The Feasibility of Lateral Minimal Invasive Open Thyroid Lobectomy / 대한내분비외과학회지

PURPOSE: Minimal invasive open thyroidectomy is one option for minimal invasive surgery. The population of planned unilateral lobectomy is on the rise in parallel to the increased incidence of confined papillary thyroid microcarcinomas in Korea. In contrast to other minimal invasive modalities, few studies have examined the surgical outcome of minimal invasive open thyroidectomy. This study compared the lateral minimal invasive open thyroid lobectomy with conventional surgery and endoscopic surgery in terms of the feasibility and safety. METHODS: A retrospective study was performed on 197 patients undergoing a thyroid lobectomy between January 2001 and December 2010. One hundred and three patients underwent a lateral minimal invasive open thyroid lobectomy, 42 patients underwent conventional surgery, and 44 patients underwent endoscopic surgery. RESULTS: The hospitalization period with endoscopic surgery was 6.2 days, which was longer than the 5.3 days with a lateral minimal invasive open thyroid lobectomy (P=0.000). The surgical time was lower in those who underwent a lateral minimal invasive open thyroid lobectomy (88.2 minutes) than in those who underwent conventional surgery (107 minutes, P=0.000) or endoscopic surgery (124.1 minutes, P=0.000). In the patients with a diagnosis of malignancy, the mean number of retrieved LNs was similar in the three groups. CONCLUSION: A lateral minimal invasive open thyroid lobectomy offers advantages, such as a shorter surgical time and hospitalization period than others. This procedure can be a feasible alternative to the conventional or endoscopic approach in selected patients undergoing thyroid lobectomy.

Central Lumpectomy with Resection of the Nipple-areolar Complex for Retroareolar or Central Breast Cancers

PURPOSE: This study was conducted to evaluate the outcome of central lumpectomy for breast conservation including nipple-areolar resection and postoperative radiation therapy in patients with central breast cancers. METHODS: 19 patients with central breast cancers, aged 39 to 72 years, operated on from May 2004 to March 2010 were identified. Recurrence, survival, and cosmesis were analyzed. Treatment was undertaken as complete excision of the nipple-areolar complex (NAC), followed by external radiation to the whole breast and tumor bed. The mean follow-up period was 37.9 (1 to 71) months. RESULTS: At pathology, 13 had invasive ductal carcinoma; 5 had ductal carcinoma in situ. 1 had neuroendocrine cancer. Only 1 had atypical ductal hyperplasia at resection margin; the remaining 18 were free margins. The mean tumor size was 1.6 cm (range, 0.8~4 cm) and the distance from the nipple was 0~1 cm. 37.5% had positive axillary nodes. Adjuvant chemotherapy was given for 12 patients, followed by radiation therapy. All 15 patients, who were hormone receptor positive, were given tamoxifen or aromatase inhibitors. With a mean follow up of 37.9 months, all 19 patients are alive and free of disease. Cosmetic results ranged from good to excellent in 18 (94.7%) patients, as judged by both the patients and the surgeons. CONCLUSION: Although this study needs further evaluation and long-term follow up, subareolar or central breast cancers can be successfully treated with breast conserving therapy using nipple-areolar resection and postoperative radiation therapy, along with acceptable cosmesis.

The Surgical Management of Papillary Thyroid Microcarcinoma / 대한내분비외과학회지

PURPOSE: There has been a rapid rise in the incidence of thyroid cancer, particularly papillary thyroid microcarcinoma (PTMC). However, there is a lack of consensus of treatment guidelines or follow-up strategies. METHODS: A retrospective analysis of 606 patients who underwent operation due to thyroid cancer from March 2000 to December 2008 was conducted. Of these patients, 587 with pure papillary carcinomas were studied, of whom 392 (67%) presented with PTMC. RESULTS: Only 23% of patients were symptomatic, but 75% of patients were positive using the imaging techniques ultrasonography or positron emission tomography. When the microcarcinoma patient group (G1) was compared with the group of remaining patients (G2), less aggressive operations were chosen for G1. A lobectomy was performed in 63.8% of G1 versus in 14% of G2, and the central compartment neck dissection was omitted in 30% of G1 versus 16% of G2. During the follow-up period (mean 37.9±25.2 months), there were 11 recurrences. Two patients developed contralateral cancers 42 and 49 months after lobectomy. One patient had recurrences on central compartment lymph nodes 34 months post-operatively. Eight patients had lateral neck lymph nodes metastases 13~52 months postoperatively. Three of these eight patients had concomitant central neck lymph node metastases. CONCLUSION: Less aggressive treatments can be chosen for PTMC patients compared to non-PTMC patients. To clarify these results, longer follow up and larger and multi-institutional data are needed.

