Breast Cancer Statistics in Korea, 2019 / 한국유방암학회지

This article provides an annual update of Korean breast cancer statistics, including the incidence, tumor stage, type of surgical treatment, and mortality. The data was collected from the Korean Breast Cancer Society registry system and Korean Central Cancer Registry.In 2019, 29,729 women were newly diagnosed with breast cancer. Breast cancer has continued to increase in incidence since 2002 and been the most common cancer in Korean women since 2019. Of the newly diagnosed cases in 2019, 24,820 (83.5%) were of invasive carcinomas, and 4,909 (16.5%) were of carcinoma in situ. The median age of women with breast cancer was 52.8 years, and breast cancer was most commonly diagnosed in the age group of 40–49 years. The number of patients who have undergone breast conserving surgery has continued to increase since 2016, with 68.6% of patients undergoing breast conserving surgery in 2019. The incidence of early-stage breast cancer continues to increase, with stage 0 or I breast cancer accounting for 61.6% of cases. The most common subtype of breast cancer is the hormone receptor-positive human epidermal growth factor receptor 2-negative subtype (63.1%). The 5-year relative survival rate of patients with breast cancer from 2015 to 2019 was 93.6%, with an increase of 14.3% compared to that from 1993 to 1995. This report improves our understanding of breast cancer characteristics in South Korea.

Relationship Between Breast and Axillary Pathologic Complete Response According to Clinical Nodal Stage: A Nationwide Study From Korean Breast Cancer Society / 한국유방암학회지

Purpose@#We evaluated the relationship between breast pathologic complete response (BpCR) and axillary pathologic complete response (ApCR) after neoadjuvant chemotherapy (NACT) according to nodal burden at presentation. As the indications for NACT have expanded, clinicians have started clinical trials for the omission of surgery from the treatment plan in patients with excellent responses to NACT. However, the appropriate indications for axillary surgery omission after excellent NACT response remain unclear. @*Methods@#Data were collected from patients in the Korean Breast Cancer Society Registry who underwent NACT followed by surgery between 2010 and 2020. We analyzed pathologic axillary nodal positivity after NACT according to BpCR stratified by tumor subtype in patients with cT1-3/N0-2 disease at diagnosis. @*Results@#A total of 6,597 patients were identified. Regarding cT stage, 528 (9.5%), 3,778 (67.8%), and 1,268 (22.7%) patients had cT1, cT2, and cT3 disease, respectively. Regarding cN stage, 1,539 (27.7%), 2,976 (53.6%), and 1,036 (18.7%) patients had cN0, cN1, and cN2 disease, respectively. BpCR occurred in 21.6% (n = 1,427) of patients, while ApCR and pathologic complete response (ypCR) occurred in 59.7% (n = 3,929) and ypCR 19.4% (n = 1,285) of patients, respectively. The distribution of biologic subtypes included 2,329 (39.3%) patients with hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative disease, 1,122 (18.9%) with HR-positive/HER2-positive disease, 405 (6.8%) with HR-negative/HER2-positive disease, and 2,072 (35.0%) with triple-negative breast cancer . Among the patients with BpCR, 89.6% (1,122/1,252) had ApCR. Of those with cN0 disease, most (99.0%, 301/304) showed ApCR. Among patients with cN1-2 disease, 86.6% (821/948) had ApCR. @*Conclusion@#BpCR was highly correlated with ApCR after NACT. In patients with cN0 and BpCR, the risk of missing axillary nodal metastasis was low after NACT. Further research on axillary surgery omission in patients with cN0 disease is needed.

Invasive Breast Cancer Presenting as a Mass Replaced by Calcification on Mammography: A Report of Two Cases

A distinct calcification pattern is one of the criteria for determining the malignancy of breast cancer according to the Breast Imaging Reporting and Data System. A mass almost entirely replaced by calcification, however, is difficult to categorize and likely to be misdiagnosed. We present the report of two patients with invasive carcinoma of the breast that presented as a mass replaced by calcification on mammography. In the first case, the mass was confirmed as a mixed carcinoma comprising mucinous and micropapillary carcinoma, and in the second case, the mass was a mucinous carcinoma. Diagnosis of cancer in the latter case was missed as the mass had been assessed as a category 2 typically benign calcification at the first screening mammography 2 years ago. This report merits publication because it shows that a mass replaced by calcification on mammography can be misdiagnosed as a benign finding.

