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BACKGROUND AND PURPOSE: Comparison of the diagnostic performance for thyroid cancer on ultrasound between a convolutional neural network and visual assessment by radiologists has been inconsistent. Thus, we aimed to evaluate the diagnostic performance of the convolutional neural network compared with the American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) for the diagnosis of thyroid cancer using ultrasound images. MATERIALS AND METHODS: From March 2019 to September 2019, seven hundred sixty thyroid nodules (≥10 mm) in 757 patients were diagnosed as benign or malignant through fine-needle aspiration, core needle biopsy, or an operation. Experienced radiologists assessed the sonographic descriptors of the nodules, and 1 of 5 American College of Radiology TI-RADS categories was assigned. The convolutional neural network provided malignancy risk percentages for nodules based on sonographic images. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were calculated with cutoff values using the Youden index and compared between the convolutional neural network and the American College of Radiology TI-RADS. Areas under the receiver operating characteristic curve were also compared. RESULTS: Of 760 nodules, 176 (23.2%) were malignant. At an optimal threshold derived from the Youden index, sensitivity and negative predictive values were higher with the convolutional neural network than with the American College of Radiology TI-RADS (81.8% versus 73.9%, P = .009; 94.0% versus 92.2%, P = .046). Specificity, accuracy, and positive predictive values were lower with the convolutional neural network than with the American College of Radiology TI-RADS (86.1% versus 93.7%, P < .001; 85.1% versus 89.1%, P = .003; and 64.0% versus 77.8%, P < .001). The area under the curve of the convolutional neural network was higher than that of the American College of Radiology TI-RADS (0.917 versus 0.891, P = .017). CONCLUSIONS: The convolutional neural network provided diagnostic performance comparable with that of the American College of Radiology TI-RADS categories assigned by experienced radiologists.
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Radiología , Nódulo Tiroideo , Humanos , Redes Neurales de la Computación , Radiólogos , Estudios Retrospectivos , Nódulo Tiroideo/diagnóstico por imagen , Ultrasonografía , Estados Unidos/epidemiologíaRESUMEN
AIM: To evaluate the diagnostic value of histogram analysis using ultrasound (US) to differentiate between the subtypes of follicular variant of papillary thyroid carcinoma (FVPTC). MATERIALS AND METHODS: The present study included 151 patients with surgically confirmed FVPTC diagnosed between January 2014 and May 2016. Their preoperative US features were reviewed retrospectively. Histogram parameters (mean, maximum, minimum, range, root mean square, skewness, kurtosis, energy, entropy, and correlation) were obtained for each nodule. RESULTS: The 152 nodules in 151 patients comprised 48 non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTPs; 31.6%), 60 invasive encapsulated FVPTCs (EFVPTCs; 39.5%), and 44 infiltrative FVPTCs (28.9%). The US features differed significantly between the subtypes of FVPTC. Discrimination was achieved between NIFTPs and infiltrative FVPTC, and between invasive EFVPTC and infiltrative FVPTC using histogram parameters; however, the parameters were not significantly different between NIFTP and invasive EFVPTC. CONCLUSION: It is feasible to use greyscale histogram analysis to differentiate between NIFTP and infiltrative FVPTC, but not between NIFTP and invasive EFVPTC. Histograms can be used as a supplementary tool to differentiate the subtypes of FVPTC.
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Adenocarcinoma Folicular/patología , Cáncer Papilar Tiroideo/patología , Neoplasias de la Tiroides/patología , Adenocarcinoma Folicular/diagnóstico por imagen , Adenocarcinoma Folicular/cirugía , Adolescente , Adulto , Biopsia con Aguja Fina , Estudios de Factibilidad , Femenino , Humanos , Biopsia Guiada por Imagen , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Cáncer Papilar Tiroideo/diagnóstico por imagen , Cáncer Papilar Tiroideo/cirugía , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/cirugía , Ultrasonografía , Adulto JovenRESUMEN
Background: In stage I/II natural killer (NK)/T-cell lymphoma, concurrent chemoradiotherapy (CCRT) had previously been shown to result in superior outcome compared with anthracycline-containing regimens, which have since been considered ineffective. The role of CCRT in comparison with approaches employing nonanthracycline-containing chemotherapy (CT) and sequential radiotherapy (RT) in such patients remains to be defined. Patients and methods: Three hundred and three untreated patients (207 men, 96 women; median age: 51, 18-86 years) with stage I/II NK/T-cell lymphoma who had received nonanthracycline-containing regimens were collected from an international consortium and retrospectively analyzed. Treatment included single modality (CT and RT), sequential modalities (CT + RT; RT + CT) and concurrent modalities (CCRT; CCRT + CT). The impact of clinicopathologic parameters and types of treatment on complete response (CR) rate, progression-free-survival (PFS) and overall-survival (OS) was evaluated. Results: For CR, stage (P = 0.027), prognostic index for NK/T-cell lymphoma (PINK) (P = 0.026) and types of initial treatment (P = 0.011) were significant prognostic factors on multivariate analysis. On Cox regression analysis, ECOG performance score (P = 0.021) and PINK-EBV DNA (PINK-E) (P = 0.002) significantly impacted on PFS; whereas ECOG performance score (P = 0.008) and stage (P < 0.001) significantly impacted on OS. For comparing CCRT ± CT and sequential CT + RT, CCRT ± CT patients (n = 190) were similar to sequential CT + RT patients (n = 54) in all evaluated clinicopathologic parameters except two significantly superior features (higher proportion of undetectable circulating EBV DNA on diagnosis and lower PINK-E scores). Despite more favorable pre-treatment characteristics, CCRT ± CT patients had CR rate, PFS and OS comparable with sequential CT + RT patients on multivariate and Cox regression analyses. Conclusions: In stage I/II NK/T-cell lymphomas, when effective chemotherapeutic regimens were used, CCRT and sequential CT + RT gave similar outcome.
