Objective: Our goal was to review outcomes of patients with heterotopic pregnancies who under went surgical treatment. Methods: From January 1, 2005 to December 31, 2021, 27 women with heterotopic pregnancies who had undergone surgical treatment were enrolled. We investigated pregnancy outcomes based on clinical records and follow-up telephone interviews. Three of the 27 patients were excluded because we were unable to contact them. Results: Of the 24 patients included in the study, 17 underwent salpingectomies for tubal pregnan cies, 5 underwent wedge resections for cornual pregnancies, and 1 underwent a unilateral salpingooophorectomy for ovarian pregnancy. One patient with a suspected heterotopic cervical pregnancy had undergone extraction with forceps and curettage under abdominal ultrasound guidance. Three patients had spontaneous abortions after treatment for heterotopic pregnancies (2 tubal pregnancies, one cervical pregnancy). Twenty-one of 24 patients had heterotopic pregnancies that occurred after assisted reproductive technology. Three cases were heterotopic pregnancies that occurred without reproductive interventions. Among 24 patients who underwent surgical treatment, 18 patients (75.0%) had full-term deliveries. Conclusion There were no hospitalizations due to preterm labor, and 21 deliveries (87.5%) were either late preterm or full-term. There were no fetal abnormalities or maternal complications. Although the development of assisted reproductive technologies has increased the incidence of heterotopic pregnancy, the outcomes of heterotopic pregnancies are generally good.

Objective: Our goal was to review outcomes of patients with heterotopic pregnancies who under went surgical treatment. Methods: From January 1, 2005 to December 31, 2021, 27 women with heterotopic pregnancies who had undergone surgical treatment were enrolled. We investigated pregnancy outcomes based on clinical records and follow-up telephone interviews. Three of the 27 patients were excluded because we were unable to contact them. Results: Of the 24 patients included in the study, 17 underwent salpingectomies for tubal pregnan cies, 5 underwent wedge resections for cornual pregnancies, and 1 underwent a unilateral salpingooophorectomy for ovarian pregnancy. One patient with a suspected heterotopic cervical pregnancy had undergone extraction with forceps and curettage under abdominal ultrasound guidance. Three patients had spontaneous abortions after treatment for heterotopic pregnancies (2 tubal pregnancies, one cervical pregnancy). Twenty-one of 24 patients had heterotopic pregnancies that occurred after assisted reproductive technology. Three cases were heterotopic pregnancies that occurred without reproductive interventions. Among 24 patients who underwent surgical treatment, 18 patients (75.0%) had full-term deliveries. Conclusion There were no hospitalizations due to preterm labor, and 21 deliveries (87.5%) were either late preterm or full-term. There were no fetal abnormalities or maternal complications. Although the development of assisted reproductive technologies has increased the incidence of heterotopic pregnancy, the outcomes of heterotopic pregnancies are generally good.

Objective: Our goal was to review outcomes of patients with heterotopic pregnancies who under went surgical treatment. Methods: From January 1, 2005 to December 31, 2021, 27 women with heterotopic pregnancies who had undergone surgical treatment were enrolled. We investigated pregnancy outcomes based on clinical records and follow-up telephone interviews. Three of the 27 patients were excluded because we were unable to contact them. Results: Of the 24 patients included in the study, 17 underwent salpingectomies for tubal pregnan cies, 5 underwent wedge resections for cornual pregnancies, and 1 underwent a unilateral salpingooophorectomy for ovarian pregnancy. One patient with a suspected heterotopic cervical pregnancy had undergone extraction with forceps and curettage under abdominal ultrasound guidance. Three patients had spontaneous abortions after treatment for heterotopic pregnancies (2 tubal pregnancies, one cervical pregnancy). Twenty-one of 24 patients had heterotopic pregnancies that occurred after assisted reproductive technology. Three cases were heterotopic pregnancies that occurred without reproductive interventions. Among 24 patients who underwent surgical treatment, 18 patients (75.0%) had full-term deliveries. Conclusion There were no hospitalizations due to preterm labor, and 21 deliveries (87.5%) were either late preterm or full-term. There were no fetal abnormalities or maternal complications. Although the development of assisted reproductive technologies has increased the incidence of heterotopic pregnancy, the outcomes of heterotopic pregnancies are generally good.

Objective: Our goal was to review outcomes of patients with heterotopic pregnancies who under went surgical treatment. Methods: From January 1, 2005 to December 31, 2021, 27 women with heterotopic pregnancies who had undergone surgical treatment were enrolled. We investigated pregnancy outcomes based on clinical records and follow-up telephone interviews. Three of the 27 patients were excluded because we were unable to contact them. Results: Of the 24 patients included in the study, 17 underwent salpingectomies for tubal pregnan cies, 5 underwent wedge resections for cornual pregnancies, and 1 underwent a unilateral salpingooophorectomy for ovarian pregnancy. One patient with a suspected heterotopic cervical pregnancy had undergone extraction with forceps and curettage under abdominal ultrasound guidance. Three patients had spontaneous abortions after treatment for heterotopic pregnancies (2 tubal pregnancies, one cervical pregnancy). Twenty-one of 24 patients had heterotopic pregnancies that occurred after assisted reproductive technology. Three cases were heterotopic pregnancies that occurred without reproductive interventions. Among 24 patients who underwent surgical treatment, 18 patients (75.0%) had full-term deliveries. Conclusion There were no hospitalizations due to preterm labor, and 21 deliveries (87.5%) were either late preterm or full-term. There were no fetal abnormalities or maternal complications. Although the development of assisted reproductive technologies has increased the incidence of heterotopic pregnancy, the outcomes of heterotopic pregnancies are generally good.

