Ho-Chang Lee - Academia.edu (original) (raw)

Papers by Ho-Chang Lee

Research paper thumbnail of Comparison of diagnostic accuracy between CellprepPlus® and ThinPrep® liquid-based preparations in effusion cytology

Diagnostic Cytopathology, 2014

Liquid-based cytology (LBC) is being increasingly used for body fluid specimens and has improved ... more Liquid-based cytology (LBC) is being increasingly used for body fluid specimens and has improved diagnostic accuracy when compared to conventional smears. We compared the diagnostic accuracy and cellular morphologic features between CellprepPlus® LBC and ThinPrep® LBC in effusion cytology. One hundred and eighty body fluid specimens, consisting of 119 pleural fluid specimens, 59 peritoneal fluid specimens, and 2 pericardial fluid specimens, were obtained from 166 patients. Equal volumes of body fluid from each specimen were used in the CellprepPlus® and ThinPrep® preparations. Sensitivity, specificity, and positive and negative predictive values were evaluated. In addition, we selected 16 specimens from patients with metastatic adenocarcinoma, confirmed them by both LBC preparations, and measured the size of the nucleus in the tumor cells in these specimens. The sensitivity of the CellprepPlus® and ThinPrep® methods was 73.1% and 50.0%, respectively. The specificity and positive predictive values were 100% for both LBC methods, and the negative predictive values of the CellprepPlus® and ThinPrep® methods were 90.9% and 83.3%, respectively. The average nuclear size of the tumor cells was calculated as 20.87 μm using the CellprepPlus® method and 15.08 μm using the ThinPrep® method (P < 0.05). The CellprepPlus® method provided better diagnostic accuracy of effusion cytology compared to the ThinPrep® method and revealed the characteristic morphological features of tumor cells, including large and hypochromatic nuclei, prominent nucleoli, distinct nuclear membranes, and high cellularity.

Research paper thumbnail of Natural History of Pure Ground-Glass Opacity Lung Nodules Detected by Low-Dose CT Scan

CHEST Journal, 2013

Although focal ground-glass opacity (GGO) lung nodules are generally reported to grow slowly, the... more Although focal ground-glass opacity (GGO) lung nodules are generally reported to grow slowly, their natural course is unclear. The purpose of this study was to elucidate the natural course of screening-detected pure GGO lung nodules in patients with no history of malignancy. We retrospectively reviewed the database of subjects who had undergone screenings involving low-dose CT scans. We included patients with pure GGO lung nodules who were followed for > 2 years after the initial screening. Between June 1997 and September 2006, 122 pure GGO nodules were found in 89 patients. The median nodule size was 5.5 mm (range, 3-20 mm) in the largest diameter on initial low-dose CT scan. The median follow-up period per patient was 59 months. On a per-person basis, the frequency of growth was 13.5% (12 of 89 patients). On a per-nodule basis, the frequency of growth was 9.8% (12 of 122 nodules). Nodule growth was significantly associated with initial size and new development of an internal solid portion. The median volume doubling time was 769 days for growing pure GGO nodules. A total of 11 growing nodules were surgically validated, and all lesions were confirmed as primary lung cancer. About 90% of the screening-detected pure GGO lung nodules did not grow during long-term follow-up in subjects with no history of malignancy and most growing nodules had an indolent clinical course. A strategy of long-term follow-up and selective surgery for growing nodules should be considered for pure GGO lung nodules.

Research paper thumbnail of Baseline SUVmax at PET-CT in Stage IIIA Non-small-cell Lung Cancer Patients Undergoing Surgery after Neoadjuvant Therapy

Academic Radiology, 2012

To evaluate the prognostic significance of maximum standardized uptake value (SUVmax) at (18)F-fl... more To evaluate the prognostic significance of maximum standardized uptake value (SUVmax) at (18)F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography in patients with stage IIIA non-small-cell lung cancer (NSCLC) who underwent surgical resection after neoadjuvant chemoradiotherapy, focused on the relationship between SUVmax values and tumor histology. We retrospectively evaluated the initial SUVmax of 205 patients (112 adenocarcinomas, 82 squamous cell carcinomas [SCCs], and 11 of other histology) with a stage IIIA NSCLC who underwent surgical resection after neoadjuvant chemoradiotherapy, and who were followed for up to 6 years. Clinical data, including histologic type, pathologic response, and treatment, were reviewed, and the relationship between the SUVmax and patient overall survival was examined. Overall, the 2-year survival rate was 68%. Between the two histologic subtypes of adenocarcinoma and SCC, we noted significant differences in all variables of gender (male predominance in SCC), initial SUVmax (greater in SCC), pathologic response (more complete remission in SCC), and overall survival (better in SCC) (all P values, < .05). SUVmax remained as a sole independent factor for survival in multivariate analysis in whole series (SUVmax cutoff, 13; median survival, 3.0 years vs. 4.0 years; P = .016) and in adenocarcinomas (SUVmax cutoff, 11.5; median survival, 2.6 years vs. 3.6 years; P = .045), but not in SCCs. The initial SUVmax is a sole significant prognostic factor in patients with a surgically resected NSCLC after neoadjuvant chemoradiotherapy, particularly in patients with an adenocarcinoma.

Research paper thumbnail of Pure Ground-Glass Opacity Neoplastic Lung Nodules: Histopathology, Imaging, and Management

American Journal of Roentgenology, 2014

Research paper thumbnail of Pleuropulmonary Paragonimiasis: CT Findings in 31 Patients

American Journal of Roentgenology, 2005

paragonimiasis is a disease caused by lung flukes characterized by migration of a juvenile worm i... more paragonimiasis is a disease caused by lung flukes characterized by migration of a juvenile worm in the early stage and by formation of cysts around the worm later on. The purpose of this study was to describe the radiologic manifestations of pleuropulmonary paragonimiasis, with special emphasis on the worm cyst and worm migration track. We retrospectively studied 71 patients who had evidence of pleuropulmonary paragonimiasis on chest radiographs (n = 71) and CT scans (n = 17). The diagnosis was based on the detection of eggs or on positive antibody tests. On chest radiographs, 59 patients (83%) had pulmonary lesions and 43 patients (61%) had pleural lesions. Pulmonary findings included patchy air-space consolidation (n = 37) with or without cystic changes; ring shadows (n 16); and peripheral linear opacities (n = 29), which were more prominent in patients with pleural effusion. Twelve patients (17%) had bilateral pleural effusions or pneumothoraces. On CT scans, round low-attenuation cystic lesions (5-15 mm), filled either with fluid (n = 5) or gas (n = 5), were characteristically seen within the consolidation.

