Publications by authors named "Seon Hyeong Choi"

38 Publications

The usefulness of the oblique coronal plane of three-dimensional isotropic T2-weighted fast spin-echo (VISTA) knee MRI in the evaluation of posterior cruciate ligament reconstruction with allograft: Comparison with the oblique coronal plane of two-dimensional fast spin-echo T2-weighted sequences.

Eur J Radiol 2019 May 16;114:105-110. Epub 2019 Mar 16.

Department of Radiology, Myongji hospital, Republic of Korea.

Purpose: We compared two imaging techniques to assess whether 3D VISTA imaging could replace 2D FSE in diagnosing PCL reconstruction complications.

Materials And Methods: This retrospective study included 40 patients who underwent surgery of PCL reconstruction and follow-up knee MRI (3D VISTA and 2D FSE) for evaluation of PCL graft integrity. Each image was interpreted independently by two radiologists without knowledge of radiologic reports or clinical history. The diagnostic performance of the 2D FSE PCL view, 3D VISTA PCL view, orthogonal 2D FSE image, and combined sequences were evaluated in terms of sensitivity, specificity, and accuracy for diagnosing complications of PCL graft. The reference diagnoses were made arthroscopically or clinically.

Results: The sensitivities of the 3D VISTA PCL view were similar to those of the 2D PCL view. The sensitivities of the combination of the orthogonal view and the 3D VISTA PCL view were also similar to those of the combination of the orthogonal view and the 2D PCL view. The specificities and accuracies of each image exhibited similar results. There was no statistically significant difference in diagnostic performance between the 3D VISTA PCL view and the 2D PCL view (solitary or combined with the orthogonal view).

Conclusions: The diagnostic performance of the PCL views on 3D VISTA images is comparable to that of 2D FSE images in the diagnosis of PCL graft complications.
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http://dx.doi.org/10.1016/j.ejrad.2019.03.009DOI Listing
May 2019

Diagnostic Value of Contrast-Enhanced Digital Mammography versus Contrast-Enhanced Magnetic Resonance Imaging for the Preoperative Evaluation of Breast Cancer.

J Breast Cancer 2018 Dec 26;21(4):453-462. Epub 2018 Dec 26.

Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

Purpose: This study aimed to compare the diagnostic performance of contrast-enhanced digital mammography (CEDM) and contrast-enhanced magnetic resonance imaging (CEMRI) in preoperative evaluations, and to evaluate the effect of each modality on the surgical management of women with breast cancer.

Methods: This single-center, prospective study was approved by the Institutional Review Board, and informed consent was obtained from all patients. From November 2016 to October 2017, 84 patients who were diagnosed with invasive carcinoma (69/84) and ductal carcinoma (15/84), and underwent both CEDM and CEMRI, were enrolled. Imaging findings and surgical management were correlated with pathological results and compared. The diagnostic performance of both modalities in the detection of index and secondary cancers (multifocality and multicentricity), and occult cancer in the contralateral breast, was compared. The authors also evaluated whether CEDM or CEMRI resulted in changes in the surgical management of the affected breast due to imaging-detected findings.

Results: Eighty-four women were included in the analysis. Compared with CEMRI, CEDM demonstrated a similar sensitivity (92.9% [78/84] vs. 95.2% [80/84]) in detecting index cancer (=0.563). For the detection of secondary cancers in the ipsilateral breast and occult cancer in the contralateral breast, no significant differences were found between CEDM and CEMRI (=0.999 and =0.999, respectively). Regarding changes in surgical management, CEDM resulted in similar changes compared with CEMRI (30.9% [26/84] vs. 29.7% [25/84], =0.610). Regarding changes in surgical management due to false-positive findings, no significant differences were found between CEDM and CEMRI (34.6% [9/26] vs. 44.0% [11/25], =0.782).

Conclusion: CEDM demonstrated a diagnostic performance comparable with CEMRI in depicting index cancers, secondary cancers, and occult cancer in the contralateral breast. CEDM demonstrated similar changes in surgical management compared with CEMRI.
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http://dx.doi.org/10.4048/jbc.2018.21.e62DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6310721PMC
December 2018

Feasibility of Preoperative Axillary Lymph Node Marking with a Clip in Breast Cancer Patients Before Neoadjuvant Chemotherapy: A Preliminary Study.

World J Surg 2018 02;42(2):582-589

Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-Gu, Seoul, 03181, Republic of Korea.

Background: The aim of this study was to determine the feasibility of image-guided marker-clip placement in axillary lymph nodes (ALNs) for breast cancer upon initial presentation and to assess the reliability of this method with sentinel lymph node biopsy (SLNB) for axillary restaging after neoadjuvant chemotherapy (NAC).

Methods: Between June 2015 and August 2016, a marker clip was placed at a clinically positive ALN under ultrasonography (US) guidance before initiation of NAC in 20 patients. Preoperative localization of marker-clipped LNs was performed, and the localized LNs were removed by SLNB. We compared the postoperative results of the marker-clipped LNs, SLNs and ALNs.

Results: Image-guided marker-clip placements and localization of marker-clipped LNs were performed successfully in 20 patients. A total of 24 marker clips were inserted, and 23 marker-clipped LNs were successfully retrieved during surgery (identification rate, 23/24, 95.8%). In the 11 patients with pathologically confirmed metastatic marker-clipped LNs, four became negative after NAC, and seven maintained metastatic residues on the marker-clipped LNs. Three of the seven patients had metastatic residues on the ALNs, and two of the three patients also had negative SLNs. Marker-clipped nodes accurately predicted the axillary nodal status in these two patients compared with SLNs alone.

Conclusion: Image-guided marker-clip placement on positive ALNs before NAC and removal with SLNB is technically feasible. This technique can improve the accuracy of the residual disease evaluation on the axilla, especially in patients with negative SLNB results, and can identify candidates for limited axillary surgery after NAC.
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http://dx.doi.org/10.1007/s00268-017-4171-8DOI Listing
February 2018

Evaluation of Screening US-detected Breast Masses by Combined Use of Elastography and Color Doppler US with B-Mode US in Women with Dense Breasts: A Multicenter Prospective Study.

