Artificial Intelligence for Breast Cancer Screening in Mammography (AI-STREAM): A Prospective Multicenter Study Design in Korea Using AI-Based CADe/x / 한국유방암학회지

Purpose@#Artificial intelligence (AI)-based computer-aided detection/diagnosis (CADe/x) has helped improve radiologists’ performance and provides results equivalent or superior to those of radiologists’ alone. This prospective multicenter cohort study aims to generate real-world evidence on the overall benefits and disadvantages of using AI-based CADe/x for breast cancer detection in a population-based breast cancer screening program comprising Korean women aged ≥ 40 years. The purpose of this report is to compare the diagnostic accuracy of radiologists with and without the use of AI-based CADe/x in mammography readings for breast cancer screening of Korean women with average breast cancer risk. @*Methods@#Approximately 32,714 participants will be enrolled between February 2021 and December 2022 at 5 study sites in Korea. A radiologist specializing in breast imaging will interpret the mammography readings with or without the use of AI-based CADe/x. If recall is required, further diagnostic workup will be conducted to confirm the cancer detected on screening. The findings will be recorded for all participants regardless of their screening status to identify study participants with breast cancer diagnosis within both 1 year and 2 years of screening. The national cancer registry database will be reviewed in 2026 and 2027, and the results of this study are expected to be published in 2027. In addition, the diagnostic accuracy of general radiologists and radiologists specializing in breast imaging from another hospital with or without the use of AI-based CADe/x will be compared considering mammography readings for breast cancer screening.DiscussionThe Artificial Intelligence for Breast Cancer Screening in Mammography (AI-STREAM) study is a prospective multicenter study that aims to compare the diagnostic accuracy of radiologists with and without the use of AI-based CADe/x in mammography readings for breast cancer screening of women with average breast cancer risk. AI-STREAM is currently in the patient enrollment phase.Trial RegistrationClinicalTrials.gov Identifier: NCT05024591

Identification of Preoperative Magnetic Resonance Imaging Features Associated with Positive Resection Margins in Breast Cancer: A Retrospective Study

OBJECTIVE: To determine which preoperative breast magnetic resonance imaging (MRI) findings and clinicopathologic features are associated with positive resection margins at the time of breast-conserving surgery (BCS) in patients with breast cancer. MATERIALS AND METHODS: We reviewed preoperative breast MRI and clinicopathologic features of 120 patients (mean age, 53.3 years; age range, 27–79 years) with breast cancer who had undergone BCS in 2015. Tumor size on MRI, multifocality, patterns of enhancing lesions (mass without non-mass enhancement [NME] vs. NME with or without mass), mass characteristics (shape, margin, internal enhancement characteristics), NME (distribution, internal enhancement patterns), and breast parenchymal enhancement (BPE; weak, strong) were analyzed. We also evaluated age, tumor size, histology, lymphovascular invasion, T stage, N stage, and hormonal receptors. Univariate and multivariate logistic regression analyses were used to determine the correlation between clinicopathological features, MRI findings, and positive resection margins. RESULTS: In univariate analysis, tumor size on MRI, multifocality, NME with or without mass, and segmental distribution of NME were correlated with positive resection margins. Among the clinicopathological factors, tumor size of the invasive breast cancer and in situ components were significantly correlated with a positive resection margin. Multivariate analysis revealed that NME with or without mass was an independent predictor of positive resection margins (odds ratio [OR] = 7.00; p < 0.001). Strong BPE was a weak predictor of positive resection margins (OR = 2.59; p = 0.076). CONCLUSION: Non-mass enhancement with or without mass is significantly associated with a positive resection margin in patients with breast cancer. In patients with NME, segmental distribution was significantly correlated with positive resection margins.