Research paper thumbnail of High-Resolution CT Findings in Fibrotic Idiopathic Interstitial Pneumonias With Little Honeycombing: Serial Changes and Prognostic Implications

American Journal of Roentgenology, 2012

This retrospective study evaluates serial changes of lung abnormalities on high-resolution CT (HR... more This retrospective study evaluates serial changes of lung abnormalities on high-resolution CT (HRCT) and clarifies prognostic determinants among CT findings in fibrotic idiopathic interstitial pneumonias (IIPs) with little honeycombing. We enrolled 154 patients with a histologic diagnosis of a fibrotic IIP (< 5% honeycombing on CT) who were followed clinically for at least 2 years. One hundred one patients had usual interstitial pneumonia (UIP) and 53 had fibrotic nonspecific interstitial pneumonia (NSIP). On baseline CT, the extent and distribution of lung abnormalities were visually assessed, and serial CT scans were evaluated with a follow-up period of at least 6 months (n = 132). Significant differences were noted in the extent of reticulation and ground-glass opacification (GGO) between the UIP and fibrotic NSIP groups (p < 0.001). On serial scans, honeycombing (5% in UIP and 3% in fibrotic NSIP; p = 0.08) and reticulation (3% in UIP and 8% in fibrotic NSIP; p = 0.03) progressed in extent and GGO (-2% in UIP and -10% in fibrotic NSIP; p = 0.009) decreased in extent. Overall extent of lesions increased in UIP (6%) and decreased in NSIP (-4%) (p = 0.04). On univariate and multivariate Cox proportional hazards analysis, the overall extent of parenchymal abnormalities was a prognostic factor predictive of poor survival duration. Even in cases of fibrotic IIP with little honeycombing, serial CT reveals an increase in the extent of honeycombing and reticulation and a decrease in extent of GGO. Overall extent of lung fibrosis on the baseline CT examination appears predictive of survival in fibrotic IIP with little honeycombing.

Research paper thumbnail of Radiologic and Metabolic Characteristics in Patients with Anaplastic Lymphoma Kinase (ALK)-Positive Lung Adenocarcinoma

Research paper thumbnail of Prognostic impact of nomogram based on whole tumour size, tumour disappearance ratio on CT and SUVmax on PET in lung adenocarcinoma

European radiology, Jan 11, 2015

Lung adenocarcinoma frequently manifests as subsolid nodules, and the solid portion and ground-gl... more Lung adenocarcinoma frequently manifests as subsolid nodules, and the solid portion and ground-glass-opacity (GGO) portion on CT have different prognostic significance. Therefore, current T descriptor, defined as the whole tumour diameter without discrimination between solid and GGO, is insufficient. We aimed to determine the prognostic significance of solid tumour size and attempt to include prognostic factors such as tumour disappearance rate (TDR) on CT and SUVmax on PET/CT. Five hundred and ninety-five patients with completely resected lung adenocarcinoma were analyzed. We developed a nomogram using whole tumour size, TDR, and SUVmax. External validation was performed in another 102 patients. In patients with tumours measuring ≤2 cm and >2 to 3 cm, disease free survival (DFS) was significantly associated with solid tumour size (P < 0.001), but not with whole tumour size (P = 0.052). Developed nomogram was significantly superior to the conventional T stage (area under the c...

Research paper thumbnail of Primary Pulmonary Low-Grade Angiosarcoma Characterized by Mismatch between (18)F-FDG PET and Dynamic Contrast-Enhanced CT

Korean journal of radiology

We report a rare case of primary pulmonary low-grade angiosarcoma on dynamic contrast-enhanced CT... more We report a rare case of primary pulmonary low-grade angiosarcoma on dynamic contrast-enhanced CT and (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT imaging. A 38-year-old, asymptomatic woman was hospitalized because of an abnormality on chest radiography. A dynamic contrast-enhanced chest CT showed a 1.2 cm-sized irregular-margined nodule with strong and persistent enhancement in the right lower lobe. The lesion had low metabolic activity on an (18)F-FDG PET/CT scan. The patient underwent a wedge resection for the lesion, and pathology revealed a primary pulmonary low-grade angiosarcoma.

Research paper thumbnail of Quantitative CT analysis of pure ground-glass opacity nodule (GGN) predicts further CT change

CHEST Journal, 2015

We sought to determine if quantitative analysis of lung adenocarcinoma manifesting as a ground-gl... more We sought to determine if quantitative analysis of lung adenocarcinoma manifesting as a ground-glass opacity (GGO) nodule (GGN) on initial computed tomography (CT) can predict further CT change or rate of growth. This retrospective study included patients with lung adenocarcinoma manifesting as pure GGN on initial CT, who were followed up with interval CT until resection. All pure GGNs were classified based on CT interval change in three subgroups as follows: group A (development of solid component), group B (growth of GGO component), and group C (no change in size). Nodule size, volume, density, mass, and CT attenuation values were assessed from initial CT datasets. Fifty-four pure GGNs were enrolled and classified into group A (n=9), group B (n=25), and group C (n=20). Nodule size, volume, mass, and density of the GGNs in each subgroup were not significantly different. The 97.5th percentile CT attenuation value and slope of CT attenuation values from 2.5th to 97.5th percentile were significantly different among the three subgroups (P = 0.02, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.00). Three of nine (33%) pure GGNs showing a new solid component developed solid component within 6 months. The 97.5th percentile CT attenuation value and slope of CT attenuation values from 2.5th to 97.5th percentile could be helpful in predicting future CT change and rate of growth of pure GGNs. Pure GGNs showing higher 97.5th percentile CT attenuation values and steeper slopes of CT attenuation values may need more frequent follow-up than the usual interval of 6 months.

