OBJECTIVE: To evaluate possible variability in chest radiologists' interpretations of the Lung Imaging Reporting and Data System (Lung-RADS) on difficult-to-classify scenarios. MATERIALS AND METHODS: Ten scenarios of difficult-to-classify imaginary lung nodules were prepared as an online survey that targeted Korean Society of Thoracic Radiology members. In each question, a description was provided of the size, consistency, and interval change (new or growing) of a lung nodule observed using annual repeat computed tomography, and the respondent was instructed to choose one answer from five choices: category 2, 3, 4A, or 4B, or “un-categorizable.” Consensus answers were established by members of the Korean Imaging Study Group for Lung Cancer. RESULTS: Of the 420 answers from 42 respondents (excluding multiple submissions), 310 (73.8%) agreed with the consensus answers; eleven (26.2%) respondents agreed with the consensus answers to six or fewer questions. Assigning the imaginary nodules to categories higher than the consensus answer was more frequent (16.0%) than assigning them to lower categories (5.5%), and the agreement rate was below 50% for two scenarios. CONCLUSION: When given difficult-to-classify scenarios, chest radiologists showed large variability in their interpretations of the Lung-RADS categories, with high frequencies of disagreement in some specific scenarios.
Consensus ; Information Systems* ; Lung Neoplasms ; Lung* ; Mass Screening ; Surveys and Questionnaires ; Thorax

Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm that typically presents as a well-defined lobular soft tissue mass commonly arising from the pleura. We report an extremely rare case of an SFT containing air arising from the right major fissure in a 58-year-old woman. Chest CT showed an ovoid air-containing cystic mass with an internal, homogeneously enhancing solid nodule. To our knowledge, this is the first case in the literature. The histopathologic findings were correlated with the radiologic findings, and the mechanism of air retention within the tumor is discussed.
Cysts/*diagnosis ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Middle Aged ; Pleura/*pathology/radiography/radionuclide imaging ; Positron-Emission Tomography/*methods ; Solitary Fibrous Tumor, Pleural/*diagnosis/surgery ; Thoracic Surgery, Video-Assisted ; Tomography, X-Ray Computed/*methods

BACKGROUND: Brain-death donation became legal in Korea after "The law of organ transplantation" was established at 2000. Therefore, in this study, we report on the clinical analysis of brain-death donors at Ajou University Hospital since the Korean Network for Organ Sharing (KONOS) was launched in the year 2000. METHODS: We reviewed 90 brain-death donors who were managed at Ajou University Hospital from 2000 to 2009 and we retrospectively analyzed the clinical characteristics. RESULTS: The number of brain-death donors was 29 from 2000 to 2005 and 61 from 2006 to 2009, and this showed an increasing tendency. Forty-three brain-death donors (47.8%) were detected at our hospital and 47 donors (52.2%) were from referring hospitals. The percent of brain-death donors at our hospital was 31.0% from 2000 to 2005 and 55.7% from 2006 to 2009 (P=0.042). The mean age of the brain-death donors was 36.3 years (range: 8 months~70 years) and the fifth decade was the most common (25.6%). The gender ratio showed significant difference (P=0.001); there were 60 male donors (66.7%) and there were 30 females (33.3%). The most common cause of brain-death was cerebrovascular disease/stroke (48 donors, 53.3%) followed by traffic accident (15 donors, 16.7%). The most common blood type was Rh+ O (35.6%). The mean number of harvested organs was 3.9 and one donor (1.1%) had the largest number of harvested organs (9) (liver, 2 kidneys, pancreas, heart, lung, 2 corneas, tissue). The mean time to procurement was 3.6 days (range: 2~24 days). CONCLUSIONS: We recommend active discovery and evaluation of brain-death donors in all the hospitals including the hospital organ procurement organization (HOPO).
Accidents, Traffic ; Brain ; Brain Death ; Cornea ; Female ; Heart ; Humans ; Jurisprudence ; Kidney ; Korea ; Lung ; Male ; Pancreas ; Retrospective Studies ; Tissue and Organ Procurement ; Tissue Donors

