Clinical Analysis of Phyllodes Tumor of the Breast / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Phyllodes tumors are fibroepithelial mammary lesions that tend to behave in a benign fashion but may undergo sarcomatous transformation. They account for 0.3 to 0.5 percent of all breast tumors. Their behavior is not well understood by many clinicians. MATERIALS AND METHODS: We retrospectively reviewed the clinical, radiologic, and pathologic finding and treatment modality of 31 patients of phyllodes tumor diagnosed at the Breast Clinic, Gachon Medical School Gil Medical Center between July 1992 and July 2000. RESULTS: Pathologically, 6 patients (19.3%) had malignant tumor and 25 patients (80.7%) had benign lesions. All were women with average age of 36 years. The patients with malignant tumors tended to be older and had larger tumors and shorter duration. For preoperative diagnosis, we used mammography, sonography, and MIBI Scintimammography, fine needle aspiration cytology and biopsy. All these diagnostic methods suggested the diagnosis of phyllodes tumors in only 8 cases (26%). All patients received surgical treatment: excision in 21 cases, wide excision in 3 cases, simple mastectomy in 5 cases, and simple mastectomy with axillary lymph node dissection 2 cases. One patient with malignant tumor, two patients with borderline tumor and three patients with benign tumor experienced recurrence (19.3%). CONCLUSION: None of the clinical or radiologic characteristics was useful in predicting for phyllodes tumor. Phyllodes tumors were difficult to make proper preoperative diagnoses and to differ malignant tumor from a benign one. This led to a simple excision and resulted in high local recurrence. We suggest that the initial or subsequent wide excision is an appropriate surgery to decrease the recurrence.

Comparison between Mammography, Ultrasonography and 99 mTc-MIBI Scintimammography in the Diagnosis of Breast Cancer

PURPOSE: To compare the feasibility of 9 9 mTc-MIBI scintimammography as a tumor localizing agent in breast lesions in comparison with that of mammography and ultrasonography, and to evaluate the efficacy of these three modalities. MATERIALS AND METHODS: Sixty-four breast lesions were classified as benign or malignant on the basis of sono-graphic and mammographic criteria and were further analyzed by means of 99mTc-MIBI scintimammography. The classifications thus obtained were compared with the biopsy findings, and in order to compare the three techniques, the sensitivity, specificity, accuracy, and negative and positive predictive values were calculated for each individual modality. RESULTS: Of 64 histologically proven lesions, 33 were malignant and 31 were benign. Sensitivities and specificities for malignancy were 86.2% and 64.5% for mammography, 87.9% and 76.7 % for sonography, and 78.8% and 74.2% for 99mTc-MIBI scintimammography. CONCLUSION: Mammography and ultrasonogrphy are reliable diagnostic modalities for the detection of breast cancer. 99mTc-MIBI scintimammography has a higher specificity than mammography and it may help to reduce unnecessary biopsies.

Correlation of Breast Cancer with Atypical Ductal Hyperplasia on Fine-needle Aspiration Cytology Speciemens / 대한암학회지

PURPOSE: Atypical ductal hyperplasia (ADH) is a lesion with significant malignant potential We evaluated the prevalence of breast carcinoma in surgical breast biopsies performed on palpable breast lesions diagnosed initially as ADH by fine needle aspiration cytology (FNAC). MATERIALS AND METHODS: Between January 1, 1996 and December 31, 1997, 942 patients who underwent FNAC at the Department of Surgery and Pathology, College of Medicine, Hallym University and Department of Surgery, Central Gil Hospital were analyzed. ADH was found in 46 (4.9%) of 942 patients, and surgica1 excision subsequently was performed in 39 of these cases. In these 39 cases, cytologic and histopathologic results from FNAC and surgical biopsies were reviewed and correlated. RESULTS: Histopathologic study of the 39 surgically excised lesions diagnosed as ADH in their FNAC specimens showed breast cancer in 15 cases (38.5%), ADH in 11 cases (28.2%) and benign disease in 13 cases (33.3%). CONCLUSION: In our patient populatian, 15 cases (38.5%) of 39 patients with ADH at FNAC had a breast cancer. Therefore, the FNAC finding of ADH may warrant a recommendation for an excisional biopsy.

