
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http://dx.doi.org/10.3348/kjr.2020.1210DOI Listing
May 2021

A New Method for Aortic Valve Planimetry with High-Resolution 3-Dimensional MRI and Its Comparison with Conventional Cine MRI and Echocardiography for Assessing the Severity of Aortic Valvular Stenosis.

Korean J Radiol 2021 Apr 23. Epub 2021 Apr 23.

Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, AB, Canada.

Objective: We aimed to compare the aortic valve area (AVA) calculated using fast high-resolution three-dimensional (3D) magnetic resonance (MR) image acquisition with that of the conventional two-dimensional (2D) cine MR technique.

Materials And Methods: We included 139 consecutive patients (mean age ± standard deviation [SD], 68.5 ± 9.4 years) with aortic valvular stenosis (AS) and 21 asymptomatic controls (52.3 ± 14.2 years). High-resolution T2-prepared 3D steady-state free precession (SSFP) images (2.0 mm slice thickness, 10 contiguous slices) for 3D planimetry (3DP) were acquired with a single breath hold during mid-systole. 2D SSFP cine MR images (6.0 mm slice thickness) for 2D planimetry (2DP) were also obtained at three aortic valve levels. The calculations for the effective AVA based on the MR images were compared with the transthoracic echocardiographic (TTE) measurements using the continuity equation.

Results: The mean AVA ± SD derived by 3DP, 2DP, and TTE in the AS group were 0.81 ± 0.26 cm², 0.82 ± 0.34 cm², and 0.80 ± 0.26 cm², respectively ( = 0.366). The intra-observer agreement was higher for 3DP than 2DP in one observer: intraclass correlation coefficient (ICC) of 0.95 (95% confidence interval [CI], 0.94-0.97) and 0.87 (95% CI, 0.82-0.91), respectively, for observer 1 and 0.97 (95% CI, 0.96-0.98) and 0.98 (95% CI, 0.97-0.99), respectively, for observer 2. Inter-observer agreement was similar between 3DP and 2DP, with the ICC of 0.92 (95% CI, 0.89-0.94) and 0.91 (95% CI, 0.88-0.93), respectively. 3DP-derived AVA showed a slightly higher agreement with AVA measured by TTE than the 2DP-derived AVA, with the ICC of 0.87 (95% CI, 0.82-0.91) vs. 0.85 (95% CI, 0.79-0.89).

Conclusion: High-resolution 3D MR image acquisition, with single-breath-hold SSFP sequences, gave AVA measurement with low observer variability that correlated highly with those obtained by TTE.
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http://dx.doi.org/10.3348/kjr.2020.1218DOI Listing
April 2021

Added Value of MRI for Invasive Breast Cancer including the Entire Axilla for Evaluation of High-Level or Advanced Axillary Lymph Node Metastasis in the Post-ACOSOG Z0011 Trial Era.

Radiology 2021 Apr 27:202683. Epub 2021 Apr 27.

From the Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea (J.H.B., Y.V.P., J.H.Y., H.J.M., E.K.K., M.J.K.); Department of Radiology and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Republic of Korea (J.H.B.); Department of Radiology, Yonsei University College of Medicine, Yongin Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yongin, Gyeonggi-do, Republic of Korea (E.K.K.); and Department of Radiology, NHIS Ilsan Hospital, Goyang, Republic of Korea (J.K.Y.).

Background In the post-American College of Surgeons Oncology Group Z0011 trial era, radiologists have increasingly focused on excluding high-level or advanced axillary lymph node metastasis (ALNM) by using an additional MRI scan positioned higher than lower axillae; however, the value of these additional scans remains undetermined. Purpose To evaluate whether a standard MRI protocol is sufficient to exclude high-level or advanced ALNM in breast cancer or additional MRI of entire axilla is needed. Materials and Methods This retrospective study evaluated women with invasive breast cancer who underwent breast MRI from April 2015 to December 2016. Some underwent neoadjuvant chemotherapy (NAC) and others underwent upfront surgery. Standard (routine axial scans including the lower axillae) and combined (routine axial scans plus additional scans including the entire axilla) MRI protocols were compared for high-level or advanced ALNM detection. Clinical-pathologic characteristics were analyzed. Uni- and multivariable logistic regression was performed to identify predictors of high-level or advanced ALNM. Results A total of 435 women (mean age ± standard deviation, 52 years ± 11) were evaluated (65 in the NAC group, 370 in the non-NAC group). With the standard MRI protocol, predictors of high-level ALNM were peritumoral edema (odds ratio [OR], 12.3; 95% CI: 3.9, 39.4; < .001) and positive axilla (OR, 5.9; 95% CI: 2.0, 15.2; < .001). Only three of 289 women with negative axillae without peritumoral edema had high-level ALNM. Predictors of advanced ALNM were positive axillae (OR, 8.9; 95% CI: 3.7, 21.5; < .001) and peritumoral edema (OR, 2.8; 95% CI: 1.1, 6.9; = .03). Only six of 310 women who had negative axillae without peritumoral edema had advanced ALNM. Conclusion The performance of standard MRI was satisfactory in excluding high-level and advanced axillary lymph node metastasis in most patients with breast cancer. However, the presence of peritumoral edema or positive axillae in the MRI findings emphasizes the benefits of a combined MRI protocol. © RSNA, 2021 See also the editorial by Abe in this issue.
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http://dx.doi.org/10.1148/radiol.2021202683DOI Listing
April 2021

Licoricidin Abrogates T Cell Activation by Modulating PTPN1 Activity and Attenuates Atopic Dermatitis In Vivo.

J Invest Dermatol 2021 Apr 12. Epub 2021 Apr 12.

School of Life Sciences, Immune Synapse and Cell Therapy Research Center, Gwangju Institute of Science and Technology, Gwangju 61005, Republic of Korea.

