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In the eighth edition, TNM staging system omits location of nodal metastasis as a criterion for staging patients with papillary thyroid cancer (PTC). Accordingly, all of non-metastatic N1b PTC patients are classified as stage I or II solely according to an age-cutoff of 55 years. We hypothesized that incorporating other lymph node (LN) factors into TNM staging system would better predict cancer-specific mortality (CSM) in N1b patients.We enrolled 745 N1b PTC patients without distant metastasis. Alternative prognostic LN factors and cut-off points were assessed using Cox regression and time-dependent ROC analysis. Alternative prognostic groupings were derived based on minimal hazard differences for CSM among groups stratified by LN risk and age. We assessed accuracy of CSM prediction.Lateral LN ratio (LNR)0.3 and largest LN size3 cm were prognostic factors for CSM. Stage II patients (eighth edition) with LN risk (lateral LNR0.3 or largest LN size3 cm) had a much higher CSM rate (20.9%) than those in the same stage without LN risk (3.2%). Alternative prognostic grouping (Group 1,55 years without LN risk; Group 2,55 years with LN risk or ≥55 years without LN risk; and Group 3, ≥55 with LN risk) achieved higher proportions of variance explained (PVEs) for predicting CSM (10.7%) than those of the eighth edition TNM staging system (4.8%).The proposed grouping for N1b patients using LN risk can distinguish patients with poor prognosis from those with good prognosis better than the eighth edition TNM staging system.

The aim of this study was to evaluate the diagnostic performance of ultrasound strain elastography (USE) for circumscribed solid thyroid nodules without malignant or benign features seen on US. This retrospective study included 197 thyroid nodules in 196 patients who underwent USE with color mapping and strain ratio measurement between 2010 and 2014. Of the 197 nodules, 24 (12.2%) were malignant. No significant differences in color mapping or strain ratio were observed between benign and malignant nodules. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 29.2% (95% confidence interval [CI]: 13.8%-49.4%), 77.5% (95% CI: 75.3%-80.3%), 15.2% (95% CI: 7.2%-25.8%), 88.7% (95% CI: 86.3%-92.0%), and 71.6% (95% CI: 67.8%-76.5%) for color mapping and 50.0% (95% CI: 30.%-69.5%), 57.2% (95% CI: 54.5%-59.9%), 14.0% (95% CI: 8.5%-18.4%), 89.2% (95% CI: 85.0%-93.4%) and 56.3% (95% CI: 51.6%-61.1%) for strain ratio measurement, respectively. USE with color mapping and strain ratio measurement has a limited ability to differentiate benign from malignant nodules for circumscribed solid thyroid nodules without definite malignant features categorized as indeterminate by B-mode US.

Purpose To investigate the detectability and imaging characteristics of primary tumors according to imaging modalities and to identify clinical features and histological prognostic factors for axillary metastases in patients with small (≤1cm, T1a and T1b) invasive breast cancer. Materials and methods A total of 221 patients with histologically confirmed small invasive cancers were included for the statistical analysis. At mammography, ultrasonography and MRI, the detectability, and imaging characteristics of primary tumors were compared in patients with or without axillary metastases. Clinical features and histological prognostic factors for axillary metastases were investigated. Results Of 221 patients examined, axillary metastasis was found in 42 (19%) at the time of surgery. There was no significant difference in detectability of small tumors using ultrasonography and MRI between patients with and without axillary metastasis. However, mammography had a higher positive rate of primary tumors in patients with axillary metastasis than without metastasis (92.9% vs. 77.1%, p =0.023). Patients with axillary metastasis in small cancers showed more common architectural distortion than negative ( p =0.0147) or mass ( p =0.0356) on mammography. Clinical features were not different in the two groups. Only lymphovascular invasion was independently associated with axillary metastasis ( p =0.0051, 95% CI, 1.527–11.597). Conclusion The detectability of small invasive breast cancers among patients with and without axillary metastasis is different with mammography, but not with US and MRI. Lymphovascular invasion is only a predictor for axillary metastasis in small invasive cancers.