Radiology 2017 11 21;285(2):660-669. Epub 2017 Jun 21.

From the Department of Radiology (S.H.L., J.M.C., N.C., W.K.M.) and Medical Research Collaborating Center (M.J.J.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Department of Radiology, Ewha Womans University Mokdong Hospital, Seoul, Korea (J.C., E.S.C.); Department of Radiology, Gyeongsang National University Hospital, Jinju, Gyeongsangnam-do, Korea (H.Y.C.); Department of Radiology, Kangbuk Samsung Hospital, Seoul, Korea (S.H.C., S.H.K.); Department of Radiology, Dongnam Institute of Radiological and Medical Science, Busan, Korea (E.B.R.); Department of Radiology, Bungdang CHA Hospital, Seongnam, Gyeonggi-do, Korea (K.H.K.); Department of Radiology, Hanyang University Hospital, Seoul, Korea (H.R.K., J.S.P.); Department of Radiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea (A.Y.); Department of Radiology, Gangnam Severance Hospital, Seoul, Korea (J.H.Y., E.J.S.); and Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea (A.J.C.).

Purpose To investigate the value of the combined use of elastography and color Doppler ultrasonography (US) with B-mode US for evaluation of screening US-detected breast masses in women with dense breasts. Materials and Methods This prospective, multicenter study included asymptomatic women with dense breasts who were referred for screening US between November 2013 and December 2014. Eligible women had a newly detected breast mass at conventional B-mode US screening, for which elastography and color Doppler US were performed. The following outcome measures were compared between B-mode US and the combination of B-mode US, elastography, and color Doppler US: area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive predictive value (PPV), and the number of false-positive findings at screening US. Results Among 1021 breast masses (mean size, 1.0 cm; range, 0.3-3.0 cm) in 1021 women (median age, 45 years), 68 were malignant (56 invasive). Addition of elastography and color Doppler US to B-mode US increased the AUC from 0.87 (95% confidence interval [CI]: 0.82, 0.91) to 0.96 (95% CI: 0.95, 0.98; P < .001); specificity from 27.0% (95% CI: 24.2%, 29.9%) to 76.4% (95% CI: 73.6%, 79.1%; P < .001) without loss in sensitivity (95% CI: -1.5%, 1.5%; P > .999); and PPV from 8.9% (95% CI: 7.0%, 11.2%) to 23.2% (95% CI: 18.5%, 28.5%; P < .001), while avoiding 67.7% (471 of 696) of unnecessary biopsies for nonmalignant lesions. Conclusion Addition of elastography and color Doppler US to B-mode US can increase the PPV of screening US in women with dense breasts while reducing the number of false-positive findings without missing cancers. RSNA, 2017 Online supplemental material is available for this article.
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http://dx.doi.org/10.1148/radiol.2017162424DOI Listing
November 2017

Expression Pattern of Smad4/GATA3 as a Predictor of Survival in Invasive Ductal Carcinoma of the Breast.

Pathobiology 2017 14;84(3):130-138. Epub 2017 Mar 14.

Department of Pathology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea.

Background: Smad4 and GATA3 proteins are known prognostic markers in various cancers. Smad4 is a mediator linked to both tumour suppression and progression. GATA3 is a regulator of development and morphogenesis of the mammary gland. We assessed and compared the predictive performance of Smad4 and GATA3 for clinical outcomes in patients with breast cancer.

Methods: The combined expression pattern based on Smad4+/- and GATA3+/- was evaluated by immunostaining using breast cancer tissue microarray, and the relationships between protein expression and clinicopathological variables were analysed.

Results: Smad4 expression was only associated with an ill-defined tumour border, whereas GATA3 was associated with several good prognostic factors. On analysis of combined markers, there was a significant difference in the expression of fascin (an important factor for cancer invasiveness) between the Smad4+/GATA3- and Smad4-/GATA3+ groups. Smad4+/GATA3- was correlated with worse clinicopathological parameters, relapse-free survival (RFS), and overall survival (OS), compared to Smad4-/GATA3+.

Conclusion: Combined markers of Smad4/GATA3 showed a superior performance compared to single markers for predicting RFS and OS in patients with breast cancer.
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http://dx.doi.org/10.1159/000449428DOI Listing
December 2017

High Ki67/BCL2 index is associated with worse outcome in early stage breast cancer.

Postgrad Med J 2016 Dec 24;92(1094):707-714. Epub 2016 May 24.

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

Aims: Breast cancers are heterogeneous, making it essential to recognise several biomarkers for cancer outcome predictions. Ki67 proliferation index and B cell lymphoma 2 (BCL2) proteins are widely used as prognostic indicators in many types of malignancies. While Ki67 is a marker of normal or tumour cell proliferation, BCL2 plays a central role in antiproliferative activities. A combination of these two biomarkers with contrary purposes can provide enhanced prognostic accuracy than an analysis using a single biomarker.

Methods: We evaluated Ki67 and BCL2 expression with 203 cases of breast cancer. The relative expression of each biomarker named as Ki67/BCL2 index was divided into two groups (low vs high) with the use of area under receiver operating characteristic curves.

Results: There were significant correlations between Ki67/BCL2 index and clinicopathological findings such as age, tumour stage, size and necrosis, histological grade, extensive intraductal component, lymphatic and vascular invasion, oestrogen receptor, progesterone receptor, human epithelial growth factor receptor 2 and p53 expression (all p<0.05). In univariate and multivariate analyses, high Ki67/BCL2 index correlated with shorter disease-free survival and overall survival in patients with early stage invasive ductal carcinoma (all p<0.05).

Conclusions: The Ki67/BCL2 index should be considered as a prognostic predictor in patients with early stage invasive ductal carcinoma.
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http://dx.doi.org/10.1136/postgradmedj-2015-133531DOI Listing
December 2016

Negative association between GATA3 and fascin could predict relapse-free and overall survival in patients with breast cancer.

