Predictive factors of central lymph node metastasis in papillary thyroid carcinoma

PURPOSE: The aim of this study was to evaluate the correlation between central lymph node (CLN) metastasis and clinicopathologic characteristics of papillary thyroid cancer (PTC). In addition, we investigated the incidence and risk factors for contralateral CLN metastasis in unilateral PTC. This study suggests the appropriate surgical extent for CLN dissection. METHODS: A prospective study of 500 patients with PTC who underwent total thyroidectomy and prophylactic bilateral CLN dissection was conducted. RESULTS: Of 500 patients, 255 had CLN metastases. The rate of CLN metastasis was considerably higher in cases of younger patients ( or =1 cm) (P = 0.019; OR, 4.440) and with ipsilateral CLN metastasis (P = 0.047; OR, 2.613). CONCLUSION: Younger age (<45 years old) and maximal tumor size greater than 1 cm were independent risk factors for CLN metastasis. Maximal tumor size greater than 1 cm and presence of ipsilateral CLN macrometastasis were independent risk factors for contralateral CLN metastasis. Therefore, both CLN dissections should be considered for unilateral PTC with a maximal tumor size greater than 1 cm or presence of ipsilateral CLN macrometastasis.

Medullary and Papillary Thyroid Carcinoma as a Collision Tumor: Report of Five Cases / 대한내분비외과학회지

Medullary thyroid carcinoma and papillary thyroid carcinoma are different subtypes of thyroid carcinoma. The concomitant occurrence of medullary thyroid carcinoma and papillary thyroid carcinoma as a collision tumor is rare. We describe five cases of medullary and papillary thyroid carcinoma as a collision tumor. Four women and one man underwent thyroidectomy for treatment of thyroid cancer. Collision tumor was then detected by histopathologic finding. Genetic testing, point mutation of the BRAF gene or mutation of the RET gene was performed in three cases. However, only one case had point mutation of the BRAF gene. Exact diagnosis of this uncommon event is important because the strategies for treatment of papillary thyroid carcinoma and medullary thyroid carcinoma are different.

Imaging Findings of Invasive Micropapillary Carcinoma of the Breast / 한국유방암학회지

PURPOSE: The purpose of this study is to evaluate imaging and histopathologic findings including the immunohistochemical characteristics of invasive micropapillary carcinoma (IMPC) of the breast. METHODS: Twenty-nine patients diagnosed with IMPC were included in the present study. Mammographic, sonographic, and magnetic resonance imaging (MRI) findings were analyzed retrospectively according to the American College of Radiology Breast Imaging Reporting and Data System lexicon. 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) findings were also evaluated. Microscopic slides of surgical specimens were reviewed in consensus by two pathologists with a specialty in breast pathology. RESULTS: Most IMPCs presented as a high density irregular mass with a non-circumscribed margin associated with microcalcifications on mammography, as an irregular hypoechoic mass with a spiculated margin on ultrasound, and as irregular spiculated masses with washout patterns on MRI. PET-CT showed a high maximum standardized uptake value (SUVmax) (mean, 11.2). Axillary nodal metastases were identified in 65.5% of the patients. Immunohistochemical studies showed high positivities for estrogen receptor and c-erbB-2 (93.1% and 51.7micro, respectively). CONCLUSION: Even though the imaging characteristics of IMPCs are not distinguishable from typical invasive ductal carcinomas, this tumor type frequently results in nodal metastases and high positivities for both estrogen receptor and c-erbB-2. The high SUVmax value that is apparent on PET-CT might be helpful in the diagnosis of IMPC.

Imaging Findings of Invasive Micropapillary Carcinoma of the Breast / 한국유방암학회지

PURPOSE: The purpose of this study is to evaluate imaging and histopathologic findings including the immunohistochemical characteristics of invasive micropapillary carcinoma (IMPC) of the breast. METHODS: Twenty-nine patients diagnosed with IMPC were included in the present study. Mammographic, sonographic, and magnetic resonance imaging (MRI) findings were analyzed retrospectively according to the American College of Radiology Breast Imaging Reporting and Data System lexicon. 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) findings were also evaluated. Microscopic slides of surgical specimens were reviewed in consensus by two pathologists with a specialty in breast pathology. RESULTS: Most IMPCs presented as a high density irregular mass with a non-circumscribed margin associated with microcalcifications on mammography, as an irregular hypoechoic mass with a spiculated margin on ultrasound, and as irregular spiculated masses with washout patterns on MRI. PET-CT showed a high maximum standardized uptake value (SUVmax) (mean, 11.2). Axillary nodal metastases were identified in 65.5% of the patients. Immunohistochemical studies showed high positivities for estrogen receptor and c-erbB-2 (93.1% and 51.7micro, respectively). CONCLUSION: Even though the imaging characteristics of IMPCs are not distinguishable from typical invasive ductal carcinomas, this tumor type frequently results in nodal metastases and high positivities for both estrogen receptor and c-erbB-2. The high SUVmax value that is apparent on PET-CT might be helpful in the diagnosis of IMPC.

