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The Differentiation of Benign from Maligant Soft Tissue Lesions using FDG-PET: Comparison between Semi-quantitative Indices (FDG-PET을 이용한 악성과 양성 연부조직 병변의 감별: 반정량적 지표간의 비교)

  • Choi, Joon-Young;Lee, Kyung-Han;Choe, Yearn-Seong;Choi, Yong;Kim, Sang-Eun;Seo, Jai-Gon;Kim, Byung-Tae
    • The Korean Journal of Nuclear Medicine
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    • v.31 no.1
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    • pp.90-101
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    • 1997
  • The purpose of this study is to evaluate the diagnostic accuracy of various quantitative indices for the differentiation of benign from malignant primary soft tissue tumors by FDG-PET. A series of 32 patients with a variety of histologically or clinically confirmed benign (20) or malignant (12) soft tissue lesions were evaluated with emission whole body (5min/bed position) PET after injection of [$^{18}F$]FDG. Regional 20min transmission scan for the attenuation correction and calculation of SUV was performed in 16 patients (10 benign, 6malignant) followed by dynamic acquisition for 56min. Postinjection transmission scan for the attenuation correction and calculation of SUV was executed in the other 16 patients (10 benign, 6 malignant). The following indices were obtained. the peak and average SUV (pSUV, aSUV) of lesions, tumor-to-background ratio acquired at images of 51 min p.i. ($TBR_{51}$), tumor-to-background ratio of areas under time-activity curves ($TBR_{area}$) and the ratio between the activities of tumor ROI at 51 min p. i. and at the time which background ROI reaches maximum activity on the time-activity curves ($T_{51}/T_{max}$). The pSUV, aSUV, $TBR_{51}$, and $TBR_{area}$ in malignant lesions were significantly higher than those in benign lesions. We set the cut-off values of pSUV, aSUV, $TBR_{51},\;TBR_{area}$ and $T_{51}/T_{max}$ for the differentiation of benign and malignant lesions at 3.5, 2.8, 5.1, 4.3 and 1.55, respectively. The sensitivity, specificity and accuracy were 91.7%, 80.0%, 84.4% by pSUV and aSUV, 83.3%, 85.0%, 84.4% by $TBR_{51}$, 83.3%, 100%, 93.8% by $TBR_{area}$ and 66.7%, 70.0%, 68.8% by $T_{51}/T_{max}$. The time-activity curves did not give additional information compared to SUV or TBR. The one false negative was a case with low-grade fibrosarcoma and all four false positives were cases with inflammatory change on histology. The visual, analysis of FDG-PET also detected the metastatic lesions in malignant cases with comparable accuracy In conclusion, all pSUV, aSUV, $TBR_{51}$, and $TBR_{area}$ are useful metabolic semi-quantitative indices with good accuracy for the differentiation of benign from malignant soft-tissue lesions.

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Expression of Hypoxia-inducible Factor-$1{\alpha}$ in Non-small Cell Lung Cancer: Relationship to Prognosis and Tumor Biomarkers (비소세포 폐암에서 HIF-$1{\alpha}$의 발현: 예후 및 종양표지자와의 관련성)