Basic Facts of Breast Cancer in Korea in 2014: The 10-Year Overall Survival Progress / 한국유방암학회지

We, the Korean Breast Cancer Society (KBCS), present the facts and the trends of breast cancer in Korea in 2014. Data on the total number of newly diagnosed patients was obtained from the Korea Central Cancer Registry database, other data were collected from the KBCS online registry database, and the overall survival data of patients were updated from Statistics Korea. A total of 21,484 female patients were newly diagnosed with breast cancer in 2014. The crude incidence rate and the age-standardized incidence rate (ASR) of breast cancer in female patients, including carcinoma in situ, were 83.4 cases and 63.9 cases per 100,000 women, respectively. The ASR showed an annual increase of 6.1% from 1999 to 2014; however, although the increase of the ASR had slowed since 2008, the incidence rate itself continuously increased. The proportion of early breast cancer increased consistently, and the pathological features changed accordingly. While breast-conserving surgery was mainly performed, the proportion of total mastectomy was slightly increased. The total number of breast reconstruction surgeries increased rapidly. The 5-year and 10-year overall survival rates for all stages of breast cancer patients were 91.2% and 84.8%, respectively. The overall survival rate of Korean patients with breast cancer was extremely high, compared with other developed countries. Thus, we consider that the clinical characteristics of breast cancer have changed over the past decade. A nationwide registry data will contribute to a better understanding of the characteristics of breast cancer in Korea.

Uncomplicated jejunal diverticulosis with pneumoperitoneum

Small bowel diverticulosis is a rare finding within all bowel diverticuloses and jejunal diverticulosis is even rarer. Their relative clinical rarity and varied presentation may make diagnosis both delayed and difficult. We experienced a case of jejunal diverticulosis, which was diagnosed intraoperatively. A 55-year-old woman was admitted to Emergency Department with pneumoperitoneum on plain chest and abdominal film from a local clinic. She was hemodynamically stable with minimal tenderness on the left upper quadrant of the abdomen but no rebound tenderness. At surgery, small bowel torsion and jejunal diverticulosis were confirmed. Over 30 variable sized small bowel diverticula were noted on the mesenteric side of the proximal jejunum. The affected segment of the jejunum was about 180 cm. On exploration, we could not find any perforation site. No postoperative complications were observed, and the patient made a full recovery. Jejunal diverticulosis is rare, but it should not be regarded as insignificant.

The Primary Thyroid Lymphoma Treated by Surgery without Chemotherapy: Two Cases Reports / 대한내분비외과학회지

Primary thyroid lymphoma (PTL) is a relatively rare disease, accounting for less than 0.5~5% of all thyroid malignancies. We encountered two cases of a primary thyroid lymphoma with Hashimoto's thyroiditis; one in a 63-year-old man and the other in a 79-year-old woman. The first case was a mucosa-associated lymphoid tissue lymphoma, and the other was a diffuse large B-cell lymphoma. Both patients underwent surgery and radiotherapy after being diagnosed using fine-needle aspiration cytology (FNAC). Both patients recovered well with no recurrence throughout the study period. The role of the surgeon in the treatment and diagnosis of thyroid lymphoma has been reduced due to the development of FNAC and combination therapy with chemotherapy and radiotherapy. On the other hand, surgery can be an effective treatment option for PTL confined to the thyroid, for achieving a definitive diagnosis, and in the treatment of patients with an airway obstruction.

