친구야 기죽지마

서경진 샘터사 2012 월간 샘터 Vol.511 No.-

Clinical Application of Next-Generation Sequencing in Patients With Breast Cancer: Real-World Data

서경진,김세현,김유정,신희철,강은영,김은규,이세준,우지원,나희영,안수민,장범섭,김인아,박소연,김지현 한국유방암학회 2022 Journal of breast cancer Vol.25 No.5

Purpose: Next-generation sequencing (NGS)-based tumor panel testing has been reimbursed by the Korean government since 2017. We evaluated the use of NGS-based tumor panel testing in real-world clinical practice, focusing on molecular profiling (MP)-guided breast cancer treatment. Methods: A total of 137 breast cancer patients underwent NGS panel testing between December 2017 and July 2020 at Seoul National University Bundang Hospital (SNUBH). Samples from patients were profiled using an in-house SNUBH pan-cancer panel. Sixty-four patients were profiled on SNUBH Pan_Cancer v1.0, targeting 89 genes, while 73 patients were profiled on SNUBH Pan_Cancer v2.0, targeting 546 genes. Results: Breast cancer subtypes included hormone receptor+/human epidermal growth factor receptor 2 (HER2)− (n = 87), triple-negative (n = 44), and HER2+ (n = 6). Most patients had locally advanced or metastatic cancers (92%). Approximately 92% (126/137) of the patients had significant genomic alterations (tiers I and II), and 62% (85/137) had targetable genomic alterations. The most common targetable genomic alterations were PIK3CA (39%) and ESR1 mutations (9%), followed by ERBB2 (7%), PTEN (7%), BRCA2 (6%), and BRCA1 mutations (4%). Of the 81 patients with locally advanced/metastatic breast cancer with targetable genomic alterations, 6 (7.4%) received MP-guided treatments, including PARP inhibitor (n = 4), ERBB2-directed therapy (n = 1), and PI3K inhibitor (n = 1). Among these 6 patients, 4 participated in clinical trials, 1 underwent treatment at their own expense, and 1 received drugs through an expanded access program. The remaining 66 patients (81%) with targetable genomic alteration did not receive MP-guided treatment due to lack of matched drugs and/or clinical trials, poor performance status, and/or financial burden. Conclusion: NGS panel testing allowed MP-guided treatment in only 4.7% (6/127) of patients with advanced breast cancer in a real-world setting. The availability of matched drugs is critical for the realistic implementation of personalized treatment.

Sonography of Invasive Apocrine Carcinoma of the Breast in Five Cases

서경진,안영이,황인용,장은덕,강봉주,김성헌,박창숙,김정수,홍현주 대한영상의학회 2015 Korean Journal of Radiology Vol.16 No.5

To evaluate the sonographic features of invasive apocrine carcinoma (IAC) of the breast. This study included five pathologically proven cases of IAC, and their sonographic features were retrospectively analyzed according to the Breast Imaging Reporting and Data System (BI-RADS) lexicon. All five lesions involved the left breast and were seen as irregularly shaped masses. All lesions, except one, had a parallel orientation to the chest wall. All five lesions showed noncircumscribed margins and heterogeneous echotexture; however, they showed various posterior features. One lesion had edema as an associated feature. Sonographic assessments were classified as BI-RADS category 4 in all five cases. Invasive apocrine carcinoma sonographic findings are difficult to differentiate from those of invasive ductal carcinoma of no special type.

IgA 신증: WHO 분류와 형태학적 소견에 따른 반정량 점수체계와의 상관관계

서경진,김태정,이교영,심상인,최영진 대한병리학회 2009 Journal of Pathology and Translational Medicine Vol.43 No.3

Background : IgA nephropathy (IgAN) is the most common glomerulonephritis worldwide, and the clinical course of IgAN shows marked variability. Many efforts have made to histologically predict the clinical outcome. There are two methods to classify IgAN. One is mainly based on the glomerular changes, such as the WHO and the Lee and Haas classification systems. The other is a morphologic semi-quantitative scoring system, which counts the changes of the glomerular, tubulointerstitial and vascular structures, respectively. The purpose of this study is to determine whether the WHO classification properly reflects the various morphologic findings of IgAN. Methods : We analyzed 354 cases of IgAN by both the WHO classification system and the semiquantitative scoring system and evaluated the correlations of these two methods. Results : The severity of the glomerular lesions (glomerulosclerosis, capsular adhesion and mesangial matrix expansion) and the tubulointerstitial lesions (interstitial fibrosis, tubular atrophy and interstitial lymphocytic infiltration) are strongly correlated with the increase of the WHO classes of IgAN (Spearman’s rho [R] ≥0.5, p<0.05). There is a weak correlation between crescent formation and the increase of the WHO classes (R=0.3, p<0.05). Conclusions : This study shows that the WHO classification well reflects the severity of various morphologic findings and this suggests a complementary role for the semi-quantitative scoring system in classifying IgAN.