Practice guideline for the performance of breast ultrasound elastography

Ultrasound (US) elastography is a valuable imaging technique for tissue characterization. Two main types of elastography, strain and shear-wave, are commonly used to image breast tissue. The use of elastography is expected to increase, particularly with the increased use of US for breast screening. Recently, the US elastographic features of breast masses have been incorporated into the 2nd edition of the Breast Imaging Reporting and Data System (BI-RADS) US lexicon as associated findings. This review suggests practical guidelines for breast US elastography in consensus with the Korean Breast Elastography Study Group, which was formed in August 2013 to perform a multicenter prospective study on the use of elastography for US breast screening. This article is focused on the role of elastography in combination with B-mode US for the evaluation of breast masses. Practical tips for adequate data acquisition and the interpretation of elastography results are also presented.

Diffuse Intense 18F-FDG Uptake at PET in Unilateral Breast Related to Breastfeeding Practice

We present an interesting case of incidental diffuse fluorodeoxyglucose (FDG) uptake at PET in her left breast, related to atypical breastfeeding practice. Clinically, differential diagnoses of diffuse intense FDG uptake in unilateral breast include advanced breast cancer, breast lymphoma and inflammatory condition. However, normal physiologic lactation may also show increased FDG uptake in the breasts. Therefore, if we encounter that finding in daily practice, we should question the patient regarding unilateral breastfeeding. In addition, mammography and ultrasound would be helpful to confirm the diagnosis.

Clinical Image Evaluation of Film Mammograms in Korea: Comparison with the ACR Standard

OBJECTIVE: The goal of this study is to compare the overall quality of film mammograms taken according to the Korean standards with the American College of Radiology (ACR) standard for clinical image evaluation and to identify means of improving mammography quality in Korea. MATERIALS AND METHODS: Four hundred and sixty eight sets of film mammograms were evaluated with respect to the Korean and ACR standards for clinical image evaluation. The pass and failure rates of mammograms were compared by medical facility types. Average scores in each category of the two standards were evaluated. Receiver operating characteristic curve analysis was used to identify an optimal Korean standard pass mark by taking the ACR standard as the reference standard. RESULTS: 93.6% (438/468) of mammograms passed the Korean standard, whereas only 80.1% (375/468) passed the ACR standard (p < 0.001). Non-radiologic private clinics had the lowest pass rate (88.1%: Korean standard, 71.8%: ACR standard) and the lowest total score (76.0) by the Korean standard. Average scores of positioning were lowest (19.3/29 by the Korean standard and 3.7/5 by the ACR standard). A cutoff score of 77.0 for the Korean standard was found to correspond to a pass level when the ACR standard was applied. CONCLUSION: We suggest that tighter regulations, such as, raising the Korean pass mark, subtracting more for severe deficiencies, or considering a very low scores in even a single category as failure, are needed to improve the quality of mammography in Korea.

Pleomorphic Adenoma of the Breast: A Diagnosis Using an Ultrasound-Guided Core-Needle Biopsy Case Report

Pleomorphic adenoma is a tumor rarely seen in the breast. To date, only about 70 cases have been reported in the literature. Many reports have used fine-needle aspiration biopsy in the preoperative diagnosis of these lesions. However, pleomorphic adenoma is sometimes mistaken for a malignant tumor because of its cytologic features. In this study, we present a 56-year-old woman with a palpable breast mass. Ultrasound indicated a 15 mm oval-shaped hypoechoic mass with complex echogenicity in the palpable region. Ultrasound-guided core needle biopsy (US-CNB) revealed a pleomorphic adenoma of the breast, which was confirmed through surgical excision. Although pleomorphic adenoma is rarely seen in the breast, results demonstrate the usefulness and accuracy of US-CNB in diagnosing pleomorphic adenoma of the breast.