Virchows Arch 2016 Apr 30;468(4):409-16. Epub 2015 Dec 30.

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

GATA3 and fascin proteins are known prognostic markers in several cancers. GATA3 is a key regulator of mammary gland morphogenesis and luminal cell differentiation, whereas fascin is a pro-metastatic actin-bundling protein. In this study, we analyzed and compared the predictive abilities of GATA3 and fascin for clinical outcomes of patients with breast cancer. The combined expression pattern based on GATA3-/+ and fascin-/+ was evaluated by immunostaining using a tissue microarray, and relationships between protein expression and several clinicopathological parameters were analyzed. GATA3 expression was associated with good prognostic parameters, but fascin was correlated with poor prognostic parameters. On comparing GATA3 and fascin, we found an inverse relationship between fascin and GATA3 expressions. On analysis of combined markers, GATA3+/fascin- was correlated with improved clinical outcomes compared to GATA3-/fascin+. Univariate and multivariate analyses revealed significant differences in relapse-free and overall survival between GATA3+/fascin- and GATA3-/fascin+. Combined marker analysis of GATA3/fascin showed an inverse association and improved prognostic information for patients with breast cancer.
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http://dx.doi.org/10.1007/s00428-015-1894-5DOI Listing
April 2016

Fascin expression predicts an aggressive clinical course in patients with advanced breast cancer.

Oncol Lett 2015 Jul 8;10(1):121-130. Epub 2015 May 8.

Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Fascin is an actin cross-linking protein, which regulates actin dynamics and filopodia or spike formation, as well as the epithelial-mesenchymal transition, and has been implicated in cell motility. Although, fascin is pivotal in mediating the aggressive behaviour of various types of cancer, its prognostic significance according to tumour stage has yet to be evaluated. Therefore, the present study investigated fascin expression in 194 patients diagnosed with invasive ductal carcinoma of the breast between 2000 and 2005. Fascin protein expression levels were evaluated by immunostaining on a tissue microarray, and the association between fascin expression and various clinicopathological parameters was analysed. Fascin expression was significantly correlated with various clinicopathological parameters, including high histological grade, tumour necrosis, resistance to adjuvant therapy, high expression of p53 and Ki-67 and specific therapeutic markers (oestrogen and progesterone receptor negativity; all P<0.05). Furthermore, univariate and multivariate analyses identified a significant association between fascin expression, and poor disease-free and overall survival, in late-stage breast cancer (all P<0.05). Therefore, fascin may be crucial in predicting aggressive tumour behaviour, particularly in patients with advanced-stage disease that has acquired the properties of migration and invasion.
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http://dx.doi.org/10.3892/ol.2015.3191DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4487011PMC
July 2015

Ultrasonography-guided surgical clip placement for tumor localization in patients undergoing neoadjuvant chemotherapy for breast cancer.

J Breast Cancer 2015 Mar 27;18(1):44-9. Epub 2015 Mar 27.

Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

Purpose: We investigated the feasibility of using surgical clips as markers for tumor localization and their effect on the imaging evaluation of treatment responses after neoadjuvant chemotherapy (NAC).

Methods: A total of 16 breast cancers confirmed by needle biopsy in 15 patients were included in this study from October 2012 to June 2014. Under ultrasonography (US)-guidance, the surgical clips were placed prior to NAC. Additional mammography, breast US, and breast magnetic resonance examinations were performed within 10 days before surgery. The time period from marker insertion to operation date was documented. Images acquired via the three modalities were evalu-ated for the following parameters: location of clip, clip migration (>1 cm), the presence of complications from clip placement, and the effect of clips on the assessment of treatment.

Results: The mean time period was 128.6±34.4 days (median, 132.0 days) from the date of clip insertion to the date of surgery. The mean number of inserted clips was 2.3±0.7 (median, 2.0). Clip migration was not visualized by imaging in any patient, and there were no complications reported. Surgical clips did not negatively affect the assessment of treatment responses to NAC.

Conclusion: Surgical clips may replace commercial tissue markers for tumor localization in breast cancer patients undergoing NAC without migration. Surgical clips are well tolerated and safe for the patient, easily visualized on imaging, do not interfere with treatment response, and are cost-effective.
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http://dx.doi.org/10.4048/jbc.2015.18.1.44DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381122PMC
March 2015

T2 relaxation times of the glenohumeral joint at 3.0 T MRI in patients with and without primary and secondary osteoarthritis.

Acta Radiol 2015 Nov 29;56(11):1388-95. Epub 2014 Oct 29.

Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Background: Quantitative magnetic resonance imaging (MRI) of cartilage has recently been applied to patients with osteoarthritis (OA). T2 mapping is a sensitive method of detecting changes in the chemical composition and structure of cartilage.

Purpose: To establish baseline T2 values of glenohumeral joint cartilage at 3.0 T and compare T2 values among subjects with and without OA.

Material And Methods: The study involved 30 patients (18 women, 12 men; median age, 67 years; age range, 51-78 years) with primary (n = 7) and secondary OA (n = 23) in the glenohumeral joint and 34 subjects without OA (19 women, 15 men; median age, 49 years; age range, 23-63 years). All subjects were evaluated by radiography and 3.0 T MRI including a multi-echo T2-weighted spin echo pulse sequence. The T2 value of the cartilage was measured by manually drawing the region of interest on the T2 map. Per-zone comparison of T2 values was performed using Mann-Whitney U test.

Results: Median T2 values differed significantly between subjects without OA (36.00 ms [interquartile range, 33.89-37.31 ms]) and those with primary (37.52 ms [36.84-39.11], P = 0.028), but not secondary (36.87 ms [34.70-41.10], P = 0.160) OA. Glenohumeral cartilage T2 values were higher in different zones between patients with primary and secondary OA than in subjects without OA.

Conclusion: These T2 values can be used for comparison to assess cartilage degeneration in patients with shoulder OA. Significant differences in T2 were observed among subjects without OA and those with primary and secondary OA.
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http://dx.doi.org/10.1177/0284185114556304DOI Listing
November 2015

IDEAL 3D spoiled gradient echo of the articular cartilage of the knee on 3.0 T MRI: a comparison with conventional 3.0 T fast spin-echo T2 fat saturation image.