Breast Cancer Screening Practice and Health-Promoting Behavior Among Chinese Women

PURPOSE: This study examined breast cancer screening practice and health promoting behaviors and the predicting factors of breast cancer screening practice in Chinese women. METHODS: A correlational research design was used to recruit a convenience sample of 770 women living in four cities (Beijing, Shanghai, Guangzhou, and Xi'an) in China. Participants completed self-report questionnaire consisting of general characteristics, breast cancer screening, health promoting behaviors, perceived benefits and perceived barriers. RESULTS: The participants were mostly 36-55 years old (51.3%), married (86.8%), premenopause (77.7%), had children (83.4%), and breastfed (73%). About 60% of Chinese women participated in some type of breast cancer screening practices, among them only 60 (7.8%) women used mammography, ultrasonogram and breast self-examination. The main reason for doing breast cancer screening was "feeling necessary for the screening". About 36% of the participants reported they did not perform any of screening practices, because they "don't feel it necessary". The women who had breast cancer screening regularly reported better health promoting behavior and perceived benefits and less perceived barriers than those who did not (F = 10.45, p < .001). Logistic regression showed that model 1 (age, higher education, being employed) and model 2 (perceived benefits and health behaviors) were the significant predicting factors (p < .05), explaining 10-13.8% of variance in breast cancer screening practice. CONCLUSION: On the basis of these results, public education about importance of breast cancer screening and health promoting behavior should be strongly advocated by health professionals and mass media in China.

Mutation-Free Expression of c-Kit and PDGFRA in Phyllodes Tumors of the Breast / 한국유방암학회지

PURPOSE: Phyllodes tumors (PTs) of the breast have been classified as benign, borderline, or malignant based on their histopathologic features. However, predicting clinical behavior based on these features has proven to be difficult given that local recurrence occurs in both benign and malignant PTs. Recurrence has been shown to mirror the histologic pattern of the primary tumor or to show dedifferentiation. The aim of this study was to assess the value of the histopathologic parameters, expression or mutation of c-Kit and platelet derived growth factor receptor alpha (PDGFRA) in predicting tumor recurrence. METHODS: Representative areas from 39 benign, 16 borderline, and 12 malignant PTs were selected for construction of tissue microarrays. Immunohistochemical analyses for p53, Ki-67, c-Kit, and PDGFRA were performed and SSCP-PCR analysis was carried out to identify mutations in exons 9, 11, 13, and 17 of the c-Kit gene and exons 12 and 18 of the PDGFRA gene. Clinicopathologic features, including tumor recurrence and margin status, were also evaluated. RESULTS: Of the 67 PTs, 11 cases (16.4%) recurred from 3 to 92 months following initial diagnosis (4 benign, 2 borderline, and 5 malignant). One benign PT case recurred as a borderline tumor and two borderline PT cases recurred as malignancies. Three patients died of malignant PT. No mutations of the c-Kit or PDGFRA genes were found and there was no statistically significant association of either p53 or p16 immunostaining with recurrent disease (p>0.05). However, histologic grade (p=0.033), margin status (p<0.001), Ki-67 (p=0.012), c-Kit (p=0.002), and PDGFRA (p=0.007) stromal immunopositivity were significantly correlated with recurrence. CONCLUSION: Even though positive or close margins were significantly associated with tumor recurrence, stromal c-Kit, PDGFRA positivity, and the Ki-67 index were useful for predicting recurrent PTs. Despite this, no c-Kit or PDGFRA mutations were found.

