BACKGROUND: Tobacco health warning labelling as one of the smoking education act has been improved in many countries. But there was no change of tobacco health warning labelling after 1989 in korea. So, for the purpose to help developing new tobacco health warning labelling, we searched the recognition rate of tobacco health warning labelling in family physician and their evaluation of labels which were required form 1976 to 1988, and after 1989 in korea. METHOD: Family physicians who were participated in autumn conference 2000 of the Korean Academy of Family Medicine were questioned about their recognition and evaluation of tobacco health warning labelling required form 1976 to 1988 and after 1989. RESULTS: Response rate to questionnaire was 25%(250/1000), but completely filled response rate included in study was 14.5%(145/1000). The recognition rate of tobacco health warning labelling required in 1976-1988(86.7%) was higher then after 1989(61.4%). When compared by sex, age, and smoking status, each results are similar. Respondents evaluated the tobacco health warning labelling required in 1976-1988 that the information was absolutely small and the vagueness of sentences lead smokers misconceived adverse effect of smoking, and also pointed out that the changed labelling after 1989 is not enough to transmit sufficient information. Respondents recognized that because government provided military personnel with tobacco of free charge, it decreased confidence and warning effect of tobacco health warning labelling(72.4%). Respondents answered active campaign of government against smoking would increase the effect of tobacco health warning labelling(92.4%), but the monopoly of tobacco production by government would support (local)government finance(75.9%). CONCLUSION: New tobacco health warning labelling is needed to increase readability, warning, information against smoking, because present labelling is not recognized well and limited to give information against smoking.
Comprehension ; Surveys and Questionnaires ; Education ; Humans ; Korea ; Military Personnel ; Physicians, Family* ; Smoke ; Smoking ; Tobacco ; Tobacco Products

PURPOSE: Primary systemic therapy (PST) downstages up to 40% of initial documented axillary lymph node (ALN) metastases in breast cancer. The current surgical treatment after PST consists of breast tumor resection and axillary lymph node dissection (ALND). This strategy, however, does not eliminate unnecessary ALND in patients with complete remission of axillary metastases. The aim of this study was to examine the accuracy of sentinel lymph node biopsy (SLNB) after PST among patients with documented ALN metastasis at presentation and to identify the rate of pathologic complete-remission (CR) with ALN after PST. METHODS: We analyzed 66 patients with ALN metastasis that was pathologically proven preoperatively who underwent SLNB and concomitant ALND after PST. Axillary ultrasound (AUS) was used to evaluate the clinical response of initially documented ALN metastasis after PST. Intraoperative lymphatic mapping was performed using blue dye with or without radioisotope. RESULTS: After PST, 34.8% of patients had clinical CR of ALN on AUS and 28.8% patients had pathologic CR of ALN. The overall success rate of SLNB after PST was 87.9%, and the sentinel lymph node identification rate in patients with clinical CR was 95.7%. In patients with successful lymphatic mapping, 70.7% of patients had residual axillary metastases. The overall accuracy and false-negative rate were 87.9% and 17.1% in all patients: 95.5% and 10.0% in patients with clinical CR of ALN, and 83.3% and 19.4% in patients with residual axillary disease after PST. CONCLUSION: Our findings suggest that SLNB may be feasible in patients with initial documented ALN metastasis who have clinical CR for metastatic ALN after PST. Further investigation in a prospective setting should be performed to confirm our results.
Breast ; Breast Neoplasms ; Humans ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Nitriles ; Pyrethrins ; Sentinel Lymph Node Biopsy

