Electroretinography in congenital nystagmus patients with a normal fundus examination

PURPOSE

To identify the ophthalmic causes of congenital nystagmus with normal eye examination by electroretinography (ERG).

STUDY DESIGN

Retrospective observational study.

METHODS

We reviewed the medical records of patients younger than 6 months of age who presented between June 2008 and November 2011 with nystagmus and no other neurological signs following an otherwise normal eye examination. A complete ophthalmic examination and ERG (Nicolet Bravo system; Nicolet Biomedial & RETIscan; Roland Instruments), fundus photography, and Ishihara color test were performed to identify any ophthalmic causes of congenital nystagmus.

RESULTS

Thirty-three patients met the criteria. Rod dysfunction was diagnosed in 4 patients (12.1%), cone dysfunction in 2 patients (6.1%), and cone-rod dysfunction in 1 patient (3.0%). The results of ERG were negative in 2 patients (6.1%). Idiopathic infantile nystagmus was diagnosed in the remaining 24 patients (72.7%) based on their normal ERG examination.

CONCLUSIONS

In Korean congenital nystagmus patients with a normal fundus examination, achromatopsia and Leber's congenital amaurosis are uncommon causes. ERG is needed to make a definite diagnosis and provide prognostic information in congenital idiopathic nystagmus patients with a normal fundus examination.

Correlation of shear-wave elastography stiffness and apparent diffusion coefficient values with tumor characteristics in breast cancer

We aimed to investigate the correlation between shear-wave elastography (SWE) and apparent diffusion coefficient (ADC) values in breast cancer and to identify the associated characteristics. We included 91 breast cancer patients who underwent SWE and breast MRI prior to surgery between January 2016 and November 2017. We measured the lesion's mean (Emean) and maximum (Emax) elasticities of SWE and ADC values. We evaluated the correlation between SWE, ADC values and tumor size. The mean SWE and ADC values were compared for categorical variable of the pathological/imaging characteristics. ADC values showed negative correlation with Emean (r =  - 0.315, p = 0.002) and Emax (r =  - 0.326, p = 0.002). SWE was positively correlated with tumor size (r = 0.343-0.366, p < 0.001). A higher SWE value indicated a tendency towards a higher T stage (p < 0.001). Triple-negative breast cancer showed the highest SWE values (p = 0.02). SWE were significantly higher in breast cancers with posterior enhancement, vascularity, and washout kinetics (p < 0.02). SWE stiffness and ADC values were negatively correlated in breast cancer. SWE values correlated significantly with tumor size, and were higher in triple-negative subtype and aggressive imaging characteristics.

Diagnostic Performance of Point-of-Care Apparent Diffusion Coefficient Measures to Reduce Biopsy in Breast Lesions at MRI: Clinical Validation

Background The Eastern Cooperative Oncology Group-American College of Radiology Imaging Network Cancer Research Group multicenter A6702 trial identified an optimal apparent diffusion coefficient (ADC) cutoff to potentially reduce biopsies by 21% without affecting sensitivity. Whether this performance can be achieved in clinical settings has not yet been established. Purpose To validate the performance of point-of-care ADC measurements with the A6702 trial ADC cutoff for reducing unnecessary biopsies in lesions detected at breast MRI. Materials and Methods Consecutive breast MRI examinations performed from May 2015 to January 2019 at a single medical center and showing biopsy-confirmed Breast Imaging Reporting and Data System category 4 or 5 lesions, without ipsilateral cancer, were identified. Point-of-care lesion ADC measurements collected at clinical interpretation were retrospectively evaluated. MRI examinations included axial T2-weighted, diffusion-weighted, and dynamic contrast-enhanced sequences. Sensitivity and biopsy reduction rates were calculated by applying the A6702 optimal (ADC, 1.53 × 10-3 mm2/sec) and alternate conservative (1.68 × 10-3 mm2/sec) cutoffs. Lesion pathologic outcomes were the reference standard. To assess reproducibility, one radiologist repeated ADC measurements, and agreement was summarized using the intraclass correlation coefficient. Results A total of 240 lesions in 201 women (mean age, 49 years ± 13 [SD]) with pathologic outcomes (63 malignant and 177 benign) were included. Applying the optimal ADC cutoff produced an overall biopsy reduction rate of 15.8% (38 of 240 lesions [95% CI: 11.2, 20.9]), with a sensitivity of 92.1% (58 of 63 lesions [95% CI: 82.4, 97.4]; sensitivity was 97.2% [35 of 36 lesions] [95% CI: 82.7, 99.6] for invasive cancers). Results were similar for screening versus diagnostic examinations (P = .92 and .40, respectively). Sensitivity was higher for masses than for nonmass enhancements (NMEs) (100% vs 85.3%; P = .009). Applying the conservative ADC cutoff achieved a sensitivity of 95.2% (60 of 63 lesions [95% CI: 86.7, 99.0]), with a biopsy reduction rate of 10.4% (25 of 240 lesions [95% CI: 6.7, 14.5]). Repeated single-reader measurements showed good agreement with clinical ADCs (intraclass correlation coefficient, 0.72 [95% CI: 0.58, 0.81]). Conclusion This study validated the clinical use of ADC cutoffs to reduce MRI-prompted biopsies by up to 16%, with a suggested tradeoff of lowered sensitivity for in situ and microinvasive disease manifesting as NME. Clinical trial registration no. NCT02022579 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Honda and Iima in this issue.

