Ginecomastia: Consideraciones médicas y quirúrgicas en cirugía general / Gynecomastia: Medical and surgical considerations in general surgery

La ginecomastia, definida como el crecimiento del tejido glandular mamario en los hombres, aparece desde la etapa neonatal hasta la senil, puede ser unilateral o bilateral, y es de causa multifactorial, incluyendo aquellos pacientes asociados al uso de medicamentos, donde predomina un desbalance en la relación testosterona­estrógeno. Relativamente, la idiopática es la más frecuente. La mayoría involucionan espontáneamente, las neonatales por perdida del influjo transplacentario en las primeras semanas, y las puberales entre 12 a 24 meses. Se presenta como un aumento del tamaño mamario, asintomático o con hipersensibilidad por inflamación durante el crecimiento del tejido fibroglandular mamario, con una repercusión psicológica enorme, sobre todo en la etapa de la adolescencia. El estudio y manejo es interdisciplinario y se ofrece de acuerdo con las condiciones y la etiología. Aquellos pacientes púberes en quienes no involuciona reciben tratamientos médicos, o tratamientos quirúrgicos cuando falla la terapéutica o hay presión social, e incluso radioterapia en casos donde desarrollan ginecomastia con hipersensibilidad al tratamiento hormonal del cáncer de próstata

Gynecomastia, defined as the growth of breast glandular tissue in men, appears from the neonatal to senile stage, can be unilateral or bilateral, and is of multifactorial cause, including those patients associated with the use of medications, where an imbalance in the testosterone ­ estrogen ratio. Relatively, idiopathic is the most common. Most regress spontaneously, neonatals due to loss of transplacental influx in the first weeks, and pubertal ones between 12 to 24 months. It presents as an increase in breast size, asymptomatic or with hypersensitivity due to inflammation during the growth of the mammary fibroglandular tissue, with an enormous psychological repercussion, especially in adolescence. The study and management is interdisciplinary and offered according to conditions and etiology. Those pubertal patients in whom it does not regress receive medical treatments, or surgical treatments when therapy fails or there is social pressure, and even radiotherapy in cases where they develop gynecomastia with hypersensitivity to hormonal treatment of prostate cancer

Additional lesions seen in magnetic resonance imaging of breast cancer patients: the role of second-look ultrasound and imaging-guided interventions

PURPOSE: The purpose of this study was to investigate the final outcomes of magnetic resonance imaging (MRI)-identified additional lesions (MRALs) in breast cancer patients and the role of second-look ultrasound (SLUS) and imaging-guided interventions. METHODS: We analyzed breast cancer patients with MRALs on preoperative MRI between January and June 2012. MRALs were defined as additional lesions suspected on MRI but not suspected on mammograms or ultrasound. The malignancy rate of MRALs, MRI-based Breast Imaging Reporting and Database System (BI-RADS) category, positional relationship with the index cancer, MRI-concordant lesion visibility on SLUS, performance of imaging-guided interventions, and total mastectomy (TM) rates were evaluated for the confirmed lesions. RESULTS: Among the 119 confirmed lesions, SLUS and imaging-guided interventions were performed in 94 (79.0%) and 82 cases (68.9%), respectively. The malignancy rate was 68.1% (81 of 119), and was significantly higher in BI-RADS 4C-5 lesions than in 4A-4B lesions (94.6% vs. 56.1%, P < 0.01) and in ipsilateral same-quadrant lesions than in contralateral lesions (84.2% vs. 33.3%, P < 0.01). The lesion visibility rate on SLUS was 90.4%. The malignancy rate was not significantly different according to lesion visibility on SLUS. The TM rate in the 98 cases with ipsilateral MRALs was 37.8%, while it was significantly lower in patients who underwent an imaging-guided intervention than in those who did not (27.9% vs. 54.1%, P=0.017). CONCLUSION: MRALs show a high probability of malignancy, especially if they are ipsilateral. SLUS and imaging-guided interventions can eliminate many unnecessary TMs.

