• Korean Journal of Radiology
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• 제22권5호
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• pp.735-741
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• 2021

Objective: To evaluate circularity as a quantitative shape factor of small renal tumor on computed tomography (CT) in differentiating fat-poor angiomyolipoma (AML) from renal cell carcinoma (RCC). Materials and Methods: In 257 consecutive patients, 257 pathologically confirmed renal tumors (either AML or RCC less than 4 cm), which did not include visible fat on unenhanced CT, were retrospectively evaluated. A radiologist drew the tumor margin to measure the perimeter and area in all the contrast-enhanced axial CT images. In each image, a quantitative shape factor, circularity, was calculated using the following equation: 4 x π x (area ÷ perimeter²). The median circularity (circularity index) was adopted as a representative value in each tumor. The circularity index was compared between fat-poor AML and RCC, and the receiver operating characteristic (ROC) curve analysis was performed. Univariable and multivariable binary logistic regression analysis was performed to determine the independent predictor of fat-poor AML. Results: Of the 257 tumors, 26 were AMLs and 231 were RCCs (184 clear cell RCCs, 25 papillary RCCs, and 22 chromophobe RCCs). The mean circularity index of AML was significantly lower than that of RCC (0.86 ± 0.04 vs. 0.93 ± 0.02, p < 0.001). The mean circularity index was not different between the subtypes of RCCs (0.93 ± 0.02, 0.92 ± 0.02, and 0.92 ± 0.02 for clear cell, papillary, and chromophobe RCCs, respectively, p = 0.210). The area under the ROC curve of circularity index was 0.924 for differentiating fat-poor AML from RCC. The sensitivity and specificity were 88.5% and 90.9%, respectively (cut-off, 0.90). Lower circularity index (≤ 0.9) was an independent predictor (odds ratio, 41.0; p < 0.001) for predicting fat-poor AML on multivariable logistic regression analysis. Conclusion: Circularity is a useful quantitative shape factor of small renal tumor for differentiating fat-poor AML from RCC.

• Korean Journal of Radiology
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• 제21권12호
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• pp.1355-1366
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• 2020

Objective: We aimed to evaluate the diagnostic value and prognostic relevance of FDG positron emission tomography/computed tomography (PET-CT) in extrahepatic cholangiocarcinoma patients. Materials and Methods: This study included 234 extrahepatic cholangiocarcinoma patients who underwent FDG PET-CT between June 2008 and February 2016. The diagnostic performance of FDG PEG-CT was compared to that of contrast-enhanced multidetector row CT (MDCT) and MRI. Independent prognosticators for poor survival were also assessed. Results: The sensitivity of FDG PET-CT for detecting primary tumor and regional lymph node metastases was lower than that of MDCT or MRI (p < 0.001), whereas the specificity and positive predictive value for detecting regional lymph nodes metastases was significantly better in FDG PET-CT compared to MDCT and MRI (all p < 0.001). There was no significant difference in the diagnostic yield of distant metastases detection among three diagnostic imaging techniques. In a multivariate analysis, maximum standardized uptake values (SUV_max) of the primary tumor (adjusted hazard ratio [HR], 1.75; 95% confidence interval [CI], 1.13-2.69) and of the metastatic lesions ≥ 5 (adjusted HR, 8.10; 95% CI, 1.96-33.5) were independent contributors to poor overall survival in extrahepatic cholangiocarcinoma patients. In a subgroup analysis of 187 patients with periductal infiltrating type of cholangiocarcinoma, an SUV_max of the primary tumor ≥ 5 was associated with an increased risk of regional lymph node (adjusted odds ratio [OR], 1.60; 95% CI, 0.55-4.63) and distant metastases (adjusted OR, 100.57; 95% CI, 3.94-2567.43) at diagnosis as well as with poor overall survival (adjusted HR, 1.81; 95% CI, 1.04-3.15). Conclusion: FDG PET-CT showed lower sensitivity for detecting primary tumor and regional lymph node involvement than MDCT and MRI. However, the SUV_max of primary tumors and metastatic lesions derived from FDG PET-CT could have significant implications for predicting prognoses in extrahepatic cholangiocarcinoma patients.