The aim of this study was to evaluate whether pleomorphic invasive lobular carcinoma (PILC) is different from classic invasive lobular carcinoma (CILC) in terms of radiologic and clinicopathologic features. We compared the radiologic and clinicopathologic features of 22 surgically confirmed PILCs in 21 patients from 2004 to 2009 and 47 CILCs from 47 consecutive patients. For all cases, we reviewed the imaging findings, medical records and pathological results. PILC had a higher T stage, N stage, nuclear and histologic grade compared to CILC. PILC was more commonly negative for estrogen receptors and positive for HER2 than CILC (all p 0.05). However, there were no significant differences in age, symptoms, tumor size, extensive intraductal component, lymphovascular invasion, triple negative profile, or multiplicity between the two groups. PILC was not detected on mammography in 1 (4.5%) of 22 cases, whereas CILC was not detected on mammography in 7 (14.9%) of 47 cases and on MRI in 2 (5.0%) of 40 (p = 0.42 and p = 1.000, respectively). MRI identified more frequent multiplicity than mammography for both PILC and CILC (p 0.001), but was similar to US (p = 0.066). Most lesions showed a spiculated mass or architectural distortion with or without calcifications on mammography and ultrasound. No differences in mass and/or non-mass lesions or kinetics on MRI were observed between the two groups. PILC shows more pathologically aggressive features, but cannot be differentiated from CILC based on imaging findings.

We explored the pathways from attitude towards cultural adjustment (separation, assimilation, and integration), marital conflict, and parenting practices of mothers of non-South Korean families on their children's school adjustment in South Korea. One hundred-and-fifty-four Chinese, Filipino, and Vietnamese mothers and their children (3rd–6th grade) from Gyeonggi province participated in the study. Questionnaires measuring mothers' attitudes toward cultural adjustment, marital conflict, and parenting practices were administered to the mothers. We analyzed data using Structural Equation Modeling (SEM). We found that mothers' assimilation and separation did not affect children's school adjustment. However, integration of the mothers had indirect effect on children's school adjustment through marital conflict and parenting practices. Acculturated mothers had lower level of marital conflict, which in turn had a higher positive effect on children's school adjustment. It is imperative that culturally relevant programs that enhance positive marital relationships and parent–child relationships among culturally diverse families be developed.

Purpose To retrospectively evaluate previous imaging findings of breast cancers that occurred in women whose combined screening using both mammography and ultrasonography was negative. Materials and methods A search of the institutional database identified 65 patients with breast cancers who had comparable previous negative screening mammography and ultrasonography (BI-RADS category 1 or 2) within 2 years. We classified each case as true or false negative. The previous imaging findings and the final outcome were analyzed. Results Among 65 cases, 42 (65%) were true negatives, 23 (35%) were false negatives. The abnormalities of false negatives were underestimated in 16 (70%) and unrecognized in 7 (30%). The findings were calcifications ( n = 8) or a mass ( n = 6) on mammography, a mass ( n = 5) or a non-mass ( n = 3) on ultrasonography and a density on mammography correlated with non-mass on ultrasonography ( n = 1). Ductal carcinoma in situ among false and true negatives accounted for 5 (22%) and 7 (17%), respectively. Symptomatic cancers among false and true negatives were 6 (26%) and 13 (31%), respectively. Conclusion Breast cancers that rarely occurred in combined screening negatives are often retrospectively seen as minimal abnormalities on previous imaging studies.

Aim To evaluate the diagnostic value of histogram analysis using ultrasound (US) to differentiate between the subtypes of follicular variant of papillary thyroid carcinoma (FVPTC). Materials and methods The present study included 151 patients with surgically confirmed FVPTC diagnosed between January 2014 and May 2016. Their preoperative US features were reviewed retrospectively. Histogram parameters (mean, maximum, minimum, range, root mean square, skewness, kurtosis, energy, entropy, and correlation) were obtained for each nodule. Results The 152 nodules in 151 patients comprised 48 non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTPs; 31.6%), 60 invasive encapsulated FVPTCs (EFVPTCs; 39.5%), and 44 infiltrative FVPTCs (28.9%). The US features differed significantly between the subtypes of FVPTC. Discrimination was achieved between NIFTPs and infiltrative FVPTC, and between invasive EFVPTC and infiltrative FVPTC using histogram parameters; however, the parameters were not significantly different between NIFTP and invasive EFVPTC. Conclusion It is feasible to use greyscale histogram analysis to differentiate between NIFTP and infiltrative FVPTC, but not between NIFTP and invasive EFVPTC. Histograms can be used as a supplementary tool to differentiate the subtypes of FVPTC.