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Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Linfoma Extranodal de Células NK-T/tratamiento farmacológico , Linfoma Extranodal de Células NK-T/radioterapia , Adolescente , Adulto , Anciano de 80 o más Años , Quimioradioterapia , Estudios de Cohortes , Esquema de Medicación , Femenino , Humanos , Linfoma Extranodal de Células NK-T/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Adulto JovenRESUMEN
The growing use of probiotics by the general public has heightened the interest in understanding the role of probiotics in promoting health and preventing disease. General practitioners and specialists often receive inquiries from their patients regarding probiotic products and their use to ward off systemic infection or intestinal maladies. Enhanced immune function is among the touted health benefits conferred by probiotics but has not yet been fully established. Results from recent clinical trials in adults suggest a potential role for probiotics in enhancing vaccine-specific immunity. Although almost all vaccinations are given during infancy and childhood, the numbers of and results from studies using probiotics in pediatric subjects are limited. This review evaluates recent clinical trials of probiotics used to enhance vaccine-specific immune responses in adults and infants. We highlight meaningful results and the implications of these findings for designing translational and clinical studies that will evaluate the potential clinical role for probiotics. We conclude that the touted health claims of probiotics for use in children to augment immunity warrant further investigation. In order to achieve this goal, a consensus should be reached on common study designs that apply similar treatment timelines, compare well-characterised probiotic strains and monitor effective responses against different classes of vaccines.
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Adyuvantes Inmunológicos/administración & dosificación , Probióticos/administración & dosificación , Vacunas/administración & dosificación , Vacunas/inmunología , Adulto , Niño , Ensayos Clínicos como Asunto , HumanosRESUMEN
BACKGROUND: The use of imatinib combined with chemotherapy has demonstrated improved outcome in adults with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph-positive ALL). However, a substantial proportion of patients continue to die as a result of disease progression. PATIENTS AND METHODS: We assessed the minimal residual disease (MRD)-based effect and long-term outcome of first-line incorporation of dasatinib (100 mg once daily) into chemotherapy alternatively for adults with Ph-positive ALL. The primary end point was the major molecular response (MMR) rate by the end of the second dasatinib cycle. Patients with a donor proceeded to allogeneic stem cell transplantation (SCT) as early as possible. MRD monitoring was centrally evaluated by real-time quantitative polymerase chain reaction (4.5-log sensitivity) using bone marrow samples. RESULTS: Fifty-one patients (median age, 46 years) were enrolled and treated with this strategy. After the first dasatinib cycle, 50 patients (98.0%) achieved complete remission (CR). By the end of the second dasatinib cycle, 46 (93.9%) of 49 assessable patients had persistent CR, and 38 (77.6%) had MMR (32.7%) or undetectable MRD (44.9%). On the basis of the MRD kinetics by this time point, the numbers of early-stable, late, and poor molecular responders were 23 (46.9%), 15 (30.7%), and 11 (22.4%), respectively. Thirty-nine patients (76.5%) underwent allogeneic SCT in CR1. After a median follow-up of 54 months, the 4-year cumulative incidence of relapse and disease-free survival (DFS) rate for all patients were 30.0% and 52.0%, respectively, and the corresponding outcomes among those receiving allogeneic SCT in CR1 were 20.5% and 64.1%, respectively. Poor molecular responders had a higher risk of relapse and DFS than those of early-stable molecular responders. CONCLUSION: This dasatinib-based protocol was effective for achieving a good quality molecular response and durable DFS in adults with Ph-positive ALL. TRIAL REGISTRATION: clinicaltrials.gov, NCT01004497.
