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Diffusion Weighted Imaging Can Distinguish Benign from Malignant Mediastinal Tumors and Mass Lesions: Comparison with Positron Emission Tomography

  • Usuda, Katsuo;Maeda, Sumiko;Motono, Nozomu;Ueno, Masakatsu;Tanaka, Makoto;Machida, Yuichiro;Matoba, Munetaka;Watanabe, Naoto;Tonami, Hisao;Ueda, Yoshimichi;Sagawa, Motoyasu
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.15
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    • pp.6469-6475
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    • 2015
  • Background: Diffusion-weighted magnetic resonance imaging (DWI) makes it possible to detect malignant tumors based on the diffusion of water molecules. It is uncertain whether DWI is more useful than positron emission tomography-computed tomography (PET-CT) for distinguishing benign from malignant mediastinal tumors and mass lesions. Materials and Methods: Sixteen malignant mediastinal tumors (thymomas 7, thymic cancers 3, malignant lymphomas 3, malignant germ cell tumors 2, and thymic carcinoid 1) and 12 benign mediastinal tumors or mass lesions were assessed in this study. DWI and PET-CT were performed before biopsy or surgery. Results: The apparent diffusion coefficient (ADC) value ($1.51{\pm}0.46{\times}10^{-3}mm^2/sec$) of malignant mediastinal tumors was significantly lower than that ($2.96{\pm}0.86{\times}10^{-3}mm^2/sec$) of benign mediastinal tumors and mass lesions (P<0.0001). Maximum standardized uptake value (SUVmax) ($11.30{\pm}11.22$) of malignant mediastinal tumors was significantly higher than that ($2.53{\pm}3.92$) of benign mediastinal tumors and mass lesions (P=0.0159). Using the optimal cutoff value (OCV) $2.21{\times}10^{-3}mm^2/sec$ for ADC and 2.93 for SUVmax, the sensitivity (100%) by DWI was not significantly higher than that (93.8%) by PET-CT for malignant mediastinal tumors. The specificity (83.3%) by DWI was not significantly higher than that (66.7%) for benign mediastinal tumors and mass lesions. The accuracy (92.9%) by DWI was not significantly higher than that (82.1%) by PET-CT for mediastinal tumors and mass lesions. Conclusions: There was no significant difference between diagnostic capability of DWI and that of PET-CT for distinguishing mediastinal tumors and mass lesions. DWI is useful in distinguishing benign from malignant mediastinal tumors and mass lesions.

Diagnostic Performance of Diffusion - Weighted Imaging for Multiple Hilar and Mediastinal Lymph Nodes with FDG Accumulation

  • Usuda, Katsuo;Maeda, Sumiko;Motono, Nozomu;Ueno, Masakatsu;Tanaka, Makoto;Machida, Yuichiro;Matoba, Munetaka;Watanabe, Naoto;Tonami, Hisao;Ueda, Yoshimichi;Sagawa, Motoyasu
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.15
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    • pp.6401-6406
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    • 2015
  • Background: It is sometimes difficult to assess patients who have multiple hilar and mediastinal lymph nodes (MHMLN) with FDG accumulation in PET-CT. Since it is uncertain whether diffusion-weighted magnetic resonance imaging (DWI) is useful in the assessment of such patients, its diagnostic performance was assessed. Materials and Methods: Twenty-three patients who had three or more stations of hilar and mediastinal lymph nodes with SUVmax of 3 or more in PET-CT were included in this study. Results: For diagnosis of disease, there were 20 malignancies (lung cancers 17, malignant lymphomas 2 and metastatic lung tumor 1), and 3 benign cases (sarcoidosis 2 and benign disease 1). For diagnosis of lymph nodes, there were 7 malignancies (metastasis of lung cancer 7 and malignant lymphoma 1) and 16 benign lymphadenopathies (pneumoconiosis/silicosis 7, sarcoidosis 4, benign disease 4, and atypical lymphocyte infiltration 1). The ADC value ($1.57{\pm}0.29{\times}10^{-3}mm^2/sec$) of malignant MHMLN was significantly lower than that ($1.99{\pm}0.24{\times}10^{-3}mm^2/sec$) of benign MHMLN (P=0.0437). However, the SUVmax was not significantly higher ($10.0{\pm}7.34$ as compared to $6.38{\pm}4.31$) (P=0.15). The sensitivity (86%) by PET-CT was not significantly higher than that (71%) by DWI for malignant MHMLN (P=1.0). The specificity (100%) by DWI was significantly higher than that (31%) for benign MHMLN (P=0.0098). Furthermore, the accuracy (91%) with DWI was significantly higher than that (48%) with PET-CT for MHMLN (P=0.0129). Conclusions: Evaluation by DWI for patients with MHMLN with FDG accumulation is useful for distinguishing benign from malignant conditions.

