The Usefulness of US-guided Vacuum-Assisted Breast Biopsy for Probably Benign Lesions

PURPOSE: We wished to determine the usefulness of ultrasound-guided vacuum-assisted biopsy (mammotome) for the removal of the breast lesions that had displayed benign evidence on sonography. METHODS: During an 11 month period, vacuum-assisted breast biopsy was performed for 186 probably benign lesions on sonography using 11-gauge (127 cases) and 8-gauge (59 cases) devices. The age of the patients ranged from 19 to 65 years, and the size of the lesions ranged from 0.4 to 3 cm. We retrospectively analyzed the clinical findings and medical history of the patients who underwent vacuum- assisted breast biopsy, and we then evaluated the complications, the histopathologic results, and the follow-up US findings. RESULTS: Of the 186 cases, the lesions were palpated in 95 cases (51%), and lesions were detected in women during a screening examination in 40 cases (36%), and lesions were detected in women having a history of benign breast biopsy or having a cancer operation in the remaining 18 cases (10%). Severe bleeding during or after the procedures was noted in 4 cases (2.2%). The lesions were pathologically proved as benign in 185 cases and malignant in 1 case. With vacuum-assisted breast biopsy, high-risk benign disease was found in 7 cases, but none of the lesions was pathologically upgraded on the subsequent open surgical biopsy. On the 3-month follow-up US, variable sized hematomas were observed in 6 of 24 cases (25%). We performed incidental treatment on four of the vacuum- assisted breast biopsy patients for nipple discharge that was caused by intraductal papilloma. CONCLUSION: US-guided vacuum-assisted breast biopsy is a minimally invasive, fast and convenient biopsy technique. In addition, it is safe and accurate to use for the histological diagnosis because it would remove all the sonographically demonstrated evidence of a probable benign lesion. This technique can potentially be a useful alternative to some forms of surgical biopsy for the properly selected patients.

Endoscopic Thyroidectomy of the Differentiated Thyroid Cancer

PURPOSE: Endoscopic neck surgery has a smaller wound size and enables the positions of the wounds to be moved to places of cosmetic benefit. Therefore, it is strongly preferred by many patients, especially women. We applied this technique to the treatment of thyroid cancer. METHODS: An endoscopic thyroidectomy was performed on 17 female thyroid cancer patients with a mean age 35 years in our Department from January 1999 to January 2003. The selection criteria were a tumor size < or =2 cm, no thyroiditis, no previous neck surgery or irradiation, no lymphadenopathy on a preoperative imaging study. The preoperative or intraoperative diagnoses of these patients included 13 papillary cancers and 4 follicular cancers. The procedure was performed using the anterior chest approach with CO2 gas insufflation. RESULTS: Fourteen hemithyroidectomies and three total thyroidectomies were successfully performed. The mean operative time was 84.2+/-20.9 min for the 14 hemithyroidectomies and 148.3+/-32.5 min for the 3 total thyroidectomies. There was no conversion to conventional surgery. The mean tumor size was 1.6 cm (0.8~2.7) The mean hospital stay was 8.9 days. All the patients were satisfied with the cosmetic result except for one patient who underwent a conventional salvage operation due to an involved surgical margin on a permanent section. The postoperative complications included one case of transient recurrent nerve palsy and one case of transient symptomatic hypocalcemia. The mean follow up period was 30 months(13~59). One patient after a total thyroidectomy had a paratracheal lymph node metastasis on the thyroid scan 2 years after surgery and received 131I radioablation. CONCLUSION: With the advent of preoperative imaging study, an endoscopic thyroidectomy for thyroid cancer is feasible and safe in properly selected patients. In addition, this procedure has a better cosmetic outcome than conventional open surgery.

