{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T22:27:01Z","timestamp":1792794421146,"version":"4.5.0"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2019,11,6]],"date-time":"2019-11-06T00:00:00Z","timestamp":1572998400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2019,11,6]],"date-time":"2019-11-06T00:00:00Z","timestamp":1572998400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100008005","name":"Yonsei University College of Medicine","doi-asserted-by":"publisher","award":["6-2014-0199"],"award-info":[{"award-number":["6-2014-0199"]}],"id":[{"id":"10.13039\/501100008005","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"published-print":{"date-parts":[[2020,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To develop a nomogram and validate its use for the intraoperative evaluation of nodal metastasis using shear-wave elastography (SWE) elasticity values and nodal size<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We constructed a nomogram to predict metastasis using ex vivo SWE values and ultrasound features of 228 axillary LNs from fifty-five patients. We validated its use in an independent cohort comprising 80 patients. In the validation cohort, a total of 217 sentinel LNs were included.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We developed the nomogram using the nodal size and elasticity values of the development cohort to predict LN metastasis; the area under the curve (AUC) was 0.856 (95% confidence interval (CI), 0.783\u20130.929). In the validation cohort, 15 (7%) LNs were metastatic, and 202 (93%) were non-metastatic. The mean stiffness (23.54 and 10.41 kPa,<jats:italic>p<\/jats:italic>= 0.005) and elasticity ratio (3.24 and 1.49,<jats:italic>p<\/jats:italic>= 0.028) were significantly higher in the metastatic LNs than those in the non-metastatic LNs. However, the mean size of the metastatic LNs was not significantly larger than that of the non-metastatic LNs (8.70 mm vs 7.20 mm, respectively;<jats:italic>p<\/jats:italic>= 0.123). The AUC was 0.791 (95% CI, 0.668\u20130.915) in the validation cohort, and the calibration plots of the nomogram showed good agreement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We developed a well-validated nomogram to predict LN metastasis. This nomogram, mainly based on ex vivo SWE values, can help evaluate nodal metastasis during surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Points<\/jats:title><jats:p><jats:italic>\u2022 A nomogram was developed based on axillary LN size and ex vivo SWE values such as mean stiffness and elasticity ratio to easily predict axillary LN metastasis during breast cancer surgery.<\/jats:italic><\/jats:p><jats:p><jats:italic>\u2022 The constructed nomogram presented high predictive performance of sentinel LN metastasis with an independent cohort.<\/jats:italic><\/jats:p><jats:p><jats:italic>\u2022 This nomogram can reduce unnecessary intraoperative frozen section which increases the surgical time and costs in breast cancer patients.<\/jats:italic><\/jats:p><\/jats:sec>","DOI":"10.1007\/s00330-019-06473-5","type":"journal-article","created":{"date-parts":[[2019,11,6]],"date-time":"2019-11-06T15:03:33Z","timestamp":1573052613000},"page":"789-797","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["A nomogram constructed using intraoperative ex vivo shear-wave elastography precisely predicts metastasis of sentinel lymph nodes in breast cancer"],"prefix":"10.1007","volume":"30","author":[{"given":"Soong June","family":"Bae","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Hyun","family":"Youk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang Ik","family":"Yoon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soeun","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi Hwan","family":"Cha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hak Woo","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung Gwe","family":"Ahn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung Ah","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun Ju","family":"Son","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0397-0005","authenticated-orcid":false,"given":"Joon","family":"Jeong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,11,6]]},"reference":[{"key":"6473_CR1","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1007\/BF01806129","volume":"10","author":"WL McGuire","year":"1987","unstructured":"McGuire WL (1987) Prognostic factors for recurrence and survival in human breast cancer. Breast Cancer Res Treat 10:5\u20139","journal-title":"Breast Cancer Res Treat"},{"key":"6473_CR2","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1016\/S1470-2045(13)70035-4","volume":"14","author":"V Galimberti","year":"2013","unstructured":"Galimberti V, Cole BF, Zurrida S et al (2013) Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): a phase 3 randomised controlled trial. Lancet Oncol 14:297\u2013305","journal-title":"Lancet Oncol"},{"key":"6473_CR3","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1200\/JCO.2016.71.0947","volume":"35","author":"GH Lyman","year":"2017","unstructured":"Lyman GH, Somerfield MR, Bosserman LD, Perkins CL, Weaver DL, Giuliano AE (2017) Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology Clinical Practice guideline update. J Clin Oncol 35:561\u2013564","journal-title":"J Clin Oncol"},{"key":"6473_CR4","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1097\/SLA.0b013e3181c0e92a","volume":"251","author":"U Veronesi","year":"2010","unstructured":"Veronesi U, Viale G, Paganelli G et al (2010) Sentinel lymph node biopsy in breast cancer: ten-year results of a randomized controlled study. Ann Surg 251:595\u2013600","journal-title":"Ann Surg"},{"key":"6473_CR5","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1056\/NEJMoa012782","volume":"349","author":"U Veronesi","year":"2003","unstructured":"Veronesi U, Paganelli G, Viale G et al (2003) A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med 349:546\u2013553","journal-title":"N Engl J Med"},{"key":"6473_CR6","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1093\/jnci\/djj158","volume":"98","author":"RE Mansel","year":"2006","unstructured":"Mansel RE, Fallowfield L, Kissin M et al (2006) Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial. J Natl Cancer Inst 98:599\u2013609","journal-title":"J Natl Cancer Inst"},{"key":"6473_CR7","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1016\/S1470-2045(10)70207-2","volume":"11","author":"DN Krag","year":"2010","unstructured":"Krag DN, Anderson SJ, Julian TB et al (2010) Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol 11:927\u2013933","journal-title":"Lancet Oncol"},{"key":"6473_CR8","doi-asserted-by":"publisher","first-page":"2336","DOI":"10.1016\/j.ultrasmedbio.2014.05.020","volume":"40","author":"JH Youk","year":"2014","unstructured":"Youk JH, Son EJ, Gweon HM, Kim H, Park YJ, Kim JA (2014) Comparison of strain and shear wave elastography for the differentiation of benign from malignant breast lesions, combined with B-mode ultrasonography: qualitative and quantitative assessments. Ultrasound Med Biol 40:2336\u20132344","journal-title":"Ultrasound Med Biol"},{"key":"6473_CR9","doi-asserted-by":"publisher","first-page":"3","DOI":"10.14366\/usg.13012","volume":"33","author":"SH Lee","year":"2014","unstructured":"Lee SH, Chang JM, Cho N et al (2014) Practice guideline for the performance of breast ultrasound elastography. Ultrasonography 33:3\u201310","journal-title":"Ultrasonography"},{"key":"6473_CR10","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1016\/j.jus.2012.06.009","volume":"15","author":"A Goddi","year":"2012","unstructured":"Goddi A, Bonardi M, Alessi S (2012) Breast elastography: a literature review. J Ultrasound 15:192\u2013198","journal-title":"J Ultrasound"},{"key":"6473_CR11","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1097\/RLI.0000000000000543","volume":"54","author":"P