Pure single-port lumpectomy non-lipolysis breast-conserving surgery in the treatment of early-stage breast cancer / 中华内分泌外科杂志

Objective:To summarize the clinical data and experience of pure single-port lumpectomy non-lipolysis breast-conserving surgery (PSLN-BCS) in patients with early-stage breast cancer.Methods:A retrospective analysis was conducted on 400 patients who underwent breast-conserving surgery for early-stage breast cancer in the Second Department of Breast Surgery at Harbin Medical University Cancer Hospital from Jan. 2022 to Jan. 2023. Patients were divided into two groups: PSLN-BCS group ( n=200) and conventional breast-conserving surgery (C-BCS) group ( n=200). The surgical time, intraoperative blood loss, postoperative drainage within three days, and short-term (3 months to 6 months after surgery) complications, including the incidence of residual fluid after drain removal and incision infection were observed. Long-term (6 months after surgery) complications, including the incidence of skin and pectoralis major muscle adhesions in the surgical area and cosmetic results after breast-conserving surgery, were also evaluated. Statistical analysis was performed using R language, and quantitative data were expressed as mean ± standard deviation ( ± s) and analyzed using t-test, while count data were analyzed using χ2 test. A p-value less than 0.05 was considered statistically significant. Results:PSLN-BCS had a longer average surgical time than C-BCS (198.341min vs 62.961min, P<0.001, 95% CI:132.028 vs 138.732). PSLN-BCS had less intraoperative bleeding (18.824 ml vs 22.627 ml, P=0.003, 95% CI: -6.294 vs -1.311) and lower postoperative drainage volume (346.157 ml vs 406.191 ml, P<0.001, 95% CI: -70.571-a-49.496). There were no significant differences in short-term postoperative complications such as subcutaneous fluid accumulation ( χ2=2.33, P=0.127) or incisional infection ( χ2=0.14, P=0.708) between the two groups. The incidence of skin and muscle adhesions in the surgical area was lower in patients who underwent PSLN-BCS at 6 months postoperatively ( χ2=11.58, P<0.001). Patients who received PSLN-BCS achieved better cosmetic outcomes, with a statistically significant difference ( χ2=273.00, P<0.001) compared to those who received C-BCS. Conclusion:Pure single-port lumpectomy non-lipolysis breast-conserving surgery is a safe and effective treatment option for early-stage breast cancer and can be considered as a surgical option for patients with cosmetic requirements.

Tumor de Brenner maligno y embarazo. Caso clínico: revisión de la bibliografía / Malignant Brenner tumor and pregnancy. Case report: Literature review

Resumen ANTECEDENTES: La asociación del tumor de Brenner con el embarazo es excepcional: solo hay cuatro casos reportados, ninguno maligno. CASO CLÍNICO: Paciente de 33 años, con antecedente de un embarazo que finalizó mediante parto y sin contratiempos, sin antecedentes médico-quirúrgicos de interés. En la ecografía de la décima segunda semana se registró una imagen sonoluscente de paredes lisas, de 41 mm, dependiente del ovario izquierdo. Durante la cesárea se practicó la tumorectomía. El estudio histológico describió una neoplasia epitelial de células transicionales, con áreas benignas, proliferativas e infiltrativas, compatible con un tumor de Brenner maligno. Se trató con cirugía radical de cáncer de ovario y quimioterapia coadyuvante. CONCLUSIONES: Es importante tener en mente al tumor de Brenner maligno como diagnóstico de exclusión ante tumoraciones de rápido y gran crecimiento durante el embarazo. En todas las ecografías de seguimiento del embarazo es indispensable valorar los anejos.

Abstract BACKGROUND: The association between Brenner tumor and pregnancy is extremely rare. Only four well-documented cases of benign Brenner tumor during pregnancy have been reported but nonmalignant. CLINICAL CASE: A 33-year-old female patient, with a history of a pregnancy that ended in delivery and without setbacks, with no medical or surgical history of interest. In the ultrasound scan of the twelfth week, a 41 mm smooth-walled sonoluscent image was recorded in the left ovary. Lumpectomy was performed during cesarean section. Histological study described a transitional cell epithelial neoplasm, with benign, proliferative and infiltrative areas, compatible with a malignant Brenner tumor. She was treated with radical ovarian cancer surgery and adjuvant chemotherapy. CONCLUSION: It is important to keep malignant Brenner's tumor in mind as a diagnosis of exclusion in the presence of rapidly and rapidly growing tumors during pregnancy. It is very important to evaluate the appendages in all follow-up ultrasounds during pregnancy.