Diagnostic Performance of Artificial Intelligence-Based Computer-Aided Detection Software for Automated Breast Ultrasound

RATIONALE AND OBJECTIVES

This study aimed to evaluate the diagnostic performance of radiologists following the utilization of artificial intelligence (AI)-based computer-aided detection software (CAD) in detecting suspicious lesions in automated breast ultrasounds (ABUS).

MATERIALS AND METHODS

ABUS-detected 262 breast lesions (histopathological verification; January 2020 to December 2022) were included. Two radiologists reviewed the images and assigned a Breast Imaging Reporting and Data System (BI-RADS) category. ABUS images were classified as positive or negative using AI-CAD. The BI-RADS category was readjusted in four ways: the radiologists modified the BI-RADS category using the AI results (AI-aided 1), upgraded or downgraded based on AI results (AI-aided 2), only upgraded for positive results (AI-aided 3), or only downgraded for negative results (AI-aided 4). The AI-aided diagnostic performances were compared to radiologists. The AI-CAD-positive and AI-CAD-negative cancer characteristics were compared.

RESULTS

For 262 lesions (145 malignant and 117 benign) in 231 women (mean age, 52.2 years), the area under the receiver operator characteristic curve (AUC) of radiologists was 0.870 (95% confidence interval [CI], 0.832-0.908). The AUC significantly improved to 0.919 (95% CI, 0.890-0.947; P = 0.001) using AI-aided 1, whereas it improved without significance to 0.884 (95% CI, 0.844-0.923), 0.890 (95% CI, 0.852-0.929), and 0.890 (95% CI, 0.853-0.928) using AI-aided 2, 3, and 4, respectively. AI-CAD-negative cancers were smaller, less frequently exhibited retraction phenomenon, and had lower BI-RADS category. Among nonmass lesions, AI-CAD-negative cancers showed no posterior shadowing.

CONCLUSION

AI-CAD implementation significantly improved the radiologists' diagnostic performance and may serve as a valuable diagnostic tool.

Unenhanced Breast MRI With Diffusion-Weighted Imaging for Breast Cancer Detection: Effects of Training on Performance and Agreement of Subspecialty Radiologists

OBJECTIVE

To investigate whether reader training improves the performance and agreement of radiologists in interpreting unenhanced breast magnetic resonance imaging (MRI) scans using diffusion-weighted imaging (DWI).

MATERIALS AND METHODS

A study of 96 breasts (35 cancers, 24 benign, and 37 negative) in 48 asymptomatic women was performed between June 2019 and October 2020. High-resolution DWI with b-values of 0, 800, and 1200 sec/mm² was performed using a 3.0-T system. Sixteen breast radiologists independently reviewed the DWI, apparent diffusion coefficient maps, and T1-weighted MRI scans and recorded the Breast Imaging Reporting and Data System (BI-RADS) category for each breast. After a 2-h training session and a 5-month washout period, they re-evaluated the BI-RADS categories. A BI-RADS category of 4 (lesions with at least two suspicious criteria) or 5 (more than two suspicious criteria) was considered positive. The per-breast diagnostic performance of each reader was compared between the first and second reviews. Inter-reader agreement was evaluated using a multi-rater κ analysis and intraclass correlation coefficient (ICC).

