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Background: Central and lateral lymph node metastases are quite common in patients with papillary thyroid carcinoma, and the predictors for those metastases have been well studied. Right upper paraesophageal lymph node metastasis has rarely been studied. The aim of this study was to identify the clinicopathological characteristics that may be risk factors for right upper paraesophageal lymph node metastasis in patients with papillary thyroid carcinoma. Methods: This was a prospective observational study of 243 patients with papillary thyroid carcinoma (PTC) who underwent total thyroidectomy and comprehensive central lymph node dissection with or without lateral lymph node dissection between April 2008 and January 2010. The clinicopathologic findings from these patients were investigated and the patterns of lymph node metastasis were analyzed in the patients who had right upper paraesophageal lymph node disease. Results: Of the 243 patients undergoing lymph node dissection, 14 had right upper paraesophageal lymph node metastases. Two of these patients had right upper paraesophageal lymph node metastasis only, without central compartment metastasis. Univariate analysis of clinicopathologic findings showed that right upper paraesophageal lymph node metastasis had significant association with larger primary tumors, multifocal tumors, extrathyroid extension, and lymphatic invasion (p <0.05 for each factor). Conclusions: Although there were no independent predictors of right upper paraesophageal lymph node metastasis, it can be the only site of metastasis without other compartmental metastasis. Therefore, during surgery for patients with central or lateral lymph node metastases from PTC, it may be helpful to examine the right upper paraesophageal lymph nodes. [ABSTRACT FROM AUTHOR]

As the complexity of 3D scenes is on the increase, the search for an effective visibility culling method has become one of the most important issues to be addressed in the design of 3D rendering processors. In this paper, we propose a new rasterization pipeline with visibility culling; the proposed architecture performs the visibility culling at an early stage of the rasterization pipeline (especially at the traversal stage) by retrieving data in a pixel cache without any significant hardware logics such as the hierarchical - z-buffer. If the data to be retrieved does not exist in the pixel cache, the proposed architecture performs a prefetch operation in order to reduce the miss penalty of the pixel cache. That is, the cache miss penalty can be reduced as the transfer of a missed cache block from the frame memory into the pixel cache can be handled simultaneously with the rasterization pipeline executions. Simulation results show that the proposed architecture can achieve a performance gain of about 32 percent compared with the conventional pretexturing architecture and about 7 percent compared to the hierarchical z-buffer visibility scheme. [ABSTRACT FROM AUTHOR]

Current pipelinable dividers require very large lookup tables. We propose a cost-effective pipelinable divider that uses a modified Taylor-series expansion and has a smaller lookup table than other pipelinable dividers. The proposed divider requires about 27 percent less area than the pipelinable divider based on normal Taylor-series expansion in single precision. [ABSTRACT FROM AUTHOR]

As a 3D scene becomes increasingly complex and the screen resolution increases, the design of an effective memory architecture is one of the most important issues for 3D rendering processors. We propose a pixel rasterization architecture that performs the depth test twice, before and after texture mapping. The proposed architecture eliminates memory bandwidth waste due to fetching unnecessary obscured texture data by performing the depth test before texture mapping. It also reduces the miss penalties of the pixel cache by using a prefetch scheme--that is, a frame memory access, due to a cache miss at the first depth test, is done simultaneously with texture mapping. We have built a trace-driven simulator for the proposed architecture. To validate the proposed architecture, the results of various simulations are provided. The proposed pixel rasterization architecture achieves memory bandwidth effectiveness and reduces power consumption while producing high-performance gains. [ABSTRACT FROM AUTHOR]

