Effect of Poloxamer-Based ThermoSensitive Sol-Gel Agent on Upper Limb Dysfunction after Axillary Lymph Node Dissection: A Double-Blind Randomized Clinical Trial / 한국유방암학회지

Purpose@#Restricted shoulder motion is a major morbidity associated with a lower quality of life and disability after axillary lymph node dissection (ALND) in patients with breast cancer.This study sought to evaluate the antiadhesive effect of a poloxamer-based thermosensitive sol-gel (PTAS) agent after ALND. @*Methods@#We designed a double-blind, multicenter randomized controlled study to evaluate the clinical efficacy and safety of PTAS in reducing upper-limb dysfunction after ALND. The primary outcome was the change in the range of motion (ROM) of the shoulder before surgery and 4 weeks after ALND (early postoperative period). Secondary outcomes were shoulder ROM at six months, axillary web syndrome, and lymphedema (late postoperative period). @*Results@#A total of 170 patients with planned ALND were randomly assigned to one of 2 groups (poloxamer and control) and 15 patients were excluded. In the poloxamer group (n = 76), PTAS was applied to the surface of the operative field after ALND. ALND was performed without the use of poloxamer in the control group (n = 79). Relative to the control group, the poloxamer group had significantly lower early postoperative restrictions in total shoulder ROM at four weeks (−30.04 ± 27.76 vs. −42.59 ± 36.79; p = 0.0236). In particular, the poloxamer group showed greater reductions in horizontal abduction at four weeks (−3.92 ± 9.80 vs. −10.25 ± 15.42; p = 0.0050). The ROM of the shoulder at 24 weeks, axillary web syndrome, and lymphedema were not significantly different between the two groups. No adverse effects were observed in either group. @*Conclusion@#We suggest that poloxamer might improve the early postoperative shoulder ROM in patients with breast cancer who have undergone ALND.

Effect of Poloxamer-Based ThermoSensitive Sol-Gel Agent on Upper Limb Dysfunction after Axillary Lymph Node Dissection: A Double-Blind Randomized Clinical Trial / 한국유방암학회지

Purpose@#Restricted shoulder motion is a major morbidity associated with a lower quality of life and disability after axillary lymph node dissection (ALND) in patients with breast cancer.This study sought to evaluate the antiadhesive effect of a poloxamer-based thermosensitive sol-gel (PTAS) agent after ALND. @*Methods@#We designed a double-blind, multicenter randomized controlled study to evaluate the clinical efficacy and safety of PTAS in reducing upper-limb dysfunction after ALND. The primary outcome was the change in the range of motion (ROM) of the shoulder before surgery and 4 weeks after ALND (early postoperative period). Secondary outcomes were shoulder ROM at six months, axillary web syndrome, and lymphedema (late postoperative period). @*Results@#A total of 170 patients with planned ALND were randomly assigned to one of 2 groups (poloxamer and control) and 15 patients were excluded. In the poloxamer group (n = 76), PTAS was applied to the surface of the operative field after ALND. ALND was performed without the use of poloxamer in the control group (n = 79). Relative to the control group, the poloxamer group had significantly lower early postoperative restrictions in total shoulder ROM at four weeks (−30.04 ± 27.76 vs. −42.59 ± 36.79; p = 0.0236). In particular, the poloxamer group showed greater reductions in horizontal abduction at four weeks (−3.92 ± 9.80 vs. −10.25 ± 15.42; p = 0.0050). The ROM of the shoulder at 24 weeks, axillary web syndrome, and lymphedema were not significantly different between the two groups. No adverse effects were observed in either group. @*Conclusion@#We suggest that poloxamer might improve the early postoperative shoulder ROM in patients with breast cancer who have undergone ALND.

The Practice Patterns and Perceptions of Korean Surgeons Regarding Margin Status after Breast-Conserving Surgery / 한국유방암학회지

Two consecutive surveys for breast surgeons in Korea were conducted to comprehend the practice patterns and perceptions on margin status after breast-conserving surgery. The surveys were conducted online in 2014 (initial) and 2016 (follow-up). A total of 126 and 88 responses were obtained in the initial and follow-up survey, respectively. More than 80% of the respondents replied to routinely apply frozen section biopsy for intraoperative margin assessment in both surveys. Re-excision recommendations of the margin for invasive cancer significantly changed from a close margin to a positive margin over time (p=0.033). Most of the respondents (73.8%) defined a negative margin as “no ink on tumor” in invasive cancer, whereas more diverse responses were observed in ductal carcinoma in situ cases. The influence of guideline establishment for negative margins has been identified. A high uptake rate of intraoperative frozen section biopsy was noted and routine use needs reconsideration.