RESULTS

Before training, the mean sensitivity, specificity, and accuracy of the 16 readers were 70.7% (95% confidence interval [CI]: 59.4-79.9), 90.8% (95% CI: 85.6-94.2), and 83.5% (95% CI: 78.6-87.4), respectively. After training, significant improvements in specificity (95.2%; 95% CI: 90.8-97.5; P = 0.001) and accuracy (85.9%; 95% CI: 80.9-89.8; P = 0.01) were observed, but no difference in sensitivity (69.8%; 95% CI: 58.1-79.4; P = 0.58) was observed. Regarding inter-reader agreement, the κ values were 0.57 (95% CI: 0.52-0.63) before training and 0.68 (95% CI: 0.62-0.74) after training, with a difference of 0.11 (95% CI: 0.02-0.18; P = 0.01). The ICC was 0.73 (95% CI: 0.69-0.74) before training and 0.79 (95% CI: 0.76-0.80) after training (P = 0.002).

CONCLUSION

Brief reader training improved the performance and agreement of interpretations by breast radiologists using unenhanced MRI with DWI.

Diagnostic performance of screening mammography according to menstrual cycle among Asian women

PURPOSE

To investigate the performance metrics of screening mammography according to menstrual cycle week in premenopausal Asian women.

METHODS

This retrospective study included 69,556 premenopausal Asian women who underwent their first screening mammography between 2011 and 2019. The presence or absence of a breast cancer diagnosis within 12 months after the index screening mammography served as the reference standard, determined by linking the study data to the national cancer registry data. Menstrual cycles were calculated, and participants were assigned to groups according to weeks 1-4. The performance metrics included cancer detection rate (CDR), sensitivity, specificity, and positive predictive value (PPV), with comparisons across menstrual cycles.

RESULTS

Among menstrual cycles, the lowest CDR at 4.7 per 1000 women (95% confidence interval [CI], 3.8-5.8 per 1000 women) was observed in week 4 (all P < 0.05). The highest sensitivity of 72.7% (95% CI, 61.4-82.3) was observed in week 1, although the results failed to reach statistical significance. The highest specificity of 80.4% (95% CI, 79.5-81.3%) was observed in week 1 (P = 0.01). The lowest PPV of 2.2% (95% CI, 1.8-2.7) was observed in week 4 (all P < 0.05).

CONCLUSION

Screening mammography tended to show a higher performance during week 1 and a lower performance during week 4 of the menstrual cycle among Asian women. These results emphasize the importance of timing recommendations that consider menstrual cycles to optimize the effectiveness of screening mammography for breast cancer detection.

Diagnostic performance of core needle biopsy as a first-line diagnostic tool for thyroid nodules according to ultrasound patterns: Comparison with fine needle aspiration using propensity score matching analysis

OBJECTIVE

This study aimed to compare the diagnostic performance of core-needle biopsy (CNB) to fine-needle aspiration (FNA) as a first-line diagnostic tool in initially detected thyroid nodules, according to ultrasound (US) patterns.

MATERIALS AND METHODS

This study included 778 consecutive nodules from 705 patients who underwent CNB from one institution and 627 nodules from 583 patients who underwent FNA from two institutions. Adjustments for significant differences in patients' characteristics were facilitated via propensity score matching. We compared the diagnostic performance of CNB and FNA for thyroid malignancy according to three diagnostic criteria for all nodules and the US patterns.

RESULTS

A 1:1 matching of 469 patients yielded no significant differences between CNB and FNA for any covariates. CNB showed a significantly higher sensitivity for malignancy than FNA with any criterion (criterion 1: category VI, criterion 2: category V and VI, criterion 3: category IV, V and VI) in overall and high suspicion nodules (90.1-99.5% vs 69.7%-88.3%, all P-values < 0.001) and low/intermediate suspicion nodules, except criterion 1 (61.9%-100% vs 36.4%-45.5%, all P ≤ .016). In ROC curve analysis, the areas under the ROC curve of CNB were significantly higher than those for FNA with any criterion in overall and high suspicion nodules (P < .001) and in low/intermediate suspicion nodules, except criterion 1 (P ≤ .008). CNB had a slightly higher minor complication rate than FNA (0.7% vs 0%, P ≥ .069).

