Epidemiology of Second Non-breast Primary Cancers among Survivors of Breast Cancer: A Korean Population–Based Study by the SMARTSHIP Group / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#This study aimed to evaluate the incidence and prognosis of second non-breast primary cancer (SNBPC) among Korean survivors of breast cancer. @*Materials and Methods@#Data from the Korean National Health Insurance Service were searched to identify women who received curative surgery for initial breast cancer (IBC) between 2003 and 2008 (n=64,340). Among them, patients with the following characteristics were excluded: other cancer diagnosis before IBC (n=10,866), radiotherapy before IBC (n=349), absence of data on sex or age (n=371), or male (n=248). Accordingly, data of 52,506 women until December 2017 were analyzed. SNBPC was defined as a newly diagnosed SNBPC that occurred 5 years or more after IBC diagnosis. @*Results@#The median follow-up time of all patients was 12.13 years. SNBPC was developed in 3,084 (5.87%) women after a median of 7.61 years following IBC diagnosis. The 10-year incidence of SNBPC was 5.78% (95% confidence interval [CI], 5.56 to 6.00). Higher SNBPC incidence was found in survivors with the following factors: old age at IBC diagnosis, low household income, and receiving combined chemotherapy with endocrine therapy, whereas receiving radiotherapy was related to a lower incidence of SNBPC (hazard ratio, 0.89; p < 0.01). Among the patients with SNBPC, the 5-year survival rate was 62.28% (95% CI, 65.53 to 69.02). @*Conclusion@#Approximately 5% of breast cancer survivors developed SNBPC within 10 years after IBC diagnosis. The risk of SNBPC was associated with patient’s age at IBC diagnosis, income level, and a receipt of systemic treatments.

Comparison of Single Incision Endoscopic Nipple-Sparing Mastectomy and Conventional NippleSparing Mastectomy for Breast Cancer Based on Initial Experience / 한국유방암학회지

Purpose@#Endoscopic breast surgery for patients with breast cancer was introduced for its superior cosmetic outcomes; it was initially studied in the field of breast-conserving surgery and, more recently, in robotic-assisted nipple-sparing mastectomy (NSM). The main purpose of this study was to investigate the feasibility and safety of endoscopic NSM (E-NSM) in patients with breast cancer by comparing E-NSM and conventional NSM (C-NSM). @*Methods@#Between May 2017 and October 2020, we retrieved the records of 45 patients who underwent NSM with permanent silicone implants and divided them into the E-NSM group (20 patients) and the C-NSM group (25 patients), depending on the use of the endoscopic device.We also analyzed demographic information, pathology, operative time, and complications. @*Results@#No significant differences were observed between the 2 groups based on demographic information, postoperative pathological data, mean length of hospital stay, and total number of complications. The mean preparation time for surgery was comparable between both groups. Compared to the C-NSM group, the E-NSM group had a significantly longer mean operative time and, subsequently, a significantly longer mean total operative time and number of complications. @*Conclusion@#The results showed that E-NSM was feasible and safe with a more inconspicuous incision in patients with breast cancer.

Comparison of Single Incision Endoscopic Nipple-Sparing Mastectomy and Conventional NippleSparing Mastectomy for Breast Cancer Based on Initial Experience / 한국유방암학회지

Purpose@#Endoscopic breast surgery for patients with breast cancer was introduced for its superior cosmetic outcomes; it was initially studied in the field of breast-conserving surgery and, more recently, in robotic-assisted nipple-sparing mastectomy (NSM). The main purpose of this study was to investigate the feasibility and safety of endoscopic NSM (E-NSM) in patients with breast cancer by comparing E-NSM and conventional NSM (C-NSM). @*Methods@#Between May 2017 and October 2020, we retrieved the records of 45 patients who underwent NSM with permanent silicone implants and divided them into the E-NSM group (20 patients) and the C-NSM group (25 patients), depending on the use of the endoscopic device.We also analyzed demographic information, pathology, operative time, and complications. @*Results@#No significant differences were observed between the 2 groups based on demographic information, postoperative pathological data, mean length of hospital stay, and total number of complications. The mean preparation time for surgery was comparable between both groups. Compared to the C-NSM group, the E-NSM group had a significantly longer mean operative time and, subsequently, a significantly longer mean total operative time and number of complications. @*Conclusion@#The results showed that E-NSM was feasible and safe with a more inconspicuous incision in patients with breast cancer.