Licoricidin, the fifth-highest fraction among the isolated 48 molecules from Glycyrrhiza uralensis extracts, has been known as anti-inflammatory bioactive molecules, however, few studies have shown its inhibitory effect on T cell activation and atopic dermatitis. The present study examined the therapeutic potential of licoricidin in atopic dermatitis by modulating T cell activation with molecular mechanism. Licoricidin attenuated the expression of IL-2 mRNA in stimulated T cells without cytotoxicity. Since tyrosine-protein phosphatase non-receptor type 1 (PTPN1) was predicted to interact physically with licoricidin in T cells in silico analysis, the results of PTPN1 activity assay and phosphorylation study predicted that licoricidin might abrogate the activity of PTPN1 during T cell activation. Pre-treatment with licoricidin controlled the dephosphorylation of Lck on T cell receptor (TCR)-mediated stimulation. Moreover, licoricidin alleviated the symptoms of DNCB/mite extract-induced AD, including ear thickness and serum IgE level. Microscopic analysis also showed the effects of licoricidin on the thickness of dermis/epidermis and infiltration of immune cells. Furthermore, mRNA level of pro-inflammatory cytokines were attenuated in the ear lesions of licoricidin-treated AD mice. Therefore, licoricidin has therapeutic potential for treating AD and its underlying mechanism involves effective modulation of T cell activation by controlling PTPN1 to maintain Lck phosphorylation.
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http://dx.doi.org/10.1016/j.jid.2021.02.759DOI Listing
April 2021

High SLC2A1 expression associated with suppressing CD8 T cells and B cells promoted cancer survival in gastric cancer.

PLoS One 2021 18;16(3):e0245075. Epub 2021 Mar 18.

Department of Internal Medicine, Eulji Hospital, Eulji University School of Medicine, Seoul, Republic of Korea.

High expression of glucose transporter family members, which augment glucose uptake and glycolytic flux, has been shown to play a pivotal role in the proliferation and survival of tumor cells, contributing to the energy supply, biosynthesis and homeostasis of cancer cells. Among the many members, solute carrier family 2 member 1 (SLC2A1) encodes a glucose transporter, GLUT1, that is critical in the metabolism of glucose, which is an energy source for cell growth that contributes to cancer progression and development. The aim of this study was to analyze the survival and genetic changes/immune profiles in patients with gastric cancer with high SLC2A1 expression and to provide treatment for improving prognosis. This study investigated the clinicopathologic parameters, the proportion of immune cells and gene sets affecting SLC2A1 expression in 279 and 415 patients with gastric cancer from the Eulji Hospital cohort and The Cancer Genome Atlas, respectively. We assessed the response to conventional chemotherapy drugs, including fluorouracil, a compound of fluoropyrimidine S-1, oxaliplatin, and all-trans-retinoic acid (ATRA), in gastric cancer cell lines with high SLC2A1 expression. High SLC2A1 expression was associated with poor prognosis, cancer cell proliferation, decreased immune cells, including CD8 T cells and B cells, and a low prognostic nutrition index, representing body nutrition-related status. In pathway network analysis, SLC2A1 was indirectly linked to the retinoic signaling pathway and negatively regulated immune cells/receptors. In the drug response analysis, the drug ATRA inhibited gastric cancer cell lines with high SLC2A1 expression. Treatment involving the use of SLC2A1 could contribute to better clinical management/research for patients with gastric cancer.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0245075PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7971512PMC
March 2021

Application of artificial intelligence-based computer-assisted diagnosis on synthetic mammograms from breast tomosynthesis: comparison with digital mammograms.

Eur Radiol 2021 Mar 12. Epub 2021 Mar 12.

Department of Radiology, Yongin Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 363, Dongbaekjukjeon-daero, Giheung-gu, Yongin-si, Gyeonggi-do, Republic of Korea.

Objective: To compare the diagnostic agreement and performances of synthetic and conventional mammograms when artificial intelligence-based computer-assisted diagnosis (AI-CAD) is applied.

Material And Method: From January 2017 to April 2017, 192 patients (mean age 53.7 ± 11.7 years) diagnosed with 203 breast cancers were enrolled in this retrospective study. All patients underwent digital breast tomosynthesis (DBT) with digital mammograms (DM) simultaneously. Commercial AI-CAD was applied to the reconstructed synthetic mammograms (SM) from DBT and DM respectively and abnormality scores were calculated. We compared the median abnormality scores between DM and SM with the Wilcoxon signed-rank test and used the Bland-Altman analysis to evaluate agreements between the two mammograms and to investigate clinicopathological factors which might affect agreement. Diagnostic performances were compared using an area under the receiver operating characteristic curve (AUC).

Result: The abnormality scores showed a mean difference (bias) of - 3.26 (95% limits of agreement: - 32.69, 26.18) between the two mammograms by the Bland-Altman analysis. The concordance correlation coefficient was 0.934 (95% CI: 0.92, 0.946), suggesting high reproducibility. SM showed higher abnormality scores in cancer with distortion and occult findings, T1 and N0 cancer, and luminal type cancer than DM (all p ≤ 0.001). Diagnostic performance did not differ between the mammograms (AUC 0.945 for conventional mammograms, 0.938 for synthetic mammograms, p = 0.499).

Conclusion: AI-CAD can also work well on synthetic mammograms, showing good agreement and comparable diagnostic performance compared to its application to DM.

Key Points: • AI-CAD which was developed based on imaging findings of digital mammograms can also be applied to synthetic mammograms. • AI-CAD showed good agreement and similar diagnostic performance when applied to both synthetic and digital mammograms. • With AI-CAD, synthetic mammograms showed relatively higher abnormality scores in cancer with distortion and occult findings, T1 and N0 cancer, and luminal type cancer than digital mammograms.
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http://dx.doi.org/10.1007/s00330-021-07796-yDOI Listing
March 2021

Standardized Pathology Report for Breast Cancer.

J Breast Cancer 2021 Feb;24(1):1-21

Department of Pathology, Busan Paik Hospital, Inje University, Busan, Korea.

Given the recent advances in management and understanding of breast cancer, a standardized pathology report reflecting these changes is critical. To meet this need, the Breast Pathology Study Group of the Korean Society of Pathologists has developed a standardized pathology reporting format for breast cancer, consisting of 'standard data elements,' 'conditional data elements,' and a biomarker report form. The 'standard data elements' consist of the basic pathologic features used for prognostication, while other factors related to prognosis or diagnosis are described in the 'conditional data elements.' In addition to standard data elements, all recommended issues are also presented. We expect that this standardized pathology report for breast cancer will improve diagnostic concordance and communication between pathologists and clinicians, as well as between pathologists inter-institutionally.
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http://dx.doi.org/10.4048/jbc.2021.24.e5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920867PMC
February 2021

Trichofolliculoma in the Auricle.