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Dasatinib/administración & dosificación , Leucemia Mielógena Crónica BCR-ABL Positiva/terapia , Neoplasia Residual/patología , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Adulto , Anciano , Supervivencia sin Enfermedad , Femenino , Humanos , Leucemia Mielógena Crónica BCR-ABL Positiva/epidemiología , Leucemia Mielógena Crónica BCR-ABL Positiva/patología , Masculino , Persona de Mediana Edad , Neoplasia Residual/epidemiología , Cromosoma Filadelfia , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiología , Leucemia-Linfoma Linfoblástico de Células Precursoras/patología , Inducción de Remisión , Trasplante de Células Madre , Trasplante Homólogo , Resultado del TratamientoRESUMEN
BACKGROUND: Abnormal deposition of melanin may cause an aesthetic skin problem; therefore, the control of unwanted excessive melanin synthesis is the major goal of cosmetic research. OBJECTIVES: To identify novel tyrosinase (TYR) inhibitors from marine plants and examine their cellular antimelanogenic effects. METHODS: The extracts of 50 marine plants endemic to Korea were screened against human TYR. Active constituents were then isolated from the selected plant extracts that showed potential and their chemical structures elucidated. Furthermore, their antimelanogenic effects were examined using murine melanoma B16/F10 cells and human epidermal melanocytes (HEM). RESULTS: Among the tested extracts, that of Phyllospadix iwatensis Makino exhibited the strongest human TYR inhibitory activity. The active constituents were purified from the butanol fraction of the P. iwatensis extract and identified as hispidulin 7-sulfate and luteolin 7-sulfate. Luteolin 7-sulfate inhibited human TYR more strongly than hispidulin 7-sulfate, luteolin, hispidulin and arbutin. Furthermore, luteolin 7-sulfate showed lower cytotoxicity than luteolin in both B16/F10 cells and HEM. Luteolin 7-sulfate attenuated cellular melanin synthesis more effectively in B16/F10 cells and HEM stimulated by α-melanocyte-stimulating hormone and l-tyrosine than arbutin. CONCLUSIONS: This study demonstrates that luteolin 7-sulfate isolated from P. iwatensis is a human TYR inhibitor with advantageous antimelanogenic properties, and would be useful for development as a therapeutic agent for the control of unwanted skin pigmentation.
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Luteolina/farmacología , Melanosis/tratamiento farmacológico , Monofenol Monooxigenasa/antagonistas & inhibidores , Fitoterapia/métodos , Zosteraceae , Organismos Acuáticos , Supervivencia Celular/efectos de los fármacos , Células Cultivadas , Citotoxinas/aislamiento & purificación , Citotoxinas/farmacología , Inhibidores Enzimáticos/aislamiento & purificación , Inhibidores Enzimáticos/farmacología , Humanos , Luteolina/aislamiento & purificación , Melaninas/metabolismo , Extractos Vegetales/aislamiento & purificación , Extractos Vegetales/farmacologíaRESUMEN
PURPOSE: To assess the risk of malignancy of thyroid incidentalomas found on 18F-FDG PET/CT by US features and cytologic results, and to evaluate the clinical usage of a combination of US features and cytology for post-FNA management of thyroid incidentalomas on 18F-FDG PET/CT. MATERIALS AND METHODS: From September 2006 to December 2008, 132 patients with 134 thyroid incidentalomas detected on 18F-FDG PET/CT who had undergone US and US-FNA were included in this study. We evaluated the malignancy rate of thyroid incidentalomas in different subgroups subdivided by US features and US-FNA cytology results. Several variables were compared between the benign and malignant group. RESULTS: The risk of malignancy was 58.2â% (78/132) in thyroid incidentalomas on 18F-FDG PET/CT. Age, gender, and tumor size were not significantly different between the malignant and benign group. âMalignancy rate of thyroid incidentalomas was significantly higher in the suspicious malignant (88.9â%) than in the probably benign group (11.3â%) on US (p <â0.001). Malignancy rates were high in thyroid nodules with "malignancy", "suspicious for malignancy", or "follicular neoplasm" on cytologic results, regardless of US features. However, malignancy rates of thyroid incidentalomas with "unsatisfactory" or "benign" results on cytology were higher in the suspicious malignant (75â%, 12.5â%, respectively) than in the probably benign (0â%) group on US.â CONCLUSIONS: This study demonstrated that the risk of malignancy was high in thyroid incidentalomas on 18F-FDG PET/CT even without suspicious US features. However, there was no malignancy in nodules with no suspicious US features and benign cytology. Based on these results, we concluded that US may not replace FNA in the diagnosis of PET incidentalomas, and that a follow-up may be considered of thyroid incidentalomas with benign cytology and no suspicious US features.