Kapetas","year":"2019","unstructured":"Kapetas P, Clauser P, Woitek R et al (2019) Quantitative multiparametric breast ultrasound: application of contrast-enhanced ultrasound and elastography leads to an improved differentiation of benign and malignant lesions. Invest Radiol 54:257\u2013264","journal-title":"Invest Radiol"},{"key":"6473_CR12","doi-asserted-by":"publisher","first-page":"660","DOI":"10.1148\/radiol.2017162424","volume":"285","author":"SH Lee","year":"2017","unstructured":"Lee SH, Chung J, Choi HY et al (2017) Evaluation of screening US-detected breast masses by combined use of elastography and color Doppler US with B-mode US in women with dense breasts: a multicenter prospective study. Radiology 285:660\u2013669","journal-title":"Radiology"},{"key":"6473_CR13","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1007\/s00330-016-4359-6","volume":"27","author":"JS Bae","year":"2017","unstructured":"Bae JS, Chang JM, Lee SH, Shin SU, Moon WK (2017) Prediction of invasive breast cancer using shear-wave elastography in patients with biopsy-confirmed ductal carcinoma in situ. Eur Radiol 27:7\u201315","journal-title":"Eur Radiol"},{"key":"6473_CR14","doi-asserted-by":"publisher","first-page":"2282","DOI":"10.1007\/s00330-016-4619-5","volume":"27","author":"Y Ma","year":"2017","unstructured":"Ma Y, Zhang S, Li J, Li J, Kang Y, Ren W (2017) Comparison of strain and shear-wave ultrasounic elastography in predicting the pathological response to neoadjuvant chemotherapy in breast cancers. Eur Radiol 27:2282\u20132291","journal-title":"Eur Radiol"},{"key":"6473_CR15","doi-asserted-by":"publisher","first-page":"3154","DOI":"10.1016\/j.ejrad.2012.04.031","volume":"81","author":"C Tourasse","year":"2012","unstructured":"Tourasse C, Denier JF, Awada A, Gratadour AC, Nessah-Bousquet K, Gay J (2012) Elastography in the assessment of sentinel lymph nodes prior to dissection. Eur J Radiol 81:3154\u20133159","journal-title":"Eur J Radiol"},{"key":"6473_CR16","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1007\/s10549-013-2747-z","volume":"143","author":"A Evans","year":"2014","unstructured":"Evans A, Rauchhaus P, Whelehan P et al (2014) Does shear wave ultrasound independently predict axillary lymph node metastasis in women with invasive breast cancer? Breast Cancer Res Treat 143:153\u2013157","journal-title":"Breast Cancer Res Treat"},{"key":"6473_CR17","doi-asserted-by":"publisher","first-page":"271","DOI":"10.7863\/ultra.15.03039","volume":"35","author":"F Kilic","year":"2016","unstructured":"Kilic F, Velidedeoglu M, Ozturk T et al (2016) Ex vivo assessment of sentinel lymph nodes in breast cancer using shear wave elastography. J Ultrasound Med 35:271\u2013277","journal-title":"J Ultrasound Med"},{"key":"6473_CR18","doi-asserted-by":"publisher","first-page":"1581","DOI":"10.1016\/j.ultrasmedbio.2017.03.016","volume":"43","author":"JH Youk","year":"2017","unstructured":"Youk JH, Son EJ, Kim JA, Gweon HM (2017) Pre-operative evaluation of axillary lymph node status in patients with suspected breast cancer using shear wave elastography. Ultrasound Med Biol 43:1581\u20131586","journal-title":"Ultrasound Med Biol"},{"key":"6473_CR19","doi-asserted-by":"publisher","first-page":"10234","DOI":"10.1038\/s41598-018-28474-y","volume":"8","author":"Y Xu","year":"2018","unstructured":"Xu Y, Bai X, Chen Y et al (2018) Application of real-time elastography ultrasound in the diagnosis of axillary lymph node metastasis in breast cancer patients. Sci Rep 8:10234","journal-title":"Sci Rep"},{"key":"6473_CR20","doi-asserted-by":"publisher","first-page":"190","DOI":"10.4048\/jbc.2018.21.2.190","volume":"21","author":"SJ Bae","year":"2018","unstructured":"Bae SJ, Park JT, Park AY et al (2018) Ex vivo shear-wave elastography of axillary lymph nodes to predict nodal metastasis in patients with primary breast cancer. J Breast Cancer 21:190\u2013196","journal-title":"J Breast