• IMMUNE NETWORK
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• 제1권2호
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• pp.143-150
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• 2001

Background : Many investigators have found transforming growth factor-${\beta}1$ (TGF-${\beta}1$) to be elevated in tumors. Changes in responsiveness to TGF-${\beta}1$ have been linked to malignant transformation, tumor progression and tumor regression. Many malignant cell lines of epithelial or hematopoietic origin are refractory to the antiproliferative effects of TGF-${\beta}1$. However, a little is known about the association of TGF-${\beta}1$ with progression of malignant tumor. Methods : In this study, we measured the plasma level of TGF-${\beta}1$ in various cancer patients and evaluated the utility of plasma TGF-${\beta}1$ as a possible tumor marker. Plasma TGF-${\beta}1$ levels were measured using enzyme-linked immunosorbent assay in cancer patients and normal controls. Carcinoembryonic antigen (CEA) and alpha-fetoprotein (AFP) as tumor marker were compared with TGF-${\beta}1$ in the aspects of sensitivity and specificity. Results : The mean of plasma TGF-${\beta}1$ levels was $1.219{\pm}0.834ng/ml$ in normal controls, $5.491{\pm}3.598ng/ml$ in breast cancer, $12.670{\pm}10.386ng/ml$ in lung cancer, $5.747{\pm}3.228ng/ml$ in hepatocellular carcinoma and $10.854{\pm}7.996ng/ml$ in cervical cancer. In comparison with CEA and AFP, TGF-${\beta}1$ is more sensitive. Conclusion : We conclude that the high levels of TGF-${\beta}1$ are common in the plasma of cancer patients. These results suggest that the plasma TGF-${\beta}1$ level can be a potent tumor marker in various cancer patients.

• 한국의학물리학회지:의학물리
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• 제21권1호
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• pp.22-28
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• 2010

유방암 중에서 가장 발생율이 높은 침윤성 관상피암을 대상으로 생체 국소 수소핵 자기공명분광법(localized in vivo $^1H$ MRS)을 시행하여 조직학적 형태에 따른 자기공명 분광상(MR spectroscopy)의 특성을 분석하고자 본 연구를 실시하였다. 조직학적으로 침윤성 관상피암으로 진단 받은 환자 40명을 대상으로 하여 종양이 있는 부위를 실험군으로 정하였고 종양이 없는 반대쪽 부위를 대조군으로 정하여 3.0T MR scanner를 이용한 수소핵 자기공명분광영상으로 검사를 시행하여 영상 및 분광 정보를 얻었다. 유방암 환자 40명 중 34명(85%)에서 3.2 ppm 분광정점을 확인할 수 있었고 MRS상 3.2 ppm에서의 분광정점 발현여부를 유방암의 진단 기준으로 선택하는 경우 민감도는 85% (34/40), 특이도는 92.5% (37/40), 양성예측율은 100% (34/34), 음성 예측율은 86% (37/43)이었다. 정상 조직의 1.3 ppm에서의 분광정점을 진단 기준으로 정할때 민감도는 92.5% (37/40), 특이도는 85% (34/40), 양성 예측율은 100% (37/37), 음성 예측율은 91.8% (34/37)이었다. $^1H$ MRS방법이 유방암의 진단에 이용될 수 있는 가능성을 제시하였고 추후 지속적인 연구를 통해 임상적으로 진단 및 치료 판정에 널리 이용될 수 있을 것으로 사료된다.

• Journal of Gastric Cancer
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• 제14권4호
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• pp.221-228
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• 2014

Purpose: This study aimed to evaluate the value of serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) levels to detect gastric cancer recurrence. Materials and Methods: We retrospectively reviewed 154 patients who developed recurrence within 2 years after curative gastric cancer surgery and analyzed the relationship between postoperative CEA and CA19-9 levels and recurrence. We readjusted the cut-off values to improve the detection of recurrence. Subgroup analysis according to clinicopathologic variables was performed to further investigate the relationship between recurrence and CEA and CA19-9 levels. Results: The sensitivity and specificity for elevated CEA levels to detect recurrence were 40.6% and 89.5%, respectively, and those for CA19-9 were 34.2% and 93.6%, respectively. The sensitivity and specificity for elevation of either tumor marker were 54.3% and 84.0%, respectively; those for elevation of both tumor markers were 19.2% and 98.4%, respectively. By readjusting the cut-off values from 5.0 ng/ml to 5.2 ng/ml for CEA and from 37.00 U/ml to 30.0 U/ml for CA19-9, the sensitivity was increased from 34.2% to 40.2% for CA19-9, while there was no increase in sensitivity for CEA. In subgroup analysis, the sensitivity of CEA was higher in patients with elevated preoperative CEA levels than in patients with normal preoperative CEA levels (86.7% versus 33.7%; P<0.001). Furthermore, the sensitivity of CA19-9 was higher in patients with elevated preoperative CA19-9 levels than in patients with normal preoperative CA19-9 levels (82.61% versus 26.83%; P<0.001). Conclusions: CEA and/or CA19-9 measurement with the readjusted cut-off values allows for more effective detection of gastric cancer recurrence.