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Biopsia con Aguja Fina , Fluorodesoxiglucosa F18 , Hallazgos Incidentales , Tomografía de Emisión de Positrones , Ajuste de Riesgo , Glándula Tiroides/diagnóstico por imagen , Glándula Tiroides/patología , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/patología , Tomografía Computarizada por Rayos X , Adenocarcinoma Folicular/diagnóstico por imagen , Adenocarcinoma Folicular/patología , Factores de Edad , Anciano , Algoritmos , Biomarcadores de Tumor/sangre , Diagnóstico Diferencial , Detección Precoz del Cáncer , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/diagnóstico por imagen , Recurrencia Local de Neoplasia/patología , Neoplasias Primarias Secundarias/diagnóstico por imagen , Neoplasias Primarias Secundarias/patología , Factores de Riesgo , Sensibilidad y Especificidad , Factores Sexuales , Nódulo Tiroideo/diagnóstico por imagen , Nódulo Tiroideo/patología , Carga Tumoral , UltrasonografíaRESUMEN
The aims of this study were to investigate the outcomes of second salvage auto-SCT and to identify the impacts of a second auto-SCT compared with systemic chemotherapy alone on disease outcome. Data from 48 patients who underwent second auto-SCT were matched to 144 patients (1:3) who received systemic chemotherapy alone from the Korean Myeloma Registry. Groups were matched for nine potential prognostic factors and compared for treatment outcomes. The median age of matching-pairs at relapse was 55.5 years. A total of 156 patients (81%) received vincristine, doxorubicin and dexamethasone induction therapy before the first auto-SCT. Thirty-five patients (73%) in the second auto-SCT group received novel agent-based therapies before the second auto-SCT, and similar proportion in both groups received novel therapies after relapse of front-line auto-SCT. With a median follow-up of 55.3 months, patients who underwent a second auto-SCT had significantly better median OS (55.5 vs 25.4 months, P=0.035). In multivariate analysis for OS, <18 months time to progression after first auto-SCT, International Staging System III and salvage chemotherapy alone were independent predictors for worse OS. The outcomes of second auto-SCT appear to be superior to those of systemic chemotherapy alone. A randomized trial comparing both treatment strategies is required.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Mieloma Múltiple/tratamiento farmacológico , Mieloma Múltiple/cirugía , Trasplante de Células Madre/métodos , Adulto , Anciano , Terapia Combinada , Dexametasona/administración & dosificación , Supervivencia sin Enfermedad , Doxorrubicina/administración & dosificación , Femenino , Humanos , Masculino , Análisis por Apareamiento , Persona de Mediana Edad , Terapia Recuperativa , Trasplante de Células Madre/efectos adversos , Tasa de Supervivencia , Resultado del Tratamiento , Vincristina/administración & dosificaciónRESUMEN
PURPOSE: To evaluate the interobserver variability for US assessments of thyroid nodules and analyze the diagnostic performances of US assessments in thyroid nodules according to nodule size. MATERIALS AND METHODS: This was an IRB-approved retrospective study with waiver of informed consent. A total of 400 surgically-confirmed thyroid nodules were included. Nodules were divided into 4 groups by size; group 1 (nodule size <â5âmm), group 2 (5âmm ≤ nodule size <â10âmm), group 3 (10âmm ≤ nodule size <â20âmm), and group 4 (nodule size ≥â20âmm). Three experienced (7â-â10 years) radiologists retrospectively reviewed the US images. Agreement of each US descriptor and final US assessment, and diagnostic performances were calculated in each group and compared. RESULTS: Composition represented substantial or good agreement (kâ=â0.719â-â0.89). Margin showed the lowest agreement (kâ=â0.322â-â0.365). Individual kappa values for final assessment according to nodule size were as follows: group 1 (kâ=â0.674), group 2 (kâ=â0.596), group 3 (kâ=â0.674), and group 4 (kâ=â0.673). Specificity, PPV, and accuracy were significantly different among the groups with different size (p value <â0.05) and lowest in group 1.âNPV, specificity, PPV and accuracy except PPV of observer 3 increased with nodule size (pâ<â0.05). CONCLUSION: Interobserver agreements were relatively good (kâ=â0.637) in final US assessment regardless of nodule size in experienced radiologists. High false-positive rate was observed in US assessment in nodules less than 5âmm in maximum diameter.
