Predictive Factors for Non-Response to Neoadjuvant Chemotherapy for Breast Cancer

Purpose@#Neoadjuvant chemotherapy (NAC) can effectively downstage locally advanced breast cancer; however, in some cases the cancer remains clinically stable and in others, there is disease progression. Although factors predictive of the response to NAC have been established, those for a non-response remain unknown. This study investigated factors predicting a stable or progressive disease course, and the extent of the response, after NAC based on anthracycline and cyclophosphamide (AC), with or without taxane. @*Methods@#Data were collected retrospectively by reviewing medical records of patients who received NAC for breast cancer using AC, with or without taxane between January 2013 and December 2017. Patients with clinically stable or progressive disease after NAC were compared statistically with those who achieved a partial or complete response. @*Results@#In total, 297 patients received NAC with AC and 196 patients received AC followed by taxane. Of these, 45 (15.2%) and 64 (32.6%) patients respectively, showed no response (i.e., stable or progressive disease). Factors related to non-response after AC included large pretreatment tumor size, clinical T3 status, and high histologic grade. Factors related to non-response after taxane included clinical T3 status and estrogen receptor or progesterone receptor positivity. @*Conclusion@#Clinical T3 stage, grade III histological grade, and estrogen or progesterone receptor positivity were predictors of no response to NAC for breast cancer.

Intraoperative Specimen Mammography for Margin Assessment in Breast-Conserving Surgery / 한국유방암학회지

Echocardiographic Plains Reflecting Total Amount of Epicardial Adipose Tissue as Risk Factor of Coronary Artery Disease

BACKGROUND: Several studies suggested that epicardial adipose tissue (EAT) might be associated with metabolic syndrome and coronary atherosclerosis. But, little had been studied whether the thickness of EAT on echocardiography could represent the whole amount of EAT. The purpose of this study was to identify the best echocardiographic methods reflecting total amount of EAT. \METHODS: Sixty subjects (32 women, mean: 58+/-12 years-old) who underwent 64-slice multidetector computed tomography (MDCT) were consecutively enrolled. All CT scanning was performed one Brilliance CT-64-channel configuration scanner (Philips, Cleveland, USA) and axially contiguous 10-mm-thickeness sections were obtained from aortic valve to diaphragm level. EAT area was manually traced in each slice and summed up. The EAT thickness was measured as the echo-lucent or echo-dense space between epicardium and pericardium at parasternal long-axis, modified 4-chamber, and apical 4-chamber view. RESULTS: The EAT thickness at parasternal long-axis and modified 4-chamber view and the sum of EAT thickness from each views (median thickness: 1.0, 2.8, 1.1 and 5.0 mm, respectively) were all correlated with total EAT area on MDCT. Among echo parameters, the EAT thickness measured on parasternal long-axis view during diastole correlated best with total EAT area on MDCT (r=0.572, p<0.001). CONCLUSION: The echocardiographic EAT measurement might be easily accessible and less harmful method representing whole amount of EAT. The measurement of the thickness of EAT on parasternal long-axis view during diastole by echocardiography might be feasible and reliable in the studying field of EAT.

The Diagnostic Accuracy of Multidetector Row CT for Evaluating the Axillary Lymph Nodes in Patients with Breast Cancer

PURPOSE: We investigated the CT (computed tomography) findings of metastatic lymph nodes (LNs), and we analyzed the diagnostic performance of multidetector row CT (MDCT) for detecting axillary LN metastases in patients with breast cancer. MATERIALS AND METHODS: We investigated 59 patients who preoperatively underwent chest MDCT, and they underwent sentinel LN biopsy or whole axillary LN dissection. We analyzed the morphologic features, the degree of enhancement and the delayed enhancement pattern. We classified the patients into the non-metastatic LN group and the metastatic LN group, and we calculated the diagnostic performance of MDCT for detecting metastatic LNs. RESULTS: When both the morphologic and quantitative criteria were consistent, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 58.1%, 100%, 100% and 68.3%, respectively, and MDCT accurately detected metastatic LNs in 2 patients that were false negative on sentinel LN biopsy. When the morphologic and quantitative criteria were consistent, the sensitivity, specificity, PPV and NPV were 87.1%, 53.6%, 67.5% and 78.9%, respectively. However, MDCT could not detect metastatic LNs, including two micrometastases (a total of 8 micrometastases) that were in each of four patients. CONCLUSION: MDCT can be used to perform the morphology and quantitative analysis of axillary LNs, and this modality has excellent specificity and a PPV for detecting metastatic LNs when the both of the diagnostic criteria are consistent.