Breast Cancer Screening: A Medical Audit of the Screening Mammography Performed at One Institution for 10 Years / 한국유방암학회지

PURPOSE: Screening for breast cancer has constantly been increasing since the benefit of screening for breast cancers was established. The purpose of this study was to investigate the efficacy of annual breast cancer screening at one institution for 10 years by conducting a medical audit. METHODS: From March 1995 to July 2004, we performed 110,588 annual clinical examinations and mammographies on 58,024 women, who wanted to undergo breast cancer screening. Two hundred fourteen breast cancers were detected during screening, and one hundred sixty one of these patients were operated on. We then compared these results with the ideal rates for medical audits. RESULTS: Of the 110,588 cases that were screened, the recall rate for further examination was 12.1% (n=13,423). The biopsy rate was 1.01% (n=1,116). Two hundred fourteen breast cancers were detected for a detection rate of 0.19%. The percent of stage 0 cancer among all the cancer was 23.6%, stage I was 40.4%, stage IIa was 19.9%, stage IIb and IIIa were a combined 6.2%, stage IIIc was 3.1%, and stage IV was 0.6%. The positive predictive value (PPV) based on the abnormal findings on the screening examinations was 1.6% (PPV1). The PPV when a biopsy or surgical consultation was recommended was 15.1% (PPV2). The percent of tumor found as stage 0 or I was 64% (103/161). The tumor found as minimal cancer (stage 0 or tumor lesser than 1 cm) was 38.5% (62/161). There were 38 cases of axillary lymph node metastasis (23.6%). The number of cases of cancers found per 1,000 cases was 1.7. The prevalence of cancer found per 1,000 first examinations was 2.3. The incidental cancer found per 1,000 follow-up examinations was 1.2. The recall rate for further evaluation was 12.1%. These results were compatible with the ideal rates for medical audits, except for the recall rate, the PPV1, the PPV2, and the cancers found per 1,000 cases. CONCLUSION: On the base of these results, breast cancer screening was properly performed in this institution. Breast cancer screening using a clinical examination and a mammography is effective for the early detection of breast cancer.

Diagnosis and Treatment Outcome of Idiopathic Granulomatous Mastitis: Clinical Analysis on 35 Cases of Granulomatous Mastitis

PURPOSE: Idiopathic granulomatous mastitis (GM) is an uncommon breast disease that mimics carcinoma in terms of the clinical and radiological findings. Its unknown etiology makes the management difficult. Although surgical excision with or without steroid therapy has been the mainstay of the treatment, the efficacy of this treatment has been inconsistent. This study was performed to evaluate the diagnostic methods and the treatment outcomes. METHODS: This retrospective study included 31 patients with the diagnosis of GM and 4 patients had bilateral disease. They were found from the database of the pathology laboratory at Cheil General Hospital between January 1999 and December 2004. We reviewed the clinical, radiological, and pathological information, and we finally evaluated the treatment outcomes according to the surgical and medical treatments. RESULTS: The mean age at diagnosis was 34.2 years (range: 27~57). All the patients were parous except one, and 82% of patients were within 5 years from their last delivery. Four patients had bilateral involvement. Only three patients used oral contraceptives and 54% of patients had a history of breast feeding. Most patients (91%) presented with mass and the remainder (9%) presented with fistula. The confirmative diagnosis was made by FNAB (fine needle aspiration biopsy), debridement, CNB (core needle biopsy) or excision. Surgical excision or debridement was successful in 13 cases (39.4%) of 33 cases. Anti-tuberculosis medications were successful in 85% (11/13). Steroid treatment was successful in only two patients (29%). CONCLUSION: Surgical excision provided not only the definite diagnosis, but also treatment of GM for the cases in which a clear surgical margin was obtained. Anti-tuberculosis medication can be considered if fistula or abscess is intractable after excision, even with failure to identify tuberculosis.

