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Fertility preservation in women with cancer is important for improving their quality of life. Successful ovarian transposition protects the ovary from radiation and preserves ovarian endocrine function and fertility. With the increasing use of 18F-FDG PET/CT in gynecologic malignancies, the findings of transposed ovaries sometimes vary. This study aimed to characterize the 18F-FDG PET/CT findings of surgically transposed ovaries among a large number of patients with various medical conditions. We retrospectively reviewed the medical records, including surgical history, and analyzed the findings of the transposed ovaries of patients who underwent ovarian transposition. Quantitative analysis was performed, and the maximum standardized uptake values (SUVs) were recorded. The Hounsfield unit (HU) and size (measured using the long diameter on the axial image) of the transposed ovary were evaluated. No significant change was found in the SUV of the transposed ovaries in relation to age and time after surgery. In two cases in which metastasis occurred in the transposed ovary, the lesions showed higher SUVs and HUs than did the other non-metastatic transposed ovaries. In several serial follow-up cases, varying 18F-FDG uptake was observed. The 18F-FDG uptake pattern of the transposed ovary did not differ from that of the normal ovary. Misinterpretation should be avoided by considering surgical records, presence of surgical clips, and patients’ disease state. If there is a high uptake in the transposed ovary, it is necessary to check for soft tissue lesions and differentiate metastasis from the physiologic uptake.

Immunotherapy for programmed cell death 1 (PD-1) and its ligand, PD-L1, has been considered an effective treatment for ovarian cancer. 18F-labeled fluoro-2-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is a widely used noninvasive imaging tool for diagnosing several cancers. In this study, we investigated the association between PD-L1 expression and the maximum standardized uptake value (SUVmax) using 18F-FDG PET/CT. We retrospectively analyzed clinical data of patients with ovarian cancer who underwent 18F-FDG PET/CT. Patients were categorized into two groups according to PD-L1 expression results. The relationship between clinicopathological characteristics of patients with ovarian cancer and PD-L1 expression was examined. SUVmax was significantly higher in PD-L1-positive tumors than in PD-L1-negative tumors (16.1 ± 5.2 and 12.7 ± 7.0, respectively; p = 0.026). There were no significant differences in age, histologic type, and tumor grade between the PD-L1-negative and PD-L1-positive groups. The receiver operating characteristic curve analysis demonstrated that the highest accuracy (61.8%) for predicting PD-L1 expression was obtained with an SUVmax cutoff value of 10.5. There was a significant correlation between 18F-FDG uptake and PD-L1 expression, suggesting a role of 18F-FDG PET/CT in selecting ovarian cancer candidates for anti-PD-L1 antibody therapy.

Background HLA-DQ typing in deceased donors is not mandatory in Korea. Therefore, when patients develop DQ antibodies after kidney transplantation (KT) from deceased donor, it is impossible to determine whether they are donor-specific antibodies (DSA). We developed DQ prediction programs for the HLA gene and evaluated their clinical utility. Methods Two HLA-DQ prediction programs were developed: one based on Lewontin's linkage disequilibrium (LD) and haplotype frequency and the other on an artificial neural network (ANN). Low-resolution HLA-A, -B, -DR, and -DQ typing data of 5,603 Korean patients were analyzed in terms of haplotype frequency and used to develop an ANN DQ prediction program. Predicted DQ (pDQ) genotype accuracy was analyzed using the typed DQ data of 403 patients. pDQ DSA agreement, sensitivity, specificity, and false-negative rate was evaluated using 1,970 single-antigen bead assays performed on 885 KT recipients. The clinical significance of DQ and pDQ DSA was evaluated in 411 KT recipients. Results pDQ genotype accuracies were 75.4% (LD algorithm) and 75.7% (ANN). When the second most likely pDQ (LD algorithm) was also considered, the genotype accuracy increased to 92.6%. pDQ DSA (LD algorithm) agreement, sensitivity, specificity, and false-negative rate were 97.5%, 97.3%, 98.6%, and 2.4%, respectively. The antibody-mediated rejection treatment frequency was significantly higher in DQ or pDQ DSA-positive patients than in DQ or pDQ DSA-negative patients (P

DDX41 mutations are associated with hematologic malignancies including myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML), but the incidence in idiopathic cytopenia of undetermined significance (ICUS) is unknown. We investigated the incidence, genetic characteristics, and clinical features of DDX41 mutations in Korean patients with ICUS, MDS, or AML. We performed targeted deep sequencing of 61 genes including DDX41 in 457 patients with ICUS (n=75), MDS (n=210), or AML (n=172). Germline DDX41 mutations with causality were identified in 28 (6.1%) patients, of whom 27 (96.4%) had somatic mutations in the other position of DDX41. Germline origins of the DDX41 mutations were confirmed in all of the 11 patients in whom germline-based testing was performed. Of the germline DDX41 mutations, p.V152G (n=10) was most common, followed by p.Y259C (n=8), p.A500fs (n=6), and p.E7* (n=3). Compared with non-mutated patients, patients with a DDX41 mutation were more frequently male, older, had a normal karyotype, low leukocyte count, and hypocellular marrow at diagnosis. Three of the four ICUS patients with germline DDX41 mutations progressed to MDS. The incidence of DDX41 mutations in Korean patients was high and there was a distinct mutation pattern, in that p.V152G was a unique germline variant. ICUS harboring germline DDX41 mutations may be regarded as a hereditary myeloid neoplasm. Germline DDX41 mutations are not uncommon and should be explored when treating patients with myeloid malignancies.

Objective We designed a study to compare the efficacy of cryoprecipitate-reduced plasma (CRP) and fresh frozen plasma (FFP), at the level of individual sessions, for treating refractory thrombotic microangiopathy (TMA) with therapeutic plasma exchange (TPE). Materials and Methods Platelet counts (× 10³/μL) and lactate dehydrogenase (LD; IU/L) levels were measured before and after each session. We compared the mean-percentage and absolute changes in platelet count and LD after each TPE session. Results The data from 33 patients treated for TMA between 2009 and 2018 were collected for this study. Both absolute and percentage increases in the platelet count were statistically significant (P = .003 and P = .011, respectively) when CRP was used. However, when patients were divided into subgroups according to specific diagnosis, no significant differences were found among the groups, except in terms of the absolute platelet count increase in the thrombotic thrombocytopenic purpura group (P Conclusion The platelet count increase was higher when patients received CRP than when they received FFP. We found that CRP may be a rescue option for patients with refractory TMA.