Long-term Results of Proximal and Total Gastrectomy for Adenocarcinoma of the Upper Third of the Stomach / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The choice of surgical strategy for patients with adenocarcinoma of the upper one third of the stomach is controversial. This study was performed to analyze the surgical results of a 11-year experience with these lesions. MATERIALS AND METHODS: From January 1990 to December 2000, 259 patients with upper third gastric cancer underwent proximal gastrectomy (n=74) or total gastrectomy (n=185) through an abdominal approach. Morbidity, mortality, recurrence patterns, and survival were compared between these two groups retrospectively. RESULTS: There were no significant differences in general complication and mortality rates between the two groups. However, the incidences of reflux esophagitis (16.2%) and anastomotic stricture (35.1%) were more common in the proximal gastrectomy group compared with the total gastrectomy group (0.5 and 8.1%). Regarding the main patterns of recurrence, local recurrence was dominant in the proximal gastrectomy group, whereas distant recurrence was dominant in the total gastrectomy group. Five-year overall survival (54.8 versus 47.8%) and survival according to tumor stage were no different between the groups. Multivariate analysis showed that the extent of resection was not an independent prognostic factor. CONCLUSION: The extent of resection for upper third gastric cancer did not appear to affect long-term outcome. However, proximal gastrectomy is associated with an increased risk of reflux esophagitis, anastomotic stricture, and local recurrence.

Endoscopy-assisted Breast Conserving Surgery of Breast Cancer

PURPOSE: Breast conserving surgery is now accepted as one of the standard therapeutic options for stage I and II breast cancers. Although breast conserving surgery can retain a good breast shape, a long marked operation scar would be a disadvantage. To improve the cosmetic outcome of the breast, endoscopy-assisted breast conserving surgery which can be performed through minimal axillary and periareolar semicircular incisions, was undertaken. METHODS: Between October 2002 and May 2003, 19 breast cancer patients whose tumor sizes were less than 3 cm and clinically node negative without invasion to the skin and pectoralis major underwent endoscopy-assisted breast conserving surgery. Firstly, an endoscopic dye-guided sentinel node biopsy was performed through a low transverse axillary incision laterally to the pectoralis major. A subpectoral pocket was gently created by Vein Harvest under the view of endoscopic monitor. A periareolar semicircular incision was made to create the skin flap and the tumor-containing quadrant resected with a Visiport and PowerStar Scissors. Frozen section biopsies were carried out to rule out tumor invasion to the resection margin. The patients and tumor characteristics, operation time and amounts of bleedings were evaluated. RESULTS: The mean age of patients was 45 years (35~64). The mean tumor size was 2.2 cm (0.2~5.0 cm). The average operation time of the initial 8 cases, with the exception of the 3 that underwent axillary node dissection was 168 minute, and that of latter 8 was 138 minute (P<0.001). The mean amounts of operative bleeding were 184 ml. There were no major complications. CONCLUSION: Endoscopy-assisted breast conserving surgery is a new technique that can minimize the long operation scar obtained with classic breast conserving surgery. In properly selected cases, our results shows maximized cosmetic satisfaction of breast cancer patients, with a shortened operation time after the learning period, and shows promise as an alternative to the classic breast conserving surgery.

Endoscopy-assisted Breast Conserving Surgery of Breast Cancer

PURPOSE: Breast conserving surgery is now accepted as one of the standard therapeutic options for stage I and II breast cancers. Although breast conserving surgery can retain a good breast shape, a long marked operation scar would be a disadvantage. To improve the cosmetic outcome of the breast, endoscopy-assisted breast conserving surgery which can be performed through minimal axillary and periareolar semicircular incisions, was undertaken. METHODS: Between October 2002 and May 2003, 19 breast cancer patients whose tumor sizes were less than 3 cm and clinically node negative without invasion to the skin and pectoralis major underwent endoscopy-assisted breast conserving surgery. Firstly, an endoscopic dye-guided sentinel node biopsy was performed through a low transverse axillary incision laterally to the pectoralis major. A subpectoral pocket was gently created by Vein Harvest under the view of endoscopic monitor. A periareolar semicircular incision was made to create the skin flap and the tumor-containing quadrant resected with a Visiport and PowerStar Scissors. Frozen section biopsies were carried out to rule out tumor invasion to the resection margin. The patients and tumor characteristics, operation time and amounts of bleedings were evaluated. RESULTS: The mean age of patients was 45 years (35~64). The mean tumor size was 2.2 cm (0.2~5.0 cm). The average operation time of the initial 8 cases, with the exception of the 3 that underwent axillary node dissection was 168 minute, and that of latter 8 was 138 minute (P<0.001). The mean amounts of operative bleeding were 184 ml. There were no major complications. CONCLUSION: Endoscopy-assisted breast conserving surgery is a new technique that can minimize the long operation scar obtained with classic breast conserving surgery. In properly selected cases, our results shows maximized cosmetic satisfaction of breast cancer patients, with a shortened operation time after the learning period, and shows promise as an alternative to the classic breast conserving surgery.

