Leiomyosarcoma of the Scrotum:A Case Report

Leiomyosarcoma (LMS) within the scrotum is a rare malignant genitourinary tumor in adults. Due to its rarity, a consensus on a clear approach to diagnosis and treatment guidelines has not yet been reached. We present a case of a paratesticular LMS in a 64-yearold man with a painless swelling of the right scrotum. Scrotal ultrasound and pelvic MRI were performed and revealed an extratesticular mass with a heterogeneous appearance.The patient underwent a right radical orchiectomy, and the mass was confirmed to be LMS, originating from the right spermatic cord. Preoperative diagnosis of LMS is challenging since it has overlapping clinical and imaging features with other sarcomas. MRI is a valuable imaging modality for the definitive characterization of the tumor. To provide timely and appropriate treatment, the correlation of the patient’s clinical information and imaging findings is necessary.

Improving the Performance of Radiologists Using Artificial Intelligence-Based Detection Support Software for Mammography: A Multi-Reader Study

Objective@#To evaluate whether artificial intelligence (AI) for detecting breast cancer on mammography can improve the performance and time efficiency of radiologists reading mammograms. @*Materials and Methods@#A commercial deep learning-based software for mammography was validated using external data collected from 200 patients, 100 each with and without breast cancer (40 with benign lesions and 60 without lesions) from one hospital. Ten readers, including five breast specialist radiologists (BSRs) and five general radiologists (GRs), assessed all mammography images using a seven-point scale to rate the likelihood of malignancy in two sessions, with and without the aid of the AI-based software, and the reading time was automatically recorded using a web-based reporting system. Two reading sessions were conducted with a two-month washout period in between. Differences in the area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, and reading time between reading with and without AI were analyzed, accounting for data clustering by readers when indicated. @*Results@#The AUROC of the AI alone, BSR (average across five readers), and GR (average across five readers) groups was 0.915 (95% confidence interval, 0.876–0.954), 0.813 (0.756–0.870), and 0.684 (0.616–0.752), respectively. With AI assistance, the AUROC significantly increased to 0.884 (0.840–0.928) and 0.833 (0.779–0.887) in the BSR and GR groups, respectively (p = 0.007 and p < 0.001, respectively). Sensitivity was improved by AI assistance in both groups (74.6% vs. 88.6% in BSR, p < 0.001; 52.1% vs. 79.4% in GR, p < 0.001), but the specificity did not differ significantly (66.6% vs. 66.4% in BSR, p = 0.238; 70.8% vs. 70.0% in GR, p = 0.689). The average reading time pooled across readers was significantly decreased by AI assistance for BSRs (82.73 vs. 73.04 seconds, p < 0.001) but increased in GRs (35.44 vs. 42.52 seconds, p < 0.001). @*Conclusion@#AI-based software improved the performance of radiologists regardless of their experience and affected the reading time.

Interobserver agreement in breast ultrasound categorization in the Mammography and Ultrasonography Study for Breast Cancer Screening Effectiveness (MUST-BE) trial: results of a preliminary study

PURPOSE: The purpose of this study was to record and evaluate interobserver agreement as quality control for the modified categorization of screening breast ultrasound developed by the Alliance for Breast Cancer Screening in Korea (ABCS-K) for the Mammography and Ultrasonography Study for Breast Cancer Screening Effectiveness (MUST-BE) trial. METHODS: Eight breast radiologists with 4-16 years of experience participated in 2 rounds of quality control testing for the MUST-BE trial. Two investigators randomly selected 125 and 100 cases of breast lesions with different ratios of malignant and benign lesions. Two versions of the modified categorization were tested. The initially modified classification was developed after the first quality control workshop, and the re-modified classification was developed after the second workshop. The re-modified categorization established by ABCS-K added size criteria and the anterior-posterior ratio compared with the initially modified classification. After a brief lecture on the modified categorization system prior to each quality control test, the eight radiologists independently categorized the lesions using the modified categorization. Interobserver agreement was measured using kappa statistics. RESULTS: The overall kappa values for the modified categorizations indicated moderate to substantial degrees of agreement (initially modified categorization and re-modified categorization: κ=0.52 and κ=0.63, respectively). The kappa values for the subcategories of category 4 were 0.37 (95% confidence interval [CI], 0.24 to 0.52) and 0.39 (95% CI, 0.31 to 0.49), respectively. The overall kappa values for both the initially modified categorization and the re-modified categorization indicated a substantial degree of agreement when dichotomizing the interpretation as benign or suspicious. CONCLUSION: The preliminary results demonstrated acceptable interobserver agreement for the modified categorization.