CONCLUSION

Our study suggests that CNB has a complementary role as an alternative first-line diagnostic tool to FNA for the initial diagnosis of thyroid nodules when performed by an experienced operator.

Inter-observer reliability and clinical validity of the MRI grading system for cervical central stenosis based on sagittal T2-weighted image

PURPOSE

The aim was to evaluate the inter-observer reliability of the Kang system among radiologists, residents, and clinicians and examine the correlation between radiologic and clinical findings.

METHODS

A total of 133 patients (M:F = 44:89, mean age 56 years) who underwent MRI of the cervical spine at our hospital were included. Two radiologists, two trainees, and two clinicians measured Central cervical spinal stenosis (CCSS) grade at the narrowest point according to the grading system suggested by Kang et al. A different clinician (a neurosurgeon) assessed the associated neurologic manifestations. Kappa statistics were used to analyze the inter-reader agreement among the radiologists, trainees, and clinicians. The clinical correlation (R) between grade and positive clinical manifestations (PCMs) was assessed using nonparametric correlation analysis (Spearman's correlation).

RESULTS

We found almost perfect agreement between trainees (k value = 0.890) and between radiologists (k value = 0.912) and substantial agreement between clinicians (k value = 0.691). Clinical correlations for all six readers suggested moderate correlation with R values ranging from 0.380 to 0.566. There was moderate correlation between grade and clinical manifestation within each group (R = 0.562-0.669).

CONCLUSION

The Kang MRI grading system of CCSS based on mid-sagittal MRI provides objective, reliable, and reproducible assessment regardless of field proficiency of the reader although the reproducibility of the clinician is slightly lower than radiologist and trainee of the radiology department. There was moderate correlation between image interpretation and clinical findings irrespective of the reader's main field of research.

Preoperative evaluation of mammographic microcalcifications after neoadjuvant chemotherapy for breast cancer

AIM

To assess the predictive value of preoperative residual mammographic microcalcifications for residual tumours after neoadjuvant chemotherapy (NAC) for breast cancer.

MATERIALS AND METHODS

This single-centre retrospective study included breast cancer patients who underwent NAC and demonstrated suspicious microcalcifications within or near the tumour bed on mammography from June 2015 to August 2018. The residual microcalcifications and remnant lesion on magnetic resonance imaging (MRI) were correlated with histopathological findings of residual tumours and immunohistochemical markers.

RESULTS

A total of 96 patients were included. Ten patients achieved pathological complete response (pCR) and previous suspicious microcalcifications were associated with benign pathology in 10.4% (10/96) of the patients. In the remaining 86 patients who did not achieve pCR, 61.5% (59/96) of the residual microcalcifications were associated with invasive or in situ carcinoma and 28.1% (27/96) with benign pathology. Hormone receptor-positive (HR⁺) patients had the highest proportion of residual malignant microcalcifications compared to HR^- patients (48.9% versus 13.5%, respectively; p=0.019). MRI correlated better than residual microcalcifications on mammography in predicting residual tumour extent in all subtypes (ICC=0.709 versus 0.365). MRI also showed higher correlation with residual tumour size for the HR^-/HER2⁺ and HR^-/HER2^- subtype (ICC=0.925 and 0.876, respectively).

CONCLUSION

The extent of microcalcifications on mammography after NAC did not correlate with the extent of residual cancer in 38.5% of women. Regardless of the extent of microcalcifications, residual tumour extent on MRI after NAC and molecular subtype could be an accurate tool in evaluating residual cancer after NAC.

