Assessment of Quality of Life and Safety in Postmenopausal Breast Cancer Patients Receiving Letrozole as an Early Adjuvant Treatment / 한국유방암학회지

PURPOSE: There are few reports from Asian countries about the long-term results of aromatase inhibitor adjuvant treatment for breast cancer. This observational study aimed to evaluate the long-term effects of letrozole in postmenopausal Korean women with operable breast cancer. METHODS: Self-reported quality of life (QoL) scores were serially assessed for 3 years during adjuvant letrozole treatment using the Korean version of the Functional Assessment of Cancer Therapy-Breast questionnaires (version 3). Changes in bone mineral density (BMD) and serum cholesterol levels were also examined. RESULTS: All 897 patients received the documented informed consent form and completed a baseline questionnaire before treatment. Adjuvant chemotherapy was administered to 684 (76.3%) subjects, and 410 (45.7%) and 396 (44.1%) patients had stage I and II breast cancer, respectively. Each patient completed questionnaires at 3, 6, 12, 18, 24, 30, and 36 months after enrollment. Of 897 patients, 749 (83.5%) completed the study. The dropout rate was 16.5%. The serial trial outcome index, the sum of the physical and functional well-being subscales, increased gradually and significantly from baseline during letrozole treatment (p<0.001). The mean serum cholesterol level increased significantly from 199 to 205 after 36 months (p=0.042). The mean BMD significantly decreased from −0.39 at baseline to −0.87 after 36 months (p<0.001). CONCLUSION: QoL gradually improved during letrozole treatment. BMD and serum cholesterol level changes were similar to those in Western countries, indicating that adjuvant letrozole treatment is well tolerated in Korean women, with minimal ethnic variation.

Robotic Endoscopic Thyroidectomy; Experience with 256 Consecutive Cases in a Single Institution / 대한내분비외과학회지

PURPOSE: Conventional thyroidectomy through a skin crease incision in the anterior neck sometimes causes a visible scar. Minimally invasive surgical techniques have been developed, and, recently, more various techniques of remote access surgery such as endoscopic and robotic thyroidectomy have been suggested and actively applied. Robotic thyroid surgery has several advantages over endoscopic thyroid surgery. These advantages include three-dimensional magnified view, tremor-filtering system, multi-articulated motion, and more comfortable surgeon position, and assistants are unnecessary for performance of the robotic thyroid surgery. METHODS: From November 2008 to July 2014, 256 patients underwent robotic endoscopic thyroidectomies through a transaxillary approach. An approximately 5 cm long incision was created on the axillary natural crease, so that the scar can be completely hidden by the arm. Patients' characteristics, postoperative clinical results, complications, and pathologic details were assessed. RESULTS: The mean age of patients was 40.9+/-10.1 years. For benign tumors, we performed 56 less-than total thyroidectomies. For malignant tumors, we performed 175 less-than total thyroidectomies with central compartment node dissection, 21 total thyroidectomies with central compartment node dissection, and four total thyroidectomies with lateral neck node dissection (Benign=56, Malignant=200). The mean actual operation time (console time) was 91.5+/-48.7 min for benign tumors and 103.0+/-65.8 min for malignant tumors. The number of retrieved lymph nodes was 5.1+/-4.1 (mean) in malignant tumors. Internal jugular vein tearing occurred in two patients. Transient hypocalcemia (four patients) and transient hoarseness (six patients) occurred, but recovered within six months. CONCLUSION: Robotic endoscopic thyroidectomy is technically safe and feasible and also shows excellent cosmetic outcome.

A Study of the Depressive Symptoms and the Quality of Life in Patients with Breast Cancer in a University Hospital / 정신신체의학