Usefulness of Apparent Diffusion Coefficient Value of Diffusion-Weighted Imaging and Peak Standardized Uptake Values of Positron Emission Tomography-CT for Predicting Prognostic Factors of Breast Cancer

PURPOSE@#This study was performed to retrospectively correlate the apparent diffusion coefficient (ADC) value and peak standardized uptake value (pSUV) with prognostic factors and MRI findings for breast lesions.@*MATERIALS AND METHODS@#Ninety four breast cancers in 82 women were included in this study. Our patients underwent presurgical MRI including diffusion-weighted imaging (DWI), 18-fluorodeoxyglucose PET-CT, and immunohistological staining of the surgical or biopsy specimens. We evaluated relationships between mean ADCs and pSUVs with a variety of prognostic factors (age, tumor size, histologic grade of tumor, hormone receptors, human epidermal growth factor receptor 2 expression status, and nodal metastasis) and MRI findings (shape, margin and internal enhancement of mass, T2-signal intensity, and kinetics), using statistical methods.@*RESULTS@#Both mean ADCs and pSUVs were significantly associated with histologic grade (p = 0.000 and p = 0.001) and nodal metastasis (p = 0.013 and p = 0.001). pSUVs were significantly associated with tumor size and estrogen receptor status, as well as irregular shape and rim enhancement pattern on MRI findings. On multivariate analysis, mean ADCs were significantly associated with invasiveness, estrogen receptor status and HER-2 expression status. PSUVs were only significantly associated with tumor size.@*CONCLUSION@#Mean pSUVs on PET-CT and ADCs on DWI helped predict prognosis of breast cancer.

The Utility of Adenotonsillectomy to Treat Snoring in Children: Acoustic Evaluation Using Smartphones / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Adenotonsillectomy is a highly effective treatment for obstructive sleep apnea symptoms in children. In this study, to investigate the effects of adenotonsillectomy on snoring in children, we analyzed and compared snoring sounds recorded using a smartphone before and after adenotonsillectomy. We also determined whether it is possible to use acoustic analysis to monitor snoring in children. SUBJECTS AND METHOD: A total of 20 children diagnosed with snoring and had undergone adenotonsillectomy performed by the same surgeon were enrolled for the study. Snoring was recorded by patients' caregivers using smartphones before and after the surgery (mean of 8.5 days) and analyzed. Questionnaires were conducted by telephone survey at 3 months and 12 months after the surgery to determine snoring status. RESULTS: Snoring completely ceased in 25% of patients and decreased in the remaining 75% during the immediate follow-up period (mean of 8.5 days; from 58.07±9.35 dB to 42.59±7.89 dB, p<0.001), and disappeared in all of the patients by 3 months after adenotonsillectomy. Snoring recurred only in one patient after 1 year. A frequency analysis offered no evident statistically significant changes during the immediate follow-up period, indicating that although snoring volume had decreased, no anatomical change had developed in the patient. Spectrography was useful in investigating the snoring patterns before and after adenotonsillectomy. CONCLUSION: The results showed that acoustic analysis of snoring sounds obtained using a smartphone may be useful for monitoring snoring during follow-up after adenotonsillectomy in pediatric snoring patients.

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.