Efficacy of extracorporeal shockwave therapy in the treatment of postherpetic neuralgia: A pilot study

Established conventional treatments for postherpetic neuralgia (PHN) and postherpetic itch (PHI) are difficult and often disappointing. In this study, the authors investigated the effect and mechanisms of extracorporeal shockwave therapy (ESWT) on pain and itch associated with PHN and PHI.Thirteen patients, 50 to 80 years of age, with symptoms associated with PHN or PHI (duration of persistent pain >3 months) and complaints of pain or itch rated >4 on a numerical rating scale (NRS), were included. ESWT was administered using a shockwave device (Piezo Shockwave, Richard Wolf GmbH, Knittlingen, Germany) to skin areas affected by pain or itch. An energy flux density of 0.09 to 0.16 mJ/mm at a frequency of 5 Hz and 2000 impulses was administered at 3-day intervals for 6 sessions. The NRS, 5D-Itch Scale, and Patients Global Impression of Change (PGIC) scale were used to evaluate the efficacy of ESWT.NRS scores of pain and itch and 5D-Itch Scale scores decreased significantly compared with before treatment and at the end of the treatment sessions (P < .0001, P = .001, P = .0002, respectively). There was a statistically significant difference between PGIC scores, which were checked every 2 sessions (P < .0001).ESWT is a noninvasive modality that significantly reduced PHN-associated pain and itch.

Metastasis of Poorly Differentiated Thyroid Carcinoma to the Sternum: A Case Report

저분화 갑상선암의 복장뼈로의 전이는 드물어 산발적인 증례 보고가 대부분이다. 저자들은 저분화 갑상선암으로 우측 갑상선편측절제술을 시행 받은 83세 여자 환자에서 수술 2년 후 복장뼈로의 전이가 발생하여 복장뼈제거술 및 재건술을 시행 받은 드문 증례를 경험하였기에 이를 보고하고자 한다.

Contrast enhanced digital mammography versus magnetic resonance imaging for accurate measurement of the size of breast cancer

OBJECTIVE

To compare the accuracy of contrast-enhanced digital mammography (CEDM) and MRI, including maximal intensity projection (MIP) images, for measuring the tumour size of breast cancer.

METHODS

We included 52 females (mean age, 50.9 years) with surgery due to breast cancer, and measured maximum diameter of main mass on mediolateral oblique (MLO) and craniocaudal (CC) views of mammography and CEDM; sagittal, axial MIP images, and early dynamic contrast-enhanced MRI (CEMRI) before surgery. Bland-Altman plot, intraclass correlation coefficient, and univariate linear regression analysis were used to evaluate the maximum size between imaging and pathology including only invasive component (OP_invasive) or with carcinoma in situ (OP_max).

RESULTS

Mean OP_invasive was 15.5 mm, and overestimation rate was similar or higher than underestimation rate on all images except CC view of mammography and axial MIP image of CEDM. Mean OP_max was 21.7 mm, and underestimation rate was higher than the overestimation rate. All parameters of CEDM and CEMRI showed good agreement ( k > 0.75) with OP_invasive, with the most favourable result being the CC view of CEDM and axial MIP image of CEMRI.

CONCLUSION

All views of CEDM and MRI provided accurate measurements of tumour size. Axial plane CEDM and MRI would be the first choice for image review and treatment planning, with the highest accuracy obtained by using CC view of CEDM.

ADVANCES IN KNOWLEDGE

Previous studies have not compared the measurement of the tumour size using detailed sequences; in our study, we discovered that CEDM can be an alternative modality to CEMRI.

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

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 in situ (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 (p=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 (p=0.999 and p=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], p=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], p=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.

2017 Thyroid Radiofrequency Ablation Guideline: Korean Society of Thyroid Radiology

Thermal ablation using radiofrequency is a new, minimally invasive modality employed as an alternative to surgery in patients with benign thyroid nodules and recurrent thyroid cancers. The Task Force Committee of the Korean Society of Thyroid Radiology (KSThR) developed recommendations for the optimal use of radiofrequency ablation for thyroid tumors in 2012. As new meaningful evidences have accumulated, KSThR decided to revise the guidelines. The revised guideline is based on a comprehensive analysis of the current literature and expert consensus.