Application of Ultrasound-Guided Trigger Point Injection for Myofascial Trigger Points in the Subscapularis and Pectoralis Muscles to Post-Mastectomy Patients: A Pilot Study

PURPOSE: To investigate the therapeutic effectiveness of ultrasound (US)-guided trigger point injection for myofascial trigger points (MTrPs) in the internal rotator muscles of the shoulder in post-mastectomy patients. MATERIALS AND METHODS: This pilot study was a non-controlled, prospective, clinical trial. Nineteen post-mastectomy patients with a diagnosis of at least one active MTrP in the subscapularis and/or pectoralis muscles were included. We performed trigger point injections into the subscapularis muscle deep behind the scapula as well as the pectoralis muscle for diagnostic and therapeutic purpose by the newly developed US-guided method. RESULTS: Visual analogue scale and range of motion of the shoulder for external rotation and of abduction showed significant improvement immediately after the first injection and 3 months after the last injection compared with baseline (p<0.05 for both). Duration from onset to surgery and duration of myofascial pain syndrome in the good responder group were significantly shorter than in the bad responder group (p<0.05). Patients did not report any complications related to the procedure or serious adverse events attributable to the treatment. CONCLUSION: In post-mastectomy patients with shoulder pain, US-guided trigger point injections of the subscapularis and/or pectoralis muscles are effective for both diagnosis and treatment when the cause of shoulder pain is suspected to originate from active MTrPs in these muscles, particularly, the subscapularis.

Clinical Manifestations of Childhood Intussusception with Ubiquitous Ultrasonography: Comparison with Small Bowel and Ileocecal Type

We analyzed the clinical characteristics and outcome of ileocecal and small bowel intussusceptions (ICI and SBI) in the pediatric patients. From August 2003 to July 2010, 144 children with intussusception were included in this study. We retrospectively reviewed the clinical records and imaging study findings. A total of 86 children with ICI and 58 children with SBI were diagnosed. Children with SBI were older than ICI (36.6+/-24.6 months vs. 24.2+/-21.6 months, p=0.002). Typical symptoms such as irritability, abdominal mass, bloody stool were more frequent in ICI than SBI (p<0.05) patients. In the ICI group, intussusceptums were reduced with air reduction (84.5%), surgery (17.4%), and spontaneity (1.2%). All patients in the SBI group were reduced spontaneously. SBI occurred in older age and was reduced spontaneously more frequently than ICI. Conservative management with close observation with follow-up by ultrasonography is recommended for SBI.

Laparoscopic Cholecystectomy for Polypoid Lesions of the Gallbladder / 대한내시경복강경외과학회지

PURPOSE: Polypoid lesions of the gallbladder have a range of causes. A problem exists in the selection of patients for surgery. This study examined the usefulness of laparoscopic cholecystectomy, suspected risk factors and plan of patients with gallbladder polyps. METHODS: This study examined 57 patients who underwent laparoscopy cholecystectomy with gallbladder polyps. All patients had been diagnosed preoperatively by ultrasound and abdominal computed tomography between October 2001 and October 2010. Preoperative radiologic diagnosis, age, gender, symptoms, size of polyps, number, concurrent gallstones and histological diagnosis of the polyps as well as the postoperative complications were reviewed retrospectively. The operation indications were polyps >10 mm, age above 55 years, symptomatic polyps, coincidence of a stone, focal thickening of gallbladder wall and detection during other operations. RESULTS: The number of each type of polyp lesion of the gallbladder was as follows: 26 cases (45.6%) had cholesterol polyps, 2 cases (3.6%) inflammatory polyps, 1 case (1.7%) mucosal lymphoid follicles, 12 cases (21.1%) adenomatous polyps, 1 case (1.7%) adenocarcinoma. Non-neoplastic and neoplastic polyps accounted for 50.9% and 22.8%, respectively. Forty-eight cases had an accepted operative indication and underwent surgery. The nine other cases also underwent surgery. Among those with operative indications, 27.1% had neoplastic polyps. Of the patients who had non-indication operative surgery or polyps <5 mm in size, there were non neoplastic polyps in any cases. Two of the patients developed complications; wound infection (1 case), and common bile duct obstruction (1 case). CONCLUSION: Observation and careful surgery is necessary for patients with polyps <5 mm in size, and who do not have accepted operative indications. Laparoscopic cholecystectomy can be considered an adequate treatment for patients with accepted operative indications.