Research paper thumbnail of Iodine Map and Whole Lung-based Quantitative Assessment of Pulmonary Parenchymal Enhancement Using Dual-energy CT: Work in Progress — Study Result in Patients with Diffuse Interstitial Lung Disease

ABSTRACT PURPOSE To evaluate whether or not dual-energy computed tomography (DECT) can be used fo... more ABSTRACT PURPOSE To evaluate whether or not dual-energy computed tomography (DECT) can be used for the quantification of regional enhancement in specific pattern such as reticulation, ground-glass opacity (GGO), or honeycombing, and disease identification and stratification of diffuse lung disease. METHOD AND MATERIALS Fifteen patients who were suspected of having an idiopathic interstitial pneumonia (IIP) and scheduled for surgical lung biopsy were prospectively enrolled, and underwent DECT (effective dose: mean 4.57 mSv, range 3.68 - 5.77). In a dedicated workstation, net iodine map images of whole lung were obtained and their parameters were compared between biopsy-proven fibrotic IIP and non-fibrotic pneumonia, and between usual interstitial pneumonia (UIP) and non-UIP fibrotic IIP. The whole lung was divided into upper, middle, and lower lung zones. Correlation between iodine value and pulmonary function test (PFT) was assessed in terms of FVC% and DLco%, and 6-minute walk test (6MWT). RESULTS Biopsy disclosed 10 fibrotic IIPs (UIP = 6, non-UIP =4) and 5 non-fibrotic pneumonias. Between fibrotic IIP and pneumonia, iodine values were significantly different (32.7 ± 7.8, 36.3 ± 6.2, respectively; p =.032) as were FVC% and 6MWT (p &lt; .05). When UIP was compared with non-UIP fibrotic IIP, lower lung zone of UIP showed significantly higher iodine value (39.7 ± 7.8, 32.5 ± 8.5, respectively; p =.028), whereas none of PFT parameters showed significant difference. CONCLUSION DECT, by rendering whole lung iodine map, is expected to be used for the quantification of lung parenchymal enhancement and for disease differentiation in diffuse lung disease. CLINICAL RELEVANCE/APPLICATION This study provides some evidence of DECT usefulness for disease identification and stratification in IIPs and thus, being an imaging device for rendering prognostic implication in these diseases.

Research paper thumbnail of Therapeutic effect of anti CEACAM6 monoclonal antibody against lung adenocarcinoma by enhancing anoikis sensitivity

Biomaterials, 2015

Carcinoembryonic antigen-related cell adhesion molecule 6 (CEACAM6) plays a crucial role in tumor... more Carcinoembryonic antigen-related cell adhesion molecule 6 (CEACAM6) plays a crucial role in tumorigenesis of lung cancer. However, the therapeutic potential for anti CEACAM6 monoclonal antibody (mAb) has only been limitedly explored. Here, we evaluate the therapeutic potential of naked anti CEACAM6 mAb against lung adenocarcinoma. Clone 8F5, recognizing B domain of CEACAM6, is established by immunizing A549 cells and screening for clones double positive for A549 and CEACAM6-Fc recombinant protein. We found that 85.7% of 70 resected lung adenocarcinoma tissue sections were positive for CEACAM6, whereas all squamous cell carcinoma examined were negative. A549 cells with high levels of CEACAM6 demonstrated more aggressive growth nature and showed increased paclitaxel chemosensitivity upon 8F5 binding. Treatment with 8F5 to A549 decreased cellular CEACAM6 expression and reversed anoikis resistance. 8F5 also decreased cellular status of Akt phosphorylation and increased apoptosis via caspase activation. In a mouse model of lung adenocarcinoma with xenotransplanted A549 cells, 8F5 treatment alone demonstrated 40% tumor growth inhibition. When combined with paclitaxel treatment, 8F5 markedly enhanced tumor growth inhibition, up to 80%. In summary, we demonstrate that anti CEACAM6 mAb is an effective therapeutic treatment for lung adenocarcinoma whose effect is further enhanced by combined treatment with paclitaxel.

Research paper thumbnail of Quantitative CT analysis of pulmonary ground-glass opacity nodules for distinguishing invasive adenocarcinoma from non-invasive or minimally invasive adenocarcinoma: the added value of using iodine mapping

European radiology, Jan 17, 2015

To determine whether quantitative analysis of iodine-enhanced images generated from dual-energy C... more To determine whether quantitative analysis of iodine-enhanced images generated from dual-energy CT (DECT) have added value in distinguishing invasive adenocarcinoma from non-invasive or minimally invasive adenocarcinoma (MIA) showing ground-glass nodule (GGN). Thirty-four patients with 39 GGNs were enrolled in this prospective study and underwent DECT followed by complete tumour resection. Various quantitative imaging parameters were assessed, including virtual non-contrast (VNC) imaging and iodine-enhanced imaging. Of all 39 GGNs, four were adenocarcinoma in situ (AIS) (10 %), nine were MIA (23 %), and 26 were invasive adenocarcinoma (67 %). When assessing only VNC imaging, multivariate analysis revealed that mass, uniformity, and size-zone variability were independent predictors of invasive adenocarcinoma (odds ratio [OR] = 19.92, P = 0.02; OR = 0.70, P = 0.01; OR = 16.16, P = 0.04, respectively). After assessing iodine-enhanced imaging with VNC imaging, both mass on the VNC imagi...

Research paper thumbnail of Locally recurrent penile apocrine carcinoma initially diagnosed as metastatic adenocarcinoma of colon

Chinese journal of cancer research = Chung-kuo yen cheng yen chiu, 2013

Apocrine carcinoma is a rare malignant adnexal neoplasm. The differential diagnosis between apocr... more Apocrine carcinoma is a rare malignant adnexal neoplasm. The differential diagnosis between apocrine carcinoma and cutaneous metastasis is often difficult. Here, we report a case of locally recurrent penile apocrine carcinoma initially diagnosed as metastatic adenocarcinoma of the colon. A 75-year-old man with a history of surgical resection due to sigmoid colon cancer and penile metastasis two years prior to this study presented with a nodule at the left penile base. He underwent a wide local resection of the penile mass under a suggested preoperative diagnosis of extra-mammary Paget's disease (EMPD) associated with previous sigmoid colon cancer. However, the previously and currently resected penile masses were identified as primary apocrine carcinoma upon hematoxylin and eosin (H&E) staining and immunohistochemical staining. Although the incidence is extremely rare, both clinicians and pathologists should be alert to the possibility of synchronous double primary apocrine carci...