Assessment of the Image Quality and Diagnostic Accuracy of Coronary CT Angiography: Effect of Sublingual Administration of Nitroglycerin

PURPOSE: We wanted to investigate the effect of sublingual nitroglycerin (NTG) on improving the image quality and diagnostic accuracy of coronary computed tomographic angiography (CTA) for detecting atherosclerosis and significant stenosis. MATERIALS AND METHODS: We retrospectively assessed the data of 81 patients who underwent coronary CTA. Forty three patients underwent coronary CTA without medication (the non-administrated group), while 38 patients were given 0.6 mg NTG sublingually before coronary CTA (the administrated group). Image quality was assessed using a five-point grading scale. We evaluated the diagnostic performance of coronary CTA for assessing atherosclerosis and significant stenosis (> or = 50%) in the 42 patients who underwent invasive coronary angiography. RESULTS: The mean image-quality grades were 4.09+/-0.72 and 4.50+/-0.60 in the non-administrated and administrated groups, respectively (p=0.008). On the per-artery analysis, the accuracy percentages for detecting coronary CTA were 65 and 88% for atherosclerosis and 82 and 80% for significant stenosis in the non-administrated and administrated groups, respectively. On the per-patient analysis, the positive predictive values for coronary CTA were 80% and 100% for atherosclerosis and 77% and 88% for significant stenosis in the non-administrated and administrated groups, respectively. CONCLUSION: Coronary CTA with NTG administration improved the image quality. The accuracy of coronary CTA for detecting atherosclerosis was higher in the administrated group than in the non-administrated group.

Usefulness of Preoperative Breast MRI in Breast Cancer Patients Diagnosed with Tumor Removal Using a US-guided Mammotome

PURPOSE: We evaluated the MRI findings that suggested the presence of a residual cancer after a mammotome biopsy in pathologically proven breast cancer patients and the usefulness of MRI to diagnose a residual cancer and additional lesions. MATERIALS AND METHODS: We reviewed 41 breast cancer patients that underwent an ultrasonography-guided mammotome biopsy for complete resection of a breast lesion. MRI was performed for preoperative assessment and MRI findings suggestive of a residual cancer at the procedure site were analyzed and correlated to the pathological findings. Additional enhancements on breast MRI were analyzed, and the diagnostic accuracy of MRI for occult additional lesions was calculated. RESULTS: A total of 32 (78.0%) patients had a residual tumor. A mass was the most common MRI finding that suggested a residual cancer. Thick rim enhancement or a mass with a non-mass like enhancement were the most suspicious findings that suggested the presence of a residual cancer. The sensitivity, specificity and accuracy of MRI for the detection of a residual cancer were 81.3%, 66.7% and 78.0%, respectively. Additional malignant lesions were found in 7 cases. The sensitivity, specificity and accuracy of MRI for the detection of additional lesions were 100%, 60.0% and 76.5%, respectively. CONCLUSION: Further complete surgery should be performed, as residual tumors are found in 50% of the negative MRI examinations, whereas preoperative MRI is helpful to evaluate occult additional lesions.

Usefulness of Breast MRI for Diagnosing an Extensive Intraductal Component of Breast Cancer: Comparison with Mammography and Ultrasonography