Purpose An inverse relationship between cancer and neurodegenerative disease, which presents the possibility of a reduced risk of dementia in cancer patients, has been suggested previously. However, a nationwide longitudinal population-based study of specific types of cancer with due consideration of treatment effects has not been conducted. Materials and Methods This nationwide population-based cohort study used data obtained in a 12-year period (January 2007-December 2018) in the Korean National Health Insurance claims database. All female breast cancer patients (age = 50 years) diagnosed between 2009 and 2010 were included after excluding those with physician visits for any cancer during a 2-year period (2007-2008). Patients with senile cataract constituted the control group. The main study outcome was the risk of developing dementia. Results From a total of 90,396 and 85,906 patients with breast cancer and cataract, respectively, patients without behavior codes were excluded. Data for 15,407 breast cancer patients and 7,020 controls were analyzed before matching. After matching for comorbidities and age, either group comprised 2,252 patients. The median follow-up time was 104.1±24.0 months after matching. After matching, breast cancer was a predictor of a lower risk of for dementia (hazard ratio, 0.091; 95% confidence interval, 0.075 to 0.111; p < 0.001). In breast cancer patients, receiving chemotherapy and endocrine therapy did not significantly affect the incidence of dementia. Conclusion Breast cancer was associated with a remarkably decreased risk of dementia. The findings strongly suggest an inverse relationship between cancer and neurodegeneration, regardless of the adverse effects of cancer treatment on cognitive function. [ABSTRACT FROM AUTHOR]

Totally implantable venous access devices (chemoports) are used increasingly in oncology patients to provide simple and durable access for intravenous delivery of drugs and fluids. However, these catheters are associated with a number of complications, such as infection, thrombosis, and stenosis. Fracture of a venous catheter is also a rare complication, known as "pinch-off syndrome." A 43-year-old female with breast cancer was presented with chest pain of one week's duration after undergoing placement of a chemoport for adjuvant chemotherapy. Her chest X-ray showed that a portion of the catheter had broken free and was lodged in the right ventricle. The embolic fragment was successfully retrieved via percutaneous femoral vein insertion of a snare. [ABSTRACT FROM AUTHOR]

Background: Hormone replacement therapy (HRT) increases the risk of breast cancer, but the association may vary according to patient factors. We investigated the association between HRT and breast cancer in a nationwide cohort with risk stratification according to risk factors for breast cancer. Methods: Using the Korean National Health Insurance Service database, 4,558,376 postmenopausal women who underwent breast cancer screening and regular health checkups from 2009 to 2014 were analyzed. Results: A total of 696,084 (15.3%) women reported current or previous HRT use. Breast cancer was newly diagnosed in 26,797 (0.6%) women during a median follow-up of 5.35 years. The HR of the risk of breast cancer in HRT users was 1.25 [95% confidence interval (CI), 1.22-1.29] compared with HRT nonusers. The risk of breast cancer increased according to HRT duration [adjusted HR = 1.08; 95% CI, 1.04-1.12, for <2 years; adjusted HR = 1.33; 95% CI, 1.25-1.40, for 2 to <5 years; and adjusted HR = 1.72; 95% CI, 1.63-1.82, for ≥5 years). The effects of HRT on breast cancer risk applied to both invasive and in situ cancer. The HRT-related risk of breast cancer was higher in women who were leaner and those who had dense breasts. Conclusions: This nationwide population-based study confirms the association between HRT use and breast cancer risk. The risk increased proportionally with duration of HRT and differed according to body weight and breast density. Impacts: Risk stratification would be useful when deciding whether to apply HRT for relief of menopausal symptoms. [ABSTRACT FROM AUTHOR]

Purpose: Recent studies revealed the BRCA1 c.5339T>C, p.Leu1780Pro variant (L1780P) is highly suggested as a likely pathogenic. The aim of this study was to evaluate clinicopathologic features of L1780P with breast cancer (BC) using multicenter data from Korea to reinforce the evidence as a pathogenic mutation and to compare L1780P and other BRCA1/2mutations using Korean Hereditary Breast Cancer (KOHBRA) study data. Materials and Methods: The data of 54 BC patients with L1780P variant from 10 institutions were collected and the clinicopathologic characteristics of the patients were reviewed. The hereditary breast and/or ovarian cancer-related characteristics of the L1780P variant were compared to those of BC patients in the KOHBRA study. Results: The median age of all patients was 38 years, and 75.9% of cases showed triple-negative breast cancer. Comparison of cases with L1780P to carriers from the KOHBRA study revealed that the L1780P patients group was more likely to have family history (FHx) of ovarian cancer (OC) (24.1% vs. 19.6% vs. 11.2%, p < 0.001 and p=0.001) and a personal history of OC (16.7% vs. 2.9% vs. 1.3%, p=0.003 and p=0.001) without significant difference in FHx of BC and bilateral BC. The cumulative risk of contralateral BC at 10 years after diagnosis was 31.9%, while the cumulative risk of OC at 50 years of age was 20.0%. Patients with L1780P showed similar features with BRCA1 carriers and showed higher penetrance of OC than patients with other BRCA1 mutations. Conclusion: L1780P should be considered as a pathogenic mutation. Risk-reducing salpingo-oophorectomy is highly recommended for women with L1780P. [ABSTRACT FROM AUTHOR]