Purpose: Thyroglobulin antibody (TgAb) elevation after I-131 ablation may be difficult to evaluate in cases of recurrence, especially in high-risk patients. This study aimed to evaluate factors contributing to TgAb normalization in papillary thyroid cancer patients receiving high-dose I-131 therapy. Methods: From September 2009 to June 2012, 98 papillary thyroid cancer patients treated with 150 mCi radioactive iodine (RAI) were retrospectively enrolled. Early (3 day) and Delayed (7 day) post-RAI neck counts and reduction ratios were measured and correlated with clinical and pathologic findings. Patients with normal neck ultrasound and undetectable level of serum thyroglobulin (Results: Thirty-five patients (35.7%) had thyroiditis and 28 (28.6%) achieved ablation success. The thyroiditis group had lower neck counts in both Early and Delayed whole-body scans (WBS), and higher reduction rates than the thyroiditis-absent group. In the ablation success group, Early and Delayed neck counts were significantly higher and the reduction rate of RAI was lower than those in the ablation failure group (p < 0.05). In multivariable analysis, Delayed neck count was the only significant factor for predicting ablation failure (odds ratio = 54.37, 95% confidence interval = 1.33-14.32; p = 0.015).Conclusion: I-131 uptake in the remnant thyroid gland and thyroiditis are factors that indicate TgAb normalization and ablation success in thyroid cancer patients receiving high-dose I-131 therapy.

Background/Aims: Postal distribution of a fecal immuno chemical test (FIT) kit has been recommended as an effec tive method of increasing participation in colorectal cancer (CRC) screening. The present study was performed to assess the impact of the round-mailed FIT kit on screening participa tion in underserved regions of Korea and to identify factors related to nonparticipation. Methods: Residents were re cruited from three rural regions of Korea that lack screening units for the National Cancer Screening Program. A package containing a FIT kit for stool self-sampling and a return enve lope addressed to the local health center was postally distrib uted to each subject. Thirty days after the kits were mailed, nonresponders were reminded via telephone as the second intervention. The participation rates and odds ratios with 95% confidence intervals (CIs) for each intervention response were calculated to evaluate the effect of the interventions and factors related to screening participation in response to the interventions. Results: CRC screening participation rates increased from 24.5% (95% CI, 21.6% to 27.4%) to 42.6% (95% CI, 39.3% to 46.0%) as a result of postal screening and increased further to 51.4% (95% CI, 48.0% to 54.9%) after the telephone reminder. After controlling for the sex, age, and household type of each subject, factors associated with poor response to postal screening were identified as low educa tional attainment and poor previous participation in the Na tional Cancer Screening Program. Conclusions: Round-mailed FIT kits with phone call reminders were an effective inter vention, nearly doubling the screening rate in underserved regions of Korea. (Gut Liver 2020;14:323-330)

Background Criteria for selection of FFP blood type has not been clearly established and use of group AB plasma is preferred by numerous transplantation protocols. Aims This study assesses the safety and efficacy of alternative group A or B plasma in ABO incompatible solid organ transplantation. Materials & methods Alternative use of group A or B plasma (incompatible plasma) was inevitable during the shortage of group AB plasma. Experience from select number of patients during the period of extreme group AB plasma shortage is described. Results The result of alternative use of group A or B plasma was within expectation, showing effective reduction of isoagglutinin titers for pre-operative desensitization and efficacy for treatment of post-operative patients. No immediate hemolytic transfusion reaction was reported. Discussion While validation in a larger cohort of patients is necessary, our limited experience have shown satisfactory clinical outcomes without adverse events. Conclusions Use of incompatible group A or B plasma is a viable option when group AB plasma is limited.

Background/Aims: Mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach is an uncommon disease. Bone marrow involvement is reported even in patients with only a mucosal lesion. We evaluated the prevalence and risk factors of marrow involvement and its implications for diagnosis and treatment. Methods: In total, 132 patients who were diagnosed with gastric MALT lymphoma at the National Cancer Center in Korea between January 2001 and December 2016 were enrolled in the study. The patient data were collected and analyzed retrospectively. Results: Of the 132 patients, 47 (35.6%) were male, with a median age of 52 years (range, 17 to 81 years). The median follow-up duration was 48.8 months (range, 0.5 to 169.9 months). Helicobacter pylori infection was detected in 82 patients (62.1%). Most patients (80.3%) had stage IE1 according to the modified Ann Arbor staging system. Ninety-two patients underwent bone marrow evaluation, and four patients (4.3%) had marrow involvement. Of these patients, one presented with abdominal lymph node involvement, while the other three had stage IE1 disease if marrow involvement was disregarded. All three patients had no significant symptoms and were monitored after local treatment without evidence of disease aggravation. Conclusions: Bone marrow involvement was found in 4.3% of the patients with gastric MALT lymphoma. Bone marrow examination may be deferred because marrow involvement does not change the treatment options or outcome in gastric MALT lymphoma confined to the stomach wall. (Gut Liver 2018;12:278-287)

This study aimed to evaluate the impact of seasonal variations in climate on the performance of the fecal immunochemical test (FIT) in screening for colorectal cancer in the National Cancer Screening Program in Korea.Data were extracted from the National Cancer Screening Program databases for participants who underwent FIT between 2009 and 2010. We compared positivity rates, cancer detection rates, interval cancer rates, positive predictive value, sensitivity, and specificity for FIT during the spring, summer, fall, and winter seasons in Korea.In total, 4,788,104 FIT results were analyzed. FIT positivity rate was lowest during the summer months. In the summer, the positive predictive value of FIT was about 1.1 times (adjusted odds ratio (aOR) 1.08, 95% confidence interval (CI) 1.00-1.16) higher in the overall FIT group and about 1.3 times (aOR 1.29, 95% CI 1.10-1.50) higher in the quantitative FIT group, compared to those in the other seasons. Cancer detection rates, however, were similar regardless of season. Interval cancer risk was significantly higher in the summer for both the overall FIT group (aOR 1.16, 95% CI 1.07-1.27) and the quantitative FIT group (aOR 1.31, 95% CI 1.12-1.52). In addition, interval cancers in the rectum and distal colon were more frequently detected in the summer and autumn than in the winter.The positivity rate of FIT was lower in the summer, and the performance of the FIT screening program was influenced by seasonal variations in Korea. These results suggest that more efforts to reduce interval cancer during the summer are needed in population-based screening programs using FIT, particularly in countries with high ambient temperatures.

Background Idiopathic cytopenia of undetermined significance (ICUS) is characterized by a persistent and clinically significant cytopenias which does not meet the diagnostic criteria for myelodysplastic syndrome (MDS). In some patients with ICUS, disease evolution to MDS or acute myeloid leukemia after variable periods of time was observed in several studies. However, the incidence and predictive factors of progression as well as management guidelines for ICUS patients are not well established. We aimed to identify the clinical and genetic characteristics of ICUS in comparison with lower-risk MDS for understanding the pathophysiologic features and providing guidance for treating physicians. Methods We performed targeted deep sequencing including 61 myeloid neoplasm-related genes with a MiSeqDx sequencer (Illumina) using bone marrow (BM) samples obtained from the patients with ICUS (n=139) and MDS (n=226) between May 2009 and December 2019. The cut-off level of variant allele frequency (VAF) was set to 2.0% of mutant allele reads. Cloncal cytopenia of undetermined significance (CCUS) was defined as ICUS with ≥ 2% VAF of mutations and lower-risk MDS was defined as MDS with revised international prognostic scoring system ≤3.5. Results When we compared the overall survival (OS) of the patients according to the disease subtypes, OS of CCUS (77.0% at 5-year) was significantly better than that of higher-risk MDS (41.0%, P Conclusion In our study, CCUS and lower-risk MDS showed similar OS which was significantly better than higher-risk MDS and worse than non-clonal ICUS. The clinical and mutational characteristics were also similar except for the degree of anemia and the SF3B1 and STAT3 mutation. Our findings suggest that the patients with CCUS may be regarded and treated as the lower-risk MDS despite a lack of significant dysplasia or MDS-associated definitive chromosomal abnormality. Disclosures Choi: Ingenium Therapeutics, Daejeon, Korea: Consultancy, Current holder of individual stocks in a privately-held company. Lee: Ingenium Therapeutics, Daejeon, Korea: Consultancy, Current holder of individual stocks in a privately-held company. Lee: Korean Society of Hematology: Membership on an entity's Board of Directors or advisory committees; AbbVie: Honoraria, Other: Advisory board; Astellas Pharma, Inc.: Consultancy, Honoraria, Other: Advisory board.

