Hee Jung Moon

Wonju Severance Christian Hospital, Genshū, Gangwon-do, South Korea

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Publications (176)487.05 Total impact

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    Preview · Article · Dec 2016 · BMC Cancer
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    ABSTRACT: Objectives To evaluate the diagnostic performance of breast magnetic resonance imaging (MRI) in preoperative evaluation of axillary lymph node metastasis (ALNM) in breast cancer patients and to assess whether breast MRI can be used to exclude advanced nodal disease. Methods A total of 425 patients were included in this study and breast MRI findings were retrospectively reviewed. The diagnostic performance of breast MRI for diagnosis of ALNM was evaluated in all patients, patients with neoadjuvant chemotherapy (NAC), and those without NAC (no-NAC). We evaluated whether negative MRI findings (cN0) can exclude advanced nodal disease (pN2-pN3) using the negative predictive value (NPV) in each group. Results The sensitivity and NPV of breast MRI in evaluation of ALNM was 51.3 % (60/117) and 83.3 % (284/341), respectively. For cN0 cases on MRI, pN2-pN3 manifested in 1.8 % (6/341) of the overall patients, 0.4 % (1/257) of the no-NAC group, and 6 % (5/84) of the NAC group. The NPV of negative MRI findings for exclusion of pN2-pN3 was higher for the no-NAC group than for the NAC group (99.6 % vs. 94.0 %, p = 0.039). Conclusions Negative MRI findings (cN0) can exclude the presence of advanced nodal disease with an NPV of 99.6 % in the no-NAC group. Key points • Breast MRI can be used to exclude advanced nodal disease (pN2-3). • Negative MRI allows breast cancer patients to avoid unnecessary axillary surgery (98.2 %). • Negative MRI findings exclude 99.6 % of pN2-pN3 in the no-NAC group. • Negative MRI findings exclude 96.0 % of pN2-pN3 in the NAC group.
    No preview · Article · Feb 2016 · European Radiology
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    ABSTRACT: To analyze whether the 5-tiered categorization system without the atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) category is sufficient compared to the 6-tiered Bethesda system. This IRB-approved retrospective study was waived informed consent. The pre-Bethesda period was from March 2008 to December 2008 and the Bethesda period was from January 2012 to January 2013. Of 4677 nodules ≥10 mm with initial ultrasonography-guided fine-needle aspiration, 2553 nodules were from the pre-Bethesda period and 1754 nodules were from the Bethesda period. The utilization and malignancy rates of each category were compared between the two periods. The utilization rate of the benign category decreased from 67.7 % in the pre-Bethesda period to 60.0 % in the Bethesda period (p = 0.001). In the pre-Bethesda period, the malignancy rates of the non-diagnostic, benign, suspicious follicular neoplasm/Hürthle cell neoplasm, suspicious for malignancy, and malignancy categories were 3.8, 1.9, 25, 78.8, and 99.7 %, respectively. The malignancy rate of the benign category decreased from 1.9 to 0.3 % after the Bethesda system (p < 0.001). The utilization and malignancy rates of the AUS/FLUS category were 7 and 22.8 %. When the AUS/FLUS category was included in the benign category, the malignancy rate became 2.6 % which was not significantly different from 1.9 % in the pre-Bethesda period (p = 0.189). The malignancy rates of other categories were not significantly different. The 5-tiered categorization system without the AUS/FLUS category for reporting cytology was sufficient for management of patients with thyroid nodules compared to the 6-tiered categorization of the Bethesda system.
    No preview · Article · Jan 2016 · Endocrine
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    ABSTRACT: To investigate the value of the annual follow-up neck ultrasonography (US) for postoperative surveillance in patients with papillary thyroid microcarcinoma (PTMC).This retrospective study has been approved by our institutional review board (IRB) with waiver for informed consent. A total of 375 patients diagnosed as PTMCs, who underwent total thyroidectomy with radioiodine remnant ablation were included, to identify the recurrence rate and the false-positive rate of annual ultrasound. The number, interval, and the results of follow-up US or fine needle aspiration were obtained from electronic medical records.Four (1.1%, 4/375) recurrences were found 3 years after the initial treatment, and only 1 patient (0.3%, 1/375) had a metastatic lymph node larger than 8 mm in the shortest diameter on US found 7.6 years after initial treatment with biochemical abnormalities. Cumulative risk of having at least 1 false-positive exam was 8.3% by the 8th US, and 8.1% by the 8-9 year follow-up. Cox multivariate regression showed shorter interval of follow-up US and presence of lymph node metastasis at initial surgery are independent predictors affecting the cumulative false-positive results (hazard ratio [HR], 0.60; 95% confidence interval [CI]: 0.49-0.73; P < 0.001 and HR, 2.19; 95% CI: 1.01-4.75; P = 0.048, respectively).Short-term follow-up US can result in higher cumulative false-positive results without detection of meaningful recurrences in patients with PTMCs who do not have biochemical abnormalities.