Downregulation of the RUNX3 Gene by Promoter Hypermethylation and Hemizygous Deletion in Breast Cancer

The RUNX3 gene is regarded as a tumor suppressor gene in many human solid tumors, and its inactivation is believed to be related with solid tumor carcinogenesis. As little information is available about the role of the RUNX3 gene in breast cancer, we investigated the relationship between the RUNX3 gene and breast cancer. We performed reverse transcriptase-polymerases chain reaction (RT-PCR), methylation specific PCR, and bicolor fluorescent in situ hybridization analysis in an effort to reveal related mechanisms. Forty breast tissue samples and 13 cell lines were used in this study. Eighty-five percent of breast cancer tissues showed downregulated RUNX3 gene expression, whereas it was downregulated in only 25% of normal breast tissues by RT-PCR assay. Sixty-seven percent of breast cancer cell lines showed downregulated RUNX3 expression, but the RUNX3 gene was not expressed in two normal breast cell lines. Hypermethylation was observed in 53% of breast cancer tissues and 57% of breast cancer cell lines. Hemizygous deletion was observed in 43% of breast cancer cell lines. Hypermethylation and/or hemizygous deletion was observed in 5 of 7 breast cancer cell lines, and the four of these five examined showed no RUNX3 gene expression. We suggest that various mechanisms, including methylation and hemizygous deletion, could contribute to RUNX3 gene inactivation.

Acute Lower Gastrointestinal Bleeding from the Appendix Diagnosed by Abdominal Multidetector Computed Tomography: A Case Report and Review of the Literature

Appendiceal bleeding is a kind of lower gastrointestinal bleeding. For treatment, it is essential to identify the location of the lower gastrointestinal tract bleeding. Appendiceal bleeding has some diagnostic difficultie. It is a very rare condition, and colonoscopy shows only the appendiceal orfice. Recently, multidetector computed tomography has increasingly been used in the diagnostic evaluation of most vascular diseases. Herein, we report the case of an appendiceal bleeding diagnosed by using abdominal multidetector computed tomography, and we present a the literature.

Usefulness of Ki-67 as a prognostic factor in lymph node-negative breast cancer / 한국유방암학회지

PURPOSE: To evaluate the independent prognostic value of Ki-67 in lymph node-negative breast cancer and the usefulness of Ki-67 when it combined with St. Gallen classification as a guidance of adjuvant chemotherapy for node-negative cancer. METHODS: We retrospectively reviewed the data of 534 patients with lymph node-negative breast cancer who underwent curative surgery between 1998 and 2001 at our institution. Patients were classified according to the guideline of risk groups of St. Gallen consensus and the level of Ki-67 expression. Distant metastasis-free survival (DFS) rates were compared between groups. RESULTS: With a median follow-up of 55 months, the overall 5-year DFS rate was 91.5%. The 5-year DFS rates for patients with high and low Ki-67 tumors (cut-off value: > or = 10%) were 84.6% and 93.7%, respectively (p < 0.001). In a Cox regression model involving potential prognostic factors, high Ki-67 expression could independently predict the risk of distant recurrence (odds ratio = 2.0 [95% confidence interval, 1.03-3.93]). The 5-year DFS rates for patients with average and minimal risk group of St. Gallen classification were 89.3% and 97.5%, respectively. The average risk group was further divided into two subgroups with significantly different prognosis according to the Ki-67 expression (DFS rate: 84.2% vs. 91.5%; p = 0.007). CONCLUSIONS: Ki-67 was an independent prognostic factor in lymph node-negative breast cancer and the combination of Ki-67 expression and the St. Gallen classification could provide a more useful therapeutic guideline for lymph node-negative breast cancer patients.