Spindle cell ductal carcinoma in situ (DCIS) is a recently recognized subtype of DCIS, which is associated with a very rare and unique morphology. Although the histologic features have been relatively well described in a few reports, the cytologic features have not. Even though the distinction of this lesion from usual DCIS is not crucial clinically, it should be noted that this lesion might simulate the features of metaplastic carcinoma on fine needle aspiration cytology. Here, we report a case of spindle cell DCIS in a 45-year-old female, with the detailed cytologic features, both on conventional and liquid-based preparations, along with some useful immunohistochemical staining markers for the differential diagnosis. [ABSTRACT FROM AUTHOR]

Purpose: Breast cancer treatment has progressed significantly over the past 20 years. However, knowledge regarding male breast cancer (MBC) is sparse because of its rarity. This study is an investigation of the clinicopathologic features, treatments, and clinical outcomes of MBC. Materials and Methods: Clinical records of 59 MBC patients diagnosed during 1995-2014 from seven institutions in Korea were reviewed retrospectively. Results: Over a 20-year period, MBC patients accounted for 0.98% among total breast cancer patients, and increased every 5 years. The median age of MBC patients was 66 years (range, 24 to 87 years). Forty-three patients (73%) complained of a palpable breast mass initially. The median symptom duration was 5 months (range, 1 to 36 months). Mastectomy was performed in 96% of the patients. The most frequent histology was infiltrating ductal carcinoma (75%). Ninety-one percent of tumors (38/43) were estrogen receptor-positive, and 28% (11/40) showed epidermal growth factor receptor 2 (HER-2) overexpression. After curative surgery, 42% of patients (19/45) received adjuvant chemotherapy; 77% (27/35) received hormone therapy. Five out of ten patients with HER-2 overexpressing tumors did not receive adjuvant anti-HER-2 therapy, while two out of four patients with HER-2 overexpressing tumors received palliative trastuzumab for recurrent and metastatic disease. Letrozole was used for one patient in the palliative setting. The median overall survival durations were 7.2 years (range, 0.6 to 17.0 years) in patients with localized disease and 2.9 years (range, 0.6 to 4.3 years) in those with recurrent or metastatic disease. Conclusion: Anti-HER-2 and hormonal therapy, except tamoxifen, have been underutilized in Korean MBC patients compared to female breast cancer patients. With the development of precision medicine, active treatment with targeted agents should be applied. Further investigation of the unique pathobiology of MBC is clinically warranted. [ABSTRACT FROM AUTHOR]

Background: The BRAFV600E mutation is the most common genetic alteration in papillary thyroid carcinoma (PTC). In recent studies, the BRAFV600E mutation has been associated with poor clinicopathological characteristics, such as lymph node metastasis, extrathyroidal extension, and advanced stage. However, other studies have failed to establish an association between the BRAFV600E mutation and clinicopathological features. Therefore, we investigated the relationship between the BRAFV600E mutation and its clinicopathological factors at a single institution. Methods: A total of 327 consecutive patients with PTC were enrolled in this study and underwent thyroid surgery at Yeouido St. Mary's Hospital between February 2010 and December 2011. BRAFV600E mutation analysis was performed using polymerase chain reaction (PCR)-based amplification of DNA extracted from paraffin-embedded tumour specimens. Results: The BRAFV600E mutation was detected in the tumours of 241 (73.7%) patients. Lymph node metastasis, TNM stage, and multifocality were not significantly associated with the BRAFV600E mutation. However, larger tumour size, extrathyroidal extension, histologic type (classic type), and concurrent Hashimoto's thyroiditis were associated with the BRAFV600E mutation in the univariate analysis, although no clinicopathological features were associated with the BRAFV600E mutation in the multivariate analysis. Conclusion: There was no idependent prognostic factor associated with BRAFV600E mutation status in this study. The BRAFV600E mutation is unlikely to serve as a prognostic factor for PTC. [ABSTRACT FROM AUTHOR]