A comparative study for surface dose evaluation in conventional treatment of carcinoma breast patients irradiated with Co-60 and 6 MV radiation beam

Aim: In the present study, surface doses within the target area and contralateral breast (CLB) received during conventional treatment of carcinoma breast are evaluate and compared for treatment on two different beam energies, i.e., Co-60 γ-ray and 6 MV X-ray beams with thermoluminescent dosimeter, LiF:Mg, Ti (TLD-100). Materials and Methods: The study includes a group of 23 patients comprising 11 patients treated with Co-60 γ-ray beam and 12 patients by 6 MV X-ray beam. Results and Discussion: The treatment using Co-60 γ-ray and 6 MV X-ray beams contributes an average percentage dose of 8.15% ± 0.56% and 4.73% ± 0.94%, respectively, to CLB in mastectomy patients. The contribution of tangential fields (mastectomy) to the CLB doses ranges between 12.71 and 16.40 cGy (5.45%–7.03%) for treatment with Co-60 γ-ray beam and 6.33–10.95 cGy (1.86–4.69%) for treatment with 6 MV X-ray beam. The supraclavicular field (SCF) contributes 1.45%–1.93% and 1.02%–1.43% for treatment with Co-60 γ-ray and 6 MV X-ray beams, respectively. The average surface dose (normalized with breast dose) 89.1% ± 8.5% for Co-60 beam in the SCF region differs significantly from the 60.2% ± 13.0% value for 6 MV X-ray beam. Conclusion: The CLB doses for mastectomy patients are higher for Co-60 beam as compared to 6 MV X-ray beam, and better dose homogeneity is achieved within the irradiated breast from 6 MV X-ray beam. The CLB doses are slightly higher for patients treated with breast conservative radiotherapy or lumpectomy. The average surface dose to SCF decreases by ~30% of treated breast dose for treatment with 6 MV X-ray beam

Comparison of clinical efficacy of complete and incomplete radical debridement for spinal tuberculosis: a Meta-analysis / 中国骨伤

<p><b>OBJECTIVE</b>To compare clinical efficacy of complete and incomplete radical debridement for spinal tuberculosis by Meta-analysis.</p><p><b>METHODS</b>The literatures of RCT or non-RCT with complete and incomplete radical debridement for spinal tuberculosis from Medline, EMBASE, Cochrane Library, Web of Science, CBM, CNKI and Wanfang were searched from the time of creating database to July, 2017. Two independent reviewers identified eligible studies, extracted data and evaluated risk of bias of included studies. Meta analysis were performed by Revman 5.3 and GRADE system were used to grade evidence. Recurrence rate, adverse effects, healing time, chemotherapy duration, spinal deformity by correction angle, bone fusion time in interface of intervertebral, erythrocyte sedimentation rate and C-reaction protein were compared between two groups.</p><p><b>RESULTS</b>Totally 9 literatures were chosen, including 5 RCT and 4 non-RCT with 1 302 patients. Compared with incomplete radical debridement, complete radical debridement had lower recurrence rate [=0.14, 95%CI(0.08, 0.22), <0.000 01], lower rate of adverse effects[=0.18, 95%CI(0.12, 0.27), <0.000 01], shorter healing time[MD=-4.80, 95%CI(-5.14, -4.45), <0.000 01]and chemotherapy duration [MD=-5.25, 95%CI(-5.64, -4.86), <0.000 01], larger spinal deformity by correction angle[MD=4.88, 95%CI(3.55, 6.27), <0.000 01], smaller erythrocyte sedimentation rate[MD=-8.74, 95%CI(-11.99, -5.49), <0.000 01] and C-reaction protein [MD=-4.75, 95%CI(-8.61, -0.88), =0.02] . However, there was no difference on bone fusion time in interface of intervertebral between two groups[MD=-0.19, 95%CI(-0.50, 0.12), =0.23].</p><p><b>CONCLUSIONS</b>Compared with incomplete radical debridement, complete radical debridement has advantages of lower incidence of recurrence, lower rate of adverse reaction, shorten healing time and chemotherapy time, recovered faster. Techniques are selected according to indication of patients individual, complete radical debridement is recommended at the same indications.</p>

The influence of lumpectomy on the axillary lymph node status of breast cancer patients / 中华肿瘤杂志