Acta Radiol 2015 Dec 27;56(12):1479-86. Epub 2014 Oct 27.

Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea.

Background: Many two-dimensional (2D) morphologic cartilage imaging sequences have disadvantages such as long acquisition time, inadequate spatial resolution, suboptimal tissue contrast, and image degradation secondary to artifacts. IDEAL imaging can overcome these disadvantages.

Purpose: To compare sound-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and quality of two different methods of imaging that include IDEAL 3D SPGR and 3.0-T FSE T2 fat saturation (FS) imaging and to evaluate the utility of IDEAL 3D SPGR for knee joint imaging.

Material And Methods: SNR and CNR of the patellar and femoral cartilages were measured and calculated. Two radiologists performed subjective scoring of all images for three measures: general image quality, FS, and cartilage evaluation. SNR and CNR values were compared by paired Student's t-tests.

Results: Mean SNRs of patellar and femoral cartilages were 90% and 66% higher, respectively, for IDEAL 3D SPGR. CNRs of patellar cartilages and joint fluids were 2.4 times higher for FSE T2 FS, and CNR between the femoral cartilage and joint fluid was 2.2 times higher for FSE T2 FS. General image quality and FS were superior using FSE T2 FS compared to those of IDEAL 3D SPGR imaging according to both readers, while cartilage evaluation was superior using IDEAL 3D SPGR. Additionally, cartilage injuries were more prominent in IDEAL 3D SPGR than in FSE T2FS according to both readers.

Conclusion: IDEAL 3D SPGR images show excellent visualization of patellar and femoral cartilages in 3.0 T and can compensate for the weaknesses of FSE T2 FS in the evaluation of cartilage injuries.
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http://dx.doi.org/10.1177/0284185114556097DOI Listing
December 2015

Evaluation of cervical lymph node metastasis in thyroid cancer patients using real-time CT-navigated ultrasonography: preliminary study.

Ultrasonography 2015 Jan 31;34(1):39-44. Epub 2014 Aug 31.

Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

Purpose: To evaluate the diagnostic accuracy of real-time neck computed tomography (CT)-guided ultrasonography (US) in detecting cervical neck lymph node metastasis (LNM) in patients with papillary thyroid cancer (PTC).

Methods: We retrospectively reviewed data from 176 patients (mean age, 43 years; range, 23 to 74 years) with surgically confirmed PTC who underwent preoperative US, neck CT, and neck CTguided US. We then compared the sensitivities and diagnostic accuracies of each of the three above modalities in detecting cervical LNM.

Results: Preoperative US showed 17.3% sensitivity and 58.5% diagnostic accuracy in detecting central LNM compared with 64.3% sensitivity and 89.2% diagnostic accuracy in detecting lateral neck LNM. Neck CT showed 23.5% sensitivity and 55.7% diagnostic accuracy in detecting central LNM and 71.4% sensitivity with 90.9% diagnostic accuracy in detecting lateral neck LNM. CT-guided US exhibited 37.0% sensitivity and 63.1% diagnostic accuracy in detecting central LNM compared with 92.9% sensitivity and 96.0% diagnostic accuracy in detecting lateral LNM. CT-guided US showed higher diagnostic accuracy with superior sensitivity in detecting central and lateral LNM than did US (P<0.001, P=0.011) and CT (P=0.026, P=0.063).

Conclusion: Neck CT-guided US is a more accurate technique with higher sensitivity for detecting cervical LNM than either US or CT alone. Therefore, our data indicate that neck CT-guided US is an especially useful technique in preoperative examinations.
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http://dx.doi.org/10.14366/usg.14030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4282224PMC
January 2015

Clinical and imaging characteristics of papillary neoplasms of the breast associated with malignancy: a retrospective cohort study.

Ultrasound Med Biol 2014 Nov 12;40(11):2599-608. Epub 2014 Sep 12.

Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

Papillary neoplasms of the breast comprise a broad range of pathologies ranging from papillomas to papillary carcinomas and have been associated with breast cancers. In this study, we evaluated the clinical, mammographic and sonographic features of papillary breast neoplasms from benign papillary breast lesions to malignancy-associated papillary lesions. A total of 194 lesions in 179 patients were analyzed, including 117 benign papillomas, 24 atypical papillomas, 41 benign papillomas with malignancies and 12 papillary carcinomas found between January 2003 and August 2011 in our institution. Statistically significant clinical factors included patient age (p = 0.001), lesion multiplicity (p = 0.009) and peripheral location (p = 0.003). Among these factors, the odds ratio for malignancy was 8.9 for bilateral multiple lesions. Visibility (p = 0.001) and density (p = 0.039) were significant factors for malignancy in mammograms, and echo patterns (p = 0.006), boundary (p = 0.001) and vascularity (p = 0.005) were significant features on ultrasound that differentiated malignancies from benign lesions. Overall, when papillary breast lesions are located bilaterally and peripherally in older patients, they are correlated with breast cancers. Additionally, for papillary breast lesions that appear highly dense on mammograms and/or exhibit positive vascularity on ultrasound, the probability of malignancy is relatively high.
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http://dx.doi.org/10.1016/j.ultrasmedbio.2014.06.018DOI Listing
November 2014

Practice guideline for the performance of breast ultrasound elastography.

Ultrasonography 2014 Jan 26;33(1):3-10. Epub 2013 Nov 26.

Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.

Ultrasound (US) elastography is a valuable imaging technique for tissue characterization. Two main types of elastography, strain and shear-wave, are commonly used to image breast tissue. The use of elastography is expected to increase, particularly with the increased use of US for breast screening. Recently, the US elastographic features of breast masses have been incorporated into the 2nd edition of the Breast Imaging Reporting and Data System (BI-RADS) US lexicon as associated findings. This review suggests practical guidelines for breast US elastography in consensus with the Korean Breast Elastography Study Group, which was formed in August 2013 to perform a multicenter prospective study on the use of elastography for US breast screening. This article is focused on the role of elastography in combination with B-mode US for the evaluation of breast masses. Practical tips for adequate data acquisition and the interpretation of elastography results are also presented.
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http://dx.doi.org/10.14366/usg.13012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4058975PMC
January 2014

Expression patterns of stromal MMP-2 and tumoural MMP-2 and -9 are significant prognostic factors in invasive ductal carcinoma of the breast.