• Clinical and Experimental Pediatrics
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• 제57권6호
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• pp.278-286
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• 2014

Purpose: To evaluate the potential utility of $^{123}I$-metaiodobenzylguanine ($^{123}I$-MIBG) scintigraphy and $^{18}F$-fluorodeoxyglucose ($^{18}F$-FDG) positron emission tomography (PET) for the detection of primary and metastatic lesions in pediatric neuroblastoma (NBL) patients, and to determine whether $^{18}F$-FDG PET is as beneficial as $^{123}I$-MIBG imaging. Methods: We selected 8 NBL patients with significant residual mass after operation and who had paired $^{123}I$-MIBG and $^{18}F$-FDG PET images that were obtained during the follow-up. We retrospectively reviewed the clinical charts and the findings of 45 paired scans. Results: Both scans correlated relatively well with the disease status as determined by standard imaging modalities during follow-up; the overall concordance rates were 32/45 (71.1%) for primary tumor sites and 33/45 (73.3%) for bone-bone marrow (BM) metastatic sites. In detecting primary tumor sites, $^{123}I$-MIBG might be superior to $^{18}F$-FDG PET. The sensitivity of $^{123}I$-MIBG and $^{18}F$-FDG PET were 96.7% and 70.9%, respectively, and their specificity were 85.7% and 92.8%, respectively. $^{18}F$-FDG PET failed to detect 9 true NBL lesions in 45 follow-up scans (false negative rate, 29%) with positive $^{123}I$-MIBG. For bone-BM metastatic sites, the sensitivity of $^{123}I$-MIBG and $^{18}F$-FDG PET were 72.7% and 81.8%, respectively, and the specificity were 79.1% and 100%, respectively. $^{123}I$-MIBG scan showed higher false positivity (20.8%) than $^{18}F$-FDG PET (0%). Conclusion: $^{123}I$-MIBG is superior for delineating primary tumor sites, and $^{18}F$-FDG PET could aid in discriminating inconclusive findings on bony metastatic NBL. Both scans can be complementarily used to clearly determine discrepancies or inconclusive findings on primary or bone-BM metastatic NBL during follow-up.

• Investigative Magnetic Resonance Imaging
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• 제12권2호
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• pp.107-114
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• 2008

목적 : 3T MR 기기를 이용하여, 췌장 주위에 발생한 낭성 종양에 대하여, 생체내, 그리고 생체외 생체내 자기공명분광법(magnetic resonance spectroscopy: MRS)를 획득한 후, 생체외 핵자기공명 (nuclear magnetic resonance, NMR) 스펙트럼을 기준으로 비교함으로써, 낭성 종양의 감별 진단에 있어 MRS의 적용 가능성을 알아보고자 하였다. 대상 및 방법 : 췌장 주위에 발행한 12예의 낭성 종양(점액성 낭성 종양=5, 췌담관내 유두종=5, 가성 낭종=1, 및 림프관종 n=1)을 대상으로 3.0T 생체내, 생체외 양성자 MRS 및 9T NMR 스펙트럼을 획득하였다. NMR의 피크와 상응하는 생체내, 생체외 양성자 MRS에서 관찰되는 피크의 존재유무를 알아보았으며, 특정 질환을 예측하는 피크에 대하여 알아보았다. 결과 : 생체내 MRS는 NMR과 민감도 29.6%, 특이도 82.6% 그리고, 67.7%의 정확도를 보였으며 (p=0.096, McNemar test), 생체외 MRS는 생체내 MRS는 민감도 57.1%, 특이도 92.6%, 그리고, 82.3%의 정확도를 보였다 (p = 0.362, McNemar test). 질병간의 스펙트럼의 차이는 NMR에서 췌담관내 유두종의 경우에서 점액성 낭성 종양에 비해 3.5-4.0 ppm에서 유의하게 많은 피크를 보였다 (p=0.026). 결론 : 결론적으로, NMR 이용한 화학물질 분석은 낭성 종양의 감별 진단에 도움이 될 가능성이 있는 기법으로 생각되지만, 생체내 및 생체외 MRS는 임상에 적용되기 위해서는 많은 기술적 발전을 필요로 하는 것으로 생각된다.