Preoperative Axillary Staging Using 18F-FDG PET/CT and Ultrasonography in Breast Cancer Patients / 한국유방암학회지

PURPOSE: The axillary lymph node status is an important prognostic factor for recurrence and survival of patients who have primary breast cancer. This study determined the accuracy of ultrasonography and 18F-FDG positron emission tomography (PET)/computed tomography (CT) in preoperative staging in axilla in patients with breast cancer. METHODS: One hundred seventy-one patients with primary breast cancer were recruited from January 2007 to August 2008. All the patients underwent axillary ultrasonography and 18F-FDG PET/CT for the axillary staging before their operation. RESULTS: The overall sensitivity, specificity, and the positive and negative predictive values and the accuracy of axillary ultrasonography for making the diagnosis of axillary metastasis were 73.07%, 84.87%, 67.85%, 87.82%, and 81.28%, respectively. On a visual assessment of 18F-FDG PET/CT, the diagnostic accuracy was 85.38% with 69.23% sensitivity, 92.43% specificity, a positive predictive value of 80.00%, and a negative predictive value of 87.30%. By the combined use axillary ultrasonography and 18F-FDG PET/CT to the axilla, the sensitivity, specificity, the positive and negative predictive values and the diagnostic accuracy were 82.35%, 97.91%, 93.33%, 94.00%, and 93.84%, respectively. CONCLUSION: The combination of 18F-FDG PET/CT and ultrasonography improves preoperative axillary staging in breast cancer that are often not found if only one imaging modalities are applied.

The Effect of BeHaS Be Happy and Strong Program on Self Esteem, Fatigue and Anxiety in Postoperative Care Patients with Breast Cancer / 기본간호학회지

PURPOSE: The purpose of the study was to identify effects of the BeHaS program on self esteem, fatigue and anxiety in postoperative care patients with breast cancer who had surgery with, chemotherapy, radiotherapy, with or without current hormone therapy. METHODS: This study was a 2-group quasi-experimental research study with a pre and post test design. Fifty-four patients with breast cancer were assigned to the experimental (n=29) or control group (n=25). The BeHaS program which strengthens self esteem through support over a 90-minute period, consists of theme activity (30 minutes), education (15 minutes), group support (15 minutes) and exercise (30 minutes). The experimental group participated in the program once a week for 10 weeks, but the control group was not involved. Data were gathered from October to December, 2008 using a questionnaire with measures of self esteem, fatigue and anxiety. Data were analyzed using t-test with SPSS Win 12.0 to identify differences between the groups. RESULTS: Self esteem was significantly increased (p= .001) and fatigue significantly decreased (p= .013) in the experimental group. But there was no significant difference in anxiety (p= .868). CONCLUSION: These results suggest that the BeHaS program for patients with breast cancer had beneficial effects on self esteem and fatigue.

Dermatomyositis in a Breast Cancer Patient

Cancer-associated rheumatic disorders are sometimes present concurrently with a tumor, but are not recognized initially. We report a case of dermatomyositis with breast cancer. A 46 year-old woman diagnosed with breast cancer with axillary lymph node metastasis had been treated by neoadjuvant chemotherapy and a lumpectomy with axillary lymph node dissection. She presented with a red rash on her face, eyelids, neck, and shoulders. A skin biopsy did not rule out dermatomyositis. Laboratory values were within normal limits, except muscle enzymes (Creatine kinase). Electromyography showed the presence of early myopathy. A PET CT-scan showed muscle uptake in left infraspinatus, r/o myositis. No abnormalities were presented in the muscle biopsy. Symptoms were improved by steroid therapy.

Promoter Methylation Profiles and Its Association with Clinicopathological Features in Breast Cancer

PURPOSE: Aberrant DNA methylation of tumor suppressor genes has been accepted as a common feature and early event in human cancer. The aim of this study was to analyze the methylation profiles of 50 well established methylation-associated genes in relation to various clinico-pathological features in breast cancer. METHODS: The methylation status of 50 genes were determined in two breast cancer cell lines, MCF7 and MDA- MB231, using HpaII-MspI-PCR. 8 genes (APC, CALCA, CDH13, MTHFR, S100A2, H19, EDNRB and MUC2) were found to be methylated in at least 1 cell line. The methylation of all 8 genes was observed in tumor tissues, but with different methylation frequencies. RESULTS: The methylation frequencies of five genes in breast cancer were as follows: MTHFR (41.9%), APC (51.6%), EDNRB (77.4%), CALCA (80.6%), S100A2 (87.1%), CDH13 (93.5%), H19 (93.5%) and MUC2 (96.8%). The results indicate that a panel of these 8 genes would be useful in the detection of breast cancer. The prognostic significance of DNA methylation in this breast cancer series, the conventional markers of LN status (P=0.05), histologic grade (P= 0.007) and P53 gene status (P=0.049) showed significant prognostic value. CONCLUSION: The methylation of APC, MTHFR, CALCA, CDH13, H19, MUC2, EDNRB and S00A2 would be useful in the detection of breast cancer. Detection of these abnormalities may be useful in the risk assessment and early detection of breast cancer.