  • Cho, Sung-Rae;Byun, Joung-Hun;Kim, Jong-In;Lee, Bong-Geun;Chun, Bong-Kwon
    • Journal of Chest Surgery
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    • v.39 no.11 s.268
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    • pp.828-837
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    • 2006
  • Background: Tissue hypoxia is characteristic of many human malignant neoplasm, and hypoxia inducible factor-1(HIF-1) plays a pivotal role in essential adaptive response to hypoxia, and activates a signal pathway for the expression of the hypoxia-regulated genes, resulting in increasing $O_2$ delivery or facilitating metabolic adaptation to hypoxia. Increased level of HIF-$1{\alpha}$ has been reported in many human malignancies, but in non-small cell lung carcinoma the influence of HIF-$1{\alpha}$ on tumor biology, including neovascularization, is not still defined. In present study the relationship of HIF-$1{\alpha}$ expression on angiogenetic factors, relationship between the tumor proliferation and HIF-$1{\alpha}$ expression, interaction of HIF-$1{\alpha}$ expression and p53, and relationship between HIF-$1{\alpha}$ expression and clinico-pathological prognostic parameters were investigated. Material and Method: Archival tissue blocks recruited in this study were retrieved from fifty-nine patients with primary non-small cell lung carcinoma, who underwent pneumonectomy or lobectomy from 1997 to 1999. HIF-$1{\alpha}$, VEGF(vascular endothelial growth factor), and p53 protein expression and Ki-67 labeling index in tumor tissues were evaluated, using a standard avidin-biotin-peroxidase complex(ABC) immunohistochemistry. Relationship between the HIF-$1{\alpha}$ expression and VEGF, p53 overexpression and correlation between the HIF-$1{\alpha}$ expresseion and Ki-67 index were analyzed. Clinico-pathologic prognostic parameters were also analyzed. Result: HIF-$1{\alpha}$ expression in cancer cells was found in 24 of 59 cases of non-small cell lung carcinoma(40.7%). High HIF-$1{\alpha}$ expression was significantly associated with several pathological parameters, such as pathological TMN stage(p=0.004), pT stage(p=0.020), pN stage (p=0.029), and lymphovascular invasion(p=0.019). High HIF-$1{\alpha}$ expression was also significantly associated with VEGF immunoreactivity(p<0.001), and aberrant p53 expression(p=0.040). but was marginally associated with Ki-67 labeling index(p=0.092). The overall 5-year survival rate was 42.3%. The survival curve of patients with a high HIF-$1{\alpha}$ expression was worse than that of patients with low-expression(p=0.002). High HIF-$1{\alpha}$ expression was independent unfavorable factors with a marginal significance in multivariate analysis performed by Cox regression. Conclusion: It is suggested that high HIF-$1{\alpha}$ expression may be associated with intratumoral neovascularization possibly through HIF-VEGF pathway, and high HIF-$1{\alpha}$ expression could be associated with lymph node metastasis and post operative poor prognosis in patients with non-small cell lung carcinoma.

On the Nighttime Correction of CO2 Flux Measured by Eddy Covariance over Temperate Forests in Complex Terrain (복잡지형의 온대산림에서 에디 공분산으로 관측된 CO2 플럭스의 야간 자료 보정에 관하여)

  • Kang, Minseok;Kim, Joon;Kim, Hyun-Seok;Thakuri, Bindu Malla;Chun, Jung-Hwa
    • Korean Journal of Agricultural and Forest Meteorology
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    • v.16 no.3
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    • pp.233-245
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    • 2014
  • Nighttime correction of $CO_2$ flux is one of the most important and challenging tasks in eddy covariance measurements over a complex mountainous terrain. In this study, we have scrutinized the quality and the credibility of the $CO_2$ flux datasets which were produced by employing three different methods of nighttime correction, i.e., (1) friction velocity ($u^*$) correction, (2) light response curve (LRC) correction, and (3) advection-based van Gorsel (VG) correction. The whole year datasets used in our analysis were collected at the two KoFlux tower sites (i.e., GDK deciduous forest site at the upper hill and GCK coniferous forest site at the lower hill) located in the valley of Gwangneung National Arboretum in central Korea. The resultant magnitudes and patterns of ecosystem respiration ($R_E$), gross primary productivity (GPP), and net ecosystem exchange (NEE) of $CO_2$ showed marked differences among the datasets produced with three different correction methods, which were also site-specific. The examination from micrometeorological and ecological perspectives suggests that the major cause of some inconsistency seems to be associated with the advection of $CO_2$ along the sloping terrain and the inappropriate selection of the correction data that might have been already affected by advective flows. The comparison with the results from other studies indicated that the overall characteristics of the corrected $CO_2$ fluxes at GDK and GCK (except those with LRC correction) were well within the ranges reported in the literature for various ecosystems in East Asia in similar latitudes. However, our study also implies that there will be always a room for further improvement in the present datasets. Therefore, caution must be exercised for the data users in order to properly use the updated version of datasets through transparent, open and participatory communication with data producers.