Necessity of Axillary Scanning After Negative Finding on Both Mammography and Subsequent Breast Ultrasound

The purpose of our study was to assess the cancer detection rate and positive predictive value (PPV) for incidentally detected abnormal axillary lymph nodes with negative mammography and subsequent breast ultrasound (US). We included 7039 screened patients (mean age, 52 y) from January 2012 to March 2015 with negative mammography and subsequent breast US results. In two patients with positive lymph nodes, neither were from breast malignancy. The calculated cancer detection rate, PPV for biopsy and axillary biopsy rate was 0.3 per 1000 axillary US, 14.3% and 0.2%. Cancer rates for patients with a family or personal operation history, with cancer history and with no family/operation/cancer history were 0%, 0.1% and 0.2%, respectively. Our results indicate that the cancer detection rate and PPV for US were too low to recommend routine axillary scanning including screening breast US in patients with negative mammography and subsequent breast US, especially with no history of any cancers.

Radiation dose reduction in plain radiography of the full-length lower extremity and full spine

OBJECTIVE

To compare the diagnostic performance of standard- and low-dose radiographs of the full-length lower extremity and spine.

METHODS

This study included 223 patients who visited our hospital and received full-length lower extremity standing radiographs and full-spine radiographs. We determined the dose area product (DAP) of each image, and effective doses (ED, mSv) were calculated based on the DAP. Subjective evaluation of the full-length radiographs was based on image quality, which was assessed by bony cortex and trabecula evaluation, and on diagnostic performance, which was assessed by leg length measurement. Subjective evaluation of the full-spine radiographs was based on image quality, which was assessed by viewing the vertebral endplate, pedicle and lateral border of vertebral body, and on diagnostic performance from measurement of Cobb's angle.

RESULTS

For the full-length view and the full-spine view both the mean DAP and ED values of the standard-dose group were significantly higher than those of the low-dose group (p < 0.05). Mean scores for subjective values did not significantly differ based on the radiation dosage (p-values, 0.15-0.99). The subjective value scores for the full-length view were 2.94-2.98 in the standard-dose group and 2.91-3.00 in the low-dose group. Of note, both groups had very high scores. Additionally, the diagnostic performance scores between the two groups were also very high (range from 2.92 to 3.00).

CONCLUSION

Reducing mAs by 50% of the standard dose does not affect the radiograph image quality or its clinical validity. Advances in knowledge: Radiation dose reduction (50% of the standard dose of mAs) in plain radiography of the full-length lower extremity and full spine do not affect the clinical validity and the image quality.

Core Needle Biopsy of the Thyroid: 2016 Consensus Statement and Recommendations from Korean Society of Thyroid Radiology

Core needle biopsy (CNB) has been suggested as a complementary diagnostic method to fine-needle aspiration in patients with thyroid nodules. Many recent CNB studies have suggested a more advanced role for CNB, but there are still no guidelines on its use. Therefore, the Task Force Committee of the Korean Society of Thyroid Radiology has developed the present consensus statement and recommendations for the role of CNB in the diagnosis of thyroid nodules. These recommendations are based on evidence from the current literature and expert consensus.

Mammographic Breast Density Evaluation in Korean Women Using Fully Automated Volumetric Assessment

The purpose was to present mean breast density of Korean women according to age using fully automated volumetric assessment. This study included 5,967 screening normal or benign mammograms (mean age, 46.2 ± 9.7; range, 30-89 years), from cancer-screening program. We evaluated mean fibroglandular tissue volume, breast tissue volume, volumetric breast density (VBD), and the results were 53.7 ± 30.8 cm(3), 383.8 ± 205.2 cm(3), and 15.8% ± 7.3%. The frequency of dense breasts and mean VBD by age group were 94.3% and 19.1% ± 6.7% for the 30s (n = 1,484), 91.4% and 17.2% ± 6.8% for the 40s (n = 2,706), 72.2% and 12.4% ± 6.2% for the 50s (n = 1,138), 44.0% and 8.6% ± 4.3% for the 60s (n = 89), 39.1% and 8.0% ± 3.8% for the 70s (n = 138), and 39.1% and 8.0% ± 3.5% for the 80s (n = 12). The frequency of dense breasts was higher in younger women (n = 4,313, 92.3%) than older women (n = 1,654, 59.8%). Mean VBD decreased with aging or menopause, and was about 16% for 46-year-old-Korean women, much higher than in other countries. The proportion of dense breasts sharply decreases in Korean women between 40 and 69 years of age.

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

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.