Ear Nose Throat J 2021 Feb 15:145561321995599. Epub 2021 Feb 15.

Department of Otorhinolaryngology, 65413National Health Insurance Service Ilsan Hospital, Goyang, Korea.

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http://dx.doi.org/10.1177/0145561321995599DOI Listing
February 2021

SILAC-Based Quantitative Proteomic Analysis of Oxaliplatin-Resistant Pancreatic Cancer Cells.

Cancers (Basel) 2021 Feb 10;13(4). Epub 2021 Feb 10.

Center for Bioanalysis, Division of Chemical and Medical Metrology, Korea Research Institute of Standards and Science, Daejeon 34113, Korea.

Oxaliplatin is a commonly used chemotherapeutic drug for the treatment of pancreatic cancer. Understanding the cellular mechanisms of oxaliplatin resistance is important for developing new strategies to overcome drug resistance in pancreatic cancer. In this study, we performed a stable isotope labelling by amino acids in cell culture (SILAC)-based quantitative proteomics analysis of oxaliplatin-resistant and sensitive pancreatic cancer PANC-1 cells. We identified 107 proteins whose expression levels changed (thresholds of 2-fold changes and -value ≤ 0.05) between oxaliplatin-resistant and sensitive cells, which were involved in multiple biological processes, including DNA repair, cell cycle process, and type I interferon signaling pathway. Notably, myristoylated alanine-rich C-kinase substrate (MARCKS) and Wntless homolog protein (WLS) were upregulated in oxaliplatin-resistant cells compared to sensitive cells, as confirmed by qRT-PCR and Western blot analysis. We further demonstrated the activation of AKT and β-catenin signaling (downstream targets of MARCKS and WLS, respectively) in oxaliplatin-resistant PANC-1 cells. Additionally, we show that the siRNA-mediated suppression of both MARCKS and WLS enhanced oxaliplatin sensitivity in oxaliplatin-resistant PANC-1 cells. Taken together, our results provide insights into multiple mechanisms of oxaliplatin resistance in pancreatic cancer cells and reveal that MARCKS and WLS might be involved in the oxaliplatin resistance.
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http://dx.doi.org/10.3390/cancers13040724DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7916634PMC
February 2021

Guideline Implementation on Fine-Needle Aspiration for Thyroid Nodules: Focusing on Micronodules.

Endocr Pract 2020 Sep;26(9):1017-1025

Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.. Electronic address:

Objective: We investigated patients who were referred to our institution after fine-needle aspiration (FNA) was performed at outside clinics to evaluate how many nodules satisfied the FNA indications of the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and compare that to the number of thyroid nodules that satisfy the FNA indications of the American College of Radiology (ACR)-TIRADS and American Thyroid Association (ATA) guidelines.

Methods: Between January 2018 and December 2018, 2,628 patients were included in our study. The included patients were those referred for thyroid surgery after having a suspicious thyroid nodule. We retrospectively applied the three guidelines to each thyroid nodule and determined whether each nodule satisfied the FNA indications. We compared the proportion of nodules satisfying the FNA indications of each guideline using a generalized linear model and generalized estimating equation.

Results: The median size of the 2,628 thyroid nodules was 0.9 cm (range, 0.2 to 9.5 cm). We found that FNA was not indicated for 54.1%, 47.7%, and 19.1% of nodules and 87.3%, 99.0%, and 97.8% among them were micronodules (<1 cm) according to the ACR-TIRADS, ATA guideline, and K-TIRADS, respectively. The proportion of micronodules which satisfied the FNA indications was significantly higher for the K-TIRADS (65.1%) compared to the ACR TIRADS (12.1%) and ATA guideline (12.1%) (P<.001).

Conclusion: Among patients referred for thyroid surgery to our institutions, about 35% of the micronodules underwent FNA despite not being appropriate for indications by the K-TIRADS. Systematic training for physicians as well as modifications to increase the sensitivity of the guideline may be needed to reduce the overdiagnosis of thyroid cancers, especially for micronodules.
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http://dx.doi.org/10.4158/EP-2020-0163DOI Listing
September 2020

Standardized pathology report for breast cancer.

J Pathol Transl Med 2021 Jan 11;55(1):1-15. Epub 2021 Jan 11.

Department of Pathology, Busan Paik Hospital, Inje University, Busan, Korea.

Given the recent advances in management and understanding of breast cancer, a standardized pathology report reflecting these changes is critical. To meet this need, the Breast Pathology Study Group of the Korean Society of Pathologists has developed a standardized pathology reporting format for breast cancer, consisting of 'standard data elements,' 'conditional data elements,' and a biomarker report form. The 'standard data elements' consist of the basic pathologic features used for prognostication, while other factors related to prognosis or diagnosis are described in the 'conditional data elements.' In addition to standard data elements, all recommended issues are also presented. We expect that this standardized pathology report for breast cancer will improve diagnostic concordance and communication between pathologists and clinicians, as well as between pathologists inter-institutionally.
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http://dx.doi.org/10.4132/jptm.2020.11.20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7829577PMC
January 2021

Deep learning-based computer-aided diagnosis in screening breast ultrasound to reduce false-positive diagnoses.

Sci Rep 2021 Jan 11;11(1):395. Epub 2021 Jan 11.

Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.