Phyllodes Tumors and Fibroepithelial Lesions with Cellular Stroma of the Breast and Diagnosed by Sonographically Guided Core Needle Biopsy: A Comparison Between the Results of Excision Biopsy and the Sonographic Findings

PURPOSE: The purpose of this study was to analyze the histologic concordance of sonographically guided core needle biopsy for phyllodes tumors or fibroepithelial lesions with cellular stroma of the breast by comparing this with the outcomes of excision biopsy and to identify any sonographic features that are helpful to predict phyllodes tumors. MATERIALS AND METHODS: We retrospectively reviewed 60 breast masses that were diagnosed as phyllodes tumors (n = 43) or fibroepithelial lesions with cellular stroma (n = 17) on a sonographically guided core needle biopsy. The tumors were all subsequently excised by surgery. The sonographic features were compared between the phyllodes tumors and the non-phyllodes tumors according to the results of excision biopsy. RESULTS: By the results on excision biopsy, there were 48 (80%) phyllodes tumors and 12 (20%) non-phyllodes tumors. Phyllodes tumors were diagnosed at a rate of 90.7% (39/43) for the nodules with phyllodes tumors on the sonographically guided core needle biopsy, and at a rate of 52.9% (9/17) for the nodules with fibroepithelial lesions with cellular stroma on the sonographically guided core needle biopsy. On sonography, heterogeneous internal echotexture (58% vs. 17%, respectively, p = 0.0239), clefts (56% vs. 17%, respectively, p = 0.0331) and horizontal linear striations (71% vs. 33%, respectively, p = 0.0221) were significantly more frequent in the phyllodes tumors than that in the non-phyllodes tumors. CONCLUSION: Identification of a heterogeneous-internal echotexture, clefts and horizontal linear striations on sonography might help differentiate phyllodes tumors from non-phyllodes tumors.

Concordant or Discordant? Imaging-Pathology Correlation in a Sonography-Guided Core Needle Biopsy of a Breast Lesion

An imaging-guided core needle biopsy has been proven to be reliable and accurate for the diagnosis of both benign and malignant diseases of the breast, and has replaced surgical biopsy. However, the possibility of a false-negative biopsy still remains. Imaging-pathology correlation is of critical importance in imaging-guided breast biopsies to detect such a possible sampling error and avoid a delay in diagnosis. We will review five possible categories and corresponding management after performing an imaging-pathology correlation in a sonography-guided core needle biopsy of a breast lesion, as well as illustrate the selected images for each category in conjunction with the pathologic finding. Radiologists should be familiar with the imaging features of various breast pathologies and be able to appropriately correlate imaging findings with pathologic results after a core needle biopsy.

The Effects of an Obesity Control Program for Children in Pediatric and Adolescent Psychiatric Hospital / 정신간호학회지

PURPOSE: This research was conducted to compare the effects of an obesity control program on knowledge of obesity, diet habit, exercise habits, and weight loss of children in a pediatric and adolescent psychiatric hospital. METHODS: A non-equivalent control group non-synchronized design was used for this study. Eighteen patients were participated in the experimental group and seventeen were participated in the control group. For 8 weeks, the experimental group received the interventions for fifty minutes weekly, which were consisted of knowledge of obesity, diet habit, and exercise habits and weight loss, while the control group received the usual care during the same period. The outcome variables were measured before and after the program. Data were analyzed using t-test with SPSS/WIN 18.0. RESULTS: The experimental group showed more significant improvement in knowledge of obesity, diet and exercise habits than the control group, but weight loss was not different between the groups. CONCLUSION: To be more effective obesity control program, nurses should collaborate with other staffs including doctors and social workers, and consistently educate the families of the patients.

Mammary Fibromatosis: Sonographic Features and Pathologic Correlations

PURPOSE: The purpose of this study was to determine if the sonographic features of mammary fibromatosis had correlation with the pathologic findings. MATERIALS AND METHODS: We identified four cases of fibromatosis of the breast at our institution over a 10-year period. The patients were all women, and they ranged from 25 to 48 years of age (mean, 34.3 years). All four patients complained of palpable breast masses and were subsequently diagnosed with mammary fibromatosis. We retrospectively reviewed their imaging findings. RESULTS: Mammography obtained in one patient revealed architectural distortion. On sonography, all four cases showed spiculated, irregular, hypoechoic masses that could not be differentiated from malignant lesions. After surgical excision and vacuum-assisted biopsy of the masses in four patients, there was no recurrence on clinical or sonographic follow-up over a 13-36 month period. CONCLUSION: Although mammary fibromatosis is a very rare condition, it should be included in the differential diagnosis when an un-calcified, spiculated, irregular and hypoechoic masses are encountered on breast sonography.