Objective: Our goal was to review outcomes of patients with heterotopic pregnancies who under went surgical treatment. Methods: From January 1, 2005 to December 31, 2021, 27 women with heterotopic pregnancies who had undergone surgical treatment were enrolled. We investigated pregnancy outcomes based on clinical records and follow-up telephone interviews. Three of the 27 patients were excluded because we were unable to contact them. Results: Of the 24 patients included in the study, 17 underwent salpingectomies for tubal pregnan cies, 5 underwent wedge resections for cornual pregnancies, and 1 underwent a unilateral salpingooophorectomy for ovarian pregnancy. One patient with a suspected heterotopic cervical pregnancy had undergone extraction with forceps and curettage under abdominal ultrasound guidance. Three patients had spontaneous abortions after treatment for heterotopic pregnancies (2 tubal pregnancies, one cervical pregnancy). Twenty-one of 24 patients had heterotopic pregnancies that occurred after assisted reproductive technology. Three cases were heterotopic pregnancies that occurred without reproductive interventions. Among 24 patients who underwent surgical treatment, 18 patients (75.0%) had full-term deliveries. Conclusion There were no hospitalizations due to preterm labor, and 21 deliveries (87.5%) were either late preterm or full-term. There were no fetal abnormalities or maternal complications. Although the development of assisted reproductive technologies has increased the incidence of heterotopic pregnancy, the outcomes of heterotopic pregnancies are generally good.

Purpose: Programmed death-1/programmed death-ligand 1 (PD-L1) inhibitors have shown efficacy in metastatic esophageal squamous cell carcinoma (ESCC) therapy. However, data is still limited regarding neoadjuvant immunotherapy for operable ESCC. Materials and Methods: Patients with clinical stage T2 or T3 and N0 ESCC received three cycles of nivolumab therapy every two weeks before surgical resection. The primary endpoint is major pathologic responses (MPR) rate (≤ 10% of residual viable tumor [RVT]). Results: Total 20 patients completed the planned nivolumab therapy. Among them, 17 patients underwent surgery as protocol, showing MPR in two patients (MPR rate, 11.8%), including one pathologic complete response, on conventional pathologic response evaluation. Pathologic response was re-evaluated using the immune-related pathologic response criteria based on immune-related RVT (irRVT). Three patients were classified as immunologic major pathologic response (iMPR; ≤ 10% irRVT, iMPR rate: 17.6%), five as pathologic partial response (> 10% and < 90% irRVT), and nine as pathologic nonresponse (≥ 90% irRVT). The combined positive score (CPS) for PD-L1 in the baseline samples was predictable for iMPR, with the probability as 37.5% in CPS ≥ 10 (3/8) and 0% in CPS < 10 (0/9). Conclusion Although the efficacy of neoadjuvant nivolumab therapy was modest in unselected ESCC patients, further researches on neoadjuvant immunotherapy are necessary in patients with PD-L1 expressed ESCC.

Purpose: In the modern era of precision medicine, next-generation sequencing (NGS) is employed for a variety of clinical purposes. The aim of this study was to investigate the trends and clinical characteristics of NGS testing in South Korea. Materials and Methods: This nationwide, population-based, retrospective cohort study examined National Health Insurance Service claims data from 2017 to 2021 for NGS and from 2008 to 2021 for gene-targeted anticancer drugs. Results: Among the total 98,748 claims, there were 51,407 (52.1%) solid cancer panels, 30,173 (30.5%) hereditary disease panels, and 17,168 (17.4%) hematolymphoid cancer panels. The number of annual claims showed a persistent upward trend, exhibiting a 5.4-fold increase, from 5,436 in 2017 to 29,557 in 2021. In the solid cancer panel, colorectal cancer was the most common (19.2%), followed by lung cancer (18.8%). The annual claims for targeted cancer drugs have increased 25.7-fold, from 3,932 in 2008 to 101,211 in 2020. Drugs for the treatment of lung cancer accounted for 488,819 (71.9%) claims. The number of patients who received non-hereditary NGS testing has substantially increased, and among them, the count of patients prescribed targeted anticancer drugs consistently rose from 508 (13.9%) in 2017 to 2,245 (12.3%) in 2020. Conclusion This study highlights the rising nationwide demand for comprehensive genetic testing for disease diagnosis and treatment following NGS reimbursement by the National Health Insurance in South Korea, in addition to the need for greater utilization of targeted anticancer drugs.