Purpose Few studies have addressed gonadal and sexual dysfunctions in childhood cancer survivors. We evaluated the prevalence rates and risk factors for gonadal failure among adolescent/young adult childhood cancer survivors and their sexual function. Materials and methods Subjects were childhood cancer survivors aged 15-29 years who had completed therapy more than 2 years ago. Demographic and medical characteristics were obtained from the patients' medical records. In addition, hormonal evaluation and semen analysis were performed and sexual function was evaluated via questionnaire. Results The study included 105 survivors (57 males, 48 females), of which 61 were adults (age > 19 years) and 44 were adolescents. In both males and females, the proportion of survivors with low sex hormone levels did not differ among age groups or follow-up period. Thirteen female subjects (27.1%) needed sex hormone replacement, while five males subjects (8.8%) were suspected of having hypogonadism, but none were receiving sex hormone replacement. Of 27 semen samples, 14 showed azospermia or oligospermia. The proportion of normospermia was lower in the high cyclophosphamide equivalent dose (CED) group (CED ≥ 8,000 mg/m2) than the low CED group (27.3% vs. 62.5%, p=0.047). Among adults, none were married and only 10 men (35.7%) and eight women (34.3%) were in a romantic relationship. Though a significant proportion (12.0% of males and 5.3% of females) of adolescent survivors had experienced sexual activity, 13.6% had not experienced sex education. Conclusion The childhood cancer survivors in this study showed a high prevalence of gonadal/sexual dysfunction; accordingly, proper strategies are needed to manage these complications.

// Ho Kyung Seo 1, 2, * , Sung Han Kim 1, 3, * , Kyung-Ohk Ahn 3 , Sang-Jin Lee 4 , Weon Seo Park 5 , Sohee Kim 6 , Sang-Hyun Hwang 7 , Do Hoon Lee 8 , Jae Young Joung 1 , Jinsoo Chung 1 , Jungnam Joo 6 and Kyung-Chae Jeong 3 1 Department of Urology, Center for Prostate Cancer, Hospital, National Cancer Center, Goyang, Gyeonggi-do, Korea 2 Biomarker Branch, Research Institute, National Cancer Center, Goyang, Gyeonggi-do, Korea 3 Translational Research Branch, Research Institute, National Cancer Center, Goyang, Gyeonggi-do, Korea 4 Immunotherapeutics Branch, Research Institute, National Cancer Center, Goyang, Gyeonggi-do, Korea 5 Department of Pathology, Center for Prostate Cancer, Hospital, National Cancer Center, Goyang, Gyeonggi-do, Korea 6 Biometrics Research Branch, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea 7 Department of Laboratory Medicine, Center for Diagnostic Oncology, National Cancer Center, Goyang-si, Korea 8 Department of Laboratory Medicine and Hematologic Malignancy Branch, Research Institute and Hospital of National Cancer Center, Goyang-si, Korea * These authors have contributed equally to this work Correspondence to: Kyung-Chae Jeong, email: jeongkc@ncc.re.kr Keywords: administration; intravesical therapy; mitomycin C; neoplasm; urinary bladder Received: March 17, 2017 Accepted: June 30, 2017 Published: October 09, 2017 ABSTRACT Objective: Sodium bicarbonate has been reported to maximize the efficacy of intravesical instillation of mitomycin-C (IVI-MMC) therapy by urine alkalinization in non-muscle-invasive bladder cancer (NMIBC). This study aimed to analyze the changes in MMC concentration according to urinary pH and evaluate the efficacy of sodium bicarbonate to maintain the concentration of active form of MMC during IVI-MMC. Methods: We prospectively enrolled 26 patients with NMIBC after transurethral resection of bladder tumor. Patients with very high-risk and low-risk NMIBC were excluded. Urinary creatinine, volume, pH, and concentrations of MMC and its degraded form were measured immediately before and after IVI-MMC. The patients were administered 1.5 g of oral sodium bicarbonate during the preceding evening, in the morning, and immediately before the fourth cycle of the six-cycle IVI-MMC. The correlation between MMC concentration and urinary pH changes was explored with or without oral bicarbonate therapy. Results: Recurrence without progression to muscle-invasive disease was noted in 4 of 26 patients in a 23.7-month follow-up. The mean urinary pH before and after the therapy increased from 6.03 to 6.50, and 6.46 to 7.24, without or with oral SB therapy, respectively. Despite this increase, the concentration of active form of MMC did not change significantly. No correlation was found between urinary pH and MMC concentration. Urine alkalinization by SB administration did not maintain the high concentration of urinary MMC. Conclusions: Urine alkalinization by sodium bicarbonate administration for IVI-MMC did not maintain the high concentration of active urinary MMC in NMIBC.

Comparative outcomes of continuous renal replacement therapy during liver transplantation have not been investigated. We retrospectively compared the outcomes of intraoperative continuous renal replacement therapy with those of non-dialytic conservative treatment in patients with pretransplant renal dysfunction.We analyzed 240 transplantation patients with preoperative renal dysfunction (estimated glomerular filtration rate 60 mL/min/1.73 mCompared with the non-dialytic conservative treatment group (n = 98), the intraoperative continuous renal replacement therapy group (n = 142) experienced more severe critical illness (as indicated by Model for End-Stage Liver Disease score) and more severe preoperative renal dysfunction, as well as more frequent hepatic encephalopathy, ventilatory care, and intensive care unit admission (P .005). There were also worse outcomes regarding patient survival, graft survival, recovery of renal function, and postoperative complications. However, the intraoperative continuous renal replacement therapy group significantly escaped volume overload (adjusted odds ratio, 0.396; 95% confidence interval, 0.223-0.703; P = .002) and unnecessary changes in serum sodium concentration ≥10 mmol/L during surgery (adjusted odds ratio, 0.208; 95% confidence interval, 0.065-0.665; P = .008).Considering the more severe critical illness of the intraoperative continuous renal replacement therapy group but the low frequency of volume overload and serum sodium fluctuation, intraoperative continuous renal replacement therapy could be useful during liver transplantation in critically ill patients with renal dysfunction. Randomized, controlled studies that could demonstrate outcome benefits and indications of intraoperative continuous renal replacement therapy during liver transplantation are needed.

