Impacts of Subtype on Clinical Feature and Outcome of Male Breast Cancer: Multicenter Study in Korea (KCSG BR16-09) / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#The treatment of male breast cancer (MBC) has been extrapolated from female breast cancer (FBC) because of its rarity despite their different clinicopathologic characteristics. We aimed to investigate the distribution of intrinsic subtypes based on immunohistochemistry, their clinical impact, and treatment pattern in clinical practice through a multicenter study in Korea. @*Materials and Methods@#We retrospectively analyzed clinical data of 248 MBC patients from 18 institutions across the country from January 1995 to July 2016. @*Results@#The median age of MBC patients was 63 years (range, 25 to 102 years). Among 148 intrinsic subtype classified patients, 61 (41.2%), 44 (29.7%), 29 (19.5%), and 14 (9.5%) were luminal A, luminal B, human epidermal growth factor receptor 2, and triple-negative breast cancer, respectively. Luminal A subtype showed trends for superior survival compared to other subtypes. Most hormone receptor-positive patients (166 patients, 82.6%) received adjuvant endocrine treatment. Five-year completion of adjuvant endocrine treatment was associated with superior disease-free survival (DFS) in patients classified with an intrinsic subtype (hazard ratio [HR], 0.15; 95% confidence interval [CI], 0.04 to 0.49; p=0.002) and in all patients (HR, 0.16; 95% CI, 0.05 to 0.54; p=0.003). @*Conclusion@#Distribution of subtypes of MBC was similar to FBC and luminal type A was most common. Overall survival tended to be improved for luminal A subtype, although there was no statistical significance. Completion of adjuvant endocrine treatment was associated with prolonged DFS in intrinsic subtype classified patients. MBC patients tended to receive less treatment. MBC patients should receive standard treatment according to guidelines as FBC patients.

Prediction of Oncotype DX Recurrence Score Using Clinicopathological Variables in Estrogen Receptor-Positive/ Human Epidermal Growth Factor Receptor 2-Negative Breast Cancer / 한국유방암학회지

Purpose@#Oncotype DX (ODX) is a well-validated multigene assay that is increasingly used in Korean clinical practice. This study aimed to develop a clinicopathological prediction (CPP) model for the ODX recurrence scores (RSs). @*Methods@#A total of 297 patients (study group, n = 175; external validation group, n = 122) with estrogen receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative, T1-3N0-1M0 breast cancer, and available ODX test results were included in the study. Risk categorization as determined by ODX RSs concurred with the TAILORx study (low-risk, RS ≤ 25; high-risk, RS > 25). Univariate and multivariate logistic regression analyses were used to assess the relationships between clinicopathological variables and risk stratified by the ODX RSs. A CPP model was constructed based on regression coefficients (β values) for clinicopathological variables significant by multivariate regression analysis. @*Results@#Progesterone receptor (PR) negativity, high Ki-67 index, and nuclear grade (NG) 3 independently predicted high-risk RS, and these variables were used to construct the CPP model. The C-index, which represented the discriminatory ability of our CPP model for predicting a high-risk RS, was 0.915 (95% confidence interval [CI], 0.859–0.971). When the CPP model was applied to the external validation group, the C-index was 0.926 (95% CI, 0.873–0.978). @*Conclusion@#Our CPP model based on PR, Ki-67 index, and NG could aid in the selection of patients with breast cancer requiring an ODX test.

Comparison of the prevalence and histology between primary benign bladder tumors and recurrent benign lesions after transurethral resection of malignant bladder tumors / 고신대학교의과대학학술지

Background@#Benign bladder tumors are rare disease entities, and insufficient studies have assessed their epidemiological characteristics. The authors investigated the prevalence of benign bladder tumors by retrospectively investigating pathology reports of transurethral resection of bladder tumor (TURBT) procedures over the past 20 years. @*Methods@#We analyzed 1,674 pathology reports of TURBT conducted in 1,160 patients from January 1, 2000, to April 30, 2022. The prevalence of benign tumors and histological classification according to the presence of primary (group 1) and recurrent (group 2) bladder lesions were retrospectively investigated. @*Results@#The mean age of patients was 65.2±11.5 years, and 1,284 cases (79.1%) were in men. Benign bladder tumors comprised 278 cases (248 patients) accounting for about 17.1% of the total TURBT cases (278/1,624). Furthermore, 184 patients (16.0%, 184/1,147) belonged to group 1 and 78 patients (27.4%, 78/285) belonged to group 2. Among all benign lesions that underwent TURBT, cystitis was the most common (41.0%, 114/278), and this rate was higher in group 2 (64/184 [34.8%] vs. 50/94 [53.2%], p<0.001). The prevalence of non-neoplastic lesions was higher in group 1 (44/184 [23.9] vs. 11/94 [11.7%], p<0.001). There was no difference in the prevalence of noninvasive urothelial neoplasms between the two groups (22/184 [12.0%] vs. 8/94 [8.5%], p=0.86). @*Conclusions@#The probability of benign lesions in TURBT was 17.1%, among which cystitis was the most common. When TURBT was performed for recurrent lesions, the frequency of benign tumors was higher than that of primary benign bladder tumors.