Objective@#To investigate the influence of lumpectomy on axillary lymph node status of breast cancer patients.@*Methods@#The clinical data of 738 invasive breast cancer patients with non-palpable axillary lymph node and sentinel lymph node (SLN) biopsy from November 2011 to August 2013 in Henan Provincial Cancer Hospital were collected and retrospectively analyzed. Among them, 136 patients underwent preoperative lumpectomy (lumpectomy group) and 602 patients underwent puncture biopsy only (biopsy group). The difference of axillary lymph node status and positive ratio of SLN detected by color Doppler ultrasound were compared between these two groups.@*Results@#Among the 738 breast cancer patients, the axillary lymph nodes of 444 (60.2%) cases could be detected by ultrasound. Among them, 92 cases belonged to lumpectomy group, significantly less than 352 cases of biopsy group (P=0.048). Among the patients with ultrasound-visible lymph nodes, the proportion of the biggest diameter of axillary lymph node >1 cm of lumpectomy group or biopsy group was 58.7% (54/92) or 52.8% (186/352), respectively, without significant difference (P=0.316). The proportion of patients with the ratio of long diameter to short diameter <2 of lumpectomy group or biopsy group was 37.0% (34/92) or 38.6% (136/352), respectively, with marginal difference (P=0.768). The positive rate of SLN of lumpectomy group or biopsy group was 23.5% (32/136) or 26.9% (162/602), respectively, without significant difference (P=0.419). The incidence rate of the ultrasound visible axillary lymph nodes of patients whose postoperative time ≤ 7 days or > 7days was 71.1% (64/90) or 60.9% (8/46), respectively, without significant difference (P=0.227). However, the positive rate of SLN of these two groups was 28.9% (26/90) and 13.0% (6/46), respectively, with significant difference (P=0.039). The number of ultrasound visible axillary lymph nodes, the biggest diameter of axillary lymph nodes and the ratio of the long diameter to short diameter <2 were substantially correlated with the positive rate of SLN (P<0.05).@*Conclusions@#The incidence rate of ultrasound visible axillary lymph node in the patients with lumpectomy is higher than that of patients with puncture biopsy only. The positive rate of SLN of the patients with a long postoperative time is lower than that of patients with a short postoperative time, even though the axillary lymph nodes are ultrasound visible.

The prophylactic effect of methylprednisolone combined with granisetron on postoperative nausea and vomiting after lumpectomy of breast / 临床麻醉学杂志

Objective To explore the prophylactic effect of methylprednisolone combined with granisetron on postoperative nausea and vomiting.Methods Two hundred patients scheduled for lumpectomy of breast were randomly divided into four groups with 50 cases each.The patients in group M1 received a pre-anesthesia intravenous doses of methylprednisolone 25 mg,the patients in group M2 were injected methylpredsisolone 25 mg repeatedly four hours later,in group D received a pre-anesthesia doses of dexamethasone 5 mg,in group N normal saline 2 ml.All the four groups of patients received granisetron 3 mg intravenously at the end of surgery.The incidence of nausea and vomiting in the 24 hours were observed.Results The PONV incidences of group M1,M2,D,N were 36%,18%,38% and 58%.Both group M1,M2 and D significantly decreased the total inci-dence of PONV (P <0.05)in the 24 h.The incidence of PONV was significantly lower in group M2, compared with group M1 and group D respectively (P <0.05).Conclusion Methylprednisolone-gran-isetron combination is as equally effective as dexamethasone-granisetron combination for preventing PONV in lumpectomy,but repeated methylprednisolone after 4 h is more effective than dexametha-sone and single-used methylprednisolone.

Routine Intraoperative Forced-Air Warmer Usage in Prevention of Perioperative Hypothermia: To Use or Not to Use in Daycare Breast Lumpectomy?

