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Mammography has been the standard screening method for breast cancer. In women with suspicious calcifications and architectural distortion identified on mammography or digital breast tomosynthesis only without detected on breast US, stereotactic biopsy and mammographyguided preoperative localization is one of the method for pathologic diagnosis. This review aims to describe the indication, contraindication, technique of stereotactic biopsy, clip placement after stereotactic biopsy, and digital breast tomosynthesis-guided stereotactic biopsy. In addition, this article reviews mammography-guided preoperative localization using a wire or non-wire device.

An advantage of breast augmentation with injectable fillers is that the desired size can be determined and achieved under local anesthesia with a short recovery time. However, a high complication rate is a critical disadvantage. Some fillers are challenging to remove, resulting in breast deformity and scarring. Five patients who underwent surgery to manage a foreign body in the breasts in 2021 were enrolled in this study. Two had copolyamide filler injections, while the other three had polyacrylamide hydrogel filler injections. A physical examination was performed, and preoperative and intraoperative photographs were obtained. Two patients underwent subcutaneous mastectomy because most of the filler had infiltrated into the normal breast tissue. In contrast, the other patients underwent filler removal and debridement because most of the filler had remained separate from the normal breast tissue. All patients who had a subcutaneous mastectomy and one who underwent only filler removal underwent immediate breast reconstruction with cohesive gel implants. The other patients rejected immediate reconstruction, and only filler removal was performed. All patients recovered without complications. We propose an algorithm for diagnosis and treatment based on our cases, which we hope can help clinicians manage the complications of filler injections for breast augmentation.

Purpose To evaluate the pattern of use and the perception of digital breast tomosynthesis (DBT) among Korean breast radiologists. Materials and Methods From March 22 to 29, 2021, an online survey comprising 27 questions was sent to members of the Korean Society of Breast Imaging. Questions related to practice characteristics, utilization and perception of DBT, and research interests. Results were analyzed based on factors using logistic regression. Results Overall, 120 of 257 members responded to the survey (response rate, 46.7%), 67 (55.8%) of whom reported using DBT. The overall satisfaction with DBT was 3.31 (1–5 scale). The most-cited DBT advantages were decreased recall rate (55.8%), increased lesion conspicuity (48.3%), and increased cancer detection (45.8%). The most-cited DBT disadvantages were extra cost for patients (46.7%), insufficient calcification characterization (43.3%), insufficient improvement in diagnostic performance (39.2%), and radiation dose (35.8%). Radiologists reported increased storage requirements and interpretation time for barriers to implementing DBT. Conclusion Further improvement of DBT techniques reflecting feedback from the user’s perspective will help increase the acceptance of DBT in Korea.

We report a case of transient unilateral exotropia, a rare complication that occurred after an infraorbital local anesthetic injection, and present the possible mechanism underlying this adverse effect. A 64-year-old man underwent an excisional biopsy under local anesthesia for bilateral lower eyelid masses. He received a subcutaneous injection of a local anesthetic (a combination of 1:100,000 epinephrine and 2% lidocaine). Intraoperatively, we observed a homogeneous, fat-attenuated mass with thin fibrous septae inside the orbital septum of each eye. Following excision of the masses, the patient developed severe diplopia accompanied by exotropia, impaired adduction, and mydriasis of the right eye. The pupillary light reflex, visual acuity, and visual field test results were within normal ranges. Notably, his symptoms completely resolved 4 hours postoperatively without intervention. To our knowledge, transient unilateral exotropia following infraorbital local anesthetic injection is rare. The exotropia was attributed to diffusion of the epinephrine/lidocaine solution, which may have affected the ciliary ganglion and the medial rectus muscle. Caution is warranted during local anesthetic injections in patients who undergo periorbital surgery.

Background Currently, the BREAST-Q can effectively measure patient's satisfaction on the quality of life from the patient's perspective in relation to different type of breast reconstruction. However, evaluation of patient satisfaction and cosmetic outcomes in breast reconstruction may have potential to led bias.