Analysis of Participant Factors That Affect the Diagnostic Performance of Screening Mammography: A Report of the Alliance for Breast Cancer Screening in Korea

OBJECTIVE: To analyze participant factors that affect the diagnostic performance of screening mammography. MATERIALS AND METHODS: We enrolled 128756 cases from 10 hospitals between 2005 and 2010. We analyzed recall rate, cancer detection rate (CDR) per 1000 examinations, positive predictive value (PPV), sensitivity, specificity, false positive rate (FPR), and interval cancer rate (ICR) per 1000 negative examinations according to participant factors including age, breast density, and number of visit to the same institution, and adjusted for confounding variables. RESULTS: Increasing age improved recall rates (27.4% in 40's, 17.5% in 50's, 11.1% in 60's, and 8.6% in 70's), CDR (2.7, 3.2, 2.0, and 2.4), PPV (1.0, 1.8, 1.8, and 2.8%), sensitivity (81.3, 88.8, 90.3, and 94.7%), specificity (72.7, 82.7, 89.0, and 91.7%), and FPR (27.3, 17.3, 11.0, and 8.4%) (p < 0.05). Higher breast density impaired recall rates (4.0% in P1, 9.0% in P2, 28.9% in P3, and 27.8% in P4), PPV (3.3, 2.3, 1.2, and 1.3%), specificity (96.1, 91.2, 71.4, and 72.5%), and FPR (3.9, 8.9, 28.6, and 27.6%) (p < 0.001). It also increased CDR (1.3, 2.1, 3.3, and 3.6) and ICR (0.2, 0.3, 0.6, and 1.6) (p < 0.05). Successive visits to the same institution improved recall rates (20.9% for one visit, 10.7% for two visits, 7.7% for more than three visits), PPV (1.6, 2.8, and 2.7%), specificity (79.4, 89.6, and 92.5%), and FPR (20.6, 10.4, and 7.5%) (p < 0.001). CONCLUSION: Young age and dense breasts negatively affected diagnostic performance in mammography screening, whereas successive visits to the same institution had a positive effect. Examinee education for successive visits to the same institution would improve the diagnostic performance.

Performance of Screening Mammography: A Report of the Alliance for Breast Cancer Screening in Korea

OBJECTIVE: To analyze the diagnostic accuracy and trend in screening mammography in Korea. MATERIALS AND METHODS: We retrospectively linked the information from hospitals participating in the Alliance of Breast Cancer Screening in Korea (ABCS-K) and the database of the National Cancer Screening Program. We calculated performance indicators, including the recall rate, cancer detection rate (CDR), positive predictive value (PPV), sensitivity, specificity, false-positive rate (FPR), and interval cancer rate (ICR). Changes in the performance indicators were calculated as the annual percent change with 95% confidence interval (CI). RESULTS: We enrolled 128756 cases from 10 hospitals from 2005 to 2010. The recall rate was 19.1% with a downward trend over time (-12.1% per year; 95% CI, -15.9 to -8.2). The CDR was 2.69 per 1000 examinations, without a significant trend. The PPV was 1.4% with an upward trend (20.8% per year; 95% CI, 15.2 to 26.7). The sensitivity was 86.5% without a significant trend, whereas the specificity was 81.1% with an upward trend (3.3% per year; 95% CI, 2.1 to 4.5). The FPR was 18.9% with a downward trend (-12.4% per year; 95% CI, -16.2 to -8.4). The ICR was 0.5 per 1000 negative examinations without a significant trend. There were institutional variations in the diagnostic accuracy and trend except for the CDR, sensitivity, and ICR. CONCLUSION: The sensitivity and CDR of screening mammography in the ABCS-K from 2005 to 2010 were compatible with those for Western women. The recall rate, PPV and specificity, however, were suboptimal, although they showed significant improvements over this period. A further analysis is required to explain institutional variations.

The Usefulness of Picture Consonant Articulation Test Determining the Effectiveness of Frenotomy in Ankyloglossia Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To determine the extent of speech articulation disorder in ankyloglossia patients and to determine whether picture consonant articulation test has potential as a screening test to predict the outcome of surgery. SUBJECTS AND METHOD: A total of 35 patients (25 boys and 10 girls with mean age of 3.69+/-1.18 years) with ankyloglossia who underwent frenotomy and recovered completely without complications were enrolled in this study. We examined the correlation between the subjective satisfaction of parents and the results of picture consonant articulation test. RESULTS: In the picture consonant articulation test, 20 patients (20/35, 57.14%) needed postoperative speech therapy. When the resutls of preoperative picture consonant articulation test and postoperative parents' subjective satisfaction were compared, "normal" had a satisfaction score of 4.53+/-0.74 points, "consider" had 3.89+/-1.05 points, and "demand" had 3.27+/-1.45 points. When a postoperative speech therapy was required, parents' satisfaction decreased (correlation coefficient r=-0.456). CONCLUSION: The preoperative picture consonant test in our study showed potential as a screening test for predicting the outcome of surgery for ankyloglossia patients.