OBJECTIVES: This study was designed to investigate the prevalence of depressive symptoms in patients with breast cancer and to identify demographic variables and clinical characteristics impact on depressive symptoms and health related quality of life in patients with breast cancer in a university hospital. METHODS: Fourty-one patients with breast cancer were selected, who had visited the department of General surgery of the Wonkwang University hospital with a diagnosis of breast cancer regularly during the period November, 2010-May, 2011. All of subjects were evaluated for the depression, anxiety and the health related quality of life with Beck Depression Inventory(BDI), anxiety subscale of Personality Assessment Inventory(PAI) and Short-Form 36 Health Survey-Korean version(SF-36-K). Patients were divided into depressive symptoms and non-depressive symptoms group according to the BDI score. We compared SF-36-K between two groups, and analized multiple regression with depression and health related quality of life as criterion variables and demographic and clinical characteristics. RESULTS: The prevalence of depression in patients with breast cancer in a University hospital was 36.4%. Compared to the non-depression, depressed patients with breast cancer appeared significantly lower mean scores on six subscales in SF-36-K : Physical function(p<.01), Role-physical(p<.001), General health(p<.05), Social function(p<.001), Role-emotional(p<.001) and Mental health(p<.001). But there was no significant difference between two groups in Vitality and Bodily pain. Anxiety, level of education and presence of enforcement of chemotherapy(63.6%) were significant explanation variables for depressive symptoms. And type of surgery and age (55.8%) were significant explanation variables for health related quality of life. CONCLUSIONS: The prevalence of depressive symptoms in patients with breast cancer in a University hospital was 36%. The depressive symptoms had not only negative impact on the health related quality of life but also important explanation variable for health related quality of life. These results suggest that depressive symptoms in patients with breast cancer should be evaluated and treated for improving patient's health related quality of life.

The Changes of the Histologic and Biologic Markers Induced by Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer / 한국유방암학회지

PURPOSE: Neoadjuvant chemotherapy (NAC) has become the standard treatment for locally advanced breast cancer. The postoperatively adjuvant systemic treatment is based on the status of the histological and biological markers of either the pre-NAC or the post-NAC. There have been several reports that have demonstrated the changes of the histological and biological markers after NAC. The aim of this study is to investigate the effects of NAC on the expression of the histological and biological markers of breast cancer. METHODS: We analyzed the paired pre- and post-NAC tumor specimens from 37 patients with stage IIIA, IIIB or IIIC breast cancer. All the patients received 2 to 6 cycles of anthracycline-containing NAC. Over 6 pieces of pre-NAC tumor specimens were taken by 14 G core needle from multiple sites of a tumor, and the post-NAC specimens were taken at the time of the operation. The histologic grade and immunohistochemical expression of estrogen receptor (ER), progesterone receptor (PR), c-erbB2, p53, Ki67, CD31 and p-glycoprotein were analyzed in the paired pre- and post-NAC tumor specimens from 37 patients. RESULTS: Twenty five patients (67.6%) revealed significant changes of more than one marker. The markers that showed changes of more than two grades were as follows; histologic grade in 1, ER in 4, PR in 9, c-erbB2 in 4, p53 in 1, Ki67 in 4, CD31 in 9 and pglycoprotein in 5 patients. In 12 patients (32.4%), significant changes were found in the markers that can influence the decision-making for adjuvant treatment (i.e. ER, PR and c-erbB2). The ER/PR status changed from positive to negative in 4 patients and c-erbB2 was changed from positive to negative in 3 patients. Among those patients, the strategy of adjuvant treatment was adjusted according to the changes. CONCLUSION: The specimens for the histologic and biologic markers of a tumor should be taken before NAC because NAC can have an influence on the expression of the prognostic markers of locally advanced breast cancers, and this may subsequently influence predicting the prognosis and making the decision for adjuvant systemic treatment.

The Diagnostic Concordance of Femoral Hernia and the Factors Influencing Diagnosis

PURPOSE: Misdiagnosis is frequent in femoral hernia as inguinal hernia. The aims of this study were to examine the diagnostic concordance and to define the factors having influence on the correct diagnosis of femoral hernia. METHODS: Thirty-two patients who underwent femoral hernia operations were analyzed retrospectively. RESULTS: The mean age of the study subjects was 65.8+/-15.5 (36~97) and the female to male ratio was 5.4:1. The mean body mass index (BMI) was 19.8 kg/m2 (14.6~26.9 kg/m2). Twelve patients (37.5%) showed pre- and post-operative diagnostic concordance and 20 patients (62.5%) did not. Among the 20 misdiagnosed cases, 16 cases were misdiagnosed as inguinal hernia, 2 cases as lipoma, and 1 case as lymphadenopathy. The factors related to the correct diagnosis of femoral hernias were associated with groin mass (96.9%, 31/32: 23 painless and 8 painful), size fluctuation of mass (cyclic wax and wane pattern) (84.4%, 27/32), long duration of mass (over 1 month) (75.0%, 24/32), femoral venous compression CT findings (63.6%, 14/22), and positive ultrasonographic findings (42.1%, 8/19). Emergency operation was done in 12 cases (37.5%). Incarceration was found in 23 cases (71.9%) and most of the incarcerated organs were omental fat (11 cases) and small bowel (10 cases). Bowel resection was done in 4 cases and 2 patients combined inguinal hernia. CONCLUSION: Through the careful taking of medical history and physical examination, physicians can achieve the correct diagnosis and can also decrease the frequency of emergency operations and their related complications.

