The effect of late-phase contrast enhancement on semi-automatic software measurements of CT attenuation and volume of part-solid nodules in lung adenocarcinomas

Cohen, J.G.,Goo, J.M.,Yoo, R.E.,Park, S.B.,van Ginneken, B.,Ferretti, G.R.,Lee, C.H.,Park, C.M. G. Thieme ; Elsevier Science Pub. Co 2016 European journal of radiology Vol.85 No.6

<P>Objectives: To evaluate the differences in semi-automatic measurements of CT attenuation and volume of part-solid nodules (PSNs) between unenhanced and enhanced CT scans. Materials and methods: CT scans including unenhanced and enhanced phases (slice thickness 0.625 and 1.25 mm, respectively) for 53 adenocarcinomas presenting as PSNs in 50 patients were retrospectively evaluated. For each nodule, semi-automatic segmentation provided the diameter, mean attenuation, mass, and volume of a whole nodule and its solid component. Interscan variability and statistical significance of the differences in those measures according to the adenocarcinoma category were evaluated by one reader. Results: All parameters except for the mean attenuation of the solid components, were significantly increased on enhanced CT (p < 0.05). For the whole nodule, the mean relative differences were as follows: the longest diameter, 1.4% (limits of agreement,-6.2-9.1); volume, 2.4% (-26.7-31.4); mass, 7.0% (-11.3-25.2); mean attenuation, 2.7% (-5.6-11). For the nodule's solid component, those differences were as follow: the longest diameter, 6.9% (-34.4-48.2); volume, 17.9% (-77.8-113.7); mass, 18.8% (-77.8-115.4). The differences of measures between the unenhanced and enhanced CT were not significantly different between two groups of adenocarcinoma in situ/minimally invasive adenocarcinomas and invasive adenocarcinomas (p > 0.05). Conclusions: As most volumetric and attenuation measurements changed significantly after contrast enhancement, care should be taken in comparing unenhanced and enhanced CT in the evaluation of PSNs. (C) 2016 Elsevier Ireland Ltd. All rights reserved.</P>

Clinicopathological features of signet-ring cell carcinoma of the colon and rectum: a case-matched study.

Min, Byung Soh,Kim, Nam Kyu,Ko, Yong Taek,Baek, Seung Hyuk,Lee, Kang Young,Sohn, Seung Kook,Cho, Chang Hwan,Kang, Dae Ryong G. Thieme 2009 Hepato-gastroenterology Vol.56 No.93

<P>BACKGROUND/AIMS: Primary colorectal signet-ring cell carcinoma (SRC) is a rare type of mucin-containing adenocarcinoma and little information exists about its clinicopathological features. METHODS: The clinicopathological features of 27 patients with primary colorectal SRC were compared with non-signet-ring cell mucinous carcinoma (MC) and non-mucinous adenocarcinoma (NMC). To analyze survival and recurrence, we used matched control groups. RESULTS: The mean age of patients in SRC was significantly younger than that of NMC (p = 0.003). The ratio of metastatic lymph nodes to harvested lymph nodes was also significantly higher in SRC (48.5 +/- 30.6) than in either MC (29.8 +/- 26.3; p = 0.009) or NMC (22.0 +/- 21.6; p = 0.003). In stage II and III, SRC was found to be associated with a worse cancer-specific survival and a higher systemic recurrence rates than either NMC or MC. CONCLUSIONS: Primary colorectal SRC has distinctive clinicopathological features and is associated with a poorer prognosis than the other histological subtypes.</P>

Laparoscopic completion total gastrectomy in remnant gastric cancer: technical detail and experience of two cases.

Song, Jyewon,Kim, Jeong Yoen,Kim, Sungsoo,Choi, Won Hyuk,Cheong, Jae Ho,Hyung, Woo Jin,Choi, Seung Ho,Noh, Sung Hoon G. Thieme 2009 Hepato-gastroenterology Vol.56 No.93