• Asian Pacific Journal of Cancer Prevention
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• 제16권15호
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• pp.6569-6573
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• 2015

Objective: To evaluate the application value of serum CA19-9, CEA, CA125 and CA242 in diagnosis and prognosis of pancreatic cancer cases treated with concurrent chemotherapy. Materials and Methods: 52 patients with pancreatic cancer, 40 with benign pancreatic diseases and 40 healthy people were selected. The electrochemiluminescence immunoassay method was used for detecting levels of CA19-9, CEA and CA125, and a CanAg CA242 enzyme linked immunoassay kit for assessing the level of CA242. The Kaplan-Meier method was used for analyzing the prognostic factors of patients with pancreatic cancer. The Cox proportional hazard model was applied for analyzing the hazard ratio (HR) and 95% confidential interval (CI) for survival time of patients with pancreatic cancer. Results: The levels of serum CA19-9, CEA, CA125 and CA242 in patients with pancreatic cancer were significantly higher than those in patients with benign pancreatic diseases and healthy people (P<0.001). The sensitivity of CA19-9 was the highest among these, followed by CA242, CA125 and CEA. The specificity of CA242 is the highest, followed by CA125, CEA and CA19-9. The sensitivity and specificity of joint detection of serum CA19-9, CEA, CA125and CA242 were 90.4% and 93.8%, obviously higher than single detection of those markers in diagnosis of pancreatic cancer. The median survival time of 52 patients with pancreatic cancer was 10 months (95% CI7.389~12.611).. Patients with the increasing level of serum CA19-9, CEA, CA125, CA242 had shorter survival times (P=0.047. 0.043, 0.0041, 0.029). COX regression analysis showed that CA19-9 was an independent prognostic factor for patients with pancreatic cancer (P=0.001, 95%CI 2.591~38.243). Conclusions: The detection of serum tumor markers (CA19.9, CEA, CA125 and CA242) is conducive to the early diagnosis of pancreatic cancer and joint detection of tumor markers helps improve the diagnostic efficiency. Moreover, CA19-9 is an independent prognostic factor for patients with pancreatic cancer.

• Nuclear Medicine and Molecular Imaging
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• 제43권4호
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• pp.301-308
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• 2009

목적: 자궁내막암의 치료 후 루틴 추적관찰로써의 FDG-PET/ET의 유용성에 대해 알아보고자 하였다. 대상 및 방법: 자궁내막암으로 치료 받은 환자 중 2004년 1월 1일부터 2008년 1월 31일 사이에 FDG-PET/CT를 시행한 101명의 환자(25-79세, 평균 50.6세)를 대상으로 하였다. 모든 환자에서 종양표지 자와 다른 영상의학적 검사(CT, MR)에 대해서도 함께 검토하였다. FDG-PET/CT상 국소 FDG 섭취를 보인 병변을 benign, equivocal, malignant로 분류하였고, equivocal과 maliganat 병변에 대하여 조직학적 혹은 임상적으로 재발유무를 판정하였다. 결과: FDG-PET/CT상 강한 섭취를 보인 경우는 19명의 30개의 병변이었다. Malignant 섭취를 보인 환자는 14명이었고, 이중 11예가 재발로 확인되었다. Equivocal 병변을 보인 환자는 5명 이었고, 이중 1예가 재발로 확인되었다. 위음성을 보인 경우는 2예가 있었고, 모두 복강내 암종증 환자로 진단되었다. 이상의 결과를 종합하였을 때, 자궁내막암의 치료 후 재발의 평가에 대한 전반적인 결과는 예민도 86 %,특이도 92 %, 양성 예측도 63 %, 음성예측도 98 %, 그리고 정확도는 91 %였다. 결론: 자궁내막암의 치료 후 루틴 추적관찰로써 FDG-PET/ET를 시행할 경우 높은 예민도, 특이도로 재발의 진단에 도움이 될 뿐만 아니라 높은 음성 예측도로 인하여 FDG-PET/CT상 음성인 경우 불필요한 추가 검사를 피할 수 있을 것으로 기대된다.

• Asian Pacific Journal of Cancer Prevention
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• 제14권4호
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• pp.2541-2544
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• 2013

Background: The aim of the present study was to evaluate the serum neuron-specific enolase (NSE) levels in patients with prostate cancer, Hodgkin lymphoma, lung cancer and peripheral nerve tumors. Materials and Methods: NSE levels were determined by ELISA in the sera of 100 prostate cancer, 47 Hodgkin lymphoma, 35 lung cancer and 35 peripheral nerve tumor patients and also in 132 healthy controls. Results: The median levels of serum NSE were elevated in patients with lung cancer (p=0.018) and peripheral nerve tumors (p=0.008). NSE levels in prostate cancer and Hodgkin lymphoma patients were higher than the controls but there was no statistically significant difference (p>0.05). Conclusions: We conclude that NSE may be applied in routine to gain insight about the clinical statuses of various cancer patients, but more studies are needed to determine the organ specificity.