Feasibility of Gasless Endoscopic Thyroid Surgery through a Single Infraclavicular Approach / 대한내분비외과학회지

PURPOSE: Several approaches in endoscopic thyroid surgery have been developed to avoid large scars on the anterior neck. We assessed the feasibility and cosmetic benefit of performing gasless endoscopic thyroid surgery through a single infraclavicular approach. METHODS: Thirty-one patients with a benign thyroid mass on sonography received gasless endoscopic thyroidectomy through a single infraclavicular approach. A 5-cm infraclavicular incision was created laterally, depending on the distance from the clavicle to the thyroid mass, but which would be completely hidden by a V-shaped shirt collar. In some cases, hand-assisted vessel ligation was performed through this incision. RESULTS: The study included 26 female patients (out of 31), and the mean age was 38.2 years old (range, 14 to 70). All patients received a unilateral thyroid lobectomy, with or without isthmectomy, and tumors were benign (follicular adenoma in 12 and adenomatous hyperplasia in 19). A recurrent laryngeal nerve was identified in all cases. The mean operation time was 162.5 min (range, 100 to 300 min). No patients required conversion to conventional open surgery or showed postoperative bleeding, even without drainage. Hoarseness occurred in 1 patient with injury of the recurrent laryngeal nerve, which was repaired through the same incision and recovered within 6 months. Temporary hoarseness occurred in another 3 patients, but recovered within 3 months. CONCLUSION: Gasless endoscopic thyroidectomy through a single infraclavicular approach improved cosmetic outcomes and allowed for bleeding control through hand-assisted ligation of vessels. Therefore, the technique is suitable for surgeons inexperienced in endoscopic thyroidectomy.

Direct Comparison of PHS(R) and Perfix(R) Herniorrhaphy under Local Anesthesia

PURPOSE: The aims of this study were to evaluate the feasibility of local anesthesia in tension-free herniorrhaphy, using prosthetic mesh, and to directly compare PHS(R) and Perfix(R) herniorrhaphy under local anesthesia. METHODS: Patients with a groin hernia, who underwent tension-free herniorrhaphy (n = 107) under local anesthesia between March 2003 and February 2006, were included. PHS(R) (n = 63) and Perfix(R) (n = 44) meshes were randomly used, with no difference between the PHS(R) and Perfix(R) groups in relation to mean age, gender, number of combined diseases, body mass index (BMI), recurred hernia and types of hernia. RESULTS: Intraoperative analgesics and/or sedatives were used in 55 patients (51.4 %) where local anesthesia was insufficient. In a univariate analysis, the additional use of intraoperative analgesics and/or sedatives was related to the patient's age and BMI. The patients at an older age and with a lower BMI were more tolerant to local anesthesia. However, only the BMI was found to be a statistically significant factor from the multivariate analysis. There was no significant difference between the PHS(R) and Perfix(R) groups on the additional use of intraoperative analgesics and/or sedatives, the use of postoperative analgesics, length of hospital stay, complication and recurrence (P > 0.05). CONCLUSION: With tension-free herniorrhaphy using the PHS(R) or Perfix(R) mesh, local anesthesia was acceptable and securable, regardless of the mesh type used. Among these patients, those at an older age and with a lower BMI were more tolerant to local anesthesia.