PURPOSE: To evaluate the accuracy of ultrasound (US) and US-guided fine needle aspiration biopsy (FNAB) for the diagnosis of metastasis in the axillary lymph node (LN) of patients with breast cancer. MATERIALS AND METHODS: A retrospective review of the data was performed on 327 breast cancer patients that underwent axillary US from Jun 2006 to July 2008. US-guided FNAB was performed when a LN indicated suspicious findings. Results of FNAB were compared with those of subsequent surgery. RESULTS: Of the 327 patients, 111 showed suspicious findings on US and underwent FNAB. Among the 111 cases, 73 (66%) were positive for cancer, while 38 (34%) were negative results. A Total of 254 patients who had normal findings on US (n=216) and negative results on FNAB (n=38) underwent SNB, of which 56 (22%) were proven to have metastasis. Sensitivity and specificity of US were 61.9% and 81.8%, respectively, with a positive predictive value (PPV) of 65.8% and negative predictive value (NPV) of 79.2%. Sensitivity and specificity of US-guided FNAB were 86.9% and 100%, respectively, with a PPV of 100% and a NPV of 71.7%. CONCLUSION: US and US-guided FNAB performed for axillary staging are useful methods with a high specificity and positive predictive value in invasive breast cancer patients.
Axilla ; Biopsy ; Biopsy, Fine-Needle ; Breast ; Breast Neoplasms ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Retrospective Studies ; Sensitivity and Specificity

PURPOSE: We wanted to evaluate the interobserver variability and diagnostic performance of 3-dimensional (3D) breast ultrasound (US) as compared with that of 2-dimensional (2D) US. MATERIALS AND METHODS: We included 150 patients who received US-guided core biopsy and 3D US between June 2009 and April 2010. Three breast imaging radiologists analyzed the 2D and 3D US images using the Breast Imaging Reporting and Data System (BI-RADS) lexicon. The intra-observer agreement and inter-observer agreement were calculated. The sensitivity and specificity of 2D and 3D US were evaluated. RESULTS: The intra-observer agreement between 2D and 3D US was mostly slight or fair agreement. However, in terms of the final category, there was substantial agreement for all three radiologists. The inter-observer agreement of 3D US was similar to that of 2D US (moderate agreement for shape, orientation, circumscribed margin and boundary; fair agreement for indistinct margin, angular margin, microlobulated margin, echo pattern and final category). The sensitivity of 3D US for breast cancer was higher than that of 2D US for two radiologists (2D vs. 3D for reader 2: 55.8% vs. 61.5%, 2D vs. 3D for reader 3: 59.6% vs. 63.5%), and the specificity of 3D US was lower than that of 2D US for all the readers (2D vs. 3D for reader 1: 90.8% vs. 86.7%, 2D vs. 3D for reader 2: 90.8% vs. 87.8%, 2D vs. 3D for reader 3: 94.9% vs. 90.8%), but the difference was not significant (p > or = 0.05). CONCLUSION: The interobserver variability and diagnostic performance of 3D breast US were similar to those of 2D US.
Biopsy ; Breast ; Breast Neoplasms ; Humans ; Information Systems ; Observer Variation ; Orientation ; Sensitivity and Specificity

Background: and Purpose Anti-neurofascin-155 (NF155) antibody is one of the autoantibodies associated with autoimmune nodopathy. We aimed to determine the clinical features of South Korean patients with anti-NF155-antibody-positive autoimmune nodopathy. Methods: The sera of 68 patients who fulfilled the diagnostic criteria for chronic inflammatory demyelinating polyneuropathy (CIDP) were tested for anti-NF155 antibodies using a cellbased assay (CBA) and enzyme-linked immunosorbent assay (ELISA). The anti-NF155-positive sera were also assayed for NF155 immunoglobulin G (IgG) subclasses, and for antiNF186 and NF140 antibodies. The clinical features of the patients were reviewed retrospectively. Results: Among the 68 patients, 6 (8.8%) were positive for anti-NF155 antibodies in both the CBA and ELISA. One of those six patients was also positive for anti-NF186 and anti-NF140 antibodies. IgG4 was the predominant subclass in four patients. The mean age at onset was 32.2 years. All six positive patients presented with progressive sensory ataxia. Five patients treated using corticosteroids presented a partial or no response. All six patients were treated using intravenous immunoglobulin (IVIg). Among them, five exhibited a partial or poor response and the other exhibited a good response. All three patients treated using rituximab showed a good response. Conclusions The clinical characteristics of the patients were consistent with those in previous studies. Anti-NF155 antibody assay is necessary for diagnosing autoimmune nodopathy and its appropriate treatment, especially in young patients with CIDP who present with sensory ataxia and poor therapeutic responses to corticosteroids and IVIg.