Predictive Value of Preoperative Serum CEA, CA19-9 and CA125 Levels for Peritoneal Metastasis in Patients with Gastric Carcinoma / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Peritoneal metastasis is a crucial factor for the prognosis in gastric cancer, but its diagnosis is difficult before laparotomy. This study analyzed the usefulness of diagnostic imaging and various tumor markers in the detection of peritoneal metastasis in gastric cancer. MATERIALS AND METHODS: The sera from 768 patients with gastric cancer were measured for CEA, CA19-9 and CA125 levels using a commercial immunoradiometric assay. All the patients underwent diagnostic imaging with computed tomography (CT) and ultrasound (US) before laparotomy. RESULTS: Preoperative levels of CEA, CA19-9 and CA125 were above the cut-off levels in 15.4%, 8.7% and 5.7% of all cases, respectively. Eighty-eight patients were diagnosed with peritoneal metastasis by laparotomy. CT and US revealed peritoneal dissemination in 15 of 88 patients (17%). Among the three tumor markers, CA19-9 and CA125 showed similar detection rates of peritoneal metastasis (37.5% and 38.6%, respectively). In particular, the serum CA125 levels showed the best sensitivity (38.6%), specificity (98.4%), and diagnostic accuracy (91.5%), and the highest odd ratio (24.46, 95% CI: 11.17~53.57) for predicting peritoneal metastasis among the markers tested. CEA did not add significant predictive information (p=0.471). CONCLUSION: Preoperative serum CA19-9 and CA125 levels may provide a predictable value in determining peritoneal metastasis in patients with gastric cancer.

Endoscopic Subcutaneous Mastectomy and Immediate Reconstruction of Breast Cancer / 한국유방암학회지

PURPOSE: A subcutaneous mastectomy has been proven to be oncologically safe for early breast cancer. Although a subcutaneous mastectomy and reconstruction are well established, most incisions are made directly on the breast. To improve the cosmetic outcome, an endoscopic subcutaneous mastectomy and immediate reconstruction was undertaken, which can be performed through minimal axillary and periareolar semicircular incisions. METHODS: Between October 2002 and December 2003, 9 patients with early breast cancer, whose tumors were less than 4 cm in size and more than 2 cm-apart from the nipple-areolar complex, and who were clinically node negative without invasion to skin and pectoralis muscle, underwent 10 endoscopic subcutaneous mastectomies with immediate reconstruction employing saline bag implants. Firstly, an endoscopic dye-guided sentinel node biopsy was performed through a low transverse axillary incision lateral to the pectoralis major. A subpectoral pocket was gently created under the view of endoscopic monitor by Vein Harvest. A periareolar semicircular incision was made to create the skin flap using Visiport and PowerStar Scissors. Frozen section biopsies were performed to rule out tumor invasion to the resection margin. After resection of the entire breast tissue, a saline bag prosthesis was inserted. The patients and tumor characteristics, operation times, amounts of bleeding, and cosmetic results were evaluated. RESULT: The mean patient age was 45 years (25~55). The mean tumor size was 2.5 cm, ranging from 0.7 to 5.0cm. The average operation time was 112 minutes (80~150). The mean amounts of operative bleeding was 232 ml. There was one case of transient necrosis of the nipple-areolar complex. An early implant removal was performed in one patient due to a suspected microperforation. Excellent or good cosmetic results were obtained in 8 patients (88.8%). CONCLUSION: An endoscopic subcutaneous mastectomy with immediate reconstruction, is a new technique that can minimize the direct operation scar on the breast skin following a classic operation. In properly selected cases, our results show maximized cosmetic satisfaction of breast cancer patients, so offers a promising alternative to a classic subcutaneous mastectomy with immediate reconstruction.