Cross-sectional Survey for Prevalence Rate of Scoliosis in Primary, Middle and High School Boys in Pusan City (부산시내 남자 초.중.고등학생의 척추측만증 유병률 측정을 위한 단면조사)

  • Kim, Bok-Yong;Park, Jung-Han;Kim, Poong-Taek
    • Journal of Preventive Medicine and Public Health
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    • v.21 no.2 s.24
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    • pp.217-223
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    • 1988
  • A cross-sectional survey was conducted to determine the prevalence rate of scoliosis in elementary, middle and high school boys in May 1988. The study population included 1,393 male students in Pusan ; 463 students of 4th grade in two elementary schools, 543 students of 1st grade in one middle school and 387 students of 1st grade in one high school. The students of elementary school were screened with inspection by two physicians at the same time and the students of middle and high schools were screened with both inspection by the same physicians and 70mm chest X-ray. Positive students in any one of the two screening tests were measured for height and body weight and asked for the shoulder side on which he carries the school bag. The angle of curvature on X-ray film was measured by Cobb's method. The number of positive students in any one of the two screening tests were 15(3.2%) in elementary schools, 174(32.0%) in middle school and 92(23.8%) in high school. However, positive rates in both tests were only 2.2% for the middle school students and 2.6% for the high school students and among these students 1.1% out of total middle school students and 2.3% of high school students had a curvature equal to or greater than $5^{\circ}$ of Cobb's angle on 70mm chest X-ray film. There was a statistically significant association between the direction of spinal curve and the shoulder side on which one carries school bag among positive students in both screening 1.sts (p<0.05) Mean height and body weight of 281 positive students in any one of two screening tests were compared with the Korean standard for the same age. Mean weight of elementary school students was nearly the same as the standard weight but the height was slightly shorter than the standard. However, both mean height and weight of the middle school students were lower than the standard while those of the high school students were higher. The prevalence rate of scoliosis for the 2nd and 3rd grades of high school is presumed to be higher than that of the 1st grade of high school and the rate for girls will be even higher than the rate for boys of the same age. Thus, scoliosis seems to be an important school health problem. To prevent scoliosis, it is recommeded to reduce the weight of school bag, educate the students to keep a right posture and exercise periodically.

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Diagnostic Efficacy of FDG-PET Imaging in Solitary Pulmonary Nodule (고립성폐결절의 진단시 FDG-PET의 임상적 유용성에 관한 연구)

  • Cheon, Eun Mee;Kim, Byung-Tae;Kwon, O. Jung;Kim, Hojoong;Chung, Man Pyo;Rhee, Chong H.;Han, Yong Chol;Lee, Kyung Soo;Shim, Young Mog;Kim, Jhingook;Han, Jungho
    • Tuberculosis and Respiratory Diseases
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    • v.43 no.6
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    • pp.882-893
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    • 1996
  • Background : Over one-third of solitary pulmonary nodules are malignant, but most malignant SPNs are in the early stages at diagnosis and can be cured by surgical removal. Therefore, early diagnosis of malignant SPN is essential for the lifesaving of the patient. The incidence of pulmonary tuberculosis in Korea is somewhat higher than those of other countries and a large number of SPNs are found to be tuberculoma. Most primary physicians tend to regard newly detected solitary pulmonary nodule as tuberculoma with only noninvasive imaging such as CT and they prefer clinical observation if the findings suggest benignancy without further invasive procedures. Many kinds of noninvasive procedures for confirmatory diagnosis have been introduced to differentiate malignant SPNs from benign ones, but none of them has been satisfactory. FOG-PET is a unique tool for imaging and quantifying the status of glucose metabolism. On the basis that glucose metabolism is increased in the malignant transfomled cells compared with normal cells, FDG-PET is considered to be the satisfactory noninvasive procedure which can differentiate malignant SPNs from benign SPNs. So we performed FOG-PET in patients with solitary pulmonary nodule and evaluated the diagnostic accuracy in the diagnosis of malignant SPNs. Method : 34 patients with a solitary pulmonary nodule less than 6 cm of irs diameter who visited Samsung Medical Center from Semptember, 1994 to Semptember, 1995 were evaluated prospectively. Simple chest roentgenography, chest computer tomography, FOG-PET scan were performed for all patients. The results of FOG-PET were evaluated comparing with the results of final diagnosis confirmed by sputum study, PCNA, fiberoptic bronchoscopy, or thoracotomy. Results : (I) There was no significant difference in nodule size between malignant (3.1 1.5cm) and benign nodule(2.81.0cm)(p>0.05). (2) Peal SUV(standardized uptake value) of malignant nodules (6.93.7) was significantly higher than peak SUV of benign nodules(2.71.7) and time-activity curves showed continuous increase in malignant nodules. (3) Three false negative cases were found among eighteen malignant nodule by the FDG-PET imaging study and all three cases were nonmucinous bronchioloalveolar carcinoma less than 2 em diameter. (4) FOG-PET imaging resulted in 83% sensitivity, 100% specificity, 100% positive predictive value and 84% negative predictive value. Conclusion: FOG-PET imaging is a new noninvasive diagnostic method of solitary pulmonary nodule thai has a high accuracy of differential diagnosis between malignant and benign nodule. FDG-PET imaging could be used for the differential diagnosis of SPN which is not properly diagnosed with conventional methods before thoracotomy. Considering the high accuracy of FDG-PET imaging, this procedure may play an important role in making the dicision to perform thoracotomy in diffcult cases.