Research paper thumbnail of Quantitative CT analysis of pulmonary ground-glass opacity nodules for the distinction of invasive adenocarcinoma from pre-invasive or minimally invasive adenocarcinoma

PloS one, 2014

We aimed to analyze the CT findings of ground-glass opacity nodules diagnosed pathologically as a... more We aimed to analyze the CT findings of ground-glass opacity nodules diagnosed pathologically as adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), and invasive adenocarcinoma in order to investigate whether quantitative CT parameters enable distinction of invasive adenocarcinoma from pre-invasive or minimally invasive adenocarcinoma. We reviewed CT images and pathologic specimens from 191 resected ground-glass opacity nodules with little or no solid component at CT. Nodule size, volume, density, mass, skewness/kurtosis, and CT attenuation values at the 2.5th-97.5th percentiles on histogram, and texture parameters (uniformity and entropy) were assessed from CT datasets. Of 191 tumors, 38 were AISs (20%), 61 were MIAs (32%), and 92 (48%) were invasive adenocarcinomas. Multivariate logistic regression analysis helped identify the 75th percentile CT attenuation value (P = 0.04) and entropy (P<0.01) as independent predictors for invasive adenocarcinoma, with an are...

Research paper thumbnail of The value of CT for disease detection and prognosis determination in combined pulmonary fibrosis and emphysema (CPFE)

PloS one, 2014

Several imaging-based indices were constructed quantitatively using the emphysema index (EI) and ... more Several imaging-based indices were constructed quantitatively using the emphysema index (EI) and fibrosis score (FS) on high-resolution computed tomography (HRCT). We evaluated the ability of these indices to predict mortality compared to physiologic results. Additionally, prognostic predictive factors were compared among subgroups with biopsy-proven fibrotic idiopathic interstitial pneumonia (IIP) (biopsy-proven CPFE) and in a separate cohort with subclinical CPFE. Three chest radiologists independently determined FS. EI was automatically quantified. PFTs, smoking history, and composite physiologic index (CPI) were reviewed. Predictors of time to death were determined based on clinico-physiologic factors and CT-based CPFE indices. The prevalence of biopsy-proven CPFE was 26% (66/254), with an EI of 9.1±7.1 and a FS of 19.3±14.2. In patients with CPFE, median survival and 5-year survival rates were 6.0 years and 34.8%, respectively, whereas those in fibrotic IIP without emphysema we...

Research paper thumbnail of Synchronous triple primary lung cancers: a case report

Korean journal of radiology : official journal of the Korean Radiological Society

Synchronous primary lung cancers are relatively rare. The accurate diagnosis remains challenging,... more Synchronous primary lung cancers are relatively rare. The accurate diagnosis remains challenging, despite of the routine use of bronchoscopy and computed tomography (CT) of the chest. Herein we report a case of synchronous triple primary cancers of the right lung in a 72-year-old male patient in whom each tumor presented distinct CT imaging findings.

Research paper thumbnail of Mucinous versus nonmucinous solitary pulmonary nodular bronchioloalveolar carcinoma: CT and FDG PET findings and pathologic comparisons

Lung cancer (Amsterdam, Netherlands), 2009

We aimed to evaluate the CT, PET, and pathologic findings of solitary pulmonary nodular mucinous ... more We aimed to evaluate the CT, PET, and pathologic findings of solitary pulmonary nodular mucinous and nonmucinous bronchioloalveolar carcinomas (BACs). From August 2003 to March 2008, we saw 24 patients with solitary pulmonary nodular mucinous (n=6) or nonmucinous (n=18) BACs that were resected. CT and PET findings of the lesions were assessed in terms of size, solidity, morphologic characteristics, attenuation and maximum standardized uptake value (mSUV). All nonmucinous BACs appeared as a pure ground-glass opacity (GGO) nodule, whereas mucinous BACs appeared as solid (n=4) or part-solid (n=2) nodules. CT attenuation values were significantly higher for mucinous BACs (-21.0 HU+/-4.9) than for nonmucinous BACs (-491.8 HU+/-172.5) (P<.001). Mean mSUVs were 2.3+/-1.9 for mucinous BACs and 0.5+/-0.8 for nonmucinous BACs (P=.007), but mSUVs were not statistically different after size adjustment (r=0.371, P=.081). Mucinous BACs appear as solid or part-solid nodules at CT, whereas nonmu...

Research paper thumbnail of Role of Imaging Biomarkers in Predicting Anaplastic Lymphoma Kinase–Positive Lung Adenocarcinoma

Clinical Nuclear Medicine, 2015

Objectives: For the ultimately efficient screening of anaplastic lymphoma kinase gene (ALK)-posit... more Objectives: For the ultimately efficient screening of anaplastic lymphoma kinase gene (ALK)-positive cases, combination of radiometabolic characteristics with clinicopathologic features may be more useful. Therefore, we determined radiologic characteristics and metabolic characteristics in patients with adenocarcinoma harboring ALK mutations. Patients and Methods: We retrospectively reviewed clinicopathologic CT and PET/CT data from patients with advanced lung adenocarcinoma screened for identifying ALK rearrangement. Lesion size, solidity, location, margins, CT attenuation, and SUV max were assessed. Pathologic features such as differentiation, the presence of signet ring cell, EGFR/KRAS mutation status, and TTF-1 expression were also reviewed. Results: Of the screened 221 patients, 41 patients (19%) demonstrated ALK rearrangements, and these individuals were younger than the ALK-negative patients (P < 0.001) and showed significant association with no exposure to tobacco (P = 0.028). ALK-positive lung adenocarcinomas were significantly less differentiated than those without rearrangements (P = 0.005). ALK-positive tumors showed significantly higher SUV max than ALK-negative tumors (P = 0.016). Multivariate logistic regression modeling for predicting the ALK-positive lung adenocarcinoma disclosed that lower CT attenuation and higher SUV max were significant independent factors of ALK rearrangements (odds ratio, 0.87 and 1.06; P = 0.03 and 0.01, respectively). Receiver operating characteristic analysis showed that the area under the receiver operating characteristic curve for SUV max /CT attenuation ratio was 0.788, and the optimal cutoff value of SUV max /CT attenuation ratio for identifying ALK-positive lung adenocarcinoma was greater than or equal to 0.208 (sensitivity, 74.2%; specificity, 81.0%).

