Contrast-enhanced ultrasound features as a potential biomarker for the prediction of breast cancer recurrence.

PURPOSE: To investigate the associations between contrast-enhanced ultrasound imaging features and disease recurrence among patients with locally advanced breast cancer treated with neoadjuvant chemotherapy. MATERIALS AND METHODS: In the study, pre- and post-neoadjuvant chemotherapy contrast-enhanced ultrasound images of 43 patients with breast cancer were retrospectively analysed. Post-acquisition image processing involved the placement of freehand-drawn regions of interest, followed by the generation of blood flow kinetics representing blood volume and velocity for these regions of interest. Qualitative and quantitative contrast-enhanced ultrasound parameters were compared to predict recurrence, and receiver operating characteristic analysis was used to evaluate predictive ability. RESULTS: Among the 43 patients, 10 (23%) exhibited disease recurrence (median [range]: 27 [4-68] months). Post-neoadjuvant chemotherapy peak enhancement, wash-in area under the curve, wash-out area under the curve, and wash-in and wash-out area under the curve (p=0.003, p=0.004, p=0.026, and p=0.014, respectively) differed between the no-recurrence and recurrence groups. The area under the receiver operating characteristic curve (0.88; 95% confidence interval: 0.75-1.00) for post-neoadjuvant chemotherapy peak enhancement was the highest among the contrast-enhanced ultrasound parameters, with a cut-off of 13.33 arbitrary units. CONCLUSION: Higher peak enhancement on post-neoadjuvant chemotherapy contrast-enhanced ultrasound images was associated with recurrence in women with locally advanced breast cancer and is a potential biomarker of tumor recurrence.

3D Breast Cancer Segmentation in DCE-MRI Using Deep Learning With Weak Annotation.

BACKGROUND: Deep learning models require large-scale training to perform confidently, but obtaining annotated datasets in medical imaging is challenging. Weak annotation has emerged as a way to save time and effort. PURPOSE: To develop a deep learning model for 3D breast cancer segmentation in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) using weak annotation with reliable performance. STUDY TYPE: Retrospective. POPULATION: Seven hundred and thirty-six women with breast cancer from a single institution, divided into the development (N = 544) and test dataset (N = 192). FIELD STRENGTH/SEQUENCE: 3.0-T, 3D fat-saturated gradient-echo axial T1-weighted flash 3D volumetric interpolated brain examination (VIBE) sequences. ASSESSMENT: Two radiologists performed a weak annotation of the ground truth using bounding boxes. Based on this, the ground truth annotation was completed through autonomic and manual correction. The deep learning model using 3D U-Net transformer (UNETR) was trained with this annotated dataset. The segmentation results of the test set were analyzed by quantitative and qualitative methods, and the regions were divided into whole breast and region of interest (ROI) within the bounding box. STATISTICAL TESTS: As a quantitative method, we used the Dice similarity coefficient to evaluate the segmentation result. The volume correlation with the ground truth was evaluated with the Spearman correlation coefficient. Qualitatively, three readers independently evaluated the visual score in four scales. A P-value <0.05 was considered statistically significant. RESULTS: The deep learning model we developed achieved a median Dice similarity score of 0.75 and 0.89 for the whole breast and ROI, respectively. The volume correlation coefficient with respect to the ground truth volume was 0.82 and 0.86 for the whole breast and ROI, respectively. The mean visual score, as evaluated by three readers, was 3.4. DATA CONCLUSION: The proposed deep learning model with weak annotation may show good performance for 3D segmentations of breast cancer using DCE-MRI. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY: Stage 2.

Maxillary basal arch forms in operated adult patients with cleft lip and palate using root apices: A pilot study.