The Practice Patterns and Perceptions of Korean Surgeons Regarding Margin Status after Breast-Conserving Surgery / 한국유방암학회지

Two consecutive surveys for breast surgeons in Korea were conducted to comprehend the practice patterns and perceptions on margin status after breast-conserving surgery. The surveys were conducted online in 2014 (initial) and 2016 (follow-up). A total of 126 and 88 responses were obtained in the initial and follow-up survey, respectively. More than 80% of the respondents replied to routinely apply frozen section biopsy for intraoperative margin assessment in both surveys. Re-excision recommendations of the margin for invasive cancer significantly changed from a close margin to a positive margin over time (p=0.033). Most of the respondents (73.8%) defined a negative margin as “no ink on tumor” in invasive cancer, whereas more diverse responses were observed in ductal carcinoma in situ cases. The influence of guideline establishment for negative margins has been identified. A high uptake rate of intraoperative frozen section biopsy was noted and routine use needs reconsideration.

Minimally invasive parathyroidectomy with or without intraoperative parathyroid hormone for primary hyperparathyroidism

PURPOSE: The improvement of intraoperative parathyroid hormone (IOPTH) assay and localization studies has enabled a minimally invasive parathyroidectomy (MIP) in primary hyperparathyroidism (pHPT). The aim of this study is to analyze the demographics, clinical presentations, and surgical outcomes of the pHPT patients who received surgical management with versus without IOPTH. METHODS: Analysis of a database was performed on 53 patients who underwent parathyroidectomy for pHPT from 2004 to 2013. Preoperative localization was done by both sestamibi scan and ultrasonography. We divided the patients into two groups (without IOPTH versus with IOPTH) and analyzed the surgical outcomes statistically between two groups. RESULTS: The concordance rate of Technetium 99m sestamibi scan and ultrasonography was 73.6% and 90.6%, respectively. The overall cure rate of group 1 (without IOPTH) was 94.9% and that of group 2 (with IOPTH) was 100%. The decline of PTH at postoperative 5 minutes and 10 minutes was 75.2% +/- 14.9% and 84.9% +/- 8.6% in cured patients. On the other hand, that of noncured patients at 5 minutes and 10 minutes was 17.2% +/- 9.7% and 8.2% +/- 2.2%. There was a significant difference in the drop rate of IOPTH between cured and persistent patients (P < 0.01). Pathological examination showed adenoma in 41 of 53 patients (77.4%) and hyperplasia in 10 of 53 patients (18.9%). CONCLUSION: Even though the localization studies were successful, IOPTH monitoring is essential to avoid a surgical failure in MIP.

Achievement of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative: recommended serum calcium, phosphate and parathyroid hormone values with parathyroidectomy in patients with secondary hyperparathyroidism / 대한외과학회지