A Case of Sclerosing Polycystic Adenosis of Parotid Gland / 대한이비인후과학회지

Sclerosing polycyctic adenosis (SPA) is a rare lesion of unknown etiology morphologically resembling fibrocystic changes of the breast. To our knowledge, 53 cases of SPA have been reported in the literature to date. SPA is well circumscribed, yet not encapsulated. Sclerosing adenosis and cystic ducts with frequent apocrine-like cells were noted. Familiarity with the cytologic and histological features of SPA is very important in making the correct diagnosis. The differential diagnosis of SPA includes polycystic disease, sclerosing sialadenitis and benign/malignant glandular neoplasias. Although atypia ranging from mild dysplasia to carcinoma in situ can occur in some cases, SPA has a favorable outcome. In this article, we describe a 38-year-old male patient diagnosed with SPA in the parotid gland.

A Case of Leiomyoma in the Inferior Turbinate

Leiomyoma is a benign myogenic tumor may occur whenever smooth muscle is present. The most common locations are the uterus, alimentary tract, skin, and subcutenous tissue. Leiomyoma of the nasal cavity and paranasal sinus is rare because of the paucity of smooth muscle on the nose. We experienced a case of leiomyoma originating in the left inferior turbinate in a 58-year-woman. It was successfully removed by an endoscopic surgery. We discussed with a review of the literatures.

A Case of Leiomyoma in the Inferior Turbinate

Leiomyoma is a benign myogenic tumor may occur whenever smooth muscle is present. The most common locations are the uterus, alimentary tract, skin, and subcutenous tissue. Leiomyoma of the nasal cavity and paranasal sinus is rare because of the paucity of smooth muscle on the nose. We experienced a case of leiomyoma originating in the left inferior turbinate in a 58-year-woman. It was successfully removed by an endoscopic surgery. We discussed with a review of the literatures.

Feasibility of Obtaining Quantitative 3-Dimensional Information Using Conventional Endoscope: A Pilot Study

BACKGROUND/AIMS: Three-dimensional (3D) imaging is gaining popularity and has been partly adopted in laparoscopic surgery or robotic surgery but has not been applied to gastrointestinal endoscopy. As a first step, we conducted an experiment to evaluate whether images obtained by conventional gastrointestinal endoscopy could be used to acquire quantitative 3D information. METHODS: Two endoscopes (GIF-H260) were used in a Borrmann type I tumor model made of clay. The endoscopes were calibrated by correcting the barrel distortion and perspective distortion. Obtained images were converted to gray-level image, and the characteristics of the images were obtained by edge detection. Finally, data on 3D parameters were measured by using epipolar geometry, two view geometry, and pinhole camera model. RESULTS: The focal length (f) of endoscope at 30 mm was 258.49 pixels. Two endoscopes were fixed at predetermined distance, 12 mm (d12). After matching and calculating disparity (v2-v1), which was 106 pixels, the calculated length between the camera and object (L) was 29.26 mm. The height of the object projected onto the image (h) was then applied to the pinhole camera model, and the result of H (height and width) was 38.21 mm and 41.72 mm, respectively. Measurements were conducted from 2 different locations. The measurement errors ranged from 2.98% to 7.00% with the current Borrmann type I tumor model. CONCLUSIONS: It was feasible to obtain parameters necessary for 3D analysis and to apply the data to epipolar geometry with conventional gastrointestinal endoscope to calculate the size of an object.