US-guided Vacuum-assisted Breast Biopsy with Air Localization for Patients with Microcalcifications

PURPOSE: Stereotactic vacuum-assisted breast biopsy (SV AB) has recently been introduced as an alternative to the traditional surgical excisional biopsy with needle localization (NLBB). Although SVAB has excellent sensitivity and specificity with very low false negative results, patients might complain about the uncomfortable table and the painful breast compression that is done during SVAB. Furthermore, the cost of SVAB is too expensive to be widely adopted in Korea. So we developed a new technique of vacuum-assisted breast biopsy with air localization (VAB-AL) for the patients suffering with microcalcifications. METHODS: From April 2005 to Oct 2005, 10 microcalcification patients, whose lesions were difficult to be seen on breast ultrasonography, underwent vacuum-assisted breast biopsies with air localization (VAB-AL). First, classical NL was done to localize the mammographic abnormalities. Instead of insertion of the wire, 1 cc amounts of air were injected through a needle. The injected air could be easily visualized as a hyperechogenic density on breast sonography. Vacuum-assisted breast biopsy for the air-induced hyperechogenic densities was then done under sonographic guidance. The specimen radiography was performed to confirm that the lesion was removed. RESULTS: The mean age of the patients was 46 (range: 37~55). The upper-outer quadrant of the breast was the most common site of the lesions (6/10, 60%); the upper-inner quadrant (2/10, 20%), and then the lower-inner quadrant (1/10, 10%) followed. The specimen radiology for all 10 patients showed that the mammographic abnormalities were successfully removed. The most common pathologic type was fibrocystic disease (6/10, 70%); intraductal carcinoma (3/10, 30%), and then atypical ductal hyperplasia (1/10, 10%) followed. There were no major complications. CONCLUSION: Vacuum-assisted breast biopsy with air localization is a new technique that can minimize the complaints of patients with microcalcifications about the uncomfortable table, the painful breast compression and the economic burden of SVAB. This new procedure was successfully performed in our 10 patients, and we believe this procedure shows a lot of promise as one of alternatives to classical NLBB and SVAB.

Capecitabine Monotherapy in Taxane-Refractory Metastatic Breast Cancer (MBC) Patients

PURPOSE: The therapeutic options for MBC patients who have been previously treated with taxane and anthracycline are limited. Capecitabine (Xeloda(R)) is a novel tumor- selective oral fluoropyrimidine, and it provides effective and well tolerated therapy for patients with MBC who are resistant to or are failing with anthracycline and taxane therapy. We present our experiences with oral capecitabine that was given as monotherapy for taxane and anthracycline pre-treated MBC patients from CNU hospital. METHODS: The study subjects were 32 female patients having MBC that progressed after anthracycline and taxane treatment, and they were then treated with oral capecitabine monotherapy from 1999 to 2002. The median disease free survival period was 26 months. All the patients had good ECOG perfomance status (>2) and normal renal function. The primary end points were the response rate, time to progression (TTP) and overall survival. The response rate was assessed with standard UICC criteria, and toxicity was assessed with NCI toxicity criteria. RESULTS: The sites of first metastasis were bone in 17 cases (53.1%); cervical LN 5 (15.6%); liver 3 (9.4%); lung 3 (9.4%); chest wall 2 (6.3%); brain 1 (3.1%); and contralateral axillary LN 1 (3.1%). The clinical response rates to therapy were 1 case of CR (3.1%); 13 cases of PR (40.6%); 11 cases of stable disease (34.4%); 6 cases of progressive disease (18.8%). The median TTP was 6.0 months (95% CI: 5.53~8.47). The median overall survival was 15.0 months (95% CI: 11.90~16.10). Toxicities related to therapy were 5 cases of hand-foot skin reaction (15.6%); 3 cases of diarrhea (9.4%); and 1 case of stomatitis (3.1%). There was no bone marrow depression or alopecia. All treatment related toxicities were improved by a short period of drug interruption or dose reduction (2, 500 mg/m2/day to 2, 000 mg/m2/day). CONCLUSION: Taxane resistant MBC has a poor prognosis. Oral capecitabine monotherapy provided activity in this subgroup of patients with an overall response rate of 43.7% and a stable disease rate of 34.4%. Oral capecitabine is well tolerated with an acceptable toxicity profile in this population.