Role of MRI in Diagnostic Evaluation of Papillary Lesions of the Breast (유방의 유두상 병변의 진단에서 자기공명영상의 역할)

  • Lee, So-Mi;Kim, Hye-Jung;Gwak, Yeon-Joo;Lee, Hui-Joong;Jang, Yun-Jin;Shin, Kyung-Min;Park, Ji-Young;Jung, Jin-Hyang
    • Investigative Magnetic Resonance Imaging
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    • v.14 no.1
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    • pp.41-46
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    • 2010
  • Purpose : To evaluate the role of magnetic resonance imaging (MRI) in the diagnosis of papillary lesions of the breast. Materials and methods : Among 45 papillary lesions diagnosed at ultrasonography-guided core biopsy (USCB), 27 benign papillary lesions in 22 patients who underwent breast MRI were reviewed. The excsional biopsy was performed in 1-10 days after MRI was done. In MRI findings, lesions were considered suspicious if they show irregular, rim enhancement, or linear enhancement in morphologic evaluation, or washout enhancement pattern of delayed phase in dynamic enhancement characteristics. Diffusionweighted images were analyzed according to visibility of lesions. MRI findings were correlated with pathologic results at excisional biopsy. Results : At excisional biopsy, two lesions (9%) were diagnosed malignant in 22 benign papillary lesions without atypia by USCB and 4 (80%) were malignant in 5 benign papillary lesions with atypia by USCB. Among 18 lesions detected on MRI, 16 lesions showed suspicious findings on MRI, 11 lesions (69%) were diagnosed as benign and 5 (31%) were malignant. Among 12 lesions detected on diffusion weighted imaging, 10 lesions were diagnosed as benign and 2 were malignant. MRI findings were not significantly correlated with pathologic results at excisional biopsy. Conclusion : MRI findings were not useful to predict malignancy in benign papillary lesions diagnosed at USCB, because MRI findings of these were mostly suspicious (88.9%, 16/18). The benign papillary lesion should be included in the false positive lesion on breast MRI.

$H\"{u}rthle$ Cell Tumor of the Thyroid (갑상선의 $H\"{u}rthle$씨 세포 종양)