The Basic Facts of Korean Breast Cancer in 2013: Results of a Nationwide Survey and Breast Cancer Registry Database / 한국유방암학회지

The Korean Breast Cancer Society (KBCS) has reported a nationwide breast cancer data since 1996. We present a comprehensive report on the facts and trends of breast cancer in Korea in 2013. Data on the newly diagnosed patients in the year 2013 were collected from 99 hospitals by using nationwide questionnaire survey. Clinical characteristics such as stage of cancer, histologic types, biological markers, and surgical management were obtained from the online registry database. A total of 19,316 patients were newly diagnosed with breast cancer in 2013. The crude incidence rate of female breast cancer including carcinoma in situ was 76.2 cases per 100,000 women. The median age at diagnosis was 50 years, and the proportions of postmenopausal women with breast cancer accounted for more than half of total patients. The proportion of early breast cancer increased consistently, and the pathologic features have changed accordingly. Breast-conserving surgery was performed in more cases than total mastectomy in the year. The total number of breast reconstruction surgeries markedly increased approaching 3-fold in last 11 years. According to annual percentile change of invasive cancer incidence, the incidence increased rapidly until 2010. And thereafter the increase of it became steadier. For ductal carcinoma in situ, the incidence consistently increased during the same period without any joinpoint. Analysis of nationwide registry data will contribute to defining of the trends and characteristics of breast cancer in Korea.

A Concurrence of Adenocarcinoma with Micropapillary Features and Composite Glandular-Endocrine Cell Carcinoma in the Stomach

We report a unique case of synchronous double primary gastric cancer consisting of adenocarcinoma components with micropapillary features and composite glandular-endocrine cell carcinoma components. The patient was a 53-year-old man presenting with a 6-month history of epigastric pain and diarrhea. A subtotal gastrectomy was performed. Histologically, one tumor was composed of micropapillary carcinoma components (50%) with tight clusters of micropapillary aggregates lying in the empty spaces, admixed with moderately differentiated adenocarcinoma components. MUC-1 was expressed at the stromal edge of the micropapillary component. The other tumor was composed of atypical carcinoid-like neuroendocrine carcinoma (50%), adenocarcinoid (30%), and adenocarcinoma components (20%). The neuroendocrine components were positive for CD56, synaptophysin, chromogranin, and creatine kinase. The adenocarcinoid components were positive for both carcinoembryonic antigen and neuroendocrine markers (amphicrine differentiation). This case is unique, due to the peculiar histologic micropapillary pattern and the histologic spectrum of adenocarcinoma adenocarcinoid-neuroendocrine carcinoma of the synchronous composite tumor.

Risk Factors of Local Recurrence after Breast Conserving Therapy in Invasive Breast Cancer / 한국유방암학회지

PURPOSE: Twenty-year follow-up results of two pioneering randomized controlled trials have demonstrated equal patient survival after mastectomy and breast conservation therapy. The use of breast conservation therapy has undoubtedly provided substantial progress towards a better quality of life for women with breast cancer. Outcomes of breast conservation therapy performed at Asan medical center were retrospectively reviewed and analyses were performed to determine significant risk factors of local recurrence. METHODS: A total of 578 women with stage I, stage II or stage III breast cancer were treated with conservative surgery and radiation therapy between January 1997 and December 2002. Outcomes of local recurrence and survival were recorded. RESULTS: During a median follow-up of 54.1 months, 21 patients (3.6%) developed local recurrence as first event and 10 patients (1.7%) developed regional recurrence and 19 patients (3.3%) developed systemic recurrence. Univariate analysis of the prognostic factors determined that age (p=0.005), nuclear grade (p=0.013), estrogen receptor negativity (p=0.008), lymphovascular invasion (p=0.009), progesterone receptor negativity (p=0.016) and lack of hormone therapy (p=0.005) were statistically significant factors associated only with locoregional recurrence. Results of multivariate analysis determined that lymphovascular invasion (p=0.045) strongly independent predictors for local recurrence. CONCLUSION: Age, nuclear grade, estrogen receptor negativity, lymphovascular invasion, progesterone receptor negativity and lack of hormone therapy were associated with local recurrence after Breast conserving surgery. The lymphovascular invasion was the strongest independent risk factors for local recurrence.