A major limitation of screening breast ultrasound (US) is a substantial number of false-positive biopsy. This study aimed to develop a deep learning-based computer-aided diagnosis (DL-CAD)-based diagnostic model to improve the differential diagnosis of screening US-detected breast masses and reduce false-positive diagnoses. In this multicenter retrospective study, a diagnostic model was developed based on US images combined with information obtained from the DL-CAD software for patients with breast masses detected using screening US; the data were obtained from two hospitals (development set: 299 imaging studies in 2015). Quantitative morphologic features were obtained from the DL-CAD software, and the clinical findings were collected. Multivariable logistic regression analysis was performed to establish a DL-CAD-based nomogram, and the model was externally validated using data collected from 164 imaging studies conducted between 2018 and 2019 at another hospital. Among the quantitative morphologic features extracted from DL-CAD, a higher irregular shape score (P = .018) and lower parallel orientation score (P = .007) were associated with malignancy. The nomogram incorporating the DL-CAD-based quantitative features, radiologists' Breast Imaging Reporting and Data Systems (BI-RADS) final assessment (P = .014), and patient age (P < .001) exhibited good discrimination in both the development and validation cohorts (area under the receiver operating characteristic curve, 0.89 and 0.87). Compared with the radiologists' BI-RADS final assessment, the DL-CAD-based nomogram lowered the false-positive rate (68% vs. 31%, P < .001 in the development cohort; 97% vs. 45% P < .001 in the validation cohort) without affecting the sensitivity (98% vs. 93%, P = .317 in the development cohort; each 100% in the validation cohort). In conclusion, the proposed model showed good performance for differentiating screening US-detected breast masses, thus demonstrating a potential to reduce unnecessary biopsies.
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http://dx.doi.org/10.1038/s41598-020-79880-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7801712PMC
January 2021

Changes in cancer detection and false-positive recall in mammography using artificial intelligence: a retrospective, multireader study.

Lancet Digit Health 2020 03 6;2(3):e138-e148. Epub 2020 Feb 6.

Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea. Electronic address:

Background: Mammography is the current standard for breast cancer screening. This study aimed to develop an artificial intelligence (AI) algorithm for diagnosis of breast cancer in mammography, and explore whether it could benefit radiologists by improving accuracy of diagnosis.

Methods: In this retrospective study, an AI algorithm was developed and validated with 170 230 mammography examinations collected from five institutions in South Korea, the USA, and the UK, including 36 468 cancer positive confirmed by biopsy, 59 544 benign confirmed by biopsy (8827 mammograms) or follow-up imaging (50 717 mammograms), and 74 218 normal. For the multicentre, observer-blinded, reader study, 320 mammograms (160 cancer positive, 64 benign, 96 normal) were independently obtained from two institutions. 14 radiologists participated as readers and assessed each mammogram in terms of likelihood of malignancy (LOM), location of malignancy, and necessity to recall the patient, first without and then with assistance of the AI algorithm. The performance of AI and radiologists was evaluated in terms of LOM-based area under the receiver operating characteristic curve (AUROC) and recall-based sensitivity and specificity.

Findings: The AI standalone performance was AUROC 0·959 (95% CI 0·952-0·966) overall, and 0·970 (0·963-0·978) in the South Korea dataset, 0·953 (0·938-0·968) in the USA dataset, and 0·938 (0·918-0·958) in the UK dataset. In the reader study, the performance level of AI was 0·940 (0·915-0·965), significantly higher than that of the radiologists without AI assistance (0·810, 95% CI 0·770-0·850; p<0·0001). With the assistance of AI, radiologists' performance was improved to 0·881 (0·850-0·911; p<0·0001). AI was more sensitive to detect cancers with mass (53 [90%] vs 46 [78%] of 59 cancers detected; p=0·044) or distortion or asymmetry (18 [90%] vs ten [50%] of 20 cancers detected; p=0·023) than radiologists. AI was better in detection of T1 cancers (73 [91%] vs 59 [74%] of 80; p=0·0039) or node-negative cancers (104 [87%] vs 88 [74%] of 119; p=0·0025) than radiologists.

Interpretation: The AI algorithm developed with large-scale mammography data showed better diagnostic performance in breast cancer detection compared with radiologists. The significant improvement in radiologists' performance when aided by AI supports application of AI to mammograms as a diagnostic support tool.

Funding: Lunit.
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http://dx.doi.org/10.1016/S2589-7500(20)30003-0DOI Listing
March 2020

Clinicopathologic Analysis of Cathepsin B as a Prognostic Marker of Thyroid Cancer.

Int J Mol Sci 2020 Dec 15;21(24). Epub 2020 Dec 15.

Department of Surgery, Gil Medical Center, College of Medicine, Gachon University, Incheon 21999, Korea.

Thyroid cancer incidence has increased worldwide; however, investigations of thyroid cancer-related factors as potential prognosis markers remain insufficient. Secreted proteins from the cancer secretome are regulators of several molecular mechanisms and are, thereby, ideal candidates for potential markers. We aimed to identify a specific factor for thyroid cancer by analyzing the secretome from normal thyroid cells, papillary thyroid cancer (PTC) cells, and anaplastic thyroid cancer cells using mass spectrometry (MS). Cathepsin B (CTSB) showed highest expression in PTC cells compared to other cell lines, and CTSB levels in tumor samples were higher than that seen in normal tissue. Further, among thyroid cancer patients, increased CTSB expression was related to higher risk of lymph node metastasis (LNM) and advanced N stage. Overexpression of CTSB in thyroid cancer cell lines activated cell migration by increasing the expression of vimentin and Snail, while its siRNA-mediated silencing inhibited cell migration by decreasing vimentin and Snail expression. Mechanistically, CTSB-associated enhanced cell migration and upregulation of vimentin and Snail occurred via increased phosphorylation of p38. As our results suggest that elevated CTSB in thyroid cancer induces the expression of metastatic proteins and thereby leads to LNM, CTSB may be a good and clinically relevant prognostic marker.
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http://dx.doi.org/10.3390/ijms21249537DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7765333PMC
December 2020

Prediction of breast cancer molecular subtypes using radiomics signatures of synthetic mammography from digital breast tomosynthesis.

Sci Rep 2020 12 9;10(1):21566. Epub 2020 Dec 9.

Department of Radiology, Research Institute of Radiological Science and Center for Clinical Image Data Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.

