Contrast-Enhanced Ultrasound Parameters in Breast Cancer: Correlations with Prognostic Factors

PURPOSE@#To correlate the value of contrast-enhanced ultrasound (CEUS) with prognostic factors of breast cancer.@*MATERIALS AND METHODS@#24 breast cancer patients were evaluated with CEUS. As a quantitative analysis, the peak enhancement (PE), wash-in and wash-out area under curve (WiWoAUC), wash-in rate (WiR) and wash-out rate, rise time, fall time, mean transit time, time to peak, and wash-in perfusion index (WiPI) were measured. As a qualitative analysis, the enhancement patterns were evaluated. Pathologic prognostic factors, including histologic grade, hormonal receptors and Ki-67 proliferative index were assessed by immunohistochemistry. Correlation of quantitative and qualitative parameters of CEUS with prognostic factors was assessed.@*RESULTS@#We found that the quantitative CEUS values (PE, WiWoAUC, and WiPI) of estrogen receptor (ER) positive breast cancer were higher than those of ER negative counterpart (all p 0.05).@*CONCLUSION@#The CEUS parameters were helpful in predicting prognostic factors, such as ER positivity or triple negativity. However, they could not predict the histologic grade.

Early Prediction of Response to Neoadjuvant Chemotherapy Using Dynamic Contrast-Enhanced MRI and Ultrasound in Breast Cancer

OBJECTIVE: To determine the diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and DCE ultrasound (DCE-US) for predicting response to neoadjuvant chemotherapy (NAC) in breast cancer patients. MATERIALS AND METHODS: This Institutional Review Board-approved prospective study was performed between 2014 and 2016. Thirty-nine women with breast cancer underwent DCE-US and DCE-MRI before the NAC, follow-up DCE-US after the first cycle of NAC, and follow-up DCE-MRI after the second cycle of NAC. DCE-MRI parameters (transfer constant [Ktrans], reverse constant [kep], and leakage space [Ve]) were assessed with histograms. From DCE-US, peak-enhancement, the area under the curve, wash-in rate, wash-out rate, time to peak, and rise time (RT) were obtained. After surgery, all the imaging parameters and their changes were compared with histopathologic response using the Miller-Payne Grading (MPG) system. Data from minor and good responders were compared using Wilcoxon rank sum test, chi-square test, or Fisher's exact test. Receiver operating characteristic curve analysis was used for assessing diagnostic performance to predict good response. RESULTS: Twelve patients (30.8%) showed a good response (MPG 4 or 5) and 27 (69.2%) showed a minor response (MPG 1–3). The mean, 25th, 50th, and 75th percentiles of Ktrans and Kep of post-NAC DCE-MRI differed between the two groups. These parameters showed fair to good diagnostic performance for the prediction of response to NAC (AUC 0.76–0.81, p ≤ 0.007). Among DCE-US parameters, the percentage change in RT showed fair prediction (AUC 0.71, p = 0.023). CONCLUSION: Quantitative analysis of DCE-MRI and DCE-US was helpful for early prediction of response to NAC.

Erratum: Follow-up Outcomes of Benign Pathology Initially Assigned as Breast Imaging Reporting and Data System Category 4A and 3 / 한국유방암학회지

This article was initially published on the Journal of Breast Cancer with a misspelled the Institutional Review Board (IRB) approval number. The IRB number should be corrected as “NCC2014-0031”.

The Korean Influenza National Immunization Program: History and Present Status

The Korean influenza national immunization program was first established as an interim program in 1997, administering the influenza vaccine to low-income elderly adults. In 2005, the program assumed its present form of providing free influenza vaccination to adults aged ≥65 years. After turning over the influenza vaccination for elderly adults to the private sectors in 2015, the influenza vaccination coverage rate among this population increased to >80%. In addition, after the 2009 H1N1 influenza epidemic crisis, the vaccine was domestically produced. By reaching a 75% vaccination coverage rate in the target groups, it was possible to put an end to the influenza pandemic and fix the shortcomings of the system that existed at that time. The influenza vaccination program, provided free of cost, was extended to include infants aged < 12 months in 2016 and ≤59 months in 2017 in order to reduce the influenza burden in these populations. However, the vaccine effectiveness remains low despite the high vaccination rates in elderly adults. Therefore, several areas, such as the adoption of quadrivalent influenza vaccine, adjuvanted influenza vaccine, and high-dose influenza vaccine and the expansion of vaccination target groups, still need to be addressed.