PURPOSE: An extensive intraductal component of breast cancer is a principal risk factor for local recurrence, and this is difficult to diagnose with performing only mammography. We investigated the usefulness of breast MRI for evaluating an extensive intraductal component of breast cancer, and we compared this modality with mammography and ultrasonography (US). MATERIALS AND METHODS: From March 2003 to July 2004, 90 patients underwent breast MRI among all the patients who were suffering with breast cancer and for whom an EIC was ultimately revealed to be present or not. A total 83 patients with stage I and II breast cancer were finally included in this study. EIC positivity was defined according to the imaging data as follows: 1) microcalcifications beyond the tumor shadow or malignant microcalcifications without a tumor mass on mammography, 2) tubular hypoechoic structures adjacent to the tumor or architectural distortion with calcifications beyond the tumor on US, and 3) linear or ductal enhancement, segmental or regional clumped enhancement, and spotty nodular or reticular enhancement adjacent to the tumor on MRI. EIC was present in 41 patients and this finding was negative in 42 patients. The results were then compared those results from mammography and US. RESULTS: The sensitivities of detecting EIC by mammography, US and MRI were 48.6%, 67.5% and 80.5%, respectively, and the corresponding specificities were 92.3%, 73.2% and 69.0%, respectively. In the cases that were suspected to be EIC positive on more than two imaging modality, the positive predictive value (PPV) was 78.1%. In cases that were suspected of being EIC positive on just one imaging modality, the negative predictive value (NPV) was 75.0%. CONCLUSION: Breast MRI provides good information about an EIC of breast cancer and it is a more sensitive study than mammography and US, yet the specificity for the detection of EIC is highest on mammography. A combined evaluation by mammography, US and MRI is the most accurate way to diagnose an EIC of breast cancer.

Traumatic Thoracic Injury: The Role of Multidetector-row CT

The introduction of Multidetector-row CT (MDCT) has revolutionized the diagnostic strategy of multitrauma patients. The rapid acquisition of a large scanning volume with a thin slice collimation allows for motion-free images of high spatial resolution, and this enables the application of the multiplanar reformat (MPR) and 3D volume-rendering (VR) images. The MPR images more accurately demonstrate aortic rupture or dissection, diaphragmatic injuries and fracture of vertebrae, sternum and costal cartilages. Diagnosing vascular injuries can be aided by using the MIP images. Rib fracture, trachea and bronchial laceration are more easily detected by the 3D images, while airway and vascular injuries can be detected from performing virtual endoscopy. We introduce our current CT imaging protocol and we present our clinical experience with using MDCT in the assessment of patients with blunt thoracic trauma

Relation between the Left Ventricular Mass and the Left Coronary Artery Dimensions as Determined by 16-Channel Multidetector CT: Comparison between the Normotensive group and the Hypertensive Group

PURPOSE: The purpose of this study is to determine the left ventricular mass (LVM) and the left coronary artery dimension and to investigate the relationship between the two values in the normotensive group and hypertensive group with using 16-channel multidetector CT (MDCT). MATERIALS AND METHODS: Among the patients who underwent a CT coronary angiogram procedure using 16-channel MDCT at Ajou University Hospital from October 2004 to February 2005, 33 patients became the subjects of this study. These 33 patients showed normal findings without calcification or stenosis of the coronary arteries. The total volume of the left ventricular wall was calculated using work-in-progress cardiac CT reconstruction software. The LVM could then be directly calculated by multiplying the left ventricular muscle volume by the myocardial tissue density, which was assumed to be 1.05 g/cm3. The coronary diameter was measured by a fixed threshold method from the transverse reformation images obtained along the long-axis of each coronary artery. We calculated the cross-sectional area (CSA) of the coronary arteries from the equation of pi D2/4 (D=diameter). Regression analysis was performed for the relationship between LVM and the left coronary artery dimensions with using a linear least-squares method. Comparison between the normotensive group and the hypertensive group was done using the Student t test. RESULTS: The average LVM was 127.9+/-36.2 g (mean+/-standard deviation) and the average left ventricular mass index (LVMI) was 74.7+/-15.5 g in this study population. The average diameter of the coronary arteries was 4.38+/-0.69 mm for the left coronary artery. In all the subjects (n=33, r=0.67, p=0.000) and the normotensive group (n=21, r=0.68, p=0.000), the LVM was significantly correlated with the CSA of the left coronary artery, but not in the hypertensive group (n=12, r=0.57, p=0.062). In the hypertensive group, the CSA of the left coronary arteries per 100 g of muscle mass tended to decrease as the LVM increased. However, no statistical significance was demonstrated (r=-0.51, p=0.087). The end-diastolic left ventricular volume of the hypertensive group was smaller than that of the normotensive group (p=0.039). CONCLUSION: Using 16-channel MDCT, we could determine the LVM and coronary artery dimensions simultaneously in all the subjects. In all the subjects and the normotensive group, the LVM was significantly correlated with the CSA of the left coronary artery. However, the coronary artery dimensions did not increase commensurately with a concomitant increase of the LVM in the patients with hypertension.