The Prognostic Value of the S-phase Fraction and Ki-67 Expression in Early Breast Cancer

PURPOSE: The aim of this study was to compare the S-phase fraction (SPF) and Ki-67 with other biologic factors, and to assess the prognostic value of Ki-67 and SPF in 108 breast cancer patients. MEHOODS: The SPF and Ki-67 level were determined in formalin-fixed, paraffin-embedded tissue specimens from 108 patients with early breast cancer who underwent surgery between January 1997 and December 2000 at the Wonkwang University Hospital. The clinicopathological characteristics of the early breast cancer such as the tumor size, node status, histological grade, hormone receptor, various tumor markers and cancer recurrence were compared with the SPF and Ki-67 values. RESULTS: The median SPF was 9.03% (range 0~43%). The SPF correlated with CD31 (P=0.020) and DNA diploidy (P=0.000). Ki-67 correlated with the histological grade (P= 0.010) and p53 (P=0.035). No correlation was found between the SPF and Ki-67. Eight cases recurred during the follow-up period. Strong expression of Ki-67, p53, DNA aneuploidy and a young age were correlated with recurrence (P=0.001, P=0.029, P=0.021 and P=0.002, respectively). However, the SPF was not related to recurrence. CONCLUSION: In early breast cancer, Ki-67 expression is correlated with the histological grade and p53 expression. In addition, strong Ki-67 expression is associated with a recurrence. Further studies regarding the prognostic significance of the proliferation markers, such as Ki-67 and SPF, will be needed to confirm these results.

Correlation of the Immunohistochemical Coexpression of p53 and HER-2/neu and the Prognosis of Breast Cancer / 한국유방암학회지

PURPOSE: Among the many biological parameters of breast cancer, the p53 and HER-2/neu genes, which are located on the chromosome 17, and their gene products have been studied extensively by many researchers in regard their relation to the prognosis. The aim of this study was to evaluate the prognostic significance of the coexpression of p53 and HER-2/neu in breast cancer. METHODS: Formalin-fixed, paraffin-embedded tissues from 126 patients with invasive breast cancer were immunostained for p53 and HER-2/neu. Other prognostic parameters such as the patients' age, tumor size, lymph node metastasis, histologic grade, the presence of estrogen receptor (ER), and progesterone receptor (PgR) were evaluated. The patients' outcome was analyzed according to the expression of p53 and HER-2/neu as well as to the other prognostic factors. RESULTS: Among the 126 patients, p53 and HER-2/neu were positive in 46 (36.5%) and 33 (26.2%) patients. According to the expression of p53 and HER-2/neu, the patients were classified into three groups; group 1: negative expression for both factors (n = 63), and group 2: positive expression for either one of the factors (n = 47), and group 3: positive expression for both factors (n = 16). The median follow-up period was 50+/-11.1 months. On the Kaplan-Meier analysis, p53 and HER-2/neu were both related to the 5-year disease free survival rate (DFSR). Group 3 showed a significantly lower 5-year DFSR than did group 2 (66.2% vs. 85.2%, respectively, p = 0.05) and the group 1 (66.2% vs. 94.0%, respectively, p = 0.01). The multivariate analysis indicated that lymph node metastasis, ER, PgR, p53 and HER-2/neu expressions were significantly related to the patients'5-year DFSR. CONCLUSION: The expression of p53 and HER-2/neu was related to the 5-year DFSR of breast cancer, and the coexpression of p53 and HER-2/neu was found to have a more significant prognostic value than either one of these two parameters alone.

ReVersible Changes of Clinical Chemical Tests in Severe Hypothyroid Patients with Differentiated Thyroid Cancer Who Were Admitted for Radioiodine Therapy

PURPOSE: Severe hypothyroidism can cause abnormalities in numerous clinical chemical test results. We observed various reVersible changes of clinical chemical test results in patients with severe hypothyroidism who were admitted for radioiodine ablation therapy after total thyroidectomy. The purpose of this study was to describe and discuss the findings. METHODS: The study comprised 168 patients (24 males, 144 females, mean age 49+/-14 years) who underwent total thyroidectomy due to differentiated thyroid cancer and who were admitted for I-131 ablation therapy. Patients who had hepatic or renal dysfunction were excluded. RESULTS: Serum mean levels of aspartate transaminase, alanine transaminase, cholesterol, high density lipoprotein, lactic dehydrogenase, total bilirubin, indirect bilirubin, and creatinine were significantly increased to the upper normal range during severe hypothyroid state (serum thyroid stimulating hormone >30 uIU/ml). While serum levels of alkaline phosphatase (ALP), triglyceride (TG) and blood urea nitrogen (BUN) remained unchanged. Six patients who showed abnormal serum creatinine level during hypothyroid condition returned to normal after recovery of thyroid function. CONCLUSION: Results of clinical chemical tests for hepatic, lipid and renal function are often increased reversibly in severely hypothyroid patients. Reversible, abnormal serum creatinine levels may develop in some cases. Follow-up study is necessary in induced severely hypothyroid patients for radioiodine therapy to differentiate the reversibility of chemical tests.