  • Chung Woong-Youn;Kim Suk-Ju;Park Cheong-Soo
    • Korean Journal of Head & Neck Oncology
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    • v.13 no.2
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    • pp.206-212
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    • 1997
  • H$\"{u}$rthle cell neoplasm of the thyroid gland is an uncommon, but potentially malignant lesion. However, in many instances, the malignant potential of the H$\"{u}$rthle cell neoplasm is very difficult to judge histologically. For this reason, the biologic behavior of this tumor and its optimal treatment have come under considerable debate in recent years. In order to review the clinicopathologic features of the H$\"{u}$rthle cell neoplasm and to determine its optimal treatment modalities, we studied 26 patients with path logical proof of H$\"{u}$rthle cell tumor from January 1987 to September 1997. We also performed an immunohistochemical study using the monoclonal antibodies against antigen CD34 for the angiogenic activity of this tumor and evaluated the differences of microvessel density(MVD) between benign and malignant tumors. The age of the patients ranged from 1 to 71 years with a mean of 44.2 years. There were 6 males and 20 females(M : F= 1 : 3.3). The accuracies of fine needle aspiration biopsy and frozen section were very low; 6.3% and 34.8%, respectively. There were 20 benign tumors and 6 malignant tumors(23.1%). All the malignant tumors were microinvasive(intermediate) type which had minimal capsular invasion and most of them(5 cases) were diagnosed postoperatively. Any specific clinicopathologic differences were not seen between benign and intermediate groups. Most of the cases had conservative surgeries(15 ipsilateral lobectomy-isthmusectomy, 7 subtotal thyroidectomy) while total thyroidectomy was performed in 4 cases. Of the cases with malignant tumor, 2 had ipsilateral lobectomy-isthmusectomy, 3 had subtotal thyroidectomy and the remaining 1 had total thyroidectomy. Mean size of the tumors was 3.0 cm(0.1- 8.5 cm) in the greatest diameter and multiple tumors were seen in 6 cases(23.1 %). During the follow-up period, only one recurrence(3.8%) of benign tumor occurred but distant metastasis or cause-specific death was seen in the benign or intermediate groups. Mean MVDs of the benign(n=13) and intermediate(n=6) groups were $121.7{\pm}35.3$ and $114.3{\pm}31.7$, respectively and there was no statistical significance between them. In conclusion, because of the low accuracies of fine needle aspiration biopsy and frozen section for the H$\"{u}$rthle cell neoplasm, the extent of surgery could be individualized based on permanent pathologic examination; Conservative surgery would be adequate for patients with benign or intermediate H$\"{u}$rthle cell neoplasm and total or near-total thyroidectomy for those with definite malignancy.

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A Case of Benign Metastasizing Leiomyoma in the Lung (양성 전이성 폐 평활근종 1예)

  • Hwang, Jae-Kyung;Park, Kae-Young;Park, Jeong-Woong;Park, Jae-Kyung;Jeong, Seong-Hwan;Suh, Jun-Bum;Lee, Han-Kyung;Lee, Jae-Woong;Oh, Young-Ha;Nam, Gui-Hyun
    • Tuberculosis and Respiratory Diseases
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    • v.49 no.2
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    • pp.231-236
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    • 2000
  • Benign metastasizing leiomyoma usually occurs in women and is associated with a past hysterectomy in 80% of the cases, which is a rare entity. The patient was a 39-year-old woman who complained of cough and sputum. She underwent hysterectomy because of benign leiomyoma ten years ago. Chest X-ray showed nodular lesion in the left lung field. Chest CT showed a 3cm sized round well defined mass at left hilum with mild indentation of segmental bronchi of left upper lobe and a small tiny nodule in right lower lung field. Nodular lesion of left upper 1000 was resected by thoracotomy. Pathological evaluation showed benign spindle-like cells having nuclei without cytotic atypia similar to those of benign leiomyoma. Immunohistochernical stainings for desmin and smooth muscle actin were positive. Therefore these nodules are considered as benign metastasizing leiomyoma from a uterine leiomyoma. We report this case with the review of literature.

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A Prospective Study on the Value of Ultrasound Microflow Assessment to Distinguish Malignant from Benign Solid Breast Masses: Association between Ultrasound Parameters and Histologic Microvessel Densities

