• 대한세포병리학회지
• /
• 제19권2호
• /
• pp.99-106
• /
• 2008

Background : Second opinion diagnosis of outside pathology slides is a common practice for efficient and proper patient management. We analyzed cytology slides from outside hospitals submitted for a second opinion diagnosis to determine whether the second opinion diagnosis had any influence on patient care. Methods : We reviewed 1,153 outside cytology slides referred to Asan Medical Center for second opinions from January, 2007, to December, 2007. All cases were categorized into three groups; no diagnostic discrepancy, minor diagnostic discrepancies (no impact on the management), and major diagnostic discrepancies (significant impact on the management and subsequent follow-up). Results : The thyroid was the most common organ system (933 cases, 80.9%), Forty cases (3.6%) belonged to the major diagnostic discrepancy group and 149 cases (12.8%) to the minor discrepancy group. For validation of second opinion diagnoses in major discrepancy cases, subsequent biopsy or surgical resection specimens and clinical information were reviewed, which were available in 29 cases. The second opinion diagnoses resulted in alteration of clinical management in 21 of 29 cases. Conclusion : For all referred patients, second opinion diagnosis is important and mandatory for appropriate patient care.

• Investigative Magnetic Resonance Imaging
• /
• 제22권1호
• /
• pp.10-17
• /
• 2018

Purpose: To evaluate interpretation errors involving spine MRIs by residents in their second to fourth year of training, classified as minor, intermediate and major discrepancies, as well as the types of commonly discordant lesions with or without clinical significance. Materials and Methods: A staff radiologist evaluated both preliminary and final reports of 582 spine MRIs performed in the emergency room from March 2011 to February 2013, involving (1) the incidence of report discrepancy, classified as minor if there was sufficient description of the main MR findings without ancillary or incidental lesions not influencing the main diagnosis, treatment, or patients' clinical course; intermediate if the correct diagnosis was made with insufficient or inadequate explanation, potentially influencing treatment or clinical course; and major if the discrepancy affected the main diagnosis; and (2) the common causes of discrepancy. We analyzed the differences in the incidence of discrepancy with respect to the training years of residents, age and sex of patients. Results: Interpretation discrepancy occurred in 229 of the 582 cases (229/582, 39.3%), including 146 minor (146/582, 25.1%), 40 intermediate (40/582, 6.9%), and 43 major cases (43/582, 7.4%). The common causes of major discrepancy were: over-diagnosis of fracture (n = 10), missed cord lesion (n = 9), missed signal abnormalities associated with diffuse marrow (n = 5), and failure to provide differential diagnosis of focal abnormal marrow signal intensity (n = 5). No significant difference was found in the incidence of minor, intermediate, and major discrepancies according to the levels of residency, patients' age or sex. Conclusion: A 7.4% rate of major discrepancies was found in preliminary reporting of emergency MRIs of spine interpreted by radiology residents, probably related to a relative lack of clinical experience, indicating the need for additional training, especially involving spine trauma, spinal cord and bone marrow lesions.

• Journal of Gastric Cancer
• /
• 제11권2호
• /
• pp.78-85
• /
• 2011

Since January of 2010, the seventh edition of UICC tumor node metastasis (TNM) Classification, which has recently been revised, has been applied to almost all cases of malignant tumors. Compared to previous editions, the merits and demerits of the current revisions were analyzed. Many revisions have been made for criteria for the classification of lymph nodes. In particular, all the cases in whom the number of lymph nodes is more than 7 were classified as N3 without being differentiated. Therefore, the coverage of the N3 was broad. Owing to this, there was no consistency in predicting the prognosis of the N3 group. By determining the positive cases to a distant metastasis as TNM stage IV, the discrepancy in the TNM stage IV compared to the sixth edition was resolved. In regard to the classification system for an esophagogastric (EG) junction carcinoma, it was declared that cases of an invasion to the EG junction should follow the classification system for esophageal cancer. A review of clinical cases reported from Asian patients suggests that it would be more appropriate to follow the previous editions of the classification system for gastric cancer. In addition, in the classification of the TNM stages in the overall cases, the discrepancy in the prognosis between the different stages and the consistency in the prognosis between the same TNM stages were achieved to a lesser extent as compared to that previously. Accordingly, further revisions are needed to develop a purposive classification method where the prognosis can be predicted specifically to each variable and the mode of the overall classification can be simplified.