Clinical Features of the Male Breast Cancer-13 Cases / 한국유방암학회지

Purpose: Breast cancer is one of the most frequent malignant tumors in American and European countries, with incidences increasing every year. In Korea it was the second most frequent cancer in 2002, followed by stomach cancer. However, in 2001 the incidence of breast cancer was first, followed by colon cancer, with incidences increasing every year. Conversely, breast cancer in men is not frequent, with an incidence of less than 1%, according to studies from both Korea and abroad. Studies on the treatment methods and prognostic factors of breast cancer in men are limited, with little clinical experience. Although there was difficulty in collecting complete data, due to lack of awareness of male breast cancer, the clinical characteristics could be determined from the experience and treatment outcomes of male breast cancer patients. Methods: The medical records of 13 male patients with breast cancer, who could be followed up, were retrospectively evaluated from 4809 patients with breast cancer, evaluated between 1989 and 2003. Results: The average age of the subjects was 64.3 years, with the breast masses with no pain situated at the center of the breast in most cases. The affected period in most patients was 1 year, with most having stage II breast cancer. Conclusion: Although asymptomatic unilateral subareolar breast mass in old ages is the most frequent symptom, most missed the period for early treatment due to lack of awareness of male breast cancer, therefore, their breast cancer had been for more than a year. Despite the difficulty due to the lack of data, attention needs to paid, and continuous studies required, toward male breast cancer.

External Anatomic Localization of Sentinel Lymph Nodes in Breast Cancer: Relationship with Axillary Hair Line and Pectoralis Major Muscle / 한국유방암학회지

PURPOSE: Recent studies have shown that the false negative rate of sentinel lymph node (SLN) biopsy is less than 5% and SLN biopsy is accepted as a highly accurate method for evaluating axillary lymph node metastasis in breast cancer. Purpose of this study was to evaluate the relationship between the location of SLNs and external anatomical structures of axilla in order to help a proper skin incision. METHODS: Between July 2001 and May 2002, SLN biopsies were performed in 25 breast cancer patients. SLNs were detected by hand-held gamma probe after subareolar injections of 99m-Tc antimony sulfur colloid. The location of the SLNs was indicated in terms of distance and direction from the lateral border of pectoralis major muscle and the axillary hair line. Breast conserving surgery or mastectomy was performed with axillary dissection in all cases. RESULTS: The location of tumors was the upper outer quadrant in 11 cases; the central portion in 4 cases; the upper inner quadrant in 4 cases; the lower inner quadrant in 3 cases; and the lower outer quadrant in 3 cases. Lymph nodemetastases were found in 5 cases of which SLNs were only metastatic nodes in 2 cases. The mean number of SLNs was 1.6. The false negative rate of SLN biopsy was 4.0% (1/25), giving a diagnostic accuracy of 96.0% (24/25). All the SLNs were located between the lateral border of pectoralis major muscle and the axillary hair line and the distance from the inferior tip of the hair line was as follows: 2 cases within 0.5 cm; 3 cases between 0.6 cm and 1 cm; 14 cases between 1.1 cm and 1.5 cm; 2 cases between 1.6 cm and 2.0 cm; 3 cases between 2.1 cm and 2.5 cm; 1 case between 2.6 cm and 3.0 cm. All the SLNs were located within a 3 cm diameter circle between the axillary hair line and the lateral border of pectoralis major muscle. CONCLUSION: The SLNs in breast cancer are located in a small area between the lateral border of pectoralis major muscle and the axillary hair line.

