Diagnostic Value of CYFRA 21-1 Measurement in Fine-Needle Aspiration Washouts for Detection of Axillary Recurrence in Postoperative Breast Cancer Patients

Purpose The objective of this study was to evaluate the diagnostic value and threshold levels of cytokeratin fragment 21-1 (CYFRA 21-1) in fine-needle aspiration (FNA) washouts for detection of lymph node (LN) recurrence in postoperative breast cancer patients. Materials and Methods FNA cytological assessments and CYFRA 21-1 measurement in FNA washouts were performed for 64 axillary LNs suspicious for recurrence in 64 post-operative breast cancer patients. Final diagnosis was made on the basis of FNA cytology and follow-up data over at least 2 years. The concentration of CYFRA 21-1 was compared between recurrent LNs and benign LNs. Diagnostic performance and cut-off value were evaluated using a receiver operating characteristic curve. Results Regardless of the non-diagnostic results, the median concentration of CYFRA 21-1 in recurrent LNs was significantly higher than that in benign LNs (p < 0.001). The optimal diagnostic cut-off value was 1.6 ng/mL. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CYFRA 21-1 for LN recurrence were 90.9%, 100%, 100%, 98.1%, and 98.4%, respectively. Conclusion Measurement of CYFRA 21-1 concentration from ultrasound-guided FNA biopsy aspirates showed excellent diagnostic performance with a cut-off value of 1.6 ng/mL. These results indicate that measurement of CYFRA 21-1 concentration in FNA washouts is useful for the diagnosis of axillary LN recurrence in post-operative breast cancer patients.ope

Three-dimensional fractal dimension and lacunarity features may noninvasively predict TERT promoter mutation status in grade 2 meningiomas

Purpose: The 2021 World Health Organization classification includes telomerase reverse transcriptase promoter (TERTp) mutation status as a factor for differentiating meningioma grades. Therefore, preoperative prediction of TERTp mutation may assist in clinical decision making. However, no previous study has applied fractal analysis for TERTp mutation status prediction in meningiomas. The purpose of this study was to assess the utility of three-dimensional (3D) fractal analysis for predicting the TERTp mutation status in grade 2 meningiomas. Methods: Forty-eight patients with surgically confirmed grade 2 meningiomas (41 TERTp-wildtype and 7 TERTp-mutant) were included. 3D fractal dimension (FD) and lacunarity values were extracted from the fractal analysis. A predictive model combining clinical, conventional, and fractal parameters was built using logistic regression analysis. Receiver operating characteristic curve analysis was used to assess the ability of the model to predict TERTp mutation status. Results: Patients with TERTp-mutant grade 2 meningiomas were older (P = 0.029) and had higher 3D FD (P = 0.026) and lacunarity (P = 0.004) values than patients with TERTp-wildtype grade 2 meningiomas. On multivariable logistic analysis, higher 3D FD values (odds ratio = 32.50, P = 0.039) and higher 3D lacunarity values (odds ratio = 20.54, P = 0.014) were significant predictors of TERTp mutation status. The area under the curve, accuracy, sensitivity, and specificity of the multivariable model were 0.84 (95% confidence interval 0.71-0.93), 83.3%, 71.4%, and 85.4%, respectively. Conclusion: 3D FD and lacunarity may be useful imaging biomarkers for predicting TERTp mutation status in grade 2 meningiomas.ope

