• Clinical Endoscopy
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• 제55권3호
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• pp.332-338
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• 2022

Continuous measurement of quality indicators (QIs) should be a routine part of colonoscopy, as a wide variation still exists in the performance and quality levels of colonoscopy in Korea. Among the many QIs of colonoscopy, the adenoma detection rate, average withdrawal time, bowel preparation adequacy, and cecal intubation rate should be monitored in daily clinical practice to improve the quality of the procedure. The adenoma detection rate is the best indicator of the quality of colonoscopy; however, it has many limitations for universal use in daily practice. With the development of natural language processing, the adenoma detection rate is expected to become more effective and useful. It is important that colonoscopists do not strictly and mechanically maintain an average withdrawal time of 6 minutes but instead perform careful colonoscopy to maximally expose the colonic mucosa with a withdrawal time of at least 6 minutes. To achieve adequate bowel preparation, documentation of bowel preparation with the Boston Bowel Preparation Scale (BBPS) should be a routine part of colonoscopy. When colonoscopists routinely followed the bowel preparation protocols, ≥85% of outpatient screening colonoscopies had a BBPS score of ≥6. In addition, the cecal intubation rate should be ≥95% of all screening colonoscopies. The first step in improving colonoscopy quality in Korea is to apply these key performance measurements in clinical practice.

• Asian Pacific Journal of Cancer Prevention
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• 제13권4호
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• pp.1361-1364
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• 2012

Background: Results of screening colonoscopy from Western countries reported adenoma detection rates (ADRs) of 30-40% while those from Asia had ADR as low as 10%. There have been limited data regarding screening colonoscopy in Thailand. The objectives of this study were therefore to determine polyp and adenoma detection rates in Thai people, to evaluate the incidence of colorectal cancer detected during screening colonoscopy and to determine the endoscopic findings of the polyps which might have some impact on endoscopists to perform polypectomy. Materials & Methods: This study was a retrospective electronic chart review of asymptomatic Thai adults who underwent screening colonoscopy in our endoscopic center from June 2007 to October 2010.Results: A total of 1,594 cases were reviewed. The patients had an average age of $58.3{\pm}10.5$ years (range 27-82) and 55.5% were female. Most of the cases (83.8%) were handled by staff who were endoscopists. A total of 488 patients (30.6%) were reported to have colonic polyps. Left-sided colon was the most common site (45.1%), followed by right-sided colon (36.5%) and the rectum (18%). Those polyps were removed in 97.5% of cases and 88.5 % of the polyps were sent for histopathology (data lost 11.5%). Two hundred and sixty three cases had adenomatous polyps, accounting for 16.5 % ADR. Advanced adenomas were detected in 43 cases (2.6%). Hyperplastic polyps were mainly located distal to the splenic flexure of the colon whereas adenomas were found throughout the large intestine. Ten cases (0.6%) were found to have colorectal cancer. Four advanced adenomas and two malignant polyps were reported in lesions ${\leq}$ 5 mm. Conclusion: The polyp detection rate, adenoma detection rate, advanced adenoma detection rate and colorectal cancer detection rate in the screening colonoscopy of Thai adults were 30.9%, 16.5%, 2.6% and 0.6% respectively. Malignant transformation was detected regardless of the size and location of the polyps. Therefore, new technology would play an important role indistinguishing polyps.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제29권2호
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• pp.116-122
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• 2003

Pleomorphic adenoma is the most common salivary neoplasm mainly occurring in the major salivary glands - especially in parotid gland, which is characterized by variable histopathologic appearances and high recurrence rate with malignant transformation according to surgical situations. And this benign mixed tumor occurring in minor salivary glands is believed to shows same clinicopathologic appearances and relatively low recurrent rate compared with the case in major salivary glands. But there are few comparative studies of large series of pleomorphic adenoma occurring in minor salivary glands which includes different histopathologic appearance, clinical characteristics, treatment methods, recurrence rate, and malignant transformation. We retrospectively studied the 54 patients who were pathologically confirmed with pleomorphic adenoma occurring in minor salivary glands, and analyzed the clinico-histopathological appearance, surgical methods, recurrent cases. The results obtained are as follows. 1. The incidence of the tumor was most frequent in 4th & 5th decade, and in female. 2. Palate(90%) including hard & soft palate was the most frequent site for pleomorphic adenoma in minor salivary glands. 3. The exact duration could not be known due to asymptomatic slow growth patterns of the tumor. 4. The mean tumor size was 2.3cm. 5. 28 (52%) pleomorphic adenomas were classified as Cellular type (cell-rich), 17 (31%) specimen as Intermediate type(equal cell to stroma ratio), and 9 (17%) as Myxoid type(stroma-rich). 6. Surgically 51 cases (94%) were showed well-encapsulated tumors, but histopathologically only 34 specimen (63%) were wellencapsulated. Therefore pleomorphic adenomas in minor salivary glands also have to be excised more widely, not enucleated. And in case of suspicious malignancy or large tumor, preoperative incisional biopsy can be applied in the center of the tumor for prevention of rupture of tumor cell, and total excision with use of frozen biopsy for detection of malignancy and confirming the excision margin, and closed follow-up according to final histopathologic results is recommended.