The Availability of Bioelectrical Impedance Analysis for Estimating the Obesity on the Relative Risk in the Breast Cancer / 한국유방암학회지

BACKGROUND: The incidence of female breast cancer has been increasing during last 10 years. There are many risk factors in breast cancer. We evaluated the relative risk of breast cancer in relation to obesity and body composition. Also we evaluated the Bioelectrical Impedance Analysis (BIA) for estimating the obesity. MATERIALS AN METHODS: The data were collected as a case-control study from September 1, 1997 to August 31, 1998. Cases were selected from newly diagnosed and treated breast cancer patients at Breast Clinic of Gil Medical Center, Gachon Medical College. Control group was randomly selected form women with benign breast disease or women in screening rest. All suspected risk factors including obesity indices and body composition were checked. Especially body fat percent, total body water and lean body mass were checked by BIA. RESULTS: There was no association between the relative risk of breast cancer and education, smoking, drinking, oral contraceptives use, reproductive factors and breast feeding factors. Data analysis showed the high possibility of positive relationship between early menarche factors( or =51 years old ) and the brest cancer, however there was no statistical significance. There was a statistical significance between risk group and control group in fat percent (p=0.0187) and WHR (waist-hip ratio) (p=0.0174) among obesity indicies. BMI & obesity (In the classification if Obesity by Japan Society for Study of Obesity) were associated with relative risk of breast cancer by menopausal status. In premenopausal women, breast cancer risk decreased in high BMI & obese group, however the increase was shown in postmenopausal women contrarily. . CONCLUSIONS: This study suggests that there I a significant difference in the relationship between the obesity index and the relative risk of breast cancer between Korean and Western women. Bioelectrical Impedance Analysis is a available method for estimating of obesity in relative risk of breast cancer women. Further studies will be needed for evaluating the role of BIA and the relationship of obesity with staging & prognosis of breast cancer.

Diagnostic Accuracy of Quantitative Scintimammography Using Tc-99m MIBI According to ROC Curve Analysis for Breast Cancer

BACKGROUND: Technetium-99m sestamibi scintimammography (SMM) has been shown to be a useful diagnostic test in the detection of breast cancer, and the receiver operating characteristic (ROC) curve analysis provides detailed information about the diagnostic test. A ROC curve analysis was performed to evaluate the feasibility of Tc-99m sestamibi quantitative scintimammography (qSMM) for differentiating malignant from benign breast lesions. METHODS: Prone anterior, lateral planar, and supine SPECT imagings were performed on 75 female patients (mean age=43.4 yr) with breast masses (size> or =0.8 cm) after intravenous injection of 30 mCi of Tc-99m sestamibi. 45 malignant and 30 benign lesions were histologically proven. Three regions of interest (ROIs) were drawn over designated areas: lesion (L), normal breast opposite to the lesion (NL), and right chest wall (CW). L/NL and the L/CW ratios on both the SPECT and the planar images were analyzed. RESULTS: ROC curve analysis revealed that planar L/NL ratio and the SPECT L/NL and L/CW ratios provide better diagnostic accuracies for detecting breast cancer than the planar L/CW ratio did (p<0.05). From the qSMM (mean), which was an arithmetic mean of the planar L/NL, ratio the SPECT L/NL ratio and the SPECT L/CW ratio, the sensitivity, the specificity, the positive predictive value, the negative predictive value, and the accuracy were 84%, 77%, 84%, 77%, and 81%, respectively. Presence of axillary lymph-node metastasis showed a higher qSMM (mean) value (4.09 {n=17} vs 3.09 {n=28}, p=0.06). CONCLUSIONS: qSMM (mean) is a useful objective method for differentiating malignant from benign breast lesions.

