• Korean Journal of Radiology
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• v.23 no.11
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• pp.1102-1111
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• 2022

Objective: To evaluate the ultrasonography (US) features for diagnosing metastasis in cervical lymph nodes (LNs) in patients with thyroid cancer and compare the US classification of risk of LN metastasis between European and Korean guidelines. Materials and Methods: From January 2014 to December 2018, US-guided fine-needle aspiration was performed on 836 LNs from 714 patients for the preoperative nodal staging of thyroid cancer. The US features of LNs were retrospectively reviewed for the following features: size, presence of hilum, margin, orientation, cystic change, punctate echogenic foci (PEF), large echogenic foci, eccentric cortical thickening, abnormal vascularity, and cortical hyperechogenicity. A multiple logistic regression analysis was performed to identify the independent US features for the diagnosis of metastatic LNs. The diagnostic performance of independent US features was subsequently evaluated. LNs were categorized according to the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and European Thyroid Association (ETA) guidelines, and the correlation between the two sets of classifications was assessed. Results: Absence of the hilum, presence of cystic changes, PEF, abnormal vascularity, and cortical hyperechogenicity were independent US features of metastatic LNs. Cystic changes, PEF, abnormal vascularity, and cortical hyperechogenicity showed high specificity (86.8%-99.6%). The absence of the hilum had the highest sensitivity yet low specificity (66.4%). When LNs were classified according to the ETA guidelines and K-TIRADS, they yielded similar categorizations of malignancy risks and were strongly correlated (Spearman coefficient, 0.9766 [95% confidence interval, 0.973-0.979]). According to the ETA guidelines, 9.8% (82/836) of LNs were classified as "not specified." Conclusion: Absence of hilum, cystic changes, PEF, abnormal vascularity, and cortical hyperechogenicity were independent US features suggestive of metastatic LNs in thyroid cancer. Both K-TIRADS and the ETA guidelines provided similar risk stratification for metastatic LNs with a high correlation; however, the ETA guidelines failed to classify 9.8% of LNs into a specific risk stratum. These results may provide a basis for revising LN classification in future guidelines.

• Korean Journal of Radiology
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• v.24 no.10
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• pp.1028-1037
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• 2023

Objective: To evaluate the computed tomography (CT) features for diagnosing metastatic cervical lymph nodes (LNs) in patients with differentiated thyroid cancer (DTC) and validate the CT-based risk stratification system suggested by the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) guidelines. Materials and Methods: A total of 463 LNs from 399 patients with DTC who underwent preoperative CT staging and ultrasound-guided fine-needle aspiration were included. The following CT features for each LN were evaluated: absence of hilum, cystic changes, calcification, strong enhancement, and heterogeneous enhancement. Multivariable logistic regression analysis was performed to identify independent CT features associated with metastatic LNs, and their diagnostic performances were evaluated. LNs were classified into probably benign, indeterminate, and suspicious categories according to the K-TIRADS and the modified LN classification proposed in our study. The diagnostic performance of both classification systems was compared using the exact McNemar and Kosinski tests. Results: The absence of hilum (odds ratio [OR], 4.859; 95% confidence interval [CI], 1.593-14.823; P = 0.005), strong enhancement (OR, 28.755; 95% CI, 12.719-65.007; P < 0.001), and cystic changes (OR, 46.157; 95% CI, 5.07-420.234; P = 0.001) were independently associated with metastatic LNs. All LNs showing calcification were diagnosed as metastases. Heterogeneous enhancement did not show a significant independent association with metastatic LNs. Strong enhancement, calcification, and cystic changes showed moderate to high specificity (70.1%-100%) and positive predictive value (PPV) (91.8%-100%). The absence of the hilum showed high sensitivity (97.8%) but low specificity (34.0%). The modified LN classification, which excluded heterogeneous enhancement from the K-TIRADS, demonstrated higher specificity (70.1% vs. 62.9%, P = 0.016) and PPV (92.5% vs. 90.9%, P = 0.011) than the K-TIRADS. Conclusion: Excluding heterogeneous enhancement as a suspicious feature resulted in a higher specificity and PPV for diagnosing metastatic LNs than the K-TIRADS. Our research results may provide a basis for revising the LN classification in future guidelines.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.19
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• pp.8351-8359
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• 2014