Early Rehabilitation after Total Mastectomy and Immediate Reconstruction with Tissue Expander Insertion in Breast Cancer Patients: A Retrospective Case-control Study / 한국유방암학회지

PURPOSE: To prevent surgical site complications, many plastic surgeons use the so-called “conventional protocol,” which immobilizes the shoulder and upper arm for 1 month after reconstruction. In an effort to improve the shoulder mobility of patients who received immediate breast reconstruction with tissue expander insertion (TEI), we introduced an early rehabilitation protocol with a short-term immobilization period of 2 weeks. This study aims to compare this early rehabilitation exercise program with the conventional protocol and to determine factors affecting shoulder mobility and quality of life of patients after immediate breast reconstruction. METHODS: A total of 115 patients with breast cancer who underwent reconstructive surgery were retrospectively reviewed. For patients who underwent reconstruction before January 2017, the conventional protocol was followed with immobilization of their shoulder for over 4 weeks. Patients who underwent reconstruction after January 2017 were educated to undergo a self-exercise program after a short-term immobilization period of 2 weeks. We compared shoulder mobility, pain, quality of life, and complications at postoperative 1 and 2 months between the groups. RESULTS: Patients who received early rehabilitation showed greater shoulder flexion and abduction range at postoperative 1 month than those who received the conventional protocol. This increased shoulder abduction range continued until postoperative 2 months. There were no significant surgical site problems in both groups during the 2 months of follow-up. CONCLUSION: To enhance the recovery of shoulder mobility, early rehabilitation with a shorter immobilization period should be recommended to patients with breast cancer undergoing reconstruction surgery with TEI. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03541161

Effects of Illness Perception and Health Beliefs on the Quality of Life of Breast Cancer Patients in the Yanbian Area of China

PURPOSE: This study aimed to identify the effects of illness perception and health beliefs on the quality of life (QOL) of breast cancer patients. METHODS: A cross-sectional study was conducted. Data were collected using questionnaires administered to 200 patients admitted for chemotherapy after a partial or total mastectomy at a university hospital in Yanji City. The data were analyzed using t-tests, analysis of variance, Pearson's correlation coefficients, and hierarchical regression analysis. RESULTS: The QOL of the breast cancer patients was significantly correlated with health beliefs and a subfactor of illness perception. The significant factors influencing QOL were understanding illness and feeling threatened, accounting for 31.7% of the variance in QOL. CONCLUSION: Illness perception of breast cancer patients had a negative influence on QOL, whereas health beliefs affected it positively. An implication of this study's findings is that interventions to reduce negative illness perception can improve the QOL among breast cancer patients.

Multimodal analgesia with multiple intermittent doses of erector spinae plane block through a catheter after total mastectomy: a retrospective observational study / 대한통증학회지

BACKGROUND: Although case reports have suggested that the erector spinae plane block (ESPB) may help analgesia for patients after breast surgery, no study to date has assessed its effectiveness. This retrospective observational study analyzed the analgesic effects of the ESPB after total mastectomy. METHODS: Forty-eight patients were divided into an ESPB group (n = 20) and a control group (n = 28). Twenty patients in the control group were selected by their propensity score matching the twenty patients in the ESPB group. Patients in the ESPB group were injected with 30 mL 0.375% ropivacaine, followed by catheter insertion for further injections of local anesthetics every 12 hours. Primarily, total fentanyl consumption was compared between the two groups during the first 24 hours postoperatively. Secondary outcomes included pain intensity levels (visual analogue scale) and incidence of postoperative nausea and vomiting (PONV). RESULTS: Median cumulative fentanyl consumption during the first 24 hours was significantly lower in the ESPB (33.0 μg; interquartile range [IQR], 27.0–69.5 μg) than in the control group (92.8 μg; IQR, 40.0–155.0 μg) (P = 0.004). Pain level in the early postoperative stage (<3 hr) and incidence of PONV (0% vs. 55%) were also significantly lower in the ESPB group compared to the control (P = 0.001). CONCLUSIONS: Intermittent ESPB after total mastectomy reduces fentanyl consumption and early postoperative pain. ESPB is a good option for multimodal analgesia after breast surgery.

