What Is New in the 2017 World Health Organization Classification and 8th American Joint Committee on Cancer Staging System for Pancreatic Neuroendocrine Neoplasms?

Choe, Jooae,Kim, Kyung Won,Kim, Hyoung Jung,Kim, Dong Wook,Kim, Kyu Pyo,Hong, Seung-Mo,Ryu, Jin-Sook,Tirumani, Sree Harsha,Krajewski, Katherine,Ramaiya, Nikhil unknown 2019 KOREAN JOURNAL OF RADIOLOGY Vol.20 No.1

<P>The diagnosis and management of pancreatic neuroendocrine neoplasms (NENs) have evolved significantly in recent years. There are several diagnostic and therapeutic challenges and controversies regarding the management of these lesions. In this review, we focus on the recent significant changes and controversial issues regarding the diagnosis and management of NENs and discuss the role of imaging in the multidisciplinary team approach.</P>

Interstitial Lung Abnormality in Health Screening Examinees: Prevalence and Progression Rate

( Jooae Choe ),( Ju Hyun Oh ),( Han Na Noh ),( Eun Jin Chae ),( Jin Woo Song ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

Background Prevalence and outcome of interstitial lung abnormality (ILA) in an Asian population remain unclear. Methods A total of 2,731 subjects (mean age: 49 years, male: 81.3%), who participated in a health screening program, and had serial chest CT images over a 5-year period (median interval: 7.0 years), were included. We initially performed a blinded assessment of ILA in each of these serial CTs using a sequential reading method. Subsequently, temporal change was evaluated by a consecutive comparison. Results In the baseline CT scan, ILA were identified in 11 participants (0.4%, 11/2731; 54.5% nonsubpleural, 36.4% subpleural nonfibrotic, and 9.1% subpleural fibrotic type) and indeterminate for ILA in 20 (0.7%), respectively. During a follow-up period of more than 5 years, 8 of 11 (72.7%) participants with ILA progressed, and 31 of 2,720 (1.1%) participants without ILA had newly developed ILA. Therefore, ILA was ultimately identified in 55 participants (2.0%, 55/2731) in follow-up. The prevalence of ILA increased with the age of the participants (Figure 1). The presence of ILA was associated with older age (OR: 1.12, p<0.001), ever-smoking (OR: 4.66, p=0.002), and higher levels of erythrocyte sedimentation rate (ESR, OR: 1.03, p=0.002) in the multivariable logistic analysis. Progression or development of ILA was associated with older age (HR=1.10, p<0.001), lower platelet count (HR=0.99, p=0.001), higher ESR level (HR=1.05, p < 0.001), lower albumin level (OR=0.29, p=0.002), and subpleural fibrotic type of ILA (HR=8.23, p=0.001) on the baseline in the multivariate Cox analysis. Conclusions Prevalence of ILA was lower in Korean population compared to other populations, but increased in a group of subjects followed over a 5-year interval. Progression or development of ILA was noted in 1.9% of the cohort, and associated with older age, subpleural fibrotic type of ILA, elevated inflammatory marker, and lower albumin level on the baseline.

Serial Changes of CT Findings in Patients with Chronic Hypersensitivity Pneumonitis

( Jieun Kang ),( Jooae Choe ),( Eun Jin Chae ),( Yeon Joo Kim ),( Kyung-hyun Do ),( Joon Seon Song ),( Jin Woo Song ) 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.-

Background Only few studies have evaluated the serial changes in chest computed tomography (CT) in patients with chronic hypersensitivity pneumonitis (cHP) and no analysis was presented regarding fibrotic progression and development of acute exacerbation (AE). Methods This retrospective study included patients with cHP with follow-up CT. Baseline and serial follow-up CT were evaluated semi-quantitatively. Fibrotic progression was defined as increase in extent of interstitial fibrosis including reticulation, honeycombing, and/or traction bronchiectasis on CT. Fibrosis score was defined as the sum of the area with reticulation and honeycombing. The modified CT pattern of Fleischner Society idiopathic pulmonary fibrosis diagnostic guidelines was evaluated. Fibrotic progression-free survival was analyzed using a Kaplan-Meier survival analysis. Risk factors for fibrotic progression and AE were determined using Cox proportional hazards regression. Results Among 101 patients diagnosed with cHP based on histopathologic findings, 91 had follow-up CT and were included in this study. The mean age was 59.1 years and 61.5% were women. The median follow-up duration was 4.9 years. Seventy-nine patients (86.8%) showed fibrotic progression with persistent areas of mosaic attenuation, finally replaced by fibrosis, and 22 (22.0%) developed AE. Fibrotic progression-free survival was significantly poorer in patients with fibrosis score ≥10% (Figure 1a) or CT pattern of usual interstitial pneumonia (UIP) or probable UIP (Figure 1b). Baseline fibrosis score and UIP or probable UIP pattern were independent risk factors for predicting fibrotic progression (hazard ratio [HR]=1.05, 95% confidence interval [CI]=1.02-1.09, p<0.001 for fibrosis score; HR=2.50, CI=1.50-4.16, p<0.001 for CT pattern) and AE (HR=1.07, CI=1.01-1.13, p=0.019 for fibrosis score; HR=5.47, CI=1.23-24.45, p=0.026 for CT pattern) after adjusting clinical covariables. Conclusions Fibrotic progression and AE were identified in 86.8% and 22.0% of patients with cHP. Fibrosis score and UIP or probable UIP pattern on baseline chest CT may predict fibrotic progression and AE.

