Satellite Nodule의 존재여부가 근치적 신절제술을 시행한 환자의 생존율에 미치는 영향

이상은,김대영,손환철,조규선,변석수,박문수,김현회 大韓泌尿器科學會 1998 Korean Journal of Urology Vol.39 No.12

외과적 갑상선 결절에 대한 임상적 고찰

박현정(Hyeon Jung Park),문상은(Sang Eun Moon) 대한두경부종양학회 1993 대한두경부 종양학회지 Vol.9 No.2

The thyroid nodules are the most common endocrine disease requiring surgical management. Up to date, various diagnostic techniques and surgical management have been developed. Authors analysed 2285 cases of thyroid nodules who were treated at Department of Surgery, Pusan National University for the duration of 10 years from January 1980 to December 1989 and the results obtained were summerized as follows: 1) Patients were composed of 1727 cases(75.8%) of benign nodule and 558 cases(24.5%) of malignant nodule. Benign nodule was prevalent in forth and fifth decade comparing with malignant nodule was sixth and fifth decade. The sexual distribution revealed female preponderance with 1:10.8 in benign nodule and 1:9.3 in malignant nodule. 2) The histopathologic classfication of benign nodule in decreasing order of frequency were follicular adenoma 1009 cases(54.8%), adenomatous goiter 573 cases(33.3%), simple cyst 65 cases(3.8%), and Hashimoto's thyroiditis 52 cases(3.0%). The malignant disease were papillary adenocarcinoma 460 cases(82.4%), follicular adenocarcinoma 69 cases(12.4%), undifferentiated carcinoma 13 cases (2.0%), and medullary carcinoma 7 cases(1.0%). 3) Fine needle aspiration cytology was performed in 1758 cases and it showed 80.5% of sensitivity, 96.5% of specificity, 19.5% of false negative and 80% of accuracy. 4) The location of nodule was 87.7%, in unilateral, 12.2% in bilateral. 5) On the radioiodine scanning, the incidence of benign nodule with cold nodule was 83.9% and the incidence of benign nodule with hot nodule was 7.5%. The incidence of thyroid carcinoma with cold nodule was 88.3% and the incidence of thyroid carcinoma with hot nodule was 4.6%. 6) Most cases of benign nodules were treated with lobectomy 82.6%, subtotal thyroidectomy 10.1% and subtotal lobectomy 3.0%. Malignant nodules were treated with lobectomy and/or isthmusectomy 37.6%, total thyroidectomy 17.7%, subtotal thyroidectomy 15.4%, and any thyroidectomy and neck dissection 13.5%. 7) Postoperative complications were developed in 3.8% of benign nodules and 13.8% of malignant nodules.

Nodule Detection in a Lung Region that’s Segmented with Using Genetic Cellular Neural Networks and 3D Template Matching with Fuzzy Rule Based Thresholding

Serhat Ozekes,Onur Osman,Osman N. Ucan 대한영상의학회 2008 Korean Journal of Radiology Vol.9 No.1

Objective: The purpose of this study was to develop a new method for automated lung nodule detection in serial section CT images with using the characteristics of the 3D appearance of the nodules that distinguish themselves from the vessels. Materials and Methods: Lung nodules were detected in four steps. First, to reduce the number of region of interests (ROIs) and the computation time, the lung regions of the CTs were segmented using Genetic Cellular Neural Networks (G-CNN). Then, for each lung region, ROIs were specified with using the 8 directional search; +1 or -1 values were assigned to each voxel. The 3D ROI image was obtained by combining all the 2-Dimensional (2D) ROI images. A 3D template was created to find the nodule-like structures on the 3D ROI image. Convolution of the 3D ROI image with the proposed template strengthens the shapes that are similar to those of the template and it weakens the other ones. Finally, fuzzy rule based thresholding was applied and the ROI's were found. To test the system's efficiency, we used 16 cases with a total of 425 slices, which were taken from the Lung Image Database Consortium (LIDC) dataset. Results: The computer aided diagnosis (CAD) system achieved 100% sensitivity with 13.375 FPs per case when the nodule thickness was greater than or equal to 5.625 mm. Conclusion: Our results indicate that the detection performance of our algorithm is satisfactory, and this may well improve the performance of computeraided detection of lung nodules. Objective: The purpose of this study was to develop a new method for automated lung nodule detection in serial section CT images with using the characteristics of the 3D appearance of the nodules that distinguish themselves from the vessels. Materials and Methods: Lung nodules were detected in four steps. First, to reduce the number of region of interests (ROIs) and the computation time, the lung regions of the CTs were segmented using Genetic Cellular Neural Networks (G-CNN). Then, for each lung region, ROIs were specified with using the 8 directional search; +1 or -1 values were assigned to each voxel. The 3D ROI image was obtained by combining all the 2-Dimensional (2D) ROI images. A 3D template was created to find the nodule-like structures on the 3D ROI image. Convolution of the 3D ROI image with the proposed template strengthens the shapes that are similar to those of the template and it weakens the other ones. Finally, fuzzy rule based thresholding was applied and the ROI's were found. To test the system's efficiency, we used 16 cases with a total of 425 slices, which were taken from the Lung Image Database Consortium (LIDC) dataset. Results: The computer aided diagnosis (CAD) system achieved 100% sensitivity with 13.375 FPs per case when the nodule thickness was greater than or equal to 5.625 mm. Conclusion: Our results indicate that the detection performance of our algorithm is satisfactory, and this may well improve the performance of computeraided detection of lung nodules.