APMIS 2014 Dec 7;122(12):1196-206. Epub 2014 Jun 7.

Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.

Matrix metalloproteinases (MMPs) are matrix-degrading enzymes that play a pivotal role in aggressive behaviours, such as rapid tumour growth, invasion, and metastasis, of several types of solid tumours. In particular, stromal MMP-2 plays important roles in the progression of malignant tumours, but most clinical studies have focused on tumoural MMP-2 and -9 expression, and not stromal MMP-2 expression. One hundred and seventy-seven cases diagnosed as invasive ductal carcinoma of the breast between 2000 and 2005 were included in this study. Expressions of tumoural MMP-2 and -9 and stromal MMP-2 were analysed by immunostaining on a tissue microarray. Subsequently, the associations between those results and various clinicopathological parameters were evaluated. Stromal MMP-2 expression correlated significantly with clinicopathological parameters such as advanced T category, larger tumour size, high histological grade, tumour necrosis, ER- and PR-negative, and HER-2-positive (all p < 0.05). In univariate and multivariate analyses, overall survival was linked with stromal MMP-2 expression as well as dual expression of stromal MMP-2 and tumoural MMP-2 and -9 (all p < 0.05). Stromal MMP-2 expression may play a crucial role in predicting aggressive clinical behaviour in breast cancer patients.
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http://dx.doi.org/10.1111/apm.12285DOI Listing
December 2014

Thyroid ultrasonography: pitfalls and techniques.

Korean J Radiol 2014 Mar-Apr;15(2):267-76. Epub 2014 Mar 7.

Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 120-752, Korea.

Thyroid ultrasonography (US) plays a key role in the diagnosis and management of thyroid-related diseases. The aim of this article was to illustrate various pitfalls that can occur in utilizing thyroid US and techniques to prevent them. In this article, we present cases demonstrating the common pitfalls associated with US equipment, performance, normal thyroid structures, misinterpretations, and surrounding structures. Knowledge of these areas is essential to avoid misdiagnosis or improper disease management.
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http://dx.doi.org/10.3348/kjr.2014.15.2.267DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3955795PMC
May 2014

Value of adding sonoelastography to conventional ultrasound in patients with congenital muscular torticollis.

Pediatr Radiol 2013 Dec 14;43(12):1566-72. Epub 2013 Jul 14.

Departments of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyeong-dong, Jongno-gu, Seoul, 110-746, South Korea.

Background: Sonoelastography has been utilized to evaluate various myopathies. However, the benefits of adding sonoelastography to conventional ultrasound (US) in patients with congenital muscular torticollis are unclear.

Objective: To evaluate the value of adding sonoelastography to conventional US in patients with congenital muscular torticollis.

Materials And Methods: This study included 27 infants clinically diagnosed with congenital muscular torticollis and 17 healthy infants who underwent conventional US and sonoelastography. The echogenicity of the sternocleidomastoid muscle was assessed as isoechoic, heterogeneous, hyperechoic or hypoechoic compared with normal muscle. The thickness of the involved and contralateral sternocleidomastoid muscles was measured. Elastographic findings were scored from 1 (soft) to 3 (hard) by two independent radiologists.

Results: The sternocleidomastoid muscle thickness, difference and ratio between involved and normal sternocleidomastoid muscle thickness, and elastographic score differed significantly between the patient and control groups. Of the 27 patients, 11 had isoechoic, 5 had heterogeneous and 11 had hyperechoic muscles. Congenital muscular torticollis patients with isoechoic muscle showed significantly higher elastographic scores than the control group, but there were no other significant differences by conventional US.

Conclusions: Adding sonoelastography to conventional US is helpful for the diagnosis of congenital muscular torticollis, especially in patients with isoechoic sternocleidomastoid muscle.
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http://dx.doi.org/10.1007/s00247-013-2750-xDOI Listing
December 2013

Phyllodes tumors of the breast: ultrasonographic findings and diagnostic performance of ultrasound-guided core needle biopsy.

Ultrasound Med Biol 2013 Jun 15;39(6):987-92. Epub 2013 Mar 15.

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

We evaluated ultrasonography (US) findings between benign and malignant phyllodes tumors and analyzed diagnostic performance of US-guided core needle biopsy (CNB) for phyllodes tumors. Surgically removed phyllodes tumors of 168 women were divided into two groups according to the benign and malignant (including borderline tumor) groups and 116 were benign and 52 were malignant. On US, the complex cystic echogenicity (p = 0.021), presence of cleft (p = 0.005) and higher final US assessment (p = 0.008) were more frequent in the malignant group. The sensitivity of CNB including fibroepithelial tumors was 67.9% (114/168) and the concordant rate between CNB and surgical excision was 82.1% (32/39) and 5.8% (3/52) in the benign and malignant group. Our results suggested that the US findings of complex cystic echogenicity, cleft, higher final US assessment were more frequent in malignant phyllodes tumors. The sensitivity of CNB was 67.9% (114/168) and malignant phyllodes tumors were rarely diagnosed as malignant by US-guided CNB.
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http://dx.doi.org/10.1016/j.ultrasmedbio.2013.01.004DOI Listing
June 2013

Validation of intra- and interobserver reproducibility of shearwave elastography: Phantom study.

Ultrasonics 2013 Jul 13;53(5):1039-43. Epub 2013 Feb 13.

Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyung-dong, Jongro-gu, Seoul, Republic of Korea.

Purpose: To assess intra- and interobserver reproducibility of quantitative ultrasound (US) elastography for breast masses using shearwave elastography (SWE).