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Neoplasias de la Tiroides/diagnóstico por imagen , Nódulo Tiroideo/diagnóstico por imagen , Adolescente , Adulto , Anciano , Biopsia con Aguja Fina , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Estudios Retrospectivos , Sensibilidad y Especificidad , Glándula Tiroides/diagnóstico por imagen , Glándula Tiroides/patología , Glándula Tiroides/cirugía , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/cirugía , Nódulo Tiroideo/patología , Nódulo Tiroideo/cirugía , Carga Tumoral , Ultrasonografía Intervencional , Adulto JovenRESUMEN
PURPOSE: To investigate whether ultrasound-guided 14-gauge core needle biopsy (US-CNB) is efficient in the diagnosis of probably benign lesions showing interval growth on follow-up US.â MATERIALS AND METHODS: From March 2008 to August 2009, 116 breast lesions in 113 women (mean age: 41.2 years, range: 19â-â63 years) which were initially assessed as category 3 showing interval growth on follow-up US underwent US-CNB, and subsequent US-guided vacuum-assisted excision, surgical excision or follow-up US for at least 12 months. Diagnostic performances of US-CNB were evaluated with histopathologic results and follow-up US as standard reference. Clinical features of the patient and lesions characteristics including follow-up interval (I), the most increased diameter (D), D per I, increased volume (%V) and %V per I were calculated and compared. RESULTS: Of the 116 lesions, 4 lesions were diagnosed as malignancy and 112 as benign on final pathology. Malignancy rate of probably benign lesions showing interval growth was 3.4â% (4/116). Incorrect biopsy rate was 0.9â% (1/116). Palpability or newly developed suspicious US features were more associated with malignancy, 75.0 to 13.4â% and 50.0 to 25.9â%, respectively, but without significance (pâ=â0.063 and 0.290). Significant differences were seen in average rank when comparing between benign and malignancy in D, %V, D per follow-up interval (I), and %V/I (pâ=â0.037, 0.017, 0.043 and 0.009, respectively). CONCLUSION: US-CNB is an efficient diagnostic method for probably benign lesions showing interval growth, with discordant biopsy rate of 0.9â%.
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Biopsia con Aguja/métodos , Neoplasias de la Mama/patología , Enfermedad Fibroquística de la Mama/patología , Ultrasonografía Intervencional/métodos , Ultrasonografía Mamaria/métodos , Adulto , Mama/patología , Neoplasias de la Mama/cirugía , Carcinoma Ductal de Mama/patología , Carcinoma Ductal de Mama/cirugía , Diagnóstico Diferencial , Femenino , Fibroadenoma/patología , Fibroadenoma/cirugía , Enfermedad Fibroquística de la Mama/cirugía , Humanos , Persona de Mediana Edad , Tumor Filoide/patología , Tumor Filoide/cirugía , Estudios Retrospectivos , Vacio , Adulto JovenRESUMEN
OBJECTIVE: The objective of this study was to compare the underestimation rate of invasive carcinoma in cases with ductal carcinoma in situ (DCIS) at percutaneous ultrasound-guided core biopsies of breast lesions between 14-gauge automated core-needle biopsy (ACNB) and 8- or 11-gauge vacuum-assisted biopsy (VAB), and to determine the relationship between the lesion type (mass or microcalcification on radiological findings) and the DCIS underestimation rate. METHODS: We retrospectively reviewed imaging-guided biopsies of breast lesions performed from February 2003 to August 2008. 194 lesions were diagnosed as DCIS at ultrasound-guided core biopsy: 138 lesions in 132 patients by 14-gauge ACNB, and 56 lesions in 56 patients by 8- or 11-gauge VAB. The histological results of the core biopsy samples were correlated with surgical specimens. The clinical and radiological findings were also reviewed. The histological DCIS underestimation rates were compared between the two groups and were analysed for differences according to the clinical and radiological characteristics of the lesions. RESULTS: The DCIS underestimation rate was 47.8% (66/138) for 14-gauge ACNB and 16.1% (9/56) for VAB (p<0.001). According to the lesion type on sonography, DCIS underestimation was 43.4% (63/145) in masses (47.6% using ACNB and 15.8% using VAB; p=0.012) and 24.5% (12/49) in microcalcifications (50.0% using ACNB and 16.2% using VAB; p=0.047). CONCLUSION: The underestimation rate of invasive carcinoma in cases with DCIS at ultrasound-guided core biopsies was significantly higher for ACNB than for VAB. Furthermore, this difference does not change according to the lesion type on ultrasound. Therefore, ultrasound-guided VAB can be a useful method for the diagnosis of DCIS lesions presented as either mass or microcalcification.