Intraoperative active warming in daycare surgery may be least popular compared to major elective surgeries due to the lesser risk of perioperative hypothermia. This prospective, single blind, randomized, controlled trial in daycare breast lumpectomy was done to evaluate the routine use of intraoperative forced-air warmer in the presence of other warming modalities in prevention of perioperative hypothermia. Fifty patients were randomized into two groups; Group 1 received forced-air warmer and Group 2 received a standard cotton thermal blanket. Both groups received circulating-water mattress. Intraoperatively, all patients received pre-warmed intravenous fluid with an in-line warmer. Ear and ambient temperature was recorded using infrared ear thermometer and digital thermo-hygrometer respectively. Measurement was done before induction, every 15 minutes intraoperatively, upon arrival in recovery room and 30 mins later, postoperatively. All patients were normothermic prior to induction of anaesthesia. During the initial half an hour post-induction, both groups mean core temperature decreased at approximately 0.5˚C. Both showed no statistical difference in mean core temperature (0.04 ˚C) within the initial half an hour. The next half an hour, both groups had approximately 0.2˚C decrement but this time, Group 2 had a slightly higher mean core temperature than Group 1 which maintained until the end of surgery. Overall, within the initial one hour postinduction of GA, there was a drop of 0.7˚C and 0.6°C in Group 1 and Group 2 respectively, however the difference in final mean core temperature between the two groups was 0.05°C and it was not statistically significant (p value < 0.05). None of the patients experienced intraoperative hypothermia (< 36˚C) and all remained in the normothermic range with no shivering or sense of feeling cold, postoperatively. The results of the present study found no significant difference in the changes of final core temperature with or without the usage of intraoperative forced-air warmer in the presence of other warming measures in daycare breast lumpectomy.

Diagnostic value of X-ray stereotactic vacuum-assisted biopsy for breast micro-calcification / 肿瘤研究与临床

Objective To compare the accuracy and clinical effect between X-ray stereotactic vacuum-assisted biopsy (SVAB) and metal wire guided lumpectony.Methods From January 2010 to June 2014,681 cases of breast micro-calcification biopsy were performed.Among them,78 cases were performed with SVAB and 603 eases were performed with the method of stereotaetic metal wire guided lumpectomy.All cases were non-palpable breast lesions (NPBLs) and breast imaging-reporting and data system (BI-RADS) assessment categories 4.The diagnostic accuracy and clinical effect were compared.Results The sensitivity of both methods was 100 ％ with no misdiagnosis.The underestimation rate of SVAB was 12.5 ％.Compared with the method of metal wire guided lumpectomy,SVAB had many advantages,such as easy to use,quickly performed,low rate of local deformation and lower rate of operative complications.77.5 ％ patients benefited from SVAB by avoiding open surgery of benign disease.Conclusions SVAB is an accurate,safe and convenient method of biopsy.It can be recommended as the preferred method of micro-calcification (BI-RADS 4).Additional operation should be performed on patients with the pathological diagnosis of middle and high grade of dysplasia and any kind of carcinoma.

The clinical significance of dynamic contrast-enhanced MR of the breast in evaluating residuals after lumpectomy / 实用医学杂志

Objective To assess the efficacy of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) of the breast in the detection of residual lesions of early stage breast carcinoma after lumpectomy. Methods 53 patients with breast masses confirmed to be malignant tumors by pathology after lumpectomy underwent the dynamic contrast-enhanced breast MR imaging and then further surgical treatment by lumpectomy. The DCE MRI-based diagnoses were compared to the results of pathological analyses after the second lumpectomy. Results 17 (32%) cases were detected with abnormal enhancement. 8 cases presented mass-like enhancements , and 6 of them showed tumorous residuals (P < 0.01). 6 presented focal enhancements, taking up 35% and one of them was confirmed pathologically to have tumorous residuals (P < 0.01). 3 cases presented mass-like enhancement, taking up 18% and 2 of them were confirmed with cancerous residuals . MR dynamic enhancement showed 68% of the them presented no abnormal enhancements in the breast and 33 of themhad no residual cancer , taking up 92%. 3 of them were confirmed with tumorous residuals , taking up 8%. The The positive predictive value and negative predictive value of DCE MR imaging for diagnosing residual malignant lesion were 52% and 92%, respectively . Conclusion The dynamic contrast-enhanced MRI of breast is helpful for evaluating residual malignant lesion after lumpectomy and affects positively subsequent treatment.

Breast Conserving Surgery in Patients with Early Breast Cancer After Local Lumpectomy / 中国微创外科杂志

Objective To explore the feasibility and safety of breast conserving surgery ( BCS) in patients with early breast cancer after local lumpectomy . Methods Clinical data of 26 patients who previously had received local lumpectomy from January 2009 to December 2011 were retrospectively analyzed .All the patients were diagnosed as solitary invasive ductal carcinoma with preoperative staging of T1N0M0.The interval from lumpectomy to BCS was 6-24 days (mean, 10 days) and the maximum diameter of tumors before first operation was 1-2 cm (mean, 1.6 cm).The shortest distance between nipple and operative incision was 2-6 cm (mean, 4.5 cm). Results The operations were successfully completed in all 26 patients, 15 of which received sentinel lymph node biopsy and 11 of which received axillary lymph node dissection .The hospital stay was 3-5 days with stage-Ⅰhealing of incision .All patients received whole breast radiation therapy after BCS .There was no local recurrence or distant metastasis during 2 -5 year ’ s follow-up (median, 32 months).All the patients were satisfied with the shape of breast and the quality of life . Conclusion For those patients with early breast cancer who have received local lumpectomy , meet the requirement of CBS , and have the willing of breast conserving , BCS is an ideal choice after rigid application of surgical indications .