Cancer"},{"key":"6473_CR21","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1148\/radiol.14132404","volume":"275","author":"RG Barr","year":"2015","unstructured":"Barr RG, Zhang Z (2015) Shear-wave elastography of the breast: value of a quality measure and comparison with strain elastography. Radiology 275:45\u201353","journal-title":"Radiology"},{"key":"6473_CR22","doi-asserted-by":"publisher","first-page":"300","DOI":"10.14366\/usg.17024","volume":"36","author":"JH Youk","year":"2017","unstructured":"Youk JH, Gweon HM, Son EJ (2017) Shear-wave elastography in breast ultrasonography: the state of the art. Ultrasonography 36:300\u2013309","journal-title":"Ultrasonography"},{"key":"6473_CR23","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1111\/j.1075-122X.2004.21280.x","volume":"10","author":"DJ Dabbs","year":"2004","unstructured":"Dabbs DJ, Fung M, Landsittel D, McManus K, Johnson R (2004) Sentinel lymph node micrometastasis as a predictor of axillary tumor burden. Breast J 10:101\u2013105","journal-title":"Breast J"},{"key":"6473_CR24","doi-asserted-by":"publisher","first-page":"1364","DOI":"10.1200\/JCO.2007.12.9791","volume":"26","author":"A Iasonos","year":"2008","unstructured":"Iasonos A, Schrag D, Raj GV, Panageas KS (2008) How to build and interpret a nomogram for cancer prognosis. J Clin Oncol 26:1364\u20131370","journal-title":"J Clin Oncol"},{"key":"6473_CR25","first-page":"89","volume":"57","author":"R Rouzier","year":"2009","unstructured":"Rouzier R, Coutant C, Incitti R et al (2009) Breast cancer: nomograms to predict pathologic response after preoperative chemotherapy. J Med Liban 57:89\u201392","journal-title":"J Med Liban"},{"key":"6473_CR26","doi-asserted-by":"publisher","first-page":"2032","DOI":"10.1200\/JCO.2009.24.6314","volume":"28","author":"O Graesslin","year":"2010","unstructured":"Graesslin O, Abdulkarim BS, Coutant C et al (2010) Nomogram to predict subsequent brain metastasis in patients with metastatic breast cancer. J Clin Oncol 28:2032\u20132037","journal-title":"J Clin Oncol"},{"key":"6473_CR27","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1111\/j.1464-410X.2008.08073.x","volume":"103","author":"SF Shariat","year":"2009","unstructured":"Shariat SF, Capitanio U, Jeldres C, Karakiewicz PI (2009) Can nomograms be superior to other prediction tools? BJU Int 103:492\u2013495 discussion 495-497","journal-title":"BJU Int"},{"key":"6473_CR28","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1016\/j.breast.2016.01.009","volume":"26","author":"A Evans","year":"2016","unstructured":"Evans A, Sim YT, Thomson K, Jordan L, Purdie C, Vinnicombe SJ (2016) Shear wave elastography of breast cancer: sensitivity according to histological type in a large cohort. Breast 26:115\u2013118","journal-title":"Breast"},{"key":"6473_CR29","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1097\/SLA.0b013e3181f08f32","volume":"252","author":"AE Giuliano","year":"2010","unstructured":"Giuliano AE, McCall L, Beitsch P et al (2010) Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg 252:426\u2013432 discussion 432-423","journal-title":"Ann Surg"},{"key":"6473_CR30","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1097\/SLA.0000000000001863","volume":"264","author":"AE Giuliano","year":"2016","unstructured":"Giuliano AE, Ballman K, McCall L et al (2016) Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: long-term follow-up from the American College of Surgeons Oncology Group (Alliance) ACOSOG Z0011 randomized trial. Ann Surg 264:413\u2013420","journal-title":"Ann Surg"},{"key":"6473_CR31","doi-asserted-by":"publisher","first-page":"1303","DOI":"10.1016\/S1470-2045(14)70460-7","volume":"15","author":"M Donker","year":"2014","unstructured":"Donker M, van Tienhoven G, Straver ME et al (2014) Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol 15:1303\u20131310","journal-title":"Lancet Oncol"},{"key":"6473_CR32","doi-asserted-by":"publisher","first-page":"830","DOI":"10.5858\/arpa.2015-0296-OA","volume":"140","author":"JA