Usefulness of Ki-67 as a prognostic factor in lymph node-negative breast cancer / 한국유방암학회지

PURPOSE: To evaluate the independent prognostic value of Ki-67 in lymph node-negative breast cancer and the usefulness of Ki-67 when it combined with St. Gallen classification as a guidance of adjuvant chemotherapy for node-negative cancer. METHODS: We retrospectively reviewed the data of 534 patients with lymph node-negative breast cancer who underwent curative surgery between 1998 and 2001 at our institution. Patients were classified according to the guideline of risk groups of St. Gallen consensus and the level of Ki-67 expression. Distant metastasis-free survival (DFS) rates were compared between groups. RESULTS: With a median follow-up of 55 months, the overall 5-year DFS rate was 91.5%. The 5-year DFS rates for patients with high and low Ki-67 tumors (cut-off value: > or = 10%) were 84.6% and 93.7%, respectively (p < 0.001). In a Cox regression model involving potential prognostic factors, high Ki-67 expression could independently predict the risk of distant recurrence (odds ratio = 2.0 [95% confidence interval, 1.03-3.93]). The 5-year DFS rates for patients with average and minimal risk group of St. Gallen classification were 89.3% and 97.5%, respectively. The average risk group was further divided into two subgroups with significantly different prognosis according to the Ki-67 expression (DFS rate: 84.2% vs. 91.5%; p = 0.007). CONCLUSIONS: Ki-67 was an independent prognostic factor in lymph node-negative breast cancer and the combination of Ki-67 expression and the St. Gallen classification could provide a more useful therapeutic guideline for lymph node-negative breast cancer patients.

Postoperative Survival and Prognostic Factors in Breast Cancer : a Single Center Analysis of 4,063 Cases / 한국유방암학회지

PURPOSE: The incidence of breast cancer in Korea has been continuously growing and is now the most common cancer in females. The proportion of early stage cancer was found to have increased. A survival analysis and the establishment of prognostic factors are essential for proper management of breast cancer in Korean. METHODS: 4063 breast cancer cases operated on Seoul National University Hospital between Jan. 1981 and Dec. 2002, were retrospectively analyzed. RESULTS: The median age of the patients was 46, with those in their 5th decade being most prevalent. The ratio of breast conservation to mastectomy was also found to be growing. The overall and disease-free survival rates after breast conservation were equivalent to those after a mastectomy. The overall 5- and 10-year survival rates were 85.9 and 71.2%, and those of the disease-free survival rates were 79.5 and 68%, respectively. From a univariate analysis, The tumor size, lymph node status, nuclear grade, histologic grade, hormonal receptor status, C-erbB2, Bcl-2 and an age 5 cm (HR 2.4 [95%CI 1.15-5.26]) and NG (HR 0.5 [95%CI 0.35-0.93]) were found to be significant prognostic factors. CONCLUSIONS: Since 1991, patients with early breast cancer have progressively increased. To date, there are more patients with early than advanced breast cancer. In addition, BCS has been rapidly increased since 1993. The tumor size, lymph node status, nuclear grade, PR and C-erbB2 were significant prognostic factors of survival in this our study.

Postoperative Survival and Prognostic Factors in Breast Cancer : a Single Center Analysis of 4,063 Cases / 한국유방암학회지

PURPOSE: The incidence of breast cancer in Korea has been continuously growing and is now the most common cancer in females. The proportion of early stage cancer was found to have increased. A survival analysis and the establishment of prognostic factors are essential for proper management of breast cancer in Korean. METHODS: 4063 breast cancer cases operated on Seoul National University Hospital between Jan. 1981 and Dec. 2002, were retrospectively analyzed. RESULTS: The median age of the patients was 46, with those in their 5th decade being most prevalent. The ratio of breast conservation to mastectomy was also found to be growing. The overall and disease-free survival rates after breast conservation were equivalent to those after a mastectomy. The overall 5- and 10-year survival rates were 85.9 and 71.2%, and those of the disease-free survival rates were 79.5 and 68%, respectively. From a univariate analysis, The tumor size, lymph node status, nuclear grade, histologic grade, hormonal receptor status, C-erbB2, Bcl-2 and an age 5 cm (HR 2.4 [95%CI 1.15-5.26]) and NG (HR 0.5 [95%CI 0.35-0.93]) were found to be significant prognostic factors. CONCLUSIONS: Since 1991, patients with early breast cancer have progressively increased. To date, there are more patients with early than advanced breast cancer. In addition, BCS has been rapidly increased since 1993. The tumor size, lymph node status, nuclear grade, PR and C-erbB2 were significant prognostic factors of survival in this our study.