• 대한두경부종양학회지
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• 제13권2호
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• pp.241-246
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• 1997

It has become evident in recent years that parathyroid adenoma and well differentiated thyroid cancer occur together more than would be expected by chance alone. However, the association between them is not well understood. We have experienced 4 cases of coexistent parathyroid adenoma and well-differentiated thyroid cancer during the past 16 years. None of them had a familial incidence or a history of radiation exposure. Three cases showed symptomatic hypercalcemia(including renal stones, bone pain, joint pain) and in two of them(patient 1 and patient 2), thyroid abnormalities were detected preoperatively by neck ultrasonography or neck CT for evaluation of parathyroid lesions. However, in patient 3, a parathyoid humor was identified and removed incidentally during the course of thyroidectomy. In 3 cases, surgeries for thyroid carcinoma and parathyroid adenoma were performed during the same exploration of the neck, but in patient 4, thyroidectomy preceded parathyroidectomy; The interval between thyroidectomy and subsequent parathyroidectomy was 11 yeras. The thyroid tumors in 3 cases were papillary carcinoma, the sizes of which ranged from 1.0 cm to 1.5 cm in greatest diameter. The remaining case(patient 4) was minimal invasive follicular carcinoma. Total or near-total thyroidectomy with various types of cervical lymphnode dissection and bilateral neck exploration for the parathyroid lesion was performed in 3 cases with papillary carcinoma. Ipsilateral lobectomy and contralateral partial thyroidectomy with consequent unilateral neck exploration for the parathyroid tumor was performed in the case of follicular cancer. In our experience, parathyroid adenoma and well-differentiated thyroid carcinomas can be coexistent and we felt that the attention to the hypercalcemic patients would be needed for detection of this rare condition.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제6권2호
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• pp.129-139
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• 2003

목 적: 당원병 제1형은 어린 소아연령에서 발현하는 가장 심한 형태의 당원병이다. 장기간 관찰시 일부 환자에서 간선종이 발생하고 드물게 간암이 합병되어 예후에 심각한 영향을 미칠 수 있다고 알려져 있지만, 아직까지 이에 대한 연구가 거의 이루어지지 못하였다. 본 연구에서는 한국의 당원병 제1형 환자들의 추적관찰을 통해 간선종과 간암 발생의 측면에서 당원병 제1형의 장기적인 예후를 살펴보고자 하였다. 방 법: 1982년 3월에서 2003년 2월까지 서울대병원 소아과에서 간 조직 검사 및 효소검사를 통해 당원병 제1형으로 진단된 43명의 환자(제1a형 40명, 제1b형 3명)를 대상으로 하였다. 복부 초음파, 전산화단층촬영 또는 자기공명영상을 시행하여 간선종의 발생여부를 관찰하였으며, 간의 종괴가 확인된 경우 가능하면 조직검사를 시행하여 간선종 및 간암을 확진하였다. 간선종 발생에 관여하는 위험요인을 알아보기 위하여 간선종이 발생한 환자를 연령에 대해 짝짓기를 시행하여 선종군과 비선종군에서 여러 임상 지표를 비교하였다. 결 과: 1) 전체 43명 중 16명(37.2%)에서 간선종이 발생하였는데, 간선종이 처음 발견된 나이는 평균 $14.2{\pm}4.1$세(범위: 7.9~25.7세)였다. 처음 발견시 다발성 선종인 경우는 14례(87.5%)였다. 2) 간선종이 발생하였던 선종군(n=16)과 비선종군(n=16)을 비교하였을 때, 신장질환이 선종군에서는 7명(43.8%)에서 동반되고, 비선종군에서는 1명(6.3%)에서 병발하여 두 군 간에 유의한 차이를 보였다(p=0.037; 교차비 11.667, 95% 신뢰구간=1.227~110.953). 저신장은 선종군 6명(37.5%)과 비선종군의 10명(62.5%)에서 관찰되어 두 군 간에 유의한 차이가 없었다(p=0.157). 당원병 제1형 환자의 대부분에서 생옥수수 전분 치료를 시행하였는데, 생옥수수 전분 치료를 시작한 연령은 선종군이 $9.1{\pm}5.2$세인 반면, 비선종군은 $3.0{\pm}1.8$세로서 통계적으로 유의하게 선종군의 치료 시작 연령이 늦었다(p=0.003). 문맥하공정맥 문합술 시행 당시의 연령 차이가 없는 상태에서(p=0.170), 선종군의 11명(68.8%)과 비선종군의 3명(18.8%)에서 단락수술을 시행 받아 두 군간에 유의한 차이를 보였다(p=0.004; 교차비 9.533, 95% 신뢰구간=1.847~49.204). 고콜레스테롤혈증, 저혈당, 고요산혈증 등의 여부는 두 군 간에 유의한 차이를 보이지 않았다(p=0.833, p=0.273, p=0.550). 3) 25.7세에 간선종이 발견되었던 1명은 26.5세에 간암으로 진단되어 간동맥 항암 화학 색전술을 시행 받았다. 결 론: 간선종은 당원병 제1형 환자들을 장기간 추적관찰 하였을 때 비교적 흔하게 발생하는 합병증으로서, 일부에서 악성화 될 가능성이 있어 중요성이 매우 크다. 당원병 제1형 환자들의 장기적 예후를 위해서는 생옥수수 전분 치료의 조기 도입과 규칙적인 추적관찰을 통한 간선종의 조기 발견이 필요하다.

