Development of Entrustable Professional Activity, Core Competencies, and Guidelines in 2021 Radiology Competency Education Project

To provide high-quality training to residents in a rapidly changing medical environment, it is very important to improve the annual training curriculum centered on competency and ensure that training hospitals maintain an environment suitable for training. The Korean Society of Radiology (KSR) has been steadily improving the training system and has suggested the improvement of the training system by strengthening the competency-based evaluation and faculty development. Currently, KSR was selected for the second annual training curriculum systematization construction project in July 2021, and developed entrustable professional activities, core competencies, and assessment guidelines required by the construction project. Therefore, the development process and assessment guidelines will be introduced to residents and the faculty.

Risk Prediction Model Based on Magnetic Resonance Elastography-Assessed Liver Stiffness for Predicting Posthepatectomy Liver Failure in Patients with Hepatocellular Carcinoma

Background/Aims@#Posthepatectomy liver failure (PHLF) is a major complication that increases mortality in patients with hepatocellular carcinoma after surgical resection. The aim of this retrospective study was to evaluate the utility of magnetic resonance elastography-assessed liver stiffness (MRE-LS) for the prediction of PHLF and to develop an MRE-LS-based risk prediction model. @*Methods@#A total of 160 hepatocellular carcinoma patients who underwent surgical resection with available preoperative MRE-LS data were enrolled. Clinical and laboratory parameters were collected from medical records. Logistic regression analyses were conducted to identify the risk factors for PHLF and develop a risk prediction model. @*Results@#PHLF was present in 24 patients (15%). In the multivariate logistic analysis, high MRE-LS (kPa; odds ratio [OR] 1.49, 95% confidence interval [CI] 1.12 to 1.98, p=0.006), low serum albumin (≤3.8 g/dL; OR 15.89, 95% CI 2.41 to 104.82, p=0.004), major hepatic resection (OR 4.16, 95% CI 1.40 to 12.38, p=0.014), higher albumin-bilirubin score (>–0.55; OR 3.72, 95% CI 1.15 to 12.04, p=0.028), and higher serum α-fetoprotein (>100 ng/mL; OR 3.53, 95% CI 1.20 to 10.40, p=0.022) were identified as independent risk factors for PHLF. A risk prediction model for PHLF was established using the multivariate logistic regression equation. The area under the receiver operating characteristic curve (AUC) of the risk prediction model was 0.877 for predicting PHLF and 0.923 for predicting grade B and C PHLF. In leave-one-out cross-validation, the risk model showed good performance, with AUCs of 0.807 for all-grade PHLF and 0. 871 for grade B and C PHLF. @*Conclusions@#Our novel MRE-LS-based risk model had excellent performance in predicting PHLF, especially grade B and C PHLF.

Plasma MicroRNA-21, 26a, and 29a-3p as Predictive Markers for Treatment Response Following Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma

BACKGROUND: We investigated an association between the levels of plasma microRNA (miRNA)-21,

Localized Adenomyomatosis of Gallbladder Mimicking Advanced Hepatic Flexure Colon Cancer: A Case Report

Localized forms of gallbladder adenomyomatosis are rarely polypoid and may mimic gallbladder cancer. Herein, we present a unique case of polypoid gallbladder adenomyomatosis penetrating the colon and preoperatively misdiagnosed as advanced hepatic flexure colon cancer.

Corrigendum: Correction of the IRB Approval Number. Accuracy of Preoperative Local Staging of Primary Colorectal Cancer by Using Computed Tomography: Reappraisal Based on Data Collected at a Highly Organized Cancer Center

The IRB approval number should be corrected.