OBJECTIVE: To describe the high-resolution CT (HRCT) findings of re-expansion pulmonary edema (REPE) following a thoracentesis for a spontaneous pneumothorax. MATERIALS AND METHODS: HRCT scans from 43 patients who developed REPE immediately after a thoracentesis for treatment of pneumothorax were retrospectively analyzed. The study group consisted of 41 men and two women with a mean age of 34 years. The average time interval between insertion of the drainage tube and HRCT was 8.5 hours (range, 1-24 hours). The patterns and distribution of the lung lesions were analyzed and were assigned one of the following classifications: consolidation, ground-glass opacity (GGO), intralobular interstitial thickening, interlobular septal thickening, thickening of bronchovascular bundles, and nodules. The presence of pleural effusion and contralateral lung involvement was also assessed. RESULTS: Patchy areas of GGO were observed in all 43 patients examined. Consolidation was noted in 22 patients (51%). The geographic distribution of GGO and consolidation was noted in 25 patients (58%). Interlobular septal thickening and intralobular interstitial thickening was noted in 28 patients (65%), respectively. Bronchovascular bundle thickening was seen in 13 patients (30%), whereas ill-defined centrilobular GGO nodules were observed in five patients (12%). The lesions were predominantly peripheral in 38 patients (88%). Of these lesions, gravity-dependent distribution was noted in 23 cases (53%). Bilateral lung involvement was noted in four patients (9%), and a small amount of pleural effusion was seen in seven patients (16%). CONCLUSION: The HRCT findings of REPE were peripheral patchy areas of GGO that were frequently combined with consolidation as well as interlobular septal and intralobular interstitial thickening.
Adolescent ; Adult ; Aged ; Drainage ; Female ; Humans ; Lung/radiography ; Male ; Middle Aged ; Observer Variation ; Pneumothorax/complications/therapy ; Pulmonary Edema/complications/*radiography ; Retrospective Studies ; Tomography, X-Ray Computed/*methods ; Young Adult

OBJECTIVE: To determine histopathologic findings related to the indeterminate or inadequate result of fine-needle aspiration biopsy (FNAB) in papillary thyroid carcinomas (PTCs) and to correlate histopathological findings with ultrasonographic features of tumors. Materials and METHODS: We retrospectively reviewed the medical records of FNAB, histopathologic characteristics, and sonographic findings of the solid portion of 95 PTCs in 95 patients. All cases were pathologically confirmed by surgery. Histopathologic characteristics were analyzed for tumor distribution, microcystic changes, fibrosis, and tumor component. We assumed several histopathologic conditions to be the cause of indeterminate or inadequate results of FNAB, including: 1) an uneven tumor distribution, 2) > 30% microcystic changes, 3) > 30% fibrosis, and 4) < 30% tumor component. Ultrasonographic findings of each PTC were evaluated for echotexture (homogeneous or heterogeneous), echogenicity (markedly hypoechoic, hypoechoic, isoechoic, or hyperechoic), and volume of the nodule. We correlated histopathologic characteristics of the PTC with results of the FNAB and ultrasonographic findings. RESULTS: From 95 FNABs, 71 cases (74%) were confirmed with malignancy or suspicious malignancy (PTCs), 21 (22%) had indeterminate results (atypical cells), and three (4%) were negative for malignancy. None of the assumed variables influenced the diagnostic accuracy of FNAB. Tumor distribution and fibrosis were statistically correlated with ultrasonographic findings of the PTCs (p < 0.05). Uneven tumor distribution was related with small tumor volume, and fibrosis over 30% was correlated with homogeneous echotexture, markedly hypoechoic and hypoechoic echogenicity, and small tumor volume (p < 0.05). CONCLUSION: No histopathologic component was found to correlate with improper results of FNAB in PTCs. In contrast, two histopathologic characteristics, uneven distribution and fibrosis, were correlated with ultrasonographic findings.
Adult ; Aged ; Biopsy, Fine-Needle/methods ; Carcinoma, Papillary/*pathology/*ultrasonography ; Female ; Humans ; Male ; Middle Aged ; Reproducibility of Results ; Retrospective Studies ; Thyroid Gland/pathology/ultrasonography ; Thyroid Neoplasms/*pathology/*ultrasonography ; Young Adult

There are several respiratory diseases that show chronic granulomatous inflammation for the histologic finding. Among them, sarcoidosis and tuberculosis are not easy to differentiate when the clinical and radiological features present similar patterns. The increasing incidence of nontuberculous mycobacteria pulmonary disease is making it more difficult for clinicians to arrive at a proper diagnosis. A 69 year old male patient visited our hospital with chronic cough as his chief compliant. His radiologic findings were multiple enlarged mediastinal lymphadenpathies with innumerable micronodules and multiple patch infiltrations. The spleen biopsy finding showed chronic granulomatous inflammation, and Mycobacterium avium was identified on the bronchoscopic culture. Because of these findings, we treated him with drugs for nontuberculous mycobacteria disease other than sarcoidosis. However, during the treatment, his symptoms and radiological features became aggravated. Thus, we reviewed the radiologic and pathologic findings and decided to treat him with steroid, which relieved his symptoms and improved the radiologic findings. We report here on a case of sarcoidosis that was initially misdiagnosed as nontuberculous mycobacteria pulmonary disease.
Biopsy ; Cough ; Humans ; Incidence ; Inflammation ; Lung Diseases ; Male ; Mycobacterium avium ; Nontuberculous Mycobacteria ; Sarcoidosis ; Spleen ; Tuberculosis

