Follow-Up Intervals for Breast Imaging Reporting andData System Category 3 Lesions on Screening Ultrasoundin Screening and Tertiary Referral Centers

Objective@#To assess the appropriate follow-up interval, and rate and timepoint of cancer detection in women with Breast ImagingReporting and Data System (BI-RADS) 3 lesions on screening ultrasonography (US) according to the type of institution. @*Materials and Methods@#A total of 1451 asymptomatic women who had negative or benign findings on screening mammogram,BI-RADS 3 assessment on screening US, and at least 6 months of follow-up were included. The median follow-up interval was30.8 months (range, 6.8–52.9 months). The cancer detection rate, cancer detection timepoint, risk factors, and clinicopathologicalcharacteristics were compared between the screening and tertiary centers. Nominal variables were compared using the chisquareor Fisher’s exact test and continuous variables were compared using the independent t test or Mann-Whitney U test. @*Results@#In 1451 women, 19 cancers (1.3%) were detected; two (0.1%) were diagnosed at 6 months and 17 (1.2%) werediagnosed after 12.3 months. The malignancy rates were both 1.3% in the screening (9 of 699) and tertiary (10 of 752) centers.In the screening center, all nine cancers were invasive cancers and diagnosed after 12.3 months. In the tertiary center, twowere ductal carcinomas in situ and eight were invasive cancers. Two of the invasive cancers were diagnosed at 6 months andthe remaining eight cancers newly developed after 13.1 months. @*Conclusion@#One-year follow-up rather than 6-month follow-up may be suitable for BI-RADS 3 lesions on screening US foundin screening centers. However, more caution is needed regarding similar findings in tertiary centers where 6-month follow-upmay be more appropriate.

Erratum: Follow-up Outcomes of Benign Pathology Initially Assigned as Breast Imaging Reporting and Data System Category 4A and 3 / 한국유방암학회지

This article was initially published on the Journal of Breast Cancer with a misspelled the Institutional Review Board (IRB) approval number. The IRB number should be corrected as “NCC2014-0031”.

Follow-up Outcomes of Benign Pathology Initially Assigned as Breast Imaging Reporting and Data System Category 4A and 3 / 한국유방암학회지

PURPOSE: This retrospective study investigated if the initially assigned category 4A or 3 in concordant benign lesions, after ultrasound (US)-guided core needle biopsy, could affect follow-up compliance. METHODS: Eight hundred thirty-eight concordant benign lesions, after core needle biopsy (674, initial category 4A group and 164, category 3 group) and follow-up US, were included in our study. If an immediate surgical excision—a surgical excision before the next follow-up—exists, those cases with pathologic reports were collected. Statistical comparisons for the result of follow-up US compliance, additional biopsy, and malignant rates among 6-month, 12-month, and long-term intervals were performed by using the chi-square test. The log-rank test was used to compare compliance rates in the timing of first follow-up between the two groups, with a significance level of 0.05. RESULTS: The number of immediate surgical excision was higher in the category 4A group (11.1%) than in the category 3 group (6.1%); only one cancer was found in the category 4A group. The patients' compliance rate in a 6-month follow-up showed an increase (p=0.003) in the category 4A group. The additional biopsy rate was higher in the initial category 4A group (10.9%) than in the category 3 group (1.9%) with statistical significance (p=0.001); four cancers were found on additional biopsy in the category 4 group. No cancer was detected in the initial category 3 group, both on immediate surgical excision and follow-up. CONCLUSION: The initial category 4A or 3 of the Breast Imaging Reporting and Data System could be a significant factor that affects immediate surgical excision and follow-up compliance. Cancers were detected only in the initial category 4A group of concordant benign lesions. More attention should be paid to the concordant benign lesions from the initial category 4A group than from the category 3 group.

SAPHO Syndrome in a Patient with Breast Cancer Mimicking Bone Metastasis: A Case Report

A 66-year-old woman was transferred to our hospital due to her right breast cancer. Preoperative breast MRI shows 1.9 cm malignancy on her right breast (cT1N0M0) and incidentally found osteosclerotic change of left coststernoclavicular region. Bone scintigraphy showed hot uptake and the possibility of bone metastasis was not excluded. However, because the bone metastasis is not common in early stage cancer and the costosternoclavicular region is not common site, other possibility should be considered. SAPHO syndrome can be diagnosed even in the absence of dermatosis when there is an axial or appendicular osteitis and hyperostosis, especially in costosternoclavicular region. Though breast imaging specialists are not accustomed to this disease entity, awareness and diagnosis of the SAPHO syndrome can help differentiate bone metastasis.

