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Objective: Fine-needle aspiration cytology (FNAC) based on a liquid-based preparation is a safe and valuable diagnostic tool. However, due to unfamiliarity with this method and the considerably altered morphology that is associated with it, diagnosing renal cell carcinoma (RCC) from this type of preparation remains a challenge for cytopathologists. The aim of this study was to evaluate the cytomorphological characteristics of SurePath™ (SP)-based preparations compared with conventional smear (CS), and also the role of SP-based FNAC in the diagnosis of clear-cell RCC (CRCC), the most common primary renal malignancy. Study Design: Ex vivo FNAC of both tumors and normal renal parenchyma was prepared from 73 cases. Comparative cytomorphological analysis between liquid-based cytology (LBC) and CS as well as Fuhrman nuclear grading (FNG) was carried out. Immunocytochemistry was performed from normal and CRCC cytology specimens. Results: Normal renal cytology (NRC) showed no significant morphological differences between LBC and CS. For CRCC, LBC showed small, fragmented cell clusters, a 3-dimensional configuration, distinct cytoplasmic vacuoles, and irregular nuclear contours when compared with CS. FNG was overgraded with LBC compared to with CS. AMACR was the most valuable immunocytochemical marker for distinguishing CRCC from NRC. Conclusion: Once cytopathologists become familiar with the altered cytomorphological features of CRCC, FNAC, along with immunocytochemistry, may prove helpful for diagnosis.

To determine the optimal surface-rendering threshold value for three-dimensional (3D) endoluminal computed tomographic (CT) colonographic images for accurate manual polyp measurement, with direct measurement of simulated polyps as the reference standard, and to assess the agreement between manual 3D measurements and automated measurements.Institutional review board approval was not required for the experimental study with pig colons obtained at an abattoir but was obtained for the use of patient data, with waiver of informed consent. Eighty-six simulated polyps (reference size, 3-15 mm) and 14 human polyps (approximate size, 5-20 mm) were included. Automated polyp measurements and manual measurements with endoluminal views that were surface rendered at threshold values of -800, -700, -600, and -500 HU were performed by one observer. Agreement between CT colonographic measurements and reference sizes and between manual and automated measurements were assessed by using the Bland-Altman method.For simulated polyps, mean measurement difference between the observed size and reference size was 0.86 mm (95% limits of agreement: -0.52 mm, 2.24 mm), 0.55 mm (95% limits of agreement: -0.75 mm, 1.85 mm), 0.20 mm (95% limits of agreement: -1.11 mm, 1.50 mm), and -0.08 mm (95% limits of agreement: -1.43 mm, 1.27 mm) for -800, -700, -600, and -500 HU, respectively. Mean measurement difference was 0.09 mm (95% limits of agreement: -1.49 mm, 1.67 mm) for automated measurement. Manual polyp size at -500 HU (P = .277) and automated polyp size (P = .288) were not significantly different from reference size. For human polyps, 10 polyps, excluding four lesions that were large, lobulated, or located adjacent to an edge of the haustral fold, showed accurate automated demarcation of lesion boundaries. Automated measurements of the 10 polyps showed the closest agreement with manual measurements at -500 HU.The optimal surface-rendering threshold value for accurate polyp measurement is approximately -500 HU. Automated measurements agree closely with manual measurements at the optimal threshold value for well-circumscribed smooth rounded polyps.

Primary liposarcoma of the liver is extremely rare. We report here on a case of primary well-differentiated liposarcoma in the left hepatic lobe of a 63-year-old woman. Abdominal ultrasonography showed a well-defined, echogenic, round mass. Abdominal computed tomography (CT) and magnetic resonance (MR) images showed an almost fatty, lobulated mass with a few, random distributed vascular structures and a small area of nodular enhancement. The resected tumor appeared as a well-defined, round, tan-yellow mass. Histological analysis showed a well-differentiated liposarcoma.

To compare prospectively obtained static two-dimensional (2D) and three-dimensional (3D) ultrasonographic (US) images in the diagnostic performance of radiologists with respect to the differentiation of benign from malignant solid breast masses with histopathologic examination as the reference standard.This study had institutional review board approval, and patient informed consent was obtained. Conventional 2D and 3D US images were obtained from 141 patients (age range, 25-71 years; mean age, 46 years) with 150 solid breast masses (60 cancers and 90 benign lesions) before excisonal or needle biopsy. Four radiologists who had not performed the examinations independently reviewed 2D US images and stored 3D US data and provided a level of suspicion concerning probability of malignancy. The sensitivity, specificity, and negative predictive values of 2D images were compared with those of 3D US images.For all readers, 3D US images were the same as or better than 2D US images in terms of sensitivity (100% vs 100% for reader 1; 100% vs 98% for reader 2; 98% vs 93% for reader 3; 93% vs 92% for reader 4), specificity (58% vs 56% for reader 1; 51% vs 46% for reader 2; 83% vs 72% for reader 3; 86% vs 84% for reader 4), and negative predictive values (100% vs 100% for reader 1; 100% vs 98% for reader 2; 99% vs 94% for reader 3; 95% vs 94% for reader 4). These differences, however, were not statistically significant (P.05).The performance of the radiologists with respect to the characterization of solid breast masses with static 2D US images was similar to that with 3D US data.