PURPOSE: The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI) 2003 has established guidelines for the treatment of secondary hyperparathyroidism (SHPT) in patients with chronic kidney disease - minerals and bone disorder (CKD-MBD). This study evaluated parathyroidectomy in SHPT patients for the achievement of the NKF-K/DOQI-recommended values of serum calcium, phosphate, and parathyroid hormone (PTH). METHODS: Between January 2005 and December 2010, parathyroidectomy was performed as recommended by the NKF-K/DOQI guidelines in 81 patients with SHPT and CKD-MBD. Serum PTH, calcium, and phosphate levels were measured prior to and 6, 12, 36, and 60 months after parathyroidectomy. RESULTS: Calcium, phosphate, and PTH levels dropped shortly after parathyroidectomy; however, a slight increase showed in the long term. Calcium levels increased for up to 60 months. Phosphate and PTH levels increased for up to 36 months but tended to decrease slightly at 60 months. The mean values were within the target ranges, except for PTH at 36 months. The target parameters of serum phosphate (42.9-61.1% of patients) and serum calcium (a peak of 61.1% of patients at 36 months, but only 28.6% at 60 months) were achieved the most. Less than 34% of patients achieved the recommended range for PTH. CONCLUSION: Parathyroidectomy was not an optimal procedure for achieving all the biochemical parameters recommended by the NKF-K/DOQI. Although it was helpful in attaining the recommended values for serum calcium and phosphate in SHPT patients resistant to medical therapy, the PTH levels did not fall within the recommended range.

D2-40, Podoplanin, and CD31 as a Prognostic Predictor in Invasive Ductal Carcinomas of the Breast / 한국유방암학회지

PURPOSE: Distant metastasis and recurrence are major prognostic factors associated with breast cancer. Both lymphovascular invasion (LVI) and blood vessel invasion (BVI) are important routes for metastasis to regional lymph nodes and for systemic metastasis. Despite the importance of vascular invasion as a prognostic factor, application of vascular invasion as a histopathological criterion is controversial. The aim of this study was to distinguish LVI from BVI in prognosis and recurrence of breast cancer using an endothelial subtype specific immunohistochemical stain (podoplanin, D2-40, and CD31). METHODS: Sections from 80 paraffin-embedded archival specimens of invasive breast cancer were stained for podoplanin, D2-40, or CD31 expression. Immunohistochemical staining results were correlated with clinicopathological features, such as tumor size, status of lymph node metastases, estrogen receptor status, progesterone receptor status, human epidermal growth factor receptor-2 expression, and recurrence. Patients with ductal carcinoma in situ and stage IV breast cancer were excluded. RESULTS: A significant correlation was found between D2-40 LVI positivity and lymph node metastasis (p=0.022). We found a significant correlation between D2-40 LVI positivity and recurrence of breast cancer (p=0.014). However, no significant correlation was found between BVI and recurrence. A poorer disease free survival was shown for D2-40 positive LVI (p=0.003). In a multivariate analysis, the presence of D2-40 LVI positivity revealed a significant association with decreased disease-free survival. CONCLUSION: D2-40 LVI positivity was a more prognostic predictor of breast cancer than BVI.

Correlation between COX-2 Expression and Hormone Receptors in Invasive Ductal Breast Cancer

PURPOSE: COX-2 is known to be elevated in breast cancer, but the clinical relevance is still a matter of debate. The purpose of this study was to determine the prognostic significance and relationship of COX-2 to hormone receptors. METHODS: Between January 2005 and February 2007, 80 specimens from breast cancer patients at Korea University Anam Hospital were reviewed by one pathologist. COX-2 was analyzed as overexpressed if >10% of the cells were stained. Clinical characteristics, hormone receptor status, and other prognostic factors were investigated to determine their association with COX-2 expression. RESULTS: COX-2 was overexpressed in 12 patients (15%). Two patients had locoregional recurrence, eight patients had systemic metastasis, and one patient died. There was no statistically significant correlation between COX-2 expression and age, size, nodal status, histological grade, hormone receptor status, and HER-2/neu positivity. Among tumors that had a positive expression of ER and PR, COX-2 expression was related to larger size (P-value 0.001 and 0.009, respectively) and nodal status (P-value 0.048 and 0.009, respectively). However, there was no statistically significant correlation with tumors that had negative ER or PR expression. CONCLUSION: This study suggests that in breast cancer, COX-2 expression has no relationship with clinicopathologic factors; however, a correlation was noted in size and nodal status for ER- and PR-positive tumors. Further prospective study with larger population to clarify the relationship between COX-2 expression and hormone receptor status is necessary.