• 대한영상의학회지
• /
• 제82권6호
• /
• pp.1545-1555
• /
• 2021

목적 동료평가를 시행하여 원격판독 불일치의 정도와 불일치 판독의 임상적 의의를 세부전공분야와 촬영장비별로 평가하고자 하였다. 대상과 방법 한 국내 원격판독 의료기관에서 2018년과 2019년에 시행한 동료평가를 대상으로 세부전공분야와 촬영장비별로 판독 불일치를 분석하였다. 동료평가 점수를 적격 진단과 부적격 진단으로 분류하였고, 판독 불일치는 임상적 의의에 따라 무의한 불일치와 유의한 불일치로 분류하였다. 카이제곱 검증으로 통계를 시행하였다. 결과 총 1312건의 동료평가 중 부적격 진단은 117건(8.9%)이고, 총 462건의 진단 불일치 중 유의한 불일치는 104건(21.6%)이었다. 세부전공분야에서 부적격 진단율은 근골격(21.4%)이 가장 높았고(각각 p < 0.05), 복부(7.3%)는 신경두경부(1.3%)에 비해 높았다(p < 0.05). 유의한 불일치는 흉부(32.7%)가 복부(17.1%)와 근골격(19.5%)에 비해 높았다(각각 p < 0.05). 촬영장비에서 부적격 진단은 MR (16.2%)이 일반촬영(7.8%)에 비해 높았고(p < 0.05), 유의한 불일치는 차이가 없었다. 결론 동료평가를 통해서 원격판독의 부적격 진단과 임상적 유의한 불일치의 정도, 세부전공분야와 촬영장비에 따른 차이를 알 수 있었다.

• 대한치과기공학회지
• /
• 제23권1호
• /
• pp.45-53
• /
• 2001

This study was performed to investigate the effect of vent on the marginal discrepancy of PFM base metal castings. Eighteen identical wax patterns of a maxillary 3 unit anterior bridge were fabricated. Nine cases out of them were vented with $\phi$2.5mm sprue wax, for direct comparison as to the marginal discrepancy of the castings with the other non vented 9 ones. The mean value of marginal discrepancies of the vented castings was $85.02{\pm}25.57{\mu}m$, and that of the non vented was $163.21{\pm}69.88{\mu}m$ respectively. Statistical analysis revealed that marginal discrepancy of the vented casting was significantly reduced(p<0.05).

• 대한안전경영과학회지
• /
• 제8권4호
• /
• pp.249-265
• /
• 2006

A life cycle assessment(LCA) is increasing its applicability as a powerful tool for an environmental burdens analysis. In this study, some cases are compared in terms of analysis procedures and results obtained with LCAs for evaluating power generation technologies in Korea. For the comparison, 3 power generation technologies are selected because they produces almost 90% of 2003 total electricity generation in Korea. It is shown that the range of evaluation values amounts to maximally the order of about 105, which is rather large discrepancy than the level of 101 in comparison with foreign studies. The difference seems to be due to the simplicity of modeling used in each case study. It is proposed that this large discrepancy should be obviously clarified to improve their reliability in that electricity is a essentialness for all industries and the capacity of LCA of national-level electricity affects the results of LCA for the other sectors.

• 대한치과의사협회지
• /
• 제51권6호
• /
• pp.302-312
• /
• 2013

It has been established that disk displacement of the temporomandibular joint(TMJ) can cause mandibular asymmetry in growing subjects. One of the causes of internal derangement of TMJ seems to be the result of poor positioning of the joint structure in unilateral cross bite, and the subsequent occlusal trauma transferred to the functioning unit of the mandible, the joint and disc. Transverse discrepancy of the maxillary and the mandibular posterior dentoalveolar units was often found in mandibular asymmetric subjects. Most of the asymmetry in growing subjects becomes worse with further growth if left untreated. However once sufficient posterior overjet is gained through orthodontic treatment, many cases have shown improvement in facial asymmetry. Furthermore, the position of condyles in computed tomogram(con-beam CT) changed from anatomically unfavorable position to more concentric position.