A Subjective and Acoustic Analysis on Voice Change after Endoscopic Sinus Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Some chronic sinusitis patients complain that voice change, which occurs during surgeries such as endoscopic sinus surgery (ESS), can lead to changes in the vocal organ. The purpose of this study is to analyze the effect of ESS on voice by questionnaire and voice analysis. SUBJECTS AND METHOD: Thirty patients (male 15, female 15) who had underwent ESS were enrolled. All patients had sinusitis confirmed by preoperative CT scan. We analyzed subjective voice impairment by way of questionnaire (Korean-Version of Voice Handicap Index, KVHI) and objective voice impairment by Computerized Speech Laboratory one day preceding and at one month following the surgery. Finally, the subjective impairment of voice was analyzed by subjective questionnaire at postoperative 6 months. In objective analysis, we analysis 11 ESS cases on the formant frequencies of five vowels (/a/, /i/, /u/, /e/, /o/) and three nasal consonants (/namu/, /nuna/, /umma/). RESULTS: In the questionnaire (KVHI), there was a little change in the functional, physical and emotional field but the results were not statistically significant (p>0.05). In the voice analysis, the first formant frequencies of /a/, /u/, the third formant frequency of /o/ of vowel and /a/ of /namu/ of nasal consonant were significantly increased postoperatively compared to those of the preoperative status (p<0.05). However, there was no major change. There was no subjective voice impairment at 6 months after operation. CONCLUSION: After ESS, some voice impairment were observed in KVHI and some formant frequencies were increased in the objective voice analysis but without serious major voice changes. We conclude that ESS is relatively safe from voice point of view; however, for some professional voice users, particular attention needs to be paid regarding fine voice changes.

An Iatrogenic Coronary Arteriovenous Fistula Caused by Guidewire Trauma during Percutaneous Coronary Intervention / 대한내과학회지

We report the case of a 51-year-old man who presented with worsening exertional chest pain in whom subsequent percutaneous coronary intervention resulted in a coronary arteriovenous fistula. Fortunately, the patient was stable and coronary angiography revealed resolution of the fistula 20 minutes later. This case study emphasizes the management of iatrogenic coronary perforations, depending on the type and severity of perforation, which generally involves initial conservative management.

A case report of primary breast angiosarcoma with fatal pulmonary hemorrhage due to thrombocytopenia / 대한외과학회지

Primary angiosarcomas of the breast are rare malignancy that account for fewer than 0.04% of all malignant breast tumors. The prognosis is poor. Surgery is the first line of treatment for angiosarcoma. Adjuvant chemotherapy and radiotherapy have been tried, but their efficacy remains controversial. Here we present the case of a 47-year-old woman with a palpable left breast mass that was diagnosed as a primary angiosarcoma. The patient underwent modified radical mastectomy with adjuvant chemotherapy and radiotherapy. Postoperatively, eighteen months later, the angiosarcoma recurred. The patient returned complaining of dyspnea and hemoptysis and was found to have a large pleural effusion. She developed a gradual onset of thrombocytopenia that persisted despite platelet transfusions. Finally, the patient died of respiratory failure secondary to pulmonary hemorrhage.

Acute Cerebral Infarction Following Intravenous Glycoprotein IIb/IIIa Inhibitor for Acute Myocardial Infarction

Stroke is a rare but serious complication of acute myocardial infarction (AMI). Currently, glycoprotein (GP) IIb/IIIa inhibitor is used in clinical practice for acute coronary syndromes and percutaneous coronary interventions (PCIs). The incidence of stroke in patients receiving GP IIb/IIIa inhibitor during PCIs is very low. We report the case of a 47-year-old man who presented with AMI and suffered an acute cerebral infarction after infusion of a GP IIb/IIIa inhibitor following primary PCI.