Preoperative Thyroid-stimulating Hormone Levels as a Predictor of Thyroid Carcinoma / 대한내분비외과학회지

PURPOSE: This study investigated the effects of serum thyroid-stimulating hormone (TSH) levels in predicting malignancy-associated differentiated thyroid cancer (DTC) and benign thyroid nodules. METHODS: Between January 2005 and December 2007, 346 patients underwent thyroid surgery at one hospital. Their records were retrospectively reviewed. RESULTS: Sixty-nine percent (237 of 346) of the patients had DTC. The mean preoperative TSH level was higher than in the malignant group (5 uIU/ml vs 0.4 uIU/ml). The rate of malignancy was the 71% in patients with TSH levels >5 uIU/ml. The TSH level of DTC with metastasis of the lymph node was higher than that with non-metastasis (3.08 uIU/ml vs 2.09 uIU/ml, P<0.01) CONCLUSION: The likelihood of DTC increases with higher serum TSH concentration. Serum TSH level might be useful in predicting malignant nodular thyroid lesion.

Phosphorylated Akt and Phosphorylated mTOR Expression in Breast Invasive Carcinomas: Analysis of 530 Cases / 한국유방암학회지

PURPOSE: The phosphatidylinositol 3-kinase (PI3K)/Akt/mammalian target of rapamycin (mTOR) pathway has a central role in regulation of cell proliferation, differentiation, motility and survival. This pathway has recently generated great interest because its elements are, potentially, novel targets for the treatment of various malignancies, including breast cancer. METHODS: Using tissue microarray sections of breast carcinoma, we performed immunohistochemical studies using antibodies against the phosphorylated forms of Akt (p-Akt) and mTOR (p-mTOR) in 530 invasive breast carcinomas and 30 ductal carcinomas in situ (DCIS). We investigated possible associations between expression of these proteins and clinicopathologic characteristics and disease outcomes. RESULTS: In 530 invasive carcinomas, weak and strong expression of p-Akt was observed in 180 (34.0%) and 288 (54.3%) cases, respectively. The expression of p-Akt was associated with expression of estrogen receptors (ER) (p=0.045), progesterone receptors (PR) (p=0.003), lymph node metastasis (p<0.001) and cancer stage (p=0.027). Weak and strong expression of p-mTOR was found in 136 (25.7%) and 207 (39.1%) cases, respectively. The mTOR pathway was more frequently activated in DCIS than in invasive breast carcinoma (p=0.001). p-mTOR expression was associated with expression of ER (p=0.040), PR (p=0.009), tumor size (p<0.001), and stage (p=0.002). In a univariate analysis, strong expression of p-Akt was associated with longer disease-free survival (DFS). In a multivariate analysis, neither p-Akt nor p-mTOR was associated with DFS. CONCLUSION: The PI3K/Akt/mTOR pathway is active in DCIS as well as in invasive carcinoma of the breast. Our study also suggests that the PI3K/Akt/mTOR pathway is influenced by ER rather than erbB-2, and that this pathway may contribute more to cancer pathogenesis in ER-positive tumors.

Immunologic Response to Mistletoe Extract (Viscum album L.) after Conventional Treatment in Patients with Operable Breast Cancer / 한국유방암학회지

