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조미연,김준미,김현기,국명철,박도윤,이재혁,장희경,정은선,김희경,진소영,최준혁,구미진,김수진,강미선,조창호,박문일,강윤경,김윤화,윤선오,배한익,주미,문우성,강대영,장세진,김경미,김우호,손진희,김미정,김우호 대한암학회 2012 Cancer Research and Treatment Vol.44 No.3
Purpose As a result of various independently proposed nomenclatures and classifications, there is confusion in the diagnosis and prediction of biological behavior of gastroenteropancreatic neuroendocrine tumors (GEP-NETs). A comprehensive nationwide study is needed in order to understand the biological characteristics of GEP-NETs in Korea. Materials and Methods We collected 4,951 pathology reports from 29 hospitals in Korea between 2000 and 2009. Kaplan-Meier survival analysis was used to determine the prognostic significance of clinicopathological parameters. Results Although the GEP-NET is a relatively rare tumor in Korea, its incidence has increased during the last decade, with the most significant increase found in the rectum. The 10-year survival rate for well-differentiated endocrine tumor was 92.89%, in contrast to 85.74% in well differentiated neuroendocrine carcinoma and 34.59% in poorly differentiated neuroendocrine carcinoma. Disease related death was most common in the biliary tract (62.2%) and very rare in the rectum (5.2%). In Kaplan-Meier survival analysis, tumor location, histological classification, extent, size,mitosis, Ki-67 labeling index, synaptophysin expression, lymphovascular invasion, perineural invasion, and lymph node metastasis showed prognostic significance (p<0.05), however, chromogranin expression did not (p=0.148). The 2000 and 2010 World Health Organization (WHO)classification proposals were useful for prediction of the prognosis of GEP-NET. Conclusion The incidence of GEP-NET in Korea has shown a remarkable increase during the last decade,however, the distribution of tumors in the digestive system differs from that of western reports. Assessment of pathological parameters, including immunostaining, is crucial in understanding biological behavior of the tumor as well as predicting prognosis of patients with GEP-NET.
손진희,조미연,박양순,김현기,김우호,김준미,정은선,김경미,이재혁,장희경,박도윤,주미,김수진,문우성,강미선,진소영,강윤경,윤선옥,한혜승,최은희 대한암학회 2015 Cancer Research and Treatment Vol.47 No.4
Purpose In 2010, the World Health Organization categorized L-cell type neuroendocrine tumors(NETs) as tumors of uncertain malignancy, while all others were classified as malignant. However, the diagnostic necessity of L-cell immunophenotyping is unclear, as are tumorstage and grade that may guide diagnosis and management. To clarify the predictivemarkers of rectal neuroendocrine neoplasms (NENs), 5- and 10-year overall survival (OS)was analyzed by pathological parameters including L-cell phenotype. Materials and MethodsA total of 2,385 rectal NENs were analyzed from our previous multicenter study and a subsetof 170 rectal NENs was immunophenotyped. ResultsIn univariate survival analysis, tumor grade (p < 0.0001), extent (p < 0.0001), size(p < 0.0001), lymph node metastasis (p=0.0063), and L-cell phenotype (p < 0.0001)showed significant correlation with the prognosis of rectal NENs; however, none of thesemarkers achieved independent significance in multivariate analysis. The 10-year OS oftumors of NET grade 1, < 10 mm, the mucosa/submucosa was 97.58%, 99.47%, and99.03%, respectively. L-Cell marker, glucagon II (GLP-1&2), with a cut off score of > 10, isuseful in defining L-Cell type. In this study, an L-cell immunophenotype was found in 83.5%of all rectal NENs and most, but not all L-cell type tumors were NET G1, small (< 10 mm)and confined to the mucosa/submucosa. ConclusionFrom these results, the biological behavior of rectal NENs does not appear to be determinedby L-cell type alone but instead by a combination of pathological parameters.