The Effect of a Wellness Program on Nutritional and Diet Knowledge, Exercise and Weight Control Knowledge, and Weight Control of Schizophrenia / 정신간호학회지

PURPOSE: This research was conducted to compare the effect of a wellness program on nutrition and diet knowledge, exercise and weight control knowledge, and weight control of schizophrenia patients. METHODS: A nonequivalent control group pretest-posttest design was used for this study. A total of 34 patients were randomly divided into the experimental group (17) and the control group (17). The experimental group received about 1 hour of a nutrition and diet knowledge intervention for 6 weeks and about 1 hour of an exercise and weight control knowledge intervention for another 6 weeks, while the control group received the usual care. The outcome variables were measured before and after the program. Data were analyzed by t-test using SPSS/WIN 14.0. RESULTS: The experimental group showed significant improvement in nutrition and diet knowledge, exercise and weight control knowledge, and reduction in body weight. CONCLUSION: The wellness program was effective on increasing nutrition and diet knowledge, exercise and weight control knowledge, and decreasing body weight of schizophrenia patients.

The Effect of a Wellness Program on Nutritional and Diet Knowledge, Exercise and Weight Control Knowledge, and Weight Control of Schizophrenia / 정신간호학회지

PURPOSE: This research was conducted to compare the effect of a wellness program on nutrition and diet knowledge, exercise and weight control knowledge, and weight control of schizophrenia patients. METHODS: A nonequivalent control group pretest-posttest design was used for this study. A total of 34 patients were randomly divided into the experimental group (17) and the control group (17). The experimental group received about 1 hour of a nutrition and diet knowledge intervention for 6 weeks and about 1 hour of an exercise and weight control knowledge intervention for another 6 weeks, while the control group received the usual care. The outcome variables were measured before and after the program. Data were analyzed by t-test using SPSS/WIN 14.0. RESULTS: The experimental group showed significant improvement in nutrition and diet knowledge, exercise and weight control knowledge, and reduction in body weight. CONCLUSION: The wellness program was effective on increasing nutrition and diet knowledge, exercise and weight control knowledge, and decreasing body weight of schizophrenia patients.

Secretory Carcinoma of the Breast: A Case Report

A secretory carcinoma of the breast is a rare, but clinically and histologically a distinct variant of the invasive ductal carcinoma, which has a slow growth pattern and a favorable prognosis. Few studies have reported the radiologic findings involved in a secretory carcinoma of the breast. We report the imaging findings of a secretory carcinoma of the breast in a 48-year-old woman, which were similar to those of a benign mass found on a mammography and sonography.

A Case Report of Intraductal Papilloma in a Young Female Patient with Bloody Nipple Discharge

Intraductal papillomas are the most common subtype of papillomas, which are benign neoplasms of the breast. An intraductal papilloma is usually found as a solitary mass which originates in the major duct of the breast. Intraductal papilloma cases are frequently presented as nipple discharge and most commonly occur in individuals between the ages of 30 and 55 years. Few reports exist regarding cases of intraductal papillomas in children. We report a case of an intraductal papilloma, with imaging findings, which occurred in the breast of an 11-year old girl and presented as bloody nipple discharge.

The Safety and Efficiency of the Ultrasound-guided Large Needle Core Biopsy of Axilla Lymph Nodes