Background: Recent epidemiological data have implicated human papilloma virus (HPV) infection in the pathogenesis of head and neck cancers, especially oropharyngeal cancers. Although, HPV has been detected in varied amounts in persons with oral dysplasia, leukoplakias and malignancies, its involvement in oral tongue carcinogenesis remains ambiguous. Materials and Methods: HPV DNA prevalence was assessed by PCR with formalin fixed paraffin embedded sections (n=167) of oral tongue squamous cell carcinoma patients and the physical status of the HPV16 DNA was assessed by qPCR. Immunohistochemistry was conducted for p16 evaluation. Results: We found the HPV prevalence in tongue cancers to be 51.2%, HPV 16 being present in 85.2% of the positive cases. A notable finding was a very poor concordance between HPV 16 DNA and p16 IHC findings (kappa<0.2). Further molecular classification of patients based on HPV16 DNA prevalence and p16 overexpression showed that patients with tumours showing p16 overexpression had increased hazard of death (HR=2.395; p=0.005) and disease recurrence (HR=2.581; p=0.002) irrespective of their HPV 16 DNA status. Conclusions: Our study has brought out several key facets which can potentially redefine our understanding of tongue cancer tumorigenesis. It has emphatically shown p16 overexpression to be a single important prognostic variable in defining a high risk group and depicting a poorer prognosis, thus highlighting the need for its routine assessment in tongue cancers. Another significant finding was a very poor concordance between p16 expression and HPV infection suggesting that p16 expression should possibly not be used as a surrogate marker for HPV infection in tongue cancers. Interestingly, the prognostic significance of p16 overexpression is different from that reported in oropharyngeal cancers. The mechanism of HPV independent p16 over expression in oral tongue cancers is possibly a distinct entity and needs to be further studied.

• 대한예방의학회:학술대회논문집
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• 1994.02a
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• pp.651-657
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• 1994

To assess quantitatively the association between benzene exposure and leukemia, we examined the mortality rate of a cohort with occupational exposure to benzene. Cumulative exposure for each cohort member was estimated from historical air-sampling data and, when no sampling data existed, from interpolation on the basis of existing data. The overall standardized mortality ratio (a measure of relative risk multiplied by 100) for leukemia was 337 (95 percent confidence interval, 154 to 641), and that for multiple myeloma was 409 (95 percent confidence interval, 110 to 1047). With stratification according to levels of cumulative exposure, the standardized mortality ratios for leukemia increased from 109 to 322, 1186, and 6637 with increases in cumulative benzene exposure from less than 40 parts per million-years (ppm-years), to 40 to 199, 200 to 399, and 400 or more. respectively. A cumulative benzene exposure of 400 ppm years is equivalent to a mean annual exposure of 10 ppm over a 40-year working lifetime; 10 ppm is the currently enforceable standard in the United States for occupational exposure to benzene. To examine the shape of the exposure-response relation, we performed a conditional logistic-regression analysis, in which 10 controls were matched to each cohort member with leukemia. From this model, it can be calculated that protection from benzene induced leukemia would increase exponentially with any reduction in the permissible exposure limit.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.17
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• pp.7181-7185
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• 2014

Cyclin D1 is an important positive regulator of the G1/S phase of the cell cycle. We investigated the association between the CCND1 G870A polymorphism and susceptibility to papillary thyroid cancer in Turkish people. This study covered 102 patients with papillary thyroid cancer and 174 healthy controls. CCND1 genotyping was determined by the PCR-RFLP method. We found that the A allele frequency was higher in the cases than in the controls (p=0.042). On stratification analysis, papillary thyroid cancer risk was significantly elevated in individuals older than 45 years with the A allele (OR=1.91, 95% CI, 1.09-3.35, p=0.024) and in females with the A allele (OR=1.73, 95% CI, 1.06-2.84, p=0.029), compared to the G allele. According to the subject age, there was an increased papillary thyroid cancer risk for the individuals older than 45 years with the AA genotype (OR=2.28, 95% CI, 1.02-5.13, p=0.046) compared to the AG+GG combined genotypes. In conclusion, it is suggested that the CCND1 G870A polymorphism may contribute to the susceptibility to papillary thyroid cancer, especially in those who were older subjects ($45{\leq}$ years old) and female, in the Turkish population.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.4
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• pp.1587-1590
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• 2015