<P>The treatment of choice for remnant gastric cancer is resection by open conventional method, but due to adhesion and deformed anatomic structure, reoperation is one of the most complicated surgeries. We therefore introduce 2 cases of laparoscopy-assisted completion total gastrectomy. One was 67 yrs old male who had radical subtotal gastrectomy with gastrojejunostomy due to stomach cancer 30 years ago. Gastric polyp was found in routine EGD. Biopsy results showed focal adenocarcinoma and laparoscopy-assisted total gastrectomy with Roux-en-Y esophagojejunostomy was decided and performed. The other case was 65 yrs old male who went through radical subtotal gastrectomy with gastroduodenostomy 8 years ago due to stomach cancer. Recur was diagnosed by routine EGD, and laparoscopic assisted total gastrectomy with Roux-en-Y esophagojejunostomy was done. As can be seen in this study, laparoscopy-assisted gastrectomy could be safely applied in remnant gastric cancer.</P>

Allele frequency of thiopurine methyltransferase and inosine triphosphate pyrophosphatase gene polymorphisms in Korean patients with inflammatory bowel diseases.

Cheon, Jae Hee,Kim, Jae Hak,Kim, Bo Young,Kim, Seung Won,Hong, Sung Yi,Eun, Chang Soo,Hong, Seong Soo,Byeon, Jeong-Sik,Kim, Tae Il,Han, Dong Soo,Yang, Suk-Kyun,Lee, Kyoung Ryul,Kim, Won Ho G. Thieme 2009 Hepato-gastroenterology Vol.56 No.90

<P>BACKGROUND/AIMS: Adverse reactions to thiopurines may be predisposed by thiopurine methyltransferase (TPMT) or inosine triphosphate pyrophosphatase (ITPA) gene mutations. METHODOLOGY: We examined the frequencies of TPMT and ITPA gene polymorphisms in 812 Korean patients with inflammatory bowel diseases using denaturing high performance liquid chromatography and direct sequencing. Results: The allele frequencies of TPMT*2, TPMT*3A, TPMT*3B, and TPMT*3C were 0, 0, 0, and 0.010 (17/1624), respectively. For the ITPA polymorphism, 173 subjects were heterozygous and 5 were homozygous for the 94C>A missense mutation (allele frequency of A, 0.113). Moreover, the 87T>C, IVS2+21A>C, and IVS2+53C>T polymorphisms were found in one patient each (1/1624), respectively. Of these, 87T>C and IVS2+53C>T were novel single nucleotide polymorphisms of the ITPA gene whose clinical significance should be further evaluated. CONCLUSIONS: Our data describe TPMT and ITPA gene mutation patterns among Koreans and provide a basis for screening studies to identify patients at high risk for myelotoxicity from thiopurine drugs.</P>

Prognostic value of thymidine phosphorylase expression for pancreatic cancer.

Hong, Sung Pil,Shin, Sung Kwan,Bang, Seungmin,Park, Seung Woo,Chung, Jae Bock,Lee, Woo Jung,Song, Si Young G. Thieme 2009 Hepato-gastroenterology Vol.56 No.93

<P>BACKGROUND/AIMS: Thymidine phosphorylase (TP) has an angiogenic activity, but the prognostic value of TP has not been fully validated for pancreatic cancer. The aim of this study was to evaluate TP expression according to clinicopathological parameters to define its prognostic value for pancreatic cancer. METHODOLOGY: Forty-three patients with pancreatic ductal adenocarcinoma were examined retrospectively. TP expression and intratumoral microvessel density (IMD) were evaluated by immunohistochemistry. TP expression was analyzed according to clinicopathological parameters. RESULTS: Twenty-eight (65%) of 42 cases showed diffuse cytoplasmic and nucleic TP staining. IMD was significantly higher in TP-positive tumors than in TP-negative tumors (27.7 +/- 8.9 vs. 18.1 +/- 4.4, p < 0.01). TP levels were significantly higher in T3 and T4 tumors than in T1 and T2 tumors (56% vs. 9.3%, respectively, p < 0.05). Patients with TP-positive tumors more frequently developed hepatic recurrence than those with TP-negative tumors after resection (p < 0.01). Patients with TP-positive tumors had a shorter survival than patients with TP-negative tumors (p < 0.05). CONCLUSION: TP expression can be used as a predictor of hepatic recurrence and as an unfavorable prognostic factor for pancreatic cancer.</P>

In vitro chemosensitivity of gastric adenocarcinomas to histone deacetylase inhibitors, compared to established drugs.