    No preview · Article · Jan 2016 · Medicine
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    ABSTRACT: The purpose of the study was to compare the diagnostic utility of the combined conventional smear (CS) and liquid-based preparation (LBP) compared to CS with respect to the non-diagnostic rate, the atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS) rate, and the diagnostic performances for malignancy. This retrospective study was approved by the Institutional Review Board, and the need to obtain informed consent was waived. In our institution, thyroid FNAs were processed with CS before October 2012, and LBP has been used in combination with CS after October 2012. On-site evaluation for the adequacy of CS was not performed. This study included nodules 5 mm or larger with FNAs performed by faculties: 811 nodules in 773 patients for CS, and 926 nodules in 894 patients for combined CS and LBP. Nodules with surgery or either benign or malignancy cytology on initial or repeat FNA were regarded to have the reference standards needed to calculate diagnostic performances. The proportion of Bethesda categories and diagnostic performances were compared between the two groups with z test. The non-diagnostic rate, the AUS or FLUS rate, and the diagnostic performances for malignancy were similar (All P > 0.05). The follicular neoplasm (FN) or suspicious for FN rate decreased from 1.2 to 0.3 % (P = 0.034). The benign rate increased from 51.4 to 57.0 % (P = 0.019). Combined CS and LBP decreased FN or suspicious for FN diagnoses, and increased benign diagnoses compared to CS with comparable non-diagnostic rates and AUS or FLUS rates, and comparable diagnostic performances.
    No preview · Article · Dec 2015 · Endocrine
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    ABSTRACT: Objective: To evaluate the clinical significance and compare the imaging features according to the Thyroid Image Reporting and Data System (TIRADS) between atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) subcategories. Design & patients: A total of 192 thyroid nodules in 188 patients (mean age: 50.2±11.8 years) that had been initially diagnosed as AUS/FLUS on US-guided fine needle aspiration (US-FNA) were included. One cytopathologist retrospectively reviewed the cytology slides, subcategorizing cytology results into AUS and FLUS. A TIRADS category was assigned to each thyroid nodule according to the number of suspicious US features. Clinical, US features, and malignancy rates were compared between the two subcategories. Results: Of the 192 AUS/FLUS lesions, 149 (77.6%) were subcategorized as AUS, and 43 (22.4%) as FLUS. Of the 192 AUS/FLUS nodules, 82 (42.7%) were malignant. The malignancy rates between AUS and FLUS subcategories were not significantly different, 45.6% to 32.6%, respectively (P=0.127). When applying TIRADS, significant differences were seen in TIRADS category between benign and malignant nodules in the AUS subcategory (P<0.001), but not in the FLUS subcategory (P=0.414). The malignancy rates in TIRADS categories 3, 4a, 4b, 4c, and 5 were 15.4%, 22.2%, 33.3%, 57.1%, and 80.0% (P<0.001) in AUS nodules and 40.0%, 50.0%, 23.5%, 22.2%, and 0.0% (P=0.414) in FLUS nodules, respectively. Conclusion: Suspicious US features are useful in predicting malignancy among AUS subcategories but not in FLUS subcategories. Subcategorization into AUS and FLUS cytology may be helpful in deciding upon treatment or management of thyroid nodules. This article is protected by copyright. All rights reserved.