Purpose: Recently, we developed allele-discriminating priming system (ADPS) technology. This method increases the sensitivity of conventional quantitative polymerase chain reaction up to 100 folds, with limit of detection, 0.01%, with reinforced specificity. This prospective study aimed to develop and validate the accuracy of ADPS epidermal growth factor receptor (EGFR) Mutation Test Kit using clinical specimens. Materials and Methods: In total 189 formalin-fixed paraffin-embedded tumor tissues resected from patients with non–small cell lung cancer were used to perform a comparative evaluation of the ADPS EGFR Mutation Test Kit versus the cobas EGFR Mutation Test v2, which is the current gold standard. When the two methods had inconsistent results, next-generation sequencing–based CancerSCAN was utilized as a referee. Results: The overall agreement of the two methods was 97.4% (93.9%-99.1%); the positive percent agreement, 95.0% (88.7%-98.4%); and the negative percent agreement, 100.0% (95.9%-100.0%). EGFR mutations were detected at a frequency of 50.3% using the ADPS EGFR Mutation Test Kit and 52.9% using the cobas EGFR Mutation Test v2. There were 10 discrepant mutation calls between the two methods. CancerSCAN reproduced eight ADPS results. In two cases, mutant allele fraction was ultra-low at 0.02% and 0.06%, which are significantly below the limit of detection of the cobas assay and CancerSCAN. Based on the EGFR genotyping by ADPS, the treatment options could be switched in five patients. Conclusion The highly sensitive and specific ADPS EGFR Mutation Test Kit would be useful in detecting the patients who have lung cancer with EGFR mutation, and can benefit from the EGFR targeted therapy.

Objective: To investigate whether reader training improves the performance and agreement of radiologists in interpreting unenhanced breast magnetic resonance imaging (MRI) scans using diffusion-weighted imaging (DWI). Materials and Methods: A study of 96 breasts (35 cancers, 24 benign, and 37 negative) in 48 asymptomatic women was performed between June 2019 and October 2020. High-resolution DWI with b-values of 0, 800, and 1200 sec/mm 2 was performed using a 3.0-T system. Sixteen breast radiologists independently reviewed the DWI, apparent diffusion coefficient maps, and T1-weighted MRI scans and recorded the Breast Imaging Reporting and Data System (BI-RADS) category for each breast. After a 2-h training session and a 5-month washout period, they re-evaluated the BI-RADS categories. A BI-RADS category of 4 (lesions with at least two suspicious criteria) or 5 (more than two suspicious criteria) was considered positive.The per-breast diagnostic performance of each reader was compared between the first and second reviews. Inter-reader agreement was evaluated using a multi-rater κ analysis and intraclass correlation coefficient (ICC). Results: Before training, the mean sensitivity, specificity, and accuracy of the 16 readers were 70.7% (95% confidence interval [CI]: 59.4–79.9), 90.8% (95% CI: 85.6–94.2), and 83.5% (95% CI: 78.6–87.4), respectively. After training, significant improvements in specificity (95.2%; 95% CI: 90.8–97.5; P = 0.001) and accuracy (85.9%; 95% CI: 80.9–89.8; P = 0.01) were observed, but no difference in sensitivity (69.8%; 95% CI: 58.1–79.4; P = 0.58) was observed. Regarding inter-reader agreement, the κ values were 0.57 (95% CI: 0.52–0.63) before training and 0.68 (95% CI: 0.62–0.74) after training, with a difference of 0.11 (95% CI: 0.02–0.18; P = 0.01). The ICC was 0.73 (95% CI: 0.69–0.74) before training and 0.79 (95% CI: 0.76–0.80) after training (P = 0.002). Conclusion Brief reader training improved the performance and agreement of interpretations by breast radiologists using unenhanced MRI with DWI.

Objectives: The association between long sleep duration and mortality is frequently attributed to the confounding influence of comorbidities. Nevertheless, past efforts to account for comorbidities have yielded inconsistent outcomes. The objective of this study was to evaluate this relationship using a large prospective cohort in Korea. Methods: The study included 114 205 participants from the Health Examinees Study, who were followed for a median of 9.1 years. A composite comorbidity score was developed to summarize the effects of 21 diseases. Using Cox proportional hazards regression, hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause, cancer, and cardiovascular mortality associated with sleep duration were estimated. These estimates were adjusted for socio-demographic factors, lifestyle factors, body mass index, and comorbidity score. Additionally, a stratified analysis by subgroups with and without comorbidities was conducted. Results: Throughout the follow-up period, 2675 deaths were recorded. After all adjustments, an association was observed between a sleep duration of 8 hours or more and all-cause mortality (HR, 1.10; 95% CI, 1.01 to 1.20). However, no such association was detected in the stratified analysis for the subgroups based on comorbidity status. Conclusions Long sleep duration was found to be associated with all-cause mortality among Koreans, even after adjusting for comorbidities. Additional studies are required to explore the mechanism underlying the association between sleep duration and major causes of mortality.