Absence of Residual Microcalcifications in Atypical Ductal Hyperplasia Diagnosed via Stereotactic Vacuum-Assisted Breast Biopsy: Is Surgical Excision Obviated?

PURPOSE

The purpose of our study was to evaluate the underestimation rate of atypical ductal hyperplasia (ADH) on vacuum-assisted breast biopsy (VABB), and to examine the correlation between residual microcalcifications and the underestimation rate of ADH.

METHODS

A retrospective study was performed on 27 women (mean age, 49.2±9.2 years) who underwent additional excision for ADH via VABB for microcalcifications observed by using mammography. The mammographic findings, histopathologic diagnosis of all VABB and surgical specimens, and association of malignancy with residual microcalcifications were evaluated. The underestimation rate of ADH was also calculated.

RESULTS

Of the 27 women with microcalcifications, nine were upgraded to ductal carcinoma in situ (DCIS); thus, the underestimation rate was 33.3% (9/27). There was no difference in age (p=0.40) and extent of microcalcifications (p=0.10) when comparing benign and malignant cases. Six of 17 patients (35.3%) with remaining calcifications after VABB were upgraded to DCIS, and three of 10 patients (30%) with no residual calcifications after VABB were upgraded (p=1.00).

CONCLUSION

The underestimation rate of ADH on VABB was 33.3%. Furthermore, 30% of patients with no remaining calcifications were upgraded to DCIS. Therefore, we conclude that all ADH cases diagnosed via VABB should be excised regardless of the presence of residual microcalcifications.

Primary squamous cell carcinoma of thyroid gland with local recurrence: ultrasonographic and computed tomographic findings

Primary squamous cell carcinoma of the thyroid gland (PSCCT) is a rare malignancy that presents with advanced disease and poor prognosis. It is difficult to diagnose PSCCT in its early stage because of its rarity and lack of typical imaging findings. We experienced an elderly woman with PSCCT confirmed by surgery. Although preoperative fine-needle aspiration revealed no malignancy, surgical resection was performed because the ultrasonogram showed diffuse microcalcifications, which suggested malignancy, and clinically, the mass grew rapidly to compress the trachea. Local tumor recurrence was noted at 3 months after surgery. Surgical resection or repeat biopsy should be considered if a cytologically benign thyroid mass shows imaging or clinical features of malignancy.

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

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.

Oxygen, nitric oxide and articular cartilage

Molecular oxygen is required for the production of nitric oxide (NO), a pro-inflammatory mediator that is associated with osteoarthritis and rheumatoid arthritis. To date there has been little consideration of the role of oxygen tension in the regulation of nitric oxide production associated with arthritis. Oxygen tension may be particularly relevant to articular cartilage since it is avascular and therefore exists at a reduced oxygen tension. The superficial zone exists at approximately 6% O2, while the deep zone exists at less than 1% O2. Furthermore, oxygen tension can alter matrix synthesis, and the material properties of articular cartilage in vitro. The increase in nitric oxide associated with arthritis can be caused by pro-inflammatory cytokines and mechanical stress. Oxygen tension significantly alters endogenous NO production in articular cartilage, as well as the stimulation of NO in response to both mechanical loading and pro-inflammatory cytokines. Mechanical loading and pro-inflammatory cytokines also increase the production of prostaglandin E2 (PGE2). There is a complex interaction between NO and PGE2, and oxygen tension can alter this interaction. These findings suggest that the relatively low levels of oxygen within the joint may have significant influences on the metabolic activity, and inflammatory response of cartilage as compared to ambient levels. A better understanding of the role of oxygen in the production of inflammatory mediators in response to mechanical loading, or pro-inflammatory cytokines, may aid in the development of strategies for therapeutic intervention in arthritis.

Pathogenesis of osteoarthritis-like changes in the joints of mice deficient in type IX collagen

OBJECTIVE

To examine the pathogenetic mechanisms of osteoarthritis (OA)-like changes in Col9a1-/- mice, which are deficient in type IX collagen.

METHODS

Knee joints and temporomandibular joints (TMJs) from Col9a1-/- mice and their wild-type (Col9a1+/+) littermates were examined by light microscopy. Immunohistochemical staining was performed to examine the expression of matrix metalloproteinase 3 (MMP-3) and MMP-13, degraded type II collagen, and the discoidin domain receptor 2 (DDR-2) in knee joints. Cartilage mechanics were also evaluated for compressive properties by microindentation testing of the tibial plateau and for tensile properties by osmotic loading of the femoral condyle.