    No preview · Article · Dec 2015 · Clinical Endocrinology
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    ABSTRACT: Purpose: The goal of this study was to evaluate the imaging features of diabetic mastopathy (DMP) and the role of image-guided biopsy in its diagnosis. Methods: Two experienced radiologists retrospectively reviewed the mammographic and sonographic images of 19 pathologically confirmed DMP patients. The techniques and results of the biopsies performed in each patient were also reviewed. Results: Mammograms showed negative findings in 78% of the patients. On ultrasonography (US), 13 lesions were seen as masses and six as non-mass lesions. The US features of the mass lesions were as follows: irregular shape (69%), oval shape (31%), indistinct margin (69%), angular margin (15%), microlobulated margin (8%), well-defined margin (8%), heterogeneous echogenicity (62%), hypoechoic echogenicity (38%), posterior shadowing (92%), parallel orientation (100%), the absence of calcifications (100%), and the absence of vascularity (100%). Based on the US findings, 17 lesions (89%) were classified as Breast Imaging Reporting and Data System category 4 and two (11%) as category 3. US-guided core biopsy was performed in 18 patients, and 10 (56%) were diagnosed with DMP on that basis. An additional vacuumassisted biopsy was performed in seven patients and all were diagnosed with DMP. Conclusion: The US features of DMP were generally suspicious for malignancy, whereas the mammographic findings were often negative or showed only focal asymmetry. Core biopsy is an adequate method for initial pathological diagnosis. However, since it yields non-diagnostic results in a considerable number of cases, the evaluation of correlations between imaging and pathology plays an important role in the diagnostic process.
    No preview · Article · Nov 2015
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    ABSTRACT: Purpose: The goal of this study was to evaluate the clinicopathological and imaging features of thyroid nodules surgically diagnosed as hyaline trabecular tumor (HTT), and to assess the role of cytology and frozen sections (FS) in the diagnosis of HTT. Methods: This study included 21 thyroid nodules in 21 patients treated from August 2005 to March 2015 (mean age, 53.3 years) who were either diagnosed as HTT or had HTT suggested as a possible diagnosis based on cytology, FS, or the final pathology report. Patients' medical records were retrospectively reviewed for cytopathologic results and outcomes during the course of follow-up. Sonograms were reviewed and categorized. Results: Twelve nodules from 12 patients were surgically confirmed as HTT. Ultrasonography (US)-guided fine needle aspiration (FNA) was performed on 11 nodules, of which six (54.5%) were papillary thyroid carcinoma (PTC) or suspicious for PTC and three (27.3%) were HTT or suspicious for HTT. Intraoperative FS suggested the possibility of HTT in seven nodules, of which three (42.9%) were confirmed as HTT. US-FNA suggested the diagnosis of HTT in 10 nodules, of which three (30.0%) were confirmed as HTT. Common US features of the 12 pathologically confirmed cases of HTT were hypoechogenicity or marked hypoechogenicity (83.4%), absence of calcifications (91.7%), parallel shape (100.0%), presence of vascularity (75.0%), and probable benignity (66.7%). Conclusion: HTT should be included in the differential diagnosis of solid tumors with hypoechogenicity or marked hypoechogenicity and otherwise benign US features that have been diagnosed as PTC through cytology.
    No preview · Article · Nov 2015
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    ABSTRACT: The Thyroid Imaging Reporting and Data System (TIRADS) has been found to be accurate in the stratification of malignancy risk, and elastography has been found to have a high negative predictive value in non-diagnostic thyroid nodules. Through assessment of 104 solid non-diagnostic thyroid nodules, this study investigated the role of both in recommending repeat ultrasonography-guided fine-needle aspiration for solid thyroid nodules with non-diagnostic cytology. All nodules were classified by TIRADS (categories 4a, 4b, 4c and 5), and elastography scores were assigned according to the Rago and Asteria criteria. The malignancy risks for TIRADS categories 4a, 4b, 4c and 5 were 12.5%, 25.0%, 25.8% and 16.7%, respectively. Elastography revealed the highest diagnostic performance for TIRADS category 4a, with a sensitivity, specificity, negative predictive value, positive predictive value and accuracy of 100%, 85.7%, 100%, 50% and 87.5% for the Asteria criteria. Observation may be considered for non-diagnostic solid nodules that have no other suspicious ultrasonographic features and are also benign on real-time strain elastography using the Asteria criteria.