Accuracy of Preoperative Local Staging of Primary Colorectal Cancer by Using Computed Tomography: Reappraisal Based on Data Collected at a Highly Organized Cancer Center

PURPOSE: In patients with colorectal cancer, preoperative staging using various imaging technologies is important for establishing the treatment plan and predicting the prognosis. Although computed tomography (CT) has been used most widely, the versatility of CT accuracy was primarily because of the lack of specialization. In this study, we aimed to identify whether any advancement in abdominal CT accuracy in the prediction of local staging has occurred. METHODS: Between December 2014 and November 2015, patients with colorectal cancer were retrospectively enrolled. All CT findings were retrospectively reported. A total of 285 patients were included, and their retrospectively collected data were retrospectively reviewed, focusing on a comparison between preoperative and postoperative staging. RESULTS: The overall prediction accuracy of the T stage was 55.1%, with overstaging occurring in 63 (22.1%) and understaging in 65 patients (22.8%). The sensitivity and specificity were 90.0% and 68.4%, respectively. The overall prediction accuracy of the N stage was 54.7%, with overstaging occurring in 89 (31.2%) and understaging in 40 patients (14.1%). The sensitivity and specificity were 71.9% and 63.2%, respectively. The CT accuracies by pathologic stage were 0%, 62.2%, 25.3%, and 81.2% for stages 0 (Tis N0), I, II, and III, respectively. CONCLUSION: CT has good sensitivity for detecting colon cancers with tumor invasion beyond the bowel wall. However, detection of nodal involvement using CT is unreliable. In our opinion, abdominal CT alone has limitations in predicting the local staging of colorectal cancer, and additional technologies, such as CT plus positron emission tomography and/or colonography, will improve its accuracy.

Is There any Role of Visceral Fat Area for Predicting Difficulty of Laparoscopic Gastrectomy for Gastric Cancer?

PURPOSE: Obesity is associated with morbidity following gastric cancer surgery, but whether obesity influences morbidity after laparoscopic gastrectomy (LG) remains controversial. The present study evaluated whether body mass index (BMI) and visceral fat area (VFA) predict postoperative complications. MATERIALS AND METHODS: A total of 217 consecutive patients who had undergone LG for gastric cancer between May 2003 and December 2005 were included in the present study. We divided the patients into two groups ('before learning curve' and 'after learning curve') based on the learning curve effect of the surgeon. Each of these groups was sub-classified according to BMI ( or =25 kg/m2) and VFA ( or =100 cm2). Surgical outcomes, including operative time, quantity of blood loss, and postoperative complications, were compared between BMI and VFA subgroups. RESULTS: The mean operative time, length of hospital stay, and complication rate were significantly higher in the before learning curve group than in the after learning curve group. In the subgroup analysis, complication rate and length of hospital stay did not differ according to BMI or VFA; however, for the before learning curve group, mean operative time and blood loss were significantly higher in the high VFA subgroup than in the low VFA subgroup (P=0.047 and P=0.028, respectively). CONCLUSIONS: VFA may be a better predictive marker than BMI for selecting candidates for LG, which may help to get a better surgical outcome for inexperienced surgeons.

Computed tomography classification for parastomal hernia / 대한외과학회지

PURPOSE: The aim of this study was to investigate the clinical and radiological incidence of parastomal hernia. METHODS: We reviewed, retrospectively, 83 patients with end colostomy operated on from January 2003 to June 2009 at Ajou University hospital. Age, sex, surgical procedure type, body mass index (weight/length2), stoma size, and respiratory co-morbidity were documented. We compared the incidence of radiological and clinical parastomal hernia. RESULTS: There were 47 males (56.6%) and 36 females (43.4%). During an overall median follow-up of 30 months (range, 6 to 45 months), 24 patients (28.9%) developed a radiological parastomal hernia postoperatively and 20 patients (24.1%) presented clinical symptoms. Using computed tomography (CT) classification, the groups were as follows: type 0 (40, 48.2%), type Ia (19, 22.9%), type Ib (8, 9.6%), type II (4, 4.8%) and type III (12, 14.5%), with 63 asymptomatic patients and 20 symptomatic patients. The aperture size was significantly different between symptomatic and asymptomatic patients (76.45 mm vs. 49.41 mm; P = 0.000). There was a significant correlation between aperture size and the radiological type (P = 0.003). CONCLUSION: This study showed the incidence of radiological parastomal hernia is acceptable compared to previous studies. CT classification may be useful to evaluate parastomal hernia.

