Evaluation of Computer Aided Diagnosis (CAD) in the Interpretation of Mass Lesions seen on Breast Sonography / 한국유방암학회지

PURPOSE: Sonography for the diagnosis of breast cancer, is important in Korea because Oriental women have denser breast and their breast cancer generally occurs at a younger age. We investigate the potential usefulness of computer aided diagnosis(CAD) as a tool for physicians to use in the differential diagnosis of the breast mass lesions seen on ultrasound examinations. METHOD: We evaluated a series of pathologically proven breast tumors that were detected in our private clinic from May 2004 to April 2005. A total of 134 breast tumors (55 malignant and 79 benign tumors) were retrospectively evaluated. We located the regions of interest (ROI) on two ultrasonic images (the vertical and longitudinal views) for each mass lesion and we evaluated the malignant score with using the SonoEye2DTM(Cad Impact Inc. Korea) system. Triple measurements were performed for each image and we then analyzed the data as two groups. The first group had their data analyzed by using the two perpendicular images of each mass and the second group had their data analyzed by using the one image with the longest diameter of the mass. RESULT: The sensitivity of CAD on ultrasound images was 81.8%-96.4% for the first group and 74.6-87.3% for the second group and the specificities were 53.2-73.4%, and 59.5-68.4% respectively. The area under the receiver operating characteristic curve(AZ) was 0.811-0.816 for the first group and 0.780-0.800 for the second group. CONCLUSION: The CAD system for the ultrasound images of breast lesions was useful in the diagnosis of breast cancer. The diagnostic accuracy for the analysis of two images was higher than for the analysis of one image.

Prognostic Value of Bone Marrow Micrometastasis Detected by Nested RT-PCR for Cytokeratin 19 and Mammaglobin in Breast Cancer

PURPOSE: Breast cancers frequently undergo distant metastasis during the early phase, on which the survival of patients is greatly dependent. It has been suggested that the occurrence of micrometastasis relates with other prognostic features of breast cancer, such as lymph node metastasis and the presence of vascular invasion. The aim of this study was to examine the presence of keratin-19 and mammaglobin mRNA in bone marrow aspirates obtained from breast cancer patients, and their possible correlation with tumor staging and disease free survival. METHODS: Bone marrow samples were obtained from 254 breast cancer patients at the time of surgery. We separated the mononuclear fraction from the samples and carried out nested reverse transcriptase polymerase chain reaction for the detection of keratin-19 and mammaglobin mRNA using two different pairs of primers. We also studied the possible correlations between the tumor size, nodal involvement, stage, and distant metastasis. RESULTS: Seventy-five of the 254 samples were studied for cytokeratin 19 and the others for cytokeratin and mammaglobin. The median follow-up time was 21.1 months. Sixty-five (26%) of the 254 samples were cytokeratin 19 positive and 25 (14.3%) of the 175 were mammaglobin positive. Eight cases (12.3%) in the cytokeratin positive group showed a recurrent disease in distant organs. Whereas, six (3.2%) out of 185 cytokeratin negative patients had distant recurrences. Mammaglobin positivity was not correlated with distant metastasis. The stage, nodal status, and estrogen receptor were independent of bone marrow micrometastasis. CONCLUSION: Bone marrow micrometastasis, detected by nested RT-PCR for cytokeratin 19, could be a useful predictive marker for the distant metastasis of breast cancer.

Clinical Analysis of Gastric Carcinoma with Single Node Metastasis

PURPOSE: In order to examine the significance of a sentinel lymph node for gastric cancer, we investigated single node metastases that were hypothesized to represent the sentinel lymph node. METHODS: Of 2, 265 primary gastric cancers patients we experienced from 1994 to 2003, 140 patients having gastric carcinoma with a single node metastasis were enrolled in this study. The factors we studied including age, gender, tumor size, location, cellular differentiation, stage, and the patients' survival rate. RESULTS: Single node metastases were found in 30.7% of T1, 35.0% of T2, 29.3% of T3 and 5.0% of T4 staged tumor. Metastatic lymph nodes were mainly located near the tumor in 122 of 140 patients (87.1%). Skip metastases, which were defined as metastases that were found at more distant locations, were found in 18 patients (12.7%), and they were mainly located around the left gastric artery, the common hepatic artery, the proper hepatic artery and the splenic artery. The frequency of skip metastases significantly increased when the tumor was located upper part of the stomach, the tumor size was more than 5 cm in diameter and depth of tumor invasion was deeper (P<0.05). We found more frequent skip metastases in lymph nodes for the diffuse type of tumor infiltration than the macronodular type (P<0.05). The patients' overall 5 year survival was 76.9%, and skip metastasis did not affect on the survival rate. CONCLUSION: Our study supports the understanding of the biology of sentinel nodes. During gastrectomy in gastric cancer patients, great attention should be paid to remove the sentinel nodes and D2 dissection should be done when skip metastasis is suspected.