A case of Breast Gigantism in a Patient with Wilson's Disease treated by Penicillamine / 한국유방암학회지

We report a case of breast gigantism in a patient with Wilson's disease treated with penicillamine. A 19-year-old female with alleged Wilson's disease visited our hospital due to diffuse enlargement of both breasts. She had been treated with penicillamine 1,000 mg/day since her age of 15 after diagnosis of Wilson's disease. At the initial presentation, there were diffuse skin thickenings in both lower inner breasts and huge lesion which replaced almost all the breast parenchyma. After gun biopsy and excision for tissue diagnosis, fibroadenoma with ductal epithelial hyperplasia was diagnosed. Although daily dose of penicillamine was lowed to 500 mg/day, her symptom progressed. After 1 year of follow up, she and her parents strongly wanted to remove her breasts because of distorted body shape and weight of breasts. The patients underwent subcutaneous mastectomy with the designed incision of the reduction mammoplasty for the future mammoplasty. Although the breast gigantism is a rare side effect of penicillamine, female patients should be followed up cautiously for the possible change of breasts. Because penicillamine is no more the first choice for Wilson's disease, it would be better to avoid using penicillamine for Wilson's disease patients especially for the young females.

A case of Breast Gigantism in a Patient with Wilson's Disease treated by Penicillamine / 한국유방암학회지

We report a case of breast gigantism in a patient with Wilson's disease treated with penicillamine. A 19-year-old female with alleged Wilson's disease visited our hospital due to diffuse enlargement of both breasts. She had been treated with penicillamine 1,000 mg/day since her age of 15 after diagnosis of Wilson's disease. At the initial presentation, there were diffuse skin thickenings in both lower inner breasts and huge lesion which replaced almost all the breast parenchyma. After gun biopsy and excision for tissue diagnosis, fibroadenoma with ductal epithelial hyperplasia was diagnosed. Although daily dose of penicillamine was lowed to 500 mg/day, her symptom progressed. After 1 year of follow up, she and her parents strongly wanted to remove her breasts because of distorted body shape and weight of breasts. The patients underwent subcutaneous mastectomy with the designed incision of the reduction mammoplasty for the future mammoplasty. Although the breast gigantism is a rare side effect of penicillamine, female patients should be followed up cautiously for the possible change of breasts. Because penicillamine is no more the first choice for Wilson's disease, it would be better to avoid using penicillamine for Wilson's disease patients especially for the young females.

Autologous Arteriovenous Fistula Formation with Basilic Vein Transposition of Forearm

PURPOSE: Arteriovenous fistulas (AVF) are crucial for hemodialysis in patients with end stage renal disease. However, the lack of suitable forearm cephalic veins has led the surgeons to perform alternative procedures, such as transposition of basilic vein or prosthetic A-V graft. To increase the use of the autologous vein in AVF, we tried a technique of basilic venous transposition of the forearm. METHOD: From 2005.1.1 to 2006.6.30, Six patients had AVFs created with a transposed basilic vein of the forearm. We estimated postoperative clinical outcomes such as primary patency rate and operative complications. RESULT: Three of six patients were male and the mean age was 66.2 yr. Two patients were having their first AVF operation, and the others were having their second AVF operation. The mean follow-up period was 14.8 months. Early graft failure was occurred in one (16.7%). The 1-year primary and secondary patency rates were 66.7%, 83.3%, respectively. CONCLUSION: Autologous AVF formation with basilic vein transposition of the forearm was a feasible surgical technique by increasing the chances autologous AVF formation, this procedure could save the vessels on the upper arm for later AVF creation, and so it avoids using artificial grafts. However, this technique needs further study of more detailed clinical outcomes in large series including the long term patency rate, surgical complications, and comparative results to other AVF formation techniques.