Materials And Methods: The US elastography phantom was used. This training phantom contained 12 masses with dimensions from 6 to 11mm and varying B-mode (hypo- iso- and hyperechoic) characteristics and viscoelastic properties varying from about 50 to 250kPa. Four attending radiologists participated as operators and used Supersonic Imaging 15-4 MHz array to acquire images. In each session, B-mode US features were assessed once and US elastography values were assessed twice in a consecutive and distinct manner. A total of three identical sessions of data acquisition were performed at 2-week intervals. For categorical variables such as BI-RADS features of mass on B-mode image and qualitative SWE features, kappa (k) values were calculated by the generalized linear mixed model. For continuous variables, kPa, and ratio, intraclass correlation coefficients (ICCs) were calculated.

Results: Interobserver agreement for SWE image similarity was moderate (k=0.57). With respect to quantitative SWE values, intraobserver ICCs were 0.65, 0.77, 0.92, and 0.91 for maximum elasticity; 0.70, 0.83, 0.94, and 0.94 for mean elasticity; and 0.67, 0.83, 0.92, and 0.92 for elasticity ratio for operators 1, 2, 3, and 4, respectively. Interobserver reproducibility showed good agreement with ICC values of 0.77 for maximum elasticity, 0.82 for mean elasticity, and 0.79 for elasticity ratio.

Conclusion: Quantitative US elastography for breast masses was highly reproducible with good agreement across operators. With respect to intraobserver reproducibility, ICC values varied but three out of four operators showed good agreement.
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http://dx.doi.org/10.1016/j.ultras.2013.01.013DOI Listing
July 2013

Diagnostic and prognostic relevance of MMP-11 expression in the stromal fibroblast-like cells adjacent to invasive ductal carcinoma of the breast.

Ann Surg Oncol 2013 Dec 1;20 Suppl 3:S433-42. Epub 2012 Nov 1.

Department of Pathology, College of Medicine, Hanyang University, Seoul, South Korea.

Background: Matrix metalloproteinase 11 (MMP-11) is a matrix degrading enzyme known to be involved in the remodeling of extracellular matrix proteins. This enzyme recently has been reported to play a key role in tumor progression and results in poor clinical outcomes for several different types of tumors.

Methods: A total of 192 patients diagnosed with invasive ductal carcinoma between 2000 and 2005 were included in this study. MMP-11 expression in tumors and stromal fibroblast-like cells was analyzed by immunohistochemical staining on a tissue microarray. Subsequently, evaluation of the associations between MMP-11 expression and clinicopathological characteristics was performed.

Results: MMP-11 expression of stromal fibroblast-like cells was correlated with prognostic factors, including tumor size, metastasis, histological grade, central tumor fibrosis, p53 expression, and luminal A subtype and was linked to therapeutic markers, such as ER and HER2 (all p < 0.05). There was a significant relationship between worse overall survival and MMP-11 expression in both tumors and stromal fibroblast-like cells (all p < 0.05). In multivariate analysis, MMP-11 expression of stromal fibroblast-like cells was still significantly associated with poor prognosis (p = 0.043).

Conclusions: MMP-11 expression was significantly related to clinicopathological parameters, which may be essential to the prediction of disease outcome in patients with invasive ductal carcinoma of the breast.
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http://dx.doi.org/10.1245/s10434-012-2734-3DOI Listing
December 2013

Diagnostic relevance of overexpressions of PKC-θ and DOG-1 and KIT/PDGFRA gene mutations in extragastrointestinal stromal tumors: a Korean six-centers study of 28 cases.

Anticancer Res 2012 Mar;32(3):923-37

Department of Pathology, Cancer Research Institute, Chungnam National University, School of Medicine, Daejeon, South Korea.

Background: We investigated the clinicopathological and immunohistochemical characteristics, genetic aberrations and prognostic factors in 28 patients with extragastrointestinal stromal tumors (EGISTs) from six centers in South Korea.

Patients And Methods: Immunohistochemistry was performed for c-KIT (CD117), PKC-θ (protein kinase C theta), DOG-1 (discovered on GIST-1), CD34, alpha-smooth muscle actin (α-SMA), vimentin, desmin and S-100 protein. Genetic analyses for the KIT gene (exon 9, 11, 13 and 17) and the platelet-derived growth factor receptor alpha (PDGFRA) gene (exons 12 and 18) were performed by direct sequencing of PCR products. The relationships of various clinicopathological characteristics and outcomes were also examined.

Results: Of the tumor samples, 78.6% (22/28) were located in the intra-abdominal cavity including the omentum and mesentery, and 10.7% (3/28) were located in the retroperitoneum. All patients were older than 39 years. The median size of the tumors was 10 cm for the maximum diameter. When first detected, 57.1% of EGISTs were large in size, measuring more than 10 cm. Tumors that were larger than 10 cm were found more frequently among tumors with more than 10 mitoses per 50 high-power fields (HPFs) and this finding was statistically significant (p<0.05). Based on immunohistochemical results, the EGISTs were positive for c-KIT in 96.4% (27/28) of samples, PKC-θ in 82.1% (23/28), DOG-1 in 85.7% (24/28), PDGFRA in 82.1% (23/28), CD34 in 67.9% (19/28), vimentin in 100% (28/28), α-SMA in 28.6% (8/28), S-100 protein in 39.3% (11/28) and desmin in 28.6% (8/28). c-KIT, DOG-1 and PKC-θ immunostains were sensitive and specific, but the PDGFRA stain was not specific for EGISTs. c-KIT expression was correlated with DOG-1 expression (p<0.05). One c-KIT-negative EGIST was also negative for DOG-1, but positive for PDGFRA and PKC-θ immunostains. Out of all EGISTs, 57.1% had tumor necrosis and most of these were more than 10 cm in size, and had obvious nuclear atypia and high mitotic counts (>10/50 HPFs). Overall survival (OS) was correlated with tumor size >10 cm, tumor necrosis, obvious nuclear atypia, mitotic counts >10/50 HPFs and epithelioid or mixed cell type (p<0.05). Eleven EGISTs (44.0%) had mutations in the KIT gene and 6 (24.0%) had mutations in the PDGFRA gene, the most common being missense mutations or deletions affecting exon 11 of the KIT gene (n=9) or exon 18 of the PDGFRA gene (n=6). Three cases showed co-existence of both KIT and PDGFRA gene mutations. There were no mutations of exon 17 of KIT and exon 12 of PDGFRA genes.

