Interstitial lung abnormalities (ILA) on routine chest CT: Comparison of radiologists' visual evaluation and automated quantification.

PURPOSE: We aimed to evaluate the performance of a fully automated quantitative software in detecting interstitial lung abnormalities (ILA) according to the Fleischner Society guidelines on routine chest CT compared with radiologists' visual analysis. METHOD: This retrospective single-centre study included participants with ILA findings and 1:2 matched controls who underwent routine chest CT using various CT protocols for health screening. Two thoracic radiologists independently reviewed the CT images using the Fleischner Society guidelines. We developed a fully automated quantitative tool for detecting ILA by modifying deep learning-based quantification of interstitial lung disease and evaluated its performance using the radiologists' consensus for ILA as a reference standard. RESULTS: A total of 336 participants (mean age, 70.5 ± 6.1 years; M:F = 282:54) were included. Inter-reader agreements were substantial for the presence of ILA (weighted κ, 0.74) and fair for its subtypes (weighted κ, 0.38). The quantification system for identifying ILA using a threshold of 5 % in at least one zone showed 67.6 % sensitivity, 93.3 % specificity, and 90.5 % accuracy. Eight of 20 (40 %) false positives identified by the system were underestimated by readers for ILA extent. Contrast-enhancement in a certain vendor and suboptimal inspiration caused a true false-positive on the system (all P < 0.05). The best cut-off value of abnormality extent detecting ILA on the system was 3.6 % (sensitivity, 84.8 %; specificity 92.4 %). CONCLUSIONS: Inter-reader agreement was substantial for ILA but only fair for its subtypes. Applying an automated quantification system in routine clinical practice may aid the objective identification of ILA.

Prevalence of asymptomatic bronchiectasis and associations among the health screening population in South Korea.

Despite the burden of bronchiectasis, there is little data from South Korea regarding asymptomatic bronchiectasis. We aimed to investigate the prevalence of bronchiectasis based on computed tomography (CT) findings, with emphasis on asymptomatic bronchiectasis (CT-proven) and its related factors. We analysed data of individuals who underwent chest CT at a South Korean health screening centre from 2016 to 2017. The prevalence of bronchiectasis was evaluated and adjusted by sex, age, and corresponding year for the Korean general population. Logistic regression analysis was performed to identify factors related to asymptomatic bronchiectasis by comparison between a group without bronchiectasis and a group with symptomatic bronchiectasis. Among the 27 617 subjects screened, 1005 were diagnosed with bronchiectasis based on CT findings, representing an adjusted prevalence of 2329 out of 100 000. The adjusted prevalence of asymptomatic bronchiectasis was 1235 out of 100 000, and that of symptomatic bronchiectasis was 1094 out of 100 000. Compared with the non-bronchiectasis group, the factors related to asymptomatic bronchiectasis were female sex (OR 1.41; 95% CI 1.18-1.70), older age (OR 1.06; 95% CI 1.05-1.07), comorbid liver disease (OR 1.32; 95% CI 1.07-1.63) or COPD (OR 4.99; 95% CI 2.88-8.64), history of tuberculosis (OR 1.98; 95% CI 1.46-2.68) and low forced expiratory volume in 1 s (FEV1; OR 0.99; 95% CI 0.98-0.998). In South Korea, the prevalence of asymptomatic bronchiectasis appeared higher than that of symptomatic bronchiectasis. Female sex, older age, liver disease, COPD, history of tuberculosis and low FEV1 may be the factors related to asymptomatic bronchiectasis.

Potential of MALDI-TOF-based serum N-glycan analysis for the diagnosis and surveillance of breast cancer.

Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS)-based serum N-glycan analysis has gained acknowledgment for the diagnosis of breast cancer in recent years. In this study, the possibilities of expanding its application for breast cancer management and surveillance were discovered and evaluated. First, a novel MALDI-TOF platform, IDsys RT, was confirmed to be effective for breast cancer analysis, showing a maximum area under the curve of 0.91. Multiple N-glycan markers were identified and validated using this process, and they were found to be applicable for differentiating recurring breast cancer samples from healthy control or ordinary breast cancer samples. Recurrence samples were especially distinct from non-recurrence samples when N-glycan signatures were sampled in multiple time points and monitored via MALDI-TOF, throughout the therapy. These results suggested the feasibility of MALDI-TOF-based N-glycan analysis for tracking the molecular signatures of breast cancer and predicting recurrence.

Breast cancer diagnosis by analysis of serum N-glycans using MALDI-TOF mass spectroscopy.

Blood and serum N-glycans can be used as markers for cancer diagnosis, as alterations in protein glycosylation are associated with cancer pathogenesis and progression. We aimed to develop a platform for breast cancer (BrC) diagnosis based on serum N-glycan profiles using MALDI-TOF mass spectroscopy. Serum N-glycans from BrC patients and healthy volunteers were evaluated using NosQuest's software "NosIDsys." BrC-associated "NosID" N-glycan biomarkers were selected based on abundance and NosIDsys analysis, and their diagnostic potential was determined using NosIDsys and receiver operating characteristic curves. Results showed an efficient pattern recognition of invasive ductal carcinoma patients, with very high diagnostic performance [area under the curve (AUC): 0.93 and 95% confidence interval (CI): 0.917-0.947]. We achieved effective stage-specific differentiation of BrC patients from healthy controls with 82.3% specificity, 84.1% sensitivity, and 82.8% accuracy for stage 1 BrC and recognized hormone receptor-2 and lymph node invasion subtypes based on N-glycan profiles. Our novel technique supplements conventional diagnostic strategies for BrC detection and can be developed as an independent platform for BrC screening.

Computer-aided detection system for masses in automated whole breast ultrasonography: development and evaluation of the effectiveness.

PURPOSE: The aim of this study was to evaluate the performance of a proposed computer-aided detection (CAD) system in automated breast ultrasonography (ABUS). METHODS: Eighty-nine two-dimensional images (20 cysts, 42 benign lesions, and 27 malignant lesions) were obtained from 47 patients who underwent ABUS (ACUSON S2000). After boundary detection and removal, we detected mass candidates by using the proposed adjusted Otsu's threshold; the threshold was adaptive to the variations of pixel intensities in an image. Then, the detected candidates were segmented. Features of the segmented objects were extracted and used for training/testing in the classification. In our study, a support vector machine classifier was adopted. Eighteen features were used to determine whether the candidates were true lesions or not. A five-fold cross validation was repeated 20 times for the performance evaluation. The sensitivity and the false positive rate per image were calculated, and the classification accuracy was evaluated for each feature. RESULTS: In the classification step, the sensitivity of the proposed CAD system was 82.67% (SD, 0.02%). The false positive rate was 0.26 per image. In the detection/segmentation step, the sensitivities for benign and malignant mass detection were 90.47% (38/42) and 92.59% (25/27), respectively. In the five-fold cross-validation, the standard deviation of pixel intensities for the mass candidates was the most frequently selected feature, followed by the vertical position of the centroids. In the univariate analysis, each feature had 50% or higher accuracy. CONCLUSION: The proposed CAD system can be used for lesion detection in ABUS and may be useful in improving the screening efficiency.

Dose reduction in automatic optimization parameter of full field digital mammography: breast phantom study.