Resource Assessment of Polymetallic Nodules Using Acoustic Backscatter Intensity Data from the Korean Exploration Area, Northeastern Equatorial Pacific

유찬민,주종민,이상훈,고영탁,지상범,김형직,서인아,형기성 한국해양과학기술원 2018 Ocean science journal Vol.53 No.2

A high level of confidence in resource data is a key prerequisite for conducting a reliable economic feasibility study in deep water seafloor mining. However, the acquisition of accurate resource data is difficult when employing traditional point-sampling methods to assess the resource potential of polymetallic nodules, given the vast size of the survey area and high spatial variability in nodule distribution. In this study, we analyzed high-resolution acoustic backscatter intensity images to estimate nodule abundance and increase confidence levels in nodule abundance data. We operated a 120 kHz deep-towed sidescan sonar (DSL-120) system (1×1 m resolution) across a 75 km2 representative area in the Korean Exploration Area for polymetallic nodules in the Northeastern Equatorial Pacific. A deep-towed camera system was also run along two tracks in the same area to estimate the abundance of polymetallic nodules on the seafloor. Backscatter data were classified into four facies based on intensity. The facies with the weakest and strongest backscatter intensities occurred in areas of high slope gradient and basement outcrops, respectively. The backscatter intensities of the two other facies correlated well with the nodule abundances estimated from still-camera images. A linear fit between backscatter intensity and mean nodule abundance for 10 zones in the study area yielded an excellent correlation (r2 = 0.97). This allowed us to compile a map of polymetallic nodule abundance that shows greater resolution than a map derived from the extrapolation of point-sampling data. Our preliminary analyses indicate that it is possible to greatly increase the confidence level of nodule resource data if the relationship between backscatter intensity and nodule abundance is reliably established. This approach has another key advantage over point sampling and image analyses in that detailed maps of mining obstacles along the seafloor are produced when acquiring data on the abundance of polymetallic nodules. The key limitation of this work is a poor correlation between nodule coverage, as observed from photographs, and nodule abundance. Significant additional ground truth sampling using well located box cores should be completed to determine whether or not there is a real correlation between the backscatter and abundance.

Resource Assessment of Polymetallic Nodules Using Acoustic Backscatter Intensity Data from the Korean Exploration Area, Northeastern Equatorial Pacific

Yoo, Chan Min,Joo, Jongmin,Lee, Sang Hoon,Ko, Youngtak,Chi, Sang-Bum,Kim, Hyung Jeek,Seo, Inah,Hyeong, Kiseong Korean Ocean Research & Development Institute and 2018 OCEAN SCIENCE JOURNAL Vol.53 No.2