• Journal of Korean Neurosurgical Society
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• 제45권5호
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• pp.271-274
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• 2009

Objective: We retrospectively analyzed the surgical outcomes of 42 patients with growth hormone (GH)-secreting pituitary adenoma to evaluate the clinical manifestations and to determine which preoperative factors that significantly influence the remission. Methods: Forty-two patients with GH-secreting pituitary adenoma underwent transsphenoidal surgery (TSS) between 1995 and 2007. The patient group included 23 women and 19 men, with a mean age of 40.2 (range 13-61) years, and a mean follow-up duration of 49.4 (range 3-178) months after the operation. For comparable radiological criteria, we classified parasellar growth into five grades according to the Knosp classification. We analyzed the surgical results of the patients according to the most recent stringent criteria for cure. Results: The overall rate of endocrinological remission in the group of 42 patients after primary TSS was 64% (26 of 42). The remission rate was 67% (8 of 12) for microadenoma and 60% (18 of 30) for macroadenoma. The remission rate was 30%(3 of 10) for the group with cavernous sinus invasion and 72% (23 of 32) for the group with intact cavernous sinus. Cavernous sinus invasion in Knosp grade III and IV was significantly correlated with the remission rate. There was a significant relationship between preoperative mean GH concentration and early postoperative outcome, with most patients in remission having a lower preoperative GH concentration. Conclusion: TSS is thought to be an effective primary treatment for GH-secreting pituitary adenomas according to the most recent criteria of cure. Because the remission rate in cases with cavernous sinus invasion is very low, early detection of the tumor before it extends into the cavernous sinus and a long-term endocrinological and radiological follow-up are necessary in order to improve the remission rate of acromegaly.

• 대한의용생체공학회:의공학회지
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• 제24권2호
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• pp.69-75
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• 2003

Virtual colonoscopy is one of the Powerful tool for non-invasive colon examination and many in-vitro and in-vivo studies have shown its accuracy in Polyp or adenoma detection. But most of virtual colonoscopy requires high quality workstation and software and its cost is high to setup whole system. We developed PC-based 3D model creation and navigation program which has diverse functions. It can be easily installed to PC and connected to network system. The performance. when used as a virtual colonoscopy. is evaluated by calculating sensitivity of detection for the simulated polyp which is artificially made inside the Pig's colon and checked its clinical feasibility, Its total sensitivity is 76%. Grouping according to Polyps diameter, the sensitivity for detection of polyps 10 ㎜ or larger was 100%(40 of 40); 5.0-9.9 ㎜, 90.0(90 of 100): and smaller then 5 ㎜. 36.7%(22 of 60).

• 대한두경부종양학회지
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• 제15권2호
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• pp.194-199
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• 1999

Introduction: Since 1996, Dr. James Norman has successfully performed mimimally invasive radio-guided parathyroidectomy(MIRP) using intraoperative nuclear mapping with $^{99m}Tc$ sestamibi scanning and radioactivity detection probe. Objectives: We aimed to introduce this new surgical technique and evaluate it's efficacy by our own experiences. Method: From May to October 1999, five consecutive patients with primary hyperparathyroidism underwent parathyroidectomy by using modified MIRP technique. $^{99m}Tc$ sestamibi scanning was performed 1.0 or 1.5 hour before operation. After intraoperative localization of the tumor under the guidance of quantitative gamma counting with a NEVIGATOR probe, an unilateral small skin incision(3.0-4.0cm) was placed. Without a skin flap, the strap muscle was directly divided with the use of a Harmonic scalpel. After careful dissection, the parathyroid tumor was removed. Result: In all patients, a single adenoma could be easily detected and removed by this new technique. Mean incision length was 3.2cm(3.0-4.0cm) and operative time ranged from 40 to 110minute. All the patients were discharged within 2 days of surgery without any complication. Conclusion: This new operative technique could become the most minimally invasive alternative to the standard operative procedure for parathyroid adenoma.