Research paper thumbnail of Uncommon of the Uncommon: Malignant Perivascular Epithelioid Cell Tumor of the Lung

Korean Journal of Radiology, 2013

Research paper thumbnail of Comparison of diagnostic accuracy between CellprepPlus® and ThinPrep® liquid-based preparations in effusion cytology

Diagnostic Cytopathology, 2014

Liquid-based cytology (LBC) is being increasingly used for body fluid specimens and has improved ... more Liquid-based cytology (LBC) is being increasingly used for body fluid specimens and has improved diagnostic accuracy when compared to conventional smears. We compared the diagnostic accuracy and cellular morphologic features between CellprepPlus® LBC and ThinPrep® LBC in effusion cytology. One hundred and eighty body fluid specimens, consisting of 119 pleural fluid specimens, 59 peritoneal fluid specimens, and 2 pericardial fluid specimens, were obtained from 166 patients. Equal volumes of body fluid from each specimen were used in the CellprepPlus® and ThinPrep® preparations. Sensitivity, specificity, and positive and negative predictive values were evaluated. In addition, we selected 16 specimens from patients with metastatic adenocarcinoma, confirmed them by both LBC preparations, and measured the size of the nucleus in the tumor cells in these specimens. The sensitivity of the CellprepPlus® and ThinPrep® methods was 73.1% and 50.0%, respectively. The specificity and positive predictive values were 100% for both LBC methods, and the negative predictive values of the CellprepPlus® and ThinPrep® methods were 90.9% and 83.3%, respectively. The average nuclear size of the tumor cells was calculated as 20.87 μm using the CellprepPlus® method and 15.08 μm using the ThinPrep® method (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). The CellprepPlus® method provided better diagnostic accuracy of effusion cytology compared to the ThinPrep® method and revealed the characteristic morphological features of tumor cells, including large and hypochromatic nuclei, prominent nucleoli, distinct nuclear membranes, and high cellularity.

Research paper thumbnail of Natural History of Pure Ground-Glass Opacity Lung Nodules Detected by Low-Dose CT Scan

CHEST Journal, 2013

Although focal ground-glass opacity (GGO) lung nodules are generally reported to grow slowly, the... more Although focal ground-glass opacity (GGO) lung nodules are generally reported to grow slowly, their natural course is unclear. The purpose of this study was to elucidate the natural course of screening-detected pure GGO lung nodules in patients with no history of malignancy. We retrospectively reviewed the database of subjects who had undergone screenings involving low-dose CT scans. We included patients with pure GGO lung nodules who were followed for &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 2 years after the initial screening. Between June 1997 and September 2006, 122 pure GGO nodules were found in 89 patients. The median nodule size was 5.5 mm (range, 3-20 mm) in the largest diameter on initial low-dose CT scan. The median follow-up period per patient was 59 months. On a per-person basis, the frequency of growth was 13.5% (12 of 89 patients). On a per-nodule basis, the frequency of growth was 9.8% (12 of 122 nodules). Nodule growth was significantly associated with initial size and new development of an internal solid portion. The median volume doubling time was 769 days for growing pure GGO nodules. A total of 11 growing nodules were surgically validated, and all lesions were confirmed as primary lung cancer. About 90% of the screening-detected pure GGO lung nodules did not grow during long-term follow-up in subjects with no history of malignancy and most growing nodules had an indolent clinical course. A strategy of long-term follow-up and selective surgery for growing nodules should be considered for pure GGO lung nodules.

Research paper thumbnail of Baseline SUVmax at PET-CT in Stage IIIA Non-small-cell Lung Cancer Patients Undergoing Surgery after Neoadjuvant Therapy

Academic Radiology, 2012

To evaluate the prognostic significance of maximum standardized uptake value (SUVmax) at (18)F-fl... more To evaluate the prognostic significance of maximum standardized uptake value (SUVmax) at (18)F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography in patients with stage IIIA non-small-cell lung cancer (NSCLC) who underwent surgical resection after neoadjuvant chemoradiotherapy, focused on the relationship between SUVmax values and tumor histology. We retrospectively evaluated the initial SUVmax of 205 patients (112 adenocarcinomas, 82 squamous cell carcinomas [SCCs], and 11 of other histology) with a stage IIIA NSCLC who underwent surgical resection after neoadjuvant chemoradiotherapy, and who were followed for up to 6 years. Clinical data, including histologic type, pathologic response, and treatment, were reviewed, and the relationship between the SUVmax and patient overall survival was examined. Overall, the 2-year survival rate was 68%. Between the two histologic subtypes of adenocarcinoma and SCC, we noted significant differences in all variables of gender (male predominance in SCC), initial SUVmax (greater in SCC), pathologic response (more complete remission in SCC), and overall survival (better in SCC) (all P values, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05). SUVmax remained as a sole independent factor for survival in multivariate analysis in whole series (SUVmax cutoff, 13; median survival, 3.0 years vs. 4.0 years; P = .016) and in adenocarcinomas (SUVmax cutoff, 11.5; median survival, 2.6 years vs. 3.6 years; P = .045), but not in SCCs. The initial SUVmax is a sole significant prognostic factor in patients with a surgically resected NSCLC after neoadjuvant chemoradiotherapy, particularly in patients with an adenocarcinoma.

Research paper thumbnail of Pure Ground-Glass Opacity Neoplastic Lung Nodules: Histopathology, Imaging, and Management

American Journal of Roentgenology, 2014

Research paper thumbnail of Pleuropulmonary Paragonimiasis: CT Findings in 31 Patients

American Journal of Roentgenology, 2005

paragonimiasis is a disease caused by lung flukes characterized by migration of a juvenile worm i... more paragonimiasis is a disease caused by lung flukes characterized by migration of a juvenile worm in the early stage and by formation of cysts around the worm later on. The purpose of this study was to describe the radiologic manifestations of pleuropulmonary paragonimiasis, with special emphasis on the worm cyst and worm migration track. We retrospectively studied 71 patients who had evidence of pleuropulmonary paragonimiasis on chest radiographs (n = 71) and CT scans (n = 17). The diagnosis was based on the detection of eggs or on positive antibody tests. On chest radiographs, 59 patients (83%) had pulmonary lesions and 43 patients (61%) had pleural lesions. Pulmonary findings included patchy air-space consolidation (n = 37) with or without cystic changes; ring shadows (n 16); and peripheral linear opacities (n = 29), which were more prominent in patients with pleural effusion. Twelve patients (17%) had bilateral pleural effusions or pneumothoraces. On CT scans, round low-attenuation cystic lesions (5-15 mm), filled either with fluid (n = 5) or gas (n = 5), were characteristically seen within the consolidation.