    No preview · Article · Nov 2015 · Ultrasound in medicine & biology
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    ABSTRACT: Background: The signal enhancement ratio (SER) of surrounding non-tumor parenchyma at breast magnetic resonance imaging (MRI) can be helpful in breast cancer patients, but has not been investigated in patients with triple negative breast cancer (TNBC). Purpose: To investigate the association between background parenchymal SER around the tumor on preoperative dynamic contrast-enhanced MRI with recurrence-free survival in patients with TNBC. Material and methods: Between April 2012 and May 2013, 71 TNBC patients who underwent preoperative MRI were included. SER values were calculated from regions of interest placed in the breast parenchyma around the tumor. Cox proportional hazards models were used to determine associations between MRI variables, clinical-pathologic variables, and recurrence-free survival. Results: Recurrence occurred in 8.5% (6/71) of patients. At univariate analysis, a higher SER around the tumor, larger tumor size, lymphovascular invasion, lymph node metastasis, receipt of neoadjuvant chemotherapy, receipt of total mastectomy, and not receiving adjuvant chemotherapy were associated with worse recurrence-free survival. At multivariate analysis of preoperative variables, a higher SER around the tumor was independently associated with worse recurrence-free survival (hazard ratio [HR] = 7.072, P = 0.003 for SER1; HR = 6.268, P = 0.006 for SER2; HR = 3.004, P = 0.039 for SER3). Conclusion: Higher SER around the tumor at preoperative dynamic contrast-enhanced MRI is an independent predictor for recurrence in TNBC patients.
    No preview · Article · Oct 2015 · Acta Radiologica
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    ABSTRACT: Purpose: To investigate the correlation between conductivity and prognostic factors of invasive breast cancer using magnetic resonance electric properties tomography (MREPT). Methods: This retrospective study was approved by the Institutional Review Board, and verbal informed consent was obtained prior to breast MRI. This study included 65 women with surgically confirmed invasive breast cancers measuring 1 cm or larger on T2-weighted fast spin echo (FSE). Phase-based MREPT and the coil combination technique were used to reconstruct conductivity. Simple and multiple linear regression analysis were used to find an independent factor associated with conductivity. Results: In total tumours, tumours with HER-2 overexpression showed lower conductivity than those without, and HER-2 overexpression was independently associated with conductivity. In 37 tumours 2 cm or larger, tumours with high mitosis or PR positivity showed higher conductivity than those without, and high mitosis and PR positivity were independently associated with conductivity. In 28 tumours 1-2 cm in size, there were no differences in conductivity according to the prognostic factors. Conclusion: Conductivity values measured using MREPT are associated with the HER-2 overexpression status, and may provide information about mitosis and the PR status of invasive breast cancers 2 cm or larger. Key points: • In all tumours, HER-2 overexpression was independently associated with conductivity. • In tumours ≥ 2 cm, high mitosis and PR positivity were associated with conductivity. • Conductivity is associated with the HER-2 overexpression status of invasive breast cancers.
    No preview · Article · Oct 2015 · European Radiology
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    ABSTRACT: Fibroadenoma is a common benign breast lesion and its malignant transformation is rare. There have been several case reports and studies that retrospectively reviewed breast cancers that arose within fibroadenomas; however, none of these studies reported serial changes in radiologic features of the cancer, including findings from mammography and ultrasound (US). We report a case of breast cancer arising adjacent to an involuting fibro adenoma in a 39-year-old woman who was undergoing serial follow-up after her fibroadenoma was diagnosed. Seven years after her diagnosis, the lesion showed evidence of coarse calcifications, a typical sign of involution. Four years later, US revealed a newly developed hypoechoic lesion with irregular margins and peripherally located calcifications adjacent to the fibroadenoma. A core biopsy was performed, and histopathological examination resulted in a diagnosis of invasive ductal carcinoma. When new suspicious features are observed in a fibroadenoma, radiologists should raise the concern for breast cancer and proceed with diagnosis and treatment accordingly.