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Biopsia con Aguja/métodos , Neoplasias de la Mama/patología , Mama/patología , Carcinoma Ductal de Mama/patología , Carcinoma Intraductal no Infiltrante/patología , Adulto , Biopsia con Aguja/instrumentación , Calcinosis/patología , Diagnóstico Tardío , Femenino , Humanos , Persona de Mediana Edad , Pronóstico , Sensibilidad y Especificidad , Ultrasonografía Intervencional/métodos , VacioRESUMEN
AIM: To compare the histological upgrade rate of ultrasound (US)-guided vacuum-assisted removal (VAR) and US-14 G-automated core needle biopsy (ACNB) in the diagnosis of papillary breast lesions. MATERIALS AND METHODS: Two hundred and seventy-one biopsies of 230 papillary lesions were examined, which underwent subsequent surgical excision or long-term follow-up after US-ACNB (n = 206) or US-VAR (n = 65). The false-negative and atypical papilloma underestimation rate were compared between the ACNB and VAR groups. Patient and lesion characteristics were collected. The histological upgrade rates of the diagnosis were estimated and compared. RESULTS: Out of 271 papillary lesions, 195 (80.0%) were benign, 21 (7.7%) were atypical, and 55 (20.3%) were malignant. There were no false negatives or underestimated atypical papillomas in the VAR group. However, in the ACNB group, the false-negative rate was 7.6% (12 of 157 benign papillomas, 95% CI; 4.4-12.9%, p = 0.039) and the atypical papilloma underestimation rate was 33% (five of 15 atypical papillomas, 95% CI; 15.2-58.3%, p = 0.135). The histological upgrade rates of the diagnosis for papillary breast lesions were 0% for the VAR (0 of 66) group and 10.2% for the ACNB (21 of 206) group before adjusting for the population (p = 0.003). CONCLUSIONS: ACNB was associated with significantly higher false-negative and histological upgrade rates of diagnosis for papillary breast lesions than VAR.
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Biopsia con Aguja/métodos , Neoplasias de la Mama/patología , Papiloma/patología , Ultrasonografía Intervencional/métodos , Adulto , Anciano , Biopsia con Aguja/instrumentación , Neoplasias de la Mama/diagnóstico por imagen , Femenino , Humanos , Persona de Mediana Edad , Papiloma/diagnóstico por imagen , Estudios Retrospectivos , Vacio , Adulto JovenAsunto(s)
Enfermedades Autoinmunes/tratamiento farmacológico , Inmunoglobulina A/metabolismo , Linfoma no Hodgkin/terapia , Trasplante de Células Madre de Sangre Periférica/efectos adversos , Enfermedades Cutáneas Vesiculoampollosas/tratamiento farmacológico , Enfermedades Autoinmunes/diagnóstico , Enfermedades Autoinmunes/metabolismo , Enfermedades Autoinmunes/patología , Membrana Basal/metabolismo , Biopsia , Humanos , Masculino , Persona de Mediana Edad , Síndromes Paraneoplásicos/inmunología , Síndromes Paraneoplásicos/metabolismo , Síndromes Paraneoplásicos/patología , Síndromes Paraneoplásicos/fisiopatología , Recurrencia , Piel/inmunología , Piel/metabolismo , Piel/patología , Enfermedades Cutáneas Vesiculoampollosas/inmunología , Enfermedades Cutáneas Vesiculoampollosas/metabolismo , Enfermedades Cutáneas Vesiculoampollosas/patología , Trasplante AutólogoRESUMEN
BACKGROUND: To analyze the clinical features, outcomes including efficacy of treatment, and prognostic factors of patients with immunoglobulin D multiple myeloma (IgD MM). DESIGN AND METHODS: Seventy-five patients diagnosed with IgD MM were selected from the Korean Myeloma Registry database (www.myeloma.or.kr). RESULTS: Median age was 57 years and the main presenting features were bone pain (77%). Renal function impairment and hypercalcemia were present in 40 (53%) and 20 (27%) patients. Sixty-seven patients (89%) had lambda light chains. Forty-eight patients (64%) were of stage III by International Staging System. Twenty-six patients (53%) had chromosomal abnormalities mostly by conventional cytogenetics. Thirty-nine patients (54%) were treated with vincristine, adriamycin, and dexamethasone chemotherapy; the overall response rate (ORR) of 56%. Sixteen patients (22%) received first-line chemotherapy including new drugs (bortezomib or thalidomide), with an ORR of 81%. At a median follow-up time of 28.6 months, median overall survival (OS) was 18.5 months. Age, extramedullary plasmacytoma, del(13) or hypoploidy, serum ß(2) microglobulin level, and platelet count were significant prognostic factors for OS. CONCLUSIONS: IgD MM is an aggressive disease that is usually detected at an advanced stage. Despite a positive initial response, survival after relapse was dismal. Intensive treatment strategies before and following stem cell transplantation may improve outcomes in younger patients.