Tumor bed volumetric changes during breast irradiation for the patients with breast cancer

PURPOSE: The aim of this study was to evaluate changes in breast tumor bed volume during whole breast irradiation (WBI). MATERIALS AND METHODS: From September 2011 to November 2012, thirty patients who underwent breast-conserving surgery (BCS) followed by WBI using computed tomography (CT) simulation were enrolled. Simulation CT scans were performed before WBI (CT1) and five weeks after the breast irradiation (CT2). The tumor bed was contoured based on surgical clips, seroma, and postoperative change. We retrospectively analyzed the factors associated with tumor bed volumetric change. RESULTS: The median tumor bed volume on CT1 and CT2 was 29.72 and 28.6 mL, respectively. The tumor bed volume increased in 9 of 30 patients (30%) and decreased in 21 of 30 patients (70%). The median percent change in tumor bed volume between initial and boost CT was -5%. Seroma status (p = 0.010) was a significant factor in tumor bed volume reduction of 5% or greater. However, patient age, body mass index, palpability, T stage, axillary lymph node dissection, and tumor location were not significant factors for tumor bed volumetric change. CONCLUSION: In this study, volumetric change of tumor bed cavity was frequent. Patients with seroma after BCS had a significant volume reduction of 5% or greater in tumor bed during breast irradiation. Thus, resimulation using CT is indicated for exquisite boost treatment in breast cancer patients with seroma after surgery.

Patrones oncoplásticos en el tratamiento conservador del cáncer de mama y lesiones de riesgo / Ncoplastic patterns in the conservative treatment of breast cancer and high risk lesions

Objetivo: Demostrar la eficacia de la utilización de patrones oncoplásticos por el cirujano de la mama en la realización de la tumorectomía adecuada con resultados cosméticos satisfactorios en el Centro Clínico Familia, Puerto Ordaz. Pacientes y método: Estudio prospectivo en pacientes con cáncer de mama o lesiones benignas de riesgo entre septiembre 2009 y diciembre 2011, en quienes la tumorectomía convencional ocasionaría acentuados defectos cosméticos y ésto determinado por tamaño, localización, relación volumen tumor/mama, multicentricidad y/o bilateralidad de la lesión. Resultados: Se operaron 11 pacientes. Ocho pacientes con cáncer. Carcinoma infiltrante: siete pacientes (63,7%), carcinoma lobulillar in situ: un paciente (9%), y con hiperplasia ductal atípica: tres pacientes (28,1%). El patrón oncoplástico más utilizado fue la mamoplastia vertical de pedículo inferior de rama única: seis paciente (54,5%). La mamoplastia vertical de pedículo superior de rama única y la técnica de Grisotti: dos pacientes (18%), respectivamente. La mamoplastia circunareolar un caso (9%). Se practicó biopsia del ganglio centinela en cinco pacientes, sin complicaciones atribuibles a la inyección de azul patente subareolar. Los resultados cosméticos fueron satisfactorios. Una paciente presentó discreta asimetría de altura de complejo areola ­ pezón y otra paciente un hematoma que se drenó ambulatoriamente. Conclusión: Los patrones oncoplásticos son técnicas quirúrgicas eficaces en el tratamiento conservador del cáncer de mama logrando la extirpación oncológica con excelentes resultados cosméticos. Estos procedimientos pueden ser practicados por el cirujano de la mama sin entrenamiento formal en cirugía plástica, pero sí fundamentado en una minuciosa planificación y técnicas sin excesiva complejidad(AU)