Abstract Background To demonstrate the value of an artificial intelligence (AI) software in the detection of mammographically occult breast cancers and to determine the clinicopathologic patterns of the cancers additionally detected using the AI software. Methods By retrospectively reviewing our institutional database (January 2017–September 2019), we identified women with mammographically occult breast cancers and analyzed their mammography with an AI software that provided a malignancy score (range 0–100; > 10 considered as positive). The hot spots in the AI report were compared with the US and MRI findings to determine if the cancers were correctly marked by the AI software. The clinicopathologic characteristics of the AI-detected cancers were analyzed and compared with those of undetected cancers. Results Among the 1890 breast cancers, 6.8% (128/1890) were mammographically occult, among which 38.3% (49/128) had positive results in the AI analysis. Of them, 81.6% (40/49) were correctly marked by the AI software and determined as “AI-detected cancers.” As such, 31.3% (40/128) of mammographically occult breast cancers could be identified by the AI software. Of the AI-detected cancers, 97.5% were found in heterogeneously or extremely dense breasts, 52.5% were asymptomatic, 86.5% were invasive, and 29.7% had axillary lymph node metastasis. Compared with undetected cancers, the AI-detected cancers were more likely to be found in younger patients (p

According to numerous chamber and free-air CO2 enrichment (FACE) studies with artificially raised CO2 concentration and/or temperature, it appears that increasing atmospheric CO2 concentrations ([CO2]) stimulates crop yield. However, there is still controversy about the extent of the yield stimulation by elevating [CO2] and concern regarding the potential adverse effects when temperature rises concomitantly. Here, we tested the effects of natural elevated [CO2] (ca. 120 ppm above the ambient level in 100 years ago) and warming (ca. 1.7–3.2 °C above the ambient level 100 years ago) on rice growth and yield over three crop seasons via a past reference investigation and current experiment (PRICE) study. In 2020–2022, the rice cultivar Tamanishiki (Oryza sativa, ssp. japonica) was grown in Wagner’s pots (1/2000 a) at the experiment fields of Chonnam National University (35°10′ N, 126°53′ E), Gwangju, Korea, according to the pot trial methodology of the reference experiment conducted in 1920–1922. Elevated [CO2] and temperature over the last 100 years significantly stimulated plant height (13.4% on average), tiller number (11.5%), and shoot biomass (10.8%). In addition, elevated [CO2] and warming resulted in a marked acceleration of flowering phenology (6.8% or 5.1 days), potentially leading to adverse effects on tiller number and grain yield. While the harvest index exhibited a dramatic reduction (12.2%), grain yield remained unchanged with elevated [CO2] and warming over the last century. The response of these crop parameters to elevated [CO2] and warming was highly sensitive to sunshine duration during the period from transplanting to heading. Despite the pot-based observations, considering a piecewise response pattern of C3 crop productivity to [CO2] of 2] (+120 ppm) and moderate warming (+1.7–3.2 °C) in the absence of adaptation measures (e.g., cultivars and agronomic management practices). Hence, our results suggest that the PRICE platform may provide a promising way to better understand and forecast the net impact of climate change on major crops that have historical and experimental archived data, like rice, wheat, and soybean.

Nitrogen (N) isotope ratios (δ15N) of multiple N species including ammonium (NH4+), nitrate (NO3−), dissolved organic N (DON), and total dissolved N (TDN) can serve as indicators of the sources of wet N deposition. However, methods for sequential analysis of these multiple N species are not well developed. In this study, methods for the determination of δ15N of these multiple N species were proposed through a traditional distillation method for NH4+ and NO3−, direct evaporation for TDN, and an isotope mass balance equation for δ15N-DON. A series of experiments were conducted 1) to find evaporation conditions including pH (2.0 mg N L−1 assuming that 200 ml of sample is used for distillation).

Objectives Nursing has embraced online education to increase its workforce while providing flexible advanced education to nurse professionals. Faculty use virtual simulation and other adaptive learning technologies to enhance learning efficiency and student outcomes in online courses. The purpose of this study was to assess the impact of simulated Electronic Health Records (EHRs) on informatics competency in a graduate online informatics course. Methods A two-group independent measures study design was adopted to assess students’ perception of a simulated EHR while comparing differences in informatics competencies between an intervention group and a control group. A simulated EHR assignment was provided to students in the intervention group, and a paper assignment was provided to those in the control group. The informatics competency of the students was measured using the Self-Assessment of Informatics Competency Scale for Health Professionals (SICS). Results Students who were enrolled in a family nurse practitioner program in fall of 2019 participated in this study (n = 39). The students expressed positive perceptions of a simulated EHR experience. The SICS results indicated that students in the intervention (simulated EHR) group showed higher informatics competency than those in the control group. Conclusions The positive results of this study support incorporating simulated EHR exercises in online courses. Higher informatics competency in the intervention group implies that the use of simulated EHR facilitated learning of complicated informatics concepts.