Yoon, Sang Nam,Roh, Seon Ae,Cho, Dong Hyung,Kim, Moon Bo,Hyun, Young-Lan,Ro, Seonggu,Kim, Byung Sik,Kim, Seon Young,Kim, Yong Sung,Kim, Jin Cheon G. Thieme 2010 Hepato-gastroenterology Vol.57 No.99

<P>BACKGROUND/AIMS: This study was performed to determine the efficacy of histone deacetylase inhibitors in gastric cancer, together with other established regimens. METHODOLOGY: The chemosensitivities of 93 gastric cancer patients to established drugs, and three histone deacetylase inhibitors (SAHA, PXD101, and a novel candidate, CG-2) were evaluated using the histoculture drug response assay. RESULTS: Tumor growth inhibition rates were the highest with cisplatin, followed by PXD101, taxol, docetaxel, and TS-1, in descending order. The response rates were 41.9-68.8%, and 37.6-47.3%, respectively, at an inhibition rate cutoff value of 30%. Synergistic activity was evident with most combinations of established drugs and histone deacetylase inhibitors. Diffuse- or mixed-type carcinomas on Lauren classification were closely associated with increased chemosensitivity to TS-1 (p = 0.044). Node-positive and 'other than tubular type' tumors on WHO classification were chemosensitive to cisplatin (p = 0.011 and 0.014, respectively). CG-2 chemosensitivity was markedly associated with low preoperative CA724 level (< or = 4 U/ml) (p = 0.046). CONCLUSIONS: This in vitro chemosensitivity assay validates the comparable chemo-response of gastric cancers to histone deacetylase inhibitors and established drugs, indicating considerable therapeutic efficacy of these agents. Additionally, a number of clinicopathological parameters are significantly associated with specific regimens.</P>

Expression of p16, p53, and Ki-67 in colorectal adenocarcinoma: a study of 356 surgically resected cases.

Huh, Jung Wook,Lee, Jae Hyuk,Kim, Hyeong Rok G. Thieme 2010 Hepato-gastroenterology Vol.57 No.101

<P>BACKGROUND/AIMS: The aim of the present study was to investigate the clinicopathological significance of p53, Ki-67, and p16 expression in patients with colorectal adenocarcinoma. METHODOLOGY: We evaluated p53, Ki-67, and p16 expression in 356 patients with primary colorectal adenocarcinoma using an immunohistochemical staining method. The relationships between these protein expressions and clinicopathological factors were statistically analyzed. RESULTS: Positive p53 staining was detected more often in typical adenocarcinoma compared to mucinous adenocarcinoma (49% versus 17%, p = 0.007) and in well or moderately differentiated adenocarcinoma compared to poorly differentiated adenocarcinoma (50% versus 32%, p = 0.030). The level of expression of p53 protein was related to lymph node metastasis (p < 0.001) and the TNM stage of the colorectal adenocarcinoma (p = 0.006). The p53 protein expression was related to an increased tendency of lymphovascular invasion (p = 0.058). However, Ki-67 and p16 expression levels were not associated with any of the clinicopathological variables. The overexpression of p53 was correlated with a higher level of Ki-67 (p = 0.001) and positive staining of p16 (p < 0.001). CONCLUSIONS: Our data suggest that overexpression of p53, which was correlated with Ki-67 and p16 expression, plays a critical role in aggressive tumor behaviors in patients with colorectal adenocarcinoma. However, further long-term followup studies are warranted to evaluate the clinical impacts of p53 in a larger group of patients.</P>

The clinical usefulness of the ZAP classification for non-erosive reflux disease (NERD), using distal esophageal biopsy.

Kim, Beom Jin,Rheez, Poong-Lyul,Lee, Hyuk,Kim, Jeong Hwan,Son, Hee Jung,Chang, Dong Kyung,Kim, Young-Ho,Kim, Jae J,Rhee, Jong Chul,Kim, Ji Hoon G. Thieme 2009 Hepato-gastroenterology Vol.56 No.90