Reconstrução mamária com implantes e tela sintética / Breast reconstruction with implants and synthetic mesh

Introdução: As mastectomias com reconstruções mamárias imediatas podem proteger a paciente de um período de estresse psicossocial, imagem corporal negativa e insatisfação sexual. O advento e utilização de novos materiais como os implantes, expansores e matrizes dérmicas acelulares também contribuíram para o sucesso das reconstruções mamárias. Porém, o uso das matrizes dérmicas acelulares é restrito no Brasil pela legislação e seu alto custo. O objetivo do estudo foi relatar a experiência do autor na reconstrução mamária com implantes e tela sintética como uma alternativa às matrizes dérmicas acelulares. Método: Foi realizada uma análise retrospectiva de 12 pacientes consecutivas (20 mamas reconstruídas) que foram submetidas à reconstrução mamária imediata ou tardia pela técnica descrita com implantes e tela sintética, entre novembro de 2015 e dezembro de 2016. Resultados: Doze pacientes (20 mamas) foram operadas pela técnica apresentada no estudo. O tempo médio de follow-up foi de 14 meses. Nesta série, 15% apresentaram complicações menores como hematoma, deiscência de sutura e rippling. O número de complicações, apesar do número restrito de casos, é compatível com a literatura. O grau de satisfação global com a cirurgia foi, em média, de 75,2 pontos em uma escala de 0-100, sendo a nota mais alta atribuída à aparência das mamas (85 pontos). Conclusão: A reconstrução mamária com implantes e tela sintética se mostrou uma técnica com baixo índice de complicações, alto grau de satisfação das pacientes com o resultado estético e com menores custos em relação ao uso de matrizes dérmicas acelulares.

Introduction: Mastectomy with immediate breast reconstruction may prevent patients from experiencing a period of psychosocial stress, negative body image, and sexual dissatisfaction. The advent and implementation of novel materials such as implants, expanders, and acellular dermal matrices have also contributed to the success of breast reconstruction procedures. However, the use of acellular dermal matrices in Brazil is restricted by law and by their high cost. The objective of the present study was to report the author's experience in breast reconstruction with implants and synthetic mesh as an alternative to acellular dermal matrices. Method: This was a retrospective analysis of 12 consecutive patients (20 reconstructed breasts) who underwent immediate or delayed breast reconstruction using the described technique with implants and synthetic mesh between November 2015 and December 2016. Results: Twelve patients (20 breasts) were operated on using the technique described in this report. The mean time of follow-up was 14 months. In this series, 15% of patients had minor complications, including hematoma, suture dehiscence, and rippling. The rate of complications was similar to the rates reported in the literature, despite the limited number of cases. The average degree of overall satisfaction with the surgery was 75.2 points on a scale of 0-100, and the highest score was given to breast appearance (85 points). Conclusion: Breast reconstruction with implants and synthetic mesh was shown to be a technique with a low rate of complications, high degree of patient satisfaction with the cosmetic result, and decreased cost relative to acellular dermal matrices.

Erector Spinae Plane Block for Effective Analgesia after Total Mastectomy with Sentinel or Axillary Lymph Node Dissection: a Report of Three Cases

No abstract available.

A simple calculation for the preoperative estimation of transverse rectus abdominis myocutaneous free flap volume in 2-stage breast reconstruction using a tissue expander

BACKGROUND: Flap volume is an important factor for obtaining satisfactory symmetry in breast reconstruction with a transverse rectus abdominis myocutaneous (TRAM) free flap. We aimed to develop an easy and simple method to estimate flap volume. METHODS: We performed a preoperative estimation of the TRAM flap volume in five patients with breast cancer who underwent 2-stage breast reconstruction following an immediate tissue expander operation after a simple mastectomy. We measured the height and width of each flap zone using a ruler and measured the tissue thickness by ultrasound. The volume of each zone, approximated as a triangular or square prism, was then calculated. The zone volumes were summed to obtain the total calculated volume of the TRAM flap. We then determined the width of zone II, so that the calculated flap volume was equal to the required flap volume (1.2×1.05×the weight of the resected mastectomy tissue). The TRAM flap was transferred vertically so that zone III was located on the upper side, and zone II was trimmed in the sitting position after vascular anastomosis. We compared the estimated flap width of zone II (=X) with the actual flap width of zone II. RESULTS: X was similar to the actual measured width. Accurate volume replacement with the TRAM flap resulted in good symmetry in all cases. CONCLUSIONS: The volume of a free TRAM flap can be straightforwardly estimated preoperatively using the method presented here, with ultrasound, ruler, and simple calculations, and this technique may help reduced the time required for precise flap tailoring.