Abstract Background The upgrade rate of biopsy-confirmed ductal carcinoma in situ (DCIS) to invasive carcinoma is up to 50% on final pathology. We investigated MRI and clinicopathologic predictors of the invasive components of DCIS diagnosed by preoperative biopsy and then compared MRI features between patients with DCIS, microinvasive ductal carcinoma (mIDC), and invasive ductal carcinoma (IDC) diagnosed on final pathology. Methods Two hundred and one patients with 206 biopsy-confirmed DCIS lesions were enrolled. MRI and clinicopathologic features were used to predict either mIDC or IDC via a cumulative logistic regression analysis. For the lesions detected on MRI, morphologic and kinetic analyses were performed using the Chi-square, Fisher’s exact, and Kruskal-Wallis tests. Results Of all the lesions, 112 (54.4%) were diagnosed as DCIS, 50 (24.3%) were upgraded to mIDC, and 44 (21.4%) to IDC. The detection on MRI as mass (Odds ratio (OR) = 8.84, 95% confidence interval (CI) = 1.05–74.04, P = 0.045) or non-mass enhancement (NME; OR = 11.17, 95% CI = 1.35–92.36, P = 0.025), negative progesterone receptor (PR; OR = 2.40, 95% CI = 1.29–4.44, P = 0.006), and high Ki-67 level (OR = 2.42, 95% CI = 1.30–4.50, P = 0.005) were significant independent predictors of histologic upgrade. On MRI, 87 (42.2%) lesions appeared as mass and 107 (51.9%) as NME. Irregularly shaped, not-circumscribed, heterogeneous, or rim-enhancing masses with intratumoral high signal intensity or peritumoral edema, clumped or clustered ring-enhancing NMEs, and high peak enhancement were significantly associated with histologic upgrade (P

Summary: Objective: The purpose of this study was to evaluate the feasibility of image fusion between US and supine MRI in breast cancer patients, and to evaluate differences in tumor location between prone and supine positions. Methods: This prospective study included 88 patients who underwent an additional supine MRI (MRsup) sequence following routine prone MRI (MRpro) for breast cancer between May 2016 and December 2017. The location of the tumor and discrepancies in the distances from nipple to lesion (NLD), skin to lesion (SLD), and chest wall to lesion (CLD) were evaluated between MRpro and MRsup (MRpro-sup), MRpro and MRsup-navigated US (MRpro-USnav), and MRsup and USnav (MRsup-USnav). Associations between breast thickness and measurement discrepancies were analyzed. Results: Total 91 index lesions were evaluated. The intraclass correlation coefficients (ICCs) for the location of MRpro and MRsup compared with USnav were 0.994 (range: 0.990–0.996) and 0.998 (range: 0.996–0.999), respectively. The mean MRpro-sup and MRpro-USnav measurement discrepancies were greater than those of MRsup-USnav, significantly. Most outer locations showed greater mean measurement discrepancies than inner locations, and each NLD, SLD, and CLD mean measurement discrepancy showed different tendencies according to location (upper or lower) and lesion depth (superficial, middle, or deep). High breast thickness showed significantly greater mean measurement discrepancies than low breast thickness. Conclusion: Image fusion between US and supine MRI is feasible in breast cancer patients, although there is a considerable difference in tumor location measurements between prone and supine positions, especially with thicker breasts.