자기공명전기물성단층촬영을 이용한 생체내 유방암 및 정상섬유유선 조직의 도전율 연구: 현성확산계수와의 비교

To evaluate the conductivity of normal breast parenchyma according to the menstrual cycle or menopausal status compared with ADC and to determine whether conductivity of normal breast tissue is affected by other clinicopathologic variables in patients with breast cancer. This study included 102 breast cancer patients who had information about menstruation and underwent breast MRI for preoperative evaluation of breast cancer between July 2013 and December 2017. The normalized conductivity and ADCs of tumor and conductivity and ADCs of contralateral normal glandular tissue were measured and compared according to menopausal status (premenopausal and postmenopausal women) and menstruation cycles (1 to 4 weeks). There were no significant differences in ADCs of contralateral normal glandular tissue between premenopausal and postmenopausal women (p=0.534) or among four menstrual weeks for premenopausal women (p=0.534). Conductivity of contralateral normal glandular tissue showed a tendency to be higher in premenopausal women than in postmenopausal women but without significant difference (p=0.057).There were no significant difference in conductivity of normal fibroglandular tissue among four menstrual weeks for premenopausal women (p=0.800). Both of normalized conductivity and ADCs of breast cancer were not significantly different between premenopausal women and postmenopausal women (p=0.920, p=0.259, respectively) and between four menstruation weeks for premenopausal women (p=0.147, p=0.949, respectively). In multivariate analysis, mammographic density was an independent factor associated with ADC of contralateral normal breast (p=0.001). Mammographic density was an independent factor associated with conductivity of contralateral normal breast (p=0.001). Parenchymal enhancement, ER status and mammographic density were independent factor associated with normalized ADC of breast cancer (p=0.001, 0.013, 0.034). There was no significant difference in the contralateral and normalized ADCs and contralateral and normalized conductivity during the menstruation cycles, suggesting that MRI can be performed at any time regardless of the menstruation cycle. Conductivity of normal breast parenchyma is a factor that is not affected by other various clinocopathologic factors, except breast density. 월경 주기 또는 폐경 여부에 따른 정상섬유유선 조직의 도전율을 현성확산계수와 비교하여 평가하고 정상섬유유선 조직의 도전율이 유방암 환자에서 다른 임상병리적 인자들에 영향을 받는지를 밝히는 것이 목적이다. 이 연구는 월경에 대한 정보가 있고 2013년 7월과 2017년 12월 사이에 유방암의 수술전 평가를 위해 유방 자기공명영상을 촬영한 102명의 유방암 환자를 포함하였다. 종양의 정규화된 도전율및 현성확산계수와 반대쪽 정상섬유유선 조직의 도전율 및 현성확산계수가 측정되었으며 폐경 여부(폐경전과 폐경후 여성)와 월경주기(1주차-4주차)에 따라 비교하였다. 폐경전과 폐경후 여성사이에 반대측 정상섬유유선 조직의 현성확산계수에는 유의한 차이가 없었으며(p=0.534) 폐경전 여성에서 월경 4주중 반대측 정상섬유유선 조직의 현성확산계수에는 유의한 차이가 없었다(p=0.534). 반대측 정상섬유유선 조직의 도전율은 폐경후 여성에서보다 폐경전 여성에서 더 높은 경향성을 보였으나 유의한 차이는 없었다 (p=0.057). 폐경전 여성에서 월경 4주중 정상 섬유유선조직의 도전율에는 유의한 차이가 없었다(p=0.800). 정규화된 도전율과 현성확산계수 둘 다 폐경전 여성과 폐경후 여성에서 유의한 차이는 없었으며 (p=0.920, p=0.259) 폐경전 여성에서 월경 4주간에도 유의한 차이는 없었다(p=0.147, p=0.949). 다변량 분석에서, 유방밀도는 반대측 정상 유방의 도전율과 연관된 독립적 인자였다(p=0.001). 배경실질 조영, 에스트로겐 수용체와 유방밀도는 유방암의 정규화된 현성확산계수와 연관된 독립적인 인자였다(p=0.001, p=0.013, p=0.034). 월경 주기동안 반대측 현성확산계수 및 유방암의 정규화된 현성확산계수와 반대측 도전율 및 유방암의 정규화된 도전율은 유의한 차이를 보이지 않았으며, 이는 자기공명영상을 월경주기에 관계없이 어느 시기에나 촬영할 수 있다는 것을 시사한다. 정상 유방 실질의 도전율은 유방치밀도를 제외한 다른 여러 임상병리적 인자들에 영향을 받지 않았다.open박

Transrectal or Transvaginal Ultrasoundguided Biopsy for Pelvic Masses: External Validation and Usefulness in Oncologic Patients

Purpose: The purpose of this study was to externally validate the diagnostic usefulness of transrectal ultrasound (TRUS) or transvaginal ultrasound (TVUS)-guided biopsy for pelvic masses, and to analyze the diagnostic performance of these methods in oncologic patients. Methods: A consecutive series of 30 patients who underwent TRUS- or TVUS-guided biopsy for pelvic masses was included. Tissue samples were obtained using an 18-gauge core biopsy needle under local anesthesia for lesions detected on computed tomography or magnetic resonance imaging. We analyzed the rates of diagnostic biopsies upon pathologic examination and biopsy-related major complications requiring treatment. In diagnostic biopsy cases, the performance was also investigated for all patients and patients with underlying malignancy. Results: The diagnostic biopsy rate was 93.3% (28 of 30) for all patients and 95.0% (19 of 20) for oncologic patients. No patients had major complications. In diagnostic biopsies, the sensitivity, specificity, positive and negative predictive value, and accuracy for identifying malignancy were 100% (17 of 17), 72.7% (8 of 11), 85.0% (17 of 20), 100% (8 of 8), and 89.3% (25 of 28) for all patients and 100% (14 of 14), 60.0% (3 of 5), 87.5% (14 of 16), 100% (3 of 3), and 89.5% (17 of 19) for oncologic patients, respectively. Conclusion: This study externally validated the feasibility and safety of TRUS- or TVUS-guided biopsy. In addition, these techniques appear to enable accurate pathologic diagnoses of pelvic masses in oncologic patients to be made safely and relatively noninvasively.ope