Research paper thumbnail of High-Resolution CT Findings in Fibrotic Idiopathic Interstitial Pneumonias With Little Honeycombing: Serial Changes and Prognostic Implications

American Journal of Roentgenology, 2012

This retrospective study evaluates serial changes of lung abnormalities on high-resolution CT (HR... more This retrospective study evaluates serial changes of lung abnormalities on high-resolution CT (HRCT) and clarifies prognostic determinants among CT findings in fibrotic idiopathic interstitial pneumonias (IIPs) with little honeycombing. We enrolled 154 patients with a histologic diagnosis of a fibrotic IIP (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 5% honeycombing on CT) who were followed clinically for at least 2 years. One hundred one patients had usual interstitial pneumonia (UIP) and 53 had fibrotic nonspecific interstitial pneumonia (NSIP). On baseline CT, the extent and distribution of lung abnormalities were visually assessed, and serial CT scans were evaluated with a follow-up period of at least 6 months (n = 132). Significant differences were noted in the extent of reticulation and ground-glass opacification (GGO) between the UIP and fibrotic NSIP groups (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). On serial scans, honeycombing (5% in UIP and 3% in fibrotic NSIP; p = 0.08) and reticulation (3% in UIP and 8% in fibrotic NSIP; p = 0.03) progressed in extent and GGO (-2% in UIP and -10% in fibrotic NSIP; p = 0.009) decreased in extent. Overall extent of lesions increased in UIP (6%) and decreased in NSIP (-4%) (p = 0.04). On univariate and multivariate Cox proportional hazards analysis, the overall extent of parenchymal abnormalities was a prognostic factor predictive of poor survival duration. Even in cases of fibrotic IIP with little honeycombing, serial CT reveals an increase in the extent of honeycombing and reticulation and a decrease in extent of GGO. Overall extent of lung fibrosis on the baseline CT examination appears predictive of survival in fibrotic IIP with little honeycombing.

Research paper thumbnail of Radiologic and Metabolic Characteristics in Patients with Anaplastic Lymphoma Kinase (ALK)-Positive Lung Adenocarcinoma

Research paper thumbnail of Prognostic impact of nomogram based on whole tumour size, tumour disappearance ratio on CT and SUVmax on PET in lung adenocarcinoma

European radiology, Jan 11, 2015

Lung adenocarcinoma frequently manifests as subsolid nodules, and the solid portion and ground-gl... more Lung adenocarcinoma frequently manifests as subsolid nodules, and the solid portion and ground-glass-opacity (GGO) portion on CT have different prognostic significance. Therefore, current T descriptor, defined as the whole tumour diameter without discrimination between solid and GGO, is insufficient. We aimed to determine the prognostic significance of solid tumour size and attempt to include prognostic factors such as tumour disappearance rate (TDR) on CT and SUVmax on PET/CT. Five hundred and ninety-five patients with completely resected lung adenocarcinoma were analyzed. We developed a nomogram using whole tumour size, TDR, and SUVmax. External validation was performed in another 102 patients. In patients with tumours measuring ≤2 cm and >2 to 3 cm, disease free survival (DFS) was significantly associated with solid tumour size (P < 0.001), but not with whole tumour size (P = 0.052). Developed nomogram was significantly superior to the conventional T stage (area under the c...

Research paper thumbnail of Primary Pulmonary Low-Grade Angiosarcoma Characterized by Mismatch between (18)F-FDG PET and Dynamic Contrast-Enhanced CT

Korean journal of radiology

We report a rare case of primary pulmonary low-grade angiosarcoma on dynamic contrast-enhanced CT... more We report a rare case of primary pulmonary low-grade angiosarcoma on dynamic contrast-enhanced CT and (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT imaging. A 38-year-old, asymptomatic woman was hospitalized because of an abnormality on chest radiography. A dynamic contrast-enhanced chest CT showed a 1.2 cm-sized irregular-margined nodule with strong and persistent enhancement in the right lower lobe. The lesion had low metabolic activity on an (18)F-FDG PET/CT scan. The patient underwent a wedge resection for the lesion, and pathology revealed a primary pulmonary low-grade angiosarcoma.

Research paper thumbnail of Quantitative CT analysis of pure ground-glass opacity nodule (GGN) predicts further CT change

CHEST Journal, 2015

We sought to determine if quantitative analysis of lung adenocarcinoma manifesting as a ground-gl... more We sought to determine if quantitative analysis of lung adenocarcinoma manifesting as a ground-glass opacity (GGO) nodule (GGN) on initial computed tomography (CT) can predict further CT change or rate of growth. This retrospective study included patients with lung adenocarcinoma manifesting as pure GGN on initial CT, who were followed up with interval CT until resection. All pure GGNs were classified based on CT interval change in three subgroups as follows: group A (development of solid component), group B (growth of GGO component), and group C (no change in size). Nodule size, volume, density, mass, and CT attenuation values were assessed from initial CT datasets. Fifty-four pure GGNs were enrolled and classified into group A (n=9), group B (n=25), and group C (n=20). Nodule size, volume, mass, and density of the GGNs in each subgroup were not significantly different. The 97.5th percentile CT attenuation value and slope of CT attenuation values from 2.5th to 97.5th percentile were significantly different among the three subgroups (P = 0.02, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.00). Three of nine (33%) pure GGNs showing a new solid component developed solid component within 6 months. The 97.5th percentile CT attenuation value and slope of CT attenuation values from 2.5th to 97.5th percentile could be helpful in predicting future CT change and rate of growth of pure GGNs. Pure GGNs showing higher 97.5th percentile CT attenuation values and steeper slopes of CT attenuation values may need more frequent follow-up than the usual interval of 6 months.

