ABSTRACT
PURPOSE: With better screening methods and patient awareness in recent years, more early stage breast cancers are being found than in the past. The outcome of breast conservation therapy for patients with early stage breast carcinoma were retrospectively reviewed, and analyses carried out to obtain the 5 and 10 year disease free survival rates and significant prognostic factors. METHODS: One hundred and fifty nine breast cancer patients were treated with breast conserving therapy, consisting of wide excision, axillary dissection and radiotherapy, for early stage breast cancer at the Keimyung University Dongsan Medical Center between 1992 and December 2001. The five and 10 year survival rates were obtained using the Kaplan- Meier method and the prognostic factors were studied with univariate and multivariate analyses using SPSS 11.0. RESULTS: The average age at the time of operation was 44.7 years, and the mean tumor size was 1.84 cm. One hundred and eleven patients (69.8%) had pathologically node negative diseases. During a median follow up of 48.7 months, 16 patients developed local and/or systemic recurrences. The 5 and 10 year disease free survivals were 88.0 and 86.0%, respectively. The univariate analysis of the prognostic factors showed that the age at the time of operation (35 years or younger vs. 36 years or older; P=0.0051) and lymph node status (P=0.0015) were statistically significantly associated with a recurrence. The results of the multivariate analysis revealed that the number of axillary lymph node was the strongest independent predictor for a recurrence. CONCLUSION: A breast conserving procedure is useful and effective for patients with early stage breast cancer, and the axillary status was the strongest independent predictor for a recurrence.
Subject(s)
Humans , Breast Neoplasms , Breast , Disease-Free Survival , Follow-Up Studies , Lymph Nodes , Mass Screening , Mastectomy, Segmental , Multivariate Analysis , Radiotherapy , Recurrence , Retrospective Studies , Survival RateABSTRACT
PURPOSE: Breast cancer is the most frequently occurring cancer in Korean women, and recently its incidence has rapidly increased. The purpose of this study was to show the survival rate and prognostic factors for breast cancer in Korean women. METHODS: Nine hundred and eighty nine consecutive breast cancer patients, first diagnosed at the Dongsan Medical Center, Keimyung University between January 1990 and December 2001, were included in this study. RESULTS: The peak incidence occurred in the 40's age group, and the average age at diagnosis was 48.1 years old. Forty four patients (4.4%) were in stage 0, 218 (22.0%) in stage I, 572 (57.9%) in stage II, 112 (11.4%) in stage III, and 22 (2.2%) in stage IV. The 5 and 10 year disease free and overall survival rates were 73.8 and 68.8 and 79.7% and 65.4%, respectively. A univariate analysis of the prognostic factors showed that age, tumor size and number of metastatic lymph nodes were statistically significant. A multivariate analysis showed that the the number of metastatic lym, ph nodes was the most significant factor for the time to recurrence and overall mortality. CONCLUSION: This study showed that the peak age of the breast cancer patients in Korea was younger than that seen in Western countries, and the survival rates were similar, despite our patients being comprised of a smaller proportion of early breast cancers. The age at time of diagnosis, tumor size, and number of axillary lymph nodes involved were confirmed to have independent influence on the overall survival and disease free survival rates.