correlation between c-erbB-2 expression and other prognostic factors in breast cancer / 한국유방암학회지

PURPOSE: Although the overexpression of c-erbB-2 has been reported to be associated with a poor clinical outcome in breast cancer, its prognostic value remains controversial. The overexpression of c-erbB-2 can be detected using immunohistochemical analysis which is cost-effective, but not ideal due to variations in tissue fixation and processing, different testing methods with variable sensitivity and the subjectivity in grading. The purpose of this study was to evaluate the grade of c-erbB-2 expression and compare the grading with the patient's prognosis. The grading was performed via immunohistochemical staining of the protein in the tissue obtained from breast cancer patients. METHODS: Between January 2000 and March 2004, 253 patients with breast cancer were studied. Immunoperoxidase staining for c-erbB-2 on paraffin blocks was interpreted as either negative or positive; the presence of circumferential membranous staining (+2 and +3) in tumor cells was interpreted as "positive" and the absence of staining, with the only the presence of cytoplasmic staining (without membranous staining) was interpreted as "negative"(0 and +1). RESULTS: Of the 253 breast cancer samples, c-erbB-2 expression was negative in 138 cases (54.5%) and positive in 115 cases (45.4%). The c-erbB-2 tissue assay grading results were G0: 62 (24.5%), G1+: 76 (30%), G2+: 53 (20.9%) and G3+: 62 (24.5%) cases. Of the prognostic factors, the histological grade (p = 0.010), P53 (p = 0.000) and the absence of estrogen receptors (p = 0.028) displayed a significant relationship (p < 0.05) with an increase in the c-erbB-2 expression grading, but the tumor size, lymph node metastasis, tumor stage, lymphovascular invasion and progesterone receptor state showed no significant differences with respect to the expression grading. CONCLUSION: The c-erbB-2 expression grading was found to be positively correlated with the histological grade, ER status and p53 but not with the tumor size, lymph node metastasis, lymphovascular invasion, tumor stage or PR status. In this study c-erbB-2 immunohistochemical staining result were insufficient to recommened the use of prognostic factor.

Clinical Study of Breast Cancer Patients Who Had More Than 10 Positive Axillary Lymph Nodes / 한국유방암학회지

PURPOSE: Nodal involvement has long been known to represent the single most reliable indicator of the prognosis for early-stage breast cancer. In common parlance, high-risk node-positive breast cancer has generally been used to describe patients who have involvement of ten or more axillary lymph nodes (10+LN). Breast cancer patients who had 10+LN clearly have a strikingly high risk of tumor recurrence and death. Thus we tried to evaluate the clinical courses of breast cancer patients who had more than 10 positive axillary lymph nodes. METHODS: Of the 587 breast cancer patients who were operated on at Chungnam National University Hospital from February 1992 to November 1999, 31 cases (5.3%) showed involvement of more than 10 axillary lymph nodes. We evaluated the clinical courses of these patients and the differences in survival according to the clinical and pathologic vaiables. Survival was calculated using the Kaplan-Meier method. RESULTS: The mean age of the patients was 50+/-4 years. A mastectomy was done in 28 cases (90.3%), and a breast conserving operation was done in 3 cases (9.7%). The mean tumor size was 4.8+/-.5 cm. The mean number of removed axillary Lymph Nodes was 23.5+/-0.2 (range:10-52), and the mean number of positive axillary LNs was 20.0+/-10.1 (10-51). At a median follow-up of 30.5 months, 23 cases (74.2%) of recurrence were noted. Among these 23 cases (69.6%) showed distant metastases as the first recurrence. The 3-year and 5-year disease-free survivals were 28.6% and 22.9%, respectively. The 3-year and 5-year expected overall survivals were 53.7% and 41.8%, respectively. There were significantly more recurrences in patients who had given up taking their adjuvant chemotherapy than for those patients who had completed 6 cycles of FEC or MMM. Also, significant survival benefits were noted in those patients who were treated using a combination chemotherapy with taxane plus cisplatin after their tumor recurrence. CONCLUSION: Breast cancer patients with 10+LNs have a strikingly high risk of tumor recurrence. Six cycles of adjuvant chemotherapy with FEC or MMM was a controllable variable for lowering the risk of tumor recurrence. A combination chemotherapy with taxane and cisplatin was also a controllable variable for increasing survival after tumor recurrence.