OBJECTIVES: The purpose was to identify the maxillary basal arch forms utilizing the root apices and compare the maxillary basal arch form of groups with cleft lip and palate (CLP) and normal group. MATERIALS AND METHODS: This study included 30 patients (21.8 ± 3.5 years old) with unilateral CLP (ULCP group) and 30 patients (20.9 ± 2.2 years old) with bilateral CLP (BCLP group). The normal group consisted of 30 non-cleft patients (21.2 ± 2.3 years old) with normal occlusion. Three-dimensional (3D) Cartesian coordinates of the root apices of each tooth were determined using cone-beam computed tomography. The 3D coordinates were projected onto the palatal plane to create the 2D coordinates. Thereafter, the basal arch forms were constructed by the Procrustes superimposition. Finally, For the basal arch form comparisons among groups, the inter-root widths were measured. RESULTS: Both CLP groups had a narrower inter-root width than the normal group. The BCLP group had significantly narrower premolar and molar widths than the UCLP group (P < .05). Especially, the inter-first molar width of the UCLP and BCLP groups was 3.7 ± 0.7 (P < .001) and 6.6 ± 0.8 (P < .001) mm smaller than that of the normal group, respectively. CONCLUSIONS: We used the root apices to identify the basal arch forms. The basal arch form of patients with CLP was narrower than that of the normal group. The basal arch form of patients with BCLP was narrower than that of patients with UCLP. Our findings may help clinicians better comprehend basal arch forms in patients with CLP and transverse discrepancies.

WGA-M001, a Mixture of Total Extracts of Tagetes erecta and Ocimum basilicum, Synergistically Alleviates Cartilage Destruction by Inhibiting ERK and NF-κB Signaling.

Tagetes erecta and Ocimum basilicum are medicinal plants that exhibit anti-inflammatory effects against various diseases. However, their individual and combined effects on osteoarthritis (OA) are unknown. Herein, we aimed to demonstrate the effects of T. erecta, O. basilicum, and their mixture, WGA-M001, on OA pathogenesis. The administration of total extracts of T. erecta and O. basilicum reduced cartilage degradation and inflammation without causing cytotoxicity. Although WGA-M001 contained lower concentrations of the individual extracts, it strongly inhibited the expression of pathogenic factors. In vivo OA studies also supported that WGA-M001 had protective effects against cartilage destruction at lower doses than those of T. erecta and O. basilicum. Moreover, its effects were stronger than those observed using Boswellia and Perna canaliculus. WGA-M001 effectively inhibited the interleukin (IL)-1ß-induced nuclear factor kappa-light-chain-enhancer of the activated B cell (NF-κB) pathway and ERK phosphorylation. Furthermore, RNA-sequence analysis also showed that WGA-M001 decreased the expression of genes related to the IL-1ß-induced NF-κB and ERK signaling pathways. Therefore, WGA-M001 is more effective than the single total extracts of T. erecta and O. basilicum in attenuating OA progression by regulating ERK and NF-κB signaling. Our results open new possibilities for WGA-M001 as a potential therapeutic agent for OA treatment.

Comparison of root apex's position between unilateral and bilateral palatally impacted canines: A pilot study.

INTRODUCTION: The purpose was to determine whether the location of the root apices of unilateral palatally impacted canines differs from that of bilateral palatally impacted canines using cone-beam computed tomography. METHODS: The subjects were divided into 3 groups: a bilateral palatally impacted canine group (BPG; n = 28), a unilateral palatally impacted canine group (UPG; n = 28), and a control group (CG; n = 28) that included contralateral normally erupted canines in the UPG. After selecting the root apex in the onDemand3D program, 3-dimensional coordinates were extracted. These 3-dimensional coordinates were converted using the MATLAB program to 2-dimensional coordinates via projection on the palatal plane. Procrustes analysis was used to superimpose these 2-dimensional coordinates. The x- and y-coordinates of the root apices were used to measure the distance between the origin and root apex. RESULTS: The distance between the root apex of the canine and the origin was 17.43 ± 1.78 mm in BPG, 17.96 ± 1.87 mm in UPG, and 13.96 ± 0.95 mm in CG. There was no statistically significant difference between UPG and BPG. However, there was a statistically significant difference between the CG and impacted groups (UPG and BPG). The same results were found for the x- and y-coordinates. CONCLUSIONS: The location of the root apices of unilateral palatally impacted canines is similar to that of bilateral palatally impacted. The location of root apices of palatally impacted canines differs from that of normally erupted canines.

Fully Automatic Assessment of Background Parenchymal Enhancement on Breast MRI Using Machine-Learning Models.