A high level of confidence in resource data is a key prerequisite for conducting a reliable economic feasibility study in deep water seafloor mining. However, the acquisition of accurate resource data is difficult when employing traditional point-sampling methods to assess the resource potential of polymetallic nodules, given the vast size of the survey area and high spatial variability in nodule distribution. In this study, we analyzed high-resolution acoustic backscatter intensity images to estimate nodule abundance and increase confidence levels in nodule abundance data. We operated a 120 kHz deep-towed sidescan sonar (DSL-120) system (<TEX>$1{\times}1m$</TEX> resolution) across a <TEX>$75km^2$</TEX> representative area in the Korean Exploration Area for polymetallic nodules in the Northeastern Equatorial Pacific. A deep-towed camera system was also run along two tracks in the same area to estimate the abundance of polymetallic nodules on the seafloor. Backscatter data were classified into four facies based on intensity. The facies with the weakest and strongest backscatter intensities occurred in areas of high slope gradient and basement outcrops, respectively. The backscatter intensities of the two other facies correlated well with the nodule abundances estimated from still-camera images. A linear fit between backscatter intensity and mean nodule abundance for 10 zones in the study area yielded an excellent correlation (<TEX>$r^2=0.97$</TEX>). This allowed us to compile a map of polymetallic nodule abundance that shows greater resolution than a map derived from the extrapolation of point-sampling data. Our preliminary analyses indicate that it is possible to greatly increase the confidence level of nodule resource data if the relationship between backscatter intensity and nodule abundance is reliably established. This approach has another key advantage over point sampling and image analyses in that detailed maps of mining obstacles along the seafloor are produced when acquiring data on the abundance of polymetallic nodules. The key limitation of this work is a poor correlation between nodule coverage, as observed from photographs, and nodule abundance. Significant additional ground truth sampling using well located box cores should be completed to determine whether or not there is a real correlation between the backscatter and abundance.

Inter-Observer Variation in Ultrasound Measurement of the Volume and Diameter of Thyroid Nodules

최영준,백정환,홍민지,이정현 대한영상의학회 2015 Korean Journal of Radiology Vol.16 No.3

Thyroid nodule measurement using ultrasonography (US) is widely performed in various clinical scenarios. The purpose of this study was to evaluate inter-observer variation in US measurement of the volume and maximum diameter of thyroid nodules. This retrospective study included 73 consecutive patients with 85 well-defined thyroid nodules greater than 1 cm in their maximum diameter. US examinations were independently performed by using standardized measurement methods, conducted by two clinically experienced thyroid radiologists. The maximum nodule diameter and nodule volume, calculated from nodule diameters using the ellipsoid formula, were obtained by each reader. Inter-observer variations in volume and maximum diameter were determined using 95% Bland-Altman limits of agreement. The degree of inter-observer variations in volumes and the maximum diameters were compared using the Student’s t test, between nodules < 2 cm in maximum diameter and those with ≥ 2 cm. The mean inter-observer difference in measuring the nodule volume was -1.6%, in terms of percentage of the nodule volume, and the 95% limit of agreement was ± 13.1%. For maximum nodule diameter, the mean inter-observer difference was -0.6%, in terms of percentage of the nodule diameter, and the 95% limit of agreement was ± 7.3%. Inter-observer variation in volume was greater in nodules of < 2 cm in maximum diameter, compared to the larger nodules (p = 0.035). However, no statistically significant difference was noted between the two groups regarding maximum nodule diameters (p = 0.511). Any differences smaller than 13.1% and 7.3% in volume and maximum diameter, respectively, measured by using US for well-defined thyroid nodules of > 1 cm should not be considered as a real change in size.