Objective: To demonstrate the effectiveness of oncoplastic techniques by the breast surgeon performing the lumpectomy with satisfactory cosmetic outcomes, at the Centro Clínico Familia, Puerto Ordaz. Patients and method: A prospective study in patients with breast cancer and risk lesions, between September 2009 - December 2011, in whom conventional lumpectomy would cause cosmetic defect and this was determined by the size, location, and relation tumor/breast volume, multicentric or bilateral lesion. Results: Eleven patients were operated. Eight with diagnosed breast cancer. Invasive carcinoma: seven patients (63.7%), lobular in situ carcinoma: one patient (9%) and with atypical ductal hyperplasia: three patients (28.1%). The oncoplastic technique more used was the vertical mamoplasty with inferior single branch pedicle: six patients (54.5%). The vertical mammoplasty with superior branch single pedicle and Grisotti´s technique: two patients (18%) respectively. periareolar mamoplasty: one case (9%). Sentinel lymph node biopsy was performed on five patients without complications due to the subareolar injection of patent blue. The cosmetic results were satisfactory. One patient presented a little asymmetry of height of complex areola - nipple and another patient presented a hematoma that was drained ambulatory. Conclusion: Oncoplastic techniques are effective surgical techniques in the conservative treatment of breast cancer and allow extensive resection with excellent cosmetic results. These procedures can be performed by the breast surgeon without formal training in plastic surgery, but based on a thorough planning of techniques without excessive complexity(AU)

A Clinical Study of the Warthin's Tumor of the Salivary Gland / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to define the clinical characteristics and treatment outcome of the salivary Warthin's tumor in order to work out a therapeutic strategy. SUBJECTS AND METHOD: The medical records of 64 patients who underwent surgery and were pathologically diagnosed with Warthin's tumor at our department from January 1997 to December 2009 were reviewed retrospectively. RESULTS: There were 60 (94%) males and 4 (6%) females with an overall male-to-female ratio of 15 : 1. The average age was 59.8+/-9.2 years (range from 35 to 78). All tumors were found in the parotid gland. Of the 66 tumors, 31 (48%) occurred in the right side, 28 (44%) tumors occurred in left side, and 5 (8%) tumors occurred in bilaterally. A superficial parotidectomy was performed in 38 (59%) patients, lumpectomy in 25 (39%) patients and bilateral lumpectomy in one patient. There were 18 (28%) postoperative complications. The most common complication was transient facial palsy that occurred in 11 (17%) patients. Recurrence occurred in 2 (3%) patients, oneipsilaterally and the other contralaterally. All recurrences were found in patients who underwent superficial parotidectomy. CONCLUSION: Warthin's tumor has a very low recurrence rate with a benign nature. The study shows that lumpectomy is an effective surgical treatment for Warthin's tumor with an advantage of reducing facial nerve palsy and recurrence rate.

Volumetric changes in the lumpectomy cavity during whole breast irradiation after breast conserving surgery

PURPOSE: This study was performed to evaluate the change in the lumpectomy cavity volumes before and after whole breast radiation therapy (WBRT) and to identify factors associated with the change of volume. MATERIALS AND METHODS: From September 2009 to April 2010, the computed tomography (CT) simulation data from 70 patients obtained before and after WBRT was evaluated. The lumpectomy cavity volumes were contoured based on surgical clips, seroma, and postoperative changes. Significant differences in the data from pre-WBRT CT and post-WBRT CT were assessed. Multiple variables were examined for correlation with volume reduction in the lumpectomy cavity. RESULTS: The mean and median volume reduction in the lumpectomy cavity after WBRT were 17.6 cm3 and 16.1 cm3, respectively with the statistical significance (p < 0.001). The volume reduction in the lumpectomy cavity was inversely correlated with time from surgery to radiation therapy (R = 0.390). The presence of seroma was significantly associated with a volumetric change in the lumpectomy cavity after WBRT (p = 0.011). CONCLUSION: The volume of lumpectomy cavity reduced significantly after WBRT. As the time from surgery to the start of WBRT increased, the volume reduction in the lumpectomy cavity during WBRT decreased. A strong correlation was observed between the presence of seroma and the reduced volume. To ensure appropriate coverage and to limit normal tissue exposure during boost irradiation in patients who has seroma at the time of starting WBRT, repeating CT simulation at boost planning is suggested.