// Jae-Won Hyun 1, 6 , Ji Hyun Park 2 , Boo Gil Kang 3 , Eun Young Park 4 , Boram Park 4 , Jungnam Joo 4 , Jong Kuk Kim 5 , Su-Hyun Kim 1 , Jee Hyang Jeong 6 , Hyang Woon Lee 6 , Kee Duk Park 6 , Kyung Gyu Choi 6 , Sang-Hyun Hwang 3, 7 , Ho-Shin Gwak 7 and Ho Jin Kim 1, 7 1 Department of Neurology, National Cancer Center, Goyang, Korea 2 Department of Oncology, Konkuk University of Medical College, Seoul, Korea 3 Department of Laboratory Medicine, National Cancer Center, Goyang, Korea 4 Biometric Research Branch, National Cancer Center, Goyang, Korea 5 Department of Neurology, Dong-A University College of Medicine, Busan, Korea 6 Department of Neurology, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, Korea 7 Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea Correspondence to: Ho Jin Kim, email: hojinkim@ncc.re.kr Keywords: leptomeningeal carcinomatosis, diagnosis, prognosis, CSF, CYFRA 21-1 Received: November 30, 2016 Accepted: May 18, 2017 Published: June 08, 2017 ABSTRACT Objectives: To investigate the diagnostic and prognostic values of cerebrospinal fluid (CSF) CYFRA 21-1 in patients with leptomeningeal carcinomatosis (LMC). Methods: Concentration of CSF CYFRA 21-1 was detected using electro-chemiluminescent immunoassay. The difference in level of CYFRA 21-1 between 61 patients with LMC and 200 patients with other neurological disease was evaluated, and diagnostic performance of CSF CYFRA 21-1 was investigated. In LMC patients treated with ventriculo-lumbar perfusion (VLP) chemotherapy, prognostic performance of CSF CYFRA 21-1 was evaluated. Results: The CSF CYFRA 21-1 was significantly higher in LMC patients than that in patients with other neurological diseases (p

The purpose of this study is to evaluate the correlation between KRAS mutation, 18F-FDG uptake, and metastatic pattern in advanced stage colorectal cancer (CRC) patients. Medical records of stage IV CRC patients who underwent 18F-FDG PET/CT for staging and KRAS mutation analysis were selected. On PET scans, a volume of interest (VOI) was drawn on the primary lesion. 18F-FDG indices (SUVmax, SUVmean, MTV, TLG) of the primary lesions were obtained and correlated with KRAS mutation of the primary lesion. Also, metastatic sites were recorded. Association between metastatic pattern and KRAS expression and FDG indices were analyzed. KRAS mutation was positive in 40 (43%) patients. Evaluation of FDG indices showed that higher SUVmax (14.0 vs. 11.2, p = 0.004), higher SUVmean (5.3 vs. 4.7, p = 0.005), and higher TLG (301.4 vs. 205.5, p = 0.023) were predictive of KRAS mutation compared to wild-type (WT) KRAS. Lung metastasis was more frequently involved in patients with KRAS mutation (50.0% vs. 22.6%, p = 0.006), and liver metastasis was more frequently involved in patients with WT KRAS (81.1% vs. 55.0%, p = 0.007). Multivariate analysis showed that primary tumor location (OR 3.92, p = 0.07) and KRAS mutation (OR 2.45, p = 0.09) were significant factors in lung metastasis model. KRAS mutation patients had more frequent lung metastasis and had higher 18F-FDG uptake compared to WT KRAS in stage IV CRC.

Objective To evaluate whether HPV DNA in urine has potential advantages as an alternative biomarker for HPV-based cervical cancer screening. Methods Among patients with Cobas HPV test results, a total of 67 HPV-positive (n = 42) and -negative (n = 25) women who agreed to participate in this study were willing to provide paired cervical and urine samples, and we observed concordance between sample types from each patient in identifying HPV genotypes using the nanowire assay. Results We detected high-risk strains of HPV DNA in unprocessed urine specimens using polyethyleneimine-conjugated nanowires (PEI-NWs). Concordance for high-risk HPV (hrHPV) between paired urine and cervical samples was 90.4% (κ = 0.90; 95% CI: 0.80–100.00). The virological sensitivity and specificity for detection of HPV DNA from a small urine sample (200 μL) were 81.3% (κ = 0.83; 95% CI: 62.1–100.0) and 98.0% (κ = 0.83; 95% CI: 94.2–100.0) for HPV16 group, 100.0% (κ = 0.65; 95% CI: 100.0–100.0) and 95.3% (κ = 0.65; 95% CI: 90.1–100.0) for HPV18 group, and 96.4% (κ = 0.97; 95% CI: 89.6–100.0) and 100.0% (κ = 0.97; 95% CI: 100.0–100.0) for other hrHPV group, respectively. Conclusions The nanowire assay demonstrated excellent ability to identify HPV DNA from urine specimens. We observed an excellent agreement in the detection of high-risk HPV between paired urine and cervical samples, even with small urine sample volume.

PURPOSE This study aimed to evaluate the prognostic value of F-FDG uptake of portal vein tumor thrombosis (PVTT) for predicting progression-free survival (PFS) and overall survival (OS) in patients with locally advanced hepatocellular carcinoma (HCC). METHODS The study retrospectively included 166 HCC patients with PVTT and no extrahepatic metastases who underwent staging FDG PET/CT. Tumor-to-liver uptake ratio (TLR) and PVTT-to-liver uptake ratio (PLR) were measured for each patient, and the prognostic values of clinical factors, TLR, and PLR were assessed. Furthermore, patients were classified into 2 subgroups according to TLR, and the prognostic value of PLR was evaluated in each subgroup. RESULTS Median PFS and OS were 6.2 and 10.1 months, respectively. On multivariate analysis, tumor size (P = 0.006) and PLR (P = 0.03) were independent prognostic factors for PFS, whereas Child-Pugh class (P = 0.02) and PLR (P = 0.02) were independent prognostic factors for OS. Tumor-to-liver uptake ratio was a significant prognostic factor for PFS and OS on univariate analysis but failed to show significance on multivariate analysis. In both patient subgroups with low and high TLR, PLR remained a significant prognostic factor for predicting OS (P = 0.04 for all). CONCLUSIONS FDG uptake of PVTT, but not FDG uptake of HCC, is an independent prognostic factor for PFS and OS in HCC patients with PVTT and no extrahepatic metastasis. Given the prognostic significance, it is strongly encouraged to use FDG uptake of PVTT in further risk stratification for HCC patients with PVTT.

Recent automated systems for the serological tests employing chemiluminescence immunoassay or electrochemiluminescent immunoassay give results within 30 minutes with high sensitivity and accuracy. However, false positive results are inevitable in serological screening for an infection due to the trade-off between sensitivity and specificity. A titration test has been used to confirm the screening results, but it is rarely performed. Instead, molecular tests are preferred in these days. Immunoassays were mostly qualitative in the past; however, quantitative kits have been developed and released on the market. The calibration step is necessary to report results quantitatively. As the calibration curve of an immunoassay is non-linear, four parameter or five parameter logistic models are adopted. analytical measurement range (AMR) verification should be performed periodically at least every six months in order to report quantitative results. Quantitative reporting is feasible only within a linear range that is verified by AMR evaluation. A new concept of quantitative measurement/qualitative reporting in immunoassays is introduced. Qualitative reporting even after the quantitative measurement has the advantage that periodic AMR verification is not required. This category can be applied if the accurate quantitative value is not clinically significant. Lately, the market of point-of-care testing (POCT) is growing rapidly due to an increasing need. Nevertheless, the performance of the serological POCT kits is much lower than that of automated systems for central laboratories. This limits the broad utilization of POCT, and thus research for enhancing its performance should continue.