  • Ah Young Park;Myoungae Kwon;Ok Hee Woo;Kyu Ran Cho;Eun Kyung Park;Sang Hoon Cha;Sung Eun Song;Ju-Han Lee;JaeHyung Cha;Gil Soo Son;Bo Kyoung Seo
    • Korean Journal of Radiology
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    • v.20 no.5
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    • pp.759-772
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    • 2019
  • Objective: To investigate the value of ultrasound (US) microflow assessment in distinguishing malignant from benign solid breast masses as well as the association between US parameters and histologic microvessel density (MVD). Materials and Methods: Ninety-eight breast masses (57 benign and 41 malignant) were examined using Superb Microvascular Imaging (SMI) and contrast-enhanced US (CEUS) before biopsy. Two radiologists evaluated the quantitative and qualitative vascular parameters on SMI (vascular index, morphology, distribution, and penetration) and CEUS (time-intensity curve analysis and enhancement characteristics). US parameters were compared between benign and malignant masses and the diagnostic performance was compared between SMI and CEUS. Subgroup analysis was performed according to lesion size. The effect of vascular parameters on downgrading Breast Imaging Reporting and Data System (BI-RADS) category 4A masses was evaluated. The association between histologic MVD and US parameters was analyzed. Results: Malignant masses were associated with a higher vascular index (15.1 ± 7.3 vs. 5.9 ± 5.6), complex vessel morphology (82.9% vs. 42.1%), central vascularity (95.1% vs. 59.6%), penetrating vessels (80.5% vs. 31.6%) on SMI (all, p < 0.001), as well as higher peak intensity (37.1 ± 25.7 vs. 17.0 ± 15.8, p < 0.001), slope (10.6 ± 11.2 vs. 3.9 ± 4.2, p = 0.001), area (1035.7 ± 726.9 vs. 458.2 ± 410.2, p < 0.001), hyperenhancement (95.1% vs. 70.2%, p = 0.005), centripetal enhancement (70.7% vs. 45.6%, p = 0.023), penetrating vessels (65.9% vs. 22.8%, p < 0.001), and perfusion defects (31.7% vs. 3.5%, p < 0.001) on CEUS (p ≤ 0.023). The areas under the receiver operating characteristic curve (AUCs) of SMI and CEUS were 0.853 and 0.841, respectively (p = 0.803). In 19 masses measuring < 10 mm, central vascularity on SMI was associated with malignancy (100% vs. 38.5%, p = 0.018). Considering all benign SMI parameters on the BI-RADS assessment, unnecessary biopsies could be avoided in 12 category 4A masses with improved AUCs (0.500 vs. 0.605, p < 0.001). US vascular parameters associated with malignancy showed higher MVD (p ≤ 0.016). MVD was higher in malignant masses than in benign masses, and malignant masses negative for estrogen receptor or positive for Ki67 had higher MVD (p < 0.05). Conclusion: US microflow assessment using SMI and CEUS is valuable in distinguishing malignant from benign solid breast masses, and US vascular parameters are associated with histologic MVD.

A Study of Voice Improvement According to the Onset Time of Voice Therapy after Laryngomicrosurgery (레이저를 이용하여 후두미세수술을 시행한 환자에서 음성치료를 시작한 시기에 따른 음성 호전 결과에 관한 연구)

  • 김한균;정필상;오양희;김영훈
    • Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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    • v.12 no.1
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    • pp.22-27
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    • 2001
  • Backgrounds and Objectives : There have been reported many studies which evaluate the effectiveness of combined laryngomicrosurgery(LMS) and voice therapy for the patients with benign vocal cord lesions. But the difference of voice improvement by onset time of voice therapy has not been reported. The purpose of this study is to analyze the differences of voice improvement by voice analysis test between the two groups with different onset time of voice therapy. Materials and Methods : Two groups, each of which comprises 15 patients, were analyzed. For the one group, the voice therapy was initiated 1 day after LMS. For the other, the therapy was initiated 1 week after LMS. Voice analytic parameters of the two groups were statistically analized to identify difference in voice improvement. Results : All measured parameters improved after voice therapy in two groups and showed no significant difference between two groups. Conclusions : The onset time of voice therapy after LMS has no significant impact on post-operative voice quality in the patients with benign vocal cord lesions. Early onset of post-operative voice therapy may serve as treatment modality for patients with benign vocal cord lesions.

