BACKGROUNDEarly detection with screening mammography can potentially reduce breast cancer mortality rates. To achieve an efficient screening, a peer review system provides a compensatory double-check reviewing, will hopefully to prevent the omission of detectable lesions and reduce unnecessary recall.

METHODSIn 2009, 4643 initial mammographic screenings reported by 74 screening radiologists had negative results with a recall rate of less than 5%. In the same year, 2538 initial positives screened by 18 screening radiologists had a recall rate higher than 15%. Those 7181 randomized screenings were evenly distributed for reassessment by 39 reviewing radiologists. The disagreement of assessments between the reviewers and screening radiologists was recorded. The differential rate was defined as the number of the disagreements divided by the number of audited films reviewed by a screening radiologist. The equality of the differential rates for each screening radiologists with negative and positive assessments was compared by a Chi-square test. The performance of the 39 auditors was measured by the Kendall's tau statistic. P values less than 0.05 were considered statistically significant.

RESULTSThe mean differential rate for screening radiologists of negative assessments was 6.7% (P = 0.588), while 35.0% for positive assessments were significant (P < 0.001). The result indicated that most of the initial negative assessments reported by the screening radiologists were generally accepted by the reviewers but not the positive assessments. With respect to the 39 reviewers, there was no significant evidence for the association of the difference rates between negative and positive assessments. Nine reviewers were found to have their differential rate for negative and positive assessments larger than the average of the population. Eleven reviewers were found to have their differential rates smaller than the average for both. Thirteen reviewers had their differential rates smaller than the average for negative assessments but larger than the average for positive assessments. The opposite condition was found for six reviewers. The Kendall's tau statistic was 0.038 (P = 0.735).

CONCLUSIONSReviewers usually agreed with the opinion of the initial screening doctors who reported negative findings. Therefore, a 5% recall rate as the lower range of reviewing negatives may be still too high. The recall rate of more than 15% was significantly related to improper interpretation, especially when the differential rate is 25% or higher, a warning to the underperforming screening radiologist is recommended. An ideal reviewer should interpret films independently. Reviewers with tendencies to be followers or contrarians should not be enrolled in the reviewing system.

Breast Neoplasms ; diagnostic imaging ; Early Detection of Cancer ; Female ; Humans ; Mammography ; Peer Review ; Reproducibility of Results ; Taiwan

BACKGROUNDBone age development is one of the significant indicators depicting the growth status of children. However, bone age assessment is an heuristic and tedious work for pediatricians. We developed a computerized bone age estimation system based on the analysis of geometric features of carpal bones.

METHODSThe geometric features of carpals were extracted and analyzed to judge the bone age of children by computerized shape and area description. Four classifiers, linear, nearest neighbor, back-propagation neural network, and radial basis function neural network, were adopted to categorize bone age. Principal component and discriminate analyses were employed to improve assorting accuracy.

RESULTSThe hand X-ray films of 465 boys and 444 girls served as our database. The features were extracted from carpal bone images, including shape, area, and sequence. The proposed normalization area ratio method was effective in bone age classification by simulation. Besides, features statistics showed similar results between the standard of the Greulich and Pyle atlas and our database.

CONCLUSIONSThe bone area has a higher discriminating power to judge bone age. The ossification sequence of trapezium and trapezoid bones between Taiwanese and the atlas of the GP method is quite different. These results also indicate that carpal bone assessment with classification of neural networks can be correct and practical.

Age Determination by Skeleton ; Carpal Bones ; anatomy & histology ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Neural Networks (Computer)

OBJECTIVETo explore the value of surgical treatment on spine metastatic tumor.

METHODS31 cases of spine metastatic tumor with severe pain or/and neurological deficit were selected and treated with various operative methods.

RESULTSExcept for 4 cases, all the patients survived from 3 months to 7 years (average 17.6 months). The patients had no complication during treatment. The symptoms and neurological functions recovered with various extent after operation.

CONCLUSIONSSurgical treatment should cautiously be adopted. When the spine metastatic tumor with severe pain and neurological deficit has no response to the conservative methods, the surgical treatment with decompression and internal fixation should be performed to improve the life quality for the patients.

Adult ; Aged ; Breast Neoplasms ; pathology ; surgery ; Female ; Humans ; Lung Neoplasms ; pathology ; surgery ; Male ; Middle Aged ; Quality of Life ; Spinal Neoplasms ; secondary ; surgery

OBJECTIVE: We wanted to assess the usefulness of four-dimensional (4D) ultrasonography (US), i.e., real-time three-dimensional US, as an adjunct for performing various US-guided interventional procedures in superficial lesions. MATERIALS AND METHODS: Thirty-three patients were referred for US-guided interventional procedures for superficial lesions, including core biopsy in 19, fine-needle aspiration in eight, therapeutic drug injection in four and needle puncture in two. The procedures were performed under 4D US guidance. We reviewed the pathologic/cytologic results of the core biopsies or needle aspirations, and also the outcomes of drug injection or needle puncture. RESULTS: For all the patients who underwent 4D US-guided core biopsy, the specimens were adequate for making the pathological diagnosis, and specimens were successfully obtained for those patients who underwent 4D US-guided aspiration. The patients treated with 4D US-guided therapeutic drug injection or needle puncture had a good response. No major procedure-related complications occurred. The procedural times were similar to those procedural times with using two-dimensional US. CONCLUSION: Combining the two dimensional and 4D US techniques aids the physician when performing US-guided interventional procedures for the superficial lesions.
Ultrasonography, Interventional/*methods ; Punctures/*methods ; Neoplasms/pathology ; Middle Aged ; Male ; Injections/*methods ; *Imaging, Three-Dimensional ; Humans ; Female ; Aged, 80 and over ; Aged ; Adult ; Adolescent

BACKGROUNDUrsolic acid (UA) is a ubiquitous molecule in the plant kingdom with specific anticancer effects that have been shown in vitro and in vivo. Although UA can inhibit the proliferation of liver cancer cells and induce apoptosis of many types of tumor cells, the molecular mechanism of its anti-hepatoma activity is still not well defined. The objective of this study was to investigate the inhibitory effect and mechanisms of UA on the human hepatoma cell line SMMC-7721.