Background/Aims We are in the process of conducting a randomized trial to determine whether compliance with the fecal immunochemical test (FIT) for colorectal cancer screening differs according to the stool-collection method. This study was an interim analysis of the performance of two stool-collection devices (sampling bottle vs conventional container). Methods In total, 1,701 individuals (age range, 50 to 74 years) were randomized into the sampling bottle group (intervention arm) or the conventional container group (control arm). In both groups, we evaluated the FIT positivity rate, the positive predictive value for advanced neoplasia, and the detection rate for advanced neoplasia. Results The FIT positivity rates were 4.1% for the sampling bottles and 2.0% for the conventional containers; these values were significantly different. The positive predictive values for advanced neoplasia in the sampling bottles and conventional containers were 11.1% (95% confidence interval [CI], −3.4 to 25.6) and 12.0% (95% CI, −0.7 to 24.7), respectively. The detection rates for advanced neoplasia in the sampling bottles and conventional containers were 4.5 per 1,000 persons (95% CI, 2.0 to 11.0) and 2.4 per 1,000 persons (95% CI, 0.0 to 5.0), respectively. Conclusions The impact of these findings on FIT screening performance was unclear in this interim analysis. This impact should therefore be evaluated in the final analysis following the final enrollment period.

The purpose of this study was to evaluate the clinical significance of 18F-FDG uptake by the spleen in patients with autoimmune disease. Methods: We retrospectively reviewed Severance Hospital's electronic medical records of patients hospitalized for the evaluation of fever who underwent 18F-FDG PET/CT. We found 91 patients with autoimmune diseases and 101 patients with localized infection. 18F-FDG uptake was assessed by measuring SUV in the spleen and liver. The spleen-to-liver ratio of the SUVmean (SLRmean) was calculated. Clinical and laboratory parameters were collected and evaluated for association with SLRmean In-hospital mortality was defined as all-cause mortality during hospital admission for fever. Results: SLRmean was significantly higher in autoimmune disease than in localized infectious disease (1.28 ± 0.43 vs. 0.91 ± 0.21, P < 0.001). In autoimmune disease, SLRmean was correlated with monocytes, aspartate aminotransferase, alanine aminotransferase, albumin, and ferritin. Analysis of receiver-operating-characteristic curves revealed that in comparison with laboratory parameters, SLRmean had the highest performance in differentiating autoimmune from localized infectious disease. Multivariate logistic regression analysis demonstrated that high SLRmean and low platelets were significantly associated with in-hospital mortality in febrile autoimmune disease. Conclusion: These findings suggest that spleen glucose metabolism is increased in febrile autoimmune disease. Spleen 18F-FDG uptake may provide information useful in differentiating febrile autoimmune disease from localized infectious disease and predicting clinical outcomes in febrile autoimmune disease.

Parathyroid adenoma detection with dual-phaseDual phase planar MIBI and SPECT/CT was performed on 82 patients. SPECT/CT was performed immediately after delayed planar scan. Thyroid density (Hounsfield unit, CT-HU) and size were measured on CT component of SPECT/CT. MIBI uptake in early scans and retention in delayed scans were visually graded and correlated with clinical factors and CT findings. Finally, planar and SPECT/CT findings were compared for parathyroid lesion visualization according to thyroid MIBI retention.In early scan, multivariate analysis showed only thyroid size predicted early uptake. In delayed scan, multivariate analysis showed higher visual grade in early scan, lower CT-HU or AITD were significant predictors for delayed thyroid parenchymal retention. Overall, ten more parathyroid lesions were visualized on SPECT/CT compared to planar scans (57 vs. 47,AITD is an important factor for MIBI thyroid parenchymal retention on delayed scans, and may impede parathyroid lesion detection. Patients with MIBI retention in the thyroid parenchyma on delayed scans are likely to benefit from an additional SPECT/CT.

Background Self-collected vaginal swab samples have been proposed as an alternative specimen collection method for human papillomavirus (HPV) DNA detection. Objectives Two vaginal swabs (a cone-shaped flocked swab (DRY) and a L-shape FLOQSwab with 2 mL eNAT transport medium (WET)) were compared to standard cervical samples for HPV DNA testing. Additionally, they were also compared by using Roche Cobas 4800 HPV (Roche_HPV) and Abbott Real-time High Risk HPV (Abbott_HPV) tests. Study design Ninety-six women were prospectively enrolled from the National Cancer Center in Korea between June and August 2015. WET and DRY vaginal swabs and cervical specimens were collected. Roche_HPV and Abbott_HPV tests were performed. The Roche_HPV test on cervical specimens was used as reference. Results The observed agreements (kappa) of Roche_HPV and Abbott_HPV between WET and DRY swabs were 89.6% (0.790, 95% confidence interval (95% CI): 0.667–0.913) and 91.7% (0.833, 95%CI: 0.723–0.943), respectively. No statistical difference was observed between WET and DRY swabs ( p > 0.05 for all comparisons). For HPV16/18, the sensitivity/specificity of Roche_HPV on the DRY and WET samples presented 93.8%/96.3% and 87.5%/97.5%, respectively. For other High Risk HPV (hrHPV), the sensitivity/specificity of Roche_HPV on the DRY and WET swabs presented 91.9%/91.5% and 97.3%/98.3, respectively. The sensitivity/specificity of the Abbott_HPV on the DRY and WET swabs were 93.8%/98.8%, 87.5%/98.8% for HPV16/18, and 91.9%/93.2%, 100.0%/93.2% for other hrHPV, respectively. Conclusions HPV tests performed similarly when using vaginal DRY and WET swab samples. Using DRY and WET swabs to collect vaginal specimens could be an alternative to collecting cervical samples for HPV DNA testing.

Objectives To evaluate the prognostic impact of ultrasonography (US) features and 18F-fluorodeoxyglucose (18F-FDG) uptake in patients with papillary thyroid microcarcinoma (PTMC).