<P>BACKGROUND/AIM: It has been reported that the Z-line appearance (the ZAP grade) wascorrelated with the prevalence of intestinal metaplasia. Therefore, we prospectively investigated the clinical usefulness of ZAP classification based on the histology in making a diagnosis of non-erosive reflux disease (NERD). METHODOLOGY: We studied 80 consecutive young male patients with heartburn and acid regurgitation. The symptom characteristics were collected by interviewing with a structured questionnaire. Upper GI endoscopy with biopsy was performed to identify the distal esophagitis. RESULTS: Correlation was significant between the ZAP score and the LA classification (Spearman cor relation factor: 0.463). There were no significant differences in symptom according to the ZAP score. There were no significant differences in microscopic esophagitis between the patients with NERD (ZAP 0) and those with ERD (Erosive Reflux Disease, ZAP I, II, III). No statistical significance was observed between the ZAP score and the histology. In the diagnosis of NERD, ZAP classificationwas more accurate than LA classification in the basis of histology at distal esophagus (p < 0.05). CONCLUSIONS: The ZAP classification could be applied to diagnosis of GERD, especially NERD. Biopsy taken at distal esophagus can be a limited but useful diagnostic tool, particularly in patients with NERD.</P>

Age as a clinical predictor of relapse after induction therapy in ulcerative colitis.

Jang, Eun Sun,Lee, Dong Ho,Kim, Jaihwan,Yang, Hyo-Joon,Lee, Sang Hyub,Park, Young Soo,Hwang, Jin Hyoek,Kim, Jin-Wook,Jeong, Sook-Hyang,Kim, Nayoung,Jung, Hyun Chae,Song, In Sung G. Thieme 2009 Hepato-gastroenterology Vol.56 No.94

<P>BACKGROUND/AIMS: Whether older patients with ulcerative colitis (UC) have a better clinical course than younger patients is unclear. We compared the clinical characteristics between older and younger age groups in South Korea to elucidate the impact of age on relapse in UC. METHODOLOGY: Patients between 18 and 85 years old who were diagnosed with UC at Seoul National University Bundang Hospital between 1 May 2003 and 31 Oct 2007 were enrolled. It was reviewed their symptoms, endoscopic and pathologic findings, and drugs used in induction treatment. RESULTS: Of the 73 patients with UC who achieved remission after induction treatment, 38 relapsed. The patients aged 18-44 and 45-85 years had similar clinical features, but the relapse rate was significantly higher in the younger group (69.2 vs. 32.4%; p = 0.002). In a multivariable analysis, age 45-85 years old was an independent protective factor against relapse (OR, 0.146; 95% CI, 0.035-0.508; p = 0.003) after adjusting for sex, frequency of diarrhea, hematochezia grade, disease extent, and systemic steroid used in induction treatment. CONCLUSION: An age of 45 years or older is an independent predictor of less relapse in UC.</P>

Selection of precore mutants during lamivudine treatment in patients with chronic hepatitis B.

Cheong, Jae Youn,Cho, Sung Won,Yoo, Jun Hwan,Hong, Sun Pyo,Kim, Soo-Ok,Yoo, Wang Don,Kim, Jin Hong G. Thieme 2008 Hepato-gastroenterology Vol.55 No.84

<P>BACKGROUND/AIMS: Evolution of precore genes can occur during lamivudine therapy in HBV infection. This study investigated the changes in precore regions in patients treated with lamivudine and the pattern during relapse. METHODOLOGY: The sequences of codon 28 in precore region in serial samples of 16 patients with HBV (11 HBeAg-positive and 5 HBeAg-negative) treated with lamivudine were analyzed by restriction fragment mass polymorphism. RESULTS: Among 9 patients who had wild-type virus, the wild-type virus was replaced by A1896 during relapse after initial treatment in 2 patients, and a pure population with A1896 selected during relapse in all 4 patients with mixed infection. In 5 patients with A1896 during relapse, 3 patients initially reverted to wild-type and later selected A1896, and 2 patients maintained A1896 during lamivudine retreatment. In 8 patients showing HBeAg negative reactivation, 3 patients showed A1896 and 5 patients showed wildtype virus. CONCLUSIONS: Lamivudine therapy induced initial reversion from precore mutants to wild-type virus, but precore mutants reappeared in patients infected with precore mutants. In some patients infected by wildtype HBV, wild-type HBV was replaced by precore mutants, resulting in a flare-up of hepatitis after cessation of lamivudine administration, and HBeAg negativity did not always correspond to the presence of precore mutants.</P>