Objective: Preoperative fine needle aspiration biopsy (FNAB) has become the initial diagnostic method for papillary thyroid carcinoma (PTC). Identification of cytomorphologic factors predicting lymph node metastasis (LNM) is clinically important for determining the appropriate treatment regimen due to the high rate of lymph node involvement in PTC at the time of diagnosis. Hobnail features (HF) have previously been described as potential histomorphologic features in the histological examination of PTC. This study evaluated the value of HF as a predictor of LNM. Study Design: Histologically confirmed FNABs (n = 111) of papillary thyroid microcarcinoma prepared by the liquid-based method were enrolled. Along with other cytomorphologic parameters, HF were evaluated for their value in predicting LNM. Results: Although HF were closely correlated with cytoplasmic vacuoles of tumor cells and background macrophages (p < 0.05), which were considered diagnostic indicators of PTC with cystic changes, HF were only found to be significantly correlated with LNM (p = 0.008). The BRAFV660E mutation was not associated with LNM. All combinations including HF were revealed as stronger predictors of LNM (odds ratios: 2.254-2.524, p < 0.05). Conclusions: HF, a distinctive cytomorphologic feature, may be used as a factor predicting LNM in preoperative FNAB of PTC.

Purpose : Our goal was to evaluate CT findings of tuberculous abscess in the retromammary region of the breast. Method : Four patients with tuberculosis extending from the retromammary region to the pleura were examined by CT and the findings were evaluated. All cases were also examined with mammography and two cases were evaluated with sonography. Diagnosis was confirmed by acid-fast bacillus stain, culture, and histologic examination. Results : Mammography showed relatively smoothly marginated, round mass density in two cases, nodular density in one, and focal bulging of the pectoral wall in one. A sonogram demonstrated in two cases a fistulous connection from the heterogeneous, fluid-containing lesion with floating internal debris in the retromammary region to the thoracic cavity. In all four cases, CT showed relatively smoothly marginated, inhomogeneous, hypodense lesions with surrounding rims of the cold abscess type. A direct fistulous connection from the retromammary lesion through the thoracic wall into the pleura was seen in two cases. Destroyed rib fragments within the abscess were noted in two cases. Conclusion : A tuberculous abscess in the retromammary region usually showed on CT a focal, smoothly marginated, inhomogeneous, hypodense lesion with a surrounding enhancing rim. A direct fistulous connection with the pleura or a destroyed rib fragment in the abscess as revealed by CT can be helpful in the differential diagnosis of other infectious types of retromammary abscess.

Purpose: The purpose of this study was to establish a quality standard for mammographic equipment in Korea and to eventually improve mammographic quality in clinics and hospitals throughout Korea by educating technicians and clinic personnel. Materials and Methods: For the phantom test and on site assessment, we visited 37 sites and examined 43 sets of mammographic equipment. Items that were examined include phantom test, radiation dose measurement, developer assessment, etc. The phantom images were assessed visually and by optical density measurements. For the clinical image assessment, clinical images from 371 sites were examined following the new Korean standard for clinical image evaluation. The items examined include labeling, positioning, contrast, exposure, artifacts, collimation among others. Results: Quality standard of mammographic equipment was satisfied in all equipment during on site visits. Average mean glandular dose was 114.9 mRad. All phantom image test scores were over 10 points (average, 10.8 points). However, optical density measurements were below 1.2 in 9 sets of equipment (20.9%). Clinical image evaluation revealed appropriate image quality in 83.5%, while images from non-radiologist clinics were adequate in 74.6% (91/122), which was the lowest score of any group. Images were satisfactory in 59.0% (219/371) based on evaluation by specialists following the new Korean standard for clinical image evaluation. Satisfactory images had a mean score of 81.7 (1 S.D.=8.9) and unsatisfactory images had a mean score of 61.9 (1 S.D=11). The correlation coefficient between the two observers was 0.93 (p

Purpose: The goal of this study was to survey the overall quality of mammographic images in Korea. Materials and Methods: A total of 598 mammographic images collected from 257 hospitals nationwide were reviewed in terms of eight image quality categories, namely positioning, compression, contrast, exposure, sharpness, noise, artifacts, and examination identification, and rated on a five-point scale: (1=severe deficiency, 2=major deficiency, 3=minor deficiency, 4=good, 5=best). Failure was defined as the occurrence of more than four major deficiencies or one severe deficiency (score of 1 or 2). The results were compared among hospitals of varying kinds, and common problems in clinical image quality were identified. Results: Two hundred and seventeen mammographic images (36.3%) failed the evaluation. Poor images were found in descending order of frequency, at The Society for Medical Examination (33/69, 47.8%), non-radiology clinics (42/88, 47.7%), general hospitals (92/216, 42.6%), radiology clinics (39/102, 38.2%), and university hospitals (11/123, 8.9%) (p