BACKGROUND: Automated measurement and classification models with objectivity and reproducibility are required for accurate evaluation of the breast cancer risk of fibroglandular tissue (FGT) and background parenchymal enhancement (BPE). PURPOSE: To develop and evaluate a machine-learning algorithm for breast FGT segmentation and BPE classification. STUDY TYPE: Retrospective. POPULATION: A total of 794 patients with breast cancer, 594 patients assigned to the development set, and 200 patients to the test set. FIELD STRENGTH/SEQUENCE: 3T and 1.5T; T2 -weighted, fat-saturated T1 -weighted (T1 W) with dynamic contrast enhancement (DCE). ASSESSMENT: Manual segmentation was performed for the whole breast and FGT regions in the contralateral breast. The BPE region was determined by thresholding using the subtraction of the pre- and postcontrast T1 W images and the segmented FGT mask. Two radiologists independently assessed the categories of FGT and BPE. A deep-learning-based algorithm was designed to segment and measure the volume of whole breast and FGT and classify the grade of BPE. STATISTICAL TESTS: Dice similarity coefficients (DSC) and Spearman correlation analysis were used to compare the volumes from the manual and deep-learning-based segmentations. Kappa statistics were used for agreement analysis. Comparison of area under the receiver operating characteristic (ROC) curves (AUC) and F1 scores were calculated to evaluate the performance of BPE classification. RESULTS: The mean (±SD) DSC for manual and deep-learning segmentations was 0.85 ± 0.11. The correlation coefficient for FGT volume from manual- and deep-learning-based segmentations was 0.93. Overall accuracy of manual segmentation and deep-learning segmentation in BPE classification task was 66% and 67%, respectively. For binary categorization of BPE grade (minimal/mild vs. moderate/marked), overall accuracy increased to 91.5% in manual segmentation and 90.5% in deep-learning segmentation; the AUC was 0.93 in both methods. DATA CONCLUSION: This deep-learning-based algorithm can provide reliable segmentation and classification results for BPE. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE: 2.

Automated breast US as the primary screening test for breast cancer among East Asian women aged 40-49 years: a multicenter prospective study.

OBJECTIVES: To prospectively evaluate the diagnostic performance of screening ABUS as the primary screening test for breast cancer among Korean women aged 40-49 years. METHODS: This prospective, multicenter study included asymptomatic Korean women aged 40-49 years from three academic centers between February 2017 and October 2019. Each participant underwent ABUS without mammography, and the ABUS images were interpreted at each hospital with double-reading by two breast radiologists. Biopsy and at least 1 year of follow-up was considered the reference standard. Diagnostic performance of ABUS screening and subgroup analyses according to patient and tumor characteristics were evaluated. RESULTS: Reference standard data were available for 959 women. The recall rate was 9.8% (95% confidence interval [CI]: 7.9%, 11.7%; 94 of 959 women) and the cancer detection yield was 5.2 per 1000 women (95% CI: -0.6, 11.1; 5 of 959 women). There was only one interval cancer. The sensitivity was 83.3% (95% CI: 53.5%, 100%; 5 of 6 cancers) and the specificity was 90.7% (95% CI: 88.8%, 92.5%; 864 of 95. women). The positive predictive values of biopsies performed (PPV3) was 20.0% (95% CI: 4.3%, 35.7%; 5 of 25 women). Women with heterogeneous background echotexture had a higher recall rate (p = .009) and lower specificity (p = .036). Women with body mass index values < 25 kg/m2 had a higher mean recall rate (p = .046). CONCLUSION: In East Asia, screening automated breast US may be an alternative to screening mammography for detecting breast cancers in women aged 40-49 years. KEY POINTS: • Automated breast US screening for breast cancer in asymptomatic women aged 40-49 is effective with 5.2 per 1000 cancer detection yield. • Women with heterogeneous background echotexture had a higher recall rate and lower specificity. • Women with body mass index < 25 kg/m2 had a higher recall rate.

Risk Stratification of Ductal Carcinoma In Situ and Texture Analysis of Contrast-Enhanced Breast Magnetic Resonance Imaging.