    Preview · Article · Oct 2015 · Journal of Breast Cancer
  • Hee Jung Moon · Min Jung Kim · Jung Hyun Yoon · Eun-Kyung Kim
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    ABSTRACT: Purpose: The malignancy risk, risk of being high-risk lesions after benign results on ultrasonography-guided 14-gauge core needle biopsies (US-CNBs), and their characteristics in breast lesions of 20 mm or greater were investigated. Methods: Eight hundred forty-seven breast lesions with benign results on US-CNB were classified as benign, high risk, and malignant through excision and clinical follow-up. The risks of being malignant or high risk were analyzed in all lesions, lesions 20 to 29 mm, and lesions 30 mm or greater. Their clinicopathological characteristics were evaluated. Results: Of 847, 18 (2.1%) were malignant, 53 (6.3%) were high-risk lesions, and 776 (91.6%) were benign. Of 18 malignancies, 6 (33.3%) were malignant phyllodes tumors and 12 (66.7%) were carcinomas. In benign lesions 20 to 29 mm, risks of being malignant or high risk were 1.6% (9 of 566) and 4.4% (25 of 566). In 281 lesions 30 mm or greater, the risks of being malignant or high risk were 3.2% and 10%. The risk of being high risk in lesions 30 mm or greater was 10%, significantly higher than 4.4% of lesions 20 to 29 mm (P = 0.002). Conclusions: Excision can be considered in lesions measuring 20 mm or larger because of the 2.1% malignancy risk and the 6.3% risk of being high-risk lesions despite benign results on US-CNB. Excision should be considered in lesions measuring 30 mm or larger because of the 3.2% malignancy risk and the 10% risk of being high-risk lesions.
    No preview · Article · Oct 2015 · Ultrasound quarterly
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    ABSTRACT: We investigated whether follow-up ultrasound (US) is enough for thyroid nodules 5-10 mm, and whether 3 years of interval between the initial US and next US is appropriate. This retrospective study was approved by the Institutional Review Board, and the need to obtain informed consent was waived. The study included 447 thyroid nodules 5-10 mm from 378 patients who underwent initial thyroid US, and underwent 3 years or more of follow-up US. The presence and characteristics of malignancy detected on follow-up were reviewed. Maximal diameters of each nodule at the initial and last US were measured. Univariate and multivariate analysis were used to assess association with nodule growth 3 mm or larger. Seven malignancies (1.6 %, 7 of 447) were detected on a mean 70.6 ± 20.3 months (range 36-104 months). Only one had growth 3 mm or larger, and all malignancies did not have extensive extrathyroidal extension, lateral lymph nodes, or distant metastasis. 6.0 % (27 of 447) of nodules had growth 3 mm or larger. Nodules in older patients were less likely to grow, and benign-looking nodules were more likely to grow. Longer follow-up time 6 years or more was not associated with growth, and no cancers were detected during the long follow-up time. Immediate US-FNA for thyroid nodules 5-10 mm are discouraged, unless suspicious metastatic lymph nodes are present. Also, a follow-up US 3 years after the initial US may be enough for these nodules.
    No preview · Article · Sep 2015 · Endocrine
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    ABSTRACT: The aim of this study was to validate inter-observer variability for strain ultrasound elastography (USE) and to compare the diagnostic performance of a combination of gray-scale ultrasound (US) and USE with that of gray-scale US. Three observers from different institutions evaluated gray-scale US images and USE video files of 443 cytopathologically proven benign or malignant thyroid nodules over a 3-mo period. Inter-observer variability did not statistically differ between USE using the Asteria criteria and gray-scale US; however, USE using the Rago criteria had the lowest inter-observer agreement (p < 0.043). For all three observers, sensitivity was increased by adding USE to gray-scale US (81.3%-88.3%, 75.4%-85.4%) compared with gray-scale US (70.4%-80.8%). Specificity was decreased by adding USE to gray-scale US (51.7%-59.1%, 59.1%-73.9%) compared with gray-scale US (69.0%-82.8%). USE and gray-scale US had comparable inter-observer variability. However, on addition of USE to gray-scale US, the additional diagnostic yield was limited compared with that of gray-scale US alone.
    No preview · Article · Sep 2015 · Ultrasound in medicine & biology
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    ABSTRACT: Background: We investigated whether short-term follow-up in 6 months was appropriate for asymptomatic benign concordant lesions on ultrasonography-guided core needle biopsy (ultrasonography-guided CNB). Methods: Of 1,111 lesions, 944 underwent follow-up within 4 to 9 months after CNB, and 359 of 944 underwent a 2nd follow-up within 9 to 15 months. One hundred sixty-seven underwent a 1st follow-up within 9 to 15 months. Follow-up intervals were classified according to an interval of 6 and 12 months with 2 different methods. First, 944 and 167 lesions were classified into the 6- and 12-month groups. Second, 944 and 526 lesions (sum of 167 and 359 lesions) were classified into the 6- and 12-month groups. Clinicopathologic factors were compared between the 2 groups. Results: None of the benign concordant lesions were malignant; 1.4% of the lesions showed progression in the 6-month group, not significantly different from 1.2% and .8% of the 12-month group. Mean age, mean lesion size, final assessments, and specific or nonspecific pathologies were not different between the 2 groups. Conclusions: Short-term follow-up in 6 months is unnecessary for asymptomatic benign concordant breast lesions at ultrasonography-guided CNB.