OBJECTIVE: To evaluate the accuracy of a computer-aided evaluation program (CAE) of breast MRI for the assessment of residual tumor extent and response monitoring in breast cancer patients receiving neoadjuvant chemotherapy. MATERIALS AND METHODS: Fifty-seven patients with breast cancers who underwent neoadjuvant chemotherapy before surgery and dynamic contrast enhanced MRI before and after chemotherapy were included as part of this study. For the assessment of residual tumor extent after completion of chemotherapy, the mean tumor diameters measured by radiologists and CAE were compared to those on histopathology using a paired student t-test. Moreover, the agreement between unidimensional (1D) measurement by radiologist and histopathological size or 1D measurement by CAE and histopathological size was assessed using the Bland-Altman method. For chemotherapy monitoring, we evaluated tumor response through the change in the 1D diameter by a radiologist and CAE and three-dimensional (3D) volumetric change by CAE based on Response Evaluation Criteria in Solid Tumors (RECIST). Agreement between the 1D response by the radiologist versus the 1D response by CAE as well as by the 3D response by CAE were evaluated using weighted kappa (k) statistics. RESULTS: For the assessment of residual tumor extent after chemotherapy, the mean tumor diameter measured by radiologists (2.0 +/- 1.7 cm) was significantly smaller than the mean histological diameter (2.6 +/- 2.3 cm) (p = 0.01), whereas, no significant difference was found between the CAE measurements (mean = 2.2 +/- 2.0 cm) and histological diameter (p = 0.19). The mean difference between the 1D measurement by the radiologist and histopathology was 0.6 cm (95% confidence interval: -3.0, 4.3), whereas the difference between CAE and histopathology was 0.4 cm (95% confidence interval: -3.9, 4.7). For the monitoring of response to chemotherapy, the 1D measurement by the radiologist and CAE showed a fair agreement (k = 0.358), while the 1D measurement by the radiologist and 3D measurement by CAE showed poor agreement (k = 0.106). CONCLUSION: CAE for breast MRI is sufficiently accurate for the assessment of residual tumor extent in breast cancer patients receiving neoadjuvant chemotherapy. However, for the assessment of response to chemotherapy, the assessment by the radiologist and CAE showed a fair to poor agreement.
Adult ; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use ; Breast Neoplasms/*diagnosis/drug therapy/surgery ; *Diagnosis, Computer-Assisted ; Humans ; *Magnetic Resonance Imaging ; Middle Aged ; *Neoadjuvant Therapy ; Neoplasm, Residual ; Young Adult

OBJECTIVE: To compare the diagnostic performance of new and established full-field digital mammography (FFDM) systems. MATERIALS AND METHODS: During a 15-month period, 1038 asymptomatic women who visited for mammography were prospectively included from two institutions. For women with routine two-view mammograms from established FFDM systems, bilateral mediolateral oblique (MLO) mammograms were repeated using the new FFDM system. One of the four reviewers evaluated two-sets of bilateral MLO mammograms at 4-week intervals by using a five-point score for the probability of malignancy according to a Breast Imaging Reporting and Data System. The lesion type and breast density were determined by the consensus of two readers at each institution. The dichotomized mammographic results correlated with a final pathologic outcome and follow-up data. Receiver operating characteristic (ROC) curves, sensitivity, and specificity were compared in general and according to the lesion type and breast density. RESULTS: Of the 1038 cases, 193 (18.6%) had cancer. The areas under the ROC curve (AUC), sensitivity, and specificity of the established system were 0.815, 65.3%, and 90.2%, respectively. Those of the new system were 0.839, 68.4%, and 91.7%, respectively. There were no significant differences in the AUCs, sensitivities or the specificities in general between new and established systems (Ps = 0.194, 0.590, 0.322, respectively). We found no significant difference in these parameters according to lesion type or breast density. CONCLUSION: The new FFDM system has a comparable diagnostic performance with established systems.
Adult ; Aged ; Area Under Curve ; Breast Neoplasms/pathology/*radiography ; Female ; Humans ; Mammography/*methods ; Middle Aged ; Prospective Studies ; ROC Curve ; Radiographic Image Enhancement/*methods ; Republic of Korea ; Sensitivity and Specificity