OBJECTIVE: The aim of this study was to investigate whether texture analysis of contrast-enhanced T1 weighted images could predict risk of ductal carcinoma in situ (DCIS). METHODS: The study included 185 DCIS lesions that were classified as either low risk or non-low risk using surgical pathology records. All magnetic resonance imaging texture analyses were performed using postprocessing software, and texture-derived parameters were extracted. RESULTS: The sphericity, compactness, and spherical disproportion were significantly different in the low-risk and non-low risk groups using the Van Nuys Prognostic Index (mean ± SD, 0.479 ± 0.189 vs 0.414 ± 0.176, 0.161 ± 0.159 vs 0.112 ± 0.134, and 2.569 ± 1.434 vs 2.934 ± 1.374, respectively; P < 0.05). In the univariate analyses, sphericity (odds ratio, 7.091; 95% confidence interval, 1.236-40.666; P = 0.028) and compactness (odds ratio, 9.267; 95% confidence interval, 1.125-76.360; P = 0.039) were significantly associated with a high probability of being low risk according to the Van Nuys Prognostic Index. CONCLUSIONS: Whole-lesion texture analysis may be helpful in identifying patients classified as having low-risk DCIS before surgery.

Lithography Processable Ta2O5 Barrier-Layered Chitosan Electric Double Layer Synaptic Transistors.

We proposed a synaptic transistor gated using a Ta2O5 barrier-layered organic chitosan electric double layer (EDL) applicable to a micro-neural architecture system. In most of the previous studies, a single layer of chitosan electrolyte was unable to perform lithography processes due to poor mechanical/chemical resistance. To overcome this limitation, we laminated a high-k Ta2O5 thin film on chitosan electrolyte to ensure high mechanical/chemical stability to perform a lithographic process for micropattern formation. Artificial synaptic behaviors were realized by protonic mobile ion polarization in chitosan electrolytes. In addition, neuroplasticity modulation in the amorphous In-Ga-Zn-oxide (a-IGZO) channel was implemented by presynaptic stimulation. We also demonstrated synaptic weight changes through proton polarization, excitatory postsynaptic current modulations, and paired-pulse facilitation. According to the presynaptic stimulations, the magnitude of mobile proton polarization and the amount of weight change were quantified. Subsequently, the stable conductance modulation through repetitive potential and depression pulse was confirmed. Finally, we consider that proposed synaptic transistor is suitable for advanced micro-neural architecture because it overcomes the instability caused when using a single organic chitosan layer.

Axillary lymph node dissection is not obligatory in breast cancer patients with biopsy-proven axillary lymph node metastasis.

PURPOSE: The ACOSOG Z0011 trial demonstrated that axillary lymph node dissection (ALND) is unnecessary in select patients with cT1-2N0 tumors undergoing breast-conserving therapy with 1-2 positive sentinel lymph nodes (SLNs). However, patients with preoperatively confirmed ALN metastasis were not included and may be subjected to unnecessary ALND. The aim of this study is to identify patients who can be considered for ALND omission when the preoperative ALN biopsy results are positive. METHODS: Breast cancer patients who underwent preoperative ALN biopsy and primary surgery were retrospectively reviewed. Among patients with positive ALN biopsy results, clinicopathological and imaging characteristics were compared according to LN disease burden (1-2 positive LNs vs. ≥ 3 positive LNs). RESULTS: A total of 542 patients were included in the analysis. Among them, 225 (41.5%) patients had a preoperative positive ALN biopsy. More than 40% of the patients (n = 99, 44.0%) with a positive biopsy had only 1-2 positive ALNs. The association between nodal burden and imaging factors was strongest when ≥ 2 suspicious LNs were identified on PET/CT images (HR 8.795, 95% CI 4.756 to 13.262). More than one imaging modality showing ≥ 2 suspicious LNs was also strongly correlated with ≥ 3 positive ALNs (HR 5.148, 95% CI 2.881 to 9.200). CONCLUSIONS: Nearly half of patients with a preoperative biopsy-proven ALN metastasis had only 1-2 positive LNs on ALND. Patients meeting ACOSOG Z0011 criteria with only one suspicious LN on PET/CT or those presenting with few abnormal ALNs on only one imaging modality appear appropriate for SLNB and consideration of ALND omission.

Colour stability and surface properties of high-translucency restorative materials for digital dentistry after simulated oral rinsing.