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Identification of Sorption Characteristics of Cesium for the Improved Coal Mine Drainage Treated Sludge (CMDS) by the Addition of Na and S (석탄광산배수처리슬러지에 Na와 S를 첨가하여 개량한 흡착제의 세슘 흡착 특성 규명)

  • Soyoung Jeon;Danu Kim;Jeonghyeon Byeon;Daehyun Shin;Minjune Yang;Minhee Lee
    • Economic and Environmental Geology
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    • v.56 no.2
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    • pp.125-138
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    • 2023
  • Most of previous cesium (Cs) sorbents have limitations on the treatment in the large-scale water system having low Cs concentration and high ion strength. In this study, the new Cs sorbent that is eco-friendly and has a high Cs removal efficiency was developed by improving the coal mine drainage treated sludge (hereafter 'CMDS') with the addition of Na and S. The sludge produced through the treatment process for the mine drainage originating from the abandoned coal mine was used as the primary material for developing the new Cs sorbent because of its high Ca and Fe contents. The CMDS was improved by adding Na and S during the heat treatment process (hereafter 'Na-S-CMDS' for the developed sorbent in this study). Laboratory experiments and the sorption model studies were performed to evaluate the Cs sorption capacity and to understand the Cs sorption mechanisms of the Na-S-CMDS. The physicochemical and mineralogical properties of the Na-S-CMDS were also investigated through various analyses, such as XRF, XRD, SEM/EDS, XPS, etc. From results of batch sorption experiments, the Na-S-CMDS showed the fast sorption rate (in equilibrium within few hours) and the very high Cs removal efficiency (> 90.0%) even at the low Cs concentration in solution (< 0.5 mg/L). The experimental results were well fitted to the Langmuir isotherm model, suggesting the mostly monolayer coverage sorption of the Cs on the Na-S-CMDS. The Cs sorption kinetic model studies supported that the Cs sorption tendency of the Na-S-CMDS was similar to the pseudo-second-order model curve and more complicated chemical sorption process could occur rather than the simple physical adsorption. Results of XRF and XRD analyses for the Na-S-CMDS after the Cs sorption showed that the Na content clearly decreased in the Na-S-CMDS and the erdite (NaFeS2·2(H2O)) was disappeared, suggesting that the active ion exchange between Na+ and Cs+ occurred on the Na-S-CMDS during the Cs sorption process. From results of the XPS analysis, the strong interaction between Cs and S in Na-S-CMDS was investigated and the high Cs sorption capacity was resulted from the binding between Cs and S (or S-complex). Results from this study supported that the Na-S-CMDS has an outstanding potential to remove the Cs from radioactive contaminated water systems such as seawater and groundwater, which have high ion strength but low Cs concentration.

