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Park, Sung-Joon,Choo, Ji Yung,Lee, Ki Yeol,Kim, Je-Hyeong,Choi, Jung-Woo,Yeom, Suk Keu,Kim, Baek Hyun Korean Cancer Association 2015 Cancer Research and Treatment Vol.47 No.3
<P>Bronchial carcinosarcoma is a very rare malignant tumor that is composed of carcinomatous and sarcomatous elements. We describe the first case in which digital tomosynthesis was useful for the evaluation of airway obstruction by bronchial carcinosarcoma that was overlooked on initial chest radiography.</P>
( Dong Oh Kang ),( Jee Youn Oh ),( Jae Kyeom Sim ),( Jong Hyun Choi ),( Ji Yung Choo ),( Jin Wook Hwang ),( Seung Heon Lee ),( Ju Han Lee ),( Ki Yeol Lee ),( Chol Shin ),( Je Hyeong Kim ) 대한결핵 및 호흡기학회 2013 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.116 No.-
Background: Low-grade endometrial stromal sarcoma (ESS) is an uncommon gynecologic malignancy of mesodermal origin. Low-grade ESS is frequently mistaken as benign uterine neoplasm like uterine leiomyoma, and unawareness on previous medical history could lead to a potential misdiagnosis. Case: We present a case of a 42-year-old woman with low-grade ESS that was initially presented as an incidental lung mass with multiple pulmonary nodules, seven years after uterine myomectomy in a local clinic. Initial radiologic finding showed right perihilar lung mass with various sized multiple peripheral nodules on both lungs suggesting metastatic lesions rather than primary lung malignancy. A 6.9×5.8 cm sized intrapelvic mass suspicious of uterine origin was found with abdomen-pelvis computed tomography scan under searching for potential extrathoracic primary origin. Diagnostic pelviscopy for intrapelvic lesion and simultaneous video assisted thoracoscopic surgery for lung biopsy were conducted for pathologic diagnosis. Finally, the diagnosis was confirmed as low-grade ESS with lung metastasis based on Hematoxylin & eosin and immunohistochemical stain which showed positivites for CD10 and hormone receptor markers (estrogen and progesterone receptors) in both pelvic and lung specimens. Subsequently, total hysterectomy with both salphingo-ophorectomy was performed and postoperative palliative chemotherapy was initiated. Conclusion: We herein report a low-grade ESS with lung metastasis which had been to be misdiagnosed as benign uterine leiomyoma at initial presentation. Background: Low-grade endometrial stromal sarcoma (ESS) is an uncommon gynecologic malignancy of mesodermal origin. Low-grade ESS is frequently mistaken as benign uterine neoplasm like uterine leiomyoma, and unawareness on previous medical history could lead to a potential misdiagnosis. Case: We present a case of a 42-year-old woman with low-grade ESS that was initially presented as an incidental lung mass with multiple pulmonary nodules, seven years after uterine myomectomy in a local clinic. Initial radiologic finding showed right perihilar lung mass with various sized multiple peripheral nodules on both lungs suggesting metastatic lesions rather than primary lung malignancy. A 6.9×5.8 cm sized intrapelvic mass suspicious of uterine origin was found with abdomen-pelvis computed tomography scan under searching for potential extrathoracic primary origin. Diagnostic pelviscopy for intrapelvic lesion and simultaneous video assisted thoracoscopic surgery for lung biopsy were conducted for pathologic diagnosis. Finally, the diagnosis was confirmed as low-grade ESS with lung metastasis based on Hematoxylin & eosin and immunohistochemical stain which showed positivites for CD10 and hormone receptor markers (estrogen and progesterone receptors) in both pelvic and lung specimens. Subsequently, total hysterectomy with both salphingo-ophorectomy was performed and postoperative palliative chemotherapy was initiated. Conclusion: We herein report a low-grade ESS with lung metastasis which had been to be misdiagnosed as benign uterine leiomyoma at initial presentation.