High-translucency restorative materials are commonly used in the restoration of anterior teeth where aesthetics is a critical factor. In this in vitro study, the impact of mouthwash on the colour stability and surface characteristics of high-translucency computer-aided design and computer-aided manufacturing (CAD-CAM) dental restorative materials was evaluated. Two-hundred specimens were fabricated from five high-translucency CAD-CAM materials: a resin nano ceramic; a polymer-infiltrated ceramic network; a feldspathic ceramic; a lithium disilicate glass ceramic; and high-translucency zirconia. Each group of ceramic specimens was then divided into four subgroups: conventional mouthwash (LISTERINE); whitening mouthwash (LISTERINE Healthy White); chlorhexidine gluconate; and distilled water. Oral rinsing was simulated at 100 rpm for 180 h, representing 15 yr of clinical simulation. The specimens were then evaluated for colour, translucency, gloss, roughness, and surface morphology. Two-way ANOVA and linear mixed models were used for intergroup comparisons (α = 0.05). The polymer-infiltrated ceramic network and feldspathic ceramic became brighter, more opaque, less glossy, and rougher after rinsing with the whitening mouthwash. The long-term use of specific mouthwashes can cause deterioration of the optical and surface properties of high-translucency CAD-CAM dental restorations.

Anatomical relationship between the maxillary posterior teeth and the sinus floor according to an anterior overbite.

OBJECTIVE: To evaluate the vertical relationship between the maxillary sinus floor (MSF) and the maxillary posterior teeth (MPT) according to an anterior overbite. SETTINGS AND SAMPLE POPULATION: The patients were divided into three groups according to an anterior overbite. The open bite group (OBG) included patients with an anterior overbite of ≤0 mm, the normal overbite group (NBG) included patients with an overbite of 0-3 mm, and the deep bite group (DBG) included patients with an overbite ≥3 mm. Thirty patients were randomly matched into each group based on age and sex. MATERIALS AND METHODS: The distances and vertical relationship between the MSF and the MPT was analysed using cone-beam computer tomography. The vertical relationship between the two was classified as either favourable or unfavourable for the intrusion of the posterior teeth. RESULTS: A higher ratio of patients in the OBG had MPT positioned close to the MSF than the DBG. Intrusion of the posterior teeth was unfavourable for an average of 87.2%, 77.2% and 70.2% molars in the OBG, NBG and DBG, respectively. CONCLUSIONS: The vertical distance between the MSF and the MPT is associated with an anterior overbite. The posterior teeth were in an unfavourable position for the orthodontic intrusion in the OBG as compared to the other groups. Additional caution is needed when planning orthodontic intrusion treatment for patients with an anterior open bite. But, there were some individual variations within each group.

The effect of build angle on the tissue surface adaptation of maxillary and mandibular complete denture bases manufactured by digital light processing.

STATEMENT OF PROBLEM: The effect of different build angles on the tissue surface adaptation of complete denture bases manufactured by digital light processing (DLP) is unclear. PURPOSE: The purpose of this in vitro study was to evaluate the effect of build angle on the tissue surface adaptation of DLP-printed complete denture bases. MATERIAL AND METHODS: Both maxillary and mandibular denture bases were virtually designed based on reference casts and fabricated by the DLP technique. For each arch, a total of 40 denture bases were fabricated with 4 different build angle conditions (90, 100, 135, and 150 degrees) and divided into 4 groups (90D, 100D, 135D, and 150D; 10 denture bases per group). The scanned intaglio surface of each DLP denture base was superimposed on the scanned edentulous area of the reference cast to compare the degree of tissue surface adaptation. Root-mean-square estimate, positive average deviation, and negative average deviation values were measured and displayed with a color deviation map. The Mann-Whitney test and Kruskal-Wallis analysis of variance were used for statistical analyses (α=.05). RESULTS: No statistically significant differences were found for root-mean-square estimate values among any build angle groups in either the maxillary or mandibular arch. With the increase of build angles, the area of positive deviation in the maxillary arch moved from the palatal region to the posterior palatal seal area, and negative deviation became pronounced at the posterior tuberosity. In the maxillary arch, the 135D group showed favorable color distribution of surface deviation. In the mandibular arch, a positive deviation was detected at the labial slope to the crest of the ridge, whereas a negative deviation was observed at the buccal shelf and the retromolar pad. The 100D group showed favorable distribution of surface deviation in the mandible. CONCLUSIONS: In both arches, the difference of overall tissue surface adaptation was not statistically significant in the 4 different build angles. However, the color deviation map revealed that the 135-degree build angle may be appropriate in the maxillary DLP-printed denture base and the 100-degree angle, in the mandibular denture base.