Surgical Treatment for Chronic Peptic Ulcer with Gastric Outlet Obstruction

PURPOSE: With the introduction of H. pylori eradication and proton pump inhibitor, the operative treatments for the acute or chronic complications of peptic ulcer, such as perforation, bleeding and stricture, have decreased. Also owing to the development of non-operative treatment such as interventional endoscopic treatment, the surgical approach to the acute complications, like perforation and bleeding, has diminished. The non-operative treatments for the stricture and obstruction of chronic peptic ulcer in part related to discontinuation of medication have not been satisfactory. We analyzed the clinical outcomes of the patients who underwent operative treatment for outlet obstruction with peptic ulcer. Materials of Methods: From January 1994 to December 2007, we reviewed 31 patients who had been operated on at the National Medical Center for peptic ulcer obstruction. We excluded the cases of adhesive obstructions that were caused by a former ulcer operation and also the cases of obstructions found during emergency operations for treating perforation and bleeding. We classified the surgical treatment group into the bypass operation group and the surgical resection group. We evaluated the effects of the operations by the Visick score. The recurrences were confirmed only by the endoscopic observation of peptic ulcer. RESULTS: The number of patients in the bypass operation group was 6 (19.4%) and that of resection group was 25 (80.6%). The mean age was 57.5 (25~81) years. The number of male patients was 29 (93.5%) and the number of females was 2 (6.5%). The mean symptom duration was 29.6 months. There were 19 smokers (61.3%), 6 NSAID users (19.4%) and 7 H. pylori positive patients (22.6%). Two patients underwent endoscopic balloon dilatation with no success. The locations of lesion were the stomach, the duodenum and both in 9, 20 and 2 cases, respectively. There were operative complications in 13 cases (41.9%), recurrent ulcers in 2 cases (6.5%), and reoperations in 4 cases. The mean Visick score was 1.8 (1~4). There were no statistically significant clinicopathologic differences between the bypass operation group and the resection group. The two groups had 1 case each of recurrence. Although the bypass group had a greater complication rate (83.3%) than the resection group (32%), this was not statistically meaningful (P=0.175). The mean Visick score was 3.0 in the bypass group and 1.6 in the resection group, so the resection group was better (P=0.001). CONCLUSION: For a case of chronic peptic ulcer with outlet obstruction, even though it has been reported that endoscopic balloon dilatation worked well, surgery is still regarded as an important treatment. If you consider the patients' satisfaction and the difficulty of diagnosing malignant ulcers, surgical resection should be recommended more often than a bypass operation.

Radiologic and Clinical Features of Idiopathic Granulomatous Lobular Mastitis Mimicking Advanced Breast Cancer

Idiopathic granulomatous lobular mastitis (IGLM), also known as idiopathic granulomatous mastitis, is a rare chronic inflammatory lesion of the breast that can clinically and radiographically mimic breast carcinoma. The aim of this study was to describe the radiological imaging and clinical features of IGLM in order to better differentiate this disorder from breast cancer. We performed a retrospective analysis of the clinical and radiographic features of 11 women with a total of 12 IGLM lesions. The ages of these women ranged between 29 and 42 years, with a mean age of 34.8 years. Ten patients were examined by both mammography and sonography and one by sonography alone. The sites that were the most frequently involved were the peripheral (6/12), diffuse, (3/12), and subareolar (3/12) regions of the breast. The patient mammograms showed irregular ill-defined masses (7/11), diffuse increased densities (3/11), and one oval obscured mass. In addition, patient sonograms showed irregular tubular lesions (7/12) or lobulated masses with minimal parenchymal distortion (2/12), parenchymal distortion without definite mass lesions (2/12), and one oval mass. Subcutaneous fat obliteration (12/12) and skin thickening (11/12) were also observed in these patients. Contrary to previous reports, skin changes and subareolar involvement were not rare occurrences in IGLM. In conclusion, the sonographic features of IGLM show irregular or tubular hypoechoic masses with minimal parenchymal distortion. Both clinical information and the description of radiographic features of IGLM may aid in the differentiation between IGLM and breast cancer, however histological confirmation is still required for the proper diagnosis and treatment of the disorder.