PURPOSE: To evaluate the safety and efficiency of the Ultrasound (US)-guided large needle core biopsy of axilla lymph nodes. MATERIALS AND METHODS: From March 2004 to September 2005, 31 patients underwent the US-guided core biopsy for axilla lymph nodes. Twenty five lesions out of 31 were detected during breast US, and 6 of 31 cases were palpable. Lymph nodes were classified based on their shape and cortical morphology. The core biopsy of axilla lymph nodes was performed on suspicious lymph nodes found during breast ultrasonography to find out whether the patients had a history of breast cancer or not. Among the 31 patients, 16 patients were associated with breast cancer. The lesion sizes varied from 0.6cm to 3.3cm (mean = 1.59 +/- 0.76cm). US-guided core biopsies were performed with 14G needles with an automated biopsy gun. Total 3 or 5 specimens were obtained. RESULTS: Among the 31 cases of axilla lymph nodes core biopsies, 11 cases showed malignant pathology. Seven out of 11 cases were metastatic lymph nodes from breast cancer; 2 cases were from primary unknown and 2 cases from lymphomas. On the other hand, 20 histopathologic results of axilla lesions were benign: subacute necrotizing lymphadenitis (n=2), dermatopathic lymphadenitis (n=1), reactive hyperplasia (n=10) and free of carcinoma (n=7). CONCLUSION: The US-guided large needle core biopsy of axilla lesions is safe and effective for the pathological evaluation. The core biopsy is believed to be easy to perform if suspicious lymph nodes or mass lesions are found in the axilla.

Invasive Papillary Carcinoma of the Breast Presenting as Post-Traumatic Recurrent Hemorrhagic Cysts

We report the sonographic features of an intracystic papillary carcinoma of the breast presenting as recurrent hemorrhagic cysts following trauma. A 56-year-old woman presented with palpable breast masses after a traumatic event; sonography showed multiple, well-defined, hemorrhagic cysts. Hemorrhagic fluid was evacuated by fine needle aspiration with no residual lesions. Cytology was negative for malignancy. Five months later, the mass reappeared; sonography demonstrated multiple cysts with solid nodules. US-guided core biopsy and surgery revealed invasive papillary carcinoma. We suggest close follow-up of cystic masses, even with negative cytology, and performance of surgical excisional biopsy in cases of rapid refilling after aspiration.

Analysis of 193 Mammographic Phantom Images

PURPOSE: To evaluate the actual state of quality control in Korea through an analysis of mammographic phantom images obtained from a multicenter, and to determine the proper exposure conditions required in order to obtain satisfactory phantom images. MATERIALS AND METHODS: Between April and June, 2002, 193 phantom images were referred to the Korea Food and Drug Administration for evaluation. Two radiologists recorded the number of fibers, specks and masses they contained, and the "pass" criteria were as follows: checked number of fibers: four or more; specks, three or more; masses, three or more (a total of ten or more features). Images in which optical density was over 1.2 were classified as satisfactory. In addition, changes in the success ratio, and difference between the two groups (i.e. "pass" and "fail", with regard to exposure conditions and optical density) were evaluated. RESULTS: Among the 193 images, 116 (60.1%) passed and 77 (39.9%) failed. Among those which passed, 73 /100 (73%) involved the use of a grid, 80/117 (68.3%) were obtained within the optimal kVp range, 50/111 (45.0%) involved the use of optimal mAs, and 79/112 (70.5%) were obtained within the optimal range of optical density. Among those which failed, the corresponding figures were 17/52 (32.6%), 33/66 (50.0%), 31/69 (44.9%), and 35/65 (53.8%). There were statistically significant differences between the pass and fail rates, and with regard to kVp, optical density, and the use of a grid, but with regard to mAs, statistical differences were not significant. If only phantom images with an optical density of over 1.2 [as per the rule of the Mammographic Quality Standard Act (MQSA)] was included, the success rate would fall from 60.1% to 43.0%. CONCLUSION: The pass rate for mammographic phantom images was 60.1%. If such images are to be satisfactory, they should be obtained within the optimal range of optical density, using optimal kVp and a grid.