Radiographic parameters predicts survival in chronic hypersensitivity pneumonitis

( Yeon Joo Kim ),( Jooae Choe ),( Eun Jin Chae ),( Jin Woo Song ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Backgound: Chronic hypersensitivity pneumonitis (cHP) shows variable course and prediction of survival is difficult. However, prognostic value of high resolution computed tomography (HRCT) parameters is not well defined in cHP. The aim of the study was to investigate prognostic roles of image parameters in patients with cHP. Methods: Clinical data and HRCT scan images were retrospectively analyzed in 101 patients with cHP (all biopsy proven cases). All CT variables were expressed as a percentage of the total lung volume. Fibrosis score was defined as the sum of reticulation and honeycombing score. HRCT patterns were classified as usual interstitial pneumonia (UIP) pattern or others. Results: The Median follow-up period was 67.6 months. The mean age of the subjects was 60.4 years, and 60.4% were female. Thirty-four (33.7%) patients died during follow-up. Non-survivors had lower ground glass opacity (GGO) and higher mosaic attenuation, bronchiectasis and fibrosis scores than survivors. In univariate Cox analysis, reticulation, honeycombing, ground glass opacity, mosaic attenuation, bronchiectasis and fibrosis score were significant prognostic factors in cHP patients. In a multivariate model adjusted by age, BMI and FVC, low extent of GGO (HR, 0.948; P = 0.031), high mosaic attenuation extent (HR, 1.044; P = 0.028), reticulation (HR, 1.040, P = 0.048), honeycombing (HR, 1.159; P = 0.005), fibrosis score (HR, 1.045; P = 0.013) and UIP pattern (HR, 3.222, P = 0.007) independently predicted the mortality. Among independent predictors of mortality, fibrosis score (C-index: 0.709) demonstrated better performance for predicting mortality compared with clinical model (age+ BMI+FVC, c-index 0.501) or GAP model (index, c-index 0.652; stage, c-index 0.640). Conclusions: In this study, images parameters were independent prognostic factors in patients with cHP, and showed better performance in predicting survival compared to clinical models.

MRI-Based Stepwise Approach to Anterior Mediastinal Cystic Lesions for Diagnosis and Further Management

Kim Jong Hee,Choe Jooae,Kim Hong Kwan,Lee Ho Yun 대한영상의학회 2023 Korean Journal of Radiology Vol.24 No.1

As the majority of incidentally detected lesions in the anterior mediastinum is small nodules with soft tissue appearance, the differential diagnosis has typically included thymic neoplasm and prevascular lymph node, with benign cyst. Overestimation or misinterpretation of these lesions can lead to unnecessary surgery for ultimately benign conditions. Diagnosing mediastinal cysts using MRI serves as a problem-solving modality in distinguishing between surgical and nonsurgical anterior mediastinal lesions. The pitfalls of MRI evaluation for anterior mediastinal cystic lesions are as follows: first, we acknowledge the limitation of T2-weighted images for evaluating benign cystic lesions. Due to variable contents within benign cystic lesions, such as hemorrhage, T2 signal intensity may be variable. Second, owing to extensive necrosis and cystic changes, the T2 shine-through effect may be seen on diffusion-weighted images (DWI), and small solid portions might be missed on enhanced images. Therefore, both enhancement and DWI with apparent diffusion coefficient values should be considered. An algorithm will be suggested for the diagnostic evaluation of anterior mediastinal cystic lesions, and finally, a management strategy based on MRI features will be suggested.