Simple and Highly Efficient Synthesis of [$^{11}C$]methionine Using Solid-Phase Extraction Method
임성재,문우연,최재칠,조시만,오승준,Lim, Sung-Jae,Moon, Woo-Yeon,Choi, Jae-Chil,Cho, Shee-Man,Oh, Seung-Jun The Korean Society of Nuclear Medicine Technology 2008 핵의학 기술 Vol.12 No.2
We developed simple and highly efficient synthesis method for [$^{11}C$]methionine using solid-phase extraction method. For synthesis, we used C18 cartridge. [$^{11}C$]methionine was synthesized on C18 cartridge according to the solid-phase [$^{11}C$]methylation of precursor L-homocysteine thiolactone hydrochloride. The radiochemical yields of [$^{11}C$]methionine was $48.9{\pm}7.93%$ decay corrected (results of 30 syntheses, mean$\pm$SD), with average production higher than 180 mCi. This procedure showed high yield and simple synthesis of [$^{11}C$]methionine.
정은선,이경분,유은실,강윤경,조미연,김준미,문우성,정진숙,박철근,박재복,강대영,손진희,진소영 대한병리학회 2016 Journal of Pathology and Translational Medicine Vol.50 No.3
Background: The histomorphologic criteria for the pathological features of liver tissue from patients with non-alcoholic fatty liver disease (NAFLD) remain subjective, causing confusion among pathologists and clinicians. In this report, we studied interobserver agreement of NAFLD pathologic features and analyzed causes of disagreement. Methods: Thirty-one cases of clinicopathologically diagnosed NAFLD from 10 hospitals were selected. One hematoxylin and eosin and one Masson’s trichrome-stained virtual slide from each case were blindly reviewed with regard to 12 histological parameters by 13 pathologists in a gastrointestinal study group of the Korean Society of Pathologists. After the first review, we analyzed the causes of disagreement and defined detailed morphological criteria. The glass slides from each case were reviewed a second time after a consensus meeting. The degree of interobserver agreement was determined by multi-rater kappa statistics. Results: Kappa values of the first review ranged from 0.0091–0.7618. Acidophilic bodies (k = 0.7618) and portal inflammation (k = 0.5914) showed high levels of agreement, whereas microgranuloma (k = 0.0984) and microvesicular fatty change (k = 0.0091) showed low levels of agreement. After the second review, the kappa values of the four major pathological features increased from 0.3830 to 0.5638 for steatosis grade, from 0.1398 to 0.2815 for lobular inflammation, from 0.1923 to 0.3362 for ballooning degeneration, and from 0.3303 to 0.4664 for fibrosis. Conclusions: More detailed histomorphological criteria must be defined for correct diagnosis and high interobserver agreement of NAFLD.
A scoring system for the diagnosis of non-alcoholic steatohepatitis from liver biopsy
이경분,정은선,유은실,강윤경,조미연,김준미,문우성,정진숙,박철근,박재복,강대영,손진희,진소영 대한병리학회 2020 Journal of Pathology and Translational Medicine Vol.54 No.3
Background: Liver biopsy is the essential method to diagnose non-alcoholic steatohepatitis (NASH), but histological features of NASH are too subjective to achieve reproducible diagnoses in early stages of disease. We aimed to identify the key histological features of NASH and devise a scoring model for diagnosis. Methods: Thirteen pathologists blindly assessed 12 histological factors and final histological diagnoses (‘not-NASH,’ ‘borderline,’ and ‘NASH’) of 31 liver biopsies that were diagnosed as non-alcoholic fatty liver disease (NAFLD) or NASH before and after consensus. The main histological parameters to diagnose NASH were selected based on histological diagnoses and the diagnostic accuracy and agreement of 12 scoring models were compared for final diagnosis and the NAFLD Activity Score (NAS) system. Results: Inter-observer agreement of final diagnosis was fair (κ = 0.25) before consensus and slightly improved after consensus (κ = 0.33). Steatosis at more than 5% was the essential parameter for diagnosis. Major diagnostic factors for diagnosis were fibrosis except 1C grade and presence of ballooned cells. Minor diagnostic factors were lobular inflammation ( ≥ 2 foci/ × 200 field), microgranuloma, and glycogenated nuclei. All 12 models showed higher inter-observer agreement rates than NAS and post-consensus diagnosis (κ = 0.52–0.69 vs. 0.33). Considering the reproducibility of factors and practicability of the model, summation of the scores of major (× 2) and minor factors may be used for the practical diagnosis of NASH. Conclusions: A scoring system for the diagnosis of NAFLD would be helpful as guidelines for pathologists and clinicians by improving the reproducibility of histological diagnosis of NAFLD.