Correlation of Breast Cancer with Atypical Ductal Hyperplasia on Fine-needle Aspiration Cytology Speciemens / 한국유방암학회지

PURPOSE: Atypical ductal hyperplasia (ADH) is a lesion with significant malignant potential. We evaluated the prevalence of breast carcinoma in surgical breast biopsies performed on palpable breast lesions diagnosed initially as ADH by fine needle aspiration cytology (FNAC). MATERIALS AND METHODS: Between January 1, 1996 and December 31, 1997, 942 patients performed FNAC at the Department of Surgery and Pathology, College of Medicine, Hallym University and Department of Surgery, Central Gil Hospital were analyzed. ADH was found in 46(4.9%) of 942 patients and surgical excision subsequently was performed in 39 of these cases. In these 39 cases, cytologic and histopathologic results from FNAC and surgical biopsies were reviewed and correlated. RESULTS: Histopathologic study of the 39 surgically excised lesions diagnosed as ADH in their fine needle aspiration cytology specimens showed breast cancer in 15 cases(38.5%), ADH in 11 cases (28.2%) and benign disease in 13 cases (33.3%). CONCLUSION: In our patient population, 15 cases(38.5%) of 39 patients with ADH at FNAC had a breast cancer. Therefore the fine needle aspiration cytology finding of ADH warrants a recommendation for an excisional biopsy.

The Biologic Singificance of Mammographic Calcification / 한국유방암학회지

During the past two decades, mammography has become established as an indispensible addition to complete evaluation of symptomatic women and as a valuable screening method to detect early breast cancer in asymptomatic women. Mammographic microcalcification is a feature in a proportion of breast-cancer patients. So we evaluate the association of mammographic microcalcifications with age, tumor stage, tumor size, axillary lymph-node positivity, estrogen-receptor progesterone-receptor positivity, histology, nuclear grading, and an extensive intraductal component(EIC). The authors retrospectively reviewed and analyzed 181 cases of breast cancer which were diagnosed and operated on from January 1994 to December 1996. We divided the subjects into two groups based on the presence of mammographic microcalcification or the absence of mammographic calcification. In this paper, we report the results of our analysis along with a review of the literature. The results are as follows: 1) Five of the 66 patients with mammographic microcalcifications had intraductal carcinomas wheres only one of the 115 patients without mammographic microcalcifications had such a carcinoma. 2) The two groups were comparable as to primary tumor size: 3.09 cm in the group with microcalcifications and 2.68 cm in the group without microcalcifications. In particular, the group with microcalcifications and axillary lymph-mode metastasis showed a primary tumor size of 4.17 cm. A high rate of axillary lymph-node metastasis was noted for patients with T3 tumors and mammographic microcalcifications. 3) The two groups were comparable as to cancer stage: stage 0.0%, stage I 17.2%, stage II 55.2% and stage III 27.5% for mammographic microcalcifications with mass and stage 0 10.8%, stage I 32.4%, stage II 43.2%, and stage III 13.5% for mammographic microcalcifications only. 4) An EIC was present in 6 of the 29 cases (20.6%) with mammographic microcalcifications with mass and in 5 of the 37 cases (13.5%) with mammographic microcalcifications only. Breast cancer patients with an EIC have a high incidence of local recurrence and a poor prognosis. We must have strict and powerful, primary and systemic management of patients with mommographic microcalcifications with mass.

Study for Mammographic Patterns of Korean Breast Cancer / 한국유방암학회지

BACKGROUND: In Korea, the incidence of breast cancer is relatively lower than in western country, but it is in increasing slope. However the mammographic patterns of Korean breast cancer patients are not well known. METHODS: The authors collected the clinical and radiologic data from new breast cancer patients between January 1992 and December 1997, and analysed the mammographic pattern. RESULTS: Of the 418 patients, the age-specific incidences were 153 (37.0%) for 40 to 49 years of age, 99 (23.9%) for 30 to 39 years, 81 (19.6%) for 50 to 59 years, 55 (13.3%) for 60 to 69 years, 14 (3.3%) for over 70 years, and 12 (2.9%) for 20 to 29 years. According to the TNM staging system, there were 2 (0.6%) with stage 0, 102 (24.9%) with stage I, 147 (35.9%) with stage IIA, 72 (17.6%) with stage IIB, 85 (20.8%) with stage IIIA, 1 (0.2%) with stage IV. The non-palpable lesions were 7.5% on physical examination. According to Wolfe's classification, there were 78 (19.0%) for N1, 78 (19.0%) for P1, 133 (32.4%) for P2, and 122 (29.7%) for DY pattern. On mammography, lumps were found in 312 cases (75.8%). Among mammographic lumps, 51.9% was not clearly defined margin. The mammographic calcifications were found in 48.3% of all patients. In the distribution of calcification, 20.6% was diffuse type and 79.4% was localized type. The size of calcifications was variable in 92.9% and the shape of calcifications was amorphous pattern in 85.6%. We could not suspect cancer in 14.7% of patients on mammography, and 10.1% of patients on ultrasound examination. CONCLUSION: We believe that these baseline mammographic data of Korean breast cancer patients may contribute to the accurate diagnosis of breast cancer, but more data will be needed.

