OBJECTIVE: To evaluate the interpretive performance and inter-observer agreement on digital mammographs among radiologists and to investigate whether radiologist characteristics affect performance and agreement. MATERIALS AND METHODS: The test sets consisted of full-field digital mammograms and contained 12 cancer cases among 1000 total cases. Twelve radiologists independently interpreted all mammograms. Performance indicators included the recall rate, cancer detection rate (CDR), positive predictive value (PPV), sensitivity, specificity, false positive rate (FPR), and area under the receiver operating characteristic curve (AUC). Inter-radiologist agreement was measured. The reporting radiologist characteristics included number of years of experience interpreting mammography, fellowship training in breast imaging, and annual volume of mammography interpretation. RESULTS: The mean and range of interpretive performance were as follows: recall rate, 7.5% (3.3–10.2%); CDR, 10.6 (8.0–12.0 per 1000 examinations); PPV, 15.9% (8.8–33.3%); sensitivity, 88.2% (66.7–100%); specificity, 93.5% (90.6–97.8%); FPR, 6.5% (2.2–9.4%); and AUC, 0.93 (0.82–0.99). Radiologists who annually interpreted more than 3000 screening mammograms tended to exhibit higher CDRs and sensitivities than those who interpreted fewer than 3000 mammograms (p = 0.064). The inter-radiologist agreement showed a percent agreement of 77.2–88.8% and a kappa value of 0.27–0.34. Radiologist characteristics did not affect agreement. CONCLUSION: The interpretative performance of the radiologists fulfilled the mammography screening goal of the American College of Radiology, although there was inter-observer variability. Radiologists who interpreted more than 3000 screening mammograms annually tended to perform better than radiologists who did not.
Area Under Curve ; Breast ; Fellowships and Scholarships ; Mammography ; Mass Screening ; Medical Audit ; Observer Variation ; ROC Curve ; Sensitivity and Specificity

PURPOSE: The purpose of this study was to record and evaluate interobserver agreement as quality control for the modified categorization of screening breast ultrasound developed by the Alliance for Breast Cancer Screening in Korea (ABCS-K) for the Mammography and Ultrasonography Study for Breast Cancer Screening Effectiveness (MUST-BE) trial. METHODS: Eight breast radiologists with 4-16 years of experience participated in 2 rounds of quality control testing for the MUST-BE trial. Two investigators randomly selected 125 and 100 cases of breast lesions with different ratios of malignant and benign lesions. Two versions of the modified categorization were tested. The initially modified classification was developed after the first quality control workshop, and the re-modified classification was developed after the second workshop. The re-modified categorization established by ABCS-K added size criteria and the anterior-posterior ratio compared with the initially modified classification. After a brief lecture on the modified categorization system prior to each quality control test, the eight radiologists independently categorized the lesions using the modified categorization. Interobserver agreement was measured using kappa statistics. RESULTS: The overall kappa values for the modified categorizations indicated moderate to substantial degrees of agreement (initially modified categorization and re-modified categorization: κ=0.52 and κ=0.63, respectively). The kappa values for the subcategories of category 4 were 0.37 (95% confidence interval [CI], 0.24 to 0.52) and 0.39 (95% CI, 0.31 to 0.49), respectively. The overall kappa values for both the initially modified categorization and the re-modified categorization indicated a substantial degree of agreement when dichotomizing the interpretation as benign or suspicious. CONCLUSION: The preliminary results demonstrated acceptable interobserver agreement for the modified categorization.
Breast Neoplasms ; Breast ; Classification ; Education ; Humans ; Korea ; Mammography ; Mass Screening ; Observer Variation ; Quality Control ; Research Personnel ; Ultrasonography

OBJECTIVE: To investigate the effects of different types of mammography equipment on screening outcomes by comparing the performance of film-screen mammography (FSM), computed radiography mammography (CRM), and digital mammography (DM).MATERIALS AND METHODS: We retrospectively enrolled 128756 sets of mammograms from 10 hospitals participating in the Alliance for Breast Cancer Screening in Korea between 2005 and 2010. We compared the diagnostic accuracy of the types of mammography equipment by analyzing the area under the receiver operating characteristic curve (AUC) with a 95% confidence interval (CI); performance indicators, including recall rate, cancer detection rate (CDR), positive predictive value₁ (PPV₁), sensitivity, specificity, and interval cancer rate (ICR); and the types of breast cancer pathology.RESULTS: The AUCs were 0.898 (95% CI, 0.878–0.919) in DM, 0.860 (0.815–0.905) in FSM, and 0.866 (0.828–0.903) in CRM (p = 0.150). DM showed better performance than FSM and CRM in terms of the recall rate (14.8 vs. 24.8 and 19.8%), CDR (3.4 vs. 2.2 and 2.1 per 1000 examinations), PPV₁ (2.3 vs. 0.9 and 1.1%), and specificity (85.5 vs. 75.3 and 80.3%) (p < 0.001) but not in terms of sensitivity (86.3 vs. 87.4 and 86.3%) and ICR (0.6 vs. 0.4 and 0.4). The proportions of carcinoma in situ (CIS) were 27.5%, 13.6%, and 11.8% for DM, CRM, and FSM, respectively (p = 0.003).CONCLUSION: In comparison to FSM and CRM, DM showed better performance in terms of the recall rate, CDR, PPV₁, and specificity, although the AUCs were similar, and more CISs were detected using DM. The application of DM may help to improve the quality of mammography screenings. However, the overdiagnosis issue of CIS using DM should be evaluated.
Area Under Curve ; Breast Neoplasms ; Breast ; Carcinoma in Situ ; Korea ; Mammography ; Mass Screening ; Medical Overuse ; Pathology ; Radiography ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity

BACKGROUND: We evaluated the associations between 25-hydroxyvitamin D (25(OH)D) concentrations in serum and insulin resistance in the healthy Korean population. METHODS: We conducted this cross-sectional analysis in 1,807 healthy Korean people (628 men and 1,179 women) aged 30 to 64 years in the Cardiovascular and Metabolic Disease Etiologic Research Center study. All participants were assessed for 25(OH)D, fasting glucose, and insulin levels, and completed a health examination and lifestyle questionnaire according to standard procedures. Insulin resistance was defined as the homeostasis model assessment insulin resistance higher than the 75 percentile. RESULTS: Compared to those in the highest tertile (≥14.3 ng/mL), the odds ratio (OR) for insulin resistance was 1.37 (95% confidence interval [CI], 1.01 to 1.86) for the 1st tertile (<9.7 ng/mL) and 1.19 (95% CI, 0.08 to 1.62) for the 2nd tertile (9.7 to 14.3 ng/mL) after adjusting for age, gender, waist circumference, alcohol consumption, smoking status, physical exercise, season, and cohort. After stratification of the subjects by adiposity, these associations remained only in non-obese subjects (lowest tertile vs. highest tertile, multivariable OR, 1.64; 95% CI, 1.05 to 2.56). CONCLUSION: Serum 25(OH)D has an independent inverse association with insulin resistance in the healthy, non-obese Korean population, even among people with vitamin D insufficiency.
Adiposity ; Alcohol Drinking ; Cohort Studies ; Cross-Sectional Studies ; Exercise ; Fasting ; Glucose ; Homeostasis ; Humans ; Insulin Resistance* ; Insulin* ; Life Style ; Male ; Metabolic Diseases ; Obesity ; Odds Ratio ; Seasons ; Smoke ; Smoking ; Vitamin D ; Waist Circumference

Hyperglycemic hyperosmolar state (HHS) is an acute complication mostly occurring in elderly type 2 diabetes mellitus (DM). Thyrotoxicosis causes dramatic increase of glycogen degradation and/or gluconeogenesis and enhances breakdown of triglyc-erides. Thus, in general, it augments glucose intolerance in diabetic patients. A 23-yr-old female patient with Graves' disease and type 2 DM, complying with methimazole and insulin injection, had symptoms of nausea, polyuria and generalized weakness. Her serum glucose and osmolarity were 32.7 mM/L, and 321 mosm/kg, respectively. Thyroid function tests revealed that she had more aggravated hyperthyroid status; 0.01 mU/L TSH and 2.78 pM/L free T3 (reference range, 0.17-4.05, 0.31-0.62, respectively) than when she was discharged two weeks before (0.12 mU/L TSH and 1.41 pM/L free T3). Being diagnosed as HHS and refractory Graves' hyperthyroidism, she was treated successfully with intravenous fluids, insulin and high doses of methimazole (90 mg daily). Here, we described the case of a woman with Graves' disease and type 2 DM developing to HHS.
Thyroid Function Tests ; Methimazole/therapeutic use ; Insulin/therapeutic use ; Hyperthyroidism/*complications/therapy ; Hyperglycemic Hyperosmolar Nonketotic Coma/*etiology ; Humans ; Graves Disease/*complications ; Fluid Therapy ; Female ; Diabetes Mellitus, Type 2/*complications ; Adult

Primary hypothyroidism and type 2 diabetes are both typically associated with the increased level of triglycerides. To date, there have been only a few case reports of type 2 diabetes patients with both type V hyperlipoproteinemia and eruptive xanthomas, but there have been no reports of hypothyroidism patients associated with eruptive xanthomas. We report here on a case of a 48-yr old female patient who was diagnosed with type 2 diabetes and primary hypothyroidism associated with both type V hyperlipoproteinemia and eruptive xanthomas. We found rouleaux formation of RBCs in peripheral blood smear, elevated TSH, and low free T4 level, and dyslipidemia (total cholesterol 18.1 mM/L, triglyceride 61.64 mM/L, HDL 3.0 mM/L, and LDL 2.54 mM/L). She has taken fenofibrate, levothyroxine, and oral hypoglycemic agent for 4 months. After treatment, both TSH level and lipid concentration returned to normal range, and her yellowish skin nodules have also disappeared.
Antilipemic Agents/therapeutic use ; Diabetes Mellitus, Type 2/blood/*complications/drug therapy ; Erythrocyte Aggregation ; Female ; Humans ; Hyperlipidemia/blood ; Hyperlipoproteinemia Type V/blood/*complications/drug therapy ; Hypoglycemic Agents/therapeutic use ; Hypothyroidism/blood/*complications/drug therapy ; Middle Aged ; Procetofen/therapeutic use ; Research Support, Non-U.S. Gov't ; Skin Diseases/blood/complications/drug therapy ; Thyrotropin/blood/therapeutic use ; Thyroxine/blood ; Treatment Outcome ; Xanthomatosis/blood/*complications/drug therapy