Comparison of maxillary basal arch forms using the root apex in adult women with different skeletal patterns: A pilot study.

INTRODUCTION: This study aimed to establish maxillary basal arch forms using the root apices and to determine the differences in the basal arch forms in adult women with different sagittal skeletal patterns. METHODS: This retrospective study included 91 adult women, with either a Class I (n = 24), Class II Division 1 (n = 22), Class II Division 2 (n = 23), or Class III (n = 22) malocclusion, who underwent cone-beam computed tomography. Three-dimensional coordinates of the root apices were determined using the multiplanar reformation mode of OnDemand3D software (Cybermed Inc, Seoul, South Korea). Two-dimensional coordinates were converted from acquired 3-dimensional coordinates via projection on the palatal plane, and the Procrustes superimposition method was used to build the basal arch form. Finally, interroot width measurements were performed for basal arch form comparisons. RESULTS: There were significant differences among the 4 groups (P <0.05) with respect to the intercanine width. The intercanine width of Class II Division 1 group was significantly narrower than that of the other groups. The Class II Division 1 and Class II Division 2 groups tended to have tapered arch forms and squared arch forms, respectively. CONCLUSIONS: We established maxillary basal arch forms using the root apices. The Class II Division 1 group had a significantly narrower intercanine distance. The use of the root apex to depict the basal arch form seems reasonable.

Correction to: Effect of training on ultrasonography (US) BI-RADS features for radiology residents: a multicenter study comparing performances after training.

The original version of this article, published on 07 January 2019, unfortunately contained a mistake.

Effect of training on ultrasonography (US) BI-RADS features for radiology residents: a multicenter study comparing performances after training.

OBJECTIVES: To evaluate the effect of training radiology residents on breast ultrasonography (US) according to the Breast Imaging Reporting And Data System (BI-RADS) and the factors that influence the training effect. METHODS: This multicenter, prospective study was approved by eight institutional review boards. From September 2013 to July 2014, 248 breast masses in 227 women were included for US image acquisition. Representative B-mode and video images of the breast masses were recorded, among which 54 cases were included in the education set and 66 in the test set. Sixty-one radiology residents scheduled for breast imaging training individually reviewed the test set, immediately before, 1 month after, and 6 months after training. Diagnostic performances and US descriptors of the residents were evaluated and compared against those of expert radiologists. RESULTS: Agreements between residents and experienced radiologists showed improvement after training, while agreements between post-training and post-6-month training descriptors did not show significant differences (all p > 0.05, respectively). Sensitivity, negative predictive value (NPV), and AUC were significantly improved for residents post-training and post-6-month training (all p < 0.05), while approximating the performances of expert radiologists except for AUC (0.836, 0.840, and 0.908, respectively, p < 0.05). Low levels of pre-training AUC, total number of breast US examinations, and the number of sessions per week that residents were involved in were factors influencing the improvement of AUC. CONCLUSION: Training using education material dedicated for breast US imaging effectively improved the diagnostic performances of radiology residents and agreements with experienced radiologists on US BI-RADS features. KEY POINTS: • Agreements on lesion descriptors between residents and experienced radiologists showed improvement after training, regardless of test point. • Sensitivity, NPV, and AUC were significantly improved for residents in post-training and post-6-month training (all p < 0.05). • Low levels of pre-training AUC, total number of breast US examinations, and the number of sessions per week that residents were involved in were factors influencing the improvement of AUC.

Comparison of Positive Predictive Values of Categorization of Suspicious Calcifications Using the 4th and 5th Editions of BI-RADS.

