The Clinical Significance of Minimal Extrathyroid Extension in Patients with Papillary Thyroid Microcarcinoma / 대한내분비외과학회지

PURPOSE: The prognosis of papillary thyroid carcinoma is determined by such risk factors as old age, male gender, a large tumor size and extrathyroid extension. The aim of this study was to investigate the value of extrathyroid extension for the recurrence of papillary microcarcinoma and its association with the risk factors for papillary thyroid carcinoma. METHODS: We retrospectively studied 167 patients with papillary microcarcinoma and who underwent thyroidectomy from Feb. 2003 to Dec. 2008. Papillary microcarcinoma (PTMC) was defined as a tumor smaller than 1 cm and an extrathyroid extension was identified by the pathological findings. Age, gender, extrathyroid extensions, the operative methods, lymph node metastasis and the MACIS score were analyzed by the appropriate statistical methods. RESULTS: Patients with PTMC showed a lower MACIS score, fewer lymph node metastasis and less extrathyroid extension, as compared to the patients with papillary thyroid carcinoma. Total thyroidectomy and selective lymph node dissection were less frequently done in the patients suffering with PTMC. Analysis of the risk factors showed that PTMC had a close relationship with lymph node metastasis, the extent of surgery and multifocal cancer. The disease free survival rate of the patients with PTMC was statistically related with lymph node metastasis, but not with an extrathyroid extension (P=0.001). CONCLUSION: The patients with PTMC showed less lymph node metastasis and extrathyroid extension as compared to the patients with PTC. Lymph node metastasis of PTMC is an independent factor for disease free survival, but minimal extrathyroid extension is not related with recurrence. PTMC with lymph node metastasis should be regarded as an aggressive large tumor and lymph node dissection should be done.

Application Patterns of Sentinel Lymph Node Biopsy in Korean Breast Cancers / 한국유방암학회지

PURPOSE: The sentinel lymph node biopsy (SLNB) has revolutionized the management of breast cancer. Since October 1995, when we first applied the SLNB for treatment of breast cancer, it has quickly become the standard of care for the management of breast cancer in Korea. Herein we provide preliminary nation-wide data on the use of SLNB. METHODS: 51 breast surgeons at 47 hospitals throughout Korea were surveyed and 33 breast surgeons answered. Questionnaires including 20 items were used to solicit information on the indications, methods, application patterns of SLNB, including the other surgical issues. The answers from 33 breast surgeons were used for the analysis. RESULTS: Twenty-six of the 33 surgeons were applying SLNB for breast cancer. 11 surgeons have been applying SLNB more than 2 years. The most common indications for the SLNB were (1) no suggested axillary lymph node metastasis and (2) tumor size less than 3 cm. According to the detection methods, radioisotope tracer only was used in 38.5%, dye only in 26.9% and combination of radioisotope trace with dye in 34.6%. The most preferred dye was isosulfan blue followed by methylene blue. The most preferred radioisotope tracers were 99mTc-tin colloid and 99mTc-antimony. The most favorable injection site was subareolar area. Most surgeons performed frozen section biopsies after SLNB. Many surgeons agreed to accreditation after 20 learning cases. CONCLUSION: SLNB becomes the standard of treatments for breast cancer in Korea. A systematic education program for SLNB is required.

Effect of Vaginal Delivery on Perineal Descent and Pudendal Nerve Terminal Motor Latency

PURPOSE: Significant associations between perineal descent (PD) and pudendal nerve terminal motor latency (PNTML) have previously been described in patients with fecal incontinence. This had led to the hypothesis that pelvic floor muscle and nerve injury initiated by childbirth might progress and cause fecal incontinence. Purpose: This study was undertaken to evaluate the association between vaginal delivery and PD, PNTML. Also, we evaluated the correlation between PD and PNTML. Methods: Sixty one women who visited the Dept. of Surgery from Aug. 1998 to May. 1999 were randomly selected. Women were excluded, who had chronic constipation,operation within 6 months before the investigation, anal trauma, diabetes mellitus, and neurologic disease. They had a mean year of 43 12.5 years (range: 23~70), a mean vaginal delivery 1.9 1.5 (range: 0~6). PD at rest and during push, and PNTML were measured. Results: PD during push (p=0.006) and the change of PD between at rest and during push (p=0.003) were significantly increased with increasing number of vaginal deliveries. Rt PNTML (p=0.08) and Lt PNTML (p=0.03) were significantly increased with increasing number of vaginal deliveries. There was correlation between Lt PNTML and change of PD (r=0.59, p=0.0). Conclusions: PD and Lt PNTML was increased with repeated vaginal deliveries. Our findings support the hypothesis that damage induced by vaginal delivery to pudendal nerve and pelvic floor will progress.