Research paper thumbnail of Iodine Map and Whole Lung-based Quantitative Assessment of Pulmonary Parenchymal Enhancement Using Dual-energy CT: Work in Progress — Study Result in Patients with Diffuse Interstitial Lung Disease

ABSTRACT PURPOSE To evaluate whether or not dual-energy computed tomography (DECT) can be used fo... more ABSTRACT PURPOSE To evaluate whether or not dual-energy computed tomography (DECT) can be used for the quantification of regional enhancement in specific pattern such as reticulation, ground-glass opacity (GGO), or honeycombing, and disease identification and stratification of diffuse lung disease. METHOD AND MATERIALS Fifteen patients who were suspected of having an idiopathic interstitial pneumonia (IIP) and scheduled for surgical lung biopsy were prospectively enrolled, and underwent DECT (effective dose: mean 4.57 mSv, range 3.68 - 5.77). In a dedicated workstation, net iodine map images of whole lung were obtained and their parameters were compared between biopsy-proven fibrotic IIP and non-fibrotic pneumonia, and between usual interstitial pneumonia (UIP) and non-UIP fibrotic IIP. The whole lung was divided into upper, middle, and lower lung zones. Correlation between iodine value and pulmonary function test (PFT) was assessed in terms of FVC% and DLco%, and 6-minute walk test (6MWT). RESULTS Biopsy disclosed 10 fibrotic IIPs (UIP = 6, non-UIP =4) and 5 non-fibrotic pneumonias. Between fibrotic IIP and pneumonia, iodine values were significantly different (32.7 ± 7.8, 36.3 ± 6.2, respectively; p =.032) as were FVC% and 6MWT (p &lt; .05). When UIP was compared with non-UIP fibrotic IIP, lower lung zone of UIP showed significantly higher iodine value (39.7 ± 7.8, 32.5 ± 8.5, respectively; p =.028), whereas none of PFT parameters showed significant difference. CONCLUSION DECT, by rendering whole lung iodine map, is expected to be used for the quantification of lung parenchymal enhancement and for disease differentiation in diffuse lung disease. CLINICAL RELEVANCE/APPLICATION This study provides some evidence of DECT usefulness for disease identification and stratification in IIPs and thus, being an imaging device for rendering prognostic implication in these diseases.

Research paper thumbnail of Therapeutic effect of anti CEACAM6 monoclonal antibody against lung adenocarcinoma by enhancing anoikis sensitivity

Biomaterials, 2015

Carcinoembryonic antigen-related cell adhesion molecule 6 (CEACAM6) plays a crucial role in tumor... more Carcinoembryonic antigen-related cell adhesion molecule 6 (CEACAM6) plays a crucial role in tumorigenesis of lung cancer. However, the therapeutic potential for anti CEACAM6 monoclonal antibody (mAb) has only been limitedly explored. Here, we evaluate the therapeutic potential of naked anti CEACAM6 mAb against lung adenocarcinoma. Clone 8F5, recognizing B domain of CEACAM6, is established by immunizing A549 cells and screening for clones double positive for A549 and CEACAM6-Fc recombinant protein. We found that 85.7% of 70 resected lung adenocarcinoma tissue sections were positive for CEACAM6, whereas all squamous cell carcinoma examined were negative. A549 cells with high levels of CEACAM6 demonstrated more aggressive growth nature and showed increased paclitaxel chemosensitivity upon 8F5 binding. Treatment with 8F5 to A549 decreased cellular CEACAM6 expression and reversed anoikis resistance. 8F5 also decreased cellular status of Akt phosphorylation and increased apoptosis via caspase activation. In a mouse model of lung adenocarcinoma with xenotransplanted A549 cells, 8F5 treatment alone demonstrated 40% tumor growth inhibition. When combined with paclitaxel treatment, 8F5 markedly enhanced tumor growth inhibition, up to 80%. In summary, we demonstrate that anti CEACAM6 mAb is an effective therapeutic treatment for lung adenocarcinoma whose effect is further enhanced by combined treatment with paclitaxel.

Research paper thumbnail of Quantitative CT analysis of pulmonary ground-glass opacity nodules for distinguishing invasive adenocarcinoma from non-invasive or minimally invasive adenocarcinoma: the added value of using iodine mapping

European radiology, Jan 17, 2015

To determine whether quantitative analysis of iodine-enhanced images generated from dual-energy C... more To determine whether quantitative analysis of iodine-enhanced images generated from dual-energy CT (DECT) have added value in distinguishing invasive adenocarcinoma from non-invasive or minimally invasive adenocarcinoma (MIA) showing ground-glass nodule (GGN). Thirty-four patients with 39 GGNs were enrolled in this prospective study and underwent DECT followed by complete tumour resection. Various quantitative imaging parameters were assessed, including virtual non-contrast (VNC) imaging and iodine-enhanced imaging. Of all 39 GGNs, four were adenocarcinoma in situ (AIS) (10 %), nine were MIA (23 %), and 26 were invasive adenocarcinoma (67 %). When assessing only VNC imaging, multivariate analysis revealed that mass, uniformity, and size-zone variability were independent predictors of invasive adenocarcinoma (odds ratio [OR] = 19.92, P = 0.02; OR = 0.70, P = 0.01; OR = 16.16, P = 0.04, respectively). After assessing iodine-enhanced imaging with VNC imaging, both mass on the VNC imagi...

Research paper thumbnail of Locally recurrent penile apocrine carcinoma initially diagnosed as metastatic adenocarcinoma of colon

Chinese journal of cancer research = Chung-kuo yen cheng yen chiu, 2013

Apocrine carcinoma is a rare malignant adnexal neoplasm. The differential diagnosis between apocr... more Apocrine carcinoma is a rare malignant adnexal neoplasm. The differential diagnosis between apocrine carcinoma and cutaneous metastasis is often difficult. Here, we report a case of locally recurrent penile apocrine carcinoma initially diagnosed as metastatic adenocarcinoma of the colon. A 75-year-old man with a history of surgical resection due to sigmoid colon cancer and penile metastasis two years prior to this study presented with a nodule at the left penile base. He underwent a wide local resection of the penile mass under a suggested preoperative diagnosis of extra-mammary Paget's disease (EMPD) associated with previous sigmoid colon cancer. However, the previously and currently resected penile masses were identified as primary apocrine carcinoma upon hematoxylin and eosin (H&E) staining and immunohistochemical staining. Although the incidence is extremely rare, both clinicians and pathologists should be alert to the possibility of synchronous double primary apocrine carci...