Endoscopic Sentinel Node Biopsy / 한국유방암학회지

PURPOSE: Sentinel node biopsy has emerged recently as an alternative to routine axillary node dissection in predicting axillary nodal metastasis. However there have been some controversies in clinical application because of its various identification rates and false negative rates. We present the usefulness of dye-guided endoscopic sentinel node biopsy. METHODS: Between October 2002 and June 2003, 30 breast cancer patients with clinically node negative results underwent endoscopic blue dye-guided sentinel node biopsy from the Department of Surgery at Kangbuk Samsung Hospital. The technique involved the injection of 5 ml of 1% isosulfan blue into subareolar plexus. The Visiport docked with Telescope was inserted through a low transverse axillary incison lateral to pectoralis major. During the dissection, we identified sentinel nodes by following blue-stained lymphatics directly into blue (or nonblue) lymph nodes. The identification rate and false negative rate was evaluated. RESULTS: The mean number of sentinel nodes was 2.2. The identification rate of th sentinel node was 93.3% (28/30). Among 22 patients with negative sentinel nodes on frozen section, 10 patients underwent axillary node dissection and the results were negative in all cases, indicating false negative rate of 0% (0/10). The overall accuracy, sensitivity and specificity were 100%. CONCLUSION: The endoscopic technique of sentinel node biopsy can minimize the operative bleeding by handling the knife of Visiport pallelel to exposed vessels under endoscopic monitor analysis and and keep better operative visual field and less invasiveness. With the bright illumination of the endoscopic light, blue-stained sentinel lymphatics could be identified more easily. Our technique of dye-guided endoscopic sentinel node biopsy demonstrates a high sentinel node identification rate and absent false negative rate, promising it could be an alternative to the classic sentinel node biopsy.

The Diagnostic Value of Contrast Enhanced Power Doppler US on Small Breast Lesions

PURPOSE: To evaluate the usefulness of contrast-enhanced power Doppler ultrasonography (PDUS) in differentiating small benign from small malignant breast lesions. MATERIALS AND METHODS: Thirty-one solid breast lesions (<2 cm in size; 17 benign and 14 malignant) prospectively underwent US and PDUS before and after the injection of contrast agent (SH U 508A). Morphologic analysis involved independent assessment of the findings of US and the patterns of Doppler signals before and after contrast enhancement at PDUS, and sensitivity and specificity were thus evaluated. The diagnostic accuracy of US accompanied by PDUS was also determined before and after contrast enhancement. Hemodynamic analysis involved measurement of the time lapse between contrast injection at PDUS and observed change in Doppler signals. For this, a sonic VIOR computer-assisted program was used and the results were correlated with the pathologic findings. RESULTS: The sensitivities of US before and after contrast enhanced PDUS were 100%, 35.7%, and 57%, with specificities of 47%, 88.2% and 76%, respectively. The diagnostic accuracy of US was 35% with noncontrast PDUS, and 77% before and after contrast enhanced PDUS. The recorded time lapse between contrast injection at PDUS and observed change in Doppler signals did not correlate closely with the pathologic findings. CONCLUSION: In that it improved visualization of the morphology of vascular Doppler signals, microbubble contrast-enhanced PDUS complemented US and PDUS in differentiating between small benign and small malignant breast lesions.