Lumpectomy as a Surgical Treatment of Primary Benign Pleomorphic Adenoma of the Parotid Gland

PURPOSE: Pleomorphic adenoma is the most common benign neoplasm in parotid gland. Superficial parotidectomy was usually used to remove the pleomorphic adenoma. But, this method has to remove tumor with normal parotid tissue. Authors did lumpectomy to remove pleomorphic adenoma in parotid gland, because pleomorphic adenoma is wrapped in a capsule as it grows. The purpose of this study is to evaluate the efficacy of lumpectomy as a treatment of pleomorphic adenoma in parotid gland. METHODS: From 2002 to 2008, 8 patients underwent the lumpectomy of the pleomorphic adenoma in parotid gland. Occurrence of the complications and recurrance were evaluated. RESULTS: Patients were followed-up for a mean 45 months. There were no recurrance or no complication after lumpectomy. CONCLUSION: Authors suggest that the lumpectomy lead to decrese complications, recurrane and can be used as a procedure for the resection of pleomorphic adenoma in parotid gland.

Central Lumpectomy with Resection of the Nipple-areolar Complex for Retroareolar or Central Breast Cancers

PURPOSE: This study was conducted to evaluate the outcome of central lumpectomy for breast conservation including nipple-areolar resection and postoperative radiation therapy in patients with central breast cancers. METHODS: 19 patients with central breast cancers, aged 39 to 72 years, operated on from May 2004 to March 2010 were identified. Recurrence, survival, and cosmesis were analyzed. Treatment was undertaken as complete excision of the nipple-areolar complex (NAC), followed by external radiation to the whole breast and tumor bed. The mean follow-up period was 37.9 (1 to 71) months. RESULTS: At pathology, 13 had invasive ductal carcinoma; 5 had ductal carcinoma in situ. 1 had neuroendocrine cancer. Only 1 had atypical ductal hyperplasia at resection margin; the remaining 18 were free margins. The mean tumor size was 1.6 cm (range, 0.8~4 cm) and the distance from the nipple was 0~1 cm. 37.5% had positive axillary nodes. Adjuvant chemotherapy was given for 12 patients, followed by radiation therapy. All 15 patients, who were hormone receptor positive, were given tamoxifen or aromatase inhibitors. With a mean follow up of 37.9 months, all 19 patients are alive and free of disease. Cosmetic results ranged from good to excellent in 18 (94.7%) patients, as judged by both the patients and the surgeons. CONCLUSION: Although this study needs further evaluation and long-term follow up, subareolar or central breast cancers can be successfully treated with breast conserving therapy using nipple-areolar resection and postoperative radiation therapy, along with acceptable cosmesis.

A Case of Lipoma of the Parotid Gland

PURPOSE: Lipomas are common soft tissue neoplasms but are rarely found in the parotid gland. They constitute 1-3% of all parotid tumors, and are often not considered in the initial differential diagnosis of parotid gland tumors. METHODS: Our experience is a case of 70-year-old male who had a slow growing, nontender parotid mass for 1 year. CT scan showed a well encapsulated mass with fat density in the superficial lobe of left parotid gland. Lumpectomy including fatty mass and adjacent gland tissue was performed, preserving branches of facial nerve. RESULTS: Frozen section showed lipomatous lesion without malignancy, so, further treatment such as superficial parotidectomy was not needed. CONCLUSION: Though lipoma of parotid gland is rare, lipoma should be included in the initial differential diagnosis of parotid gland tumors and lumpectomy would be enough to treat lipoma if frozen section excluded the possibility of malignancy.

Recurrence Following Breast Conserving Therapy / 한국유방암학회지

BACKGROUNDS: BCT (breast conserving therapy) is now accepted as one of the standard therapeutic options for stage I, II breast cancers. However, especially in Korean breast cancer patients, many questions still remain to be answered in terms of the optimal indication, the extent of resection and the frequency and proper management of recurrence due to the lack of studies involving large numbers of patients. The aims of this study were to examine the pattern and the frequency of recurrence following BCT and to identify the risk factors of local recurrence and systemic relapse. In addition, the outcomes for the patients treated with a quadrantectomy and with a lumpectomy were compared with particular emphasis on the rate of local recurrence. METHODS: The medical records of 386 patients who underwent a BCT at Korea Cancer Center Hospital during the period from January 1986 to December 1996 were reviewed. RESULTS: Among the 386 patients, 269 (69.7%) patients underwent a quadrantectomy and 117 (30.3%) patients underwent a lumpectomy with microscopic confirmation of margin status. Level I, II axillary dissection and whole breast irradiation, including electron beam boost to tumor site, were performed routinely. The axillar and supraclavicular areas were included in the irradiation field when 4 or more positive nodes were found. Systemic treatment (CMF or CAF?tamoxifen) was done depending on the pathological stage and the hormone receptor status of the disease. During the period of follow up (median 66 months), 9 cases (2.3%) of local recurrence and 18 cases (4.7%) of systemic relapse were identified in 24 (6.2%) patients. Between the quadrantectomy and the lumpectomy groups, there were no significant differences in the frequencies of local recurrence (p=0.179) and systemic relapse (p=0.266). Young age (2cm) (p=0.03) and lymph node metastasis (p=0.003) were risk factors of systemic relapse. CONCLUSION: The rates of local recurrence were very low in both the quadrantectomy and the lumpectomy group compared with those in a Western series. These results show that a quadrantectomy or a lumpectomy with confirmation of margin status by radiation therapy can provide excellent results in terms of local control and survival in Korean breast cancer patients.