Autologous Arteriovenous Fistula Formation with Basilic Vein Transposition of Forearm

PURPOSE: Arteriovenous fistulas (AVF) are crucial for hemodialysis in patients with end stage renal disease. However, the lack of suitable forearm cephalic veins has led the surgeons to perform alternative procedures, such as transposition of basilic vein or prosthetic A-V graft. To increase the use of the autologous vein in AVF, we tried a technique of basilic venous transposition of the forearm. METHOD: From 2005.1.1 to 2006.6.30, Six patients had AVFs created with a transposed basilic vein of the forearm. We estimated postoperative clinical outcomes such as primary patency rate and operative complications. RESULT: Three of six patients were male and the mean age was 66.2 yr. Two patients were having their first AVF operation, and the others were having their second AVF operation. The mean follow-up period was 14.8 months. Early graft failure was occurred in one (16.7%). The 1-year primary and secondary patency rates were 66.7%, 83.3%, respectively. CONCLUSION: Autologous AVF formation with basilic vein transposition of the forearm was a feasible surgical technique by increasing the chances autologous AVF formation, this procedure could save the vessels on the upper arm for later AVF creation, and so it avoids using artificial grafts. However, this technique needs further study of more detailed clinical outcomes in large series including the long term patency rate, surgical complications, and comparative results to other AVF formation techniques.

Preoperative Evaluation of Lymph Node Metastasis with Using Ultrasonography for Examining the Axilla in Early Stage Breast Cancer / 한국유방암학회지

PURPOSE: The axillary lymph node status is the most significant prognostic factor in breast cancer. The development of tools to accurately evaluate the axillary lymph node status with less morbidity has been the important treatment issue. Although sentinel lymph node biopsy is the promising alternative to axillary lymph node dissection, the high false negative rate of this procedure is a considerable problem. This study aimed to evaluate the efficacy of performing preoperative axillary ultrasonography (US) for predicting axillary lymph node metastasis. METHODS: Between January 2003 and December 2004, preoperative axillary US was performed in 646 patients who were suffering with T1 or T2 infiltrating ductal carcinoma and they had no palpable axillary lymph nodes. RESULTS: The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of preoperative axillary US findings were 82.8%, 93.2%, 86.3%, 91.2%, and 89.6%, respectively. The positive and negative predictive values for performing axillary US findings for tumors with a size 2cm, the positive and negative predictive values were 90.6 and 89.4, respectively. CONCLUSION: We found that performing preoperative axillary US is a relatively accurate and useful non-invasive method for assessing axillary lymph node metastasis. It showed the potential to replace sentinel lymph node biopsy in tumors > or = 2cm in size with low false negative rate. If we can improve the positive predictive value of US finding by using strict decision criteria, and especially for the tumors >2cm in size, then axillary lymph node dissection might be recommended for the cases with positive US finding.

The Clinicopathologic Characteristics of 38 Metaplastic Carcinomas of the Breast / 한국유방암학회지

PURPOSE: Metaplastic carcinomas of the breast (MCBs) are rare diseases. The aim of this study is to evaluate the clinicopathologic characteristics of MCBs and to compare them with those of infiltrating ductal carcinoma (IDC). METHODS: Thirty-eight patients who underwent surgery at Seoul National University Hospital from May 1982 to December 2002 were retrospectively analyzed on the basis of the medical records and the pathology reports. These patients were compared with 3578 IDC patients that we experienced during the same period. RESULTS: The histologic subtypes of MCBs were 7 squamous, 6 matrix-producing, 7 sarcomatous, 4 mixed, 1 osteogenic, and 13 unclassified tumors. The mean tumor size was 4.4+/-3.1 cm. The operations' methods were a modified radical mastectomy in 26 patients, breast conserving surgery in 11 patients and only an incisional biopsy in one patient. Lymph node metastases and distant metastases were detected in 11 (29.7%) and 5 (13.2%) patients respectively. Lymph node metastases of MCBs were significantly lower than that for the IDC group (p = 0.030). Otherwise, the distant metastases were significantly higher than that of the IDC group (p = 0.019). The MCBs group also showed a significantly higher nuclear grade and histologic grade than did the IDC group (p = 0.001, p = 0.001). Estrogen receptor and progesterone receptor positivity was 5.3% and 5.3% respectively, which were significantly lower than that for the IDC group (p < 0.001, p = 0.002). The overall 5 year survival rate was 65% and the 5 year disease-free survival rate was 68%. After exclusion of patients with distant metastasis, the overall survival rates were not significantly different between the two groups (p = 0.291). CONCLUSION: MCB is a rare pathological entity. Compared with IDC, MCB displays a larger size, less lymph node metastasis, more distant metastasis, a higher histologic grade, and less hormone receptor expression. MCB has a poorer overall survival rate, which is probably due to its frequent distant metastasis.