Correlation between the Her-2/neu Status as Determined by Immunohistochemical Analysis and the Serum Her-2/neu Concentration as Determined by the Use of ADVIA Cencaur(R) Automated Immunoassay in Breast Cancer Patients / 한국유방암학회지

PURPOSE: Serum Her-2/neu is extracted from the extracelluar domain of the Her-2/neu tyrosine kinase to serum. We evaluated the correlation between the Her-2/neu status as determined by immunohistochemical analysis (IHC) and the serum Her-2/neu concentration in a population of Korean women with breast cancer. METHODS: Serum Her-2/neu levels were examined from 254 female patients with primary breast cancer and 38 patients with metastatic breast cancer. Serum Her-2/neu levels were measured by the use of a chemiluminescence immunoassay (ADVIA centaur(R) system) during the preoperative period. The level of Her-2/neu in all of the breast cancer tissue samples was determined by IHC, and samples with an IHC grade +2 were subject to fluorescence in situ (FISH). When tissue samples exhibited IHC grade +3 or showed amplification of Her-2/neu as determined by FISH analysis, Her-2/neu was considered overexpressed. The cut-off value for serum Her-2/neu level was 10.2 ng/mL. RESULTS: The mean serum Her-2/neu level was 10.1 ng/mL in primary breast cancer samples. The serum Her-2/neu concentration significantly correlated with expression of Her-2/neu as determined by tissue IHC analysis (grade 1/3, 9.33+/-1.7 ng/mL; grade 2/3, 8.89+/-1.6 ng/mL; grade 3/3, 12.37+/-4.0 ng/mL, p<0.001). Increased serum HER-2/neu levels were associated with the lymph node status (p=0.003) and hormone unresponsiveness (p<0.001), tumor size (p<0.01) and age group (p<0.001). In metastatic breast cancer samples, the mean serum Her-2/neu level was 13.6 ng/mL. Elevated serum Her-2/neu levels were seen in 71.7% of metastatic breast cancer samples. The serum Her-2/neu level correlated with expression of Her-2/neu in metastatic tissue as determined by IHC analysis (p<0.001) rather than with the Her-2/neu status of the primary breast cancer (p=0.16) CONCLUSION: Serum Her-2/neu appears to be correlate with tissue Her-2/neu expression in primary and metastatic breast cancer where Her-2/neu is overexpressed. Further studies to determine levels of serum Her-2/neu are required to determine cuttoff values and the clinical application of the finding for breast cancer patients in Korea.

The Efficacy of Enoxaparin for the Prevention of a Pulmonary Thromboembolism in a Skin-sparing Mastectomy with Immediate Reconstruction in Breast Cancer / 한국유방암학회지

PURPOSE: Performance of a skin-sparing mastectomy with immediate reconstruction provides psychological satisfaction and good cosmetic outcome for patients with breast cancer. However, this is a lengthy procedure to perform, and there is increased risk of pulmonary thromboembolism (PTE). The purpose of this study was to evaluate the efficiency of the use of low molecular weight heparins (enoxaparin) for prophylaxis against a pulmomary thromboembolism followed by mastectomy with an immediate transverse rectus abdominis myocutaneous flap (TRAM) in breast cancer. METHODS: A total of 123 patients underwent a skin-sparing mastectomy with an immediate TRAM. The "non-enoxaparin group" wore compression stockings for PTE prophylaxis and the "enoxaparin group" received enoxaparin (40 mg SC injection, once daily starting 2 hr before surgery and continuing for 6 days postoperatively) in conjunction with the use of compression stockings. Lung perfusion, inhalation scans, and serum D-dimer assays were performed on postoperative day 3. If findings were clinically suspicious or intermediate to high probability of a PTE in a lungs scan, embolism computed tomography was performed. Patients were prospectively investigated according to the clinicopathological data. We compared the incidence of PTE and hemorrhagic complications between the two groups. RESULTS: There were no significant clinicopathological differences between the two groups. Eleven patients developed a PTE (nine patients in the non-enoxaparin group and two patients in the enoxaparin group). The prevalence rate of a PTE was 17.3% and 3.2% for each group, respectively (p=0.01). One patient in the non-enoxaparin group required a second operation for bleeding control and three patients in the enoxaparin group needed transfusions. There were minor hemorrhagic complications in the enoxaparin group that improved after supportive management. CONCLUSION: Although there were minor hemorrhagic complications, enoxaparin is safe and effective in a preventing PTE in patients that undergo immediate reconstruction after a skin-sparing mastectomy.