Perception survey on the introduction of clinical performance examination as part of the national nursing licensing examination in Korea / 보건의료교육평가

PURPOSE: The purpose of this study was to analyze opinions about the action plan for implementation of clinical performance exam as part of the national nursing licensing examination and presents the expected effects of the performance exam and aspects to consider regarding its implementation. METHODS: This study used a mixed-methods design. Quantitative data were collected by a questionnaire survey, while qualitative data were collected by focus group interviews with experts. The survey targeted 200 nursing professors and clinical nurses with more than 5 years of work experience, and the focus group interviews were conducted with 28 of professors, clinical instructors, and nurses at hospitals. RESULTS: First, nursing professors and clinical specialists agreed that the current written tests have limitations in evaluating examinees' ability, and that the introduction of a clinical performance exam will yield positive results. Clinical performance exam is necessary to evaluate and improve nurses' work ability, which means that the implementation of a performance exam is advisable if its credibility and validity can be verified. Second, most respondents chose direct performance exams using simulators or standardized patients as the most suitable format of the test. CONCLUSION: In conclusion, the current national nursing licensing exam is somewhat limited in its ability to identify competent nurses. Thus, the time has come for us to seriously consider the introduction of a performance exam. The prerequisites for successfully implementing clinical performance exam as part of the national nursing licensing exam are a professional training process and forming a consortium to standardize practical training.

Current Status and Future Direction of Nursing Education for Clinical Practice / 의학교육논단

The quantitative expansion of nursing schools has necessitated the qualitative improvement of nursing education, which requires the development of nursing education for clinical practice. To identify strategies for strengthening the educational capacity of clinical fields and nursing schools, this study first examined the current status of nursing education for clinical practice, and then proposed several prospective directions for education. Nursing clinical practice-related studies from several Korean and international electronic databases were reviewed. Insufficient training hospitals and lack of qualified clinical training instructors were the main problems found within nursing educational resources for clinical practice, while the simple practice contents based on observation and inadequate evaluations were the main problems found in nursing educational management for clinical practice. This study suggests better standards and educational accountability for training hospitals and programs to nurture human resources for clinical practice, as well as a variety of training methods to integrate practical training courses and the expansion of formation evaluation. Based on these results, it is necessary to establish governance for nursing education for clinical practice and clarify the role and standards of each practitioner, strengthen the educational role of the hospital, and improve the system. In addition, introducing various types of education methods and strengthening evaluation standards are needed in order to enhance nursing education for clinical practice.

Follow-up Outcomes of Benign Pathology Initially Assigned as Breast Imaging Reporting and Data System Category 4A and 3 / 한국유방암학회지

PURPOSE: This retrospective study investigated if the initially assigned category 4A or 3 in concordant benign lesions, after ultrasound (US)-guided core needle biopsy, could affect follow-up compliance. METHODS: Eight hundred thirty-eight concordant benign lesions, after core needle biopsy (674, initial category 4A group and 164, category 3 group) and follow-up US, were included in our study. If an immediate surgical excision—a surgical excision before the next follow-up—exists, those cases with pathologic reports were collected. Statistical comparisons for the result of follow-up US compliance, additional biopsy, and malignant rates among 6-month, 12-month, and long-term intervals were performed by using the chi-square test. The log-rank test was used to compare compliance rates in the timing of first follow-up between the two groups, with a significance level of 0.05. RESULTS: The number of immediate surgical excision was higher in the category 4A group (11.1%) than in the category 3 group (6.1%); only one cancer was found in the category 4A group. The patients' compliance rate in a 6-month follow-up showed an increase (p=0.003) in the category 4A group. The additional biopsy rate was higher in the initial category 4A group (10.9%) than in the category 3 group (1.9%) with statistical significance (p=0.001); four cancers were found on additional biopsy in the category 4 group. No cancer was detected in the initial category 3 group, both on immediate surgical excision and follow-up. CONCLUSION: The initial category 4A or 3 of the Breast Imaging Reporting and Data System could be a significant factor that affects immediate surgical excision and follow-up compliance. Cancers were detected only in the initial category 4A group of concordant benign lesions. More attention should be paid to the concordant benign lesions from the initial category 4A group than from the category 3 group.