• 대한세포병리학회지
• /
• 제9권2호
• /
• pp.129-137
• /
• 1998

Although the success of the Papanicolaou test as a screening tool of cervical cancer is evident, there still exists $2{\sim}5%$ of discrepancy rate by both human and machine. To improve the qualilty of cervico-vaginal cytology, the authors compared cervicovaginal smear with cervical biopsy diagnoses, and analysed the causes of discrepancies. Among 30,922 cervicovaginal smears from June 1996 to April 1997 at our hospital, there were 271 cases of cervicovaginal smear with subsequent cervical punch or LEEP cone biopsies within several months. The biopsies and smears from a total of 98 discordant cases were reviewed. The discrepancy was attributed to sampling errors in 43 cases(43.9%), and to cytologic diagnosis in 49 cases(50.0%). Among these, 43 cases were interpretative errors(categories A;19, B;16 and C;8) whereas six cases were screening errors(categories B:2 and C:4). Among cervical biopsy cases, errors were present in four. As for 10% random rescreening, cytotechnologists reviewed 3,196 of 30,922 smears during the same period, There were 43 cases of screening error(categories A;27, B;16). Cytologic/histologic correlation was superior to 10% random rescreening of negative cases. The most effective method for quality improvement in cervicovaginal cytology was to implement both quality control(rescreening) and qualify assurance(cytologic/histologic correlation) programs.

• International Journal of Fuzzy Logic and Intelligent Systems
• /
• 제11권1호
• /
• pp.59-64
• /
• 2011

In 2001, the notion of a fuzzy poset defined on a set X via a triplet (L, G, I) of functions with domain X ${\times}$ X and range [0, 1] satisfying a special condition L+G+I = 1 is introduced by J. Negger and Hee Sik Kim, where L is the 'less than' function, G is the 'greater than' function, and I is the 'incomparable to' function. Using this approach, we are able to define a special class of fuzzy posets, and define the 'skeleton' of a fuzzy poset in view of major relation. In this sense, we define the linear discrepancy of a fuzzy poset of size n as the minimum value of all maximum of I(x, y)${\mid}$f(x)-f(y)${\mid}$ for f ${\in}$ F and x, y ${\in}$ X with I(x, y) > $\frac{1}{2}$, where F is the set of all injective order-preserving maps from the fuzzy poset to the set of positive integers. We first show that the definition is well-defined. Then, it is shown that the optimality appears at the same injective order-preserving maps in both cases of a fuzzy poset and its skeleton if the linear discrepancy of a skeleton of a fuzzy poset is 1.

• 대한세포병리학회지
• /
• 제8권2호
• /
• pp.120-128
• /
• 1997

Fine needle aspiration cytology of breast lesion is well known as a simple, economic and effective diagnostic modality. For the evaluation of cytohistologic correlation, 256 cases of cytologic smears and subsequent histologic sections during 2-year period from Jan. 1995 to Dec. 1996 were reviewed. 1. Fifteen cases(5.9%) were proven as insufficient for evaluation, and 13 of them were fibrocystic change histologically. One case of carcinoma exhibiting sufficient amount of aspirates with no malignant cells on smear was regarded as inadequate. 2. Cytohistologic correlation of 240 cases revealed sensitivity 87.0%, specificity 100.0%, positive predictive value 100.0%, negative predictive value 97.0%, false positive rate 0.0% and false negative rate 13.0%. Total diagnostic accuracy is 95.7%. 3. Total 6 cases of negative were due to small amount of aspirates containing scantiness of malignant cells in two and underestimation in four. 4. Diagnostic concordance rates of fibrocystic change and fibroadenoma were 95.5% and 80.0%, respectively. Diagnostic discrepancies were noted in 7 cases of fibrocystic change and 6 cases of fibroadenoma, however, cytologic discrimination of two entities was not easy in seven of them. 5. In a case of phyllodes tumor and a case of duct ectasia, the discrepancy was due to targeting error. Other three cases(lymphoma, adenomyoepithelioma and granulomatous mastitis) were misinterpreted because of poor acquaintance with those entities. Diagnostic accuracy of fine needle aspiration cytology of breast lesions are relatively high. However, good technique on aspiration and adequate interpretation are necessary to reduce the false negative rate and the discrepancy between cytologic and histologic diagnoses.