Mammographic Evaluation of Suspicious Malignant Lesions Based on ACR(American College of Radiology) Breast Imaging Reporting and Data System( BI-RADS )

PURPOSE: The purpose of this study was to assess the mammographic features and pathologic outcome of category 4 lesions using the Breast Imaging Reporting and Data System(BI-RADS), and to evaluate the significance of final assessment categories. MATERIALS AND METHODS: Using BI-RADS, the interpretations of 8,134 mammograms acquired between January 1997 and May 1998 were categorized. From among 161 lesions categorized as "4"("suspicious abnormality") and pathologically confirmed by surgery or biopsy, we analysed 113, found in 66 patients. RESULTS: The pathologic outcome of these 113 lesions was as follows: infiltrating ductal carcinoma, 17.7%(20/113); DCIS(ductal carcinoma in sitv), 8.0 %(9/113); ADH(atypical ductal hyperplasia), 5.3 % (6/113); DEH(ductal epithelial hyperplasia), 1.8 %(2/113); ductectasia, 0.9 %(1/113), FCD(fibrocystic change), 27 .4 %(31/113); fibroadenoma, 7.1 %(8/113); stromal fibrosis, 9.7%(11/113); normal parenchyma, 7.1 % (8/113); other pathology, 15.0 %(17/113). The most frequent mammographic features of BI-RADS category 4 lesions were irregular mass shape(41.2 %), spiculated mass margin(52.3%), amorphous calcification(47.3%) and clustered calcification distribution(37.1% ). CONCLUSION: Because category 4 lesions account for about 25.7 % of all breast malignancies, mammographic lesions in this category ("suspicious abnormality")should be considered for supplementary study and breast biopsy rather than short-term follow-up. Initial pathologic findings can thus be confirmed.

Mammographic Evaluation of Suspicious Malignant Lesions Based on ACR(American College of Radiology) Breast Imaging Reporting and Data System( BI-RADS )

PURPOSE: The purpose of this study was to assess the mammographic features and pathologic outcome of category 4 lesions using the Breast Imaging Reporting and Data System(BI-RADS), and to evaluate the significance of final assessment categories. MATERIALS AND METHODS: Using BI-RADS, the interpretations of 8,134 mammograms acquired between January 1997 and May 1998 were categorized. From among 161 lesions categorized as "4"("suspicious abnormality") and pathologically confirmed by surgery or biopsy, we analysed 113, found in 66 patients. RESULTS: The pathologic outcome of these 113 lesions was as follows: infiltrating ductal carcinoma, 17.7%(20/113); DCIS(ductal carcinoma in sitv), 8.0 %(9/113); ADH(atypical ductal hyperplasia), 5.3 % (6/113); DEH(ductal epithelial hyperplasia), 1.8 %(2/113); ductectasia, 0.9 %(1/113), FCD(fibrocystic change), 27 .4 %(31/113); fibroadenoma, 7.1 %(8/113); stromal fibrosis, 9.7%(11/113); normal parenchyma, 7.1 % (8/113); other pathology, 15.0 %(17/113). The most frequent mammographic features of BI-RADS category 4 lesions were irregular mass shape(41.2 %), spiculated mass margin(52.3%), amorphous calcification(47.3%) and clustered calcification distribution(37.1% ). CONCLUSION: Because category 4 lesions account for about 25.7 % of all breast malignancies, mammographic lesions in this category ("suspicious abnormality")should be considered for supplementary study and breast biopsy rather than short-term follow-up. Initial pathologic findings can thus be confirmed.