The Clinical Significance of Scored CT Findings for Pre-operative Prediction of Lateral Cervical Lymph Node Metastasis in Thyroid Cancer / 대한내분비외과학회지

PURPOSE: Although ultrasound is routinely used for pre-operative evaluation of neck nodes in patients with papillary thyroid carcinoma, CT is also widely used. We designed a prediction score of lateral cervical lymph node metastasis (PSLCNM) for improving diagnostic ability of CT. The purpose of our study was to determine the clinical significance of the PSLCNM. METHODS: A total of 124 patients with thyroid carcinoma who underwent surgery of lateral cervical lymph node dissection after pre-operative CT evaluation were enrolled in this study. We retrospectively evaluated the diagnostic ability between CT findings by one radiologist and PSLCNM for prediction of lateral lymph node metastasis. RESULTS: In terms of predicting lateral cervical node metastasis, the positive predictive value of CT findings of indeterminate, suspicious, or metastatic nodes were 37.5% (21/56), 68.3% (28/41), 85.7% (18/21). Those of 1, 2, 3, 4 in sum of PSLCNM were 34% (16/47), 60% (30/50), 91% (10/11), 100% (10/10). CONCLUSION: Prediction of lateral cervical node metastasis using PSLCNM showed a better result than conventional CT findings and could decrease unnecessary surgical procedures and postoperative complications in the surgery of thyroid cancer.

Small Focal Hepatic Lesions <=1 cm: Their Detection and Characterization with Performing Diffusion-Weighted Sensitivity-Encoding versus SPIO-Enhanced 3T MR Imaging

PURPOSE: We wanted to compare the accuracy of 3T DW-SENSE imaging with that of SPIO-enhanced imaging for the detection and characterization of small hepatic lesions. MATERIALS AND METHODS: 124 focal hepatic lesions of 42 patients were retrospectively reviewed. The DW-SENSE imaging and four T2-weighted imaging, including the respiratory-triggered and breath-hold fast spin-echo images, the half-fourier single-shot turbo spin-echo images and the T2*-weighted fast field-echo images, were acquired. Four T2-weighted examinations were performed after administering SPIO. The images were divided into two sets: the SPIO image set (four pre- and post-contrast T2-weighted images) and the DW-SENSE image set (four DW-SENSE and pre-contrast T2-weighted images). These were sorted according to the confidence levels for lesion detection and characterization into four and five grades. The ROC curve (Az) was calculated. RESULTS: The detection accuracy with using the DW-SENSE image set (Az=0.932, 0.889) was higher than with using the SPIO image set (Az=0.852, 0.798) for all the lesions and the small lesions (<= 1 cm) (p < 0.05). For lesion characterization, the accuracy with using the DW-SENSE image set (Az=0.934, 0.896) was higher than that with using the SPIO image set (Az=0.914, 0.882) for all the lesions and the small lesion, but this was not statistically significant. CONCLUSION: The 3T MR DW-SENSE image set showed higher accuracy for the detection of small hepatic lesions than the SPIO image set.

Evaluation of Portal Hypertension: A Comparison of the Use of Liver Perfusion CT with Wedge Hepatic venous Pressure and Hepatic venous Pressure Gradient

PURPOSE: We compared the hepatic perfusion indices obtained using hepatic perfusion CT with the wedge hepatic venous pressure (WHVP) and hepatic venous pressure gradient (HVPG) to determine the efficacy of the use of liver perfusion CT for the evaluation of portal hypertension. MATERIALS AND METHODS: Thirty-five patients with liver cirrhosis underwent hepatic vein catheterization to measure WHVP and HVPG and underwent a liver perfusion CT examination. Arterial perfusion, portal perfusion, total perfusion and the hepatic perfusion index (HPI) were calculated by the methods described by Miles and Blomley. The overall correlation coefficients (r) between the perfusion indices and WHVP and HVPG were calculated. An additional correlation coefficient of 23 alcoholic cirrhosis patients was calculated. RESULTS: Using Blomley's equation, HPI had a positive correlation with WHVP (r = .471; p < .05) and HVPG (r = .482; p < .05). For the alcoholic liver cirrhosis patients, HPI had a higher positive correlation with WHVP (r = .500; p < .05) and HVPG (r= .539; p < .05) than for the non-alcoholic cirrhosis patients. There was no statistical difference between the use of Miles' equation and Blomley's equation for the evaluation of portal hypertension. CONCLUSION: This preliminary study showed that HPI positively correlated with WHVP and HVPG, especially in alcoholic cirrhosis patients. Liver perfusion CT may be useful in the evaluation of portal hypertension.