The Effect of Tumor Characteristics on the Repeated Nondiagnostic Fine-needle Aspiration Biopsy Results in Thyroid Nodules / 대한내분비외과학회지

PURPOSE: The management of nondiagnostic fine-needle as-piration biopsy (FNAB) of thyroid nodules has not been determined because the significance of persistent nondiagnostic FNAB has been underestimated. The purposes of the present study were to estimate the likelihood of malignancy in patients with nondiagnostic FNAB results and to evaluate whether tumor factors could affect the nondiagnostic FNAB results. METHODS: 2,400 FNABs were performed for thyroid nodules at our institution from 2001 to 2005. A total 294 patients who had initial nondiagnostic results were the subjects of this study. We retrospectively reviewed the age, gender, tumor size, the sonographic findings, the FNAB results and the pathologic reports. RESULTS: The initial nondiagnostic rate was 12.3% (294/2,400). Among the 294 initial nondiagnosted patients, FNAB was secondarily performed in only 99 patients. Seventy patients (70.7%) were diagnostic and 29 (29.3%) remained nondiagnosed. Twenty of seventy diagnosed patients had malignant FNAB results, including atypical cells, and the other 50 patients were benign. The causes of nondiagnostic FNAB results by pathologic descriptions were 43.1%: scanty cellularity, 29.2%: blood, 13.2%: fluid or colloid, 11.1%: inconclusive, and 3.5%: dry artifact. There are no differences in the nondiagnostic rate according to tumor size (P=0.2) and calcification (P=0.7). When the sonographic results could predict the pathologic results, no difference was noted according to the sonographic findings that determined malignancy (P=0.4). Ten percent of the initial nondiagnostic FNAB results were finally reported as malignancy. CONCLUSION: Scanty cellularity and blood aspiration were the major causes of nondiagnostic FNAB results (43.1% and 29.2%, respectively). Tumor characteristics such as tumor size, the presence of calcification and sonographic findings did not predict nondiagnostic FNAB results. Reaspiration biopsy for the initially nondiagnostic FNAB in the thyroid nodules had a high probability of achieving a nondiagnositc result. Because nondiagnostic FNAB of the thyroid nodules may be associated with a relatively high probability of thyroid malignancy, a nondiagnostic FNAB should not be considered as benign. So, if reaspiration biopsy is nondiagnostic, it should be the subject of concern or the patient might be considered for surgery with taking into account the other characteristics, in particularily malignant sonographic findings.

Prognostic Role of HER-2 according to Lymph Node Involvement in Invasive Ductal Carcinoma of Breast

PURPOSE: This study was conducted to investigate the prognostic value of HER2 in breast cancer patients. METHODS: A total of 100 consecutive formalin-fixed, paraffin- embedded sections of invasive ductal carcinomas were evaluated by immunohistochemical staining (IHC) and a fluorescence in situ hybridization (FISH) assay for HER2. The cases of 0/1+ IHC were regarded as negative and 3+ as positive. Among the 100 cases tested by IHC, the 2+ cases were confirmed by FISH. RESULTS: Twenty-seven of 100 cases (27%) were confirmed positive for HER-2, which was significantly correlated with the nuclear grade (NG), ER and PR (P=0.014, P=0.004, and P=0.023, respectively). The mean disease-free survival periods (DFS) and overall survival periods (OS) of the HER-2-positive and -negative patients were 64.6+/-6 months and 82+/-3 months (P=0.0031), and 70+/-6 months and 85+/-2 months, respectively (P=0.0096). Of the 48 axillary lymph node (LN) positive patients, the mean DFS and OS of the HER-2-positive and -negative patients were 46+/-9 months and 80+/-4 months (P=0.0007) and 54+/-9 months and 83+/-4 months, respectively (P= 0.001). In the LN negative patients; however, HER-2 overexpression showed no significant correlation with the prognosis. In a multivariate analysis, DFS was significantly correlated with LN involvement and HER-2 overexpression (P=0.015, and P=0.0396, respectively). However, with regard to the OS. LN involvement and NG were statistically significant (P=0.041, and P=0.0125, respectively). CONCLUSION: This study indicates that HER-2 overexpression may play a useful role as an indicator of poor prognosis in invasive ductal carcinoma of breast, especially in LN positive patients.