Dermatomyositis in a Patient with Cholangiocarcinoma Detected by an [18F]-Fluorodeoxyglucose Positron Emission Tomography–Computed Tomography Scan

서경진,박진균,조승철,박현경,백해운,이경분,이동수,이경훈 대한암학회 2016 Cancer Research and Treatment Vol.48 No.2

Cholangiocarcinoma with paraneoplastic dermatomyositis (DM) is extremely rare, and the whole body positron emission tomography–computed tomography (PET-CT) finding of paraneoplastic DM is rarely reported. We report a 66-year-old woman with metastatic cholangiocarcinoma, initially presented with bilateral proximal muscle uptake on PET-CT without clinical muscle symptoms. The initial interpretation of the high muscle uptake was metastasis to the muscles. However, while awaiting for chemotherapy, muscle weakness evolved and rapidly progressed. The level of creatine phosphokinase was significantly elevated. Electromyography revealed moderate myopathy, and a muscle biopsy showed degenerating myofibers with variable sizes. The diagnosis of paraneoplastic dermatomyositis was made. This case highlights that, although rare, paraneoplastic dermatomyositis can be present with cholangiocarcinoma. Also, muscle inflammation can precede the clinical muscle symptoms, and paraneoplastic DM should be considered as a possible differential diagnosis in the assessment of cancer patients who present with abnormal muscle tracer uptake in PET-CT scans.

상완신경총의 영상

서경진,이정현,이경규 대한자기공명의과학회 2007 Investigative Magnetic Resonance Imaging Vol.11 No.2

상완신경총의 영상 진단은 복잡한 해부학적인 구조와 다양하게 침범하는 병들로 인해 어렵고 도전적이다. 상완신경총 영상 진단의 일차적인 목표는 외상성 손상과 비외상성 손상의구별이다. MRI의 급속경사와 전용표면코일을 이용한 적절한 공간분해능을 가진 영상기기의발전과 이를 이용한 다양한 펄스열의 개발이 상완신경총의 외상성 손상과 비외상성 손상에대한 구별에 많은 도움을 주어 정확한 진단으로 수술 여부의 결정에 이용된다. MRI는 비외상성 상완신경총 병변의 진단에 가장 좋은 영상진단이며, CT 척수강조영술은 상완신경총을침범하는 신경근견열 병변의 검사에 많이 이용된다. 그리고 일반적으로 고화질, 고해상력의MRI 가 상완신경총 비외상성병변의 진단에 일차적인 영상검사로 중요한 역할을 하고 있다.

경피경간 담배액술 : 175예의 분석

서경진 대한영상의학회 1990 대한영상의학회지 Vol.26 No.4

Percutaneous transhepatic biliary drainage is a safe, effective and palliative means of treatment in biliary obstruction, especially in cases with malignant obstruction which are inoperable. 175 cases of transhepatic biliary drainage were performed on 119 patients with biliary obstruction from January 1985 to June 1989 at kyung-pook National University Hospital. The causes of obstructive jaundice were 110 malignant diseases and 9 benign diseases. The most common indication for drainage was pilliative intervention of obstruction secondary to malignant tumor in 89 cases. 86 cases of external drainage were performed including 3 cases of left duct approach, 29 cases of external-internal drainage and 60 cases of endoprosthesis. In external and external-internal drainages, immediate major complications(11.9%) occured, including not restricted to, but sepsis, bile peritonitis and hemobilia. Delayed major complications942.9%) were mainly catheter related. The delayed major complicatio of endoprosthesis resulted from obstruction of the internal stent. The mean time period to reobstruction of the internal stent was about 12 weeks. To improve management status, regular follow-up is required, as is education of both patients and their families as to when immediate clinical attention is mandated. Close communication amongst the varying medical specialties involved will ber necessary to provide optimal treatment for each patient.

유골골종 : 수술전 CT 유도하의 핵표식

서경진 대한영상의학회 1996 대한영상의학회지 Vol.35 No.5

Purpose : To evaluate the utility of preoperative nidus localization guided by computed tomography(CT).Methods and Materials : In the light of clinical, radiographic, and imaging findings, osteoid osteoma wassuspected in all ten patients studied. An osteoid osteoma of the tibia was present in seven cases, and of thefemur in three. During the 24 hours preceeding surgery, a small hole was drilled directly over the nidus with a 15gauge Ostycut bone biopsy needle, using CT for control and guidance. The hole and needle tract were stained withGentian violet and GE 9800 and Hi Speed Advantage CT (GE) were used to obtain both 2D and 3D images. Results :Each osteoid osteoma was in the cortex of the bone, nidi ranged in size from 10x6x6 to 40$\times$7$\times$9mm and thesclerotic area around each varied in size between 150$\times$18$\times$14 and 50$\times$15$\times$12mm. Marking was successful on thefirst attempt in eight cases, on the second attempt in one case and on the third attempt in one case. The averagetime per marking attempt was 15 minutes. In the operating field, stained marking on the cortex was easily found inall cases. With the marking it was possible to excise only as much of the bone as necessary and none of the tenpatients suffered complications either during or after the procedure. The diagnosis of osteoid osteoma washistopathologically confirmed in all patients. Conclusion : CT guided nidus marking of an osteoid osteoma assuredprecise localization during surgery ; bone resection was therefore minimal and the time required for surgery wasreduced. The procedure is a simple, safe, effective method for precise and easy nidus excision.