Exchange transfusion (ET) is an established, efficacious, and reliable practice for severe neonatal hyperbilirubinemia, hemolytic disease of the newborn, and neonatal sepsis. This study assessed the indications and clinical outcomes of ET performed in a tertiary hospital in Korea.We studied 64 ET sessions performed on 23 neonates between March 1999 and March 2018. ET was performed based on estimated double volume exchange transfusion using fresh red blood cells and fresh frozen plasma. Patients' clinical information, including demographic data and ET indication, and laboratory data were collected pre- and post-ET.The most common ET indication was hyperbilirubinemia with hemolytic anemia due to non-ABO maternal blood group discrepancies. In three preterm babies, ETs were performed for severe anemia, leukocytosis, and hyperkalemia cases. Before ET, the patients showed slightly high WBC counts, low hemoglobin levels, and low platelet counts. After ET, blood examination revealed normal WBC counts, increased hemoglobin levels, and decreased platelet counts (all P0.001). Bilirubin levels decreased immediately after ET (P0.001). Electrolyte and C-reactive protein levels showed no significant changes after ETs. Adverse events occurred in 11 (47.8 %) patients; the most common were hypoxemia and hypotension. One infant experienced cardiorespiratory arrest due to hypercalcemia and was successfully resuscitated. No one died within 24 h of ET. However, five infants showed hyperbilirubinemia aggravation.ET is an effective treatment modality for leukocytosis and hyperbilirubinemia with low mortality but involves common adverse events post-ET. This report provides an overview of current ET practices in Korea.

Para-Bombay phenotypes are rare blood groups that have inherent defects in producing H antigens associated with FUT1 and/or FUT2. We report the first case of para-Bombay blood type in a Southeast Asian patient admitted at a tertiary hospital in Korea. A 23-year-old Indonesian man presented to the hospital with fever and was diagnosed with a disseminated nontuberculous mycobacterium infection and anemia. During blood group typing for blood transfusion, cell typing showed no agglutination with both anti-A and anti-B reagents. Serum typing showed strong reactivity against B cells and trace agglutination pattern with A1 cells. His red blood cells failed to react with anti-H reagents. Direct sequencing of FUT1 and FUT2 revealed a missense variation, c.328G>A (p.Ala110Thr, rs56342683, FUT1*01W.02), and a synonymous variant, c.390C>T (p.Asn130=, rs281377, Se357), respectively. This highlights the need for both forward and reverse grouping., Graphical Abstract

Objective Human papillomavirus testing by self-sampling and urine sampling might be alternatives to Papanicolaou test (Pap test) for cervical cancer screening (CCS), and may increase compliance and adherence thereto. The present study aimed to explore satisfaction and preferences for cervical screening modalities among Korean women. Methods In total, 732 women aged between 20 and 69 years responded to a questionnaire designed to survey the women's perceived satisfaction for the 3 CCS modalities: clinician-collected Pap test, self-collected vaginal sampling (self-sampling) and urine sampling. Results Overall satisfaction was significantly higher with both the self-sampling and urine sampling than the clinician-collected Pap test (odds ratio [OR]=2.01; 95% confidence interval [CI]=1.48–3.00 and OR=2.47; 95% CI=1.75–3.48, respectively). Psychological distress, including embarrassment, pain, anxiety, discomfort, and stress, with self-sampling and urine sampling were significantly lower than that with the Pap test. 52% of participants reported preferences for self-sampling in the next screening round. Conclusions Korean women were more likely to report satisfaction with alternative modalities (self-sampling and urine sampling) for CCS in comparison to the Pap test. This suggests that self-collected modalities may help with improving CCS uptake rates by eliminating burden related with the Pap test. However, further studies for test accuracy and cost-effective analysis of the alternative modalities should be conducted in order to apply CCS.

This pilot study sought to evaluate the feasibility of utilizing vaginal self-swabs and urine samples for HPV-based cervical cancer screening in 700 women who had undergone conventional Pap smear screening via the national cervical cancer program in Korea. The cobas 4800 HPV test was utilized to detect HPV in the self-samples. Pap smear results revealed three cases of atypical squamous cells of undetermined significance, 649 cases of negative for an intraepithelial lesion or malignancy, and 48 non-specific inflammatory findings. High-risk HPV was detected in 6.7% of urine samples and 9.6% of vaginal self-swab samples. The overall agreement for HPV 16/18 between urine and vaginal self-swab samples was 99.1% (95%CI 98.1% to 99.6%). Colposcopic biopsy revealed one cervical intraepithelial neoplasia (CIN) 3 lesion, 12 CIN1 lesions, and 23 normal or chronic cervicitis lesions. In conclusion, urine and vaginal self-swab sampling was feasible and deemed a potential alternative for HPV detection in women who hesitate to participate in cervical cancer screening programs. Meanwhile, due to overall lower rates of abnormal cytology and sexual risk behaviors in Korea, a larger sample size than expected is needed to assess the sensitivity of CIN2+ detection via self-samples.

Background Anti-HBc IgG is almost always detected in hepatitis B virus (HBV)-infected individuals and persists in resolved infections. In certain cases, anti-HBc IgG is the only serological marker and anti-HBc-positive result generally means anti-HBc total positivity. Objectives To evaluate the clinical sensitivity and specificity of an investigational medical device, Elecsys Anti-HBc II, using samples from the Korean population. Agreement between Elecsys Anti-HBc II and its widely utilized predecessor Elecsys Anti-HBc was also evaluated. Study design Residual serum or plasma samples stored at below −20 °C without individual identifiers were used in this study. This study had 106 randomly selected HBV deoxyribonucleic acid (DNA)-positive samples used for evaluating clinical sensitivity. For clinical specificity, a total of 239 both HBV DNA and hepatitis B surface antigen-negative samples, which were anti-HBc-negative by Elecsys Anti-HBc, were used. Agreement between Elecsys Anti-HBc and Elecsys Anti-HBc II was evaluated in total 345 samples. The Architect Anti-HBc II was used as a confirmatory test regarding discrepancies between Elecsys Anti-HBc and Elecsys Anti-HBc II results. Results The clinical sensitivity and specificity of Elecsys Anti-HBc II were found to be 99.06% and 100%, respectively. In total, 345 samples showed 100% agreement. Both positive and negative agreements were also 100%. Conclusions The clinical performance of Elecsys Anti-HBc II was confirmed as sufficient in Korean samples. Elecsys Anti-HBc II demonstrated an exceptional performance, exceeding the requirements of the Ministry of Food and Drug Safety and confirming its reliability as an in vitro diagnostic device for HBV diagnosis in Korea.

The Hounsfield unit (HU) ratio of thyroid nodules was assessed compared to the contralateral thyroid lobe on noncontrast computed tomography (CT) to stratify further the risk of malignancy in thyroid incidentalomas found on 18F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography/CT (PET/CT).This retrospective analysis included 82 patients who had thyroid incidentalomas on PET/CT in 2011. On PET/CT, the maximal standardized uptake value ratios of the thyroid nodule compared to liver (T/BSUV) and the HU ratios of the thyroid nodule compared to contralateral thyroid lobe (T/BHU) were calculated. Diagnostic performances of the T/BSUV and T/BHU were compared.The area under the curve of T/BHU was higher than that of T/BSUV (0.941 vs. 0.689, p 0.0001). The sensitivity, specificity, and accuracy of T/BHU were significantly higher than those of T/BSUV (100% vs. 77.8%, p = 0.0313; 80.0% vs. 60.0%, p = 0.0433; 86.6% vs. 65.9%, p = 0.0041, respectively). The risk of malignancy was much higher (71.1%) in nodules with a T/BHU cutoff value ≤0.68, whereas it was 0% in nodules with a T/BHU of0.68. In this study, there were 18 nodules with nondiagnostic (n = 7) or atypia of undetermined significance or follicular lesion of undetermined significance cytologies (n = 11) after fine-needle aspiration biopsy (FNAB). When the T/BHU cutoff value was applied, three (60%) of the five nodules with a T/BHU of ≤0.68 were found to be papillary carcinomas. The remaining 13 nodules with a T/BHU of0.68 were all benign with a risk of malignancy of 0%.T/BHU is a simple and effective parameter to stratify the risk of malignancy in thyroid incidentalomas found on PET/CT. This may be of clinical relevance in those nodules with nondiagnostic or undetermined significance cytologies upon FNAB in the scheme of current clinical practice.