Recurrence and Survival Analysis in Skin-Sparing Mastectomy with Immediate Reconstruction Compared with Conventional Mastectomy / 한국유방암학회지

PURPOSE: A skin-sparing mastectomy (SSM), followed by immediate reconstruction, which has aesthetic advantages, is being increasingly used to treat many early breast carcinomas; however, there are few data regarding the outcome and safety of this procedure. The objective of this study was to evaluate the safety of utilizing a SSM with immediate reconstruction compared with the outcome of a conventional mastectomy. METHODS: A retrospective review was performed on 169 patients who underwent a SSM with immediate reconstruction, and 2102 patients who received a conventional mastectomy between January 1996 and December 2002, at the Asan Medical Center. The patient and tumor characteristics, as well as the types of reconstruction, incidences of recurrence and survival rates were examined. RESULTS: The mean age of the SSM group was younger (39 vs. 47 years, p < 0.001), and the mean tumor size smaller than those of the mastectomy group (2.6 vs. 3.2cm, p = 0.002). Lymph node involvement was present in 39.6% and 48.4% of the SSM and mastectomy groups, respectively (p = 0.24). The proportion at early stages (0 and 1) in the SSM group was higher than those in the mastectomy group (50.9 vs. 30.7%, p < 0.001). In the high-risk patients, postoperative radiation was administered to 24.1 and 54.9% of the SSM and mastectomy group, respectively (p = 0.002). With a median follow-up of 41 months, the recurrence rates for the SSM and mastectomy groups were 11.8 (20 of 169 patients) and 14.4% (303 of 2102 patients), respectively (p = 0.22). There were no differences in the locoregional and distant recurrences between the two groups. The 5-year disease free survivals for the SSM and mastectomy groups were 81.9 and 81.7%, respectively (p = 0.71). The 5-year overall survivals for the SSM and mastectomy groups were 91.7 and 88,8%, respectively (p = 0.13). In a univariate analysis, the factors associated with a recurrence and the survival rates were the tumor stage and a lymph node positive state. CONCLUSION: No significant differences were found in the recurrence and survival rates of the SSM group, with immediate reconstruction, compared to those of the mastectomy only group. A skin-sparing mastectomy, with immediate reconstruction, which has greater aesthetic benefits, appeared to be an oncologically safe treatment option for breast carcinomas.

Delayed Splenic Artery Aneurysm after Blunt Trauma

With the exception of aneurysms of the aorta and iliac segments, splenic artery aneurysms are the most common form of aneurysm found in the abdomen. The pathogenesis of splenic artery aneurysms may be largely congenital, in women, and atherosclerotic, in men. A blunt trauma may be one of the less common causes of splenic artery aneurysms. Furthermore, to our knowledge, the delayed development of a splenic artery aneurysm, after a blunt trauma, is extremely rare. We report a case of a 35-year-old man with the delayed development of a splenic artery aneurysm on a follow- up computed tomographic scan of the spleen, 2 weeks after injury. Our case showed that a follow-up computed tomographic scan, after a blunt trauma, provided valuable clinical information on the diagnosis and management of splenic injury for documentign the healing or the progression of the injury, even though some studies have suggested this has no particular value.

S4a+S5 with Caudate Lobe (S1) Resection as a Parenchyma-preserving Liver Resection for a Patient with Type IIIb Hilar Bile Duct Cance

The prognosis of hilar bile duct cancer has been improved by extensive curative resection, but massive hepatectomy can result in surgical and medical complications in high-risk patients. We report a case of type IIIb hilar bile duct cancer undergone S4a S5 with caudate lobe (S1) resection as a parenchyma-preserving hepatectomy. The operation was a modified type of Taj Mahal liver resection omitting parencymal transection between S4b and S8. Such an extent of hepatectomy combined with bile duct resection made 3 right and 3 left intrahepatic segmental duct openings, which were reconstructed as a whole at each side of transection plane after ductoplasty. The patient recovered uneventfully. Although surgical technique for S4a+S5+S1 must be more complex comparing with other anatomical hepatectomy, but it could be accepted as a safe curative resection for some selected patients with advanced hilar bile duct cancer, by which favorable recovery of the liver function may lead to prevention of postoperative complications. Comprehension to the anatomy of the intrahepatic ducts is a prerequisite for S4a+S5+S1 resection, thus we discussed it in detail.