Evaluation of Tumor Elasticity and Clinicopathologic Factors Affecting Neoadjuvant Chemotherapy Response in Patients with Breast Cancer

Purpose@#This study aimed to determine the clinicopathologic factors, including tumor elasticity, affecting neoadjuvant chemotherapy response in breast cancer. @*Methods@#Among 95 patients who received neoadjuvant chemotherapy for clinical stage IIa-IIIc primary breast cancer, 75 underwent strain elastography assessments. The patients were divided into soft and hard tumor groups based on the Tsukuba elasticity scoring system. Pathologic factors, including tumor cellularity and stromal characteristics, were evaluated using core needle biopsy specimens collected before neoadjuvant chemotherapy. Pathologic complete response (pCR) was defined as the absence of invasive carcinoma in the breast and axillary lymph nodes. Residual cancer burden (RCB) was also calculated in 79 cases. @*Results@#Twenty-two patients achieved pCR (23.2%). The rates of estrogen receptor (ER) negativity (p=0.04), progesterone receptor (PR) negativity (p=0.03), and nuclear grade 3 (p=0.03) were higher in patients with pCR than those in patients without pCR. The rates of PR negativity (p=0.03), nuclear grade 3 (p=0.01), and high tumor-infiltrating lymphocyte (TIL) levels (p=0.04) were significantly higher in the favorable RCB group (RCB-0 and I) than those in the unfavorable RCB group (RCB-II and III). No significant difference in tumor elasticity was observed between the groups (p=0.30). Hormone receptor (HR) negativity was an independent predictor of favorable RCB in the multivariate analysis (p=0.04). @*Conclusion@#Tumor elasticity was not associated with pCR or RCB. HR negativity was an independent predictor of favorable RCB.

Evaluation of Tumor Elasticity and Clinicopathologic Factors Affecting Neoadjuvant Chemotherapy Response in Patients with Breast Cancer

Purpose@#This study aimed to determine the clinicopathologic factors, including tumor elasticity, affecting neoadjuvant chemotherapy response in breast cancer. @*Methods@#Among 95 patients who received neoadjuvant chemotherapy for clinical stage IIa-IIIc primary breast cancer, 75 underwent strain elastography assessments. The patients were divided into soft and hard tumor groups based on the Tsukuba elasticity scoring system. Pathologic factors, including tumor cellularity and stromal characteristics, were evaluated using core needle biopsy specimens collected before neoadjuvant chemotherapy. Pathologic complete response (pCR) was defined as the absence of invasive carcinoma in the breast and axillary lymph nodes. Residual cancer burden (RCB) was also calculated in 79 cases. @*Results@#Twenty-two patients achieved pCR (23.2%). The rates of estrogen receptor (ER) negativity (p=0.04), progesterone receptor (PR) negativity (p=0.03), and nuclear grade 3 (p=0.03) were higher in patients with pCR than those in patients without pCR. The rates of PR negativity (p=0.03), nuclear grade 3 (p=0.01), and high tumor-infiltrating lymphocyte (TIL) levels (p=0.04) were significantly higher in the favorable RCB group (RCB-0 and I) than those in the unfavorable RCB group (RCB-II and III). No significant difference in tumor elasticity was observed between the groups (p=0.30). Hormone receptor (HR) negativity was an independent predictor of favorable RCB in the multivariate analysis (p=0.04). @*Conclusion@#Tumor elasticity was not associated with pCR or RCB. HR negativity was an independent predictor of favorable RCB.