Predictors of Positive or Close Surgical Margins in Breast-Conserving Surgery for Patients with Breast Cancer

PURPOSE: This study aimed to determine the clinical and pathological factors associated with a higher rate of positive or close margins after breast-conserving surgery (BCS) by comparing these patients to patients with a negative margin. The second aim was to evaluate intraoperative resection margin status and reoperation rates for margin control in patients who underwent BCS. METHODS: We reviewed the clinical and pathological data of all women diagnosed with invasive breast carcinoma (IBC) and ductal carcinoma in situ (DCIS) at our institution between January 2006 and December 2016. RESULTS: During the 10-year study period, 785 patients were diagnosed with either IBC or DCIS, and 402 of these patients had undergone a total mastectomy as the primary treatment. The remaining 383 patients who underwent BCS were included in the final analysis. Of these, 100 patients (26.1%) had intraoperative positive or close margins. The remaining 283 patients (73.9%) had a negative margin intraoperatively, but 32 of these patients had positive or close margins on permanent sections. In the multivariate analyses, microcalcifications on mammograms (vs. none; odds ratio [OR], 1.911; 95% confidence interval [CI], 1.156−3.160), in situ carcinomas larger than 2.0 cm (vs. ≤2.0 cm; OR, 3.106; 95% CI, 1.193−8.086), and lumpectomy (vs. quadrantectomy; OR, 2.863; 95% CI, 1.268−6.622) showed a significant association with a positive or close surgical margins. Patients with intraoperative positive or close margins underwent more reoperation than those with negative margins (5.0% vs. 2.8%). CONCLUSION: After BCS, microcalcifications on mammograms, large-sized in situ carcinomas, and lumpectomy were more likely to have positive or close margins.

Trends in breast reconstruction: Implications for the National Health Insurance Service

BACKGROUND: Breast reconstruction has become more common as mastectomy has become more frequent. In Korea, the National Health Insurance Service (NHIS) began covering breast reconstruction in April 2015. This study aimed to investigate trends in mastectomy and breast reconstruction over the past 10 years and to evaluate the impact of NHIS coverage on breast reconstruction. METHODS: Nationwide data regarding mastectomy and breast reconstruction were collected from the Korean Breast Cancer Society registry database. Multiple variables were analyzed in the records of patients who underwent breast reconstruction from January 2005 to March 2017 at a single institution. RESULTS: At Seoul National University Hospital, the total number of reconstruction cases increased 13-fold from 2005 to 2016. The proportion of immediate breast reconstruction (IBR) cases out of all cases of total mastectomy increased from 4% in 2005 to 52.0% in 2016. The proportion of delayed breast reconstruction (DBR) cases out of all cases of breast reconstruction and the overall number of DBR cases increased from 8.8% (20 cases) in 2012 to 18.3% (76 cases) in 2016. After NHIS coverage was initiated, the proportions of IBR and DBR showed statistically significant increases (P < 0.05). Among the IBR cases, the percentage of prosthesis-based reconstructions increased significantly (P < 0.05), but this trend was not found with DBR. Total mastectomy became significantly more common after the expansion of NHIS coverage (P < 0.05). CONCLUSIONS: Over the last decade, there has been an increase in mastectomy and breast reconstruction, and the pace of increase accelerated after the expansion of NHIS coverage. It is expected that breast reconstruction will be a routine option for patients with breast cancer under the NHIS.