Background For deceased-donor liver graft retrieval, the warm dissection technique of hilar dissection before perfusion had been the standard procedure in the early period of liver transplantation. Thereafter, the cold dissection technique of in situ flushing and hilar dissection after perfusion has been preferred in many transplantation centers for rapid procurement of multiple organs. This study intended to assess the safety and usefulness of the warm dissection technique used in deceased-donor liver transplantation. Methods This study analyzed a single surgeon's experience of the warm dissection technique for 165 cases of liver graft retrieval, regarding the prolongation of retrieval operation time, retrieval-associated graft injury, and recipient outcomes. Results An additional 20 to 40 minutes was required for warm dissection. The incidence of retrieval-associated graft injury was 13 (7.9%), in which hepatic parenchymal injury was detected in 7 (capsular tear in 6 and subcapsular hematoma in 1) and vascular injury in 6 (celiac axis injury in 5 and common hepatic artery injury in 1). There was no other episode of injury at the branch artery, vena cava, portal vein, and bile duct. There was no significant difference of 1-year graft survival rates between liver grafts with and without graft injury (83% vs 83.3%, P = .73). Conclusions When the vital signs of deceased donor are stable, the warm dissection technique may be helpful to decrease the cold ischemic preservation time because the risk of graft injury is acceptably low and it provides more time for recipient preparation, thus giving potential advantages for marginal liver grafts.

Background Coronary computed tomographic angiography (coronary CT) is a non-invasive test for diagnosis of cardiac function. Coronary calcium scores determined by coronary CT are associated with cardiovascular risk factors. However, no studies have investigated the association between coronary calcium scores and cardiovascular complications after liver transplantation (LT). We therefore evaluated the utility of preoperative coronary calcium scores for predicting early postoperative cardiovascular complications in LT recipients. Methods Between 2010 and 2012, 443 LT recipients were analysed retrospectively. Preoperative cardiovascular assessments, including coronary CT, were performed. A coronary calcium score >400 was defined as a positive finding. Predictive factors of early postoperative cardiovascular complications were evaluated by univariate and multivariate analyses. Major cardiovascular complications occurring during a period of 1 month after LT were noted. Results Of the 443 patients, 38 (8.6%) experienced one or more cardiovascular complications. Positive coronary CT findings were seen in 11 (2.5%) patients. In the multivariate analysis, a coronary calcium score >400 {odds ratio (OR)=4.62 [95% confidence interval (CI): 1.14–18.72], P=0.032} and female sex [OR=2.76 (1.37–5.57), P=0.005] were predictive of cardiovascular complications. Conclusions A preoperative coronary calcium score of >400 predicted cardiovascular complications occurring 1 month after LT, suggesting that preoperative evaluation of coronary calcium scores could help predict early postoperative cardiovascular complications in LT recipients.

This study assessed the prognostic values of volumetric parameters on 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in predicting early intrahepatic recurrence-free survival (RFS) after curative resection in patients with hepatocellular carcinoma (HCC). A retrospective analysis was performed on 242 patients with HCC who underwent staging FDG PET and subsequent curative surgical resection. The tumor-to-non-tumorous liver uptake ratio, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the HCC lesions on PET were measured. The prognostic values of clinical factors and PET parameters for predicting overall RFS, overall survival (OS), extrahepatic RFS, and early and late intrahepatic RFS were assessed. The median follow-up period was 54.7 months, during which 110 patients (45.5%) experienced HCC recurrence and 62 (25.6%) died. Patients with extrahepatic and early intrahepatic recurrence showed worse OS than did those with no recurrence or late intrahepatic recurrence (p

There is a growing body of evidence demonstrating an association between smoking and DNA methylation. Accordingly, DNA methylation is now considered a promising biomarker of smoking exposure. We evaluated the relationship between methylation markers (AHRR and F2RL3) and urine cotinine as well as self-reported smoking status. DNA methylation levels of AHRR and F2RL3 in blood as well as urine cotinine were measured in 330 adults (46 to 87 years of age). Pyrosequencing was performed to measure DNA methylation of AHRR and F2RL3 associated with smoking exposure. The lung cancer risk associated with DNA methylation and urine cotinine was analyzed using logistic regression analysis. The AHRR and F2RL3 genes were significantly hypomethylated in current smokers compared to in individuals who have never smoked. An inverse relationship was observed between urine cotinine and methylation levels. Methylation of AHRR and F2RL3 distinguished current smokers from never-smokers with high accuracy. Logistic multivariate analysis showed that AHRR methylation is significantly associated with the risk of lung cancer (OR = 0.96, P = 0.011). Our study validated the smoking-associated DNA methylation markers reported in a Korean population-based cohort. In conclusion, DNA methylation of AHRR and F2RL3 provided accurate measures for smoking exposure. Methylation markers reflecting the long-term effect of smoking on the risk of lung cancer showed better performance in distinguishing former smokers from never-smokers.

PURPOSE The aim of this study was to evaluate the prognostic value of pretreatment metabolic tumor volume (MTV) and total lesion glycolysis (TLG) using F-FDG PET/CT in patients with metastatic renal cell carcinoma (RCC) after treatment with anti-vascular endothelial growth factor-targeted agents. METHODS Fifty-six patients with metastatic RCC who underwent F-FDG PET/CT for staging and recurrence evaluation were retrospectively enrolled. SUVmax, MTV, and TLG were measured using F-FDG PET/CT in all patients. The highest SUV in all the metastatic RCC lesions of each patient was defined as SUVmax. Metabolic tumor volume was defined as the total tumor volume greater than 40% of SUVmax. Total lesion glycolysis was calculated as (MTV) · (SUVmean). The prognostic significance of PET/CT parameters and clinical factors for progression-free survival (PFS) and overall survival (OS) were evaluated by univariate and multivariate analyses, along with other clinical factors. RESULTS The most common organ for metastases was lung (35 patients). In the univariate analysis, hypercalcemia, time from diagnosis to treatment, SUVmax, MTV, and TLG were significant prognostic factors affecting PFS (P < 0.05), and Karnofsky score, hypercalcemia, time from diagnosis to treatment, SUVmax, MTV, and TLG were significant prognostic factors affecting OS (P < 0.05). In the multivariate analysis, hypercalcemia, MTV, and TLG were independent prognostic factors affecting PFS (P < 0.05), and hypercalcemia, time from diagnosis to treatment, MTV, and TLG were independent prognostic factors affecting OS (P < 0.05). In subgroup analyses, the high MTV or TLG groups showed poor prognosis for PFS and OS in patients with intermediate or poor risk. CONCLUSIONS Metabolic tumor volume and TLG are independent prognostic factors for predicting PFS and OS in patients with metastatic RCC. Furthermore, MTV and TLG could provide additional prognostic information in patients with clinically high-risk metastatic RCC treated with anti-vascular endothelial growth factor-targeted therapies.