Invasive Ductal Carcinoma Arising from Axillary Accessory Breast / 한국유방암학회지

As a consequence of the incomplete resolution of embryologic mammary ridges, ectopic breast tissue can be present anywhere along the "milk line", including the axillary region. Aberrant breast tissue can develop with any disease that affects the normal breast, including a breast carcinoma. A carcinoma of aberrant breast tissue is rare, but should still be investigated and treated properly with respect to other breast cancers in the embryonic milk-line. Herein is reported our recent experience of a carcinoma originating from aberrant breast tissue in the right axilla. An abnormal nodule around the periphery of the normal breast should be suspected as a breast carcinoma and differential diagnosis and properly treated.

Mitogen-activated Protein Kinases Activities and c-erbB-2 Expression in Breast Cancer Carcinogenesis and Progression

PURPOSE: Increased level mitogen-activated protein kinase (MAPK) and activation of MAPK have been reported in human breast cancers, especially in breast cancers with HER2/neu overexpression. To understand the relationship between the MAPK protein expressions and other clinico-pathological parameters, we examined the status of MAPKs in 20 breast cancers compared to those of paired normals. METHODS: A total of 20 breast cancers and paired normal breast tissues were included in this study. Tissues were obtained at the operation room and stored at -80degrees C. Tissue proteins were extracted and the concentration was determined by Bio-Rad protein assay method. Western blot analysis were performed to determine the level of MAPKs expressions using 100 ug of tissue protein in 8%, 10%, or 12% sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE). MAPK assays were carried out by a non-radioactive method developed by Cell Signaling Tech. as recommened by the manufacturer. Clinico-pathological information was provided from the Breast Cancer Registry of Department of Surgery, Yonsei University College of Medicine. RESULTS: The levels of MAPKs were higher in 95% of breast cancers compared to those of paired normals. The levels of ERK1/2 were significantly higher in cancer tissues compared to paired normals but the activated forms were not. The levels of JNK, p38, and MKP1 proteins were significantly increased in the cancer tissue compared to the paired normals. The levels of ERK1/2 and activated ERK1/2 proteins were not different between tumor stages. There were no significant differences of the levels of ERK1/2 and activated ERK1/2 proteins between HER2-negative and HER2- positive cancers. There were significantly higher levels of activated ERK1/2 proteins in ER-positive cancers than those in ER-negative cancers (P<0.05). CONCLUSION: The levels of MAPKs, but not the activated forms, seem to be increased in breast cancer tissues compared to those of paired normals. The levels of activated MAPKs seem to be associated with estrogen receptor expression in cancer tissues.

Ductal Carcinoma In Situ (DCIS) of the Breast; Clinico-pathological Analysis, Expression of Molecular Markers, and Correlations between Known Prognostic Factors

PURPOSE: The improved availability of breast cancer screening, including mammography, has dramatically increased the detection rate of DCIS (ductal carcinoma in situ). However, there has been controversy regarding the clinico-pathological characteristics and optimal management of DCIS. This analysis was conducted in order to evaluate the clinico- pathological findings of DCIS, and any possible correlations between the known prognostic factors. METHODS: We analyzed 58 consecutive cases of DCIS, from 1990 to 1995, including data on the annual proportion of DCIS to total breast cancer cases, the clinico-pathological characteristics and the expressions of ER, PR, c-erbB-2 and p53. The median length of follow-up was 98.5 months. RESULTS: The proportion of DCIS was 8.8%, with progressive increases from 1990 to 1995. The mean age at diagnosis was 47.1 years, with the peak of prevalence seen in women aged 40~49 years. The most common presentation was a palpable breast mass in 28 (48.3%) cases, but 18 (31%) patients were asymptomatic. The mammographic findings demonstrated calcification in 75% and mass density in 59.6%. There was only 1 (1.8%) case of a bilateral lesion, and 5 (8.6%) of multifocal or multicentric lesions. Axillary lymph nodes were positive in 5.5% of the patients who underwent an axillary dissection. Breast conserving operations were performed in 8 (13.8%) cases. The frequencies of ER, PR, c-erbB-2 and p53, positivity, by immunohistochemistry were 52, 50, 55.1 and 30.6%, respectively. c-erbB- 2 immunoreactivity was found more often in DCIS with larger size, higher nuclear grade and negative ER and PR (P= 0.011, P=0.001, P=0.002, and P=0.006, respectively). There was a significant association between higher nuclear grade and negative ER and PR, and comedotype (P=0.001, P= 0.000, and 0.008, respectively). Although an invasive ductal carcinoma had developed in 5.4% of the contralateral breasts, there were no cases of systemic relapse, or disease-specific mortality, at the last follow-up.