Long-term clinical course and outcome of Korean patients with microscopic polyangiitis associated interstitial lung disease

( Donghee Lee ),( Jinwoo Song ),( Jooae Choe ),( Heesang Hwang ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Background: Microscopic polyangiitis (MPA) is a systemic vasculitis affecting small vessels. Interstitial lung disease (ILD) is the most common pulmonary manifestations of MPA and is known to be associated with poor outcome. This study aimed to investigate clinical course and outcome in Korean patients with MPA -ILD and to find out prognostic factors. Methods: Clinical data were retrospectively analyzed in 37 patients with MPA-ILD (biopsy proven case, n=5) between 2000 to 2019 at Asan Medical Center. High resolution computed tomography (HRCT) images were categorized as usual interstitial pneumonia (UIP) pattern and others. Results: The median follow-up period was 51.2 months. Of total patients, the mean age was 68.8 years, 62% was male, and 64% was ever-smokers. Six (16.2%) patients died during followup, and the median survival period was 51.5 months (survival rate, 1 year: 86.5%, 3 year: 64.9%, 5 year 46%). Nonsurvivors, at baseline, showed lesser frequent renal involvement and a tendency to have older age, and lesser frequent MPO-positivity, than survivors. However, there were no differences in gender, respiratory symptoms, lung functions, exercise capacity and bronchoalveolar lavage fluid findings between nonsurvivors and survivors. During follow-up, there were more frequent acute exacerbation, pneumonia and alveolar hemorrhage in nonsurvivors compared with survivors. In multivariate Cox analysis, old age was an independent prognostic factor (hazard ratio: 1.209, 95% confidence interval: 1.003-1.457, p=0.046 ) in patients with MPA-ILD. Conclusions: In this study, clinical course and outcome of Korean patients with MPA-ILD were similar to previous reports. Old age means poor prognosis in patients with MAP-ILD.

Pleuroparenchymal Fibroelastosis in Rheumatoid-associated Interstitial Lung Disease

( Woo Jung Seo ),( Jooae Choe ),( Eun Young Lee ),( Sung Hae Chang ),( Jin Woo Song ) 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.-

Purpose Pleuroparenchymal fibroelastosis (PPFE) is a rare condition characterized by fibrosis involving the pleura and subpleural lung parenchyma, predominantly in the upper lobes. PPFE may be associated with other interstitial lung diseases (ILD) in the lower lobes, but was not reported in patients with rheumatoid arthritis (RA)-associated ILD. This study aimed to identify prevalence and clinical impact of PPFE in patients with RA-ILD. Methods Clinical data and high resolution computed tomography (HRCT) images were retrospectively analyzed in 309 patients with RA-ILD. The radiological criteria for PPFE were defined as follows: 1) bilateral subpleural dense fibrosis with or without pleural thickening in the upper lobes on HRCT, 2) evidence of disease progression, and 3) no clinical evidence of identifiable etiology. Results Of total subjects, the mean age was 61.7 years, 44.3% was male, and 4.5% had radiologic PPFE. When classified according to HRCT patterns, patients with a usual interstitial pneumonia (UIP) or probable UIP pattern (n=206) had PPFE numerically more frequently (5.8 vs. 1.9%; p=0.153) than those without. The median follow-up period was 53.5 months. The PPFE group showed lower body mass index (21.2 vs. 23.6, p=0.005), and forced vital capacity (63.5 vs 74.7 % predicted, p=0.042), and higher residual volume/total lung capacity (39.0 vs 33.0, p=0.02) than the no-PPFE group at baseline. During follow-up, the PPFE group had more frequent pneumothorax or pneumomediastinum than the no-PPFE group (28.6% vs.7.5%, p=0.029); however, there were no differences in survival (median, 47.0 vs. 113.0 months, p= 0.52) between two groups (figure 1). PPFE was an independent risk factor for pneumothorax or pneumomediastinum (HR = 8.354, 95% CI: 2.335-29.891, p=0.001), but was not for mortality in patients with RA-ILD. Conclusion Our Results suggest that in patients with RA-ILD, combined PPFE is not rare and associated with a higher risk of pneumothorax or pneumomediastinum.