Abstract Background Breast magnetic resonance (MR) imaging does not usually assess axillary lymph nodes -using dedicated axillary sequence. The additional utility of dedicated axillary sequence is poorly understood. We evaluated the diagnostic performance of dedicated axillary imaging sequence for evaluation of axillary lymph node. Methods In this retrospective study from January 2018 to March 2018, 750 consecutive women underwent breast MR imaging. 263 patients were excluded, due to neoadjuvant chemotherapy (n = 235), incomplete histopathological information (n = 14) and follow-up loss (n = 14), 487 women were included. Two radiologists scored lymph node on confidence level scale from 0 (definitely benign) to 4 (definitely malignant), −using standard MR and dedicated axillary imaging sequences. Diagnostic performance parameters were compared and calculated correlation coefficient of quantitative features (largest dimension, cortical thickness, and the ratio of cortical thickness to largest dimension of lymph node). Results 68 (14.0%) were node-positive and 419 (86.0%) were node-negative. The sensitivity, specificity, positive, negative predictive values and accuracy were respectively, 66.2, 93.3, 61.6, 94.4, and 89.5% for dedicated axillary sequence and 64.7, 94.0, 63.8, 94.3, 89.9% for standard MR sequence The dedicated axillary and standard sequences s did not exhibit significant differences in detection of positive lymph nodes (AUC, 0.794 for standard and 0.798 for dedicated axillary sequence, P = 0.825). The cortical thickness appeared to be the most discriminative quantitative measurement using both axillary (AUC, 0.846) and standard sequences (AUC, 0.823), with high correlation coefficient (0.947). Conclusion Evaluation of axillary nodal status using standard breast MR imaging is comparable to dedicated axillary MR imaging.

Fly ash (FA) and zeolite (Z) are known to reduce bioavailability of metals in soils via immobilization; however, these amendments may not only immobilize metals such as copper (Cu) and zinc (Zn), but also reduce nitrogen (N) and phosphorus (P) availability in the soils via sorption (for N by Z) and precipitation (for P by FA). This study was conducted to evaluate the effects of application of FA and Z (0, 5, and 10% rate) on the availability of nutrients as well as metals in the metal-contaminated soils cultivated with paddy rice (Oryza sativa L.). Both FA and Z reduced Cu and Zn uptake by rice while increasing metal retention in the soils regardless of the application rates. However, reduced uptake of metals did not translate into increase in rice growth, especially at the 10% of amendment rates, due to decreased nutrient uptake as indicated by higher NH4+ and available P concentration in the soils amended with Z and FA, respectively, which inhibited tillering in the early rice growth period and thus reduced biomass accumulation at maturity. Our results suggest that FA and Z may reduce Cu and Zn uptake by rice in the soils contaminated with the metals; however, the availability of N and P is likely to be co-decreased. We suggest that the capacities of FA and Z to immobilize nutrients as well as metals need to be considered prior to using the amendments in metal-contaminated rice paddies. Keywords: Ammonium sorption, Heavy metals, Immobilization, Phosphate precipitation, Soil amendments

Summary: Background/Objective: The purpose of this study was to perform a comprehensive analysis of the radiological and clinicopathological factors that could predict recurrence of invasive breast cancer who underwent curative surgery without neoadjuvant chemotherapy. Methods: Three hundred and sixty-four consecutive women who underwent preoperative mammography, ultrasound, and breast magnetic resonance imaging for newly diagnosed invasive breast cancers and curative surgery between January and December 2010 were included. We analyzed the radiological findings of each modality and reviewed the histopathological features. A Cox proportional hazards model was used to determine the association between the radiological and clinicopathological parameters and disease-free survival (DFS). Results: During the median follow-up period of 5.3 years, 23 patients (6.3%) developed recurrences: locoregional recurrence in six patients, contralateral breast recurrence in three patients, and distant recurrences in 14 patients. Microcalcifications on mammography showed a tendency towards worse DFS. The multivariate Cox regression analysis showed that presence of lymphovascular invasion (LVI) (p = 0.006), negative progesterone receptor (PR) status (p

In temperate monsoon areas, major constraints of soybean production in drained paddy fields are excess soil water during monsoon seasons. To further understand how agronomic practices and weather course affect the yield of soybeans, we conducted field experiments at Gwangju, Korea (35°10′ N, 126°53′ E) over three years (2018–2020). Double-crop soybeans were grown at two tillage systems (TS) [rotary tillage (RT), deep plowing followed by rotary tillage (DPRT)] and three sowing dates (SD) (June 10–15, June 25–30, and July 10–15) in drained paddy fields. Flowering phenology (R2) was accelerated by 5 days with each 15-day delay in SD. This resulted in a significant reduction in vegetative growth up to R2, with subsequent reductions in CGR and NAR through R2–R5 (beginning of grain filling). With a 30-day delay in SD, yield was significantly reduced by 27.0%. The better performance of RT over DPRT was demonstrated by greater yields (13.7%). In addition, yield was greatly varied with weather volatility among years, ranging from 123.8 to 552.0 g m−2. Weather volatility was the greatest contributor to yield variability (30.4%), followed by SD (17.0%) and TS (10.3%). Our results suggest that the yield might be mainly determined by how much growth has already been achieved before flowering and through R2–R5.