Extra-Mammary Findings Detected on Breast Magnetic Resonance Imaging: A Pictorial Essay

Magnetic resonance imaging (MRI) of the breast is used for various indications. Contrary to computed tomography as a staging tool, breast MRI focuses on the breast parenchyma and axilla. In spite of narrow field of view, many structures such as the anterior portion of the lungs, mediastinum, bony structures and the liver are included which should not be neglected because the abnormalities detected on the above structures may influence the staging and provide a clue to systemic metastasis, which results in the change of treatment strategy. The purpose of this pictorial essay was to review the unexpected extra-mammary findings seen on the preoperative breast MRI.

Anaplastic Thyroid Cancer: Ultrasonographic Findings and the Role of Ultrasonography-Guided Fine Needle Aspiration Biopsy

PURPOSE: To investigate the ultrasonographic (US) features of anaplastic thyroid cancer (ATC) and the diagnostic performance of US-guided fine needle aspiration biopsy (FNAB) therein. MATERIALS AND METHODS: Eighteen cases of ATC diagnosed between January 2001 and May 2011 were included. FNAB was performed in all cases. Initial FNAB results were divided into three groups: 1) the cytological ATC group, cytological diagnosis of ATC; 2) the underestimated group, cytological diagnoses of malignancy other than ATC; and 3) the false negative group, cytological diagnoses of atypical, benign and non-diagnostic lesions. We retrospectively reviewed US findings and compared treatment modalities between each group. RESULTS: Among the 18 patients, there were nine in the initially cytological ATC group, four in the underestimated group and five in the false negative group. The most common US features of ATC were a solid (64.7%) and irregular shaped (88.2%) mass with lymph node involvement (76.4%). However, except for lymph node involvement (p=0.003), US findings for each group were not statistically different. The initial cytological diagnostic accuracy of ATC was 50% (9/18). Surgery was performed less in the ATC group (11%) and the false negative group (20%) than the underestimated group (75%). CONCLUSION: The US features of ATC were not especially different from other types of aggressive thyroid cancer. A correct diagnosis of ATC by initial US-FNAB was made in 50% of the patients, which is significant in that therapeutic surgery can be undertaken in lower numbers if correctly diagnosed.

Combined Anomaly of the Right Hepatic Lobe Agenesis and Absence of the Inferior Vena Cava: a Case Report

The absence of the inferior vena cava is an uncommon congenital anomaly that has recently been identified as an important risk factor contributing to the development of deep venous thrombosis. Congenital agenesis of the right hepatic lobe is a rare anomaly which is found incidentally in radiologic examinations. We present a case of a congenital absence of the infrarenal inferior vena cava, combined with agenesis of the right hepatic lobe in a 62-year-old man presented with symptoms of deep venous thrombosis.

Intensive Care Unit Nurse's Knowledge, Nursing Performance, and Stress about Delirium / 성인간호학회지

PURPOSE: The study was conducted to survey intensive care unit nurse's knowledge, nursing performance, and stress involving delirium. METHODS: The subjects of this study were 278 nurses from three hospitals in Seoul, who had worked at the intensive care unit more than six months. Data were collected using questionnaire from December, 2005 to January, 2006. RESULTS: The mean score of knowledge about delirium was 31.60 out of 50 and it was significantly lower among those with clinical experience of 12-35 months and 60-119 months and those who didn't experience conflicts with patients' families. The mean score of nursing performance for delirium was 16.10 out of 23, and it was significantly higher among those who took care of 2 patients. The mean score of stress related to delirium was 63.92 out of 100, and it was significantly higher among those aged over 40, nurses who were university graduates, nurses who experienced conflicts with patients' families, and nurses who took care of 5 patients. CONCLUSION: We need to develop systematic education programs in charge of patients with delirium.