Leiomyosarcoma of the breast in a 48-year old male

@#<p style="text-align: justify;">This is a case of a 48-year old male with left-sided 9.0cm x 8.0cm exophytic, foul-smelling, bleeding breast mass. Core needle biopsy revealed a malignant phylloides tumor. He underwent total mastectomy and final histopathology showed a primary breast leiomyosarcoma staining positive for smooth muscle actin. A review of cases of primary breast leiomyosarcoma was done and to date, there are only 70 documented. The treatment of breast sarcomas still follows those strategies for soft tissue sarcomas in other locations. An important prognosticating factor is complete resection on initial treatment. Lymph node metastasis is rare for sarcomas in general.</p><p style="text-align: justify;"> </p>

Enfermedad de Paget de la mama en una paciente suazí / Paget´s disease of the breast in a suazi patient

Se describe el caso clínico de una paciente de 63 años de edad, quien acudió a la consulta de Oncología del Hospital Gubernamental de Mbabane, en Suazilandia, por presentar una lesión ulcerada en el pezón de la mama izquierda desde hacía 1 año. Luego de realizarle una biopsia por escisión, que reveló la presencia de la enfermedad de Paget, clasificada en el estadio 0 según los resultados de los exámenes complementarios, se decidió remitirla al Servicio de Cirugía donde le practicaron una mastectomía simple. La paciente mostró buena evolución clínica y se mantenía estable hasta la última consulta en que fuera asistida

The case report of a 63 years patient who went to the Oncology Service of the Government Hospital of Mbabane, in Swaziland is described, due to an ulcerated lesion in the nipple of the left breast for 1 year. After carrying out an excision biopsy that revealed the presence of the Paget´s disease, classified in the stage 0 according to the results of the complementary tests, she was referred to the Surgery Service where a simple mastectomy was carried out. The patient showed good clinical course and she remained stable until the last appointment when she was assisted

Correlação entre as escalas analógica visual, de Glasgow, Colorado e Melbourne na avaliação de dor pós-operatória em cadelas submetidas à mastectomia total unilateral / Correlation between visual analog scales, Glasgow, Colorado and Melbourne in the evaluation of postoperative pain in dogs undergoing total unilateral mastectomy

Objetivou-se correlacionar a necessidade de resgate analgésico pós-operatório por meio das escalas analógica visual (EVA), de Glasgow, Colorado e Melbourne, por meio de um avaliador experiente (AE) e outro não experiente (ANE), em cadelas submetidas à mastectomia unilateral total. Foram utilizadas 24 cadelas, hígidas, internadas 24 horas antes do procedimento cirúrgico, para avaliação do seu comportamento, com o auxílio das escalas descritas acima no momento basal (M0). Foram pré-medicadas com acepromazina e morfina (0,02 e 0,5mg/kg) e induzidas à anestesia geral com propofol (4mg/kg), mantidas em plano anestésico com CAM de isoflurano 1%. A manutenção analgésica transoperatória foi realizada com cetamina e fentanil (10µg/kg/min e 10µg/kg/h). As demais avaliações ocorreram em uma, duas, quatro, seis, oito, 12 e 24 horas de pós-operatório, sendo os resgates realizados com morfina (0,5mg/kg), pela via intramuscular, quando fosse observada uma pontuação maior ou igual a 50, seis, dois e nove pontos, respectivamente, para as escalas descritas, quando observada pelo AE e quando ao menos duas das escalas demonstrassem esses valores. Houve aumento dos escores de dor do M1 ao M12 para o AE e para o ANE para a EVA. Na análise de Colorado, maiores pontuações de dor ocorreram em relação ao M0 entre o M2 e o M8 para o AE e do M1 ao M12 para o ANE. Na análise de Glasgow, maiores escores foram detectados entre o M1 e o M12 para o AE e do M1 ao M24 para o ANE. E para a de Melbourne, maiores valores foram observados do M1 e do M24 para o AE e o ANE. A melhor correlação entre as escalas foi de 0,775 entre Glasgow e Colorado e entre os avaliadores de 0,925 para a Glasgow. Conclui-se que a escala de Glasgow apresentou-se mais sensível para detectar resgates analgésicos em cadelas submetidas à mastectomia total unilateral, que a inexperiência do avaliador não compromete a qualidade das avaliações de dor e sugere-se reduzir a pontuação da EVA e Melbourne para aumentar a sua capacidade em detectar resgates analgésicos pós-operatórios.(AU)