Short Term Effect of Neoadjuvant Therapy with Docetaxel and Adriamycin in Advanced Breast Cancer / 한국유방암학회지

PURPOSE: The objective of this study was to test the efficacy and toxicity of adriamycin plus docetaxel as primary chemotherapy for women with locally advanced breast carcinoma, including patients with inflammatory breast cancer. METHODS: From 2001, April to 2003, July, 18 patients with locally advanced breast cancer were treated with Adriamycin (50 mg/m2; intravenous bolus) followed by docetaxel (75 mg/m2; 1-hour intravenous infusion) on day of each cycle for four cycles. RESULTS: Two of 18 patients (11.8%) had inflammatory breast carcinoma. 17 (94.4%) patients underwent surgery. 14 (82.4%) patients had clinical responses, of them, two (11.8%) patients had complete clinical response in primary tumor. One case showed a pathologic complete response. In the lymph node response, four (23.6%) patients had clinical complete responses and 11 (64.7%) patients had partial clinical responses. Grade 3 or 4 neutropenia was recorded in 21.7% (21/97 cycles) and febrile neutropenia was recorded in 13.4% (13/97 cycles). Grade 3 or 4 anemia was recorded in 4.2% (4/97 cycles), but there was no severe thrombocytopenia. Other side effects were diarrhea, oral mucositis and mild emesis. CONCLUSION: Neoadjuvant chemotherapy with adriamycin plus docetaxel was a feasible and effective threatment in an unfavorable series of patients with locally advanced breast cancer including patients with inflammatory breast cancer.

Benign Neoplasm of the Breast

The discovery of a breast lump is one of the most anxiety-provoking occurrences in a woman's life. The initial purpose of a surgical consultation is to determine whether a true mass exists. The majority of breast masses are self-discovered or are identified by a primary care provider. Once a breast mass has been identified, the first determination to be made is whether it is benign or malignant by using breast imaging techniques or pathologic examination. Once a breast lesion has been shown to be benign on pathologic examination, the most improtant clinical consideration is the risk of subsequent breast cancer associated with that lesion. The diagnosis of a fibroadenoma can be made using excisional biopsy or the combined modalities of CBE, ultrasound, and FNA. A true intraductal papilloma develops in one of the major subareolar ducts and is the most common lesion causing a serous or serosanguinous discharge. A mass may be felt on examination in as many as one-third of cases. The treatment of choice is microdochectomy. Hamartomas can produce a classic mammographic image that is virtually diagnostic. Because the clinical and radiologic characteristics of fat necrosis resemble those of carcimoma in the majority of cases, a needle localization or excisional biopsy is required.

Combined Peritumoral and Subareolar Injection of Blue Dye Improves Sentinel Lymph Node Localization Rates / 한국유방암학회지

PURPOSE: The sentinel lymph node (SLN) biopsy was recently introduced into the treatment of early breast cancer. However, there have been varying degrees of success in identifying the SLNs. Lymphatic mapping in breast cancer performed solely by intraparenchymal injection of blue dye remains an accepted method of identifying SLNs, largely because of its simplicity. This article describes the technical aspect and improved results of combined peritumoral and subareolar injection of isosulfan blue dye. METHODS: From Jan. 2000 to Jul. 2000, 55 patients with breast cancer (size<5 cm and clinically negative axillary nodes) were enrolled for SLN biopsy by peritumoral and subareolar injection of 1% isosulfan blue dye. And all patients underwent a complete axillary dissection. RESULTS: The identification rate of SLN was 96.4% (in 53 of 55 patients). Of these 53 patients, 11 patients (20.8%) had positive SLNs and 42 patients had negative SLNs. In 42 patients with negative SLNs, one patients was found to have disease on complete dissection, for a false-negative rate of 8.3% (1/12). Conclusion: Compared with other series of blue dye- directed lymphatic mapping, the present study of peritumoral plus subareolar plexus dye-only injection demonstrates a high SLNs localization rate and rapid learning curve. On the basis of these results, it is expected that subareolar lymphatic plexus is the central route to sentinel lymph nodes and the optimal way to perform dye-only lymphatic mapping of the breast.