Malignancies in congenital cystic adenomatoid malformations (CCAMs) of the lung are rare. We report a 41-year-old male patient with a pulmonary cystic lesion suspicious for CCAM, unrecognized until the patient was 40 years of age, and which subsequently became more consolidated during the interval between initial presentation and surgery. Microscopic examination of the resected specimen revealed features of type 1 CCAM with a mucinous adenocarcinoma, metastatic to the mediastinal lymph nodes. This case illustrates the importance of prompt surgical resection for all suspected CCAMs, especially those discovered in adulthood.
Adult ; Male ; Female ; Humans ; Adenocarcinoma ; Neoplasm Metastasis

BACKGROUND: Caspase-3 is a cysteine protease that plays a major role in the process of apoptotic cell death. The dysregulated expression of c-myc contributes to the tumorigenesis in a variety of human cancers. The aim of this study was to investigate the expressions of caspase-3 and c-myc and their significances as prognosis markers in patients with completely resected non-small cell lung cancer (NSCLC). MATERIAL AND METHOD: A total 130 consecutive patients who had undergone complete resection without pre-operative radio-therapy or chemotherapy between May 1996 and December 2003 for NSCLC were retrospectively reviewed. The median follow-up period of the patients was 50 months (range: 3~128 months). The expressions of caspase-3 and c-myc were immunohistochemically examined, and these were correlated with the clinico-pathologic data. RESULT: The prevalence of caspase-3 and c-myc expressions in the patients was 68% (88/130) and 59% (77/130), respectively. Significant association was found between the frequency of the expressions of caspase-3 and c-myc (p=0.025). The caspase-3 and c-myc expressions were not significantly associated with the prognosis in all the patients. However, according to stages, a positive caspase-3 expression was significantly correlated with a favorable prognosis for patients with stage IIIa disease (median survival period: 35 months vs. 10 months, p=0.021). Multivariate analysis showed the pathologic stage to be significantly correlated with a good prognosis in all the patients (p=0.024), and with a positive caspase-3 expression, well differentiated tumor and negative neuronal invasion in the patients with stage IIIa disease (p=0.005, p=0.003, p=0.004, respectively). CONCLUSION: Caspase-3 and c-myc were frequently expressed in NSCLC, suggesting its possible involvement in tumor development. The caspase-3 expression, as determined with performing immunohistochemical staining, may be a favorable prognostic indicator in patients with completely resected NSCLC of an advanced stage (IIIa).
Carcinoma, Non-Small-Cell Lung ; Caspase 3 ; Cell Death ; Cell Transformation, Neoplastic ; Cysteine Proteases ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Neurons ; Prevalence ; Prognosis ; Retrospective Studies

BACKGROUND: Gefitinib is an EGFR tyrosine kinase inhibitor that has shown dramatic effectiveness in a subset of non-small cell lung cancer (NSCLC) patients. We evaluated the response rate to gefitinib, and the significance of the EGFR and HER2/neu status as predictive markers of the tumor response. METHODS: The EGFR and HER2/neu protein expressions, as determined by immunohistochemistry (IHC) and gene amplification via chromogenic in situ hybridization (CISH), were analyzed in biopsy specimens from 46 patients with advanced NSCLC. After their failure with the first-line treatment, all the patients had received gefitinib treatment. RESULTS: A partial response (PR) was achieved in 8 patients (17.4%). An EGFR overexpression was detected in 80.4% (37/46) of the tumors, and this was observed exclusively in patients with a PR (100% vs 75.3%, respectively; p=0.076). EGFR gene amplification was present in 47.8% of the tumors (22/46). HER2/neu was overexpressed in 13%(6/46) and it was amplified in 17% (7/46). The overall survival was prolonged in the female patients (p=0.007), and in patients with T1 and T2 disease (p=0.039), adenocarcinoma (p=0.010), a PR (p=0.022), an EGFR IHC+ status (p=0.033), an EGFR IHC+/CISH+ status (p=0.010), or an EGFR+/HER2/neu+ status (p=0.030). On multivariate analysis, gender, T disease and EGFR IHC/CISH remained the significant predictors of survival. CONCLUSIONS: Gefitinib showed a modest effect for the patients with chemotherapy-refractory advanced NSCLC. A combination of EGFR IHC and CISH might be important for identifying those patients who are most likely to benefit from gefitinib therapy.
Female ; Humans ; Adenocarcinoma ; Biopsy ; Lung Neoplasms

A patient with adenocarcinoma of the lung was treated sequentially using two kinds of EGFR tyrosine kinase inhibitors, gefitinib and erlotinib. The patient was a 73-year-old female who received gefitinib as a second line treatment, which resulted in a partial response with response duration of 6 months. After progression of the disease, the patient received erlotinib, which resulted in partial response again with response duration of 11.5 months. This observation suggests that treatment with erlotinib may be effective in patients who develop progressive disease after a primary treatment with gefitinib following an initial response.
Adenocarcinoma* ; Aged ; Female ; Humans ; Lung Neoplasms ; Lung* ; Protein-Tyrosine Kinases ; Erlotinib Hydrochloride