The Biologic Significance of Mammographic Calcification

During the past two decades, mammography has become established as an indispensible addition to complete evaluation of symptomatic women and as a valuable screening method to detect early breast cancer in asymptomatic women. Mammographic microcalcification is a feature in a proportion of breast- cancer paients. So we evaluate the association of mammographic microcalcifications with age, tumor stage, tumor size, axillary lymph-node positivity, estrogen-receptor progesterone-receptor positivity, histology, nuclear grading, and an extensive intraductal component(EIC). The authors retrospectively reviewed and analyzed 181 cases of breast cancer which were diagnosed and operated on from January 1994 to December 1996. We divided the subjects into two groups based on the presence of mammographic microcalcification or the absence of mammographic calcification. In this paper, we report the results of our analysis along with a review of the literature. The results are as follows : 1) Five of the 66 patients with mammographic microcalcifications had intraductal carcinomas wheres only one of the 115 patients without mammographic microcalcifications had such a carcinoma. 2) The two groups were comparable as to primary tumor size : 3.09 cm in the group with microcalcifications and 2.68 cm in the group without microcalcifications. In particular, the group with microcalcifications and axillary lymph-node metastasis showed a primary tumor size of 4.17 cm. A high rate of axillary lymph-node metastasis was noted for patients with T3 tumors and mammographic microcalcifications. 3) The two groups were comparable as to cancer stage : stage 0 0%, stage I 17.2%, stage II 55.2% and stage III 27.5% for mammographic microcalcifications with mass and stage 0 10.8%, stage I 32.4%, stage II 43.2%, and stage III 13.5% for mammographic microcalcifications only. 4) An EIC was present in 6 of the 29 cases(20.6%) with mammographic microcalcifications with mass and in 5 of the 37 cases(13.5%) with mammograhic microcalcifications only. Breast cancer patients with an EIC have a high incidence of local recurrence and a poor prognosis. We must have strict and powerful, primary and systemic management of patients with mammographic microcalcifications with mass.

Needle Localization Biopsy of Nonpalpable lesions of Breast under the Local Anesthesia

In performing needle localization breast biopsies(NLBB) under local anesthesia in an outpatient setting, we investigated, whether complication rates would be acceptable when compared with complications of the breast performed for palpable masses. We were also interested in determining whether our rate of missed biopsies would be acceptable or not. We performed the NLBB on 55 patients with a nonpalpable breast lesion, and open biopsy on 98 patients with a palpable breast mass under local anesthesia from 1992 to 1995. The missed biopsy rate was one (1.8%) of 55. Complication of NLBB occured in 4 cases(7.3%), including 1 case of seroma, 2 cases of hematoma, and 1 case of abscess. The complication rate was not statistically different from NLBB(7.3%) and open biopsy(6.1%). (P=0.25) Eleven carcinomas, including 8 cases of invasive and 3 cases of DCIS, were found with NLBB procedure.. But there was no in situ carcinoma among the palpable lesions. Needle localization breast biopsies can be performed under local anesthesia and complications rates were similar to those associated with biopsies of palpable lesions. But missed biopsy could occur if the localization was not performed exactly.

Clinical analysis of 98 patients undergoing concomitant cholecystectomy and exploration of the common bile duct

No abstract available.