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Inmunoglobulina D/sangre , Mieloma Múltiple/patología , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos/uso terapéutico , Femenino , Trasplante de Células Madre Hematopoyéticas , Humanos , Masculino , Persona de Mediana Edad , Mieloma Múltiple/inmunología , Mieloma Múltiple/terapia , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
BACKGROUND: Specimen radiography has been used widely to evaluate the complete excision of calcified breast lesions but has not been evaluated for thyroid cancer. METHODS: Specimen radiographs were evaluated retrospectively to identify additional cancers that were demonstrated only as calcifications. Receiver operating characteristic curve analysis was performed to compare the combination of specimen radiography and ultrasonography versus ultrasonography alone for detecting multifocality. RESULTS: Some 122 thyroid cancer specimens were obtained from 122 patients between January and April 2008. Specimen radiography detected 27 cancers (18.5 per cent) not detected by ultrasonography. Diagnoses were changed after evaluation of specimen radiographs in three of these patients. The area under the curve of the combination of specimen radiography and ultrasonography was significantly higher than that of ultrasonography alone (P = 0.005). CONCLUSION: Specimen radiography is a potentially useful tool for diagnosing cancer type and predicting the extent of thyroid cancer.
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Calcinosis/diagnóstico por imagen , Carcinoma Papilar/diagnóstico por imagen , Neoplasias de la Tiroides/diagnóstico por imagen , Adolescente , Adulto , Anciano , Biopsia con Aguja , Calcinosis/patología , Carcinoma Papilar/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Curva ROC , Radiografía , Sensibilidad y Especificidad , Neoplasias de la Tiroides/patología , Ultrasonografía , Adulto JovenRESUMEN
The purpose of this study was to determine whether the interpretation of microcalcifications assessed on images zoomed (x 2.0) from digital mammograms is at least equivalent to that from digital magnification mammography (x 1.8) with respect to diagnostic accuracy and image quality. Three radiologists with different levels of experience in mammography reviewed each full-field digital mammography reader set for 185 patients with pathologically proven microcalcification clusters, which consisted of digital magnification mammograms (MAGs) with a magnification factor of 1.8 and images zoomed from mammograms (ZOOM) with a zoom factor of 2.0. Each radiologist rated their suspicion of breast cancer in microcalcific lesions using a six-point scale and the image quality and their confidence in the decisions using a five-point scale. Results were analysed according to display methods using areas under the receiver operating characteristic curves (A(z) value) for ZOOM and MAGs to interpret microcalcifications, and the Wilcoxon matched pairs signed rank test for image quality and confidence levels. There was no statistically significant difference in the level of suspicion of breast cancer between the ZOOM and MAG groups (A(z) = 0.8680 for ZOOM; A(z) = 0.8682 for MAG; p = 0.9897). However, MAG images were significantly better than ZOOM images in terms of visual imaging quality (p < 0.001), and the confidence level with MAG was better than with ZOOM (p < 0.001). In conclusion, the performance of radiologists in the diagnosis of microcalcifications using ZOOM was similar to that using MAGs, although image quality and confidence levels were better using MAGs.
Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Calcinosis/diagnóstico por imagen , Mamografía/métodos , Adulto , Anciano , Femenino , Humanos , Aumento de la Imagen/métodos , Persona de Mediana Edad , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Radiología/normas , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
AIM: To determine the diagnostic performance of dynamic magnetic resonance imaging (MRI) for breast cancer in breasts augmented with liquid paraffin or silicone injection. MATERIALS AND METHODS: Among 62 patients with breast augmentation by liquid paraffin or silicone injection who had undergone dynamic breast MRI at our institution, 27 women, who had pathological diagnosis or at least 1-year MRI follow-up, were included in this retrospective study and their MRI images were reviewed. For enhancing lesions on MRI, the morphological features, enhancement kinetics, and BI-RADS assessment category were analysed. The lesion characteristics at MRI were correlated with the final diagnosis based on the histopathological result or at least 1-year MRI follow-up. RESULTS: Of the 27 patients, 17 enhancing lesions in 13 patients were found on MRI. All six lesions that were confirmed as malignancy showed suspicious morphological findings and type 2 or 3 enhancement kinetics, assigned to BI-RADS category 4 or 5. Of the remaining 11 benign lesions, 10 showed benign-favouring morphological findings, and all showed type 1 enhancement kinetics, assigned to BI-RADS category 2 or 4. CONCLUSION: In patients with breasts injected with foreign material, MRI was used to successfully diagnose malignant breast lesions and could be the diagnostic method of choice. Analysis of the morphological and kinetic features at MRI in conjunction with clinical findings is essential.