Purpose : To compare the radiologic findings of pyogenic abscess(PA) and inflammatory cancer(IC) of the breast, as seen on mammograms, US, and MR images and to evaluate the usefulness of the differential diagnostic findings of MRI for differentiation of PA and IC of the breast. Materials and Methods : We retrospectively analyzed the mammographic, US and MR findings of nine histopathologically proven cases of PA and four cases of IC of the breast. Parenchymal density, mass density, skin thickening and calcification were evaluated by mammography, and the extent of lesion and its morphologic characteristics and changes of dermal lymphatics by US and MRI. The latter was also used to analyse signal intensity and enhancement pattern. Results : Mammographic findings for both lesions were non-specific. US showed that the pyogenic abscess was a hypoechoic and anechoic complex lesion with posterior acoustic enhancement, while inflammatory cancer was a spiculated lesion with a heterogeneous hypoechoic echotexture. On 3D-GRE dynamic enhanced MRI, PA was shown in six cases(66.7 %) to be a lesion with superficial periareolar involvement, in contrast to the deep parenchymal spread seen in all cases of IC. A central non- enhanced portion with an irregular thick peripheral enhanced rim was seen in eight cases of PA(88.9 %) , and in all cases of IC an inhomogeneously enhanced spiculated lesion in parenchyma and a diffusely enhanced dermal and subcutaneous layer was apparent. An MRI time-intensity curve showed that the enhancement pattern was slow in five cases of PA(55.6 % ) and irregular in four(44.4 %), while for IC it was rapid in three cases(33.3 %) and irregular in one(11.1 % ). Conclusion : As compared with mammography and US, 3D-GRE dynamic MRI was a useful method for the differential diagnosis of PA and IC of the breast. The characteristic MR findings of PA were a central non-enhanced portion with an irregularly thick peripheral enhanced rim, located mainly in the superficial periareloar area and spreading into the parenchymal layer. An inhomogeneously enhanced spiculated solid mass in the parenchyma associated with diffuse dermal thickening and lymphatic dilatation was more suggestive of IC.

Purpose : To clarify the distribution of joint effusion, and the relationship between type of injury andamount of joint effusion seen in traumatic knee joint magnetic resonance imaging (MRI). Materials and Methods : Weretrospectively reviewed the MR images of 400 patients with traumatic knee joint effusion. The knee joint spacewas divided into four compartments: central portion (para-ACL, para-PCL), suprapatellar pouch, posterior femoralrecess, and subpopliteal recess, and we then compared the amount and distribution of effusion. For statisticalanalysis, the chi-square test was used. Results : Among 400 MRI examinations of joint effusion, 383 knees (96%)showed homogeneous low intensity on T1-weighted images, and - except for ten cases of fluid-fluid levels-homogeneous high intensity on T2-weighted images. Knee joint effusion was clearly shown to be distributed mainlyin the suprapatellar pouch (345, 86%), followed by the central posterior femoral recess, and the subpoplitealrecess (P

Background: Silibinin has been known for its role in anti-cancer and radio-protective effect. Radiation therapy for treating lung cancer might lead to late-phase pulmonary inflammation and fibrosis. Thus, this study aimed to investigate the effects of silibinin in radiation-induced lung injury with a mouse model. Methods: In this study, we examined the ability of silibinin to mitigate lung injury in, and improve survival of, C57BL/6 mice given 13 Gy thoracic irradiation and silibinin treatments orally at 100 mg/kg/day for seven days after irradiation. In addition, Lewis lung cancer (LLC) cells were injected intravenously in C57BL/6 mice to generate lung tumor nodules. Lung tumor-bearing mice were treated with lung radiation therapy at 13 Gy and with silibinin at a dose of 100 mg/day for seven days after irradiation. Results: Silibinin was shown to increase mouse survival, to ameliorate radiation-induced hemorrhage, inflammation and fibrosis in lung tissue, to reduce the number of inflammatory cells in the bronchoalveolar lavage fluid (BALF) and to reduce inflammatory cell infiltration in the respiratory tract. In LLC tumor injected mice, lung tissue from mice treated with both radiation and silibinin showed no differences compared to lung tissue from mice treated with radiation alone. Conclusions: Silibinin treatment mitigated the radiation-induced lung injury possibly by reducing inflammation and fibrosis, which might be related with the improved survival rate. Silibinin might be a useful agent for lung cancer patients as a non-toxic complementary approach to alleviate the side effects by thorax irradiation.