Bishop","year":"2016","unstructured":"Bishop JA, Sun J, Ajkay N, Sanders MA (2016) Decline in frozen section diagnosis for axillary sentinel lymph nodes as a result of the American College of Surgeons Oncology Group Z0011 Trial. Arch Pathol Lab Med 140:830\u2013835","journal-title":"Arch Pathol Lab Med"},{"key":"6473_CR33","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1093\/ajcp\/aqw078","volume":"146","author":"JM Jorns","year":"2016","unstructured":"Jorns JM, Kidwell KM (2016) Sentinel lymph node frozen-section utilization declines after publication of American College of Surgeons Oncology Group Z0011 trial results with no change in subsequent surgery for axillary lymph node dissection. Am J Clin Pathol 146:57\u201366","journal-title":"Am J Clin Pathol"},{"issue":"Suppl 1","key":"6473_CR34","doi-asserted-by":"publisher","first-page":"S64","DOI":"10.1016\/j.breast.2017.06.031","volume":"34","author":"MEM van der Noordaa","year":"2017","unstructured":"van der Noordaa MEM, Vrancken Peeters M, Rutgers EJT (2017) The intraoperative assessment of sentinel nodes - standards and controversies. Breast 34(Suppl 1):S64\u2013S69","journal-title":"Breast"},{"key":"6473_CR35","doi-asserted-by":"publisher","first-page":"1023","DOI":"10.1007\/s00330-011-2340-y","volume":"22","author":"DO Cosgrove","year":"2012","unstructured":"Cosgrove DO, Berg WA, Dore CJ et al (2012) Shear wave elastography for breast masses is highly reproducible. Eur Radiol 22:1023\u20131032","journal-title":"Eur Radiol"},{"issue":"11","key":"6473_CR36","doi-asserted-by":"publisher","first-page":"5999","DOI":"10.1007\/s00330-019-06195-8","volume":"29","author":"Riwa Kishimoto","year":"2019","unstructured":"Kishimoto R, Kikuchi K, Koyama A et al (2019) Intra- and inter-operator reproducibility of US point shear-wave elastography in various organs: evaluation in phantoms and healthy volunteers. Eur Radiol. https:\/\/doi.org\/10.1007\/s00330-019-06195-8","journal-title":"European Radiology"}],"container-title":["European Radiology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-019-06473-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1007\/s00330-019-06473-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-019-06473-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,3]],"date-time":"2022-10-03T20:32:15Z","timestamp":1664829135000},"score":1,"resource":{"primary":{"URL":"http:\/\/link.springer.com\/10.1007\/s00330-019-06473-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,6]]},"references-count":36,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2020,2]]}},"alternative-id":["6473"],"URL":"https:\/\/doi.org\/10.1007\/s00330-019-06473-5","relation":{},"ISSN":["0938-7994","1432-1084"],"issn-type":[{"value":"0938-7994","type":"print"},{"value":"1432-1084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11,6]]},"assertion":[{"value":"21 June 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 August 2019","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 September 2019","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 November 2019","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with Ethical Standards"}},{"value":"The scientific guarantor of this publication is Joon Jeong.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Guarantor"}},{"value":"The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interest"}},{"value":"Biostatistics Collaboration Unit at Yonsei University College of Medicine has been consulted for statistical analysis.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and Biometry"}},{"value":"Written informed consent was obtained from all patients in this study.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed Consent"}},{"value":"Institutional Review Board approval was obtained.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval"}},{"value":"\u2022 prospective\u2022 diagnostic study\u2022 performed at one institution","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}