We aimed to predict molecular subtypes of breast cancer using radiomics signatures extracted from synthetic mammography reconstructed from digital breast tomosynthesis (DBT). A total of 365 patients with invasive breast cancer with three different molecular subtypes (luminal A + B, luminal; HER2-positive, HER2; triple-negative, TN) were assigned to the training set and temporally independent validation cohort. A total of 129 radiomics features were extracted from synthetic mammograms. The radiomics signature was built using the elastic-net approach. Clinical features included patient age, lesion size and image features assessed by radiologists. In the validation cohort, the radiomics signature yielded an AUC of 0.838, 0.556, and 0.645 for the TN, HER2 and luminal subtypes, respectively. In a multivariate analysis, the radiomics signature was the only independent predictor of the molecular subtype. The combination of the radiomics signature and clinical features showed significantly higher AUC values than clinical features only for distinguishing the TN subtype. In conclusion, the radiomics signature showed high performance for distinguishing TN breast cancer. Radiomics signatures may serve as biomarkers for TN breast cancer and may help to determine the direction of treatment for these patients.
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http://dx.doi.org/10.1038/s41598-020-78681-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7726048PMC
December 2020

Impact of Body Mass Index Change on the Prognosis of Chronic Obstructive Pulmonary Disease.

Respiration 2020;99(11):943-953. Epub 2020 Dec 2.

Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Background: Low body mass index (BMI) is an important prognostic factor in chronic obstructive pulmonary disease (COPD). However, the prognostic value of longitudinal BMI change in COPD has not been well studied.

Objective: We aimed to evaluate the association between longitudinal change of BMI and prognosis of COPD in Korean COPD cohort.

Methods: This study was conducted in a prospective Korean Obstructive Lung Disease (KOLD) cohort where COPD patients were recruited on an outpatient basis at 17 hospitals in South Korea. Annual BMI was measured over a period of 3 years or more. All patients were categorized into underweight (UW), normal weight (NW), and overweight (OW) groups by BMI. Clinical characteristics and outcomes including exacerbation and mortality were compared based on initial BMI grade and longitudinal change of BMI.

Results: This analysis included 537 COPD patients (mean age = 67.4 ± 7.9 years, male = 97.0%, mean BMI = 23.0 ± 3.1) of KOLD cohort. The proportions of UW, NW, and OW groups were 6.9% (n = 37), 68.9% (n = 370), and 24.2% (n = 130) respectively. The UW group showed lower forced expiratory volume in 1 s (FEV1) (p < 0.001), shorter 6-minute walk distance (p < 0.001), higher modified Medical Research Council score (p = 0.002), higher St. George Respiratory Questionnaire score (p < 0.001), higher emphysema index (p < 0.001) and air-trapping index (p < 0.001), and more frequent (p < 0.001) and severe exacerbations (p = 0.003). Multivariable analyses demonstrated that decrease of BMI (hazard ratio [HR] = 0.786, p = 0.038) and the descent of BMI group (HR = 3.167, p = 0.016) at 3-year follow-up along with age, initial BMI, post-bronchodilator FEV1, and severe exacerbations were significantly associated with mortality.

Conclusions: This study demonstrated that BMI decrease during follow-up was independently associated with exacerbation and higher mortality of COPD, suggesting BMI reduction in COPD should be carefully managed.
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http://dx.doi.org/10.1159/000511022DOI Listing
December 2020

Author Correction: NOVA1 induction by inflammation and NOVA1 suppression by epigenetic regulation in head and neck squamous cell carcinoma.

Sci Rep 2020 Nov 30;10(1):21299. Epub 2020 Nov 30.

Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, 03722, South Korea.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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http://dx.doi.org/10.1038/s41598-020-77481-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7704637PMC
November 2020

Exploring the Role of a Novel Peptide from Larvae in Ameliorating Lipid Metabolism in Obesity.

Int J Mol Sci 2020 Nov 12;21(22). Epub 2020 Nov 12.

Department of Food Science and Nutrition, Dong-A University, Busan 49315, Korea.

The aim of this study was to identify an anti-obesity peptide from and investigate the lipid metabolic mechanism. Enzymatically hydrolyzed larvae were further separated using tangential flow filtration and consecutive chromatographic processes. Finally, an anti-obesity peptide that showed the highest inhibitory effect on lipid accumulation was obtained, and the sequence was Glu-Ile-Ala-Gln-Asp-Phe-Lys-Thr-Asp-Leu (EIA10). EIA10 decreased lipid aggregation in vitro and significantly reduced the accumulation of body weight gain, liver weight, and adipose tissue weight in high-fat-fed mice. Compared with the control group, the levels of total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL), insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) in the high-fat diet (HFD) group increased significantly, and the content of high-density lipoprotein cholesterol (HDL) in the serum decreased significantly. On the contrary, the levels of TC, TG, and insulin in the EIA10 group decreased significantly, and the HDL content increased significantly compared with the HFD group. Additionally, EIA10 dramatically decreased mRNA and protein levels of transcription factors involved in lipid adipogenesis. Taken together, our results suggest that EIA10 could be a promising agent for the treatment and prevention of obesity.
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http://dx.doi.org/10.3390/ijms21228537DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7698306PMC
November 2020

Strap muscle invasion in differentiated thyroid cancer does not impact disease-specific survival: a population-based study.

Sci Rep 2020 10 26;10(1):18248. Epub 2020 Oct 26.

Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.

The American Joint Committee on Cancer (AJCC) 8 TNM staging system of differentiated thyroid cancer defines gross strap muscle invasion as T3b stage. However, the impact of strap muscle invasion on disease-specific survival (DSS) remains controversial. To elucidate the survival impact of strap muscle invasion of any degree in thyroid cancers, the Surveillance, Epidemiology, and End Results (SEER) database (1973-2018) was queried for thyroid cancer only patients on July 2019 (n = 19,914). The Cox proportional hazard analysis with multivariable adjustment revealed that strap muscle invasion was not a significant factor for DSS in tumors equal to or smaller than 40 mm (hazard ratio (HR) = 1.620 [confidence interval (CI) 0.917 - 2.860]; p = 0.097). The competing risk analysis with multivariable adjustment showed that strap muscle invasion did not significantly impact DSS regardless of tumor size or cause of death (cancer-caused death (Subdistribution HR (SDHR) = 1.567 [CI 0.984 - 2.495]; p = 0.059); deaths to other causes (SDHR = 1.155 [CI 0.842 - 1.585]; p = 0.370). A "modified" staging schema discarding strap muscle invasion as a T stage criterion showed better 10-year DSS distinction between T stages. The modified staging schema may better reflect cancer-caused death risk and may prevent potential overstaging.
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http://dx.doi.org/10.1038/s41598-020-75161-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7589560PMC
October 2020

Calcifications with suspicious morphology at mammography: should they all be considered with the same clinical significance?