Annual Neck Ultrasonography Surveillance between 3 to 12 Years after Thyroid Lobectomy for Papillary Thyroid Microcarcinoma

Background and Objectives@#In South Korea, neck ultrasonography (US) has been used widely at 1- or 2-year intervals to detect recurrence after thyroidectomy. The aim of this study is to assess the prevalence and pattern of recurrence and to establish a proper frequency of follow-up neck US after thyroid lobectomy for papillary thyroid microcarcinoma (PTMC). @*Materials and Methods@#We retrospectively reviewed 262 consecutive patients who had undergone thyroid lobectomy for PTMC from January 2005 to October 2009. They were divided into two groups based on the presence of recurrence (240 patients in group 1 and 22 patients in group 2). The comparison between the two groups involved clinical and pathological characteristics. @*Results@#Recurrences were found in 22 (8.4%) of 262 patients with 132.5 months follow-up (range, 120-180 months). There was a significant difference in the mean number of follow-up neck US after 5 years postoperatively, shortened interval, total number of follow-up neck US (p=0.002, p＜0.001, p＜0.001). All recurrences were found between 2-3 to 11-12 years. Recurrences after 5 years were found in 16 (72.7%) of 22 patients. @*Conclusion@#Recurrence after thyroid lobectomy for PTMC occurred with various times during follow up. The minimum frequency of follow-up neck US was not enough for detecting tumor recurrence, especially after 5 years postoperatively. Our results suggest that annual neck US may be appropriate between 3 to 12 years after thyroid lobectomy for PTMC.

The effectiveness of prophylactic ipsilateral central neck dissection in selected patients who underwent total thyroidectomy for clinically node-negative unilateral papillary thyroid carcinoma / 영남의대학술지

Background@#Prophylactic central neck dissection (CND) in clinically node-negative (cN0) papillary thyroid carcinoma (PTC) remains controversial. The purpose of this study was to evaluate the benefits of prophylactic ipsilateral CND compared with bilateral CND in total thyroidectomy for cN0 unilateral PTC. @*Methods@#We retrospectively enrolled 174 patients who underwent total thyroidectomies with prophylactic CND for cN0 unilateral PTC between January 2009 and May 2010. The prophylactic CND patients were divided into group 1, the ipsilateral CND group (n=74), and group 2, the bilateral CND group (n=100). The incidence of central lymph node metastasis (CLNM) and postoperative complications, such as hypoparathyroidism, recurrent laryngeal nerve injury, and recurrence were assessed. @*Results@#CLNM was found in 22 (29.8%) in group 1 and 69 (69%) in group 2. The incidence of postoperative severe hypocalcemia less than 7.0 was also significantly different (six patients [8.1%] in group 1 and 23 [23%] in group 2; p=0.009). Permanent hypoparathyroidism was significantly more frequent in group 2 (4.1% vs. 19%; p=0.005). However, the incidence of transient hypoparathyroidism, recurrence, and recurrent laryngeal nerve injury was not significantly different. @*Conclusion@#Prophylactic ipsilateral CND has advantage not only to reduce incidence of some complications but also to have similar recurrence rate compared with bilateral CND. We suggest that prophylactic ipsilateral CND may be safe and effective for selected patients undergoing total thyroidectomy for cN0 unilateral PTC.

Postoperative Recurrent Bladder Tumors Detection by Narrow-Band Imaging Cystoscopy

Purpose@#We compared the effectiveness of narrow-band imaging (NBI) cystoscopy and white light cystoscopy (WLC) for detection of intravesical recurrence of bladder cancer. @*Materials and Methods@#We studied the positive predictive value (PPV) in the recurrent suspicious lesions in patients with nonmuscle invasive bladder cancer (NMIBC) for the 13 months of the follow-up from July 2016 to June 2017 with WLC and another 13 months from July 2017 to July 2018 with NBI, respectively. We also studied the second transurethral resection of bladder tumor (TURBT) free survival (STFS) and cancer-specific recurrence-free survival (CSRFS) with WLC and NBI in the 12 months of short-term follow-up. @*Results@#The total number of first TURBT patients in the follow-up was 164. Eighty patients were excluded. Among the 84 patients with NMIBC, WLC group was 43, NBI group was 41. Thirty-six patients had more than second TURBT. In 48 cases of patients with more than second TURBT, PPV of WLC and NBI was 81.8% and 61.5%, respectively. There was no statistically significance of PPV between the 2 groups (p=0.124). There were no pathological differences between the results about 1 year of follow-up patients with one of WLC or NBI (p=0.288). STFS was statistically significantly shorter in NBI (p=0.002), but there were no statistically significant difference in CSRFS. @*Conclusions@#NBI had made the bladder lesions detected early but had a low PPV for cancer recurrence within the bladder and there is no survival benefit.