Recurrence Following Breast Conserving Therapy

BACKGROUND: BCT (breast conserving therapy) is now accepted as one of the standard therapeutic options for stage I, II breast cancers. However, especially in Korean breast cancer patients, many questions still remain to be answered in terms of the optimal indication, the extent of resection and the frequency and proper management of recurrence due to the lack of studies involving large numbers of patients. The aims of this study were to examine the pattern and the frequency of recurrence following BCT and to identify the risk factors of local recurrence and systemic relapse. In addition, the outcomes for the patients treated with a quadrantectomy and with a lumpectomy were compared with particular emphasis on the rate of local recurrence. METHODS: The medical records of 386 patients who underwent a BCT at Korea Cancer Center Hospital during the period from January 1986 to December 1996 were reviewed. RESULTS: Among the 386 patients, 269 (69.7%) patients underwent a quadrantectomy and 117 (30.3%) patients underwent a lumpectomy with microscopic confirmation of margin status. Level I, II axillary dissection and whole breast irradiation, including electron beam boost to tumor site, were performed routinely. The axillar and supraclavicular areas were included in the irradiation field when 4 or more positive nodes were found. Systemic treatment (CMF or CAF tamoxifen) was done depending on the pathological stage and the hormone receptor status of the disease. During the period of follow up (median 66 months), 9 cases (2.3%) of local recurrence and 18 cases (4.7%) of systemic relapse were identified in 24 (6.2%) patients. Between the quadrantectomy and the lumpectomy groups, there were no significant differences in the frequencies of local recurrence (p=0.179) and systemic relapse (p=0.266). Young age (2 cm) (p=0.03) and lymph node metastasis (p=0.003) were risk factors of systemic relapse. CONCLUSION: The rates of local recurrence were very low in both the quadrantectomy and the lumpectomy group compared with those in a Western series. These results show that a quadrantectomy or a lumpectomy with confirmation of margin status followed by radiation therapy can provide excellent results in terms of local control and survival in Korean breast cancer patients.

Lumpectomy with Axillary Dissection for Breast Cancer / 대한암학회지

PURPOSE: The study was to evaluate the various risk factors related to local recurrence and distant metastasis in early breast cancer treated by lumpectomy with axillary dissection MATERIALS AND METHODS: Forty nine patients with early breast cancer were treated by lumpectomy with axillary dissection between January, 1990 and December, 1996. We analysed the risk factors such as age, tumor size, axillary lymph node metastasis, stage, pathologic classification and radiotherapy for local recurrence and distant metastasis RESULTS: The peak incidence was in the fifth decade (15 cases, 31%) and the average age was 47. The most common tumor size was 0~2 cm in 27 of 49 cases (55%). The preoperative chemotherapy was performed in 25 of 49 cases. The axillary lymph node metastasis was absent in 41 of 49 cases (84%). The most common pathologic type was invasive ductal carcinoma (29 cases, 60%). The breast skin incision was performed with curvilinear incision in 40 cases (85%), radial incision in 7 cases (15%). The axillary skin incision was performed with seperated incision in 45 cases (96%), nonseperated incision in 2 cases (4%). The most common complication was wound seroma (6 cases, 12%). By the time of follow-up, crude local recurrence rate was 10% (5 out of 49 cases) and crude distant metastasis rate was 6% (3 out of 49 cases). CONCLUSION: The factors such as age, tumor size, positive axillary nodes and stage were not statistically significantly related to local recurrence. Postoperative radiation therapy and preoperative chemotherapy were the significant factor related to local recurrence (2.6% for 39 cases with radiation therapy vs. 40.0% for 10 cases without radiation therapy, p<0.05; 0% for 25 cases with preoperative chemotherapy vs. 20.8% for 24 cases without preoperative chemotherapy, p<0.05).