Analysis of Local Recurrence Following Proximal Gastrectomy in Patients with Upper Third Gastric Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Little is known about local recurrence following proximal gastrectomy in patients with upper third gastric cancer. We performed this study to evaluate the long-term results of a proximal gastrectomy, and to analyze the risk factors of local recurrence affecting survival in these patients. MATERIALS AND METHODS: We undertook a retrospective study of 63 patients who underwent potentially curative proximal gastrectomy between 1990 and 1999, with special reference to local recurrence. RESULTS: During a median follow-up period of 37 months, 25 of the 63 patients (39.7%) developed a recurrence of cancer, with local recurrence in 15 patients (23.8%), the majority of these occurring at the remnant stomach or anastomosis. The median time to local recurrence was 38 months (8~78 months). Univariate analysis of risk factors for local recurrence revealed an infiltrative or diffuse gross type, with a tumor sizes>5 cm, a distal resection margin

Patients Outcome Following Surgical Treatment of Upper Third Gastric Cancer

PURPOSE: Although there is an increasing incidence of upper third gastric cancers, the appropriate extent of resection for upper third gastric cancer is not known. This study was performed to analyze a 9-year experience with upper third gastric adenocarcinomas from one institution treated by either total gastrectomy (TG) or proximal gastrectomy (PG). METHODS: The records and survival data of 158 upper third gastric cancer patients who underwent curative TG (n=106) or PG (n=52) through an exclusively abdominal approach were retrospectively analyzed. RESULTS: There was no significant difference in age, sex, tumor gross type, tumor differentiation, and stage between the groups who underwent TG and those who underwent PG. In addition, there were no significant differences in hospital mortality, overall 5-year survival, and disease-free survival rates between PG and TG group. However, PG group showed higher rates of postoperative reflux esophagitis and anastomosis stricture than TG group. Regarding the main patterns of recurrence, local recurrence was dominant in PG group, whereas distant recurrence was dominant in TG group. CONCLUSION: The extent of resection for upper third gastric cancer does not affect long-term outcome, and both procedures can be accomplished safely. When the cancer is confined to upper third of the stomach without serosal invasion, PG combined with antireflux procedures can be indicated.

The Usefulness of Breast MRI

PURPOSE: The most important prognostic factors of breast cancer are the tumor size and lymph node metastases. The accuracy of breast MRI in estimating tumor size has been investiated. Also, the role of breast MRI in diagnosing breast cancer has been studied since 1970s. METHODS: Between June 1997 and July 1998, 60 female patients with clinically and/or mammographically, sonographically suspicious breast carcinoma underwent surgery (surgical biopsy, lumpectomy, or mastectomy). With Gd-DTPA (ga dolinium-diethylenetriamine pentaacetic acid), contrast-enhanced MR imaging of the breast was per formed in all patients. we analyzed the specificity and the sensitivity of breast MRI compared to breast sonography and the mammography. We correlated the preoperative measurements of breast tumor size obtained using mammography, ultrasonography, and MRI with the values obtained from pathologic examination. RESULTS: The average age of the patients was 44.5 years and 48 patients (80%) had a pal pable mass. On histopathologic examination, 40 of 60 patients (66.7%) had malignant lesions. The specificities and the sensitivities of breast MRI, sonography and mammography were 73.7% and 85.0%, 70.0% and 92.9%, and 66.7% and 66.7%, respectively. MRI measurements demonstrated the highest correlation coefficient (r=0.895), with the lowest residual standard deviation (1.323) calculated in relation to the regression line. The correlation coefficient between sonographic tumor size and pathologic tumor size was 0.807 and the residual standard deviation was 2.194. CONCLUSION: The specificity and the sensitivity of the breast MRI were higher than those of mammography, but there was no difference between MRI and sonography. Breast MRI yielded the most accurate determination of breast cancer size in this series. As a result, MRI was useful for the diagnosis and the measurement of the tumor size.