The aim of this study was to determine the relationship between [(18)]-2-fluoro-2-deoxy-D-glucose (FDG) uptake and excision repair cross-complementation group 1 (ERCC-1) expression and to evaluate the prognostic effect of these two factors in resectable non-small cell lung cancer (NSCLC) patients.We retrospectively reviewed 212 patients with resectable NSCLC who underwent FDG positron emission tomography/computed tomography (PET/CT) scan for cancer staging and ERCC-1 expression analysis between January 2008 to December 2011. All patients were then followed-up for survival analysis. Semiquantitative evaluation of ERCC-1 was performed with the H-scoring system and was correlated with maximum standardized uptake value (SUVmax) of NSCLC. Univariate and multivariate analyses were performed to evaluate for FDG uptake and ERCC-1 expression predicting overall survival.In 212 patients (139 male, median age 68 ± 9.11), 112 patients had ERCC-positive tumors and 100 patients had ERCC-negative tumors. There was no significant difference in SUVmax between ERCC-1-positive tumors (8.02 ± 5.40) and ERCC-1-negative tumors (7.57 ± 6.56, p = 0.584). All patients were followed-up for a median of 40.5 months (95 % confidence interval [CI], 38.5-42.2 months). Univariate analysis and multivariate analysis for all patients showed that both ERCC-1 expression (hazard ratio [HR], 2.78; 95 % CI, 1.20-6.47) and FDG uptake (HR, 4.50; 95 % CI, 2.07-9.77) independently predicted overall survival.We have found no statistical correlation between FDG uptake and ERCC-1 expression in NSCLC. However, both higher FDG uptake and positive ERCC-1 expression are independent predictive markers of prognosis, suggesting that both should be obtained during patient workup.

Department of Chemistry and Research Institute for Basic Sciences, Kyung Hee University, Seoul 131-701, Korea *E-mail: sshah@khu.ac.kr Department of Laboratory Medicine, Center for Diagnostic Oncology, Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeinggi-do 410-769, Korea Hematologic Malignancy Branch, Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeinggi-do 410-769, Korea. *E-mail: mindcatch@ncc.re.kr Received January 13, 2014, Accepted January 22, 2014

Background Documentation is very important; a considerable number of documents exist for use in accreditation inspection. However, most laboratories do not effectively manage the processes of documentation, organization, and storage. The purpose of this study was to facilitate the establishment of a strategically effective and sustainably standardized document management system. Methods A document code formatting system was modified by comparing the document list data received from 3 major university hospitals. In addition, a questionnaire regarding document code standardization was created and sent to 268 institutes to establish document classifications and generate a standard coding scheme. A computerized document management system was developed. Results Only 32% (8 out of 25 institutes) answered that they were able to identify all of the document types and their numbers. In total, 76% of institutes (19 out of 25) answered that a systematic document management system was necessary. Disorganized document files were systemized by classifying them into 8 major groups according to their characteristics: patient test records (T), test quality control (Q), manuals (M), equipment and environment management (E), statistics (S), division administration (A), department administration (R), and others (X). Conclusions Our documentation system may serve as a basis for the standardization of documents and the creation of a document management system for all hospital laboratories.

The aim of this article was to evaluate the prognostic value of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) on preoperative F-FDG PET/CT for predicting intrahepatic recurrence-free survival (IHRFS), extrahepatic metastasis-free survival (EHMFS), and overall survival (OS) in patients with very early/early hepatocellular carcinoma (HCC).We retrospectively enrolled 132 patients with very early/early HCC who underwent F-FDG PET/CT followed by surgery. The maximum tumor SUV-to-mean normal liver SUV ratio, MTV, and TLG were measured for each patient. Prognostic significances of PET/CT parameters and clinicopathologic factors for IHRFS, EHMFS, and OS were evaluated. Cumulative IHRFS, EHMFS, and OS were calculated using the Kaplan-Meier method.Thirty-three (25%) and 21 (15.9%) of 132 patients experienced intrahepatic and extrahepatic recurrence, respectively, during a median follow-up period of 38.1 months. In multivariate analysis, none of the factors were significant for IHRFS. Metabolic tumor volume and TLG were only significant factors for EHMFS and OS (P0.05). The 5-year EHMFS rates were 94.8% in patients with low MTV and TLG, and 62.1% and 63.2% in patients with high MTV and TLG, respectively (P0.001). The 5-year OS rates were 92.6% and 92.4% in patients with low MTV and TLG, and 63.3% and 64.3% in patients with high MTV and TLG, respectively (P0.001).Metabolic tumor volume and TLG on preoperative PET/CT were independent prognostic factors for EHMFS and OS but not IHRFS in patients with very early/early HCC. Therefore, patients with high MTV or TLG should be closely observed for extrahepatic metastasis using systemic evaluations.

Background Human papillomavirus (HPV) testing based on cervical samples is important for use in cervical cancer screening. However, cervical sampling is invasive. Therefore, non-invasive methods for detecting HPV, such as urine samples, are needed. Objectives For HPV detection in urine samples, two real-time PCR (RQ-PCR) tests, Roche cobas 4800 test (Roche_HPV; Roche Molecular Diagnostics) and Abbott RealTime High Risk HPV test (Abbott_HPV; Abbott Laboratories) were compared to standard cervical samples. Study design The performance of Roche_HPV and Abbott_HPV for HPV detection was evaluated at the National Cancer Center using 100 paired cervical and urine samples. The tests were also compared using urine samples stored at various temperatures and for a range of durations. Results The overall agreement between the Roche_HPV and Abbott_HPV tests using urine samples for any hrHPV type was substantial (86.0% with a kappa value of 0.7173), and that for HPV 16/18 was nearly perfect (99.0% with a kappa value of 0.9668). The relative sensitivities (based on cervical samples) for HPV 16/18 detection using Roche_HPV and Abbott_HPV with urine samples were 79.2% (95% CI; 57.9–92.9%) and 81.8% (95% CI; 59.7–94.8%), respectively. When the cut-off C T value for Abbott_HPV was extended to 40 for urine samples, the relative sensitivity of Abbott_HPV increased to 91.7% from 81.8% for HPV16/18 detection and to 87.0% from 68.5% for other hrHPV detection. The specificity was not affected by the change in the C T threshold. Conclusions Roche_HPV and Abbott_HPV showed high concordance. However, HPV DNA detection using urine samples was inferior to HPV DNA detection using cervical samples. Interestingly, when the cut-off C T value was set to 40, Abbott_HPV using urine samples showed high sensitivity and specificity, comparable to those obtained using cervical samples. Fully automated DNA extraction and detection systems, such as Roche_HPV and Abbott_HPV, could reduce the variability in HPV detection and accelerate the standardization of HPV detection in urine. Thus, urine samples may be an effective alternative for HPV detection in women who hesitate to participate in cervical cancer screening programs.