Ipsilateral Breast Tumor Recurrence with Metachronous Contralateral Axillary Lymph Node Metastasis after Breast-Conserving Surgery with Axillary Lymph Node Dissection

Contralateral axillary lymph node metastasis (CAM) is classified into synchronous and metachronous CAM. It is considered a stage IV disease by American Joint Community on Cancer (AJCC) cancer staging system. Although ipsilateral breast tumor recurrence (IBTR) with metachronous CAM is rare, it can occur after previous axillary lymph node dissection (ALND) because of altered lymphatic drainage. Metachronous CAM might be a regional disease progression rather than a distant metastasis. Here, we present a case of IBTR with metachronous CAM. This patient was treated with curative intent. The management of CAM remains controversial.

Impact of the Updated Guidelines on Human Epidermal Growth Factor Receptor 2 (HER2) Testing in Breast Cancer / 한국유방암학회지

Purpose@#In 2007, the American Society of Clinical Oncology and the College of American Pathologists had established a human epidermal growth factor receptor 2 (HER2) testing guideline, which was updated in 2013 and subsequently in 2018. We assessed the clinical impact of the recent update by comparing the in situ hybridization (ISH) results based on the 2007, 2013, and 2018 guidelines. @*Methods@#We assessed 2 cohorts. The first cohort included 1,161 primary invasive breast cancer (IBC) samples including 18 bilateral IBC cases, with both immunohistochemistry (IHC) and silver-enhanced ISH (SISH) results available for the HER2 status. The second cohort included 160 IBC cases with equivocal HER2 IHC, assessed using SISH. We retrospectively evaluated and compared the HER2 SISH results. @*Results@#There were 22 (1.9%) and 20 (12.5%) cases with altered SISH results according to the 2013 guidelines in cohorts 1 and 2, respectively. As per the 2018 guidelines, final HER2 statuses of 16 (1.4%) and 14 (8.5%) cases changed in cohorts 1 and 2, respectively. The 2013 guidelines increased the positive rate compared to the 2007 guidelines, in both cohorts (0.6% and 6.2%, respectively). Most equivocal cases in cohorts 1 (92.3%) and 2 (100%) as per the 2013 guidelines were reclassified as HER2-negative according to the 2018 guidelines.The 2018 guidelines increased the negative rates (1.3% in cohort 1 and 8.7% in cohort 2) and slightly decreased the positive rates (−0.2% in cohort 1 and −3.1% in cohort 2), compared to the 2013 guidelines. With each update, minor changes in the positive and negative rates were observed in whole breast cancer samples (cohort 1). However, the 2018 guidelines affected previously defined HER2-positive IBC with equivocal IHC results. @*Conclusion@#Under the 2013 guidelines, the positive and equivocal cases increased. However, the 2018 guidelines eliminated ambiguous cases by reclassifying them as HER2-negative.

Postoperative Recurrent Bladder Tumors Detection by Narrow-Band Imaging Cystoscopy

Purpose@#We compared the effectiveness of narrow-band imaging (NBI) cystoscopy and white light cystoscopy (WLC) for detection of intravesical recurrence of bladder cancer. @*Materials and Methods@#We studied the positive predictive value (PPV) in the recurrent suspicious lesions in patients with nonmuscle invasive bladder cancer (NMIBC) for the 13 months of the follow-up from July 2016 to June 2017 with WLC and another 13 months from July 2017 to July 2018 with NBI, respectively. We also studied the second transurethral resection of bladder tumor (TURBT) free survival (STFS) and cancer-specific recurrence-free survival (CSRFS) with WLC and NBI in the 12 months of short-term follow-up. @*Results@#The total number of first TURBT patients in the follow-up was 164. Eighty patients were excluded. Among the 84 patients with NMIBC, WLC group was 43, NBI group was 41. Thirty-six patients had more than second TURBT. In 48 cases of patients with more than second TURBT, PPV of WLC and NBI was 81.8% and 61.5%, respectively. There was no statistically significance of PPV between the 2 groups (p=0.124). There were no pathological differences between the results about 1 year of follow-up patients with one of WLC or NBI (p=0.288). STFS was statistically significantly shorter in NBI (p=0.002), but there were no statistically significant difference in CSRFS. @*Conclusions@#NBI had made the bladder lesions detected early but had a low PPV for cancer recurrence within the bladder and there is no survival benefit.