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Implantación de Mama , Neoplasias de la Mama/diagnóstico , Carcinoma Ductal de Mama/diagnóstico , Imagen por Resonancia Magnética/métodos , Adulto , Anciano , Medios de Contraste , Diagnóstico Diferencial , Femenino , Células Gigantes de Cuerpo Extraño , Humanos , Persona de Mediana Edad , Parafina , Estudios Retrospectivos , Geles de SiliconaRESUMEN
Domino kidney paired donation (KPD) is a method by which an altruistic living nondirected donor (LND) is allocated to a pool of incompatible donor-recipient pairs (DRP) and a series of KPDs is initiated. To evaluate the feasibility and clinical outcomes of multicenter domino KPD, we retrospectively analyzed a cohort of DRPs who underwent domino KPD between February 2001 and July 2007 at one of 16 transplant centers. One hundred seventy-nine kidney transplants were performed, with 70 domino chains initiated by altruistic LND. There were 45 two-pair chains, 15 three-pair chains, 7 four-pair chains, 2 five-pair chains and 1 six-pair chain. A majority of donors were spouses (47.5%) or altruistic LNDs (39.1%). DRPs with a blood type O recipient or an AB donor comprised 45.9% of transplanted DRPs. HLA mismatch improved in transplanted donors compared to intended donors in pairs enrolled to improve HLA mismatch (3.4 +/- 0.7 vs. 4.8 +/- 1.0, p < 0.001). One-year and 5-year graft survival rates were 98.3% and 87.7%, respectively, with a median follow-up of 46 months. One-year and 5-year patient survival rates were 97.2% and 90.8%, respectively. In conclusion, multicenter domino KPD could multiply the benefits of donation from LNDs, with patients and graft survival rates comparable to those seen with conventional KPD.
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Trasplante de Riñón , Donantes de Tejidos , Altruismo , Humanos , Resultado del TratamientoRESUMEN
AIM: To evaluate the ultrasound (US) features of the diffuse sclerosing variant of papillary carcinoma (DSVPC) of the thyroid, with histopathological correlations. MATERIALS AND METHODS: The US and histopathological findings of six patients with surgically proven DSVPC of the thyroid were retrospectively assessed. RESULTS: Most of cases showed diffuse, scattered microcalcifications with or without associated masses and underlying heterogeneous hypoechogenicity at the site of the DSVPC in the thyroid. At ultrasound, scattered microcalcifications and heterogeneous hypoechogenicity seen in the DSVPC correlated to psammoma bodies and lymphocytic infiltration at histopathological review. CONCLUSION: DSVPC of the thyroid usually manifested as diffuse scattered microcalcifications and associated suspicious mass on ultrasound. These findings are not specific for the DSVPC of the thyroid. However, in relatively young patients with suspicious masses associated with underlying diffuse scattered microcalcifications on US, the possibility of DSVPC should be included in differential diagnosis.
Asunto(s)
Carcinoma Papilar/diagnóstico por imagen , Neoplasias de la Tiroides/diagnóstico por imagen , Adulto , Biopsia con Aguja/métodos , Calcinosis/complicaciones , Calcinosis/diagnóstico por imagen , Calcinosis/patología , Carcinoma Papilar/complicaciones , Carcinoma Papilar/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Esclerosis/complicaciones , Esclerosis/diagnóstico por imagen , Esclerosis/patología , Glándula Tiroides/diagnóstico por imagen , Glándula Tiroides/patología , Neoplasias de la Tiroides/complicaciones , Neoplasias de la Tiroides/patología , UltrasonografíaRESUMEN
No published data are available about the expression of peroxisome proliferator-activated receptor gamma (PPARgamma) and the role of PPARgamma in retinoblastoma protein (RB)-deficient human colorectal cancer (CRC) cells (SNU-C4 and SNU-C2A). Our aim was to investigate whether PPARgamma is expressed in SNU-C4 and SNU-C2A cells and to elucidate possible molecular mechanisms underlying the effect of pioglitazone, a synthetic ligand for PPARgamma, on cell growth in these cell lines. RT-PCR and Western blot analysis showed that both human CRC cell lines expressed PPARgamma mRNA and protein. Pioglitazone inhibited the cell growth of both cell lines through G2/M phase block and apoptosis. In addition, pioglitazone caused a down-regulation of the X chromosome-linked inhibitor of apoptosis (XIAP), Bcl-2, and cyclooxygenase-2 (COX-2) under conditions leading to PPARgamma down-regulation. These results suggest that pioglitazone may have therapeutic relevance or significance in the treatment of human CRC, and the down-regulation of XIAP, Bcl-2, and COX-2 may contribute to pioglitazone-induced apoptosis in these and other RB-deficient cell lines and tumors.