Volume doubling time of lung cancer detected in idiopathic interstitial pneumonia: comparison with that in chronic obstructive pulmonary disease

Kim, Cherry,Lee, Sang Min,Choe, Jooae,Chae, Eun Jin,Do, Kyung-Hyun,Seo, Joon Beom Springer-Verlag 2018 EUROPEAN RADIOLOGY Vol.28 No.4

<P>aEuro cent Shorter CT follow-up interval may be necessary in IIP with suspicious nodules.</P>

Blood KL-6 Predict Survival in Primary Sjogren’s Syndrome-associated Interstitial Lung Disease

( Ho Jeong Kim ),( Yun Jae Kim ),( Jooae Choe ),( Jin Woo Song ) 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.0

Background Interstitial lung disease associated with primary Sjögren’s syndrome (pSS-ILD) has a variable clinical course and prediction of prognosis is difficult. However, the role of blood biomarkers in pSS-ILD is not well defined. The aim of this study was to evaluate the prognostic value of blood biomarkers in pSS-ILD. Methods Clinical data of 46 patients with pSS-ILD were retrospectively reviewed. Plasma levels of biomarkers, including Krebs von den Lungen-6 (KL-6), CC chemokine ligand 18 (CCL18), chitinase-3-like-1 (YKL-40), interleukin-4 receptor alpha (IL-4Ra), and matrix metalloproteinase-7 (MMP-7) were measured using the multiplex Luminex assays (R&D Systems, Minneapolis, USA). Results Of total subjects, the mean age was 59.4 years, and 17% were men. The median follow-up period was 59 months and the 10- year survival rate was 60%. The level of KL-6 was significantly elevated in non-survivors (n=12) (119.6 vs 59.5 pg/mL, p=0.037) compared with survivors (n=34), but the levels of other biomarkers were not different between the two groups. Blood KL-6 level was correlated with forced vital capacity (r=-0.499, p<0.001), diffusing capacity for carbon monoxide (DLco) (r=-0.498, p=0.001), and six-minute walk distance (r=-0.575, p< 0.001) in patients with pSS-ILD. In the receiver operating characteristic analysis for 10-year mortality, KL-6 showed significantly better performance for predicting survival (Figure 1; AUC=0.750, p=0.037, cut off value=53.5 pg/mL, sensitivity 66.7%, specificity 79.4%) than other biomarkers. In the multivariate Cox analysis adjusted by DLco, a high KL-6 level ( >53.5 pg/mL) was a significant prognostic factor for the 10-year mortality (hazard ratio [HR]: 5.010, 95% CI: 1.218-20.600, p=0.026). Patients with high KL-6 levels (>53.5 pg/mL) had poorer survival (10-year survival rate: 30% vs 75%, p=0.001), and more frequent acute exacerbation (27% vs 3%, p=0.017) compared with those without (≤53.5 pg/ mL). Conclusions Our Results suggest that blood KL-6 might be a useful predictor of prognosis in patients with pSS-ILD.

Comparative Analysis of CT Findings and Clinical Outcomes in Adult Patients With Disseminated and Localized Pulmonary Nocardiosis

Lee Han Na,Do Kyung-Hyun,Kim Eun Young,Choe Jooae,Sung Heungsup,Choi Sang-Ho,Kim Hwa Jung 대한의학회 2024 Journal of Korean medical science Vol.39 No.11

Background: Pulmonary nocardiosis is a rare opportunistic infection with occasional systemic dissemination. This study aimed to investigate the computed tomography (CT) findings and prognosis of pulmonary nocardiosis associated with dissemination. Methods: We conducted a retrospective analysis of patients diagnosed with pulmonary nocardiosis between March 2001 and September 2023. We reviewed the chest CT findings and categorized them based on the dominant CT findings as consolidation, nodules and/ or masses, consolidation with multiple nodules, and nodular bronchiectasis. We compared chest CT findings between localized and disseminated pulmonary nocardiosis and identified significant prognostic factors associated with 12-month mortality using multivariate Cox regression analysis. Results: Pulmonary nocardiosis was diagnosed in 75 patients, of whom 14 (18.7%) had dissemination, including involvement of the brain in 9 (64.3%) cases, soft tissue in 3 (21.4%) cases and positive blood cultures in 3 (21.4%) cases. Disseminated pulmonary nocardiosis showed a higher frequency of cavitation (64.3% vs. 32.8%, P = 0.029) and pleural effusion (64.3% vs. 29.5%, P = 0.014) compared to localized infection. The 12-month mortality rate was 25.3%. The presence of dissemination was not a significant prognostic factor (hazard ratio [HR], 0.80; confidence interval [CI], 0.23–2.75; P = 0.724). Malignancy (HR, 9.73; CI, 2.32–40.72; P = 0.002), use of steroid medication (HR, 3.72; CI, 1.33–10.38; P = 0.012), and a CT pattern of consolidation with multiple nodules (HR, 4.99; CI, 1.41–17.70; P = 0.013) were associated with higher mortality rates. Conclusion: Pulmonary nocardiosis with dissemination showed more frequent cavitation and pleural effusion compared to cases without dissemination, but dissemination alone did not affect the mortality rate of pulmonary nocardiosis.