Granular cell tumors involving the esophagus are rare tumors. Since Abrikossoff first reported five cases of granular tumor of the tongue in 1926, fewer than 200 cases of esophageal granular cell tumors have been reported in the world. The granular cell tumors usually were seen in tongue, skin & breast. it has rarely been noted in the esophagus. The treatment of this tumor was not established well. Therefore, we report a case of granular cell tumor of the low esophagus, which was resected by polypectomy following 'O'-band ligation. This 56-year-old male patient was transferred to our hospital because of abnormal endoscopic finding on the esophagus at local clinic. There was esophageal polypoid lesion on the low esophagus. After polypectomy, the lesion was revealed as granular cell tumor in histopathologic examination.
Breast ; Endoscopes ; Esophagus ; Granular Cell Tumor* ; Humans ; Ligation* ; Male ; Middle Aged ; Skin ; Tongue

Idiopathic Myelofibrosis (IMF), a clonal disorder of a multipotent hemtopoietic progenitor cell of unknown etiology, is characterized by massive splenomegaly, leukoerythroblastic blood changes, and bone marrow fibrosis. Portal hypertension occurs in approximately 10% of patients with IMF. Alsom there mey be bleeding from esophageal varices. A 59-year-old woman was admitted with intermittent abdominal distension and melena. An esophagogastroduodenoscopy revealed extensive esophageal varices with red colored signs, and subsequently esophageal variceal ligation was performed. Marked splenomegaly and ascites was observed through abdominal US and MRI scan. Bone marrow biopsy revealed an increase in reticulin and fibrosis. Extramedullary hematopoiesis and sinusoidal change were observed in the liver biopsy specimen. This case of IMF causing an esophageal variceal hemorrhage is herein reported.
Ascites ; Biopsy ; Bone Marrow ; Endoscopy, Digestive System ; Esophageal and Gastric Varices ; Female ; Fibrosis ; Hematopoiesis, Extramedullary ; Hemorrhage* ; Humans ; Hypertension, Portal ; Ligation ; Liver ; Magnetic Resonance Imaging ; Melena ; Middle Aged ; Primary Myelofibrosis* ; Reticulin ; Splenomegaly ; Stem Cells

Human colon epithelial cells secrete an array of proinflammatory cytokines that includes IL-8, MCP-1, GM-CSF, TNF alpha and IL-6. This response may serve to attract neutrophils and macrophags to the site of infection. In addition to IL-8 and MCP-1, the chemokine family contains other members, which, alone or in combination, can recruit and/or activate inflammatory and lymphoid cells. In this study, we asked whether colon epithelial cells express a broader array of chemokines than previously described. The colon epithelial cell line, Caco-2, was stimulated for 3h with IL-1 alpha, or was infected with Salmonella dublin. RNA was extracted and chemokine mRNA levels were determined by quantitative reverse transcription-PCR using internal RNA standards. Ex pression of GRO alpha, GRO beta, GRO gamma and IP-10 increased by bacterial infection or IL-l alpha stimulation. These data strongly support the notion that epithelal cells are an important and integral component of the host's natural immune system.
Bacterial Infections ; Chemokines ; Colon* ; Cytokines ; Epithelial Cells* ; Granulocyte-Macrophage Colony-Stimulating Factor ; Humans* ; Immune System ; Interleukin-1alpha ; Interleukin-6 ; Interleukin-8 ; Lymphocytes ; Neutrophils ; RNA ; RNA, Messenger ; Salmonella

PURPOSE: Chemokines are potent regulators of the host inflammatory or immune responses. Mucosal synthesis of chemokines may be important in the pathogenesis of mucosal inflammation in ulcerative colitis (UC). We performed this study to investigate the expression of C-X-C chemokine genes in UC. METHODS: Mucosal tissues were obtained from six normal controls and six UC patients by endoscopic biopsies. In patients with UC, mucosal tissues were separately obtained from both involved and uninvolved regions. RNA was extracted and mRNA levels of five C-X-C chemokines were determined by quantitative reverse transcription-PCR using internal RNA standards. RESULTS: Mucosal mRNA levels of all chemokines tested increased in the involved region of UC compared with the uninvolved region of UC or normal controls. CONCLUSION: Our data suggest that mucosal expression of C-X-C chemokines contributes to the pathogenesis of UC
Biopsy ; Chemokines ; Chemokines, CXC ; Colitis, Ulcerative* ; Colon* ; Humans ; Inflammation ; Mucous Membrane* ; RNA ; RNA, Messenger ; Ulcer*