• Asian Pacific Journal of Cancer Prevention
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• 제15권22호
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• pp.9801-9804
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• 2014

Background: Colorectal cancer is currently the third most common cancer in Indonesia, yet colonoscopy - the most accepted mode of screening to date - is not done routinely and national data are still lacking. Objective: To determine the detection rate of colorectal cancers and adenomas in unselected patients undergoing colonoscopy for various large bowel symptoms at the Digestive Disease and GI Oncology Centre, Medistra Hospital in Jakarta, Indonesia. Materials and Methods: Colonoscopy data from January 2009 to December 2012 were reviewed. New patients referred for colonoscopy were included. Data collected were patient demographic and significant colonoscopy findings such as the presence of hemorrhoids, colonic polyps, colonic diverticula, inflammation, and tumor mass. Histopathological data were obtained for specimens taken by biopsy. Associations between categorical variables were analyzed using chi-square test, while mean differences were tested using the t-test. Results: A total of, 1659 cases were included in this study, 889 (53.6%) of them being men. Polyps or masses were found in 495 (29.8%) patients while malignancy was confirmed in 74 (4.5%). Patients with a polyp or mass were significantly older (60.2 vs 50.8 years; p<0.001; t-test) and their presence was significantly associated with male gender (35.0% vs 23.9%; prevalent ratio [PR] 1.71; 95% confidence interval [CI] 1.38-2.12; p<0.001) and age >50 years (39.6% vs 16.6%; PR 3.29; 95% CI 2.59-4.12; p<0.001). Neoplastic lesions was found in 257 (16.1%), comprising 180 (11.3%) adenomas, 10 (0.6%) in situ carcinomas, and 67 (4.2%) carcinomas. Conclusions: Polyps or masses were found in 30% of colonoscopy patients and malignancies in 16.1%. These figures do not represent the nation-wide demographic status of colorectal cancer, but may reflect a potentially increasing major health problem with colorectal cancer in Indonesia.

• Asian Pacific Journal of Cancer Prevention
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• 제17권8호
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• pp.4143-4147
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• 2016

Purpose: We evaluated all PET/CTs acquired for patients without a primary diagnosis of colorectal cancer, and compared results for those who had subsequent colonoscopy within 6 months, to assess the accuracy of FDG PET/CT for detection of incidental pre-malignant polyps and malignant colon cancers. Materials and Methods: Medical records of 9,545 patients who underwent F-18 FDG PET/CT studies over 3.5 years were retrospectively reviewed. Due to pre-existing diagnosis of colorectal cancer, 818 patients were excluded. Of the remainder, 157 patients had colonoscopy within 6 months (79 males; mean age 61). We divided the colon into 4 regions and compared PET/CT results for each region with colonoscopy and histopathologic findings. True positive lesions included colorectal cancer, villous adenoma, tubulovillous adenoma, tubular adenoma and serrated hyperplastic polyp/hyperplastic polyposis. Results: Of 157 patients, 44 had incidental colonic uptake on PET/CT (28%). Of those, 25 had true positive (TP) uptake, yielding a 48% positive predictive value (PPV); 9% (4/44) were adenocarcinoma. There were 23 false positive (FP) lesions of which 4 were hyperplastic polyp, one was juvenile polyp and 7 were explained by diverticulitis. Fifty eight patients had false negative PET scans but colonoscopy revealed true pre-malignant and malignant pathology, yielding 23% sensitivity. The specificity, negiative predictive value (NPV) and accuracy were 96%, 90% and 87%, respectively. The average SUVmax values of TP, FP and FN lesions were 7.25, 6.11 and 2.76, respectively. There were no significant difference between SUVmax of TP lesions and FP lesions (p>0.95) but significantly higher than in FN lesions (p<0.001). The average size (by histopathology and colonoscopy) of TP lesions was 18.1 mm, statistically different from that of FN lesions which was 5.9 mm (p<0.001). Fifty-one percent of FN lesions were smaller than 5 mm (29/57) and 88% smaller than 10 mm (50/57). Conclusions: The high positive predictive value of incidental focal colonic FDG uptake of 48% for colonic neoplasia suggests that colonoscopy follow-up is warranted with this finding. We observed a low sensitivity of standardly acquired FDG-PET/CT for detecting small polyps, especially those less than 5 mm. Clinician and radiologists should be aware of the high PPV of focal colonic uptake reflecting pre-malignant and malignant lesions, and the need for appropriate follow up.