Research of New Biomarker for Breast Cancer Using Proteomic Patterns / 한국유방암학회지

PURPOSE: Early detection and treatment of cancer is a primary focus of health care. Many serum markers are available for breast cancer, but are not good enough for screening. Cancer antigen CA 15-3 is the most widely used biomarker for breast cancer. However, CA 15-3 has low sensitivity and specificity. This study was performed to analyze the serum proteomic pattern in breast cancer patients by surface-enhanced laser desoption/ionization time- of-flight (SELDI-TOF). METHODS: We screened for potential tumor biomarkers in 42 serum samples, including samples from a group of 23 breast cancer patients at different clinical stages [stage I (n=3), stage II (n=11), stage III (n=6), and stage IV (n=1)], and a control group of 19 healthy women. Diluted serum samples were applied to a C16 hydrophobic interaction chip (H4). Complex protein profiles of different groups were compared and analyzed using the Protein Chip software 2.1 (Ciphergen Biosystems). RESULTS: There were 7 significant protein peaks in the breast cancer group and 5 in the control group. Scoring the expression of each peak, the mean score was 8.5 in the cancer group and 3.5 in the control. The results of the combination of each peak were highly sensitive (91.2%) and specific (94.7%). These proteomic patterns did not correlate with tumor stage and hormonal receptor, c-erb B2. CONCLUSION: In this preliminary report, we identified protein profiles that were differentiated in breast cancer patients. After proper validation, serum proteomic pattern analysis may ultimately be applied in screening breast cancer as a stand-alone or combined with current options.

Clinical Analysis of Three Different Surgical Techniques in Unilateral Thyroid Lobectomy / 대한내분비외과학회지

PURPOSE: The conventional surgical treatment for thyroid disease requires long skin incision with skin flap that can result in prominent scar, parethesia, hypesthesia in the neck. With recent developement in surgical techniques for thyroid tumors, several apporaches have been applied to neck surgery. We performed thyroid operations with 3 different methods and evaluated the role of respective operation method. METHODS: Three different surgical methods; conventional, minimally invasive open, and endoscopic thyroidectomy with axillary approach, were performed on 60 patients who were admitted to Ajou medical center from June to December 2003. All patients were diagnosed as having a benighn mass in unilateral lobe of thyroid gland preoperatively by ultrasonography and fine needle aspiration cytology. We compared the clinical results of respective 3 operation methods each other. RESULTS: Hospital stay and the operation time for minimal invasive open thyroidectomy was significantly shorter than those for endoscopic thyroidectomy (P<0.000). Amounts of post operative analgesics were the lowest in minimal invasive open thyroidectomy than other groups (P<0.019). The patients who was treated by using endoscopic procrdure were more satisfied with the cosmetic result. There was no significant complication in three groups. CONCLUSION: Minimally invasive open thyroidectomy and endoscopic thyroidectomy can be performed safely with cosmetic benefit, and then recommanded as a alternative operative method in selected patients.

MRI as a Preoperative Single Imaging Test in Hepatocellular Carcinoma / 한국간담췌외과학회지

BACKGROUNDS/AIMS: MRI performed preoperatively for Hepatocellular Carcinoma(HCC) not only detects and provides information on the tumor characteristics but can also be used as a noninvasive method via MR-angiogram. MR-angiogram can reconstruct the tumor and its relation to vessels in three dimension. Therefore, it has the advantage of presenting the exact relations of the tumor and the intrahepatic vessels. Recently, preoperative imaging in HCC has become more complex. The invasive angiography is at the center of these various, complex tests and there is a tendency for unnecessary, repeated testing. The cost of these complex tests is hard to ignore. The purpose of this study was to compare single preoperative MRI with other tests and weigh the advantages. METHODS: The subjects were thirty-nine patients who underwent surgery for HCC from November, 1997 through October, 1998. Ten of these patients who had HCC with the diameter of less than 5cm, were evaluated with MRI and when necessary MR angiogram only. The control group were eleven patients with tumor of the same size as above but whom were evaluated with abdominal CT + Hepatic angiogram + Transcatheter arterial chemoembolization(TACE) + lipodol CT, abdominal CT + Hepatic angiogram + CT - AP + TACE + lipodol CT or abdominal CT + Hepatic angiogram + CT - AP + TACE during the identical period. RESULTS: The average cost of preoperative testing was lowest with MRI only. There were no deaths in either group and complication occured in one case of each group. Comparison of the duration of admission between these groups showed a statistically significant difference(p=0.003). The MRI only group with an average of 22.5 days and the control group of 30.8 days. This was due to shortening of the preoperative testing time. Another point worth noting is that patients who underwent MRI alone complained less of discomfort. CONCLUSION: MRI alone group was comparable to control group in providing of preoperative anatomical information. Not performing angiography did not increase risks technically during operation. The authors suggest that MRI as the single preoperative imaging test can be in alternative to the various preoperative imaging test.