The objective was to relate the need for analgesic postoperative recovery through Visual Analogue Scale (VAS), Glasgow, Colorado and Melbourne, by an experienced assessor (AE) and other non-experienced ones (ANE), in bitches undergoing total unilateral mastectomy. Otherwise healthy bitches, a total of 24, were admitted 24 hours before the surgical procedure for assessment of behavior with the help of the above scales to determine the baseline (M0) moment. They were pre-medicated with morphine and acepromazine (0,02 and 0,5 mg/kg) and general anesthesia was induced with propofol (4 mg/kg) and maintained with isoflurane at 1% MAC. The analgesic during surgery was maintained with ketamine and fentanyl (10 µg/kg/min and 10 µg/kg/h). The other evaluations were performed at 1, 2, 4, 6, 8, 12 and 24 hours postoperatively, and redemptions made with intramuscular morphine (0,5 mg/kg) when a greater than or equal score of 50, 6, 2 and 9 points was observed respectively for the described ranges, as observed by the AE and when at least two scales demonstrated these values. There was an increase of M1 to M12 pain scores for AE and the ANE for VAS. In Colorado analyses, the highest painful scores occurred in relation to M0 between M2 and M8 to the AE and M1 to M12 for ANE. In Glasgow analyses, higher scores were detected between M1 to M12 for AE and M1 to M24 for ANE. And for the Melbourne highest values were observed in M1 and M24 for AE and ANE. The best correlation between the scales was 0,775 between Glasgow and Colorado and of the evaluators of 0,925 to Glasgow. The Glasgow scale was shown to be more sensitive to detect painkiller redemptions in dogs undergoing total unilateral mastectomy, the inexperience of the appraiser does not compromise the quality of painful reviews, and it is suggested to reduce the score VAS and Melbourne to increase it is ability to detect rescue postoperative analgesics.(AU)

Basic Facts of Breast Cancer in Korea in 2014: The 10-Year Overall Survival Progress / 한국유방암학회지

We, the Korean Breast Cancer Society (KBCS), present the facts and the trends of breast cancer in Korea in 2014. Data on the total number of newly diagnosed patients was obtained from the Korea Central Cancer Registry database, other data were collected from the KBCS online registry database, and the overall survival data of patients were updated from Statistics Korea. A total of 21,484 female patients were newly diagnosed with breast cancer in 2014. The crude incidence rate and the age-standardized incidence rate (ASR) of breast cancer in female patients, including carcinoma in situ, were 83.4 cases and 63.9 cases per 100,000 women, respectively. The ASR showed an annual increase of 6.1% from 1999 to 2014; however, although the increase of the ASR had slowed since 2008, the incidence rate itself continuously increased. The proportion of early breast cancer increased consistently, and the pathological features changed accordingly. While breast-conserving surgery was mainly performed, the proportion of total mastectomy was slightly increased. The total number of breast reconstruction surgeries increased rapidly. The 5-year and 10-year overall survival rates for all stages of breast cancer patients were 91.2% and 84.8%, respectively. The overall survival rate of Korean patients with breast cancer was extremely high, compared with other developed countries. Thus, we consider that the clinical characteristics of breast cancer have changed over the past decade. A nationwide registry data will contribute to a better understanding of the characteristics of breast cancer in Korea.

Oncologic Outcomes after Immediate Breast Reconstruction Following Total Mastectomy in Patients with Breast Cancer: A Matched Case-Control Study / 한국유방암학회지

PURPOSE: The use of immediate breast reconstruction (IBR) following total mastectomy (TM) has increased markedly in patients with breast cancer. As the indications for IBR have been broadened and more breast-conserving surgery-eligible patients are undergoing IBR, comparing the oncologic safety between TM only and IBR following TM becomes more difficult. This study aimed to analyze the oncologic outcomes between TM only and IBR following TM via a matched case-control methodology. METHODS: A retrospective review was conducted to identify all patients who underwent TM between 2008 and 2014. We excluded patients who underwent neoadjuvant chemotherapy, including palliative chemotherapy, and had a follow-up duration 0.050). Matching was considered successful for the matching variables and other factors, such as family history, histology, multiplicity, and lymphovascular invasion. There were no significant differences in overall survival (log-rank p=0.454), disease-free survival (log-rank p=0.186), local recurrence-free survival (log-rank p=0.114), or distant metastasis-free survival rates (logrank p=0.537) between the two groups. CONCLUSION: Our results suggest that IBR following TM is a feasible treatment option for patients with breast cancer.