    No preview · Article · Sep 2015 · American journal of surgery
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    ABSTRACT: Objective: To evaluate the diagnostic outcomes of ultrasonography-guided core needle biopsy (US-CNB), US-guided vacuum-assisted biopsy (US-VAB), and stereotactic-guided vacuum-assisted biopsy (S-VAB) for diagnosing suspicious breast microcalcification. Materials and methods: We retrospectively reviewed 336 cases of suspicious breast microcalcification in patients who subsequently underwent image-guided biopsy. US-CNB was performed for US-visible microcalcifications associated with a mass (n = 28), US-VAB for US-visible microcalcifications without an associated mass (n = 59), and S-VAB for mammogram-only visible lesions (n = 249). Mammographic findings, biopsy failure rate, false-negative rate, and underestimation rate were analyzed. Histological diagnoses and the Breast Imaging Reporting and Data System (BI-RADS) categories were reported. Results: Biopsy failure rates for US-CNB, US-VAB, and S-VAB were 7.1% (2/28), 0% (0/59), and 2.8% (7/249), respectively. Three false-negative cases were detected for US-CNB and two for S-VAB. The rates of biopsy-diagnosed ductal carcinoma in situ that were upgraded to invasive cancer at surgery were 41.7% (5/12), 12.9% (4/31), and 8.6% (3/35) for US-CNB, US-VAB, and S-VAB, respectively. Sonographically visible lesions were more likely to be malignant (66.2% [51/77] vs. 23.2% [46/198]; p < 0.001) or of higher BI-RADS category (61.0% [47/77] vs. 22.2% [44/198]; p < 0.001) than sonographically invisible lesions. Conclusion: Ultrasonography-guided vacuum-assisted biopsy is more accurate than US-CNB when suspicious microcalcifications are detected on US. Calcifications with malignant pathology are significantly more visible on US than benign lesions.
    Preview · Article · Sep 2015 · Korean journal of radiology: official journal of the Korean Radiological Society
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    ABSTRACT: Purpose To compare malignancy risk stratification of thyroid nodules with the 2014 American Thyroid Association (ATA) management guidelines and the Thyroid Imaging Reporting and Data System (TIRADS). Materials and Methods This retrospective study was approved by the institutional review board. The requirement to obtain informed consent was waived. From November 2013 to July 2014, 1293 thyroid nodules in 1241 patients (mean age, 50.8 years ± 13.5) were included in this study. All nodules measured at least 10 mm. Solidity, hypoechogenicity or marked hypoechogenicity, microlobulated to irregular margin, microcalcifications or mixed calcifications, and nonparallel shape were considered suspicious features at ultrasonography (US). A TIRADS category and the US pattern as determined with ATA guidelines were assigned to each nodule. The correlation between the TIRADS category or ATA pattern and the malignancy rate was evaluated with the Spearman rank test. Results Of the 1293 thyroid nodules, 1059 (81.9%) were benign and 234 (18.1%) were malignant. Forty-four of the 1293 nodules (3.4%) did not meet the criteria for the ATA patterns and were classified as "not specified." The malignancy rates of TIRADS category 3, 4a, 4b, 4c, and 5 nodules were 1.9% (six of 316 nodules), 4.2% (17 of 408 nodules), 12.9% (33 of 256 nodules), 49.8% (130 of 261 nodules), and 92.3% (48 of 52 nodules), respectively, with significant differences between categories (P < .001). Malignancy rates of nodules with very low, low, intermediate, and high suspicion for malignancy with the ATA guidelines and not specified patterns were 2.7% (11 of 407 nodules), 3.1% (10 of 323 nodules), 16.7% (39 of 233 nodules), 58.0% (166 of 286 nodules), and 18.2% (eight of 44 nodules), respectively, with significant differences between patterns (P < .001). There was high correlation between classification with TIRADS (r = 1.000, P < .001) and ATA guidelines (r = 0.900, P = 0.037), without statistically significant differences (P = .873). Conclusion Both TIRADS and the ATA guidelines provide effective malignancy risk stratification for thyroid nodules. Nodules that do not meet the criteria for a specific pattern with the ATA guidelines have a relatively high risk of malignancy (18.2%). (©) RSNA, 2015 Online supplemental material is available for this article.