This investigation was to evaluate the applicability and prediction accuracy of pedotransfer function (PTF) to estimate the water retention curves of Ap horizon soils for five soil series which cannot be directly used to cultivate upland crops other than rice because of their high salinity. Soil water retention curves (SWRCs) were obtained from 150 undisturbed soil samples collected from the Ap horizons of which soil textures were grouped into sandy loam with high contents of sand (>60%) and low clay contents (60%) and low sand content (2 values greater than 0.9 for sandy loam and silt loam represent RB-PTF and are suitable for predicting SWRCs in RTFS because the measured data points do not vary around the estimated regression line.

Abstract Background We investigated the radiologic and clinical findings of radial scar and complex sclerosing lesions, and evaluated the rate of pathologic upgrade and predicting factors. Methods From review of our institution’s database from January 2006 to December 2012, we enrolled 82 radial scars/complex sclerosing lesions in 80 women; 51 by ultrasound guided core needle biopsy, 1 by mammography-guided stereotactic biopsy, and 38 by surgical excision. The initial biopsy pathology revealed that 53 lesions were without high risk lesions and 29 were with high risk lesions. Radiologic, clinical and pathological results were analyzed statistically and upgrade rates were calculated. Results Of the 82 lesions, 64 (78.0%) were surgically excised. After surgical excision, two were upgraded to DCIS and two were upgraded to lesions with high risk lesions. The rate of radial scar with high risk lesions was significantly higher in the surgical excision group (11.1% vs. 42.2%, p = 0.015), which also demonstrated larger lesion size (10.7 ± 6.5 vs. 7.1 ± 2.6 mm, p = 0.001). The diagnoses with high risk lesions on final pathological results showed older age (52.9 ± 6.0 years vs. 48.4 ± 6.7 years, p = 0.018). Conclusions Radial scars with and without high risk lesions showed no statistically significant differences in imaging, and gave relatively low cancer upgrade rates.

Purpose Our study investigated whether any sonographic findings could be useful for differentiating between small triple-negative breast cancer (TNBC) and fibroadenoma. Methods This retrospective study was approved by our Institutional Review Board, which waived the requirement for patient consent. From January 2009 to December 2010, the sonographic features of 181 pathologically proven TNBC tumors and 172 fibroadenomas measuring less than or equal to 2 cm in the longest dimension were reviewed and analyzed according to the fifth edition of the Breast Imaging Reporting and Data System (BI-RADS) lexicon. Mean tumor roundness was also measured using in-house software. Results The median longest lesion dimension was 16 mm (range, 13 to 18 mm) in TNBCs and 13 mm (range, 10 to 16 mm) in fibroadenomas. In comparison to fibroadenomas, small TNBC tumors presented with a higher incidence of irregular shapes (66.9%), noncircumscribed margins (91.7%), hypoechoic echotexture (59.1%), posterior acoustic enhancement (65.2%), and associated features (24.4%). Most TNBCs were classified as BI-RADS category 4 (65.2%) or 5 (28.2%). The mean tumor roundness of small TNBCs was greater than that of fibroadenomas (60%±12% vs. 53%±13%). Multivariate analysis showed that older patient age, irregular shape, nonparallel orientation, posterior acoustic enhancement, associated features, a BI-RADS final assessment category of 4 or 5, and greater tumor roundness were significant independent factors indicative of TNBCs. Conclusion TNBC tumors tend to demonstrate more suspicious sonographic features and greater tumor roundness than fibroadenomas. These features may have the potential to help differentiate between small TNBCs and fibroadenomas.