Background: Chronic lymphoid leukemia (CLL) is the most frequent type of adult leukemia. The Rai and Binet staging systems have been well recognized as standards for assessing the treatment requirements and overall survival in CLL patients. However, there is a need to seek newer prognostic markers to identify stable or progressive forms of CLL that will facilitate risk-adapted treatment strategies. Currently a molecular biomarker ZAP-70 has attracted interest as providing prognostic information in CLL patients. Objective: To determine the frequency of ZAP-70 positivity in B-CLL patients at disease presentation. Materials and Methods: From January 2011 to September 2014, 89 patients were diagnosed to have chronic lymphoid leukemia. Complete blood count was done on an automated analyzer (Cell Dyne, Abott Architect, USA), while immunophenotyping was conducted for each patient to establish the diagnosis of the disease. ZAP-70 expression was evaluated by flow cytometry. Data were compiled and analyzed by SPSS version 21. Results: Out of the total of 89 B-CLL patients, 62 (69.7%) were male and 27 (30.3%) were females with a male to female ratio of 2:1. The mean age was $57.5{\pm}12.1years$. The frequency of ZAP-70 positivity in our B-CLL patients was found to be 13.5%. ZAP-70 positivity was significantly correlated with stage III disease and high absolute lymphocytic count (P<0.05). No correlation of ZAP-70 could be established with age and gender (p>0.05). Conclusions: The frequency of ZAP-70 in our patients appears low. It is approximately half that in international data. We would recommend to screen all the newly diagnosed patients with CLL for ZAP-70 protein expression for risk stratification, family counseling and to predict overall survival.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.2
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• pp.895-898
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• 2014

Objectives: The present study aimed to examine the cytogenetic and genetic mutation features of acute myeloid leukemia (AML) in elderly Chinese patients. Methods: A retrospective analysis of cytogenetics and genetic mutations was performed in 113 cases (age range 50-82 years) with de novo AML. Results: The most frequent cytogenetic abnormality was t (15;17) (q22;q21), detected in 10.0% (n = 9) of successfully analyzed cases, followed by t (8;21) (q22;q22) in 8.89% (n = 8), and complex karyotypes in 5.56% (n = 5). Those with complex karyotypes included 4 cases (4.44%) of monosomal karyotypes. The frequencies of NPM1, FLT3-ITD, c-kit, and CEBPA mutations were 27.4% (31/113), 14.5% (16/110), 5.88% (6/102), and 23.3% (7/30), respectively. The complete remission rates of patients in low, intermediate, and high risk groups were 37.5%, 48.6%, and 33.3%, respectively (${\chi}^2$ = 0.704, P = 0.703) based on risk stratification. Conclusion: Cytogenetics and genetic mutations alone may not be sufficient to evaluate the prognoses of elderly AML patients. The search for a novel model that would enable a more comprehensive evaluation of this population is therefore imperative.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.5
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• pp.2707-2710
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• 2013