The Pattern of Systemic Failure and Factors Influencing on the Outcome after Distant Metastastasis in Breast Cancer / 한국유방암학회지

PURPOSE: Systemic failure after intial treatment of breast cancer is the most troublesome issue. To investigate the factors influencing on the outcome of metastatic breast cancer, this study was designed. METHODS: Two hundred sixty-seven breast cancer patients with distant metastasis after initial treatment were included for this study. The patients showing confined metastasis to the ipsilateral supraclavicular lymph node, were excluded. Preferred sites of metastasis, intervals to distant metastasis, survival rates after systemic failure were investigated in association with clinico-pathological parameters. Student ttest, chi-square test and log-rank test were used for statistical analysis. RESULTS: Patient age ranges from 20 to 71 years of age (mean 44.9). Forty-eight patients (18%) were initially included in stage 0 or I, 137 (51%) in stage II, and 82 (31%) in stage III. The preferred sites of metastasis were bone (47%), lung (29%), liver (9%), brain (8%) and multiple organs (4%) in descending order. Initial pathologic stage (P<0.001) and lymph node metastasis (P=0.016) were associated with the interval to distant metastasis, but not the tumor size (P= 0.246). Poor survival after systemic failure was associated with metastasis to the multiple organs or to liver (P<0.001), with no treatment after failure (P<0.001), and with failure within 3 years after initial treatment (P=0.056) CONCLUSION: Bone is the most prevalent metastatic site of breast cancer. Axillary lymph node status, especially the number of involved nodes, was associated with shorter disease free survival after initial treatment, which suggests that it might be a predictor of micrometastasis and a marker for an aggressive systemic treatment. Hepatic metastasis and metastasis to multiple organs was a poor prognostic marker of metastatic breast cancer. An aggressive systemic treatment after systemic failure might improve the survival.

Ductal Carcinoma in Situ (DCIS) and Ductal Carcinoma in Situ with Microinvasion (DCIS-MI) of the Breast

PURPOSE: The use of mammographic screening has led to the early detection of breast cancers as well as the increasing incidence of ductal carcinoma in situ (DCIS) and DCIS with microinvasion (MI). The biologic behaviors and management of DCIS and DCIS with MI remain uncertain and controversial. We designed this study to investigate the differences in clinical behavior and association with pathological parameter of both DCIS and DCIS with MI. METHODS: DCIS with MI was defined as DCIS with and invasive area of 1 mm or less in greatest dimension. We analyzed and compared the clinico-pathological features and treatment outcomes of 155 DCIS patients and 73 DCIS with MI patients. Chi-square test, student t-test and Kaplan-Meier method using SPSS 9.0 for MS-windows were used to verify the statistical significance. RESULTS: Both DCIS with MI and DCIS were most prevalent in women in the fifth decade, and the mean ages of the two groups were 45.0 and 46.8 years old, respectively. The primary tumors of DCIS with MI were more palpable (72.6% vs. 56.8%, P=0.032) upon physical examination and larger (3.1+/-0.21 cm vs. 2.6+/-0.12 cm, P=0.037) than those of the DCIS group. The rate of axillary lymph node metastasis was higher in the DCIS with MI group (8.3% vs. 0.7%, P=0.003). The DCIS with MI group was more commonly associated with high nuclear grade (50% vs. 28%, P=0.028). The DCIS with MI group was also linked with comedo type, although not to a statistically significant degree (67.6% vs. 52.6%, P=0.095). In terms of hormone receptor, there was no significant difference between the groups. There were three systemic metastases in DCIS patients and two DCIS with MI patients (P>0.05). There were no local-regional recurrences in either groups. The 8-year disease-free survival rates of the DCIS and DCIS with MI groups were 98.1% and 95.8% respectively (P>0.05). CONCLUSION: DCIS with MI has several clinical-pathological characterisitcs: more palpable on physical examination, larger in size, higher incidence of lesions with comedo necrosis and high nuclear grade. Examination of the axillary lymph node with less invasive techniques may be necessary in cases with suspicious invasion. Since DCIS with MI is thought to be a transitional disease entity between DCIS and invasive ductal carcinoma and has a metastatic potential, a careful histologic evaluation is necessary for the diagnosis of DCIS.