OBJECTIVE. The objective of this study was to evaluate changes in the positive predictive value (PPV) of categorization of suspicious calcification for malignancy with the 4th versus the 5th edition of BI-RADS. MATERIALS AND METHODS. A total of 469 cases from 444 women (mean age, 50.1 years; age range, 23-82 years) with pathologically confirmed suspicious calcifications from January 2012 to June 2016 were enrolled in this retrospective study. Two radiologists determined morphology and distribution by consensus and categorized suspicious calcifications using the categorization systems in the 4th and 5th editions of BI-RADS. The PPVs for morphology, distribution, and categorization of calcifications were analyzed. The Pearson chi-square test was used to compare PPVs for morphology and distribution of suspicious calcification. RESULTS. The PPVs of categorization using the 5th edition matched better with BI-RADS category assessment than did categorization using the 4th edition. The PPVs of morphology were as follows: amorphous, 15.9%; coarse heterogeneous, 31.7%; fine pleomorphic, 58.2%; and fine linear or branching, 90.6% (p < 0.001). The PPVs of distribution were as follows: regional, 31.5%; grouped, 31.3%; linear, 50%; and segmental, 77.9% (p < 0.001). When distribution was divided into two types (grouped or regional vs segmental or linear) and analyzed in combination with suspicious morphology, distribution affected the PPVs and categorization of coarse heterogeneous, fine pleomorphic, and fine linear or branching calcifications. CONCLUSION. Categorization using both morphology and distribution according to the BI-RADS 5th edition was helpful to stratify risk levels of areas of suspicious calcification.

Emerging trends of inflammatory bowel disease in South Korea: A nationwide population-based study.

BACKGROUND AND AIM: Little is known regarding the exact burden of inflammatory bowel disease (IBD) in Asian countries because previous epidemiologic studies were hospital based. We aimed to develop and validate an operational definition of IBD cases from health insurance claims data and to examine the epidemiological features of IBD in Korea. METHODS: We analyzed stratified sample data from the Korean Health Insurance Review and Assessment (2010-2016) database using 12 different definitions and applied the best definition to the entire (2007-2016) dataset. RESULTS: The definition that combined the International Classification of Disease 10th revision code with IBD-specific medications had the best performance characteristics among the 12 tested definitions. During the 8-year study period, IBD prevalence increased from 25 345 in 2009 to 47 444 in 2016. Over that period, the prevalence of Crohn's disease increased 1.9-fold (from 16.0/100 000 in 2009 to 29.6/100 000 in 2016) and that of ulcerative colitis increased 1.6-fold (from 41.4/100 000 in 2009 to 66.0/100 000 in 2016). Similarly, the estimated incidence of Crohn's disease also increased 1.2-fold (from 2.4 to 2.9 per 100 000) and that of ulcerative colitis rose 1.3-fold (from 4.0 to 5.3 per 100 000). During the study period, the predominant increase in IBD incidence was among younger individuals, especially those aged < 30 years. CONCLUSION: Patients with IBD can be accurately identified using Korean insurance claims data by combining information regarding the International Classification of Disease 10th revision codes and the IBD medications used. The prevalence of IBD continues to increase, with an apparent shift toward younger (< 30 years) age groups.

Associations Between Magnetic Resonance Imaging Findings and Clincopathologic Factors in Triple-Negative Breast Cancer.

OBJECTIVE: The aim of the study was to evaluate the magnetic resonance imaging findings associated with clinicopathologic factors in patients with triple-negative breast cancer. METHODS: One hundred one patients with surgically confirmed triple-negative breast cancer who underwent preoperative breast magnetic resonance imaging with diffusion-weighted imaging (DWI) were included in this study. Presence of rim enhancement on contrast-enhanced T1-weighted imaging and hyperintense rim on DWI were visually assessed. Pathologic data about presence of recurrence and presence of lymphovascular invasion (LVI) were reviewed. Statistics for relative risk of recurrence carried out. RESULTS: Of the 101, 13 cases (12.9%) were recurred after a median follow-up of 18.5 months. Rim enhancement was more frequently seen in the LVI-positive group (P = 0.046). Hyperintense rim on DWI and apparent diffusion coefficient values showed no significant relationship with clinical-pathologic factors. CONCLUSIONS: Rim enhancement was significantly associated with positive LVI status in patients with triple-negative breast cancer. Our study suggests that rim enhancement may be useful to predict the prognosis.