PURPOSE: We evaluated the impact of three automatic optimization of parameters (AOP) modes of digital mammography on the dose and image quality. METHODS: Computerized Imaging Reference Systems phantoms were used. A total of 12 phantoms with different thickness and glandularity were imaged. We analyzed the average glandular dose (AGD) and entrance surface exposure (ESE) of 12 phantoms imaged by digital mammography in three modes of AOP; namely standard mode (STD), contrast mode (CNT), and dose mode (DOSE). Moreover, exposure factors including kVp, mAs, and target/filter combination were evaluated. To evaluate the quality of the obtained digital image, two radiologists independently counted the objects of the phantoms. RESULTS: According to the AOP modes, the score of masses and specks was sorted as CNT>STD=DOSE. There was no difference in the score of fiber among the three modes. The score of image preference was sorted as CNT>STD>DOSE. The AGD, ESE, and mAs were sorted as CNT>STD>DOSE. The kVp was sorted as CNT=STD>DOSE. The score of all test objects in the phantom image was on a downtrend with increasing breast thickness. The score of masses was different among the three groups; 20-21%>30%>50% glandularity. The score of specks was sorted as 20-21%=30%>50% glandularity. The score of fibers was sorted as 30%>20-21%=50% glandularity. The score of image preference was not different among the three glandularity groups. The AGD, ESE, kVp, and mAs were correlated with breast thickness, but not correlated with glandularity. CONCLUSION: The DOSE mode offers significant improvement (19.1-50%) in dose over the other two modes over a range of breast thickness and breast glandularity with acceptable image quality. Owning knowledge of the three AOP modes may reduce unnecessary radiation exposure by utilizing the proper mode according to its purpose.

Preoperative US-guided hookwire localization for nonpalpable cervical masses.

PURPOSE: We investigated whether the preoperative ultrasound (US)-guided hookwire localization for nonpalpable cervical masses allows surgeons to find these masses more easily and more confidently. METHODS: Eight patients underwent preoperative US-guided hookwire insertion for nonpalpable cervical masses at our institution between January 2008 and January 2011. Cervical masses were detected by US or CT, and seven of the eight patients underwent US-guided fine-needle aspiration. Before surgery, a radiologist inserted a hookwire into the cervical mass, under US guidance. RESULTS: US-guided hookwire insertion took about 5-10 minutes and was successful in all cases without complications. Final pathologic results were metastatic papillary thyroid cancer (n = 4), no metastasis (n = 1), parathyroid adenoma (n = 1), tuberculosis (n = 1), and Kikuchi's disease (n = 1). CONCLUSIONS: Preoperative US-guided hookwire insertion in nonpalpable cervical lesions provides surgeons with an effective means of lesion location.

Supplemental use of optical diffusion breast imaging for differentiation between benign and malignant breast lesions.

OBJECTIVE: The objective of our study was to prospectively evaluate the diagnostic accuracy of optical diffusion breast imaging in patients who underwent conventional ultrasound followed by surgery or biopsy. SUBJECTS AND METHODS: We performed optical diffusion breast imaging after conventional ultrasound of 193 patients (mean age, 47 years) with 217 lesions. All patients underwent ultrasound-guided core needle biopsy or surgery. One of six radiologists reviewed conventional ultrasound features, assessed a BI-RADS category, and reviewed optical diffusion imaging results for each lesion. Surgery and biopsy results were used as reference standards. We compared the diagnostic accuracy including the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of conventional ultrasound alone and of conventional ultrasound followed by optical diffusion imaging. In addition, we prospectively investigated if total hemoglobin level or oxygen saturation level is the most reliable indicator in optical diffusion imaging. RESULTS: Of the 217 breast lesions, 108 were malignant and 109 were benign. For differentiation of malignant from benign lesions, conventional ultrasound was associated with a sensitivity of 100%, specificity of 27.5%, PPV of 57.8%, NPV of 100%, and accuracy of 63.6%. The supplemental use of optical diffusion imaging after conventional ultrasound was associated with a sensitivity of 98.1%, specificity of 41.3%, PPV of 62.4%, NPV of 95.7%, and accuracy of 69.7%. The area under the receiver operating characteristic curve was 0.738 for total hemoglobin level and 0.502 for oxygen saturation level. The cutoff value was 0.195 mmol/L for total hemoglobin, with 68.4% sensitivity and 69.7% specificity. CONCLUSION: Optical diffusion imaging might be a good supplemental tool to increase the diagnostic accuracy of conventional ultrasound in differentiating malignant from benign breast lesions.

BI-RADS descriptors for mammographically detected microcalcifications verified by histopathology after needle-localized open breast biopsy.