Subject(s)
Female , Humans , Breast Neoplasms , Breast , Diagnosis , Disease-Free Survival , Hydrogen-Ion Concentration , Incidence , Korea , Lymph Nodes , Mortality , Multivariate Analysis , Recurrence , Survival RateABSTRACT
PURPOSE: Clustered microcalcifications on mammogram represent an important feature of the breast cancer, especially that of intraductal carcinoma. The positive predictive value for malignancy of the clustered microcalcifications has been reported to be between 20 and 30%. This study was carried out to determine the radio-histological correlation of clustered microcalcifications seen on mammograms in a university hospital in Daegu, Korea. METHODS: The medical records of 77 consecutive patients who underwent wire localization biopsy for clustered microcalcifications between January 1997 and March 2001 were reviewed. Patients with palpable mass in the breast were excluded. All of the mammograms were read by a single radiologist and interpreted as at least category 3 or above according to the American College of Radiology Breast Imaging Reporting and Data System (BIRADS). The localization was done using a J wire in the Diagnostic radiology department in the morning on the day of surgery. Removal of the clustered microcalcifications was confirmed in each case with specimen mammography. RESULTS: All patient were female, with mean age of 47.7 years old. There was no complication from the procedures. Excision of the microcalcifications was incomplete in four patients, giving the successful complete excision rate of 94.8%. Pathologic report showed malignancy in 29.9% consisting of ductal carcinoma in situ in 19.5% and invasive carcinoma in 10.4%. Only one of eight patients with invasive carcinoma had axillary lymph node involvement. CONCLUSION: Needle localized surgical biopsy is safe, rapid, and accurate method for localizing small, potentially highly curable breast cancers with minimal sacrifice of breast tissue.
Subject(s)
Female , Humans , Biopsy , Breast , Breast Neoplasms , Carcinoma, Intraductal, Noninfiltrating , Information Systems , Korea , Lymph Nodes , Mammography , Medical Records , NeedlesABSTRACT
PURPOSE: The stati of estrogen (ER) and progesterone receptors (PR) have been established as useful prognostic and predictive factors in the clinical management of women with breast cancer. This study was designed to correlate the presence of hormonal receptors with the established clinicopathological parameters, including age, tumor size, nodal status, stage, p53 and c-erbB-2 stati and to assess the prognostic significance of the hormonal receptors stati. METHODS: A retrospective study was conducted of all the breast cancer patients with known ER and PR stati between 1983 and 2002 at the Dongsan Medical center. The clinical features and pathological and immunohistochemistry reports were reviewed, and the ER and PR stati compared with the clinicopathological factors using independent sample T-tests, cross-tabulation, chi-square tests, and a one way ANNOVA. A survival analysis was performed using Kaplan-Meier method and log rank tests. RESULTS: Of 893 patients, 443 (49.6%) and 435 (48.5%) were ER-positive and PR-positive, respectively. The ratios of the patients with ER+PR+, ER+PR-, ER-PR+ and ER-ER- were 37.1, 12.5, 11.6 and 38.7%, respectively. The ER status was not related to the age, tumor size, nodal status, stage and c-erbB-2 status. The ER-negative patients had significantly more frequent overexpression p53 gene than the ER-positive patients (P=0.000). The PR status was not related to the age, nodal status, stage and c-erbB-2 status, but the average tumor size was larger in the PR-negative than the PR-positive patients (P=0.02). The PR-negative patients also had significantly more frequent overexpression p53 gene than the PR-positive patients (P= 0.000). The ER-positive or PR-positive patients had a better prognosis than the ER-negative and PR-negative patients (P=0.000). CONCLUSION: The hormonal receptors stati were not definitely related to the clinicopathological factors including the age, tumor size, lymph node status, stage, c-erbB-2 status, with the exception of p53 overexpression. A positive hormonal receptor status was a good prognostic factor.
