Screening Ultrasound in Women with Negative Mammography: Outcome Analysis

PURPOSE: To show the results of an audit of screening breast ultrasound (US) in women with negative mammography in a single institution and to analyze US-detected cancers within a year and interval cancers. MATERIALS AND METHODS: During the year of 2006, 1974 women with negative mammography were screened with US in our screening center, and 1727 among them had pathologic results or any follow up breast examinations more than a year. We analyzed the distribution of Breast Imaging Reporting and Data System (BI-RADS) category and the performance outcome through follow up. RESULTS: Among 1727 women (age, 30-76 years, median 49.5 years), 1349 women (78.1%) showed dense breasts on mammography, 762 (44.1%) had previous breast US, and 25 women (1.4%) had a personal history of breast cancers. Test negatives were 94.2% (1.627/1727) [BI-RADS category 1 in 885 (51.2%), 2 in 742 (43.0%)]. The recall rate (=BI-RADS category 3, 4, 5) was 5.8%. Eight cancers were additionally detected with US (yield, 4.6 per 1000). The sensitivity, specificity, and positive predictive value (PPV1, PPV2) were 88.9%, 94.6%, 8.0%, and 28.0%, respectively. Eight of nine true positive cancers were stage I or in-situ cancers. One interval cancer was stage I cancer from BI-RADS category 2. CONCLUSION: Screening US detected 4.6 additional cancers among 1000. The recall rate was 5.8%, which is in lower bound of acceptable range of mammography (5-12%), according to American College of Radiology standard.

Role of BRAF(V600E) Mutation Analysis for Thyroid Nodules Classified as Indeterminate on Ultrasonography

PURPOSE: We aimed to evaluate a possible role for BRAF(V600E) mutation analysis of aspiration specimens in the work up of thyroid nodules classified as indeterminate on US. MATERIALS AND METHODS: A total of 122 nodules from 122 patients were prospectively classified as indeterminate nodules based on US findings. US-guided fine needle aspiration (FNA) was done for all 122 nodules. The presence of a BRAF(V600E) mutation in FNA specimens was determined by allele-specific PCR. RESULTS: US-indeterminate nodules were confirmed as malignant in 20.5% (25/122) of cases and benign in 76.2% (93/122) after FNA or surgery. A few (3.3% (4/122), remained indeterminate. A BRAF(V600E) mutation was identified in 14.8% (18/122) of USindeterminate nodules. Of those 18 nodules, three were benign and 13 were malignant after the initial FNA. One (0.8%, 1/122) with an initially benign cytology and a BRAF(V600E) mutation was confirmed to be malignant after surgery. The remaining two benign nodules with a mutation were not followed-up. All 9 initial FNA-nondiagnostic nodules were mutation negative but 2 (11.8%) of 17 indeterminate nodules on initial FNAs were mutation positive. CONCLUSION: BRAF(V600E) mutation analysis prevents false negative cytology for only 0.8% of cases and reduces ambiguous diagnoses for 1.6% of all US-indeterminate thyroid nodules. Therefore, adding BRAF(V600E) mutation analysis to FNA for US-indeterminate nodules is of limited usefulness.

The Prevalence of Simple Renal Cysts Studied by Ultrasonography, and the Relations to Age and Hypertension / 대한신장학회잡지

Simple renal cyst is the most common space- occupying lesion of kidney in adults. However, there were a few systematic Korean reports for the prevalence of simple renal cysts. Our purpose was to estimate the prevalence of simple renal cysts using ultrasonography, and to determine the relations to age and hypertension. The subjects were 504 volunteers (aged over 29 years) of the persons who were enrolled a health check-up program of Naju Hospital, Naju, Korea. Number of male in 504 persons was 334 (66.3%) and female 170 (33.7%). Mean age was 55 years (range; 30-86). The results were as follows: 1) One or more renal cysts were found in 50 individuals of 504 persons aged over 29 years (9.9%). In 331 persons aged over 49 years, the prevalence of simple renal cysts was 12.1%. The prevalence was significantly increased with age (P<0.001), but the difference between male (9.6%) and female (10.6%) was insignificant. 2) Mean value of cyst diameter was 23mm (5-69 mm) and was not correlated with age. However, the cyst diameter was significantly higher in female than in male, 32.4mm vs 18.0mm (P<0.001). Total number of cysts per person tended to increase with age (P<0.001). 3) The correlation between prevalence of simple renal cysts and blood pressure was statistically insignificant. However, the prevalence of hypertension in persons with cysts was higher than in persons with no cyst (27.9% vs 15.3%, P<0.05). Cyst diameter was not correlated with blood pressure. 4)Urinalysis in persons with cysts, showed microscopic hematuria in 47.4% and proteinuria in 26.3 %, however, grade of microscopic hematuria and proteinuria were not correlated with cyst diameter. The concentrations of blood urea nitrogen, serum creatinine, hemoglobin and hematocrit were not affected by presence or absence of simple renal cysts. By comparison with the recent foreign reports, the prevalence of simple renal cysts in Korean was similar to those in foreigners. Our study ascertained that simple renal cysts are age-dependent and total number of cysts per person also increases with age. In most of persons with simple renal cysts, the renal function is not affected and the related symptoms are trivial. However, we suggested that simple renal cysts may cause hypertension. To elucidate the correlation between simple renal cyst and hypertension, further studies are needed.