Eur Radiol 2021 Apr 22;31(4):2529-2538. Epub 2020 Sep 22.

Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.

Objectives: To evaluate the positive predictive values (PPVs) of calcifications with suspicious morphology by incorporating distribution and clinical factors in two separate cohorts to provide more practical guidance for management.

Methods: This retrospective study included 1076 consecutive women from two cohorts (cohort A, 556; cohort B, 520), with calcifications of suspicious morphology seen on mammography that were pathologically confirmed or followed with mammography. Reader-averaged PPVs of the calcifications were analyzed and compared by logistic regression using the generalized estimating equation. Multivariate logistic regression analysis was performed to evaluate independent factors associated with the PPVs of suspicious calcifications.

Results: Overall reader-averaged PPVs of suspicious calcifications were 16.8% and 15.2% in cohort A and B, respectively. Reader-averaged PPVs according to morphology in cohort A and B were as follows: amorphous 9.1%, 6.4%; coarse heterogeneous 16.1%, 22.1%; fine pleomorphic 78.8%, 44.7%; and fine linear branching 78.6%, 85.1%, respectively (p < 0.001). PPVs for diffuse amorphous combinations were 2.6% and 2.6%, and for regional amorphous calcifications, 3.6% and 3.1%, respectively. Among diffuse amorphous calcifications, the PPVs for women ≥ 50 years and women without a personal history of breast cancer ranged from 0.0 to 1.9%.

Conclusions: Amorphous calcifications have lower reader-averaged PPVs compared to calcifications with other suspicious morphology, falling into the BI-RADS 4a assessment (PPV 2-10%). Amorphous calcifications with diffuse distributions detected in women > 50 years old and without a personal history of breast cancer have reader-averaged PPVs < 2.0%. Further prospective studies are necessary to confirm if these patients can be managed with imaging follow-up.

Key Points: • In two cohorts, reader-averaged positive predictive values (PPVs) for suspicious calcifications showed lower rates for amorphous calcifications. • In two separate cohorts, reader-averaged PPVs showed lower rates for diffuse amorphous calcifications, falling into the BI-RADS 4a assessment category (PPV 2-10%). • Diffuse amorphous calcifications detected in women > 50 years old and without a personal history of breast cancer have reader-averaged PPVs < 2.0%.
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http://dx.doi.org/10.1007/s00330-020-07215-8DOI Listing
April 2021

Diagnosis of thyroid nodules on ultrasonography by a deep convolutional neural network.

Sci Rep 2020 09 17;10(1):15245. Epub 2020 Sep 17.

Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.

The purpose of this study was to evaluate and compare the diagnostic performances of the deep convolutional neural network (CNN) and expert radiologists for differentiating thyroid nodules on ultrasonography (US), and to validate the results in multicenter data sets. This multicenter retrospective study collected 15,375 US images of thyroid nodules for algorithm development (n = 13,560, Severance Hospital, SH training set), the internal test (n = 634, SH test set), and the external test (n = 781, Samsung Medical Center, SMC set; n = 200, CHA Bundang Medical Center, CBMC set; n = 200, Kyung Hee University Hospital, KUH set). Two individual CNNs and two classification ensembles (CNNE1 and CNNE2) were tested to differentiate malignant and benign thyroid nodules. CNNs demonstrated high area under the curves (AUCs) to diagnose malignant thyroid nodules (0.898-0.937 for the internal test set and 0.821-0.885 for the external test sets). AUC was significantly higher for CNNE2 than radiologists in the SH test set (0.932 vs. 0.840, P < 0.001). AUC was not significantly different between CNNE2 and radiologists in the external test sets (P = 0.113, 0.126, and 0.690). CNN showed diagnostic performances comparable to expert radiologists for differentiating thyroid nodules on US in both the internal and external test sets.
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http://dx.doi.org/10.1038/s41598-020-72270-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7498581PMC
September 2020

Survival Rates of Breast Cancer Patients Aged 40 to 49 Years according to Detection Modality in Korea: Screening Ultrasound versus Mammography.

Korean J Radiol 2021 02 28;22(2):159-167. Epub 2020 Aug 28.

Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Objective: The aim of this study was to compare the survival rates of Korean females aged 40 to 49 years with breast cancer detected by supplemental screening ultrasound (US) or screening mammography alone.

Materials And Methods: This single-institution retrospective study included 240 patients with breast cancer (mean age, 45.1 ± 2.8 years) detected by US or mammography who had undergone breast surgery between 2003 and 2008. Medical records were reviewed for clinicopathologic characteristics and detection methods. Disease-free survival (DFS) and overall survival (OS) were compared between patients with breast cancer in the US and mammography groups using the log-rank test. Multivariable cox regression analysis was used to identify independent variables associated with DFS and OS.

Results: Among the 240 cases of breast cancer, 43 were detected by supplemental screening US and 197 by screening mammography (mean follow-up: 7.4 years, 93.3% with dense breasts). There were 19 recurrences and 16 deaths, all occurring in the mammography group. While the US group did not differ from the mammography group in tumor stage, the patients in this group were more likely to undergo breast-conserving surgery and radiation therapy than the mammography group. The US group also showed better DFS ( = 0.016); however, OS did not differ between the two groups ( = 0.058). In the multivariable analysis, the US group showed a lower risk of recurrence (hazard ratio, 0.097; 95% confidence interval, 0.001-0.705) compared to the mammography group.

Conclusion: Our study found that Korean females aged 40-49 years with US-detected breast cancer showed better DFS than those with mammography-detected breast cancer. However, there were no statistically significant differences in OS.
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http://dx.doi.org/10.3348/kjr.2019.0588DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7817635PMC
February 2021

VGLL4 with low YAP expression is associated with favorable prognosis in colorectal cancer.

APMIS 2020 Oct 14;128(10):543-551. Epub 2020 Sep 14.

Department of Pathology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea.