Combined Peritumoral and Subareolar Injection of Blue Dye Improves Sentinel Lymph Node Localization Rates

PURPOSE: The sentinel lymph node (SLN) biopsy was recently introduced into the treatment of early breast cancer. However, there have been varying degrees of success in identifying the SLNs. Lymphatic mapping in breast cancer performed solely by intraparenchymal injection of blue dye remains an accepted method of identifying SLNs, largely because of its simplicity. This article describes the technical aspect and improved results of combined peritumoral and subareolar injection of isosulfan blue dye. METHODS: From Jan. 2000 to Jul. 2000, 55 patients with breast cancer (size<5 cm and clinically negative axillary nodes) were enrolled for SLN biopsy by peritumoral and subareolar injection of 1% isosulfan blue dye. And all patients underwent a complete axillary dissection. RESULTS: The identification rate of SLN was 96.4% (in 53 of 55 patients). Of these 53 patients, 11 patients (20.8%) had positive SLNs and 42 patients had negative SLNs. In 42 patients with negative SLNs, one patients was found to have disease on complete dissection, for a false-negative rate of 8.3% (1/12). CONCLUSION: Compared with other series of blue dye- directed lymphatic mapping, the present study of peritumoral plus subareolar plexus dye-only injection demonstrates a high SLNs localization rate and rapid learning curve. On the basis of these results, it is expected that subareolar lymphatic plexus is the central route to sentinel lymph nodes and the optimal way to perform dye-only lymphatic mapping of the breast.

Neuroendocrine Neoplasm of the Colon and Rectum

PURPOSE: This report outlines the incidence and the clinical features of patients with a neuroendocrine (NE) neoplasm of the colon and rectum and describes, in detail, their histologic and immunohistochemical findings. Also, we attempted to determine the impact of several clinical variables, including tumor stage, tumor location, NE pattern, and cellular subtype on survival. METHOD: Of 690 colorectal cancers operated on from April 1990 to November 1998 at Chungnam National University Hospital, 41 cases were originally diagnosed as poorly differentiated adenocarcinoms on the basis of conventional light microscopy. Paraffin blocks from the aforementioned cases were retrieved, and sections were im munostained with antibodies to human chromogranin A, neuron specific enolase, and synaptophysin. RESULTS: Of the 690 cases of colorectal caner, 35 cases (5.1%) of NE neoplasm were identified retrospectively: 28 males and 7 females. About 90% of the tumors were located at the cecum and the rectosigmoid. Pathologic stages were as follows: modified Dukes stage B2, 6; stage C1, 8; stage D1, 12; and stage D2, 9. The most common metastatic site at the time of diagnosis was the liver (8/9). Four NE patterns were identified: pure NE (n=4), and predominantly NE (n=8), equal NE and exocrine (n=4), and predominantly exocrine (n=19). Two cellular subtypes were identified: well-differentiated (n=3) and intermediate (n=32) cells. Survival statistically correlated with stage (p=0.03), but not with age, sex, tumor location, NE pattern, or cellular subtype. CONCLUSION: This study suggests that NE neoplasms of the colon and rectum are more frequent than previously believed. Since a NE neoplasm is believed to be an extremely biologically aggressive tumor, recognition of a NE neoplasm is very important because of its evident clinical and therapeutic implications.

Predictors of Axillary Lymph Node Metastases in Patients with T1 Breast Cancer

PURPOSE: In T1 tumors, the reported incidence of lymph node metastasis ranges from 6% to 31%. The authors analyzed the clinical and the pathological parameters of T1 tumors for their association with the likelihood of axillary lymph node metastases (ALNM). METHODS: The authors reviewed data from 57 patients with T1 breast carcinomas who had undergone a level I/II axillary dissection from January 1996 to March 2000. The association between the incidence of ALNM and clinical/pathologic factors (age, site, size, neoadjuvant chemotherapy, histologic grade, lymphovascular invasion, estrogen receptor status, progesterone receptor status, p53, and c-erbB-2) were analyzed by using chi-square tests. RESULTS: Approximately 42% of the 57 patients with a T1 breast carcinoma had ALNM. Chi-square tests showed that lymph node metastases were associated with tumor size (P=0.043), lymphovascular invasion (P=0.001), and expression of c-erbB-2 (P=0.026). CONCLUSION: The authors conclude that the charac teristics of the primary tumor can be used to estimate the risk of ALNM in patients with a T1 breast carcinoma. Such a risk assessment might facillitate appropriate management.