We evaluated the sonographic findings that can help differentiate widely invasive follicular thyroid carcinomas (WIFTC) from minimally invasive follicular thyroid carcinomas (MIFTC).We retrospectively compared the sonographic and clinical findings of 24 patients (M:F=5:19) with 24 MIFTCs and 12 patients (M:F=1:11) with 13 WIFTCs that were confirmed pathologically and available in sonography at our institution between 1995 and 2007.WIFTC was more common in elderly patients than MIFTC (p0.0001). WIFTC was seen with a larger size than MIFTC (p=0.0092). The best cut-off values for age and size were 49 years and 5.6 cm, respectively. On sonography, all tumors were seen as a well-defined oval or round mass. Heterogeneous mulberry-like echotexture was more common for WIFTC than for MIFTC (77% vs. 25%) (p=0.0046). The presence of calcifications was more frequent in WIFTC than in MIFTC (54% vs. 8%) (p=0.0041). Ring calcifications (86%) were the most common type for WIFTC. WIFTC was commonly hypoechoic (70%) and rarely cystic change (8%), but without statistical differences. When WIFTCs represented tumors with two or more findings with a statistical difference, the specificity was 96%.WIFTC is distinguishable from MIFTC by sonography for patients with an ageor=49 years, a tumoror=5.6 cm, a heterogeneous mulberry-like echotexure, or the presence of calcifications. The sonographic impression of a WIFTC can support a preoperative or intraoperative diagnosis of a difficult case as determined by FNA or with a frozen section.

Aim Occult lymph node metastasis is common in differentiated thyroid cancer (DTC). However, the role of lymph node dissection in the treatment of DTC remains controversial. The authors investigated the usefulness of methylene blue dye only method and combined radioisotope and methylene blue dye method for detecting SLN and compared the values of these two methods in patients with DTC. Methods From February to May 2008, 97 patients with DTC underwent sentinel lymph node biopsy (SLNB). The methylene blue dye method (dye only method) was used in 54 of the 97 patients, and radioisotope and methylene blue dye method (combined method) in 43 patients. Results The SLNs were identified in 89 patients, and the sensitivity and specificity of SLNB in the 97 patients were 85% and 100% respectively. For the dye only method, sensitivity, specificity, and the false negative rate (FNR) were 79%, 100%, and 21%; and for the combined method (43 patients) the corresponding figures were, 91%, 100%, and 9%, respectively. Six patients with SLN metastasis in the lateral neck underwent additional modified radical neck dissection (MRND). Conclusions SLNB was found to be feasible, repeatable, and accurate in evaluating the lymph node status in patient with DTC. The present study indicates that the combined method could reduce false negative rate and increase detection rates of sentinel lymph node metastases, especially in lateral neck, compared to the dye only method.

Breast lymphoma is uncommon, accounting for approximately 0.15% of malignant breast lesions. It usually originates from lymphocytes in breast parenchyma and ipsilateral axillary lymph nodes. In breast, diffuse large B-cell lymphoma is more common than T-cell lymphoma. Here, we report a rare case of cutaneous natural killer/T-cell (NK/T) lymphoma mimicking panniculitis of the breast, that was presented as a growing palpable mass and pain in both breasts of a 33-year-old male patient. Ultrasonographic appearance was extensive hyperechogenicity in subcutaneous fat layer of mammary areas, mimicking panniculitis or fat necrosis. Pathologically, a histologic subtype was extranodal natural killer/T-cell lymphoma, nasal-type.