Infiltrating Ductal Carcinoma with Mammographic 'Halo Sign' Correlation with Histopathology

PURPOSE: To analyze and correlate mammographic/ sonographic features with pathologic findings in patientswith infiltrative ductal carcinoma with the mammographic 'halo sign'. MATERIALS AND METHODS: We retrospectivelyreviewed 27 cases of surgically confirmed infiltrative ductal breast carcinoma with the mammographic 'halo sign',analysing the mammographic/sonographic findings, clinical records and pathologic findings. RESULTS: Twenty-sevenpatients with infiltrating ductal breast carcinoma with the mammographic 'halo sign' were aged 32-72 (mean 49+/-12)years. For periods of between 2 days and 5 months(mean, 1.9 months), all had complained of a palpable mass.Histologic sections indicated parenchymal compression(27/27), microscopic infiltration of tumor margin(11/27) andparenchymal fat compression(15/27), without a true capsule. Infiltrating ductal carcinomas with the mammographic'halo sign' were nuclear grade 1 (17/27) or histologic grade III (14/27). Mammography (complete halo:3;partialhalo:24) showed a round(15/27) or macrolobulated (9/27) mass (size : 2.5+/-1cm) which showed partialspiculation(17/27) or-rarely-calcification(2/27). Sonography revealed a hypoechoic mass with a thinboundary(13/15);in five of these 13 cases, pathologic examination revealed microscopic infiltration of the tumormargin. Bilateral shadowing (8/15), posterior enhancement(13/15), and heterogeneous internal echogenicity(13/15)were also noted on sonography. CONCLUSION: When correlated with the histopathologic findings, infiltrating ductalbreast carcinoma with the 'halo sign' showed a relatively poor pathologic grade, which is known to be one of theprognostic factors. Surrounding parenchyma and fat compression at the margin of a tumor are considered to be oneof the causes of the mammographic 'halo sign'.

CT Findings of Pleural Dissemination in Primary Lung Cancer

PURPOSE: To evaluate the CT findings of pleural dissemination in primary lung cancer and the limitations of CT scanning in detecting pleural dissemination in primary lung cancer. MATERIALS AND METHODS: Primary lung cancer with pleural dissemination was diagnosed in 68 patients and confirmed by pleural biopsy, cytology and surgery, and these cases were the subject of this study. Adenocarcinoma accounted for 49, squamous cell carcinoma for 13 and small cell carcinoma for six. Eight CT features, namely the amount of pleural effusion, the contour, extent andlocation of pleural thickening, the shortest distance between pleura and mass, pleural calcification, pleural tailsign and the extent of extrapleural fat proliferation, were evaluated. RESULTS: Pleural effusion was noted in 51 of 68 patients(75%), though in most cases(70%), the amount of this was small. Among 42 patients(62%) in whom thickened pleura, were noted, pleural thickening was thin and irregular in 22(52%), thick and irregular in 16(38%), and thin and regular in 4(10%). The extent of pleural thickening was multifocal in 22 patients(52%),diffuse in 16(38%), and circumferential and single in two(5%). Pleural thickening was more frequently noted at theposterior than the anterior pleura. Pleural abutting was seen in 53 patients(78%). In ten patients(15%), chest CTscans revealed no perceptible pleural abnormalities. CONCLUSION: If in primary lung cancer, the primary lung masscontacts the pleura, and if pleural thickening, even when slight, shows marginal irregularity, pleuraldissemination should be considered. Although CT scanning is very useful for the detection of pleural disseminationin primary lung cancer, about 15% of patients showed no perceptible pleural abnormalities. Other diagnosticmodalities such as thoracoscopy are mandatory for the correct diagnosis of pleural dissemination in primary lung cancer.