Diagnostic Usefulness of Serum Level of Cyfra 21-1, SCC Antigen and CEA in Lung Cancer (폐암에서 혈중 Cyfra 21-1, SCC 항원 및 CEA의 진단적 유용성)

  • Kim, Kyoung-Ah;Lee, Me-Hwa;Koh, Youn-Suck;Kim, Seon-Hee;Lim, Chae-Man;Lee, Sang-Do;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong;Moon, Dae-Hyuk
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.6
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    • pp.846-854
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    • 1995
  • Background: Cytokeratin 19 is a subunit of cytokeratin intermediate filament expressed in simple epithelia such as respiratory epithelial cells and their malignant counterparts. An immunoradiometric assay is available to detect a fragment of the cytokeratin, referred to as Cyfra 21-1 in the serum. This study was conducted to evaluate the clinical utility of this new marker in the diagnosis of lung cancer compared with established markers of squamous cell carcinoma antigen (SCC Ag) and carcino-embryonic antigen(CEA). In addition, we compared the diagnostic sensitivity and specificity of Cyfra 21-1 with those of SCC Ag in squamous cell carcinoma of the lung. We also measured the level of Cyfra 21-1 in the different stages of squamous cell carcinoma of the lung. Method: We measured Cyfra 21-1(ELSA-CYFRA 21-1), SCC Ag(ABBOTT SCC RIABEAD) and CEA(ELSA2-CEA) in 79 patients with primary lung cancer and in 78 persons as a comparison group including 32 patients with pulmonary tuberculosis, 23 patients with benign lung disease and 23 cases with healthy individual. Cyfra 21-1 is measured by a solid-phase immunoradiometric assay(CIS Bio International, France) based on the two-site sandwich method. SCC Ag is measured by a radioimmunoassay(Abbott Laboratories, USA). CEA is measured by a immunoradiometric assay(CIS Bio International, France). All data were expressed as the mean$\pm$standard deviation. Results: 1) The mean value of Cyfra 21-1 was $18.38{\pm}3.65\;ng/mL$ in the lung cancer and $1.l6{\pm}0.53\;ng/mL$ in the comparison group(p<0.0001). SCC Ag was $3.53{\pm}6.06\;ng/mL$ in the lung cancer and $1.19{\pm}0.5\;ng/mL$ in the comparison group(p<0.01). CEA was $35.03{\pm}13.9\;ng/mL$ in the lung cancer and $2.89{\pm}1.01\;ng/mL$ in the comparison group(p<0.0001). 2) Cyfra 21-1 level in squamous cell carcinoma($31.52{\pm}40.13\;ng/mL$) was higher than that in adenocarcinoma($2.41{\pm}1.34\;ng/mL$)(p<0.0001) and small cell carcinoma($2.15{\pm}2.05\;ng/mL$)(p=0.007). SCC Ag level in squamous cell carcinoma($5.1{\pm}7.68\;ng/mL$) was higher than that in adenocarcinoma($1.36{\pm}0.69\;ng/mL$)(p=0.009) and small cell carcinoma($1.1{\pm}0.24\;ng/mL$) (p=0.024). 3) The level of Cyfra 21-1 was not correlated with the progression of stage in squamous cell carcinoma of the lung. 4) Using the cut-off value of 3.3ng/mL, the diagnostic sensitivity of Cyfra 21-1 was 83% in squamous cell carcinoma, 22% in adenocarcinoma and 17% in small cell carcinoma. The sensitivity of SCC Ag and CEA were 39% and 20%, respectively in squamous cell carcinoma, 11% and 39% in adenocarcinoma, and 0% and 33% in small cell carcinoma. 5) Comparison of the receiver operating characteristics curves(ROC curve) for Cyfra 21-1, SCC Ag and CEA revealed that Cyfra 21-1 showed highest diagnostic sensitivity among them in the diagnosis of lung cancer. Conclusion: Cyfra 21-1 is thought to be a better tumor marker for the diagnosis of lung cancer than SCC Ag and CEA, especially in squamous cell carcinoma of the lung.

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