Malignant Lymphoma Associated with Hashimoto's Thyroiditis

Primary lymphoma of the thyroid gland is relatively rare disease. Its incidence varies in different series from 1% to 5% of all thyroid malignancies. Most primary thyroid lymphoma are of non-Hodgkin's type, have a B-cell phenotype, and arise in a background of autoimmune thyroiditis in about 80% of cases. A 69-year old woman presented with anterior neck swelling. Ultrasonography and computed tomography demonstrated a heterogenous soft tissue mass in both thyroid lobes and lymphadenopathy. Total thyroidectomy with lymph node dissection was performed. Histopathological findings demonstrated high-grade mucosa-associated lymphoid tissue (MALT)-type lymphoma with Hashimoto's thyroiditis. Radiation therapy was performed. We report a case of primary thyroid lymphoma with Hashimoto's thyroiditis.

Fine Needle Aspiration Cytology of Salivary Duct Carcinoma with Calcification in Submandibular Gland: A Case Report / 대한세포병리학회지

Salivary duct carcinoma is an uncommon aggressive malignant epithelial neoplasm with similarity to intraductal carcinoma of the breast. This neoplasm occurs most often in the parotid gland of middle-aged and older males. About 7% of reported tumors occured in the submandibular gland. The report of salivary duct carcinoma with calcification is rare. We report a case of salivary duct carcinoma with calcification in the submandibular gland. The patient was a 73-year-old male with a mass of the right submandibular gland for 1 year. On the fine needle aspiration cytology, the aspirate showed scant cellularity, small clusters of tumor cells, and scattered small calcifications. Nuclei of the tumor cells showed mild pleomorphism and round to oval in shape, and cytoplasm was abundant and finely granular. Nucleoli were indistinct and necrosis was not noted. There were no cribriform or papillary arrangements of tumor cells. Cytologic findings of salivary duct carcinoma are variable depending on histologic findings, and calcifications could be an additional cytologic finding.

Relationship between Cathepsin D Expression and Other Prognostic Factors in Primary Breast Cancer / 한국유방암학회지

PURPOSE: Cathepsin D, a lysosomal protease has been proposed to play a role in the local invasion and metastatic dissemination in primary breast cancer. Although there are many conflicting results, the overexpression of cathepsin D has been considered to be related with a poorer prognosis of breast cancer. This study was designed to verify whether cathepsin D expression is related to other prognostic factors in breast cancer. METHODS: Cathepsin D was assessed by immunohistochemistry using murine monoclonal anti-cathepsin D antibody (ZyMED) in 79 paraffin-embedded primary breast cancer specimens. Cathepsin D expression was compared to other prognostic parameters such as tumor size, axillary lymph node metastasis, tumor histologic grades, hormone receptors (ER & PR), p53, c-erb B2, Ki-67, MVD (microvessel density), and Pgp (P-glycoprotein). RESULTS: A high-expression of cathepsin D was found in 35 of 79 patients (44.3%) with primary breast cancer. Cathepsin D expression was not related to tumor size, axillary lymph node metastasis, tumor histologic grades, hormone receptors, p53, Ki-67, or CD31. However, a significant relationship was found between cathepsin D expression and c-erb B2 (p=0.007), and between cathepsin D expression and Pgp (p=0.003). CONCLUSION: These results suggest that cathepsin D expression may be an indicator of a poor prognosis in breast cancer. However, further studies are required to verify the xact role of cathepsin D in the prognosis of breast cancer.

Relationship between Cathepsin D Expression and Other Prognostic Factors in Primary Breast Cancer

PURPOSE: Cathepsin D, a lysosomal protease has been proposed to play a role in the local invasion and metastatic dissemination in primary breast cancer. Although there are many conflicting results, the overexpression of cathepsin D has been considered to be related with a poorer prognosis of breast cancer. This study was designed to verify whether cathepsin D expression is related to other prognostic factors in breast cancer. METHODS: Cathepsin D was assessed by immunohistochemistry using murine monoclonal anti-cathepsin D antibody (ZyMED) in 79 paraffin-embedded primary breast cancer specimens. Cathepsin D expression was compared to other prognostic parameters such as tumor size, axillary lymph node metastasis, tumor histologic grades, hormone receptors (ER & PR), p53, c-erb B2, Ki-67, MVD (microvessel density), and Pgp (P-glycoprotein). RESULTS: A high-expression of cathepsin D was found in 35 of 79 patients (44.3%) with primary breast cancer. Cathepsin D expression was not related to tumor size, axillary lymph node metastasis, tumor histologic grades, hormone receptors, p53, Ki-67, or CD31. However, a significant relationship was found between cathepsin D expression and c-erb B2 (p=0.007), and between cathepsin D expression and Pgp (p=0.003). CONCLUSION: These results suggest that cathepsin D expression may be an indicator of a poor prognosis in breast cancer. However, further studies are required to verify the exact role of cathepsin D in the prognosis of breast cancer.