Ipsilateral Breast Tumor Recurrence with Metachronous Contralateral Axillary Lymph Node Metastasis after Breast-Conserving Surgery with Axillary Lymph Node Dissection

Contralateral axillary lymph node metastasis (CAM) is classified into synchronous and metachronous CAM. It is considered a stage IV disease by American Joint Community on Cancer (AJCC) cancer staging system. Although ipsilateral breast tumor recurrence (IBTR) with metachronous CAM is rare, it can occur after previous axillary lymph node dissection (ALND) because of altered lymphatic drainage. Metachronous CAM might be a regional disease progression rather than a distant metastasis. Here, we present a case of IBTR with metachronous CAM. This patient was treated with curative intent. The management of CAM remains controversial.

Impact of the Updated Guidelines on Human Epidermal Growth Factor Receptor 2 (HER2) Testing in Breast Cancer / 한국유방암학회지

Purpose@#In 2007, the American Society of Clinical Oncology and the College of American Pathologists had established a human epidermal growth factor receptor 2 (HER2) testing guideline, which was updated in 2013 and subsequently in 2018. We assessed the clinical impact of the recent update by comparing the in situ hybridization (ISH) results based on the 2007, 2013, and 2018 guidelines. @*Methods@#We assessed 2 cohorts. The first cohort included 1,161 primary invasive breast cancer (IBC) samples including 18 bilateral IBC cases, with both immunohistochemistry (IHC) and silver-enhanced ISH (SISH) results available for the HER2 status. The second cohort included 160 IBC cases with equivocal HER2 IHC, assessed using SISH. We retrospectively evaluated and compared the HER2 SISH results. @*Results@#There were 22 (1.9%) and 20 (12.5%) cases with altered SISH results according to the 2013 guidelines in cohorts 1 and 2, respectively. As per the 2018 guidelines, final HER2 statuses of 16 (1.4%) and 14 (8.5%) cases changed in cohorts 1 and 2, respectively. The 2013 guidelines increased the positive rate compared to the 2007 guidelines, in both cohorts (0.6% and 6.2%, respectively). Most equivocal cases in cohorts 1 (92.3%) and 2 (100%) as per the 2013 guidelines were reclassified as HER2-negative according to the 2018 guidelines.The 2018 guidelines increased the negative rates (1.3% in cohort 1 and 8.7% in cohort 2) and slightly decreased the positive rates (−0.2% in cohort 1 and −3.1% in cohort 2), compared to the 2013 guidelines. With each update, minor changes in the positive and negative rates were observed in whole breast cancer samples (cohort 1). However, the 2018 guidelines affected previously defined HER2-positive IBC with equivocal IHC results. @*Conclusion@#Under the 2013 guidelines, the positive and equivocal cases increased. However, the 2018 guidelines eliminated ambiguous cases by reclassifying them as HER2-negative.

Clinical significance of serum neutrophil gelatinase-associated lipocalin in the early diagnosis of renal function deterioration after radical nephrectomy / 고신대학교의과대학학술지

OBJECTIVES: The standard metrics used to monitor the progression of acute kidney injury (AKI) include markers such as serum creatinine, blood urea nitrogen, and estimated glomerular filtration rate (eGFR). Moreover, neutrophil gelatinase-associated lipocalin (NGAL) expression has been reported to modulate oxidative stress. METHODS: We aimed to evaluate the usefulness of serum NGAL levels for monitoring renal function after radical nephrectomy (RN). We prospectively collected data from 30 patients who underwent RN. We analyzed serum NGAL and creatinine at 6 time points: preoperative day 1, right after surgery, 6 hours after surgery, postoperative day (POD) 1, POD 3, and POD 5. We compared these measurements according to the eGFR values (classified as chronic kidney disease stage III; CKD III or not) using data obtained 3 months after surgery. RESULTS: The mean age was 65.5 years (range, 45–77 years), and the male-to-female ratio was 2:1. At the last follow-up examination, there were 12 patients (40%) with CKD III. Using receiver operating characteristic analysis, we found that serum creatinine on POD 5 (area under the curve [AUC], 0.887; P= 0.000) and NGAL at 6 hours after LRN (AUC, 0.743, P= 0.026) were significant predictors of CKD III. The development of CKD III after LRN was associated with the serum creatinine level on POD 5 and the NGAL at 6 hours after surgery. CONCLUSIONS: Compared to serum creatinine, serum NGAL enabled earlier prediction of postoperative CKD III. Therefore, serum NGAL measured 6 hours after surgery could be a useful marker for managing patients after RN.