Research paper thumbnail of Quantitative CT analysis of pulmonary ground-glass opacity nodules for the distinction of invasive adenocarcinoma from pre-invasive or minimally invasive adenocarcinoma

PloS one, 2014

We aimed to analyze the CT findings of ground-glass opacity nodules diagnosed pathologically as a... more We aimed to analyze the CT findings of ground-glass opacity nodules diagnosed pathologically as adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), and invasive adenocarcinoma in order to investigate whether quantitative CT parameters enable distinction of invasive adenocarcinoma from pre-invasive or minimally invasive adenocarcinoma. We reviewed CT images and pathologic specimens from 191 resected ground-glass opacity nodules with little or no solid component at CT. Nodule size, volume, density, mass, skewness/kurtosis, and CT attenuation values at the 2.5th-97.5th percentiles on histogram, and texture parameters (uniformity and entropy) were assessed from CT datasets. Of 191 tumors, 38 were AISs (20%), 61 were MIAs (32%), and 92 (48%) were invasive adenocarcinomas. Multivariate logistic regression analysis helped identify the 75th percentile CT attenuation value (P = 0.04) and entropy (P<0.01) as independent predictors for invasive adenocarcinoma, with an are...

Research paper thumbnail of The value of CT for disease detection and prognosis determination in combined pulmonary fibrosis and emphysema (CPFE)

PloS one, 2014

Several imaging-based indices were constructed quantitatively using the emphysema index (EI) and ... more Several imaging-based indices were constructed quantitatively using the emphysema index (EI) and fibrosis score (FS) on high-resolution computed tomography (HRCT). We evaluated the ability of these indices to predict mortality compared to physiologic results. Additionally, prognostic predictive factors were compared among subgroups with biopsy-proven fibrotic idiopathic interstitial pneumonia (IIP) (biopsy-proven CPFE) and in a separate cohort with subclinical CPFE. Three chest radiologists independently determined FS. EI was automatically quantified. PFTs, smoking history, and composite physiologic index (CPI) were reviewed. Predictors of time to death were determined based on clinico-physiologic factors and CT-based CPFE indices. The prevalence of biopsy-proven CPFE was 26% (66/254), with an EI of 9.1±7.1 and a FS of 19.3±14.2. In patients with CPFE, median survival and 5-year survival rates were 6.0 years and 34.8%, respectively, whereas those in fibrotic IIP without emphysema we...

Research paper thumbnail of Synchronous triple primary lung cancers: a case report

Korean journal of radiology : official journal of the Korean Radiological Society

Synchronous primary lung cancers are relatively rare. The accurate diagnosis remains challenging,... more Synchronous primary lung cancers are relatively rare. The accurate diagnosis remains challenging, despite of the routine use of bronchoscopy and computed tomography (CT) of the chest. Herein we report a case of synchronous triple primary cancers of the right lung in a 72-year-old male patient in whom each tumor presented distinct CT imaging findings.

Research paper thumbnail of Mucinous versus nonmucinous solitary pulmonary nodular bronchioloalveolar carcinoma: CT and FDG PET findings and pathologic comparisons

Lung cancer (Amsterdam, Netherlands), 2009

We aimed to evaluate the CT, PET, and pathologic findings of solitary pulmonary nodular mucinous ... more We aimed to evaluate the CT, PET, and pathologic findings of solitary pulmonary nodular mucinous and nonmucinous bronchioloalveolar carcinomas (BACs). From August 2003 to March 2008, we saw 24 patients with solitary pulmonary nodular mucinous (n=6) or nonmucinous (n=18) BACs that were resected. CT and PET findings of the lesions were assessed in terms of size, solidity, morphologic characteristics, attenuation and maximum standardized uptake value (mSUV). All nonmucinous BACs appeared as a pure ground-glass opacity (GGO) nodule, whereas mucinous BACs appeared as solid (n=4) or part-solid (n=2) nodules. CT attenuation values were significantly higher for mucinous BACs (-21.0 HU+/-4.9) than for nonmucinous BACs (-491.8 HU+/-172.5) (P<.001). Mean mSUVs were 2.3+/-1.9 for mucinous BACs and 0.5+/-0.8 for nonmucinous BACs (P=.007), but mSUVs were not statistically different after size adjustment (r=0.371, P=.081). Mucinous BACs appear as solid or part-solid nodules at CT, whereas nonmu...

Research paper thumbnail of Role of Imaging Biomarkers in Predicting Anaplastic Lymphoma Kinase–Positive Lung Adenocarcinoma

Clinical Nuclear Medicine, 2015

Objectives: For the ultimately efficient screening of anaplastic lymphoma kinase gene (ALK)-posit... more Objectives: For the ultimately efficient screening of anaplastic lymphoma kinase gene (ALK)-positive cases, combination of radiometabolic characteristics with clinicopathologic features may be more useful. Therefore, we determined radiologic characteristics and metabolic characteristics in patients with adenocarcinoma harboring ALK mutations. Patients and Methods: We retrospectively reviewed clinicopathologic CT and PET/CT data from patients with advanced lung adenocarcinoma screened for identifying ALK rearrangement. Lesion size, solidity, location, margins, CT attenuation, and SUV max were assessed. Pathologic features such as differentiation, the presence of signet ring cell, EGFR/KRAS mutation status, and TTF-1 expression were also reviewed. Results: Of the screened 221 patients, 41 patients (19%) demonstrated ALK rearrangements, and these individuals were younger than the ALK-negative patients (P < 0.001) and showed significant association with no exposure to tobacco (P = 0.028). ALK-positive lung adenocarcinomas were significantly less differentiated than those without rearrangements (P = 0.005). ALK-positive tumors showed significantly higher SUV max than ALK-negative tumors (P = 0.016). Multivariate logistic regression modeling for predicting the ALK-positive lung adenocarcinoma disclosed that lower CT attenuation and higher SUV max were significant independent factors of ALK rearrangements (odds ratio, 0.87 and 1.06; P = 0.03 and 0.01, respectively). Receiver operating characteristic analysis showed that the area under the receiver operating characteristic curve for SUV max /CT attenuation ratio was 0.788, and the optimal cutoff value of SUV max /CT attenuation ratio for identifying ALK-positive lung adenocarcinoma was greater than or equal to 0.208 (sensitivity, 74.2%; specificity, 81.0%).

Research paper thumbnail of Uncommon of the Uncommon: Malignant Perivascular Epithelioid Cell Tumor of the Lung

Korean Journal of Radiology, 2013