Micrometastasis of Sentinel Lymph Node in Breast Cancer / 한국유방암학회지

PURPOSE: Sentinel lymph node (SLN) biopsy is thought to be a highly accurate method of assessing axillary nodal status in breast cancer. Furthermore, it can improve axillary staging by providing a more detailed examination of selected lymph nodes with a high probability of metastasis rather than the entire axillary nodes. The purpose of this study was to assess the incidence of SLN micrometastasis in node-negative breast cancer. METHODS: SLN biopsy was performed in 40 patients with clinically node-negative breast cancer using vital blue dye and/or radioisotope methods; the blue dye method was used in 21 cases, the isotope method in 14 cases, and a combination of both methods in 5 cases. All lymph nodes were evaluated by routine pathologic examination, and a more detailed examination was performed on sentinel nodes in node-negative cases; sentinel nodes were serially sectioned at an interval of 40micrometer depth followed by H&E and cytokeratin immunohistochemical (IHC) staining. RESULTS: Sentinel nodes were detected in 35 of 40 patients (87.5%). The mapping technique used in the remaining 5 cases was vital blue dye method only. Axillary node metastasis was found in 16 of 40 patients. Sentinel node biopsy accurately reflected the axillary node status in all cases; the sensitivity, specificity, and overall accuracy were 100, 100 and 100%, respectively. In 11 of 16 node-positive patients (68.8%), sentinel nodes were the only metastatic nodes. Occult micrometastases were found in SLN by serial section and IHC staining in 4 of 19 patients diagnosed as node- negative by routine pathological examination (21.1%). Occult micrometastasis of SLN was not correlated with primary tumor size, histologic grade or lymphovascular invasion with the exception of the S-phase fraction (P=0.023). CONCLUSION: SLN biopsy was a highly accurate method of assessing axillary node metastasis in breast cancer. Serial sectioning and IHC staining of SLN were sensitive methods in the detection of occult lymph node metastasis.

Micrometastasis of Sentinel Lymph Node in Breast Cancer / 한국유방암학회지

PURPOSE: Sentinel lymph node (SLN) biopsy is thought to be a highly accurate method of assessing axillary nodal status in breast cancer. Furthermore, it can improve axillary staging by providing a more detailed examination of selected lymph nodes with a high probability of metastasis rather than the entire axillary nodes. The purpose of this study was to assess the incidence of SLN micrometastasis in node-negative breast cancer. METHODS: SLN biopsy was performed in 40 patients with clinically node-negative breast cancer using vital blue dye and/or radioisotope methods; the blue dye method was used in 21 cases, the isotope method in 14 cases, and a combination of both methods in 5 cases. All lymph nodes were evaluated by routine pathologic examination, and a more detailed examination was performed on sentinel nodes in node-negative cases; sentinel nodes were serially sectioned at an interval of 40micrometer depth followed by H&E and cytokeratin immunohistochemical (IHC) staining. RESULTS: Sentinel nodes were detected in 35 of 40 patients (87.5%). The mapping technique used in the remaining 5 cases was vital blue dye method only. Axillary node metastasis was found in 16 of 40 patients. Sentinel node biopsy accurately reflected the axillary node status in all cases; the sensitivity, specificity, and overall accuracy were 100, 100 and 100%, respectively. In 11 of 16 node-positive patients (68.8%), sentinel nodes were the only metastatic nodes. Occult micrometastases were found in SLN by serial section and IHC staining in 4 of 19 patients diagnosed as node- negative by routine pathological examination (21.1%). Occult micrometastasis of SLN was not correlated with primary tumor size, histologic grade or lymphovascular invasion with the exception of the S-phase fraction (P=0.023). CONCLUSION: SLN biopsy was a highly accurate method of assessing axillary node metastasis in breast cancer. Serial sectioning and IHC staining of SLN were sensitive methods in the detection of occult lymph node metastasis.