Endoscopic Thyroidectomy

PURPOSE: Endoscopic surgery is becoming more widely used because of its low invasiveness and cosmetic effect. However reports on its use in thyroid surgery are scarce particularly with regard to exploiting the advantage of eliminating the unattractive scars that are sometimes encountered in con ventional operations on the exposed anterior part of the neck. Thus, we applied this to thyroidectomy. METHODS: This clinical trial was conducted on a total of 29 patients hospitalized in our Department from December 1998 to August 1999. Our operation method was as follows. Three trochars were inserted, one at each circumareolar area on the breast (5 mm) and one in the skin between these (15 mm). Subplatysmal and subcutaneous operative space was created with CO2 insufflation at 6-7 mmHg from straight-line between two nipples to just below the thyroid gland. The thyroidal vessels and the parenchyma of the gland were dissected and divided using an ultrasonic scalpel and commonly used-laparoscopic instruments. RESULTS: The patients consisted of 25 females and 4 males. The anesthesia and operation time was 220 10.4 minutes and 165.7 9.4 minutes respectively. We had 4 cases of conversion to a conventional thyroidectomy because of uncontrolled intraoperative bleeding (1 case), technical failure (1 case) and thyroid carcinoma (2 cases). Postoperative complications occurred in 2 cases, injury of recurrent laryngeal nerve and severe anterior chest discomfort for 3 months. The average length of postoperative stay was 6.7 days. Operative scars were completely covered by clothes, and cosmetic results were excellent. CONCLUSION: With these results, the cosmetic effect may be regarded as the only strength of an endoscopic thyroidectomy but by going through more cases, this technique could be performed safely with the other advantages of endoscopic surgery such as shortened operation time and hospital stay, et al. We hope an endoscopic thyroidectomy will be another surgery of choice for most patients with thyroid disease.

Dye-Injection Microdochectomy for Intraductal Papilloma of the Breast

BACKGROUND: Intraductal papillary tumors of the breast exhibit bloody discharge, often with no evidence of a palpable tumor, making discrimination between benign and malignant lesions sometimes difficult for pathologists and surgeons. Thus the technique used in removing the offending ductal system should be fully diagnostic, adequately therapeutic and cosmetically. Microdochectomy has been the accepted treatment for intraductal papillomas of the breast. METHODS: We performed dye-injection microdochectomy on intraductal papillomas of the breast in 15 patients. This procedure utilize a lacrimal probe and 24-gauge medicut that were gently advanced into the offending duct, and methylene blue dye was injected to outline the involved duct for easy dissection through a circumareolar incision. Also a visual check was made as the duct filled with eye. With careful dissection as far as the base of the nipple and good hemostasis, the suspicious duct was easily isolated and then dissected along its entire length and removed with a small cone of the breast tissue surrounding the duct. RESULTS: The peak incidence was in the 3rd and the 4th decades (67%). Among the 15 patients operated on for an intraductal papilloma, 7 (47%) had bloody discharge, 2 (13%) were serous, 2 (13%) were yellowish and 4 (26.7%) had both bloody dischrage and mass. Microdochectomy was performed under general anesthesia in 12 (80%). There were single papillomas in 9 (60%) and multiple papillomas in 6 (40%). Postoperative complication was seroma in the wound in 1case (7%). CONCLUSIONS: Because we could perform dye-injection microdochectomy safely, rapidly, and effectively, we think that this procedure should be a standard treatment for intraductal papilloma of the breast.

Atypical Sonographic Patterns of Fibroadenoma of the Breast: Pathologic Correlation