Subject(s)
Female , Humans , Breast Neoplasms , Equidae , Estrogens , Genes, p53 , Immunohistochemistry , Lymph Nodes , Prognosis , Receptors, Progesterone , Retrospective StudiesABSTRACT
PURPOSE: A fibroadenoma is a very common benign breast tumor, which has been reported to be present in 7 to 13% of patients examined in breast clinics. This study was carried out, at a university hospital in Daegu, Korea, to find the clinical manifestations and characteristics of fibroadenomas in Korean women. METHODS: Four hundred and sixty-four patients, with pathological diagnosis of fibroadenomas, who underwent excisional biopsies, between January 1996 and December 2001, were included in this study. Clinical manifestations, diagnoses, including the sonographic findings, and the clinical characteristics, including the mean age of the patients at the time of diagnosis, tumor siz and location, and the solitary or multiple nature of the tumor, were analysed. RESULTS: The most common symptom was a palpable mass in the breast. In the majority of patients (81.5%), a mass was the only symptom, but the breast mass was associated with breast pain in only 8.8% of patients. Diagnosis was usually made from the characteristic clinical and sonographic findings. Frozen section examinations were rarely necessary for the differentiation from a carcinoma. The mean age of the patients was 34 years, but 34% of the women were aged 40 or older. Left sided fibroadenomas were slightly more common than those of the right. Bilateral tumors were found in 9.3% of patients. The most common locations of the breast tumors were the upper outer quadrant, followed by the center and upper inner quadrant. The mean size of the tumor was 2.35 cm. CONCLUSION: The clinical manifestations in Korean women were similar to those in Western reports, but the age at diagnosis was older in this study.
Subject(s)
Female , Humans , Biopsy , Breast , Breast Neoplasms , Diagnosis , Fibroadenoma , Frozen Sections , Korea , Mastodynia , UltrasonographyABSTRACT
PURPOSE: To evaluate interim results in terms of failure, cosmetic results and survival after breast conserving operation and radiation therapy in early breast cancer. MATERIALS AND METHODS: From January 1992 through December 1997, seventy two patients with early stage 0, I and II breast cancer were treated with conservative surgery plus radiotherapy at Keimyung University Dongsan Medical Center. Age distribution was 25 to 77 years old with median age of 43. According to TNM stage, five patients had stage 0, thirty three were stage I, twenty five were IIa, and nine were IIb. Most patients underwent excision of all gross tumor and ipsilateral axillary dissection. Breast was irradiated through medial and lateral tangential fields of 6 MV photons to 50.4 Gy in 28 fractions over 5.5 weeks. We delivered a boost irradiation dose of 10 to 16 Gy in 1 to 2 weeks to excision site. Adjuvant chemotherapy was administered in forty one patients with CMF (cyclophosphamide, methotrexate, 5-fluorouracil) regimens of 6 cycles concurrently or before radiation. Cosmetic results were assessed by questionnaire to patients grading of excellent, good, fair, poor. Follow-up periods were 22 to 91 months with median 40 months. RESULTS: Five year disease free survival rate (5YDFS) was 95.8%. According to stage, 5YDFS was 100%, 96.9%, 96% and 88.9% in stage 0, I, IIa and IIb, respectively. Two patients had distant metastasis and one had local and distant failure. One patient with distant failure had bone and liver metastasis at 14 months after treatment and the other had lung and both supraclavicular metastasis at 21 months after treatment. Patient with local and distant failure had local recurrence on other quadrant in same breast and then salvaged with total mastectomy and chemotherapy but she died due to brain metastasis at 55 months. Complications were radiation pneumonitis in five patients (four patients of asymptomatic, one patients of symptomatic) and hand or arm edema(4 patients). Fifty nine patients answered our cosmetic result questionnaire and cosmetic results were good to excellent in fifty one patients (86%). CONCLUSION: We considered that conservative surgery and radiation for the treatment of early stage invasive breast cancer was safe and had excellent survival and cosmetic results. We need to assess about prognostic factors with longer follow up and with large number of patients.