저산소성 뇌손상의 자기공명영상 소견: 유병기간 및 예후와의 연관성

서경진,강채훈,유동수,김상준 대한자기공명의과학회 2006 Investigative Magnetic Resonance Imaging Vol.10 No.1

목적 : 저산소성 뇌손상의 자기공명영상(MR) 소견을 유병기간 및 예후와 연관 지어 알아보고자 하였다. 대상 및 방법 : 임상적으로 저산소성 뇌손상으로 진단된 환자 18명의 19예의 MR을 대상으로 분석하였다. MR은 저산소증 발생 후 1일에서 20일(평균 8.6일)사이에 시행되었으며, 대상환자의 T1 및 T2 강조영상에서 비정상 고신호강도 병변의 위치, 뇌부종의 동반 유무 및 시간경과와 예후에 따른 병변의 양상을 분석하였다. 결과 : 전체 19예의 MR영상에서, T2 강조영상에서의 고신호강도 병변은 기저핵(15예, 78.9%), 뇌피질(13예, 68.4%), 뇌백질(9예, 47.4%), 시상(6예, 31.6%), 소뇌(4예, 21.1%), 뇌간(1예, 5.3%)의 순으로 관찰되었다. 뇌피질의 병변은 모든 경우 심부회색질에도 이상소견을 동반 하였으며 양측성, 미만성의 병변을 보였고, 뇌피질 대부분 또는 두정·후두엽에 국한되어 나타났다. 뇌피질 및 심부회색질의 T2 강조영상에서의 고신호는 급성기(6일이내)부터 아급성기(6일이후)에 걸쳐 1예를 제외한 전 예에서 다양한 정도로 있었다. 뇌간이나 소뇌의 침범은 비교적 드물었고 모두 뇌피질의 병변이 동반되어 관찰되었다. 뇌백질의 병변도 대부분 아급성기에 뇌피질과 심부회색질의 병변이 있을 때 발생했지만 양측성 분수경계역 뇌경색의 소견으로 단독 침범한 경우도 1예 있었다. T1 강조영상에서의 고신호강도 병변은 뇌피질 및 심부회색질에 주로 아급성기에 관찰되었으나, 급성기에도 일부 관찰되었다. 뇌부종은 11예에서 급성기, 아급성기에 걸쳐 관찰되었다. 의식이 회복된 환자의 MR에서 뇌피질의 침범이나 뇌부종의 빈도가 적었다. 결론 : 저산소성 뇌손상의 MR소견은 다양하지만, 거의 대부분 뇌피질과 심부 뇌회색질을 침범하는 양측성 미만성의 병변으로 나타났다. 뇌백질의 병변은 아급성기 이후에 주로 나타나나 급성기의 혹은 단독의 병변으로도 나타날 수 있다. 뇌피질의 침범정도가 경미하거나 뇌부종이 미약한 경우 예후가 좋았다.

Costs and clinical outcomes of patients with diffuse large B-cell lymphoma in first remission: role of PET/CT surveillance

서경진,김기환,김률,변자민,김미소,박진현,김범석,김태민,김진수,최인실,허대석 대한내과학회 2019 The Korean Journal of Internal Medicine Vol.34 No.4

Background/Aims: The role of [18F]-f luorodeoxyglucose positron emission tomography- computed tomography (PET/CT) in patients with diffuse large B-cell lymphoma (DLBCL) in first remission is unclear. Methods: Medical costs within the first 3 years of treatment completion and clinical outcomes of 118 patients with DLBCL in first remission with and without surveillance PET/CT (PET/CT [+] group [n = 76] and PET/CT [–] group [n = 42], respectively) were retrospectively analyzed. Results: In a propensity matched cohort with adjustment for International Prognostic Index risk and relapse, the PET/CT (+) group was shown to have similar medical costs as the PET/CT (–) group. Relapse-free survival (RFS) and overall survival (OS) were comparable between the two groups (median RFS not reached [NR] for both groups, p = 0.133; median OS NR, p = 0.542). Among 76 patients with surveillance PET/CT, 31 (40.8%) had findings suggestive of recurrence and 16 of these (51.6%) were later confirmed to have recurrent disease. Fifteen patients (48.4%) were confirmed to not have recurrence after follow-up CT or PET/CT evaluation (n = 10) and biopsy (n = 4). None of the patients with negative PET/CT findings had disease recurrence. Sensitivity, specificity, positive predictive value, and negative predictive value of PET/CT for detection of recurrence were 1, 0.75, 0.52, and 1, respectively. Conclusions: Surveillance PET/CT resulted in similar clinical outcomes and medical costs compared to no surveillance PET/CT. Approximately half of patients with PET/CT findings of recurrence had no recurrence after follow-up imaging and biopsy, which would not have been carried out if PET/CT had not been performed in the first place.