Comparative study of off-clamp, laparoscopic partial nephrectomy (OCLPN) and conventional hilar control, laparoscopic partial nephrectomy (HCLPN) for renal tumors: One-year follow-up results of renal function change / 고신대학교의과대학학술지

OBJECTIVES: We designed the study to compare the oncologic and renal function outcomes of off-clamp, laparoscopic partial nephrectomy (OCLPN) and conventional laparoscopic partial nephrectomy (HCLPN) for renal tumors. METHODS: Between March 2008 and July 2015, 114 patients who underwent laparoscopic partial nephrectomy (LPN) of a renal neoplasm were studied. We performed LPN without hilar clamp on 40 patients (OCLPN, Group 1), and conventional LPN with hilar control and renorrhaphy on another 40 patients (HCLPN, Group 2). We retrospectively reviewed the medical records of each patient's age, sex, R.E.N.A.L. nephrometry score (RNS), operation time, complications, hospitalization period, tumor size, positive resection margin, histologic classification of tumor, pathologic stage, Fuhrman grade, estimated blood loss (EBL), warm ischemic time (WIT), and estimated glomerular filtration rate (eGFR) before and one year after surgery. RESULTS: There were no significant differences in age, sex, preoperative eGFR, EBL, surgical (anesthesia) time, and tumor size between the two groups. The mean eGFR was not significantly different between the OCLPN and HCLPN groups 1 month (95 and 86.2 mL/min/1.73 m², respectively; P = 0.106), 6 months (92.9 and 83.6 mL/min/1.73 m², respectively; P = 0.151) and 12 months (93.8 and 84.7 mL/min/1.73 m², respectively; P = 0.077) postoperatively. The change in eGFR after one year was 3.9% in the OCLPN group and −7.9% in the HCLPN group. CONCLUSIONS: OCLPN was superior to HCLPN in preserving renal function one year after surgery, and there was no statistically significant difference in tumor treatment results.

Endovascular aortic aneurysm repair using a bifurcated stent graft in a patient with femoro-femoral bypass

A challenging iliac anatomy remains a major obstacle to successful endovascular aortic aneurysm repair. The authors experienced an abdominal aortic aneurysm with bilateral common iliac artery aneurysms in a patient that had undergone femoro-femoral bypass due to left external iliac artery (EIA) occlusion. To treat this patient in a totally endovascular manner, a bifurcated stent graft was used. One iliac limb was deployed in the right internal iliac artery (IIA) and the other in the right EIA; the left IIA was embolized with coils. Here, the authors describe the procedure used and provide technical tips.

Preliminary Study on Safety of Robotic or Endoscopic Thyroidectomy via Bilateral Axillo-breast Approach (BABA) without Drainage Procedure: Multicenter Trial / 대한내분비외과학회지

PURPOSE: The aim of this study was to evaluate the safety of robotic or endoscopic thyroidectomy via bilateral axillo-breast approach (BABA) without a drainage procedure. METHODS: A total of 64 patients who underwent robotic or endoscopic thyroidectomy via BABA without a close suction drain between February and March 2012 were enrolled. We checked postoperative symptoms or signs including change of vital signs, dyspnea, swelling or fluctuation of anterior chest and neck and compression symptoms at 1, 6, 24, and 48 hours and 1 month after surgery. Postoperative ultrasonography was performed in patients with at least one or more postoperative symptoms or signs in order to confirm hematoma or fluid collection. RESULTS: None of the enrolled patients had dyspnea or change of vital signs. Two of 64 patients had swelling, 1 of 64 patients had fluctuation on the anterior chest, and 1 of 64 patients had compression symptoms. Fluid collection was confirmed in 2 of 4 of the above mentioned patients and the collected fluid was aspirated. The amounts of aspirated fluid were 25 mL and 8 mL. Thereafter, the follow up ultrasonography showed no more fluid collection in all patients. In addition, we rechecked the above mentioned symptoms or signs at 1 month after surgery; none of the enrolled patients had symptoms or signs. CONCLUSION: Robotic or endoscopic thyroidectomy via BABA without a closed suction drain shows no serious seroma or hematoma collection. Therefore, we expect that robotic or endoscopic thyroidectomy via BABA without a closed suction drain can reduce the pain, discomfort or longer hospital stay as a result of closed suction drain using this method.