Primary Localized Amyloidosis of the Ureter Associated with Osseous Metaplasia / 대한비뇨기과학회지

Since localized amyloid deposits of the ureter were first described by Lehmann in 1937, approximately 90 cases have been reported. Isolated primary amyloidosis of the ureter is a rare disease, and its diagnosis cannot be made by radiologic findings. Because of radiographic similarity to transitional cell carcinoma, these lesions are often clinically mistaken for malignancies, and nephroureterectomy is usually performed. Here, we report a case of localized ureteral amyloidosis with osseous metaplasia, which was managed successfully by renal sparing segmental resection with the bladder Boari flap.

Dermatofibrosarcoma Protuberance of the Breast: Case Report

Dermatofibrosarcoma protuberans is a rare cutaneous soft tissue neoplasm with the potential for intermediate malignancy, and is characterized by local invasion and recurrence. It can occur at almost any site, but usually arises in the trunk and extremities. Dermatofibrosarcoma protuberans mimicking a primary breast lesion has not previously been reported in Korea. We report on the case of a 28-year-old female patient with dermatofibrosarcoma protuberans on one of her breasts, which is a very unusual site.

Radiologic Findings of Mucocele-like Tumor of the Breast

PURPOSE: To evaluate the mammographic and ultrasonographic findings of mucocele-like tumors. MATERIALS AND METHODS: Twelve breast lesions from 1994 through 2004, coded as mucocele or mucocele-like tumors, were retrieved from the surgical pathology database files at our institution. Eleven of the patients had undergone mammography, and sonography had been performed in all 12 patients. We retrospectively reviewed the mammographic, sonographic and pathologic findings. RESULTS: The mammographies showed calcifications alone (n=6), calcification with mass or asymmetric density (n=3), and normal mammogram (n=2). The shapes of the calcifications were pleomorphic (n=4, 44.4%), amorphous (n=3, 33.3%) and round (n=2, 22.2%). Sonography was performed in all patients (n=12) and showed cysts (n=8), cystic mass (n=2), tubular hypoechoic structure (n=1) and hypoechoic mass (n=1). Pathologic examination revealed 5 cases of benign mucocele-like tumor that included epithelial hyperplasia without atypia (n=2) and atypical ductal hyperplasia (n=4), and 3 cases of associated intraductal carcinoma. Calcification was more frequently detected in the mucocele-like tumors with atypical ductal hyperplasia or intraductal carcinoma than in the benign tumors. Pleomorphic calcification was only visualized in those cases involving atypical hyperplasia or intraductal carcinoma. Of the 9 cases of calcification seen in the mammograms, 7 cases (77.8%) were detected in the associated sonograms and all were located within the lesion. CONCLUSION: The most common mammographic finding of mucocele-like tumors was segmentally distributed pleomorphic or amorphous calcifications, and the most common sonographic finding was cyst or cystic mass.

Percutaneous Drainage with Ultrasound Guidance in the Intensive Care Unit

PURPOSE: To determine the efficacy and safety of bedside percutaneous drainage procedures with ultrasound guidance in critically ill patients in the intensive care unit (ICU). MATERIALS AND METHODS: Sixty five percutaneous drainage procedures performed at the bedside, in 39 ICU patients, were evaluated. All of the procedures were performed with ultrasound guidance alone. The procedures consisted of percutaneous drainage of abdominal (n=35) and pleural (n=27) fluids, percutaneous cholecystostomy (n=2) and percutaneous nephrostomy (n=1). The clinical responses were classified as 'complete response', 'partial response', 'failure' or 'undetermined'. The medical records were reviewed retrospectively to evaluate the clinical response. RESULTS: Technical success was achieved in 64 of the 65 procedures (98.5%). The complication rate was 13.8% (9 cases). There was no immediate procedure-related death or worsening of the clinical condition of the patients. The clinical responses after drainage were 'complete response' in 39 cases (60.9%), 'partial response' in 14 (21.9%), 'failure' in 3 (4.7%), and 'undetermined' in 8 (12.5%). CONCLUSION: Bedside drainage procedures with ultrasound guidance are effective and safe to perform when patients are too critically ill to be moved from the ICU to the angiography room.