Background: The natural course of cytologically benign thyroid nodules remains unclear. The aim of this study was to evaluate whether ultrasonographic (US) changes are associated with changes in nodule volume during follow-up. Methods: We retrospectively reviewed over 4 years of clinical records of patients with benign thyroid nodules as confirmed by fine needle aspiration (FNA). In total, 186 patients with 202 benign thyroid nodules were included for study. We assessed for changes in nodule volume and examined the cystic portion of the nodule as well as four US features (echogenicity, margin, calcification pattern, and shape). Results: During follow-up (mean, 21.7±10.7 months) and using 50% as a cutoff value, nodule volumes increased in 11.8%, exhibited no change in 79.9%, and decreased in 8.3% of patients. Proportion of nodules demonstrating at least one US change was 20.8% (42/202). The most common US changes (in descending order of frequency) were cystic change, margin change, and calcification pattern change. Nodule shape and echogenicity rarely changed. Increased nodule volume was not significantly associated with any US features or with the number of FNAs but was associated with younger age at time of diagnosis. Conclusion: Although a portion of thyroid nodules confirmed as benign showed US changes or volume changes during the follow-up period, these findings may only represent the natural course of benign nodules. Frequent follow-up with US might be needed for only a small number of cases with suspicious US findings. [ABSTRACT FROM AUTHOR]

Background: Genomic alterations are important events in the origin and progression of various cancers, with DNA copy number changes associated with progression and treatment response in cancer. Array CGH is potentially useful in the identification of genomic alterations from primary tumor and blood in breast cancer patients. The aim of our study was to compare differences of DNA copy number changes in blood and tumor tissue in breast cancer. Methods: DNA copy number changes in blood were compared to those in tumor tissue using array-comparative genomic hybridization in samples obtained from 30 breast cancer patients. The relative degree of chromosomal changes was analyzed using log2 ratios and data was validated by real-time polymerase chain reaction. Results: Forty-six regions of gains present in more than 30% of the tissues and 70 regions of gains present in more than 30% of blood were identified. The most frequently gained region was chromosome 8q24. In total, agreement of DNA copy numbers between primary tumor and blood was minimal (Kappa = 0.138, p < 0.001). Conclusion: Although there was only a slight agreement of DNA copy number alterations between the primary tumor and the blood samples, the blood cell copy number variation may have some clinical significance as compared to the primary tumor in IDC breast cancer patients. [ABSTRACT FROM AUTHOR]

Background:Cervical lymph node metastases are quite common in papillary thyroid cancer (PTC) and they usually spread in a contiguous fashion. However, “skip metastasis,” defined as lateral lymph node metastasis without central lymph node metastasis, also occurs in patients with PTC. There is little information regarding skip metastasis in papillary thyroid microcarcinoma (PTMC). The goal of this study was to determine the prevalence and associated clinical and imaging features of skip metastasis in PTMC.Methods:We performed a retrospective study of 245 patients with PTMC who underwent either thyroidectomy and central lymph node dissection or thyroidectomy, central lymph node dissection, and lateral lymph node dissection if preoperative ultrasonography or computed tomography suggested lateral node metastasis. Clinicopathologic results were reviewed, and the patterns of cervical lymph node metastasis were analyzed.Results:Cervical lymph node metastases were present in 26.5% of cases. The frequency of lymph node metastases was 21.8% in the group that only had thyroidectomy and central lymph node dissection and 51.3% in the group that had thyroidectomy, central lymph node dissection, and lateral lymph node dissection. Younger age, larger tumor size, multiplicity, bilaterality, encapsulation, extrathyroid extension, and lymphatic invasion were associated with metastasis to nodes in the central or lateral compartment. Lateral lymph node dissection was performed in 15.9% of patients. Skip metastasis was observed in 7.7% of the cases in which combined central and lateral node dissection was performed. No features of the primary thyroid tumor could be associated with the development of skip metastasis.Conclusions:Skip metastases occur in a minority of patients with PTMC. We recommend, therefore, that preoperative studies in patients suspected of having PTMC focus not only on nodes in the central compartment but also lateral cervical nodes since the information obtained would guide the extent of surgery. [ABSTRACT FROM AUTHOR]