The Hippo pathway is a tumor suppressive pathway regulating Yes-associated protein-TEA domain-containing sequence-specific transcription factor (YAP-TEAD) complex. VGLL (Vestigial-like) proteins are transcriptional cofactors competing with YAP for TEAD binding and interfering oncogenic activity of YAP-TEAD complex. We evaluated the expression of VGLL4, YAP, and TEAD4 and assessed their correlations with clinicopathologic factors and prognostic effects in 295 colorectal cancers. VGLL4 was positive in 164 (55.6%) cases and correlated with small tumor size, low pT classification, and absence of lymph node metastasis. YAP and TEAD4 were highly expressed in 138 (46.8%) cases and 144 (48.8%) cases, respectively, and high expressions were associated with presence of lymphovascular invasion and lymph node metastasis, or distant metastasis. VGLL4 expression was significantly correlated with low YAP expression (p < 0.001) and had significantly better overall survival than negative expression (p < 0.001). High YAP (HR, 2.108; 95% confidence interval, 1.239-3.584; p = 0.006) and TEAD4 (1.724; 1.021-2.912; p = 0.042) expressions were associated with poor overall survivals. The combined VGLL4 YAP expression showed the best overall survival than other groups (p < 0.001). VGLL4 expression (0.381; 0.212-0.683; p = 0.001) and combined VGLL4 YAP expression (0.227; 0.108-0.475; p < 0.001) were independent good prognostic factors in colorectal cancers. The expressions of VGLL4, YAP, and TEAD4 can be used as prognostic markers in colorectal cancer patients.
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http://dx.doi.org/10.1111/apm.13070DOI Listing
October 2020

Inverted Papilloma of the Epiglottis: A Rare Case.

Ear Nose Throat J 2020 Aug 3:145561320945567. Epub 2020 Aug 3.

Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, Goyang, Korea.

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http://dx.doi.org/10.1177/0145561320945567DOI Listing
August 2020

Brown adipose tissue ameliorates autoimmune arthritis via inhibition of Th17 cells.

Sci Rep 2020 07 23;10(1):12374. Epub 2020 Jul 23.

Laboratory of Immune Network, Conversant Research Consortium in Immunologic Disease, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea.

The functions of adipose tissue are associated with autoimmune diseases, such as rheumatoid arthritis (RA). Some studies have shown that the three compositions of adipose tissue (white, brown, and beige) have different functions. Brown adipose tissue (BAT) is known to secrete several factors that differ from those in white adipose tissue. This suggests that BAT might have potential positive advantages in the physiology of autoimmune diseases. We compared the functions of collagen-induced arthritis mice-derived BAT (CIA BAT) with normal mice-derived BAT. DBA/1J mice (6-7 weeks of age) were immunized by intradermal injection at the base of the tail with 100 μg of bovine type II collagen (CII) emulsified in complete Freund's adjuvant. Immunized mice then received booster immunizations by intraperitoneal injection with 100 μg of CII in incomplete Freund's adjuvant. We transplanted CIA BAT and normal BAT into CIA recipient mice. After transplantation, we measured the functions of CIA BAT and normal BAT in mice. Normal BAT-transplanted mice showed significantly lower scores of bone damage, inflammation, and cartilage damage. The proinflammatory cytokines in normal BAT-transplanted mice, such as IL-12, IL-17, IL-6, and tumor necrosis factor-α (TNF-α), tended to decrease. Microarray analysis showed that the PI3K-AKT signaling pathway and IL-17 levels of CIA BAT tissues were significantly higher than those of normal BAT tissues. These results suggest that the transplantation of normal brown fat may have a therapeutic effect in RA patients.
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http://dx.doi.org/10.1038/s41598-020-68749-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7378076PMC
July 2020

Follow-Up Intervals for Breast Imaging Reporting and Data System Category 3 Lesions on Screening Ultrasound in Screening and Tertiary Referral Centers.

Korean J Radiol 2020 09;21(9):1027-1035

Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Objective: To assess the appropriate follow-up interval, and rate and timepoint of cancer detection in women with Breast Imaging Reporting and Data System (BI-RADS) 3 lesions on screening ultrasonography (US) according to the type of institution.

Materials And Methods: A total of 1451 asymptomatic women who had negative or benign findings on screening mammogram, BI-RADS 3 assessment on screening US, and at least 6 months of follow-up were included. The median follow-up interval was 30.8 months (range, 6.8-52.9 months). The cancer detection rate, cancer detection timepoint, risk factors, and clinicopathological characteristics were compared between the screening and tertiary centers. Nominal variables were compared using the chi-square or Fisher's exact test and continuous variables were compared using the independent test or Mann-Whitney U test.

Results: In 1451 women, 19 cancers (1.3%) were detected; two (0.1%) were diagnosed at 6 months and 17 (1.2%) were diagnosed after 12.3 months. The malignancy rates were both 1.3% in the screening (9 of 699) and tertiary (10 of 752) centers. In the screening center, all nine cancers were invasive cancers and diagnosed after 12.3 months. In the tertiary center, two were ductal carcinomas and eight were invasive cancers. Two of the invasive cancers were diagnosed at 6 months and the remaining eight cancers newly developed after 13.1 months.

Conclusion: One-year follow-up rather than 6-month follow-up may be suitable for BI-RADS 3 lesions on screening US found in screening centers. However, more caution is needed regarding similar findings in tertiary centers where 6-month follow-up may be more appropriate.
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http://dx.doi.org/10.3348/kjr.2019.0747DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7371624PMC
September 2020

Preoperative Magnetic Resonance Imaging Features Associated with Positive Resection Margins in Patients with Invasive Lobular Carcinoma.

Korean J Radiol 2020 08;21(8):946-954

Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.

Objective: To investigate preoperative magnetic resonance imaging (MRI) findings associated with resection margin status in patients with invasive lobular carcinoma (ILC) who underwent breast-conserving surgery.

Materials And Methods: One hundred and one patients with ILC who underwent preoperative MRI were included. MRI (tumor size, multifocality, type of enhancing lesion, distribution of non-mass enhancement [NME], and degree of background parenchymal enhancement) and clinicopathological features (age, pathologic tumor size, presence of ductal carcinoma [DCIS] or lobular carcinoma , presence of lymph node metastases, and estrogen receptor/progesterone receptor/human epidermal growth factor receptor type 2 status) were analyzed. A positive resection margin was defined as the presence of invasive cancer or DCIS at the inked surface. Logistic regression analysis was performed to determine pre- and postoperative variables associated with positive resection margins.