Subject(s)
Aged , Humans , Age Distribution , Arm , Brain , Breast Neoplasms , Breast , Chemotherapy, Adjuvant , Disease-Free Survival , Drug Therapy , Follow-Up Studies , Hand , Liver , Lung , Mastectomy, Simple , Methotrexate , Neoplasm Metastasis , Photons , Surveys and Questionnaires , Radiation Pneumonitis , Radiotherapy , RecurrenceABSTRACT
PURPOSE: A papillary carcinoma of the breast is relatively rare. Only about 1 to 2% of the breast carcinomas have been reported to be papillary carcinomas. So far, we have not found any report of a clinicopathological analysis of a papillary carcinoma in Korean women. METHODS: The records of 13 women diagnosed as having a papillary carcinoma were reviewed. The H&E and specially stained microscopic slides from each case were re-examined. The clinical data, tumor sizes, lymph node status, hormone receptor status, surgical procedures, and recurrences were analyzed. RESULTS: The 13 cases of papillary cancer represented an incidence of 1.28% of all breast cancers diagnosed at the Keimyung University Dongsan Medical Center. The mean age of the patients was 47.08 11.79. The tumor was frequently located centrally (61.5%), and the most common symptom was a palpable mass in the breast (92.3%). Four out of the 13 patients (32.5%) had axillary lymph node metastases. Hormone receptors were positive in five of seven patients (71.4%). Only one patient with advanced disease at the time of operation experienced distant metastases within 17 months after surgery. CONCLUSION: A papillary carcinoma is a rare type of breast cancer and has a favorable prognosis. The clinical outcome and histolgic characteristics were similar to those in other reports, but the mean age of the patients in this report was lower than that of Caucasian women.
Subject(s)
Female , Humans , Breast Neoplasms , Breast , Carcinoma, Papillary , Incidence , Lymph Nodes , Neoplasm Metastasis , Prognosis , RecurrenceABSTRACT
PURPOSE: Preoperative chemotherapy has been extensively used in inoperable or locally advanced breast cancer to achieve tumor reduction and, thus, to facilitate extensive surgery. METHODS: A hospital-based case-control study was carried out to identify the effect of induction chemotherapy on breast cancer. 49 patients with breast cancer were treated with initial chemotherapy between October 1986 and June 1998. 43 patients were treated with three courses of the CMF regimen (cyclophosphamide and metho trexate and 5-fluorouracil), four patients with three courses of the FEC regimen (5-fluorouracil, epirubicine and cyclophosphamide), two patients with three courses of the FAC regimen (5-fluorouracil, adriamycin and cyclophosphamide). RESULTS: The response, rate to induction chemotherapy was 83.7% including 4% complete response, and there were no significant differences in response rates according to the chemo therapy regimen. At a mean follow-up of 51.9 months, recurrence and distant metastasis were observed in 32.7% and 18.4% of the patients, respectively. The five-year disease- free survival rate of the patients in the induction group was lower than that of the patients in the control group (35.5+/-8.7% versus 59.9+/-9.0%), but the five-year overall survival rate in the induction group was higher than control group (88.7 5.3% versus 76.9+/-6.6%). CONCLUSIONS: Preoperative induction chemotherapy is a useful treatment option for patients with locally advanced breast cancer. Also, there is an improvement in the five-year overall survival rate for patients in the induction chemotherapy group compared with that for patients in the age- and stage-controlled postoperative adjuvant chemotherapy group.
Subject(s)
Humans , Breast Neoplasms , Breast , Case-Control Studies , Chemotherapy, Adjuvant , Doxorubicin , Drug Therapy , Epirubicin , Follow-Up Studies , Induction Chemotherapy , Neoplasm Metastasis , Recurrence , Survival RateABSTRACT
BACKGROUND: Phyllodes tumors are relatively rare fibroepithelial tumors of the breast. There are no strict criteria for the classification of benign and malignant phyllodes tumor. The recurrence rate is relatively high, and no single criterion for predicting recurrence has yet been established. In an attempt to define the clinical features and their histopathological correlations, we have reviewed a total of 38 patients with original pathological diagnoses of cystosarcoma phyllodes and phyllodes tumors. METHODS: Thirty-eight cases of phyllodes tumors were reviewed. Microscopic slides were re-examined and reclassified using newly defined histologic criteria which were modified from those of Pietruszka et al. The pathologic criteria examined were the number of mitoses, the invasiveness of the tumor border, the stromal overgrowth, and the stromal cellular pleomorphism. The clinical features evaluated included age, incidence, clinical manifestation, surgical procedure, and recurrence. RESULTS: The mean age was 34.9 +/- 12.4 years with the peak age between 40 and 49. The yearly incidence trend showed a slow increase. Twenty-three tumors (62%) fullfilled the criteria for benign phyllodes tumors, seven tumors (19%) were borderline, and seven tumors (19%) were malignant. The mean ages of the patients with benign, borderline, and malignant phyllodes tumors were 31.9, 39.1, and 40.9 years, respectively. The sizes of the benign phyllodes tumors were smaller than those of the borderline or the malignant tumors. Recurrence was found after initial excision in two patients with benign phyllodes tumors. However, after an initial wide excision, there was no recurrence in five patients with borderline and malignant tumors. CONCLUSIONS: There were no dependable histopathological features to predict recurrence; that is, histologic type does not influence the rate of recurrence or the prognosis after an adequate excision.