The Screening of Middle-aged and Geriatric Diseases for 2,021 Residents over 39 Years of Age in Hwasun County, Korea / 대한내과학회지

OBJECTIVE: Middle-aged and geriatric diseases are becoming prevalent in developing countries and some industrialized nations. The present study was undertaken to determine the prevalence of middle-aged and geriatric diseases in Hwasun County, a rural area of Korea, and to examine the correlation between them and various clinical parameters. METHODS: Population-based cross-sectional study by random cluster sampling of registered residents over 39 years of age was performed. Out of the 3,138 subjects scheduled for the survey, 2,021 residents (male 812, female 1,209) underwent the actual examinations (response rate:64.4%). We examined their weight, height, blood pressure, diet pattern, past and family history, alcohol-drinking and smoking history, and various laboratory parameters. RESULTS: The mean body mass index (BMI) was 22.8+/-3.8. In BMI criteria, the crude prevalence of obesity was found to be 24.6% (grade I obesity; 22.9%, grade II obesity; 1.7%). We found the increasing hypertension, diabetes mellitus, hypercholesterolemia as BMI increased. Overall crude prevalence was 21.4% for hypertension defined as BP (blood pressure) > or =140/90 mmHg or subject on medication, and 16.1% for BP > or =160/100 mmHg or subject on medication. The crude prevalence of diabetes mellitus, hypercholesterolemia, alcoholic liver disease, ischemic heart disease diagnosed by electrocardiography were 6.2%, 6.0%, 4.4%, and 2.3%, respectively. These prevalence were found to be relatively lower than those of reported elsewhere in the world. CONCLUSION: These data indicate that middle-aged and geriatric diseases in the rural area of korea are becoming prevalent, although they are less prevalent than in the urban area or advanced countries. We hope that the present study contributes to understand the prevalence of middle-aged and geriatric diseases in the rural area of Korea, and to prevent and control them adequately.

Differential Diagnosis of Vertebral Lesions with paraspinal Mass with MRI

PURPOSE: To assess the characteristic features of MR findings which would be useful for the differentiation of various spinal diseases involving paraspinal soft tissue mass. MATERIALS AND METHODS: We retrospectively reviewed MR findings in 31 cases(M:F=20:11) of spinal disease in which paraspinal mass was involved. The breakdown of cases was as follows : spinal tuberculosis, 12; spinal metastasis, 13; multiple myeloma, 3; pyogenic spondylitis, 2; spinal aspergillosis; 1. RESULTS: The pattern of bone marrow invasion in spinal metastasis, multiple myeloma, spinal tuberculosis and aspergillosis was mixed ; focal, homogeneously diffuse and inhomogeneously patterns were seen. Pyogenic spondylitis showed inhomogeneously diffuse invasion; an intravertebral abscess was seen in the only five cases of spinal tuberculosis. Vertebral posterior compartment invasion was observed in seven cases of spinal tuberculosis, two of multiple myeloma, the one case of spinal aspergillosis and in all 13 cases of spinal metastasis. This and multiple myeloma showed no disc space invasion, in any case, but all cases of infectious spondylitis showed such invasion. Peripheral rim-enhancement in the paravertebral mass was seen in 11 cases of spinal tuberculosis, one case of pyogenic spondylitis and the case of aspergillosis. Bilobate anterior epidural mass was noted in 60% of spinal tuberculosis cases, 36% of spinal metastasis and one case of pyogenic spondylitis. CONCLUSION: MR findings of spinal disease involving a paraspinal soft tissue mass were useful for differentiation.

CT Findings of Thyroglossal Duct Cyst

PURPOSE: The purpose of this study was to evaluate the CT findings of thyroglossal duct cysts MATERIALS AND METHODS: Sixteen patients with pathologically proved thyroglossal duct cysts were included in the study. CT scans were assessed'retrospectively for shape, size, location, density of the central portions, septations, rim enhancement, changes in the adjacent fascial planes and investment within the strap muscles in the infrahyoid cysts. RESULT: Thirteen cases of thyroglossal duct cysts were seen as round or oval cystic masses, two cases of them were seen as irregular-shaped Iobulated cystic masses, and one case was seen as ovoid soft tissue mass. The cysts were from 1.4 to 5.7cm in diameter(mean, 2.6cm). The cyst was infrahyoid in 15 cases and suprahyoid in one case. The cyst was located in midline in eight cases, off midline in four cases, and both midline and off midline in four cases. The density of the central portions ranged from 15 to 82HU(mean, 32HU). Septations were noted in four cases. Rim enhancement was seen in 14 cases(93%), and heterogenously enhancing soft tissue mass was seen in one case. In four cases, abnormal fascial planes were observed. All but one of the infrahyoid cysts(14/15) were embedded within the strap muscles, and one case of them was located anteriorly to strap muscles. CONCLUSION: CT permits one to make the diagnosis a thyroglossal duct cyst with a high degree of accuracy, as it can differentiate thyroglossal duct cysts from the other anterior neck masses by their typical location, characteristic morphology, and investment within the strap muscles.

Correlation between MR Imaging and Histology of Intracranial Meningioma

PURPOSE: The magnetic resonance(MR) appearance of 23 biopsy-proven meningiomas were retrospectively evaluated and correlated with histologic pattern ;fibroblastic, transitional, syncytial, angioblastic. MATERIALS AND METHODS: Twenty three patients with biopsy-proven meningiomas were examined with MR imaging over a 3 years period. Images were assessed for average T1, T2 intensity score(1-5), degree of edema, calcification, cyst formation or necrosis, and dural tail sign. RESULTS: Tl-weighted images showed only one significant correlation between fibroblastic type and angiobiastic type (p<0.04). Angioblastic type was more hypointense than gray matter(1.83/isointense to gray 3) on T1-weighted image. Syncytial and angioblastic tumors had average T2 intensity scores much higher than those of fibroblastic and transitional types. All three cases of angioblastic tumors had shown severe edema. Calcified lesions were much more common in transitional and fibroblastic types than in syncytial and angioblastic types. CONCLUSION: MRI is a helpful diagnostic imaging modality with good correlation between its MR findings and histologic patterns.