Neuronal Apoptosis Inhibitory Protein is Overexpressed in Patients with Unfavorable Prognostic Factors in Breast Cancer

Neuronal apoptosis inhibitory protein (NAIP) is a recently identified inhibitor of apoptosis protein. However, the clinical relevance of NAIP expression is not completely understood. In an attempt to determine the clinical relevance of NAIP expression in breast cancer, the levels of NAIP and survivin expression were measured in 117 breast cancer samples and 10 normal breast tissues using quantitative reversetranscriptase-polymerase chain reaction. While there was no evidence of NAIP expression in the normal breast tissue, NAIP was expressed in all breast cancer samples. The level of NAIP expression in breast cancer was significantly higher (257 times) than in the universal tumor control. There was a strong correlation between the level of NAIP expression and the level of survivin expression (p=0.001). The level of NAIP expression in patients with a large tumor (> or =T2) and patients with an unfavorable histology (nuclear grade III) was significantly higher than in those patients with a small tumor (T1) and patients with a favorable histology (nuclear grade I, II) (p=0.026 and p=0.050, respectively). Although the level of NAIP expression was higher in patients with other unfavorable prognostic factors, it was not significant. The three-year relapse-free survival rate was not significantly the patients showing high NAIP expression and patients showing low NAIP expression (86.47+/-4.79% vs. 78.74+/-6.57%). Further studies should include the expressions of NAIP in a larger number of patients and for a longer period of follow-up to evaluate correlation with metastasis and treatment outcome. In conclusion, NAIP is overexpressed in breast cancer patients with unfavorable clinical features such as stage and tumor size, suggesting that NAIP would play a role in the disease manifestation.

Analysis of the Clinicopathological Features in the Micrometastasis and the Macrometastasis in Sentinel Lymph Node of Primary Breast Cancer

PURPOSE: The aim of this study was to compare the micrometastasis group with the macrometastasis group, and to analyze clinical and pathological variables to determine what factors might predict non-sentinel lymph node (NSLN) involvement in the women with sentinel nodes that contained only micrometastasis. METHODS: Between June 2003 and September 2005, 650 patients with primary breast cancer and who underwent a SLN procedure were retrospectively reviewed. Of those 650 patients, 138 patients with metastasis in the SLNs were analyzed. RESULTS: The median number of harvested sentinel lymph nodes (SLNs) was 2.5 (range: 1~7) and the median number of tumor positive LNs was 2.1 (range: 1~22). Of the 138 patients with a positive SLN, macrometastasis was identified in 105 patients and micrometastasis was noted in 33 patients. The SLN micrometastases were smaller than 0.2 mm in 18 patients and it was between 0.2 to 2.0 mm in 15 patients. Completion axillary dissection was performed in 17 (51.5%) patients with SLN micrometastasis and in 105 (100%) patients with SLN macrometastasis. NSLN involvement was found in 43/105 (41.0%) patients with SLN macrometastasis, while it was not found in the patients with SLN micrometastasis. Univariate analysis showed that T stage, multiplicity, lymphovascular invasion and histologic type were significantly associated with the difference between micrometastasis and macrometastasis in the SLNs. Multivariate analysis identified T stage as a significant factor. CONCLUSION: This study suggests that NSLN metastasis is associated with size of metastasis found in the SLN and completion axillary dissection may not be necessary in patients who have micrometastatic disease in the SLN.

Retrospective Study of Clinical Features and Courses of Raynaud's Phenomenon

PURPOSE: Raynaud's phenomenon is characterized by recurrent episodes of arterial vasospasm of the digits upon exposure to cold, and this can occur alone or in association with other underlying conditions. The aim of this study was to investigate the clinical course of Raynaud's phenomenon and the effects of treatment. METHOD: Between September 1994 and December 2004, 69 patients with Raynaud's phenomenon were retrospectively evaluated. The symptoms of the patients and the results of photoplethysmography were reviewed before and after medical treatment. RESULT: The mean age of the patients was 47.4 years and 33 patients (47.8%) were in their 30s and 40s. Thirty seven patients (53.6%) were male and 32 patients (46.4%) were female. Twelve patients (17.4%) had combined disease and the majority of the total patients (n=58, 84%) presented with bilateral lesions. After treating with aspirin, cilostazol, PGI2 and PGE1, the symptoms improved in 27 cases (39.1%) and the photoplethysmographic findings improved in 20 cases (45.5%). However, there was no association between the period of treatment and the clinical results or the results of performing photoplethysmography. CONCLUSION: The majority of patients with Raynauds phenomenon develop bilateral symptoms without the presence of any underlying diseases. Antiplatelet agents and vasodilator drugs can have a positive effect on the management of Raynaud's phenomenon.

Intraoperative Examination of Sentinel Lymph Nodes by Rapid Immunohistochemistry in Breast Cancer

PURPOSE: The recently developed method of rapid immunohistochemistry (IHC) was applied to the intraoperative examination of sentinel lymph node (SLN) because as their routine frozen-section examination is liable to yield a false-negative results. This study is devoted to establish a reliable protocol for rapid IHC of SLN. METHODS: Between August 2004 and April 2005 a retrospective study was performed. SLNs from 50 breast cancer patients with clinically negative SLN were examined intraoperatively using hematoxylin-eosin (H&E) stain and immunostain for cytokeratin by rapid IHC assay. After examination of the frozen section, the SLNs were paraffin embedded and serially sectioned at 5 micrometer intervals. RESULTS: The median age and tumor size of the patients was 61.0 years and 1.4 cm (6% Tis, 70% T1, and 24% T2), respectively. The total number of dissected SLN was 112, with a mean of 2.2 (range, 1~4) SLNs per patient. Seven SLNs were found to be positive from metastasis in permanent pathological sections. Of these, 5 were stained by both intraoperative rapid IHC and H&E stain while one was not stained at all. The remaining SLN was initially stained with only the rapid IHC assay. The mean turn around time of the rapid IHC was less than 20 minutes, with sensitivity, true negative value, true positive values and accuracy of 85.7, 99.1, 100, and 99.1% respectively. CONCLUSIONS: The rapid IHC was a very sensitive and rapid technique for the intraoperative detection of metastatic involvement of SLNs, whitch may be helpful at increasing the accuracy of detecting the micro-metastasis of sentinel lymph nodes during an operation.

Surgical Outcome and Prognostic Factors of Primary Gallbladder Carcinoma

PURPOSE: Cancer of the gallbladder, which is the eighth most common malignancy of the digestive system in Korea, is almost always associated with an unfavorable prognosis, and the clinical outcome has not improved much over the past couple of decades. This study was intended to examine our surgical experience and to evaluate the prognostic significance of the clinicopathological factors for a primary carcinoma of the gallbladder. METHODS: The data of 202 patients with gallbladder carcinomas operated on at our surgical department over a period of 10 years from May 1994 to Dec. 2003 were retrospectively reviewed. RESULTS: Overall, the 5-year survival was 46.8% with the median survival of 58.8 months. The histopathological type and grade, TNM stage, stage grouping, symptom, CA 19-9 level, and jaundice were significant prognostic factors. Among the 85 patients with T2 cancer, the outcome after a resection was better than that after simple cholecystectomy. CONCLUSION: A complete tumor resection and no lymph node involvement are associated with a good prognosis. The long-term survival may be achieved by an early diagnosis with a curative, radical resection. Additionally, a radical resection may be beneficial for patients with a T2 gallbladder carcinoma.