Epithelial-Mesenchymal Transition Phenotype Is Associated with Clinicopathological Factors That Indicate Aggressive Biological Behavior and Poor Clinical Outcomes in Invasive Breast Cancer / 한국유방암학회지

PURPOSE: Cancer tissue may display a wide spectrum of expression phenotypes of epithelial-mesenchymal transition (EMT)-related proteins. The purpose of this study was to investigate the clinical significance of EMT phenotypes in breast cancer. METHODS: We evaluated the expression pattern of the EMT-related proteins E-cadherin and fibronectin in samples from 1,495 patients with invasive breast carcinoma (IBC) on tissue microarrays using immunohistochemistry to investigate the clinical significance of EMT phenotypes in IBC. EMT phenotypes were divided into complete type (E-cadherin-negative/fibronectin-positive), incomplete type (hybrid type, E-cadherinpositive/fibronectin-positive; null type, E-cadherin-negative/fibronectin-negative), and wild-type (E-cadherin-positive/fibronectin-negative). We analyzed the correlation of EMT phenotype with clinicopathological factors and patient survival. RESULTS: Loss of E-cadherin was observed in 302 patients (20.2%), and fibronectin was expressed in the cancer cells of 354 patients (23.7%). In total, 64 (4.3%), 290 (19.4%), 238 (15.9%), and 903 (60.4%) samples were categorized as complete, hybrid, null, and wild-type, respectively. The complete EMT phenotype exhibited significant associations with young age (p=0.017), advanced pT (p<0.001) and pN (p<0.001) stages, higher histological grade (p<0.001), lymphovascular invasion (p<0.001), and triple negativity (p<0.001). Patients with complete and hybrid EMT phenotypes had poorer overall survival (OS) and disease-free survival (DFS) than those with the wild-type phenotype (OS, p=0.001; DFS, p<0.001). In multivariate analysis, the hybrid EMT phenotype was an independent prognostic factor for DFS in patients with IBC (p=0.032). CONCLUSION: EMT phenotypes exhibited significant associations with clinicopathological factors indicating aggressive biologic behavior and poor outcome in patients with IBC.

Immediate Direct-To-Implant Breast Reconstruction Using Anatomical Implants

BACKGROUND: In 2012, a new anatomic breast implant of form-stable silicone gel was introduced onto the Korean market. The intended use of this implant is in the area of aesthetic breast surgery, and many reports are promising. Thus far, however, there have been no reports on the use of this implant for breast reconstruction in Korea. We used this breast implant in breast reconstruction surgery and report our early experience. METHODS: From November 2012 to April 2013, the Natrelle Style 410 form-stable anatomically shaped cohesive silicone gel-filled breast implant was used in 31 breasts of 30 patients for implant breast reconstruction with an acellular dermal matrix. Patients were treated with skin-sparing mastectomies followed by immediate breast reconstruction. RESULTS: The mean breast resection volume was 240 mL (range, 83-540 mL). The mean size of the breast implants was 217 mL (range, 125-395 mL). Breast shape outcomes were considered acceptable. Infection and skin thinning occurred in one patient each, and hematoma and seroma did not occur. Three cases of wound dehiscence occurred, one requiring surgical intervention, while the others healed with conservative treatment in one month. Rippling did not occur. So far, complications such as capsular contracture and malrotation of breast implant have not yet arisen. CONCLUSIONS: By using anatomic breast implants in breast reconstruction, we achieved satisfactory results with aesthetics better than those obtained with round breast implants. Therefore, we concluded that the anatomical implant is suitable for breast reconstruction.

Squamous Cell Carcinoma of the Suprapubic Cystostomy Tract With Bladder Involvement

Herein we report a case of a squamous cell carcinoma of a well-healed suprapubic cystostomy tract scar involving the bladder mucosa in a 56-year-old man. He presented with a spontaneous suprapubic urinary leak from a suprapubic cystostomy tract scar. He had a history of urethral stricture and failed urethroplasty. Preoperative cystoscopy suggested a bladder mass. Transurethral biopsy of the bladder mass revealed a squamous cell carcinoma confined to the suprapubic cystostomy tract involving the bladder mucosa. The patient died 6 months after the start of radiation therapy after lung metastasis and pneumonia.