Endoluminal Placement of Stent-Graft for the Treatment of Peripheral Saccular Aneurysm

PURPOSE: To determine the therapeutic effect of stent grafting in the treatment of saccular aneurysms of the peripheral artery. MATERIALS AND METHODS: Eight patients [M:F=7:1 ; age:22-72(mean, 47) years] with ten saccular aneurysms of the peripheral artery who underwent stent grafting were included in this study. The etiologies of the aneurysms were Behcet's disease in four patients, atherosclerosis in two, trauma in one and 'uncertain' in one; they were located at the common iliac artery in three cases, the renal artery in two, the subclavian artery in two, the anterior tibial artery in one, and at both the proximal and distal anastomotic sites of the common carotid-internal carotid bypass graft. In two cases, stent grafting and coils were used to embolize collateral vessels. Post-procedural evaluations involved the use of computed tomography, Doppler sonography and magnetic resonance imaging. The mean follow-up period was 14.7(range, 4-36) monthes. RESULTS: The saccular aneurysms were successfully excluded in all cases. Post-procedural angiography revealed minor leakage in two cases, but at follow-up these showed complete exclusion. Follow-up evaluation also revealed complete resolution in five cases and complete thrombosis accompanied by size reduction in three. In patients with aneurysms of the proximal and distal ends of a common carotid-internal carotid bypass graft, total occlusion occurred in the stent graft. CONCLUSION: Percutaneous stent-graft insertion is an effective and convenient method for the treatment of peripheral arterial aneurysms, and is an alternative to vascular surgery.

Percutaneous implantation of intra-arterial port system for regional drug infusion: Results and complications in 110 cases

PURPOSE: To investigate the feasibility and complications of a percutaneously implantable port system for regional drug infusion. MATERIALS AND METHODS: For intra-arterial drug infusion, a 5.8 or 5-F pediatric venous port system was implanted in 110 patients with hepatocelluar carcinoma (n = 79), liver metastasis (n = 16), gallbladder cancer (n = 4), stomach cancer (n = 3), pancreatic cancer (n = 3), Burger's disease (n = 2), diabetes mellitus (n = 2), or lymphoma (n = 1). All intra-arterial port implantations were performed percutaneously in an angiographic ward through the common femoral artery (n = 98), left subclavian artery (n = 10), or left superficial femoral artery (n = 2). Complications were evaluated during the follow-up period, which ranged from 21 to 530 (mean, 163) RESULTS: The technical success rate for percutaneous implantation of the system was 97.3% (107 of 110 patients). The tips of the port catheter were located in the common hepatic artery (n = 34), proper hepatic artery (n = 49), right hepatic artery (n = 8), left hepatic artery (n = 1), descending aorta at T9 level (n = 10), left popliteal artery (n = 2), right external iliac artery (n = 1), left external iliac artery (n = 1), or left deep femoral artery (n = 1). Complications were encountered in 24 patients(22.4%), namely chamber site infection (n = 7), catheter dislodgement (n = 7), catheter occlusion (n = 3), migration of coil (n = 2), disconnection between chamber and catheter (n = 1), kinking of catheter (n = 1), arterial occlusion (n = 1), necrosis of overlying skin (n = 1), and leakage around port chamber (n = 1). Outcomes of complications included removal of port systems or cessation of therapy in 12 cases (11.2%), correction of catheter location using a guide wire in five (4.7%), thrombolysis with urokinase in three (2.8%), and straightening using a snare in one (0.9%). In three patients, the port system was used without reintervention. CONCLUSION: Percutaneous implantation of an intra-arterial port system showed a high technical success rate and a low rate of serious complications. The method may be useful for regional drug infusion in various

An Autopsy Case of Double Aortic Arch

Double aortic arch is the most common type of symptomatic vascular ring. In most patients, the symptoms are manifested at birth or in early infancy. Double aortic arch usually has more severe symptoms than other types of complete vascular rings. We experienced one case of complete duplicated double aortic arch with left descending aorta and left patent ductus arteriosus. A one-day-old female neonate was transferred to our hospital because of mild dyspnea and stridor. She showed intractable CO2 retention and respiratory difficulty with time in spite of ventilator therapy. She died of respiratory failure 23 hours after birth. On autopsy, we found that the diameter of the vascular ring was 0.7cm in maximum extent. It was ovoid and contained trachea and esophagus. The trachea was flattened due to allowing 0.1x0.2cm. The compression level of the trachea was approximately 1cm from the tracheal bifurcation.