Clinical significance of the lymph node ratio in N1 breast cancer

PURPOSE: The purpose of this study was to evaluate the prognostic value of the lymph node ratio (LNR), which was defined as the proportion of involved nodes of all dissected nodes, in pN1 breast cancer. MATERIALS AND METHODS: We retrospectively analyzed the clinical data of patients with pN1 breast cancer (N = 144) treated at Keimyung University Dongsan Medical Center, Daegu, Korea between 2001 and 2010. The median age was 46 years (range, 27 to 66 years). The LNR was 0.01–0.15 (low LNR) in 130 patients and >0.15 (high LNR) in 14 patients. Sixty-five patients (45.1%) had T1 tumors, 74 (51.4%) had T2 tumors, and 5 (3.5%) had T3 tumors. Eighty-eight patients (61.1%) underwent total mastectomy and 56 (38.9%) underwent partial mastectomy. Fifty-nine patients (41.0%) underwent radiotherapy and 12 (8.3%) underwent regional radiotherapy. The median follow-up period was 65 months. RESULTS: The 5- and 10-year disease-free survival (DFS) rates were 92.7% and 82.4%, respectively. Univariate analyses revealed that high LNR (p = 0.004), total mastectomy (p = 0.006), no local radiotherapy (p = 0.036), and stage T2 or T3 (p = 0.010) were associated with worse DFS. In multivariable analysis, only high LNR (p = 0.015) was associated with worse DFS. CONCLUSION: High LNR is an independent prognostic factor in pN1 breast cancer and could be an indication for adjuvant radiotherapy in these patients.

Clinical significance of the lymph node ratio in N1 breast cancer

PURPOSE: The purpose of this study was to evaluate the prognostic value of the lymph node ratio (LNR), which was defined as the proportion of involved nodes of all dissected nodes, in pN1 breast cancer. MATERIALS AND METHODS: We retrospectively analyzed the clinical data of patients with pN1 breast cancer (N = 144) treated at Keimyung University Dongsan Medical Center, Daegu, Korea between 2001 and 2010. The median age was 46 years (range, 27 to 66 years). The LNR was 0.01–0.15 (low LNR) in 130 patients and >0.15 (high LNR) in 14 patients. Sixty-five patients (45.1%) had T1 tumors, 74 (51.4%) had T2 tumors, and 5 (3.5%) had T3 tumors. Eighty-eight patients (61.1%) underwent total mastectomy and 56 (38.9%) underwent partial mastectomy. Fifty-nine patients (41.0%) underwent radiotherapy and 12 (8.3%) underwent regional radiotherapy. The median follow-up period was 65 months. RESULTS: The 5- and 10-year disease-free survival (DFS) rates were 92.7% and 82.4%, respectively. Univariate analyses revealed that high LNR (p = 0.004), total mastectomy (p = 0.006), no local radiotherapy (p = 0.036), and stage T2 or T3 (p = 0.010) were associated with worse DFS. In multivariable analysis, only high LNR (p = 0.015) was associated with worse DFS. CONCLUSION: High LNR is an independent prognostic factor in pN1 breast cancer and could be an indication for adjuvant radiotherapy in these patients.