Purpose The purpose of our study was to investigate the morphology and distribution of calcifications initially interpreted as benign or probably benign, but proven to be malignant by subsequent stereotactic biopsy, and to identify the reason for misinterpretation or underestimation at the initial diagnosis. Materials and Methods Out of 567 women who underwent stereotactic biopsy for calcifications at our hospital between January 2012 and December 2014, 167 women were diagnosed with malignancy. Forty-six of these 167 women had previous mammography assessed as benign or probably benign which was changed to suspicious malignancy on follow-up mammography. Of these 46 women, three women with biopsy-proven benign calcifications at the site of subsequent cancer were excluded, and 43 patients were finally included. The calcifications (morphology, distribution, extent, associated findings) in the previous and follow-up mammography examinations were analyzed according to the Breast Imaging Reporting and Data System (BI-RADS) lexicon and assessment category. We classified the patients into two groups: 1) group A patients who were still retrospectively re-categorized as less than or equal to BI-RADS 3 and 2) group B patients who were re-categorized as equal to or higher than BI-RADS 4a and whose results should have prompted previous diagnostic assessment. Results In the follow-up mammography examinations, change in calcification morphology (n = 27, 63%) was the most frequent cause of assessment change. The most frequent previous mammographic findings of malignant calcification were amorphous morphology (n = 26, 60%) and grouped distribution (n = 36, 84%). The most frequent calcification findings at reassessment were amorphous morphology (n = 4, 9%), fine pleomorphic calcification (n = 30, 70%), grouped distribution (n = 23, 53%), and segmental calcification (n = 12, 28%). There were 33 (77%) patients in group A, and 10 patients (23%) in group B. Conclusion Amorphous morphology and grouped distribution were the most frequent mammographic findings of calcifications that were misinterpreted or underestimated by the initial radiologist and confirmed as malignancy at follow-up.

Purpose To assess the imaging and clinicopathologic outcomes of recurrent and second breast cancer after breast-conserving surgery for invasive ductal carcinomas detected on follow-up mammography and breast ultrasound (US). Materials and Methods Seventy-six women with an ipsilateral breast tumor recurrence (IBTR) or regional lymph node recurrence and/or contralateral breast cancer (RLNR & CBC) after breast-conserving surgery were included in this study. The mammography and US images were analyzed and the clinicopathologic parameters were compared between the groups. Results Thirty had an IBTR, and 46 had a RLNR & CBC. The IBTR group's mammography and US images frequently revealed calcification and masses on the breast, respectively. The most frequent site of RLNR detected during follow-up mammography and breast US was the axilla. In univariate analysis, the tumors in the IBTR group were predominantly estrogen receptor (ER)-negative, HER-2 overexpression, and p53-positive. ER and HER-2 were shown by the multivariate analysis to be independent parameters associated for both types of recurrences. Conclusion A mass or calcification is frequently present in IBTR and the axillary lymph node is the most frequent site of RLNR. ER and HER-2 status are major independent factors associated with recurrent and second breast cancer.

Purpose: The purpose of this study is to evaluate the use of second-look ultrasonography (US) for investigating additional suspicious lesions detected on preoperative staging magnetic resonance imaging (MRI) for breast cancer. Methods: Between September 2008 and August 2010, 1,970 breast MRIs were performed at our medical institution for the evaluation of breast cancer before surgery. Second-look US was recommended for 135 patients with 149 suspicious lesions, following the MRI interpretation, and 108 patients with 121 lesions were included in this study. The detection rate on second-look US, according to the lesion type, diameter, and histopathological outcome, was analyzed. Results: Of the 121 lesions considered in this study, 97 (80.2%) were diagnosed on MRI as masses and 24 (19.8%) as non-mass-like lesions; 105 lesions (86.8%) were correlated and 16 (13.2%) were not correlated with the findings of second-look US. Of the 105 correlated lesions, 29 (27.6%) were proven to be malignant and 76 (72.4%) were benign. Although a greater number of large malignant lesions were correlated on second-look US than small benign lesions, there was no statistically significant difference according to lesion diameter or type, as seen on MRI or pathology. Conclusion: We have concluded that second-look US is a useful diagnostic tool for lesions incidentally detected on breast MRI, as in this study, it could identify 86.8% of the MRI-detected breast lesions.