Diagnostic Accuracy of Percutaneous Transthoracic Needle Lung Biopsies: A Multicenter Study
이경희,임건영,서영주,허진,Dae Hee Han,강미진,Ji Yung Choo,김채리,Jung Im Kim,윤순호,Woojoo Lee,박창민 대한영상의학회 2019 Korean Journal of Radiology Vol.20 No.8
Objective: To measure the diagnostic accuracy of percutaneous transthoracic needle lung biopsies (PTNBs) on the basis of the intention-to-diagnose principle and identify risk factors for diagnostic failure of PTNBs in a multi-institutional setting. Materials and Methods: A total of 9384 initial PTNBs performed in 9239 patients (mean patient age, 65 years [range, 20–99 years]) from January 2010 to December 2014 were included. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of PTNBs for diagnosis of malignancy were measured. The proportion of diagnostic failures was measured, and their risk factors were identified. Results: The overall accuracy, sensitivity, specificity, PPV, and NPV were 91.1% (95% confidence interval [CI], 90.6–91.7%), 92.5% (95% CI, 91.9–93.1%), 86.5% (95% CI, 85.0–87.9%), 99.2% (95% CI, 99.0–99.4%), and 84.3% (95% CI, 82.7–85.8%), respectively. The proportion of diagnostic failures was 8.9% (831 of 9384; 95% CI, 8.3–9.4%). The independent risk factors for diagnostic failures were lesions ≤ 1 cm in size (adjusted odds ratio [AOR], 1.86; 95% CI, 1.23–2.81), lesion size 1.1–2 cm (1.75; 1.45–2.11), subsolid lesions (1.81; 1.32–2.49), use of fine needle aspiration only (2.43; 1.80–3.28), final diagnosis of benign lesions (2.18; 1.84–2.58), and final diagnosis of lymphomas (10.66; 6.21–18.30). Use of conebeam CT (AOR, 0.31; 95% CI, 0.13–0.75) and conventional CT-guidance (0.55; 0.32–0.94) reduced diagnostic failures. Conclusion: The accuracy of PTNB for diagnosis of malignancy was fairly high in our large-scale multi-institutional cohort. The identified risk factors for diagnostic failure may help reduce diagnostic failure and interpret the biopsy results.
Jeon, Kyung Nyeo,Goo, Jin Mo,Lee, Chang Hyun,Lee, Youkyung,Choo, Ji Yung,Lee, Nyoung Keun,Shim, Mi-Suk,Lee, In Sun,Kim, Kwang Gi,Gierada, David S.,Bae, Kyongtae T. Lippincott Williams Wilkins, Inc. 2012 Vol. No.
OBJECTIVE: The aim of this study was to evaluate whether a computer-aided diagnosis (CAD) system improves interobserver agreement in the interpretation of lung nodules at low-dose computed tomography (CT) screening for lung cancer. MATERIALS AND METHODS: Baseline low-dose screening CT examinations from 134 participants enrolled in the National Lung Screening Trial were reviewed by 7 chest radiologists. All participants consented to the use of their deidentified images for research purposes. Screening results were classified as positive when noncalcified nodules larger than 4 mm in diameter were present. Follow-up evaluation was recommended according to the nodule diameter: 4 mm or smaller, more than 4 to 8 mm, and larger than 8 mm. When multiple nodules were present, recommendations were based on the largest nodule. Readers initially assessed the nodule presence visually and measured the average nodule diameter manually. Revision of their decisions after reviewing the CAD marks and size measurement was allowed. Interobserver agreement evaluated using multirater &kgr; statistics was compared between initial assessment and that with CAD. RESULTS: Multirater &kgr; values for the positivity of the screening results and follow-up recommendations were improved from moderate (&kgr; = 0.53–0.54) at initial assessment to good (&kgr; = 0.66–0.67) after reviewing CAD results. The average percentage of agreement between reader pairs on the positivity of screening results and follow-up recommendations per case was also increased from 77% and 72% at initial assessment to 84% and 80% with CAD, respectively. CONCLUSION: Computer-aided diagnosis may improve the reader agreement on the positivity of screening results and follow-up recommendations in the assessment of low-dose screening CT.
