Comparison of the efficiency of transgelin, smooth muscle myosin, and CD31 antibodies for the assessment of vascular tumor invasion and free tumor deposits in gastric, pancreatic, and colorectal adenocarcinomas

Background: This study aimed to compare CD31, smooth muscle myosin (SMM), and transgelin antibodies for their efficiency in detecting venous invasion (VI) and the nature of free tumor deposits (TDs) in gastric, pancreatic, and colorectal adenocarcinomas. Materials and Methods: Eleven Whipple, 5 gastrectomy, and 3 colectomy specimens and 1 low anterior resection specimen were reviewed and examined, revealing 254 probable foci. Foci were reviewed and divided into 3 types: Type A, the “orphan artery” pattern; Type F, free TDs in the periorgan adipose and connective tissue without an unaccompanied artery; and Type X, a focus that could be detected only with the immunohistochemical procedures mentioned. Results: No foci were positive for CD31. Transgelin staining was more sensitive than SMM staining in all focus types, Type A only and Type F only (P < 0.001, P = 0.001, and P = 0.10, respectively). In free TDs (Type F), 35.7% of the samples were negative for all four stains, and 64.2% of the samples were positive for SMM and transgelin. We did not make the distinction between a metastatic lymph node and VI in positive foci. Conclusion: We conclude that hematoxylin and eosin (H and E) staining is inadequate and that smooth muscle markers, such as transgelin and/or SMM, are more effective than endothelial markers, such as CD31, in revealing VI and lymph node/large extramural invasion.

The Association between Adequate Prenatal Care and Severe Maternal Morbidity: A Population-based Cohort Study

PURPOSE: This study identified the relationship between adequate prenatal care and severe maternal morbidity among delivered women. METHODS: Data were extracted from the Korean National Health Insurance Service-National Sample Cohort for 91,767 cases of delivery that were delivered during 2003~2013. Severe maternal morbidity status was determined using the Center for Disease Control and Prevention's algorithm including the diagnosis and procedure code during delivery and postpartum hospitalization. A generalized estimating equation (GEE) model with log link was performed for the relationship with severe maternal morbidity and women's factors to estimate adjusted relative risk. RESULTS: Of the 91,767 delivery cases, 2,248 (2.45%) had severe maternal morbidity. In the GEE model, severe maternal morbidity was higher in women who had inadequate prenatal care than in those who had adequate prenatal care (relative risk (RR) 1.39, 95% CI 1.11~1.75, p-value 0.0045). For maternal age, women who delivered at extremely young or old ages had high risks of severe maternal morbidity, which showed a U-shaped distribution through the whole age range. Women who had the lowest level of income, who had cesarean section delivery, who were nulliparous, who had twins or more than triplet births had high risks of severe maternal morbidity. CONCLUSION: Inadequate prenatal care delivery was associated with the occurrence of severe maternal morbidity. Therefore, policy makers should consider making quality indicators for early, timely, and sufficient visits during pregnancy and should monitor adequacy of prenatal care to prevent severe maternal morbidity.

Diagnostic Performance of Combined Single Photon Emission Computed Tomographic Scintimammography and Ultrasonography Based on Computer-Aided Diagnosis for Breast Cancer / 핵의학분자영상

PURPOSE: We investigated whether the diagnostic performance of SPECT scintimammography (SMM) can be improved by adding computer-aided diagnosis (CAD) of ultrasonography (US). MATERIALS AND METHODS: We reviewed breast SPECT SMM images and corresponding US images from 40 patients with breast masses (21 malignant and 19 benign tumors). The quantitative data of SPECT SMM were obtained as the uptake ratio of lesion to contralateral normal breast. The morphologic features of the breast lesions on US were extracted and quantitated using the automated CAD software program. The diagnostic performance of SPECT SMM and CAD of US alone was determined using receiver operating characteristic (ROC) curve analysis. The best discriminating parameter (D-value) combining SPECT SMM and the CAD of US was created. The sensitivity, specificity and accuracy of combined two diagnostic modalities were compared to those of a single one. RESULTS: Both SPECT SMM and CAD of US showed a relatively good diagnostic performance (area under curve = 0.846 and 0.831, respectively). Combining the results of SPECT SMM and CAD of US resulted in improved diagnostic performance (area under curve =0.860), but there was no statistical differerence in sensitivity, specificity and accuracy between the combined method and a single modality. CONCLUSION: It seems that combining the results of SPECT SMM and CAD of breast US do not significantly improve the diagnostic performance for diagnosis of breast cancer, compared with that of SPECT SMM alone. However, SPECT SMM and CAD of US may complement each other in differential diagnosis of breast cancer.