PURPOSE: To reduce the side effects and improve the effectiveness of standard chemoradiation therapy, many complementary or alternative medicines have been tried. However, little is known about its immunologic effects in breast cancer patients. The aim of this study was to assess the immunologic effects of mistletoe extract (Viscum album L., VAE) in patients with early breast cancer after surgery followed by standard adjuvant chemoradiation therapy. METHODS: A total 20 patients with early breast cancer treated with breast conserving surgery followed conventional chemoradiation therapy. Ten of these patients received subcutaneous injections of VAE for 7 weeks. IL-2, IL-4, IL-6, IL-10, TGF-beta, and IFN-gamma levels in serum samples were measured in all patients. RESULTS: The concentrations of IL-2, IL-4, IL-10, and TGF-beta were not significantly changed between before and after VAE treatment in both test and control group. The concentration of IL-6 in the test group was increased from 8.19+/-1.75 pg/mL to 9.86+/-1.46 pg/mL after treatment (p=0.013). The concentration of IFN-gamma in the test group was remarkably increased from 91.76+/-17.16 pg/mL to 167.42+/-66.61 pg/mL after treatment (p=0.009). CONCLUSION: Significant increases in the concentration of IL-6 and IFN-gamma were observed after VAE treatment. These results suggest that VAE treatment can stimulate immune responses, especially cell-mediated immunity in immune-compromised patients received the chemoradiation for breast cancer.

Predictive Factors and Survival Rate for Brain Metastasis from Breast Cancer / 한국유방암학회지

PURPOSE: The incidence of symptomatic brain metastases from breast cancerhas ranged from 10% to 16%. Brain metastases are traditionally viewed as a late complication of systemic disease, for which few effective treatment options exist. The aim of this study was to evaluate the factors that can predict brain metastases and to analyze the survival rate as compared with other systemic metastases. METHODS: Between February 1983 and October 2005, 119 patient who developed systemic metastasis during the follow up period after optimal surgical treatment at Korea University Hospital were included in this study. Twenty-nine of these 119 patients had complaints of symptoms and they were consequently diagnosed as having brain metastases. RESULTS: Estrogen receptor (-), progesterone receptor (-) and Her2 (-), and Triple negative were a significantly higher in the patients with brain metastases (p=0.04). The other clinicopathologic factors showed no difference between the patients with brain metastases and the patients without brain metastases. Lung metastases existed previously more often than the other systemic metastases (p=0.04). The overall survival of the patients with brain metastases was not significantly different from the patients with other systemic metastases. However, the disease specific survival of patients with brain metastases, as compared with other systemic metastases was poorer than that for patients with bone and lung metastases, respectively (p=0.01 and 0.03). A poor prognosis was shown for the cases with brain metastases within 1 yr after operation. CONCLUSION: Clinician should give attention to the possibility of brain metastases for the breast cancer patients with triple negative findings or the patients who have developed lung metastases as this represents a symptom of central nervous system.

A Recurrence of Ovarian Carcinoma Presenting as Only Axillary Lymphatic Metastasis: A Case Report / 한국유방암학회지

Ovarian carcinoma usually metastasizes to the peritoneal cavity and the regional lymph nodes. While the peritoneal metastases if often widespread, metastases beyond the peritoneal cavity including axillary lymph nodes are uncommon. A recurrence of ovarian carcinoma in only the axillary lymph node is also a rare case. We report here on an axillary lymphatic metastasis as a result of recurrence of ovarian carcinoma in a 43-yr-old woman. Six years after the initial operation for ovarian carcinoma, multiple lymphatic metastases in the right axilla were noted as a palpable axillary masses. There are few previous reports about ovarian carcinoma that metastatized to the axillary lymph nodes. It must be differentiated from breast carcinoma because the treatment and prognosis of metastatic ovarian carcinoma differ from those of primary breast carcinoma.