윤순호,구진모,Julip Jung,Helen Hong,박은아,이창현,이유경,진광남,Ji Yung Choo,이녕근 대한영상의학회 2014 Korean Journal of Radiology Vol.15 No.3
Objective: To evaluate the technical feasibility, performance, and interobserver agreement of a computer-aided classification (CAC) system for regional ventilation at two-phase xenon-enhanced CT in patients with chronic obstructive pulmonary disease (COPD). Materials and Methods: Thirty-eight patients with COPD underwent two-phase xenon ventilation CT with resulting wash-in (WI) and wash-out (WO) xenon images. The regional ventilation in structural abnormalities was visually categorized into four patterns by consensus of two experienced radiologists who compared the xenon attenuation of structural abnormalities with that of adjacent normal parenchyma in the WI and WO images, and it served as the reference. Two series of image datasets of structural abnormalities were randomly extracted for optimization and validation. The proportion of agreement on a per-lesion basis and receiver operating characteristics on a per-pixel basis between CAC and reference were analyzed for optimization. Thereafter, six readers independently categorized the regional ventilation in structural abnormalities in the validation set without and with a CAC map. Interobserver agreement was also compared between assessments without and with CAC maps using multirater κ statistics. Results: Computer-aided classification maps were successfully generated in 31 patients (81.5%). The proportion of agreement and the average area under the curve of optimized CAC maps were 94% (75/80) and 0.994, respectively. Multirater κ value was improved from moderate (κ = 0.59; 95% confidence interval [CI], 0.56–0.62) at the initial assessment to excellent (κ = 0.82; 95% CI, 0.79–0.85) with the CAC map. Conclusion: Our proposed CAC system demonstrated the potential for regional ventilation pattern analysis and enhanced interobserver agreement on visual classification of regional ventilation.
윤순호,박창민,이경희,임건영,서영주,임동진,허진,Dae Hee Han,강미진,Ji Yung Choo,김채리,김정임,홍현숙 대한영상의학회 2019 Korean Journal of Radiology Vol.20 No.3
ObjectiveTo analyze the complications of percutaneous transthoracic needle biopsy using CT-based imaging modalities for needle guidance in comparison with fluoroscopy in a large retrospective cohort. Materials and MethodsThis study was approved by multiple Institutional Review Boards and the requirement for informed consent was waived. We retrospectively included 10568 biopsies from eight referral hospitals from 2010 through 2014. In univariate and multivariate logistic analyses, 3 CT-based guidance modalities (CT, CT fluoroscopy, and cone-beam CT) were compared with fluoroscopy in terms of the risk of pneumothorax, pneumothorax requiring chest tube insertion, and hemoptysis, with adjustment for other risk factors. ResultsPneumothorax occurred in 2298 of the 10568 biopsies (21.7%). Tube insertion was required after 316 biopsies (3.0%), and hemoptysis occurred in 550 cases (5.2%). In the multivariate analysis, pneumothorax was more frequently detected with CT {odds ratio (OR), 2.752 (95% confidence interval [CI], 2.325–3.258), p < 0.001}, CT fluoroscopy (OR, 1.440 [95% CI, 1.176–1.762], p < 0.001), and cone-beam CT (OR, 2.906 [95% CI, 2.235–3.779], p < 0.001), but no significant relationship was found for pneumothorax requiring chest tube insertion (p = 0.497, p = 0.222, and p = 0.216, respectively). The incidence of hemoptysis was significantly lower under CT (OR, 0.348 [95% CI, 0.247–0.491], p < 0.001), CT fluoroscopy (OR, 0.594 [95% CI, 0.419–0.843], p = 0.004), and cone-beam CT (OR, 0.479 [95% CI, 0.317–0.724], p < 0.001) guidance. ConclusionHemoptysis occurred less frequently with CT-based guidance modalities in comparison with fluoroscopy. Although pneumothorax requiring chest tube insertion showed a similar incidence, pneumothorax was more frequently detected using CT-based guidance modalities.