Multiple Organ Involvement of Lymphoepithelioma-Like Carcinoma in the Kidney and the Ureter / 대한비뇨기과학회지

A lymphoepithelioma-like carcinoma is a tumor with morphological features identical to an undifferentiated nasopharyngeal carcinoma that occurs outside the nasopharynx. This kind of tumor has been found in the salivary gland, stomach, lung, thymus, bladder, prostate, vagina and skin, but is particularly rare in the urinary tract. We report a case of a lymphoepithelioma-like carcinoma, which are usually found simultaneously in the kidneys and ureter. This is the first case of multiorgan involvement of this tumor.

Antegrade Ureteral Stenting in Ureteral Obstruction / 대한비뇨기과학회지

PURPOSE: Antegrade ureteral stenting was attempted in cases where cystoscopic retrograde ureteral stenting had been unsuccessful in the alleviation of a ureteral rupture, stricture or obstruction. Attempts were made to evaluate the clinical outcomes and technical issues of antegrade ureteral stenting in ureteral obstruction. MATERIALS AND METHODS: Between 1998 and 2003, antegrade ureteral stenting was attempted in 15 patients. Here, the results were retrospectively analyzed. Of the 15 patients, the retrograde ureteral stenting failed in 13. The causes of the ureteral obstructions were urological and nonurological malignancies in 12 patients, genitourinary tuberculosis in 2 and endoscopic ureteral trauma in 1. RESULTS: Thirteen of the 15 patients were successfully stented using the antegrade methods. One cervical cancer patient was stented using a pull-through technique. Four out of 6 patients with radiologically completely obstructed ureters were stented successfully. The ureteral stents were removed in two patients where the causes of the ureteral obstructions were relieved. Seven patients were successfully stented for the relief of obstructive renal failure, and all showed rapid decreases in their serum creatinine level and/or improvements on imaging studies. Five patients were successfully stented for the relief a ureteral obstruction, and all showed improvements on imaging studies. Changes of the ureteral stents were performed by cystoscopy in four patients. CONCLUSIONS: Antegrade ureteral stenting is an alternative technique for the alleviation of a ureteral obstruction should retrograde ureteral stenting not be possible. An antegrade ureteral stenting trail is recommended, even in the case of a radiologically complete obstruction on an antegrade ureterogram. Antegrade ureteral stenting is one of the choices for the alleviation of a ureteral obstruction unless the patient has an intravesical obstruction and the inability to move.

Primary Transitional Cell Carcinoma of Female Urethra Treated with Anterior Pelvic Exenteration / 대한비뇨기과학회지

Primary urethral carcinoma in females is a relatively rare disease representing only 0.02% of all types of cancer in women. Primary transitional cell carcinoma of the female urethra is about 20% of all female urethral cancer. We report a case of primary transitional cell carcinoma of the female urethra treated with anterior pelvic exenteration in an 80-year-old woman.

Detectability of the Mediastinal Lines: Comparison of Conventional Film-Screen Radiography and DigitalRadiography

PURPOSE: Using dynamic range compression (DRC) processing, this study compared the detectability ofmediastinal lines by conventional film screen rediography (FS) and by storage phosphor digital radiography(DR). MATERIALS AND METHODS: We selected 200 normal consecutive chest radiographs (100 FS, 100 DR) ; dynamic rangecompression was applied to DR processing and moving grids were used in both systems. Seven mediastinal lines (leftfaraspinal, right paraspinal, azygoesophageal, left para-aortic, posterior junctional, anterior junctional andright paratracheal) were scored from 0 point to 3 point(0:not visible, 1:suspiciously visible, 2:visible, but notclear, 3: clearly visible) according to visibility and sharpness, as agreed by a radiologist and a resident. Thedifferences between the two modalities were compared and analyzed by chi-square test. RESULTS: Among the 1400mediastinal lines analyzed, 419 lines by DR(59.9%) and 232 lines by FS(33.1%) were scored more than 2 points. Inall mediastinal lines except the left para-aortic, DR was more detectable and clearer than FS, with statisticalsignificance(P<.01). CONCLUSION: DR processed with DRC visualizes mediastinal lines more frequently and clearlythan conventional FS, and is therefore thought to be useful for the evaluation of mediastinal diseases.