Graves병에서 발생한 갑상선 암

권수경,임동현,강상중,김성만,최영식,박요한 고신대학교 의학부 2000 高神大學校 醫學部 論文集 Vol.15 No.1

Background Thyroid nodules in patients with Graves' disease are common and raise concern about coexistent thyroid malignancy. Furthermore, it was reported that thyroid cancers in patients with Graves' disease were more aggressive than those without. Thus, it is important to detect thyroid cancer in the patients with Graves' disease prior to surgery. However, there has been no standard guideline suggested for the management of thyroid nodules in the Graves' disease. Therefore, we tried to characterize thyroid nodules associated with Graves' disease and to assess the usefulness of ultrasonography and high resolution ultrasound-guided fine needle aspiration (FNA) in the management of thyroid nodules associated with Graves' disease. Methods Sixty-five patients were included in the study who underwent high resolution ultrasound-guided FNA for thyroid nodules of the 341 patients with Graves' disease at Kosin Medical Center from June, 1996 to January, 1999. Thyroid nodules were classified according to the internal echo pattern, numbers and the size of nodule. Results Thyroid nodules occurred in 19.1% of patients with Graves' disease. The age of the patients with nodules distributed evenly through third to seventh decade (18-68 years, mean 43 years). Thyroid nodules occurred evenly between third decade seventh decade. Male to female ratio was 1:4.09. Thyroid cancers occurred in 6 patients (9.2%) of nodules, and was 1.76% of the total Graves' patients. Eight cases underwent operation. Of those 5 were papillary carcinoma and 2 adenomatous goiter, and 1 Hu¨rthle cell carcinoma. Malignant thyroid nodules occur evenly between third decade to seventh decade. The incidence of malignancy was 10.7%(3/28) in solitary nodule and 8.1%(3/37) in multiple nodules. Thirty-six cases (55.4%) were measured 1㎝ or less, 27 cases (41.4%) between 1.0㎝ to 3.0㎝, and 2 cases (0.32%) above 3㎝, and malignant nodules were 3 (11.1%), 2(7.4%), and 1 (50.0%) respectively. The size of malignant nodule ranged between 0.5㎝ and 4.2㎝. Three of malignant nodules were microcarcinoma (≤1㎝) and the smallest one (0.5㎝) metastasized to regional lymph node. Of the 65 nodules, 50 cases were solid, 4 cystic, and 11 mixed. Malignant nodules were more frequent in the solid nodule, but there was no significant difference between each group. The titers of thyrotropin binding inhibitory immunoglobulin(TBⅡ) in the malignant patients were 9.2% to 350.0% and TBⅡ was positive in the 4 of 6 cases of malignacy. The obtainability of adequate cytologic specimen by ultrasound-guided FNA was 95.9%. No complication except pain on aspiration site was noted during this study. Conclusion The incidence of thyroid nodule in Graves' patients was high and the rate of malignancy also high in Graves' patients with thyroid nodule. Malignant thyroid nodules occurred relatively evenly through third to seventh decade. Large proportions of malignant nodules were microcarcinomas and even the smallest on of the malignant nodules metastasized to regional lymph node. Therefore, for the proper management of thyroid nodule associated with Graves' disease, it is suggested that ultrasonography be needed to detect thyroid nodule in all Graves' patients, and ultrasound-guided FNA be performed for the diagnosis of small thyroid cancer.

Impact of Nodule Size on Malignancy Risk Differs according to the Ultrasonography Pattern of Thyroid Nodules

홍민지,나동규,백정환,성진용,김지훈 대한영상의학회 2018 Korean Journal of Radiology Vol.19 No.3

Objective: To test whether the impact of thyroid-nodule size on the malignancy risk differs according to the ultrasonography (US) patterns of nodules. Materials and Methods: This study is a post hoc analysis using data from the Thyroid Imaging Reporting and Data System (TIRADS) multicenter retrospective study which included 2000 consecutive thyroid nodules (≥ 1 cm) with final diagnoses. A total of 2000 consecutive thyroid nodules from 1802 patients (1387 women and 613 men; mean age, 51.2 ± 12.2 years) were enrolled in this study. The malignancy risk of the nodules was assessed according to the nodule size and US patterns (Korean-TIRADS). Results: Overall, the malignancy risk did not increase as nodules enlarged. In high-suspicion nodules, the malignancy rate had no association with nodule size (p = 0.467), whereas in intermediate- or low-suspicion nodules there was a trend toward an increasing malignancy risk as the nodule size increased (p = 0.004 and 0.002, respectively). The malignancy rate of large nodules (≥ 3 cm) was higher than that of small nodules (< 3 cm) in intermediate-suspicion nodules (40.3% vs. 22.6%, respectively; p = 0.001) and low-suspicion nodules (11.3% vs. 7.0%, respectively; p = 0.035). There was a trend toward a decreasing risk and proportion of papillary carcinoma and an increasing risk and proportion of follicular carcinoma or other malignant tumors as nodule size increased (p < 0.001, respectively). Conclusion: The impact of nodule size on the malignancy risk differed according to the US pattern. A large nodule size (≥ 3 cm) showed a higher malignancy risk than smaller nodules in intermediate- and low-suspicion nodules.