Risk Factors of Local Recurrence in Phyllodes Tumor

PURPOSE: A phyllodes tumor is a rare disease of the breast, which shows various clinicopathological aspects. However, there is some controversy over its clinical behavior, pathologic characteristics, and local recurrence rates. Therefore, the clinicopathological characteristics of phyllodes tumor and the risk factor that influence a local recurrence after surgery were analyzed. METHODS: The medical records of 56 patients with a phyllodes tumor who had undergone surgery at the Department of Surgery, Yonsei University, from 1986 to 1998, were analyzed retrospectively. The median follow up period was 57.2 months (12~245 months). The microscopic slides were re-examined and the pathologic criteria analyzed were cellular atypia, stromal cellularity, pleomorphism, necrosis, differentiation, tumor margin, and number of mitoses. The malignancy was reclassified using the histological criteria reported by Pietruszka et al. (benign was 0~4 mitoses/10 high- power fields, borderline 5~9 mitoses, and malignant more than 10 mitoses). The clinical features evaluated included age, preoperative diagnosis, tumor size, surgical methods, and local recurrence. RESULTS: The mean age was 41 years 14~69 years) and the mean tumor size was 4.5 cm (1~12 cm). Only 9 cases (16.1%) were preoperatively diagnosed as having a phyllodes tumor. The most commonly performed surgical procedures were local or wide excision (46 cases, 82.1%), and a mastectomy in 10 cases (17.9%). Out of 56 cases reviewed, 43 (76.8%) were confirmed as being a benign, 7 (12.5%) as being a borderline, and 5 (1.8%) as being a malignant phyllodes tumor. Cellular atypia was minimal in 40 cases (71.4%) and prominent in 14 cases (25.0%). The stromal cellularity was minimal in 32 cases (57.1%) and prominent in 23 cases (41.1%). Pleomorphism and necrosis were represented in only 1 case (1.8%). The tumor margin was infiltrating in 11 cases (19.6%) and pushing in 43 cases (76.8%). A local recurrence developed in 9 cases (16.1%). There were no dependable histopathological features to predict a local recurrence except for cellular atypia, stromal cellularity, and an infiltrating tumor margin. CONCLUSION: From the above results, the strong prognostic factors that can be used to predict a local recurrence appear to be cellular atypia, stromal cellularity, and an infiltrating tumor margin.

Neoadjuvant Chemotherapy for the Local Advanced Breast Cancer / 한국유방암학회지

PURPOSE: The definition of locally advanced breast cancer (LABC) includes stage III breast cancer. In order to investigate the factors influencing on the final outcome we analysed the data of LABC patients that received neoadjuvant chemotherapy prior to definitive surgery. METHODS: 122 LABC patients, who underwent neoadjuvant chemotherapy between 1980 and 1997, were included for the analysis. Clinical responses to neoadjuvant chemother apy were classified as complete response (CR), partial response (PR), and no response (NR). Overall survival (OS), Loco-regional relapse free survival (LRRFS), and distant relapse free survival (DRRFS) probabilities were investigated according to initial clinical stage, clinical response to neoadjuvant chemotherapy, and pathologic stage after neo adjuvant chemotherapy. Statistical analyses were performed with chi2-test, Kaplan-Meier, and Cox-regression methods using SPSS. RESULTS: The mean age at diagnosis was 47 years old (range 31~73) and median follow-up period was 61.6 months (range 3~227 months). Among 122 LABC patients, 69 (56.6%) were included in stage IIIA, 37 (30.3%) in stage IIIB, and 16 (13.1%) in IIIC at diagnosis. 10 patients (8.2%) have shown CR, 85 (69.7%) patients PR, and the remaining 27 (22.1%) patients showed NR. The overall response rate to neoadjuvant chemotherapy was 77.5%. However, only 51 (41.8%) were demonstrated to have pathologically down-staged results. There were 32 loco-regional recurrences and 59 distant metastases. All of the initial clinical stage, clinical response to neoadjuvant chemotherapy, and pathologic stage influenced the final outcome of 10 year OS, LRRFS, DRFS. However, in multivariate analysis pathologic stage after neoadjuvant chemotherapy was the most influencing factor on the final outcome. CONCLUSION: Pathologic stage after neoadjuvant chemotherapy could be the most important prognostic factor of the LABC.