Conclusion: The c-KIT, PKC-θ and DOG-1 antigens are the most sensitive and specific immunomarkers for confirming EGISTs. PKC-θ and PDGFRA immunostains are helpful markers for c-KIT-negative EGISTs. Survival analyses indicated that tumor size >10 cm, mitotic rate >10/50 HPFs, tumor necrosis, obvious nuclear atypia, and epithelioid or mixed cell type were significant predictors of survival. We found that the combination of these parameters helped to predict aggressive tumor behavior and may be useful for predicting the prognosis of EGISTs. The majority of gene mutations were identified in exon 11 of the KIT gene or exon 18 of the PDGFRA gene. The pattern of KIT and PDGFRA mutations in EGISTs was essentially similar to the one in GISTs. From the immunohistochemistry and molecular genetics perspective, EGISTs may be a special subtype of GISTs. Both immunohistochemical and molecular evaluation are useful for classifying tumors as EGISTs.
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March 2012

Man to man training: can it help improve the diagnostic performances and interobserver variabilities of thyroid ultrasonography in residents?

Eur J Radiol 2012 Mar 1;81(3):e352-6. Epub 2011 Dec 1.

Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University, College of Medicine, 250 Seongsanno, Seodaemun-gu, 120-752 Seoul, Republic of Korea.

Objective: The purpose of this study was to determine whether the man to man training can improve the diagnostic performances and interobserver variabilities of residents on thyroid ultrasonography.

Materials And Methods: A set of 80 quiz cases with ultrasonography images of thyroid nodules (40 benign and 40 malignant on histopathology) were shown to the residents. Residents 1, 2, and 3 had not received the man to man training while Residents 4, 5, 6, and 7 had. The seven residents were asked to fill out one of the ultrasonography features (internal composition, echogenicity, margin, calcification, and shape) and the final assessment (probably benign and suspicious). Thyroid nodules with one or more ultrasonography features including marked hypoechogenicity, microlobulated or irregular margins, microcalcifications, and taller than wide shape were assessed as suspicious nodules. The diagnostic performances of US by the seven residents and interobserver variabilities between the seven residents and a faculty radiologist were calculated.

Results: The sensitivities, negative predictive values, and accuracies of Residents 4, 5, 6, and 7 were higher than those of Residents 1, 2, and 3. The final assessment between Residents 4, 5, 6, and 7 and the faculty radiologist showed almost perfect agreement but that between Residents 1, 2, and 3 and the faculty radiologist showed substantial agreement.

Conclusion: The man to man training is crucial for the residents to show better diagnostic performances and improvement of interobserver variabilities for evaluating thyroid nodules with ultrasonography.
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http://dx.doi.org/10.1016/j.ejrad.2011.11.011DOI Listing
March 2012

Clinical usefulness of endoscopic ultrasonography in the differential diagnosis of gallbladder wall thickening.

Dig Dis Sci 2012 Feb 31;57(2):508-15. Epub 2011 Aug 31.

Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108, Pyung-Dong, Jongro-Ku, Seoul, 110-746, South Korea.

Background And Aims: The differential diagnosis of gallbladder (GB) cancer from inflammatory diseases in patients with a thickened GB wall is difficult, whereas the pre-operative diagnosis of GB cancer is critical for selecting the appropriate surgical modality. We evaluated the clinical usefulness of endoscopic ultrasonography (EUS) for the differential diagnosis of GB wall thickening.

Methods: The medical records, post-operative pathology reports, and images of EUS for 134 patients with GB wall thickening (>3 mm) who underwent laparoscopic or open cholecystectomies at our institution between December 2006 and February 2010 were retrospectively reviewed.

Results: Thirteen patients (9.7%) had neoplastic GB wall thickening (11 with adenocarcinomas and two with adenosquamous carcinomas) and the remaining 121 patients (90.3%) had non-neoplastic GB wall thickening (117 with inflammatory GB wall thickening and four with adenomyomatosis). The mean (± standard deviation [SD], mm) GB wall thickness was 6.5 ± 3.3 and 19.4 ± 7.7 for non-neoplastic and neoplastic GB wall thickening, respectively (P < 0.01). The EUS variables which had a statistically significant association with neoplastic GB wall thickening were GB wall thickening >10 mm, disruption of the normal two layers of the GB wall, hypoechoic internal echogenecity, and the absence of gallstones. Based on the multivariate analyses, GB wall thickening >10 mm and hypoechoic internal echogenecity were independent predictive factors for neoplastic GB wall thickening.

Conclusions: The diagnostic power of EUS for differentiating neoplastic and non-neoplastic GB wall thickening could be improved by the appropriate application of some EUS variables.
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http://dx.doi.org/10.1007/s10620-011-1870-0DOI Listing
February 2012

Imaging-histologic discordance after sonographically guided percutaneous breast biopsy: a prospective observational study.

Ultrasound Med Biol 2011 Nov 19;37(11):1771-8. Epub 2011 Aug 19.

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

The objective of this study was to determine the frequency of imaging-histologic discordance and to compare the frequency of carcinoma between concordant and discordant lesions in sonographically (US)-guided 14-gauge core needle biopsies (CNBs). From January 2005 to December 2006, we performed US-guided 14-gauge automated CNB on 3339 breast lesions and obtained benign results in 2194 cases. Five radiologists prospectively reviewed the pathologic reports in conjunction with the imaging. We included a total of 1588 lesions that were either excised (n = 658) or followed up for at least 2 years (n = 930) after CNB. We evaluated the rate of discordance and the clinical findings for both discordant and concordant lesions. We also analyzed the clinical and imaging differences between the upgrade and non-upgrade groups. Imaging-histologic discordance was present in 103 of 1588 (6.5%) lesions. The upgrade rate was 6.8% (7/103) in discordant lesions and 0.4% (6/1485) in concordant lesions (p < 0.01). Lesion size, Breast Imaging, Reporting and Data System (BI-RADS) category and the presence or absence of symptoms was statistically significant between the upgrade and non-upgrade groups in discordant cases (p < .05). Imaging-histologic discordance is an indication for excision because it has a higher upgrade rate than concordant lesions.
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http://dx.doi.org/10.1016/j.ultrasmedbio.2011.07.006DOI Listing
November 2011

Ultrasound and clinicopathological characteristics of triple receptor-negative breast cancers.