Background: Papillary thyroid microcarcinoma (PTMC) detection has been increasing explosively with the recent improvement and application of new diagnostic tools. However, the associations between clinical, histopathological, and molecular findings are often not fully evaluated in reaching a decision for the treatment of PTMC. Objective: To retrospectively evaluate the patients diagnosed with PTMC in terms of the clinical and histopathological features and the immunohistochemical findings of specific molecular markers, and thereby provide an association with the disease prognosis for the Korean patients. Design: We have reviewed the clinical records of patients who underwent surgery for thyroid cancer (during January 2000 to August 2006 interval) at St. Mary''s Hospital, Seoul, Korea. The clinical and histopathological characteristics of 217 PTMCs were evaluated cross-sectionally after surgery, and immunohistochemical staining of p53, epidermal growth factor receptor (EGFR), Ki-67, and cyclooxygenase-2 (COX-2) for 87 isolated specimens was performed. Main outcome: The proportions of extrathyroid extension, lymphatic invasion, and lymph node metastasis cited were 31.9, 19.2, and 17.8, respectively. However, distant metastasis was not noted. Fifty-three (27.1) patients had multiplicity, and 39 patients (20.0) had bilateral disease. A primary tumor larger than 5 mm was significantly associated with extrathyroid extension, lymphatic invasion, and lymph node metastasis. The absence of EGFR expression shown by immunohistochemical analysis was closely correlated with extrathyroid extension and lymph node metastasis, while the absence of COX-2 expression was associated with multiplicity and bilaterality. Conclusion: Many patients with PTMC had clinical and histopathological poor prognostic factors. The expression of molecular markers, such as EGFR and COX-2, may have a role in the prognosis of PTMC. When considering all of the prognostic factors, a more tailored management approach appears to be necessary for patients with PTMC. [ABSTRACT FROM AUTHOR]

Abstract  Bilateral chylothorax is a rare complication of neck dissection, but it is potentially serious and sometimes life threatening. Because of the rarity of chylothorax, surgeons are unfamiliar with its early signs, which allow a prompt diagnosis and effective management. Most cases reported in the literature were associated with a concurrent external chyle leakage, which occurred either during or after surgery. We report two cases of bilateral chylothoraces without concurrent external chyle leakage, which occurred after left-sided neck dissections for thyroid cancer. We treated both patients successfully with conservative management. [ABSTRACT FROM AUTHOR]

Objective:We analyzed the sonographic characteristics of thyroid nodules and assessed the diagnostic value of ultrasonography in order to distinguish between benign and malignant lesions in terms of the management of thyroid nodules. Design:We retrospectively analyzed the sonographic features of thyroid nodules in 580 patients who had been examined with fine-needle aspiration cytology or who underwent surgery for a thyroid nodule. The sonographic features that suggested malignancy include microcalcifications, an irregular or microlobulated margin, marked hypoechogenicity, and a shape that was taller than it was wide. The presence of one or more of these features indicated classification as category 3 (malignant). The absence of all of these features indicated classification as category 2 (benign). Presence of an anechogenic cystic nodule was classified as category 1 (benign). Main outcome:Of 124 lesions classified as category 3, 60 of the lesions were malignant. Of 418 lesions classified as category 1 or 2, 409 were benign. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy based on the sonographic classification method were 87.0, 86.5, 48.4, 97.8, and 86.5, respectively. Conclusions:Our results identified this sonographic classification as a useful tool in the differentiation of malignant nodules from benign nodules. In view of the high negative predictive value of sonographic classification, a more aggressive approach is recommended only for category 3 nodules. [ABSTRACT FROM AUTHOR]