It is practical value for determination the teenagers whether the age is full of the legal responsibility age of 18 years old or not by estimating skeletal age of sternal end of clavicle. The traditional methods mainly based on X-ray radiography. However, sternal end of clavicle and adjacent lung, bronchus, sternum, rib, transverse process of thoracic vertebra are overlapped each other. As a result of overlapping, there will be obtained false negative or positive film reading results when according to X-ray observation of epiphyseal growth of sternal end of clavicle, which directly affect the scientificalness and accuracy of estimating of skeletal age. In recent years, the scholars at home and abroad have started to use thin layer CT scan technology to estimate skeletal age of the sternal end of clavicle. With the 2D and 3D CT recombination technology, the accuracy of the film reading distinctly improves by making the shape, size and position of epiphysis displayed clearly. This article reviews the application and research progress of thin layer CT scanning technology in estimating skeletal age of sternal end of clavicle at home and abroad, analyzes the superiority and value of thin layer CT scan technology, which applied to skeletal age of sternal end of clavicle.
Adolescent ; Age Determination by Skeleton/methods* ; Clavicle/growth & development* ; Epiphyses/growth & development* ; Female ; Forensic Anthropology/methods* ; Humans ; Image Processing, Computer-Assisted ; Male ; Osteogenesis ; Retrospective Studies ; Sternum/growth & development* ; Tomography, X-Ray Computed/methods* ; Young Adult

OBJECTIVE: To establish a CT staging method of sternal end of clavicle epiphyseal growth for teenagers by thin layer CT scan, multiplanar reconstruction (MPR) and volume reconstruction (VR) technologies. METHODS: The CT imaging characteristics, which collected from 460 teenagers (aged from 15 to 25) in East and South China, were studied through both sternal ends of clavicles' imagings by thin layer coronal CT scan and axial CT scan, MPR and VR technologies. The parameters of sternal end of clavicle including the longest diameter of epiphysis, the longest diameter of metaphysis, their length ratio, area of epiphysis, area of metaphysis, and their area ratio were measured and calculated in order to establish new classification. RESULTS: Based on the staging method of Schmeling, integrating the CT imaging reconstruction information of sternal end of clavicle, the new classification of sternal end of clavicle epiphyseal growth were divided into 1 to 5 stages, and stage 2 and stage 3, respectively, contained a, b and c sub-classification. CONCLUSION This new classification has merits of large sample size, wide age range and easy operability. By using CT imaging reconstruction techniques and analyzing the data which closely related to sternal end of clavicle epiphyseal growth of teenagers, the feasibility of the staging method could be increased.
Adolescent ; Adult ; Age Determination by Skeleton/methods* ; China ; Clavicle/growth & development* ; Epiphyses/growth & development* ; Feasibility Studies ; Female ; Forensic Anthropology ; Humans ; Image Processing, Computer-Assisted ; Male ; Osteogenesis ; Sex Characteristics ; Sternum/growth & development* ; Tomography, X-Ray Computed ; Young Adult

PURPOSE: In this study we evaluated the significance of false positive screening bone scintigraphy (BS) in primary invasive breast cancer patients. Lymphatic vessel invasion (LVI), estrogen receptor (ER), progesterone receptor (PR), nuclear grade, histology grade, epidermal growth factor receptor (EGFR) and C-erb-B2 values were examined in terms of their abilities to predict the accuracy of abnormal BS. We also examined the incidence of bone metastasis in primary invasive breast cancer patients according to the 1988 and 2003 AJCC classifications. METHODS: A retrospective review was performed on 2,044 primary invasive breast cancer patients that had received BS screening, and who were treated by mastectomy or breast conserving surgery at the Seoul National University Hospital between Jan 1995 and Jul 2003. Abnormal screening BS results were divided into "less suspicious" and "highly suspicious" groups. Patient's stages according to the 1988 AJCC classification were reclassified according to the 2003 AJCC classification. Bone metastasis was confirmed by further radiological examination or follow-up BS. All statistical analyses were two-tailed. RESULTS: The incidences of bone metastasis and an abnormal screening BS result were 1.7% (35/2,044) and 13.8% (283/2,044), respectively. The false positive rate of screening BS was 87.6% (248/283). LVI was the only significant predictive factor of bone metastasis in 283 of the abnormal BS patients (p <.001). c-erb-B2 showed no significance to predict bone metastasis in the "less suspicious" group, but was Bone is the most common site of distant metastasis in invasive breast cancer at the time of primary diagnosis. The vertebrae are the most common sites of bone metastasis and the ribs, skull, sternum and proximal long bones are also frequently involved. Bone metastases affect 8% of patients marginally significant in the "highly suspicious" group (p = .046). ER, PR, nuclear grade, histology grade, and EGFR showed no significance in terms of predicting the accuracy of an abnormal BS result. The incidences of bone metastasis were 0.6, 1.3 and 7.6% in stages I, II and III, respectively, according to the 1988 AJCC classification, while these incidences were 0.6, 0.7 and 5.8% according to the 2003 AJCC classification. CONCLUSION: The use of screening bone scintigraphy as a routine screening test is hard to justify due to its high false positive rate. LVI may be a useful factor in that it predicts the accuracy of an abnormal BS result. The incidences of bone metastasis in stages II and III were lower for the 2003 AJCC staging system.
Breast Neoplasms* ; Breast* ; Classification ; Diagnosis ; Estrogens ; Follow-Up Studies ; Humans ; Incidence ; Lymphatic Vessels ; Mass Screening* ; Mastectomy ; Mastectomy, Segmental ; Neoplasm Metastasis* ; Radionuclide Imaging* ; Receptor, Epidermal Growth Factor ; Receptors, Progesterone ; Retrospective Studies ; Ribs ; Seoul ; Skull ; Spine ; Sternum