Analysis of Sentinel Lymph Node Biopsy in 500 Cases with Breast Cancer

PURPOSE: Sentinel lymph node biopsy has emerged as a new standard method of treatment in small-sized breast cancer and has allowed the elimination of unnecessary axillary lymph node dissection in patients with negative axillary lymph nodes metastasis. In sentinel lymph node biopsy, pathologic analysis can be scrutinized and accurate stage-diagnosis can be made with the methods of serial sectioning and immunohistochemical staining on routine basis. In this study, we tried to evaluate the accuracy of sentinel lymph node biopsy. METHODS: We evaluated 500 cases of sentinel lymph node biopsy operated at Samsung Medical Center between October 1995 and February 2004. Cases were categorized in 2 groups: cases operated during the period of learning curve (October 1995~December 1999) and the period of clinical application (January 2000~February 2004). RESULTS: Overall failure rate and false negative rate of sentinel node biopsy were 9% and 14.7% respectively. The failure rate of the period of learning curve and the period of clinical application were 15.3% and 5.6% respectively (P <0.01). In sentinel lymph node detection, combined blue dye and radioisotope method was superior to blue dye or radioisotope method. About 40% of lymph node metastases were found in patients with tumors more than 2 cm in size. Clinical findings including previous biopsy, multiple tumor, neo- adjuvant chemotherapy, obesity and old age were not absolute contraindications for sentinel node biopsy. CONCLUSION: Sentinel lymph node biopsy can be an accurate and reliable method to examine the status of axillary nodes in a small breast cancer.

S-phase Fraction as an Independent Prognostic Factor in Invasive Breast Carcinoma -A Study of Long-term Follow-up / 한국유방암학회지

PURPOSE: To evaluate the significance of the S-phase fraction (SPF) and DNA ploidy, determined by DNA flow cytometry, as prognostic markers in invasive breast cancer. METHODS: Between October 1986 and June 1999, 143 breast carcinoma patients, treated by surgery, were analyzed. Flow cytometry was performed for the identification of the SPF and DNA ploidy, with immunohistochemistry performed on paraffin embedded material for the hormone receptor. Two SPF classes were defined on the basis of the median value (10) by using a log rank test (high SPF>10, low SPF<10). The correlation between SPF and the clinicopathological factors (tumor size, lymph node status, histological grade and steroid receptor status) and between the SPF and 5 yr disease-free survival (DFS) were investigated. RESULTS: DNA ploidy was not associated with tumor size, lymph node status, histological grade, overall survival and DFS. In a univariate analysis, high SPF values were associated with shorter 5 yr DFS in individual groups. In the node negative group, the 5 yr DFS of the low SPF group was higher than that of the high SPF group, but in the node positive group, the SPF values showed statistical significance with the 5 yr DFS. In a multivariate analysis, the SPF was independently associated with the 5 yr DFS in the node negative group. CONCLUSION: These results suggested the SPF is an independent prognostic factor in lymph node negative, estrogen receptor positive and progesterone receptor negative breast cancers.

The Significance of bcl-2 and P53 Expressions in the Papillary Thyroid Cancer / 대한내분비외과학회지

PURPOSE: Papillary thyroid cancer (PTC) has a good prognosis, and it's known to be related to the apoptosis of papillary thyroid cancer. The expression of bcl-2 is thought to be associated with the inhibition of apoptosis. We evaluated the differences of bcl-2 and P53 between PTC and the control (normal tissue and benign lesion). We then analyzed the correlation between the bcl-2 and P53 expressions and the classic prognostic factors. METHODS: Between January 2001 and December 2005, 30 patients who underwent total thyroidectomy for the PTC were included in this study and immunohistochemical staining was performed on the tumors. RESULTS: bcl-2 was expressed in 18 cases (60%) in their PTC (P<0.05). The expression of P53 was not significantly related with the clinicopathological factors, but P53 was expressed in 9 cases (30%) of PTC (P<0.05). The positive staining for was noted in 18 cases (62.1%) of the PTC tissue among the 30 patients, and as the TNM stage progresses, the expression rate of was significantly decrease for 7 stage I cases (100%), for 4 stage ll cases (80%) and for 7 stage ll cases (38.9%). CONCLUSION: bcl-2 was expressed more as the TNM stage of PTC decreases. So bcl-2 is possibly useful as a prognostic factor for PTC, but further studies are needed for confirming its significance.