The Clinicopathologic Characteristics of 38 Metaplastic Carcinomas of the Breast / 한국유방암학회지

PURPOSE: Metaplastic carcinomas of the breast (MCBs) are rare diseases. The aim of this study is to evaluate the clinicopathologic characteristics of MCBs and to compare them with those of infiltrating ductal carcinoma (IDC). METHODS: Thirty-eight patients who underwent surgery at Seoul National University Hospital from May 1982 to December 2002 were retrospectively analyzed on the basis of the medical records and the pathology reports. These patients were compared with 3578 IDC patients that we experienced during the same period. RESULTS: The histologic subtypes of MCBs were 7 squamous, 6 matrix-producing, 7 sarcomatous, 4 mixed, 1 osteogenic, and 13 unclassified tumors. The mean tumor size was 4.4+/-3.1 cm. The operations' methods were a modified radical mastectomy in 26 patients, breast conserving surgery in 11 patients and only an incisional biopsy in one patient. Lymph node metastases and distant metastases were detected in 11 (29.7%) and 5 (13.2%) patients respectively. Lymph node metastases of MCBs were significantly lower than that for the IDC group (p = 0.030). Otherwise, the distant metastases were significantly higher than that of the IDC group (p = 0.019). The MCBs group also showed a significantly higher nuclear grade and histologic grade than did the IDC group (p = 0.001, p = 0.001). Estrogen receptor and progesterone receptor positivity was 5.3% and 5.3% respectively, which were significantly lower than that for the IDC group (p < 0.001, p = 0.002). The overall 5 year survival rate was 65% and the 5 year disease-free survival rate was 68%. After exclusion of patients with distant metastasis, the overall survival rates were not significantly different between the two groups (p = 0.291). CONCLUSION: MCB is a rare pathological entity. Compared with IDC, MCB displays a larger size, less lymph node metastasis, more distant metastasis, a higher histologic grade, and less hormone receptor expression. MCB has a poorer overall survival rate, which is probably due to its frequent distant metastasis.

The Relationship between Abnormal Screening Bone Scintigraphy and Bone Metastasis in Breast Cancer Patients / 한국유방암학회지

PURPOSE: In this study we evaluated the significance of false positive screening bone scintigraphy (BS) in primary invasive breast cancer patients. Lymphatic vessel invasion (LVI), estrogen receptor (ER), progesterone receptor (PR), nuclear grade, histology grade, epidermal growth factor receptor (EGFR) and C-erb-B2 values were examined in terms of their abilities to predict the accuracy of abnormal BS. We also examined the incidence of bone metastasis in primary invasive breast cancer patients according to the 1988 and 2003 AJCC classifications. METHODS: A retrospective review was performed on 2,044 primary invasive breast cancer patients that had received BS screening, and who were treated by mastectomy or breast conserving surgery at the Seoul National University Hospital between Jan 1995 and Jul 2003. Abnormal screening BS results were divided into "less suspicious" and "highly suspicious" groups. Patient's stages according to the 1988 AJCC classification were reclassified according to the 2003 AJCC classification. Bone metastasis was confirmed by further radiological examination or follow-up BS. All statistical analyses were two-tailed. RESULTS: The incidences of bone metastasis and an abnormal screening BS result were 1.7% (35/2,044) and 13.8% (283/2,044), respectively. The false positive rate of screening BS was 87.6% (248/283). LVI was the only significant predictive factor of bone metastasis in 283 of the abnormal BS patients (p <.001). c-erb-B2 showed no significance to predict bone metastasis in the "less suspicious" group, but was Bone is the most common site of distant metastasis in invasive breast cancer at the time of primary diagnosis. The vertebrae are the most common sites of bone metastasis and the ribs, skull, sternum and proximal long bones are also frequently involved. Bone metastases affect 8% of patients marginally significant in the "highly suspicious" group (p = .046). ER, PR, nuclear grade, histology grade, and EGFR showed no significance in terms of predicting the accuracy of an abnormal BS result. The incidences of bone metastasis were 0.6, 1.3 and 7.6% in stages I, II and III, respectively, according to the 1988 AJCC classification, while these incidences were 0.6, 0.7 and 5.8% according to the 2003 AJCC classification. CONCLUSION: The use of screening bone scintigraphy as a routine screening test is hard to justify due to its high false positive rate. LVI may be a useful factor in that it predicts the accuracy of an abnormal BS result. The incidences of bone metastasis in stages II and III were lower for the 2003 AJCC staging system.