Body Mass Index as a Risk and Prognostic Factor of Breast Cancer

PURPOSE: In order to study the effect of body mass index (BMI) on the risk and the prognosis of breast cancers, we analyzed the BMI and clinico-pathological data of the breast cancer patients. We compared the BMIs of breast cancer patients to those of normal women and investigated the association of the BMI with the clinico-pathological data. Then the overall and disease-free survial probabilities were analyzed according to the BMI groups. METHODS: 1,201 breast cancer patients were available for the analysis of BMI and the BMI of the normal control women was adopted from the report of the National Health, Nutrition Survey of 1998. We classified the BMI groups by he World Health Organization classification as follows; BMI under 18.5 as under-weight group, 18.5-24.9 as the normal weight group, 25-30 as the overweight group, and over 30 as the obesity group. BMI was compared between the patient group and the control group by age, while the correlation between BMI and the clinico-pathological characteristics and the recurrence and survival rates for each BMI group were comparatively analyzed. The statistical analysis were performed using x2 test, one-way ANOVA, independent T-test, and one sample T test, and the survival probabilities were generated by Kaplan-Meier methods. RESULTS: The means of BMI increased by aging in both the patients and the control group. The means of BMI of the 30s and 50s were significantly lower in breast cancer patients than those of normal women (P=0.001, 0.002). However, those of 60s and 70s were higher in breast cancer patients with marginal significance (P=0.159). In the pre- menopausal patient group, BMI was associated with the tumor size (P=0.012) and the tumor stage (P=0.018). In the post-menopausal patients, on the other hand, BMI had positive relationship with well-differentiation of the tumor (P=0.025), and also showed a marginal association with estrogen receptor positivity (P=0.074). BMI did not influence on the outcome of premenopausal breast cancer patients but lower BMI (underweight group) showed poorer outcome in postmenopausal patients in terms of overall survival (P= 0.278), locoregional relapse-free survival (P=0.581), and distant relapse-free survival (P=0.040). CONCLUSIONS: As a breast cancer risk factor, BMI seems to have a different association by the age. Higher BMI for the 60s and 70s but lower BMI for the younger age group seems to be a risk factor for the breast cancer development. In terms of the relationship with the clinico-pathological characteristics, BMI has different association by the menopausal status. BMI did not influence on the outcome of premenopausal breast cancer patients but lower BMI (underweight group) showed significantly poorer outcome in postmenopausal patients.

Mucinous Carcinoma of the Breast / 대한암학회지

PURPOSE: Mucinous carcinoma of the breast is relatively rare among the malignant breast lesions. It has distinctive pathological and behavioral characteristics to separate from other types of breast cancers. Accoding to the WHO definition, mucinous carcinoma of the breast is a carcinoma containing large amounts of extracellular epithelial mucus, sufficient to be visible grossly, and recognizable microscopically surrounding and within tumor cells. Mucinous carcinoma shows the characteristic features clinically and histologically because of the mucus production by the tumor. MATERIALS AND METHODS: We reviewed 29 cases of mucinous carcinoma that had been treated from 1985 to 1996 in the Department of General Surgery, Yonsei University College of Medicine. RESULTS: The results were as follows: The prevalent age group was the fifth decade (37.9%). The 27 cases were female and 2 were male. The most common sign and symptom was a palpable mass (100%). The most patients visited the hospital within 2 months of onset (55.2%). Most frequent tumor size was 2-3 cm in diameter, found in 10 cases (34.5%), and 13.8% of cases was more than 5 cm in diameter. The most frequent site of tumor was the upper outer quadrant in 16 cases (55.2%). The operations performed were as follows: Modified radical mastectomy (Auchincloss or Patey) in 24 cases (82.8%), quadrantectomy with axillary lymph node dissection in 4 cases (13.8%), simple mastectomy with lower axillar dissection in 1 cases (3.4%). Axillary lymph node metastasis was present in 3 cases (10.3%). The most common stage at diagnosis was stage IIa in 13 cases (44.8%). CONCLUSION: This study shows some characteristics of mucinous carcinoma of breast distinict from those previously proposed Further studies are needed to identify clinical parameters which characterize mucinous carcinoma of the breast.