A Retrospective Study with Immunohistochemical Analysis of Axillary Nodal Micrometastasis in Breast Cancer / 한국유방암학회지

PURPOSE: It is well established that the presence of axillary nodal metastases is the most important prognostic factor in primary operable breast cancer. However, it has also been shown that 15-30% of patients without lymph node metastases as assessed by light microscopy have recurrence within 10 years. In this study, our aim was first to investigate the diagnostic value of immunohistochemical staining in detecting micrometastases and secondly to correlate their presence with prognosis (recurrence and survival) MATERIALS AND METHODS: We retrospectively analyzed 492 axillary nodes from 49 consecutive node-negative invasive breast cancers treated at Kyung-Hee University Hospital from 1991 to 1995 with average follow-up of 60.2 (21-100) months. An additional section of original paraffin blocks was cut and stained by immunohistochemical chemical technique using monoclonal antibodies (AE 1/3 and No.7) to cytokeratin. RESULTS: Micrometastases with individual cell and cell clusters were readily detected by this technique in 27% of the cases. These were no predictors of micrometastses among the clinicopathological data of patient. The presence of micometastases wes not associated with disease-free and overall survival but loco-regional recurrence rate. CONCLUSIONS: A combination of immunohistochemistry and serial sectioning of axillary lymph node would help evaluate the significance of occult axillary metastases. Patients with node-negative disease may relapse after many years and prolonged follow-up is required to establish the role of mirometastases. Such an approach, together with a search for bone marrow micrometastases and epidemiologic, clinical, pathologic and/or biochemical prognostic factors, may serve to identify high risk patients in the presumed node-negative group. It would provide a rational basis for the selective use of adjuvant therapy.

A Survey on Ostomates With the special reference to physical, psychosocial and sexual problems

The survey was undertaken among the 105 ostomates who attended the 2nd Workshop for Stoma Rehabilitation on Aug. 30th, 1997 by the Department of Surgery, Kyung-Hee University Hospital to assess the physical, psychosocial and sexual problems with a stoma. The 97% of ostomates had permanent colostomies following abdominoperineal resection. The 67% of ostomates had one or more physical problems caused by stoma. Frequent bowel movement (94.3%), impairment of irrigation (64.6%), unpleasant odor (27.3%), and urinary frequency (21.3%) were common problems encountered by ostomates. Concerning the psychosocial problems, 3.8% of them suffered from profound restriction of social activities and 1.9% of them had psychologic problems such as depression. 42 of 58 ostomates (72.4%) who were employed before operation returned to their work. Among 71 men, 44 (62%) were impaired by sexual function. Most ostomates suffered physical, social, psychologic and sexual problems in their daily life and needed helps of experts such colorectal surgeons, enterostomal therapists, and ostomy association. Attention is needed more to improve the quality of life for the ostomates.