METHODSAfter treatment with UA, the growth inhibition of SMMC-7721 cells was assessed by MTT assay. Cells were also evaluated by flow cytometric analysis, Wright-Giemasa staining, Hoechst 33258 staining and transmission electron microscope after they were induced by UA. DNA microarray technology was used to investigate the gene expression pattern of SMMC-7721 cells exposed to UA 40 micromol/L. The molecular mechanism of cells death was analyzed by real-time RT-PCR and Western blotting.

RESULTSThe proliferation of SMMC-7721 cells was significantly inhibited in a dose- and time-dependent manner after UA treatment. UA induced cell cycle arrest and apoptosis. The DNA microarray analysis indicated that 64 genes were found to be markedly up- or down-expressed, including GDF15, SOD2, ATF3, and fos. The result of Western blotting showed the apoptotic proteins p53 and Bax were up-regulated while the anti-apoptotic protein Bcl-2 was down-regulated. Real-time RT-PCR confirmed UA could up-regulate the mRNA expressions of GDF15, SOD2, ATF3 and down-regulate the mRAN expression of fos. Meanwhile these effects were partly blocked by pretreatment with the p53 inhibitor Pft-alpha.

CONCLUSIONActivation of the p53 pathway is involved in UA inhibition of SMMC-7721 human hepatocellular carcinoma cell growth and induction of apoptosis.

Apoptosis ; drug effects ; Blotting, Western ; Carcinoma, Hepatocellular ; drug therapy ; metabolism ; Cell Cycle ; drug effects ; Cell Line, Tumor ; Flow Cytometry ; Humans ; Liver Neoplasms ; drug therapy ; metabolism ; Microscopy, Electron, Transmission ; Reverse Transcriptase Polymerase Chain Reaction ; Signal Transduction ; drug effects ; Triterpenes ; therapeutic use ; Tumor Suppressor Protein p53 ; metabolism

OBJECTIVETo introduce a modified surgery for total auriculoplasty and the experience in one hundred and forty-six cases (155 ears).

METHODSThe procedure was a two-stage operation. The first stage involved fabrication and grafting of a costal cartilage framework. A U-shaped skin incision was made on the posterior edge of the lobule and the remnant ear cartilage was removed completely. The area for the insertion of the cartilage framework was undermined. Skin flaps were sutured after insertion of the cartilage framework. The second-stage surgery was usually performed six months after the first-stage operation. The reconstructed auricle was elevated, and a costal cartilage block was fixed to the posterior part of the auricle. A temporoparietal fascia flap was then used to cover the costal cartilage block. Finally, the posterior aspect of the projected auricle was covered with a spit-thickness skin graft.

RESULTSThe incisions healed in one hundred and forty-one patients (150 ears) after the first stage operation. Partial necrosis of the postauricular flap was observed in five cases (5 ears) after the first stage operation, but no exposure or absorption of the cartilage took place. The skin grafts survived in one hundred and thirty-nine cases (147 ears) after the second-stage surgery. Partial necrosis of the skin graft was observed in seven cases (8 ears), but healed after one-week of dressing changes. Ninety-four cases (97 ears) were followed up, but fifty-two cases (58 ears) were lost to follow up. The follow-up at six months to two years showed satisfactory contour and projection of the constructed ears.

CONCLUSIONThis two-stage surgery is simple and ideal for auricloplasty with few complications.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Ear Auricle ; surgery ; Ear, External ; surgery ; Female ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; methods ; Surgical Flaps ; Young Adult

Radiofrequency ablation (RFA) is a thermal ablation technique widely used for the management of benign thyroid nodules. To date, five academic societies in various countries have reported clinical practice guidelines, opinion statements, or recommendations regarding the use of thyroid RFA. However, despite some similarities, there are also differences among the guidelines, and a consensus is required regarding safe and effective treatment in Asian countries. Therefore, a task force was organized by the guideline committee of the Asian Conference on Tumor Ablation with the goal of devising recommendations for the clinical use of thyroid RFA. The recommendations in this article are based on a comprehensive analysis of the current literature and the consensus opinion of the task force members.

The first edition of the guidelines for the use of ultrasound contrast agents was published in 2004, dealing with liver applications. The second edition of the guidelines in 2008 reflected changes in the available contrast agents and updated the guidelines for the liver, as well as implementing some nonliver applications. The third edition of the contrast-enhanced ultrasound (CEUS) guidelines was the joint World Federation for Ultrasound in Medicine and Biology-European Federation of Societies for Ultrasound in Medicine and Biology (WFUMB-EFSUMB) venture in conjunction with other regional US societies such as Asian Federation of Societies for Ultrasound in Medicine and Biology, resulting in a simultaneous duplicate on liver CEUS in the official journals of both WFUMB and EFSUMB in 2013. However, no guidelines were described mainly for Sonazoid due to limited clinical experience only in Japan and Korea. The new proposed consensus statements and recommendations provide general advice on the use of Sonazoid and are intended to create standard protocols for the use and administration of Sonazoid in hepatic and pancreatobiliary applications in Asian patients and to improve patient management.