ABSTRACT
PURPOSE: To determine accurately the extent of the disease and risk of recurrence is important in enhancing the therapeutic success rate of breast cancer. Primary tumor state and axillary node invasion were some well known factors to predict the prognosis of breast cancer. However, some patients with early stage cancer developed systemic metastasis later despite of little possibility of recurrence based on some previously establised prognostic system. These results demand another approach to predict systemic metastases in patient without gross evidence of further recurrence. Micrometastases is a promising key to explain the recurrence in these patients and micrometastases in bone marrow could raised the ongoing recurrence in skeletal system which is the most frequent metastatic site in breast cancer. Therefore we tricd to determine the rate of micrometastasis in surgically resectable Korean breast cancer patients and the relationship with clinicopathological characteristics of the cancer. MATERIALS AND METHODS: We studied bone marrow aspirate specimens from 38 patients with breast cancer who underwent curative resection at Chonnam University Hospital from January 1996 to February 1997. And reverse transcription polymerase chain reaction (RT-PCR) to detect messenger RNA for cytokeratin 19 was performed. RESULTS: Metastases in bone marrow were detected in 8/38 patients (21.1%). No sta- tistically significant relationship existed between bone marrow metastasis and clinicopa- thological parameters for predicting prognosis that consisted of tumor state, lymph node invasion, histologic grade, steroid receptor, and c-erbB2 overexpression. In particular, bone marrow metastasis developed even from ductal carcinoma in situ. CONCLUSION: Bone marrow metastasis may be developed from the extremely early stage of breast cancer and we can not make the corelationship between the bone marrow metastasis and establised some prognostic factors. Based on these results, we recommand the evaluation of bone marrow metastasis in all breast cancer patients and require the close follow-up to allow more sensitive prediction of ongoing recurrence and higher curability.
Subject(s)
Humans , Bone Marrow , Breast Neoplasms , Breast , Carcinoma, Intraductal, Noninfiltrating , Keratin-19 , Lymph Nodes , Neoplasm Metastasis , Neoplasm Micrometastasis , Polymerase Chain Reaction , Prognosis , Receptors, Steroid , Recurrence , Reverse Transcription , RNA, MessengerABSTRACT
BACKGROUND: Myocardial contrast echocardiography(MCE) has been known to be a safe and useful method to assess the adequacy of myocardial perfusion. This study was performed to assess the change of myocardial perfusion following successful percutaneous transluminal coronary angioplasty using MCE in the patients with significant coronary arterial obstructive diseases. METHODS: The study comprised of eight patients(mean age 55 years, male 7, female 1). Four patients were unstable angina and four patients post non-Q wave myocardial infarction angina. Six patients had one vessel disease and two paients two vessel disease. All patients underwent successful PTCA at the proximal(2 patients) and the mid(6 patients) left anterior descending coronary artery. Pre- and post-PTCA myocardial perfusion was assessed by comparing peak contrast intensity and slope of time-intensity curve after injection of hand-agitated Hexabrix(6cc) respectively. The variables were measured off-line at thirty two end-diastolic frames of the left ventricle in each patient. RESULTS: 1) Diameter stenosis of target lesion changed from 91±9 to 24±14% after successful coronary angioplasty(p < 0.005). 2) Peak contrast intensity was increased from 47.4±30.7 to 64.9±36.4 gray scale U/pixel in anteroseptal segment and from 46.6±14.3 to 67.9±35.8 gray scale U/pixel in anterior segment(p < 0.05). 3) The slope of time-intensity curve after PTCA became more steeper compared to that of pre-PTCA(anteroseptal : −0.32±0.48 vs −0.76±0.66 p=0.071, anterior : −0.33±0.39 vs −0.81±0.80 p=0.086). 4) During the study, there was no significant clinical or hemodynamic complications except three patients who developed transisient sinus bradycardia after intracoronary injection of handagitated Hexabrix. CONCLUSION: Myocardial contrast echocardiography appeared to be safe and useful in the evaluation of myocardial perfusion following coronary angioplasty assessed by the changes of peak contrast intensity and slope of contrast time-intensity curve.