Retrospective Analysis of Idiopathic Granulomatous Mastitis: Its Diagnosis and Treatment

PURPOSE: Idiopathic granulomatous mastitis (IGM) is a rare disease characterized by noncaseating granulomatous inflammation of unknown origin. Because its clinical features are similar to those of other type of mastitis or breast cancer, accurate diagnosis and adequate treatment are essential to ensuring a short symptom duration and improving the quality of life. METHODS: The clinical, radiologic, pathophysiologic, and treatment data for 43 patients diagnosed with IGM at the Breast Cancer Center of Gachon University Gil Medical Center between 2005 and 2016 were retrospectively reviewed. RESULTS: Forty-one patients (95.34%) were of childbearing age, seven (16.27%) had a history of lactation, and five (11.62%) had a history of oral contraceptive use. In terms of radiologic findings, 30 patients (69.77%) were diagnosed with Breast Imaging-Reporting and Data System category ≥4A lesions. Corticosteroid therapy was administered to 36 patients (83.72%); overall, 18 patients (41.86%) did not require surgery and 25 patients (58.13%) underwent partial or total mastectomy. Twelve patients (27.90%) developed recurrence. CONCLUSION: IGM is a benign disease that can be misdiagnosed as breast cancer because of its similar clinical and radiologic findings. Proper diagnosis and treatment can be difficult, but delays may lead to prolonged pain and cosmetic and socioeconomic problems. Efforts should be aimed at establishing the cause of IGM and developing efficient protocols for its diagnosis and treatment.

Actual Conversion Rate from Total Mastectomy to Breast Conservation after Neoadjuvant Chemotherapy for Stages II–III Breast Cancer Patients

PURPOSE: Neoadjuvant chemotherapy (NCT) is a treatment modality that increases the breast-conserving rate in breast cancer. This prospective study was performed to evaluate the actual breast-conserving rate using NCT in a clinical setting in a single institution. METHODS: Between 2014 and 2015, 265 patients who were scheduled to receive NCT and surgery were enrolled in this study. Patients were classified into three groups based on the immunohistochemical results of estrogen receptor (ER)/progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2): ER or PR positive (luminal), ER/PR negative and HER2 positive (HER2+), and triple-negative breast cancer (TNBC). Before starting and immediately after completing NCT, a surgeon decided if breast-conserving surgery (BCS) or total mastectomy (TM) should be performed. We analyzed the rate of type of surgery performed. RESULTS: Before administering NCT, 107 patients (40.4%) and 158 patients (59.6%) were candidates for BCS and TM, respectively. Of the 158 patients, 61 were eligible for BCS after chemotherapy, with a conversion rate of 38.6%. NCT increased the BCS eligible rate from 40.4% to 62.6%. Of the 61 patients, 53 chose to undergo BCS, and BCS was successful in 46 (86.8%). Of the 107 BCS candidates at baseline, 100 patents finally underwent BCS (93.5%). According to the subtype, the conversion rates were 35.4%, 50.0%, and 40.5% for luminal, HER2+, and TNBC groups, respectively. CONCLUSION: NCT increased the eligibility for BCS from 40.4% to 62.6% in a clinical setting. This benefit is similar to that observed in other clinical trials.

Oncologic safety of breast-conserving surgery in breast cancer patients under the age of 35

PURPOSE: Breast-conserving surgery (BCS) shows no difference in survival rates compared with total mastectomy. So, BCS is considered standard breast surgery with modified radical mastectomy. But in patients who received BCS, there is a risk of local recurrence in their long term follow up periods. Especially, BCS of young age is controversial regarding oncologic safety because of local recurrence. In this study, we struggle to confirm the oncologic safety of BCS compared with total mastectomy under the age of 35 in South Korea.METHODS: All patients who underwent surgery for breast cancer were 5,366 at Severance Hospital, Yonsei University Health System, from January 1981 to April 2008. Of them, patients younger than 35 years old were 547. We excluded patients who received chemotherapy before surgery and included only stage 1 and 2 patients who identified through the pathology after surgery. Finally, we got 367 patients; total mastectomy was performed in 245 and BCS, in 122. We compared clinicopathological characteristics and oncologic outcomes between two groups using SPSS program.RESULTS: In patients received BCS, a local recurrence rate was 7.7% at 5 years and up to 20.3% at 10 years. In patients received total mastectomy, a local recurrence rate was 1.9% over 10 years (P<0.001). However, there was no difference in 5-year and 10-year overall survival rates between two groups (P=0.689). Adjuvant chemotherapy decreased local recurrence rate in BCS patients (P=0.019).CONCLUSION: So, we concluded that BCS under the age of 35 has oncologic safety with undergoing chemotherapy.