RESULTS

Histologic analysis showed age-dependent OA-like changes in the knee and TMJs of Col9a1-/- mice starting at the age of 3 months. At the age of 6 months, enhanced proteoglycan degradation was observed in the articular cartilage of the knee and TMJs of the mutant mice. The expression of MMP-13 and DDR-2 protein and the amount of degraded type II collagen were higher in the knee joints of Col9a1-/- mice than in their wild-type littermates at the age of 6 months. Changes in cartilage mechanics were observed in the femoral and tibial plateaus of Col9a1-/- mice at 6 months, including a decrease in the compressive modulus and uniaxial modulus. At 3 and 6 months of age, tibial cartilage in Col9a1-/- mice was found to be more permeable to fluid flow, with an associated compromise in the fluid pressurization mechanism of load support. All of these changes occurred only at medial sites.

CONCLUSION

Lack of type IX collagen in Col9a1-/- mice results in age-dependent OA-like changes in the knee joints and TMJs.

Zonal variations in the three-dimensional morphology of the chondron measured in situ using confocal microscopy

OBJECTIVE

Chondrocytes in articular cartilage are surrounded by a narrow pericellular matrix (PCM), which together with the enclosed cell(s) are termed the "chondron". Although the precise function of this tissue region is unknown, previous studies provide indirect evidence that the PCM plays an important role in governing the local mechanical environment of chondrocytes. In particular, theoretical models of the chondron under mechanical loading suggest that the shape, size, and biomechanical properties of the PCM significantly influence the stress-strain and fluid flow environment of the cell. The goal of this study was to quantify the three-dimensional morphology of chondron in situ using en bloc immunolabeling of type VI collagen coupled with fluorescence confocal microscopy.

METHODS

Three-dimensional reconstructions of intact, fluorescently labeled chondrons were made from stacks of confocal images recorded in situ from the superficial, middle, and deep zones of porcine articular cartilage of the medial femoral condyle.

RESULTS

Significant variations in the shape, size, and orientation of chondrocytes and chondrons were observed with depth from the tissue surface, revealing flattened discoidal chondrons in the superficial zone, rounded chondrons in the middle zone, and elongated, multicellular chondrons in the deep zone.

CONCLUSIONS

The shape and orientation of the chondron appear to reflect the local collagen architecture of the interterritorial matrix, which varies significantly with depth. Quantitative measurements of morphology of the chondron and its variation with site, disease, or aging may provide new insights into the influence of this structure on physiology and the pathology of articular cartilage.

An in situ calibration of an ultrasound transducer: a potential application for an ultrasonic indentation test of articular cartilage

A change in mechanical properties of articular cartilage would be considered one of the most reliable signs of cartilage degeneration. While an indentation method has the potential to measure the cartilage properties in vivo, an accurate measurement of cartilage thickness in situ is technically difficult. An ultrasound transducer has often been used to measure the cartilage thickness. However, its accuracy is limited by the lack of an accurate measurement of the ultrasound speed of cartilage, for the ultrasound speed varies according to the pathological conditions of the tissue. Therefore, the objective of this study is to develop an in situ calibration method of predicting the true ultrasound speed of cartilage and thus allow the ultrasound transducer to measure the thickness of the tissue with great accuracy. By simultaneously implementing an indentation testing protocol using the ultrasound transducer as an indenter, this method can also provide an indentation stiffness measurement of cartilage. The feasibility of the proposed method was examined using normal and proteoglycan-depleted cartilage specimens. It was found that the true ultrasound speed measured by the in situ calibration method was sensitive to the proteoglycan depletion (1735+/-35 m/s for normal, and 1598+/-28 m/s for proteoglycan-depleted cartilage), and that the measured cartilage thickness was consistently accurate regardless of the tissue condition. The measured indentation stiffness of articular cartilage was also sensitive to the tissue condition. Thus, this study demonstrates that the proposed ultrasonic indentation technique can be used to accurately identify the abnormality of articular cartilage in situ.