OBJECTIVE: The objective of our study was to retrospectively determine the positive predictive value of each descriptor and of combined descriptors for microcalcifications to predict the risk of malignancy as well as the appropriate final assessment category. MATERIALS AND METHODS: A total of 308 needle-localized open breast biopsies for mammographically detected microcalcifications were performed in 295 women (age range, 33-71 years; mean age, 52 years) during 7 years. Thirteen patients had bilateral microcalcifications that were studied separately. Two breast radiologists retrospectively reviewed the microcalcifications with regard to their morphology, distribution, and extent and to associated findings and final assessment category, after which they categorized them into nine combined descriptors. Surgical pathology served as the reference standard for malignant lesions and follow-up of at least 12 months served as the reference for benign lesions. The Fisher's exact test, including odds ratios, was used for statistical analysis. RESULTS: Of the 308 needle-localized open breast biopsies, 144 (47%) were malignant and 164 (53%) were benign. For combined descriptors of morphology and distribution, the odds ratios of malignancy regarding the higher probability of malignancy and ductal distribution were as follows: 0 for typically benign morphology or scattered distribution, 93.00 for intermediate concern and regional, 33.53 for intermediate concern and clustered, 5.00 for intermediate concern and ductal, 24.00 for higher probability of malignancy and regional, and 1.13 for higher probability of malignancy and clustered. CONCLUSION: Each descriptor and combined descriptors for microcalcifications and the final assessment category could help to predict the risk of malignancy.

A rare case of recurrent myoid hamartoma mimicking malignancy: imaging appearances.

Myoid hamartoma is an uncommon type of breast hamartoma and its recurrence is very rare. We report the imaging appearance of an unusual case of recurrent myoid hamartoma of the breast mimicking malignancy in a 43-year-old woman. Although the mammographic and ultrasonographic findings have long been described in the literature, MR finding with a dynamic study has not, to the best of our knowledge, been reported previously.

Normal and abnormal sonographic findings at the thyroidectomy sites in postoperative patients with thyroid malignancy.

OBJECTIVE: We describe typical sonography characteristics of locally recurrent tumors after thyroidectomy for thyroid cancer and the benign conditions mimicking tumor recurrence, with an emphasis on the differential diagnosis. CONCLUSION: Ultrasound is an effective imaging technique not only for the detection of locally recurrent tumors but also for the differential diagnosis of locally recurrent tumors and other abnormalities mimicking tumor recurrence.

Ultrasound features of suture granulomas in the thyroid bed after thyroidectomy for papillary thyroid carcinoma with an emphasis on their differentiation from locally recurrent thyroid carcinomas.

The purpose of our study was to evaluate the ultrasound features of suture granulomas at the thyroid bed after thyroidectomy for papillary thyroid carcinoma with an emphasis on their differentiation from locally recurrent thyroid carcinomas. We enrolled 14 suture granulomas in 10 patients and 20 locally recurrent carcinomas in 18 patients after thyroidectomy, confirmed by surgery (15 out of 20 recurrent carcinomas), or ultrasound-guided fine needle aspiration cytology (14 suture granulomas and 5 recurrent carcinomas). The ultrasound findings, including presence of internal echogenic foci suggesting calcification or suture material, were compared between the two groups. In the cases with internal echogenic foci, the size, number, distribution pattern, and the presence of a paired appearance were also evaluated. In result, most of the suture granulomas were irregular (n=13) and heterogeneous (n=9) (p<0.05). The incidence of internal echogenic foci was higher in suture granulomas (n=12) than in recurrent carcinomas (n=7) (p<0.05). The internal echogenic foci in all suture granulomas were clustered centrally or paracentrally, unlike those in recurrent carcinomas (p<0.05). Most of the echogenic foci in suture granulomas were larger than 1 mm in diameter (p<0.05) and had a paired appearance (p<0.05). Shape, heterogeneity, and the presence of central or paracentral internal echogenic foci are helpful criteria for differentiating suture granulomas from locally recurrent tumors in the thyroid bed.