Background: This study used pre-hepatitis A vaccination era data in U.S. to study the relationship between serum hepatitis A antibody positivity with pancreas cancer mortality in adults. Patients and Methods: Public use National Health and Nutrition Examination Survey (NHANES III) data were employed. NHANES III uses complex probabilistic methods to sample nationally representative samples. Household adult laboratory and mortality data were merged. Sample persons who were available to be examined in the Mobile Examination Center (MEC) were included in this study. All results were obtained by using specialized survey software taking into account the primary sampling unit and stratification variables and the weights assigned to the sample persons examined in the MEC. Thus they are representative of the U.S. population. Results: The mean risk (95%CI) of death in the study population for pancreas cancer was 0.0014 (-0.000069 -.0029); their mean age (95%CI) at the mobile examination center (MXPAXTMR) was 473.43 (463.85-482.10); the follow up in months from their medical examination (permth_exm) was 170.12 (164.17-176.07). The odds ratios (S.E.) of the statistically significant univariables were: age, 1.007 (1.005-1.009); serum anti-hepatitis antibody status, 0.038 (0.004-0.376); and drinking hard liquor, 1.014 (1.004-1.023). The coefficients (S.E.) of the statistically significant variables after multivariate analysis were 0.006 (0.002-0.010) for age and -2.528 (-4.945--0.111) for serum anti-hepatitis A antibody negativity (using serum anti-hepatitis A antibody positivity as a reference). Conclusion: Serum hepatitis A antibody positivity correlates with higher pancreas cancer mortality in adults.

• Journal of the Korea Society of Computer and Information
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• v.23 no.6
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• pp.51-58
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• 2018

This study was conducted to investigate the relationship between drinking, smoking, meat intake, and exercise. The participants were 1,060 males and females who voluntarily responded to the survey by visiting the health promotion booth at the H Festival held in C city in 2014. Research data were collected in interview form using questionnaires on alcohol use, smoking, exercise, and meat intake. The data were analyzed by descriptive analysis, cross tabulation analysis, multinominal logistic regression after stratification of gender using the SPSS 24 program. The results of the study are as follows: Smokers had a significantly higher frequency of drinking ($x^2=163.33$, p<.001) than non-smokers. Meat intake was high when alcohol use was high ($x^2=35.13$, p<.001). The risk rates for smoking, meat consumption, and exercise related to alcohol use are as follows. The smoking was higher as the frequency of drinking increased. For men, smoking OR(odd ratio) was 6.26 (p=.001) and for women, smoking risk OR was 16.82 (p=.002). Meats intake showed a higher OR as the alcohol use increased. The OR of almost daily ingestion of meat at frequent drinking days was 4.40 (p=.002) for males and 4.52(p=.009) for females. As the frequency of drinking increased, the OR of days of exercise tended to decrease. In men, the OR was 0.36 (p=.003), the lowest in the probability of exercising more than 5 days when drinking high. In the case of women drinking less than once a week, the OR was 0.43 (p=.027), which was the lowest for exercise for 5 days or more. In conclusion, the higher the frequency of drinking, the higher the smoking and meat intake, and the less exercise. If drinking, smoking, and meat intake are high but there is a lack of exercise, a chronic disease can occur and cause premature death unless there is a change in the new health behavior. The results of this study suggest researches to understand the motives related to alcohol abstinence, smoking cessation, dietary control and exercise, and to develop programs.

• Journal of Korean Biological Nursing Science
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• v.19 no.4
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• pp.215-226
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• 2017

Purpose: The purpose of this study was to investigate the effects of general, health, and alcohol-related characteristics on blood pressure and stress according to the Alcohol Use Disorders Identification Test (AUDIT). Methods: This was a descriptive study. From participants in the 2013 Korea National Health and Nutrition Examination Survey, 319 participants who responded to the survey when they were attending college or university were selected. Data were analyzed using the SPSS Win 23.0 program for composite sample data reflecting the composite design elements of stratification, colonization, and weighting. Results: Mean age of onset of alcohol drinking was $17.91{\pm}0.16$ years, the average AUDIT score was $7.56{\pm}0.41$, and 25 (9.1%) participants fell into the high-risk drinking group. In the high-risk AUDIT group, systolic blood pressure was influenced by age, gender, institution, health status, body mass index, and suicidal ideation, and the explanatory power of the model ($R^2$) was 75.0%. For diastolic blood pressure, institution and health status were the influential factors, and $R^2$ was 66.2%. Predictors of stress were health status, depression, and the age of onset of drinking, and $R^2$ was 57.2%. Conclusion: It was confirmed that the explanatory power of the variables in models of systolic and diastolic blood pressure and stress is greater in those with higher scores on AUDIT.