Comparison of the Diagnostic Value between Mammography and Mammography with Breast Ultrasonography in Diagnosing Breast Cancer

BACKGROUND: Because the sensitivity of mammography (MAM) is lower in young women than in old and in women with dense breast than those without, many physicians utilize breast ultrasonography (US) with MAM. But the addictive value of US is unclear. This study compared the diagnostic value between MAM and MAM US. METHODS: Between September, 2002, and February, 2003, there were 89 cases of breast disease confirmed by surgery, that had both MAM and US results. The results of MAM and US were classifed by Breast Imaging Reporting and Data System (BI-RADS) and were categorized as positive or negative. Among the positive results, BI-RADS Category 0 and Category 3 with recommendation of other test were regarded as an intermediate result. RESULTS: Among all 89 cases, 38 cases were malignancies. The receiver operating characteristic curves showed non-significant increase in diagnostic value by adding US to MAM. The sensitivity of MAM was non-significantly higher in above-50-years women than in below- 49-years women and in women with dense breast than in women with non-dense breast. Among positive results of MAM, 21 cases were 'intermediate results'. US correctly regraded 8 benign lesions from 19 cases of false-positive MAM and 1 extra malignancy with palpable lump from 4 false-negative MAM. CONCLUSION: MAM is a valuable test in diagnosing breast cancer. US is a valuable complementary test to MAM in evaluating palpable lump with negative MAM and intermediate result of MAM.

The Relationship between Obesity and Functional Status in the Korean Elderly: An Analysis of Korean National Health and Nutrition Examination Survey, 1998

BACKGROUND: Aging and obesity are both positive determinants of chronic disease in the elderly. This study was done to examine the relationship between obesity and functional status and, to examine the relationship between comorbidity and the different levels of BMI among older Koreans. METHODS: A total of 920 community dwelling women and men who completed both the home questionnaire and medical examination that was conducted in 1998 were chosen as subjects. The proportion of subjects with prevalence of obesity-related diseases and functional limitation by NHLBI classifications was determined. Risks for functional limitation associated with comorbidity of obesity-related diseases and fat distribution were examined using multivariate adjusted logistic regression methods. RESULTS: Among 920 subjects studied, 91% were functionally independent. The underweight were one in ten and the overweight were one in four. The overall prevalence of functional limitation in a major activity among underweight was one in ten, but that of overweight or over was one in two. After multivariate adjustment, significant predictors for functional limitation in ADLs and IADLs were vision and hearing impairment, unemployed occupational status, depression, living with spouse, and a history of stroke. Though not significantly shown in the statistics, comorbidity (>or=3) of six obesity-related diseases had odds of 5.4 times and in obese elderly women the odds were 7.9 times. CONCLUSION: We suggest that there is a positive trend between overweight and functional limitation. Although there is no statistical significance, obesity in older Korean women had higher odds for functional limitation in ADLs and IADLs.

An Analysis of Cost-Effective Screening Interval for HCC in Korean Hepatitis B Virus Carriers

BACKGROUND: The purpose of this study was to evaluate the cost-effectiveness of screening tests (AFP and US) for early detection of primary hepatocellular carcinoma (HCC) and its optimal screening interval in Korean hepatitis B virus carriers. METHODS: Data relating to tumor incidence, efficacy of screening tests, tumour growth times and various cost for detecting HCC were obtained from reviews of Korean literature. Decision analysis technique was used to calculate the efficacy of these screening tests and screening interval. RESULTS: When the doubling time of HCC was 6 months, the most cost-effective screening interval of each AFP and US was 6 months, respectively. The optimal screening intervals of AFP and US were 3 and 5 months for each, respectively, and 7 months for both when a detection rate of 80% was expected. These results were significantly altered when the different tumour growth times reported in other literatures were applied. CONCLUSION: If the doubling time of HCC was 6 months, the optimal screening interval was 7 months on using both tests. Because the tumour doubling time alters the optimal screening interval, further evaluation on the doubling time of Korean hepatoma is needed.