Prediction of additional axillary metastasis of breast cancer with positive sentinel lymph nodes / 한국유방암학회지

PURPOSE: Axillary lymph node dissection in breast cancer patients with positive sentinel lymph node (SLN) is accepted as a routine procedure. In a significant proportion of women with breast cancer, the SLN is the sole site of regional metastasis. These patients would not be expected to benefit from complete lymph node dissection. The purpose of this study is to determine which factors are associated with additional positive lymph nodes in the axilla of patients who have positive sentinel lymph nodes. METHODS: Between September 2001 and May 2005, we examined 135 cases where the patients underwent a breast conserving operation and a SLN biopsy. There were 34 patients with positive SLN. Univariate analysis was used to identify the clinicopathologic features in the SLN positive patients that can predict metastasis in the nonsentinel lymph nodes (NSLNs). RESULTS: Fifteen patients (44.1%) had metastasis in the NSLNs. There were significant differences in the location of tumors (p=0.018), the nodal status of each patient (p=0.001) and c-erbB2 protein expression (p =0.017) in NSLN metastasis as determined by univariate analysis. CONCLUSION: The location of the breast cancer, nodal status and c-erbB2 expression are of predictive value for NSLN involvement. We suggest that a full axillary lymph node dissection may be considered as a sparing treatment in these situations.

Evaluation of Perioperative Serum Parathyroid Hormone Levels in Predicting Post-thyroidectomy Hypocalcemia

PURPOSE: Postoperative hypocalcemia is one of the most common complications in patients who undergo a bilateral thyroid resection and can prolong hospital stay. However, there is no reliable predictor of clinical hypocalcemia after a thyroidectomy. The aim of this study was to identify the clinical predictors of hypocalcemia after a thyroidectomy and to determine if the perioperative measurements of iPTH would be helpful in identifying patients at risk of post-thyroidectomy hypocalcemia. METHODS: 213 consecutive patients undergoing thyroidectomy between Nov 2004 and Feb 2005 were examined. The iPTH, serum calcium and ionized calcium levels were measured at 6 hours, 1 day and 2 weeks after surgery, respectively. All the patients were divided into the lower PTH group (<10 pg/ml) and normal PTH group according to the level of iPTH measured at 6 hours after surgery. RESULTS: The lower PTH group comprised 33% of all patients: 39% after the total thyroidectomy and 11% after a less than total thyroidectomy. The incidence of IV calcium replacement was 36% in the lower PTH group compared with 13% in the normal PTH group. Hypocalcemia and a lowered PTH level occurred more frequently in patients who underwent surgery for a malignant tumor than for a benign tumor. CONCLUSION: There was a correlation between the level of ionized calcium and the incidence of calcium replacement and with the 6 hr-later iPTH level. Therefore, a iPTH leve

Application of the Alvarado Score to the Diagnosis of Acute Appendicitis

PURPOSE: The purpose of this study is to confirm the clinical usefulness of the Alvarado score's application and the differences in diagnostic values between male and female for patients who were diagnosed with acute appendicitis when they came to the hospital for pain in the right lower abdomen. METHODS: The subjects of this study were 211 patients who entered the surgical department of this hospital for doubtful acute appendicitis from June 2003 to May 2005. Using a retrospective method, we examined the patients' records and compared their ages, sex, symptoms, preoperative physical examinations, leukocyte and neutrophils figures, and the final postoperative pathological diagnosis. RESULTS: One hundred twelve patients were male, and 99 were female. A clinical Alvarado score of above 7 in sensitivity, specificity, positive predictive value, and negative predictive value was the standard for being judged positive. In this study, the sensitivity of the Alvarado score was 86.2%, its specificity was 61.6%, and the accuracy of diagnosis was 82.9%. The positive predictive value was 92.6%, and the negative predictive value was 51.0%. The accuracies were 83.9% and 81.8%, respectively, that for males being a little higher than that for female, but with no statistically significant differences. CONCLUSIONS: This study showed that the diagnosis of acute appendicitis was highly accurate for an Alvarado score above 7 (82.9%). The diagnosis of acute appendicitis by using the Alvarado score is simple, fast, reliable, and repeatable, and it can be used under any conditions without other expensive and complicated diagnostic tools.

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.