PURPOSE: To correlate the atypical sonographic patterns of fibroadenoma of the breast with the pathologicfindings. MATERIALS AND METHODS: Among 203 surgically proven 43 which were sonographi-cally atypicalfibroadenomas, were retrospectively reviewed. The diagnostic criteria for atypical va riety, as seen onsonography, were an ill-defined margin, microlobulated or irregular shape, heterogeneous internal echo-pattern,posterior shadowing, micro-calcification, and clefts. The atypical sonographic patterns of these 43 fibroadenomaswere analysed and compared with the pathologic findings. RESULTS: Among 43 lesions, ill-defined margins orirregular shapes were seen in 15 c a s e s, heterogeneous internal echo-patterns in 27, posterior attenuation innine, and clefts in seven. Thirty-seven (86%) of the 43 were predominantly ductal or hada mixed ductal and stromalcomponent. Eleven (73.3%) of fifteen ill-defined margin or irregular shaped lesions were caused by interdigitationof surrounding normal breast parenchyma and mass. Twenty two (81.5%) of 27 heterogeneous internal echo-pat-ternswere related to dilated ducts, phyllodes features, collagen bundles, adenosis, mi-crocalcification, or fatvacuoles. Eight (88.9%) of nine posterior attenuations were caused by collagen bundles, microcalcification, ductalproliferation or dilatation. All seven cases showing clefts revealed phyllodes features and dilated ducts. CONCLUSIONS: Most atypical fibroadenomas had a redominantly ductal or mixed component. Ill-defined margin orirregular shape was mainly due to interdigitation of normal surrounding parenchyma. Variable histologic featureswere related to the het-erogeneous internal echo-pattern, posterior shadowing, and the clefts revealed by atypicalsonographic findings.

MRI of Breast Implant-related Complications

PURPOSE: To assess the usefulness of MRI in the preoperative diagnosis of breast implant-relatedcomplications. MATERIALS AND METHODS: Thirty four breast implants in 17 patients were examined. Eight breasts hada history of repeated surgery due to rupture and in eight others, simultaneous interstitial silicone injection hadbeen performed. MR images of the 34 implants were prospectively analyzed for implant-related complications,without prior clinical information, and the findings were compared with the results of surgery. RESULTS: Theimplant-related complications seen on MRI were infections in three cases, seromas in two, and implant malpositionin two. The linguine sign was seen in eight cases and intraparenchymal silicone in 17. Among the 32 removedimplants, rupture was genuine in ten cases (nine, extracapsular; one, intracapsular). In evaluating the MRfindings of implant rupture, the linguine sign showed 80% sensitivity, 100% specificity and 93.8% accuracy.Intraparenchymal silicon also revealed high sensitivity (90%), but relatively low specificity and accuracy (63.7%and 71.9%, respectively); this was due to the difficulty of differentiating granulomas still present after aprevious rupture from injected silicone material. MRI was useful for visualization of implant migration, thedirect relationship of extended or extruded silicone in extracapsular rupture and the localization of siliconegranulomas, as seen on multiplanar images. The extent of infection was clearly demonstrated on contrast enhancedscan. There was relatively good correlation between the degree of contracture seen on physical examination andthat seen on MRI. CONCLUSION: MRI was an effective and useful method for the preoperative evaluation ofimplant-related complications; degree of contracture was successfully predicted.

Laparoscopic Partial Gastric Resection for Benign Gastric Tumors / 대한소화기내시경학회지

BACKGROUND/AIMS: Since the laparoscopic cholecystectomy has been introduced, minimally invasive techniques have been applied to the management of various intraabdominal lesions. Laparoscopic resection of benign gastric tumor has several advantages compared to open surgery; such as reduced postoperative discomfort, early hospital discharge and less complications. METHODS: We performed laparoscopic gastric resection for 6 benign gastric leiomyomas and 3 heterotropic gastric pancreases diagnosed by gastric endoscopy and did endoscopic ultrasonography routinely to find out the exact location of mass and depth of invasion. RESULTS: 1) Male to female ratio was 2: 7 and mean age was 48 years. 2) The masses were located at posterior wall of body in 5 cases, fundus in 2 cases, anterior wall of antrum in 1 case, and enterior wall of body, lesser curvature in 1 case. 3) Resection of benign gastric tumors were readily achieved laparoscopically, aided by disposable stapling instruments. 4) Mean operation time was 120 minutes and mean hospital stay was 5.1 days. CONCLUSIONS: The benign gastric tumors can be managed laparoscopically with good results and this procedure provides another choice for the resection of them.