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Nature of Lesions Undergoing Radical Nephrectomy for Renal Cancer

  • Mustafa, Gunes;Ilhan, Gecit;Necip, Pirincci;Kerem, Taken;Kadir, Ceylan
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.9
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    • pp.4431-4433
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    • 2012
  • Aim: The aim of the present study was to evaluate retrospectively histopathologically-diagnosed lesions that were detected in the kidney after radical nephrectomy for a preoperative diagnosis of kidney cancer. Methods: The medical records of 83 patients (51 male, 32 female) were included. Preoperative staging was accomplished by various methods including physical examination, blood hemography and biochemistry, abdominal ultrasonography (US), chest x-ray, abdominal computed tomography (CT) and abdominal magnetic resonance imaging (MRI). Results: Totals of 70 patients underwent radical nephrectomy and 13 nephron sparing surgery. Of the 83 patients, 70 had malignant lesions (renal cell carcinoma, squamous cell carcinoma or other malignancies) 13 had a variety of benign lesions, the most frequently detected being oncoytoma (6), angiomyolipoma (3), xanthogranulamatous pyelonephritis (2), cortical cyst (1) and chronic pyelonephritic change (1). Conclusion: It was concluded that in spite of great technological developments regarding radiological imaging modalities such as US, CT and MRI, benign lesions might still be detected pathologically in patients who undergo radical nephrectomy with the preoperative diagnosis of renal cancer. But, all renal masses should be regarded as malignant and should be managed surgically otherwise proven benign.

Squamous cell carcinoma arising within a maxillary odontogenic keratocyst: A rare occurrence

  • Jalali, Elnaz;Ferneini, Elie M.;Rengasamy, Kandasamy;Tadinada, Aditya
    • Imaging Science in Dentistry
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    • v.47 no.2
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    • pp.135-140
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    • 2017
  • Squamous cell carcinoma (SCC) arising within the lining of an odontogenic keratocyst (OKC) is a rare occurrence. Although potentially locally destructive, OKC is a benign odontogenic process that typically presents with clinical and radiographic features characteristic of a benign intraosseous neoplasm. We present the clinical and radiographic features of a maxillary mass that demonstrated SCC arising from the lining of an OKC. Although the initial clinical and radiographic presentation suggested an infection or malignant neoplasm, biopsies revealed an infiltrative well-differentiated SCC contiguous with and arising from the focus of a pre-existing OKC. The patient subsequently underwent a type II hemi-maxillectomy with neoadjuvant chemoradiation. This report discusses the clinical and radiographic features associated with intraosseous malignancies, especially those arising from an otherwise benign odontogenic lesion. While the majority of OKCs are benign, the current report illustrates the potential for carcinomatous transformation within the lining of an OKC.

Quality of Life and its Related Factors in Patients with Benign Prostatic Hyperplasia in One General Hospital (일개 상급전문종합병원 전립샘비대증 환자들의 삶의 질 영향 요인)

  • Seok, Yoon Hee;Yi, Myungsun
    • Journal of Korean Clinical Nursing Research
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    • v.23 no.3
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    • pp.332-340
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    • 2017
  • Purpose: This study was to identify the quality of life and its related factors in patients with benign prostatic hyperplasia. Methods: A cross-sectional survey design was utilized. Data were collected using questionnaires from 128 patients with benign prostatic hyperplasia who visited an outpatient department at one general hospital in 2016. Data were analyzed using Mann-Whitney U test, Kruskal Wallis test, Pearson's correlation coefficient and hierarchical multiple regression analysis. Results: Mean age of the participant was $67.81{\pm}6.94$. Mean years since diagnosis was $6.41{\pm}5.20$. The mean score of quality of life was $0.82{\pm}0.09$, indicating that QOL was relatively low. Lower urinary tract symptoms (p=.029), anxiety, depression, Activities of daily living were significantly correlated to with quality of life (p<.001). Activities of daily living accounted for 54% (p<.001) of the variance in quality of life as a result of hierarchical multiple regression analysis. Conclusion: The results of the study showed that nursing intervention may improve the quality of life of patients with benign prostatic hyperplasia by increasing their Activities of daily living.