Results: Among the 101 patients, 21 (20.8%) showed positive resection margins. In the univariable analysis, NME, multifocality, axillary lymph node metastasis, and pathologic tumor size were associated with positive resection margins. With respect to preoperative MRI findings, multifocality (odds ratio [OR] = 3.977, = 0.009) and NME (OR = 2.741, = 0.063) were associated with positive resection margins in the multivariable analysis, although NME showed borderline significance.

Conclusion: In patients with ILC, multifocality and the presence of NME on preoperative breast MRI were associated with positive resection margins.
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http://dx.doi.org/10.3348/kjr.2019.0674DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7369210PMC
August 2020

GUIDELINE IMPLEMENTATION ON FINE-NEEDLE ASPIRATION FOR THYROID NODULES: FOCUSING ON MICRONODULES.

Endocr Pract 2020 Jul 13. Epub 2020 Jul 13.

From: Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.

OBJECTIVE We investigated patients who were referred to our institution after FNA was performed at outside clinics to evaluate how many nodules satisfying the FNA indications of the K-TIRADS, and to compare the number of thyroid nodules that satisfy the FNA indications of the ACR TIRADS and ATA guideline. MATERIALS AND METHODS Between January 2018 to December 2018, 2,628 patients were included in our study. The included patients were those ones referred for thyroid surgery after having a suspicious thyroid nodule. We retrospectively applied the three guidelines to each thyroid nodule and determined whether each nodule satisfied the FNA indications. We compared the proportion of nodules satisfying the FNA indications of each guideline using the generalized linear model with the generalized estimating equation. RESULTS The median size of 2,628 thyroid nodules was 0.9cm (range 0.2-9.5cm). We found that FNA was not indicated for 54.1%, 47.7%, and 19.1% of nodules and 87.3%, 99.0%, and 97.8% among them were micronodules (<1cm) according to the ACR TIRADS, ATA guideline and K-TIRADS, respectively. The proportion of micronodules which satisfied the FNA indications was significantly higher for the K-TIRADS (65.1%) compared to the ACR TIRADS (12.1%) and ATA guideline (12.1%) (<.001). CONCLUSION Among patients referred to thyroid surgery to our institutions, about 35% of the micronodules underwent FNA despite not being appropriate for indications by the K-TIRADS. Systematic training for physicians as well as modifications to increase the sensitivity of the guideline may be needed to reduce the overdiagnosis of thyroid cancers, especially for micronodules.
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http://dx.doi.org/10.4158/EP-2020-0163DOI Listing
July 2020

Cytopathologic criteria and size should be considered in comparison of fine-needle aspiration vs. core-needle biopsy for thyroid nodules: results based on large surgical series.

Endocrine 2020 12 12;70(3):558-565. Epub 2020 Jul 12.

Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Republic of Korea.

Purpose: To evaluate and compared the diagnostic performances of FNA and CNB using various cytopathologic criteria and size subgroups to see how the comparison results differ accordingly.

Methods: From May 2012 to May 2019, 8187 thyroid nodules in 8139 patients who had undergone preoperative US-guided FNA or CNB at outside clinics were included in this retrospective study (mean size: 11.9 ± 9.5 mm). Preoperative US-FNA was performed in 7496 (91.6%) nodules and US-CNB was performed in 691 (8.4%) nodules. Propensity score matching was used to compare the sensitivities between FNA and CNB in diagnosis of malignancy and neoplasm according to different cytologic test criteria.

Results: Of the 8187 thyroid nodules, 7833 (95.7%) were malignant and 354 (4.3%) were benign. Mean size of the thyroid nodules in the CNB group was significantly larger than the FNA group, 15.7 ± 12.7 mm vs. 11.6 ± 9.0 mm, respectively (P < 0.001). After matching, sensitivity in the CNB group were significantly higher in the total population, and in subgroups <10 mm for criteria 1 and 2 (all P < 0.05, respectively). No significant differences were seen between the sensitivities of FNA and CNB for nodules ≥10 mm regardless of criteria in diagnosis of malignancy or neoplasm (all P > 0.05, respectively).

Conclusions: Results comparing sensitivities between FNA and CNB differ according to the different cytopathologic criteria used for calculation. CNB has significantly higher sensitivity to FNA in subcentimeter nodules when using criteria 1 or 2. Diagnostic sensitivities did not show significant differences for nodules ≥10 mm regardless of the cytopathologic criteria used, that should be considered in selecting biopsy methods.
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http://dx.doi.org/10.1007/s12020-020-02416-zDOI Listing
December 2020

Predictive performance of ultrasonography-based radiomics for axillary lymph node metastasis in the preoperative evaluation of breast cancer.

Ultrasonography 2021 Jan 1;40(1):93-102. Epub 2020 Apr 1.

Department of Radiology, Severance Hospital, Research Institute of Radiological Science and Center for Clinical Image Data Science, Yonsei University College of Medicine, Seoul, Korea.

Purpose: The purpose of this study was to evaluate the predictive performance of ultrasonography (US)-based radiomics for axillary lymph node metastasis and to compare it with that of a clinicopathologic model.

Methods: A total of 496 patients (mean age, 52.5±10.9 years) who underwent breast cancer surgery between January 2014 and December 2014 were included in this study. Among them, 306 patients who underwent surgery between January 2014 and August 2014 were enrolled as a training cohort, and 190 patients who underwent surgery between September 2014 and December 2014 were enrolled as a validation cohort. To predict axillary lymph node metastasis in breast cancer, we developed a preoperative clinicopathologic model using multivariable logistic regression and constructed a radiomics model using 23 radiomic features selected via least absolute shrinkage and selection operator regression.

Results: In the training cohort, the areas under the curve (AUC) were 0.760, 0.812, and 0.858 for the clinicopathologic, radiomics, and combined models, respectively. In the validation cohort, the AUCs were 0.708, 0.831, and 0.810, respectively. The combined model showed significantly better diagnostic performance than the clinicopathologic model.

Conclusion: A radiomics model based on the US features of primary breast cancers showed additional value when combined with a clinicopathologic model to predict axillary lymph node metastasis.
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http://dx.doi.org/10.14366/usg.20026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7758097PMC
January 2021