An Unusual Case of Anaphylaxis After Fluorine-18-Labeled Fluorodeoxyglucose Injection
이동윤,이종진,권혁수,문우연,진소영,이상주,오승준,류진숙 대한핵의학회 2013 핵의학 분자영상 Vol.47 No.3
[18F]FDG (fluorine-18 fluoro-2-deoxy-D-glucose)positron emission tomography (PET) is used worldwide for oncologic and neurologic applications. To date, the potential harm caused by [18F]FDG has focused on its radiation exposure effects rather than on its pharmacological effects. While an allergic response in the form of a skin manifestation has been reported after exposure to [18F]FDG, this report describes the first case of hypotension following exposure to this tracer. Here, the development of anaphylaxis after [18F]FDG injection is described.
노동영,문형곤,한원식,이종원,고은영,김은규,유종한,정소연,여채연,문우경,황기태 한국유방암학회 2010 Journal of breast cancer Vol.13 No.2
Purpose: A better predictive model for occult invasive disease in ductal carcinoma in situ (DCIS) patients is essential to guide the tailored use of sentinel node biopsies. We hypothesized that recent improvement of contrast-enhanced breast magnetic resonance imaging (MRI) could provide more accurate information on the presence of occult invasion in DCIS patients. Methods: From a prospectively maintained database, we identified 143 DCIS patients diagnosed with needle biopsies in whom MRI images were available. Results: Sixty-five patients (45.5%) were upstaged to invasive carcinoma after curative surgery. Ultrasonographic lesion size, mass-appearance on mammography, type of needle used, and the presence of suspicious microinvasive foci were associated with increased likelihood of upstaging. Among the features of MRI, only mass-appearance was significantly associated with the presence of invasive disease (p=0.002). However, up to 50% of masses in MRI cases had massappearance on mammography as well. Other morphologic and pharmacokinetic features of MRI, such as shape, margin, and patterns of enhancement and washout, did not have a significant association. Conclusion: Among various morphologic and pharmacokinetic parameters of contrast-enhanced MRI, only mass-appearance was associated with occult invasive disease. Our results show the limitations of current contrast-enhanced MRI in predicting invasive disease in patients with preoperative diagnoses of DCIS.
폐결핵 의심 환자에서 기관지 내시경 검체를 이용한 Xpert MTB/RIF 검사의 진단적 유용성
이하연,성문우,박성섭,황승식,이진우,박영식,이창훈,이상민,유철규,김영환,한성구,임재준 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.-
목적: Xpert MTB/RIF검사는 결핵 진단에 대해 높은 민감도와 특이도를 가진다. 한편, 도말 음성 혹은 객담을 배출하지 못하는 환자에서 기관지내시경 검사를 시행하였을 경우 폐결핵의 진단율을 높인다는 보고들이 있다. 이 연구의 목적은 폐결핵 의심 환자에서 기관지내시경 검체로 Xpert MTB/RIF검사를 시행하였을 때 진단에 얼마나 도움이 되는지를 확인하는 것이다. 방법: 2011년 9월부터 2012년 6월까지 서울대병원을 내원한 폐결핵이 의심되어 기관지내시경 검체를 이용한 Xpert MTB/RIF 검사가 시행된 환자들을 대상으로 하였다. 기관지내시경 검체로 시행한 Xpert MTB/RIF검사와 항산균 도말 검사 및 배양 검사의 민감도, 특이도, 양성예측도, 음성예측도를 구하여 분석하였다. 폐결핵은 배양검사 결과, 영상의학적, 병리적, 임상 소견을 모두 종합하여 진단하였다. 성적: 전체 132명을 분석하였고, 이중 50명이 폐결핵으로 진단되었다. 기관지내시경 검체를 이용하여 Xpert MTB/RIF 검사를 시행하였을 때 민감도, 특이도, 양성예측도, 음성예측도는 각각 70%, 100%, 100%, 84.5%였다. 항산균 도말 검사의 민감도와 특이도는 10.0%와 98.8% 였으며, 결핵균 배양 검사의 민감도 와 특이도는 62.0%와 100%였다. 결론: 기관지 내시경 검체를 이용한 Xpert MTB/RIF 검사는 도말 음성이거나 객담을 배출할 수 없는 환자에게서 빠르고 정확하게 폐결핵을 진단하는데 도움을 준다.