Occult Micrometastasis of Sentinel Lymph Node in Node-negative Breast Cancer

PURPOSE: Sentinel lymph node (SLN) biopsy is thought to be a highly accurate method of assessing axillary nodal status in breast cancer. Furthermore, it can improve axillary staging by providing a more detailed examination of selected lymph nodes with a high probability of metastasis rather than the entire axillary nodes. The purpose of this study was to assess the incidence of SLN micrometastasis in node-negative breast cancer. METHODS: SLN biopsy was performed in 40 patients with clinically node-negative breast cancer using vital blue dye and/or radioisotope methods; the blue dye method was used in 21 cases, the isotope method in 14 cases, and a combination of both methods in 5 cases. All lymph nodes were evaluated by routine pathologic examination, and a more detailed examination was performed on sentinel nodes in node-negative cases; sentinel nodes were serially sectioned at an interval of 40nm depth followed by H&E and cytokeratin immunohistochemical (IHC) staining. RESULTS: Sentinel nodes were detected in 35 of 40 patients (87.5%). The mapping technique used in the remaining 5 cases was vital blue dye method only. Axillary node metastasis was found in 16 of 40 patients. Sentinel node biopsy accurately reflected the axillary node status in all cases; the sensitivity, specificity, and overall accuracy were 100, 100 and 100%, respectively. In 11 of 16 node-positive patients (68.8%), sentinel nodes were the only metastatic nodes. Occult micrometastases were found in SLN by serial sectionand IHC staining in 4 of 19 patients diagnosed as node- negative by routine pathological examination (21.1%). Occult micrometastasis of SLN was not correlated with primary tumor size, histologic grade or lymphovascular invasion with the exception of the S-phase fraction (P=0.023). CONCLUSION: SLN biopsy was a highly accurate method of assessing axillary node metastasis in breast cancer. Serial sectioning and IHC staining of SLN were sensitive methods in the detection of occult lymph node metastasis.

Diagnostic Usefulness of Tc-99m Tetrofosmin Scintimammography in Patients with Primary Breast Cancer / 대한핵의학회잡지

PURPOSE: The purpose of this study was to evaluate the diagnostic usefulness of scintimammography performed with Tc-99m tetrofosmin in the detection of primary breast cancer. MATERIALS AND METHODS: Sixty-one patients underwent Tc-99m tetrofosmin scintimammography, plain-filrn mammography and ultrasonography. After intravenous injection of Tc-99m tetrofosmin (740 MBq), prone lateral and anterior scintimammograms were obtained. Scintimammogram was visually interpreted as positive, probably positive, probably negative and negative for malignancy. The tumor to background count ratio (T/B) was measured at 5 minutes and 1 hour. Plain-film mammogram was interprcted as one of 5 categories. Final diagnosis was achieved by surgical histology (58/61) or fine needle aspiration (3/61). Of 61 patients, 44 had cancer and 17 had benign lesion. Tumor size of malignant and benign lesions on ultrasonogram were 2.51+/-1.30 cm (range 1-8 cm), 2.50+/-1.35 cm (range 0.96-6 cm), respectively. RESULTS: The sensitivity of plain-film mammography was 88.6%, specificity 58.8%, positive predictive value 84.7%, and negative predictive value 66.7%. The sensitivity of Tc-99m tetrofosmin scintimammography was 90.9%; specificity, 88.2%; positive predictive value, 94.9%; negative predictive value, 78.9%. Of 25 patients with indeterminate degree of suspicion for malignancy on plain-film mammogram, 23 were correctly diagnosed by scintimamography. The T/B at 5 minutes and 1 hour were 3.78+/-2.21, 3.25+/-1.80 respectively. The T/B was decreased significantly at 1 hour (p<0.001). CONCLUSION: Tc-99rn tetrofosrnin scintimammography was useful diagnostic procedure in the detection of primary breast cancer, especially in patients with indeterminate degree of suspicion for malignancy on plain-film mammogram.