Umbilical dermatoses simulating Sister Mary Joseph nodule

( Min Young Yang ),( Jeong Min Kim ),( Gun Wook Kim ),( Margaret Song ),( Hoon Soo Kim ),( Hyun Chang Ko ),( Byung Soo Kim ),( Moon Bum Kim ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.2

Background: Umbilicus is the remnant organ of the umbilical cords and its adnexa in prenatal periods. When seeing umbilical nodule, most physician instinctively recall Sister Mary Joseph nodule. In this respect, dermatologists need to recognize other umbilical dermatoses simulating it. Objectives: To present what kinds of dermatoses simulate Sister Mary Joseph nodule and useful differential diagnostic points. Methods: 23 patients were enrolled with 2 patients of Sister Mary Joseph nodule as control. Their clinical and dermatoscopic photos were checked, and final diagnosis was pathologically confirmed. Results: The most common dermatosis was dermatofibroma (21.7%) followed by keloid (13.0%), soft fibroma (13.0%). Benign nodule showed various color including red, brown to black, skin-color and various surface change such as ulcer in giant neurofibroma, verrucous change in seborrheic keratosis, verruca. On the other hand, Sister Mary Joseph nodule had erythematous color, and satellite lesion in the vicinity of umbilical nodule on clinical examination. Furthermore, Sister Mary Joseph nodule exhibited a polymorphous vascular pattern in dermoscopic finding, while benign lesion showed different pattern such as white area in dermatofibroma, thrombosed capillaries in verruca, and the ‘pore’ sign in epidermal cyst. Conclusion: Various benign dermatoses can manifest as Sister Mary Joseph nodule-like appearance, and the clinical and dermatoscopic differences could be useful for differential diagnosis.

Graves병에서 발생한 갑상선 암

권수경,임동현,강상중,김성만,최영식,박요한 고신대학교(의대) 고신대학교 의과대학 학술지 2000 고신대학교 의과대학 학술지 Vol.15 No.1

Background : Thyroid nodules in patients with Graves' disease are common and raise concern about coexistent thyroid malignancy. Furthermore, it was reported that thyroid cancers in patients with Graves' disease were more aggressive than those without. Thus, it is important to detect thyroid cancer in the patients with Graves' disease prior to surgery. However, there has been no standard guideline suggested for the management of thyroid nodules in the Graves' disease. Therefore, we tried to characterize thyroid nodules associated with Graves' disease and to assess the usefulness of ultrasonography and high resolution ultrasound-guided fine needle aspiration (FNA) in the management of thyroid nodules associated with Graves' disease. Methods : Sixty-five patients were included in the study who underwent high resolution ultrasound-guided FNA for thyroid nodules of the 341 patients with Graves' disease at Kosin Medical Center from June, 1996 to January, 1999. Thyroid nodules were classified according to the internal echo pattern, numbers and the size of nodule. Results : Thyroid nodules occurred in 19.1% of patients with Graves' disease. The age of the patients with nodules distributed evenly through third to seventh decade (18-68 years, mean 43 years). Thyroid nodules occurred evenly between third decade to seventh decade. Male to female ratio was 1:4.09. Thyroid cancers occurred in 6 patients (9.2%) of nodules, and was 1.76% of the total Graves' patients. Eight cases underwent operation. Of those 5 were papillary carcinoma and adenomatous goiter, and 1 Hurthle cell carcinoma. Malignant thyroid nodules occur evenly between third decade to seventh decade. The incidence of malignancy was 10.7% (3/28) in solitary nodule and 8.1% (3/37) in multiple nodules. Thirty-six cases (55.4%) were measured 1cm or less, 27 cases (41.4%) between 1.0cm to 3.0cm, and 2 cases (0.32%) above 3cm, and malignant nodules were 3 (11.1%), 2 (7.4%) and 1 (50.0%) respectively. The size of malignant nodule ranged between 0.5cm and 4.2cm. Three of malignant nodules were microcarcinoma (≤1cm) and the smallest one (0.5cm) metastasized to regional lymph node. Of the 65 nodules, 50 cases were solid, 4 cystic, and 11 mixed. Malignant nodules were more frequent in the solid nodule, but there was no significant difference between each group. The titers of thyrotropin binding inhibitory immunoglobulin (TBII) in the malignant patients were 9.2% to 350.0% and TBII was positive in the 4 of 6 cases of malignancy. The obtainability of adequate cytologic specimen by ultrasound-guided FNA was 95.9%. No complication except pain on aspiration site was noted during this study. Conclusion : The incidence of thyroid nodule in Graves' patients was high and the rate of malignancy also high in Graves' patients with thyroid nodule. Malignant thyroid nodules occurred relatively evenly through third to seventh decade. Large proportions of malignant nodules were microcarcinomas and even the smallest one of the malignant nodules metastasized to regional lymph node. Therefore, for the proper management of thyroid nodule associated with Graves' disease, it is suggested that ultrasonography be needed to detect thyroid nodule in all Graves' patients, and ultrasound-guided FNA be performed for the diagnosis of small thyroid cancer.