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Y.M. Sung



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    P3.13 - Poster Session 3 - SCLC (ID 202)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P3.13-008 - Long-term Survival of 187 Patients with Small Cell Lung Cancer Based on the AJCC 6th and 7th TNM Edition (ID 1603)

      09:30 - 09:30  |  Author(s): Y.M. Sung

      • Abstract

      Background
      The AJCC 7[th] TNM staging system is recommended for both non-small cell and small cell lung cancer (SCLC), although SCLC has traditionally been classified using the limited and extensive definition. We evaluated long-term survival of patients with SCLC according to the AJCC 6[th] and 7[th] TNM edition.

      Methods
      239 patients had been pathologically diagnosed with SCLC from January 2000 through December 2009 in our hospital. We included 187 patients who had initial CT scan of the thorax. We analyzed all available data for TNM staging using the AJCC 6[th] and 7[th] edition as well as the long-term survival rates.

      Results
      According to stages defined by the 6th TNM edition system, 5-year stage-specific survivals (5-YSR) were 43% for stage I and II, 36% for stage IIIA, 10% for stage IIIB, and 7% for stage IV. Applying the 7th edition system, 5-YSR were 46% for stage I and II, 24% for stage IIIA, 7% for stage IIIB, and 9% for stage IV. Using the 7[th] edition, 5-YSR of the stage IV was higher than that of stage IIIB. The number of changed stage from IIIB in the 6[th] edition to IV in the 7[th] edition was 22 and all were related to malignant pleural effusion.

      Conclusion
      Application of the TNM staging to SCLC stratifies survival more distinctly than limited and extensive definition by providing more substages. Slightly better survival of stage IV SCLC than that of stage IIIB in the 7[th] edition is related to malignant pleural effusion.

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    P3.19 - Poster Session 3 - Imaging (ID 181)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Imaging, Staging & Screening
    • Presentations: 2
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      P3.19-006 - Pseudopathologic Vertebral Body Enhancement in the Presence of Superior Vena Cava Obstruction on Computed Tomography (ID 1519)

      09:30 - 09:30  |  Author(s): Y.M. Sung

      • Abstract

      Background
      Superior vena cava (SVC) obstruction can cause development of collateral vessels. During contrast-enhanced thoracic CT, contrast material may reflux into the collaterals such as paravertebral venous plexus. However, unusual pseudopathologic vertebral body enhancement on CT in the presence of SVC obstruction has not been studied previously. So, the aim of this study was to demonstrate clinical presentation and imaging findings of pseudopathologic vertebral body enhancement in patients with SVC obstruction.

      Methods
      From March 2009 to September 2012, a retrospective radiologic database review was performed to identify patients with obstruction of SVC causing contrast reflux into collateral vessels and presented with unusual vertebral body enhancement on thoracic CT. Thirteen patients (eleven men, mean age 51.4 years) with vertebral body enhancement were enrolled. The underlying diseases that caused SVC obstruction were adenocarcinoma of the lung in four, non-small cell lung cancer in two, large cell neuroendocrine carcinoma, small cell lung cancer, thymic carcinoma, sarcomatoid carcinoma, diffuse large B-cell lymphoma, Hodgkin’s lymphoma and metastatic lymphadenopathy from pancreatic cancer in one patient each. Enhancement patterns, locations and the presence of a connection between vertebral body enhancement and the paravertebral venous plexus were evaluated. Enhancement patterns of vertebral bodies were classified as nodular enhancement with round shape that occupying < 1/3 of vertebral body or polygonal enhancement that occupying ≥ 1/3 of vertebral body on axial image. The locations of enhanced areas within vertebral bodies were described using right lateral/central/left lateral, anterior/posterior, and upper/middle/lower in the x-, y-, or z-axis directions, respectively.

      Results
      A total of 39 vertebral body enhancements were found in the 13 patients, involving cervical (n = 12), thoracic (n = 25), or lumbar (n = 2) vertebrae. Vertebral body enhancements showed a nodular (n = 19) or a polygonal (n = 20) pattern. The central portions of vertebral bodies were more frequently involved. The connection to the paravertebral venous plexus was observed in 34 lesions (87.2%).

      Conclusion
      Patients with SVC obstruction with extensive collateral vessels might exhibit a pseudopathologic vertebral enhancement. They tended to involve the central portion of the vertebral body and most of them showed connection to the paravertebral venous plexus.

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      P3.19-007 - Reliability Analysis of Visual Ranking of Coronary Artery Calcification on Low-Dose CT of the Thorax for Lung Cancer Screening: Comparison with ECG-gated Calcium Scoring CT (ID 2244)

      09:30 - 09:30  |  Author(s): Y.M. Sung

      • Abstract

      Background
      Coronary artery calcification (CAC) is frequently detected on low-dose CT of the thorax (LDCT). Concurrent assessment of CAC and lung cancer screening using LDCT is beneficial in terms of cost and radiation dose reduction. The aim of our study was to evaluate the reliability of visual ranking of CAC on LDCT compared to Agatston score on ECG-gated calcium scoring CT.

      Methods
      The subjects were 576 patients who were consecutively registered for health screening and undergoing both LDCT and ECG-gated calcium scoring CT. We excluded subjects with a calcium score of zero. The final study cohort included 117 patients with CAC (97 men; mean age, 53.4±8.5). Agatston score on ECG-gated calcium scoring CT was used as the gold standard (mean score, 166.0; range, 0.4-3719.3). Two board-certified radiologists and two radiology residents participated in an observer performance study. Visual ranking of CAC was performed according to four categories (1-10, 11-100, 101-400, and 401 or higher) for coronary artery disease (CAD) risk stratification. Weighted kappa statistics was used to measure the degree of reliability on visual ranking of CAC on LDCT: kappa values between 0 and 0.40 were considered to indicate positive but poor agreement; between 0.40 and 0.75, good agreement; greater than 0.75, excellent agreement.

      Results
      The degree of reliability on visual ranking of CAC on LDCT compared to ECG-gated calcium scoring CT was excellent for board-certified radiologists and good for radiology residents. A high degree of association was observed with 71.6% of visual rankings in exactly the same category as the Agatston category and 98.9% varying by no more than one category.

      Conclusion
      Visual ranking of CAC on LDCT is reliable for prediction of categorization of Agatston score ranks. LDCT is useful for both CAD risk stratification and lung cancer screening.