Subject(s)
Humans , Breast , Classification , Diagnosis , Incidence , Mitosis , Phyllodes Tumor , Prognosis , RecurrenceABSTRACT
A hospit based case-control study was carried out to identify reproductive risk factors for breast cancer. Four-hundred-eighty-one breast cancer patients and 491 age-matched control patients examined between 1988 and 1994 were included in this study. Eleven reproductive risk factors were selected for comparison using cross tabulation and chi-square method, and univariate and multivariate logistic regression analyses were used to evaluate the odds ratios for the risk of breast cancer. The mean age of the breast cancer patients in this study was 47.5 years. Analyses demonstrated that nulliparous women had a higher risk for breast cancer (odds ratio 3.46, p=0.03) than women with 1-4 live births, and women who had an abortion during their first pregnancy had a slightly increased risk (odds ratio 1.86, p<0.01) than women who had normal deliveries, but the age at menarche and menopause did not have any influence on the risk of developing breast cancer. Although there were similarities in risk factors between Western women and women in this study, such as a higher risk for nulliparous women, two key factors were found to contrast with those of Western women. First the mean age of breast cancer patients in this study was only 47.5 years. Second, the age of menarche and menopause of these women did not have any influence on the risk of breast cancer.
Subject(s)
Female , Humans , Pregnancy , Breast Neoplasms , Breast , Case-Control Studies , Live Birth , Logistic Models , Menarche , Menopause , Odds Ratio , Risk FactorsABSTRACT
PURPOSE: Reclassfication of the medullary carcinoma using a strict histologic criteria and analysis of the clinical and pathological characteristics of the medullary carcinoma. MATERIAL & METHODS: Thirty-seven cases of the breast carcinoma originally diagnosed as medullary carcinoma were reviewed. One to ten microscopic slides of each case were reexamined and reclassified using the strictly defined histologic criteria defined by Ridolfi et al. Tumors were excluded from the category of the typical medullary carcinoma (TMC) on the basis of presence of glandular features, focal marginal infiltrations, or sparse mononuclear infiltrations. Tumor with two or more atypical features, or extensive marginal infiltrations, no mononuclear cell infiltration and/or less than 75% syncytial growth were classified as infiltrating ductal carcinoma with medullary feature (IDC). A predominantly syncytial growth pattern (75% or more) was requisite for inclusion in both TMC and atypical medullary carcinomas (AMC). RESULTS: Twenty-two tumors (60%) fulfilled the criteria for TMC, and 12 tumors (32%) were AMC and three tumors (8%) were IDC. TMC occupied 3.1% of breast cancer. The mean age of patients with TMC was 45.4+/-11.2 years and the average size of the tumor in TMC was slightly larger than that of breast cancer in general, although not statistically significant. The frequency of lymph node metastasis in TMC was similar to breast cancer in general. Five year survival of patients with TMC was 95.5% which was significantly better than breast cancer in general. CONCLUSION: The TMC occupied 3.1% of breast cancer. The mean age of patient, tumor size and lymphnode metastasis were not different from that of breast cancer but 5 years survival of patient with TMC was significantly better than breast cancer in general.