    No preview · Article · Sep 2015 · Radiology
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    ABSTRACT: Objectives: The purpose of this study was to investigate the level of conclusive results obtained with ultrasound (US)-guided core needle biopsy (CNB) and how this method should be applied for diagnosis of thyroid nodules. Methods: From January 2013 to November 2014, US-guided CNB was performed in 84 thyroid lesions of 83 patients. Based on CNB pathologic reports, thyroid nodules were divided into 2 categories: conclusive (nodules reaching a definite pathologic diagnosis suggesting benignity or malignancy) and inconclusive (nodules that were not able to reach a definite diagnosis because of ambiguous results). Medical records and US examinations were reviewed and compared. Results: The mean age of the 83 patients ± SD was 49.7 ± 14.1 years. Of the 84 thyroid nodules, 73 (86.9%) were diagnosed as benign or malignant and 11 (13.1%) as inconclusive by CNB pathologic analysis. Among the 11 nodules with inconclusive results, the possibility of a follicular neoplasm was suggested in 8 nodules (72.7%). No significant difference was seen in tumor size and US features when comparing the nodules with conclusive and inconclusive results (all P >.05). Conclusions: Ultrasound-guided CNB may have supplemental roles in addition to US-guided fine-needle aspiration for diagnosis of selected cases. A considerable proportion of inconclusive results are seen on US-guided CNB, especially for diagnosis of follicular lesions, which must be considered when using this method for diagnosis of thyroid nodules.
    No preview · Article · Sep 2015 · Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine
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    ABSTRACT: Objective: The purposes of this study were to investigate the optimal subset for texture analysis by use of a histogram and cooccurrence matrix in the differential diagnosis of benign and malignant thyroid nodules and to compare the results with those of gray-scale ultrasound and elastography. Materials and methods: From a retrospective search of an institutional database between June and November 2009, 633 solid nodules 5 mm or larger from 613 patients who underwent gray-scale ultrasound and elastography and subsequent ultrasound-guided fine-needle aspiration were included in this study. Each nodule was categorized as probably benign or suspicious of being malignant according to findings at gray-scale ultrasound and elastography. Histogram parameters (mean, SD, skewness, kurtosis, and entropy) and cooccurrence matrix parameters (contrast, correlation, uniformity, homogeneity, and entropy) were extracted from gray-scale ultrasound and elastographic images. The diagnostic performances of gray-scale ultrasound, elastography, and texture analysis for differentiating thyroid nodules were evaluated. Results: Gray-scale ultrasound had the best diagnostic performance with an ROC AUC (Az) of 0.809 among all parameters. Elastography had significantly poorer performance (Az = 0.646) than gray-scale ultrasound (p < 0.001). Mean extracted from gray-scale ultrasound had the highest Az (0.675) among all histogram and cooccurrence matrix parameters extracted from gray-scale ultrasound and elastographic images. However, mean and the combination of mean and gray-scale ultrasound had poorer performance than gray-scale ultrasound alone. Conclusion: Using texture analysis does not improve diagnostic performance in the evaluation of thyroid cancers.
    No preview · Article · Aug 2015 · American Journal of Roentgenology

Publication Stats

2k Citations
487.05 Total Impact Points

Institutions

  • 2013-2015
    • Wonju Severance Christian Hospital
      Genshū, Gangwon-do, South Korea
  • 2010-2015
    • Yonsei University Hospital
      • Surgery
      Sŏul, Seoul, South Korea
  • 2009-2015
    • Korea Institute of Radiological & Medical Sciences
      Sŏul, Seoul, South Korea
    • Yonsei University
      • Department of Radiology
      Sŏul, Seoul, South Korea
  • 2007-2010
    • Yeungnam University
      • Division of Internal Medicine
      경산시, Gyeongsangbuk-do, South Korea
    • CHA University
      • College of Medicine
      Sŏul, Seoul, South Korea
  • 2008-2009
    • Kosin University
      • College of Medicine
      Busan, Busan, South Korea