Solid Breast Lesions: Evaluation with Power versus Conventional Color Doppler Sonography

PURPOSE: To compare power and conventional color Doppler sonography for depiction of the vasculature of solidbreast lesions, and to evaluate the usefulness of power Doppler sonography for differential diagnosis of malignantbreast lesions. MATERIALS AND METHODS: In order to detect vascularity, 82 cases of solid breast lesions wereevaluated by power and color Doppler sonography. Fifty-eight pathologically proven cases (37 benign and 21malignant lesions) were analyzed for the amount and patterns of Doppler signals, morphology of vessels, and thediagnostic accuracy. RESULTS: In 45 of 82 cases, power Doppler sonography depicted flow better than did colorDoppler sonography, while in 37 cases, depiction was equal. On power Doppler sonography, the incidence of markedblood flow in malignant lesions was three times higher than in benign lesions. The pattern of vasculature was morepredominantly central (85.5 %) and penetrating (61.9 %) in malignant lesions than in benign lesions. Branching(57.1 %) and disordered vessels (33.3 %) were more frequent in malignant lesions than in benign. For the diagnosisof malignancy, sensitivity for power Doppler sonography was 65 %, specificity was 79 % and diagnostic accuracy was74.1 % ; for color Doppler sonography, the corresponding figures were 76.9 %, 75.6 % and 75.9 %. CONCLUSION: Power Doppler sonography was more sensitive than color Doppler sonography for the detection of flow in solidbreast lesions. For the differentiation of benign from malignant lesions, however, there was no difference indiagnostic accuracy between the two modalities. findings of central and penetrating distribution patterns ofDoppler signals, and branching and disordered shapes of vessels, along with other sonographic criteria, arehelpful for predicting malignancy.

The Dye-injection Microdochectomy for Intraductal Papilloma of the Breast / 한국유방암학회지

Intraductal papillary tumors of the breast exhibit bloody discharge with often no evidence of a palpable tumor, making discrimination between benign and malignant lesions sometimes difficult for pathologists and surgeons. So the technique used in removing the offending ductal system should be fully diagnostic, adequately therapeutic and cosmetically. Microdochectomy has been accepted treatment for intraductal papilloma of the breast. We performed dye-injection microdochectomy on intraductal papilloma of the breast in 15 patients. This procedure utilizes lacrimal probe and 24-gauge medicut that are gently advanced into the offending duct and methylene blue dye is injected to outline the involved duct for easy dissection through a circumareolar incision. Because we could perform dye-injection microdochectomy safely, rapidly and effectively, we think that this procedure is standard treatment of intraductal papilloma of the breast.

p53 Protein Overexpression and p53 Mutations in Invasive Breast Carcinomas Comparison to lymph node status, DNA ploidy and histologic grade

Functional loss of the tumor suppressor gene p53 is one of the most frequently detected and diffusely distributed findings among human cancers. Their mutant protein products or point mutations can be detected through immunohistochemistry(IHC) or polymerase chain reaction and single stranded conformational polymorphism(PCR-SSCP). Evaluation of the DNA content of the tumor cell by flow cytometry(FCM) can provide indirect evidence of the functional loss of p53, because the spindle checkpoint in the mitotic phase depends on p53. To evaluate the correlation between p53 mutation and the status of lymph node metastasis or the histological grade of the tumor cell, IHC, SSCP, and FCM in the same tissue was performed from 43 patients of human breast cancer. The results obtained are as follows; 1. Functional loss of p53 was detected in 81.4% of the breast cancer cases by using triple tests and 58.1% at the cases by double test(IHC and SSCP). Positive rates by single test were 41.8% by IHC, 44.2% by SSCP, and 58.1% by FCM. 2. For breast carcinomas no correlation between lymph-node metastasis and the functional loss of p53 detected by IHC or SSCP. 3. The correlation between the functional loss of p53 detected by IHC or SSCP and the aneuploidy of the tumor cells was statistically significant. 4. The triple tests revealed a functional loss of p53 in all cases of grade III breast cancer.