J Breast Cancer 2011 Jun 18;14(2):119-23. Epub 2011 Jun 18.

Department of Radiology, Breast and Thyroid Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

Purpose: Triple receptor-negative (TRN) breast cancer is associated with high risk of recurrence and poor prognosis. The present study assessed the clinicopathologic characteristics and ultrasound (US) features of TRN breast cancers.

Methods: Pathological and biological data were reviewed for 558 breast cancer patients treated at Kangbuk Samsung Hospital, between January 2003 and December 2009. The patients were separated into TRN breast cancer and non-TRN breast cancer groups, based on the results of immunohistochemical prognostic panels. Clinical and pathologic features were compared for the two groups. US features, including shape, orientation, margins, boundaries, echo patterns, posterior acoustic features, surrounding tissues, and microcalcifications, were determined for 41 TRN patients and 189 non-TRN controls (ER+/PR+/HER2-).

Results: Of 558 cases, 58 (10.4%) had the TRN phenotype. Four hundred and thirty-four cases (77.8%) were invasive ductal carcinomas. TRN cancer was significantly associated with specific characteristics of tumor size, nuclear grade, histologic grade, venous invasion, and lymphatic invasion. With respect to US features, TRN cancers were more likely to have an oval shape, a circumscribed margin, and marked hypoechogenicity.

Conclusion: Tumor characteristics were different between TRN and non-TRN breast cancers, although US cannot differentiate the subtype of breast cancers TRN cancer tend to show somewhat different US morphology.
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http://dx.doi.org/10.4048/jbc.2011.14.2.119DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148546PMC
June 2011

Factors affecting inadequate sampling of ultrasound-guided fine-needle aspiration biopsy of thyroid nodules.

Clin Endocrinol (Oxf) 2011 Jun;74(6):776-82

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

Purpose: The aim of this study was to evaluate the overall ultrasonographic features and clinical factors that contribute to inadequate sampling in ultrasound-guided fine-needle aspiration biopsy (US-FNAB) of thyroid nodules.

Materials And Methods: From April 2008 to December 2008, 4077 US-FNABs in 3767 consecutive patients were reviewed. We evaluated the clinical, ultrasound and pathological features of patients and analysed the association between these features and inadequate samples. We also compared inadequate sample rates according to the experience of the performing doctor.

Results: The inadequate sample rate was 16·1% (654/4077). Univariate analysis revealed an association between inadequate samples and cyst dominancy, macrocalcification and benign pathology of the nodule. The inadequate sample rate was also higher in the inexperienced group than in the experienced group. In multivariate analysis, cyst dominancy and macrocalcification of a nodule were significantly associated with inadequate samples in the experienced group.

Conclusion: Cyst dominancy and macrocalcifications in thyroid nodules, inexperience of the performing doctor and benign pathology were factors associated with high inadequate sample rates of US-FNAB in thyroid nodules.
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http://dx.doi.org/10.1111/j.1365-2265.2011.04011.xDOI Listing
June 2011

Anomalous double right coronary arteries: characteristic multidetector-row computed tomography findings.

J Comput Assist Tomogr 2010 Sep-Oct;34(5):666-9

Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea.

Purpose: To evaluate the characteristic multidetector-row computed tomography (MDCT) findings of anomalous double right coronary arteries (RCAs), an extremely rare variant.

Methods: During a 3-year period, 2569 patients with chest pain underwent MDCT coronary angiography. Five patients (0.2%) with anomalous double RCAs were found (mean age, 66 years; range, 43-81 years; 3 women). The location and number of orifice, anatomical distribution of the RCA and its branches, and presence of atherosclerosis were analyzed.

Results: All the 5 cases of double RCAs originated from the right sinus of Valsalva and could be classified into 3 types according to the characteristics. One patient (type 1) had a double RCA arising from 2 separated orifices in the right sinus of Valsalva; another patient (type 2) had 2 separate RCAs originating from a common orifice in the sinus of Valsalva; the other 3 patients with double RCAs (type 3) had a common main RCA in the sinus of Valsalva with a proximal bifurcation, like the usual left coronary arterial system.

Conclusions: Our data showed that although a double RCA is a rare anomaly, it is easily detected using MDCT and can be classified into 3 types.
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http://dx.doi.org/10.1097/RCT.0b013e3181e1053aDOI Listing
October 2010

Solitary drain-site recurrence after lumpectomy for breast cancer.

Yonsei Med J 2010 May;51(3):469-71

Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 250 Seongsan-ro, Seodaemun-gu, Seoul 120-752, Korea.

Locoregional recurrence after breast conservative surgery is not a rare event. However, a metastatic nodule solely at the surgical drain site seems to be extremely unusual. In this report, we present a patient who received a lumpectomy for breast cancer but a metastatic nodule developed at the drain site more than two years after her surgery.
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http://dx.doi.org/10.3349/ymj.2010.51.3.469DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2852810PMC
May 2010

Intravascular metastasis at the internal jugular vein from follicular thyroid carcinoma.

J Ultrasound Med 2010 Apr;29(4):659-62

Department of Radiology, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Korea.

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http://dx.doi.org/10.7863/jum.2010.29.4.659DOI Listing
April 2010

Spontaneously infarcted fibroadenoma mimicking breast cancer.

J Ultrasound Med 2009 Oct;28(10):1421-3

Department of Radiology, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea.

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http://dx.doi.org/10.7863/jum.2009.28.10.1421DOI Listing
October 2009