Effects of Transcranial Direct Current Stimulation on the Static Balance Ability of Patients with Back Pain

PURPOSE: This study examined the effects of transcranial direct current stimulation (tDCS) on the static balance ability of patients with back pain.METHODS: The subjects comprised of 30 males and females in their 20s, who were divided into two groups with and without tDCS. The balance posture ratio score was calculated to determine the changes in balance ability before and after the application of tDCS using balance equipment. A paired t-test was conducted to determine the changes over time, and an independent t-test was performed to determine the changes between the groups. The significance level was set to α=0.05.RESULTS: A significant difference in the changes in the static balance ability of CTDCSG between before and after applying tDCS was observed while the subjects' eyes were open (p<0.05). A comparison between the groups after the experiments revealed significantly increased changes in CTDCSG compared to STDCSE (p<0.05). The changes in static balance ability were not significant when the subjects' eyes were closed (p>0.05).CONCLUSION: The application of tDCS positively changed the static balance ability of patients with back pain. The results of this study showed that tDCS could be used as an intervention to increase the static balance ability of patients with back pain in the clinical field. The study results could be used further as foundational data for future studies on tDCS.

Effects of Blood Flow Restriction and Different Support Surfaces on the Thickness of Type-I Muscle Fibers in the Trunk

PURPOSE: This study was conducted to investigate the effects of blood flow restriction and different support surfaces for bridge exercises on the thickness of the transverse abdominis and multifidus, which are trunk-stabilizing muscles. METHODS: The study's subjects were 45 adults who were divided into three groups that performed bridge exercises over a six-week period on their respective support surfaces after blood flow restriction. Changes in the thickness of the subjects' transverse abdominis and multifidus muscles were measured using ultrasonography before the experiment, then three and six weeks after the experiment. The changes in each variable over time were analyzed using a repeated-measures analysis of variance (ANOVA). RESULTS: The transverse abdominis showed significant differences in muscle thickness with regard to time and the interaction between time and each group (p0.05). The multifidus showed significant differences in muscle thickness with regard to time, the interaction between time and each group, and changes between groups (p<0.05). CONCLUSION: Blood flow restriction and different support surfaces for bridge exercises led to significant differences in the thickness of the transverse abdominis and multifidus. This study's results may be used as the basis for future studies and for rehabilitation in clinical practice.

Clinical Analysis of Insulinoma / 대한내분비외과학회지

PURPOSE: Insulinoma is a rare disease for which early diagnosis followed by proper surgical management provides a chance for cure. Analyses of clinicopathological features of patients can help optimize the surgical approach in the treatment of insulinoma. METHODS: The records of 13 patients (seven male, six female mean age 44.3 years; age range 17~62 years) who were diagnosed clinically and pathologically with insulinoma and who underwent surgery between March 1997 and April 2007 at the Department of Surgery, Seoul National University Hospital. Hospital in English please were retrospectively examined. RESULTS: All patients had findings compatible with Whipple's triad. Mean fasting blood sugar was 40.5 mg/dl, serum insulin level was 33.5µU/ml, and insulin-to-glucose ratio was 0.6. A prolonged starvation test was performed on six patients. Tumors were localized in 10 patients with a computed tomography (CT) scan and in three patients with CT angiography. Five tumors were located in the pancreas head and uncinate process, five in the body, and four at the body-tail border and tail. Patients underwent resection of tumorby enucleation, distal pancreatectomy, pylorus-preserving pancreaticoduodenectomy, laparoscopic distal pancreatectomy, and duodenum-preserving resection of pancreas head. Four immediate postoperative complications (fluid collection, pancreatic fistula, delayed gastric emptying) occurred. No symptoms or recurrences were apparent during the median 15 month follow-up. CONCLUSION: Insulinoma is difficult to diagnose correctly without a prolonged duration of symptoms. Localization of insulinoma can be aided by a CT scan and/or CT angiography. Less aggressive operative procedures such as simple enucleation might be a sufficient and feasible procedure for curative resection of benign insulinomas.

Efficacy of Breast Ultrasonography for Detection of Local, Regional, and Contralateral Recurrence of Breast Cancer / 한국유방암학회지

PURPOSE: Breast ultrasonography (US) is not recommended for recurrence monitoring after breast cancer surgery due to the lack of evidence for its advantage. The purpose of this study was to evaluate the usefulness of US for detecting local recurrence (LR), regional recurrence (RR) and contralateral breast cancer (CBC) in breast cancer patients during follow-up. METHODS: The medical records of 5,833 breast cancer patients who underwent breast cancer surgery between January 2003 and December 2009 were reviewed retrospectively. Physical examination (PE), mammography (MMG), and US were done routinely to detect recurrences. Detection rate for locoregional and contralateral recurrence was compared between the three modalities. RESULTS: During the follow-up period, 125 LR, 46 RR, 83 CBC, and 29 synchronous local and regional recurrences developed in 245 patients among the study population of 5,833 breast cancer patients. Median time to recurrence was 34.7 months. The recurrence detection rate was 51.9%, 43.5%, and 90.1% for PE, MMG, and US, respectively. Mean size of the recurrent lesions detected by US (1.57 cm) was smaller than that of PE (2.69 cm) and MMG (2.03 cm) (p=0.002). CONCLUSION: Breast US had higher recurrence detection rate for LR, RR, and CBC than PE or MMG after breast cancer surgery.

The Impact of Primary Tumor Resection on the Survival of Patients with Stage IV Breast Cancer / 한국유방암학회지

PURPOSE: The main treatment for stage IV breast cancer is currently systemic therapy. Surgical resection of the primary tumor is usually done for treating the tumor-related complications. Recent studies have suggested that surgery may improve the long-term survival of stage IV breast cancer patients. We evaluated the impact of the primary surgical resection site on the survival of stage IV breast cancer patients. METHODS: We reviewed the records of the stage IV breast cancer patients who were treated at Seoul University Hospital between April 1992 and December 2007. The tumor and clinical characteristics, the type of treatments and the overall survival were compared between the surgically versus nonsurgically treated patients. RESULTS: Of the 198 identified patients, 110 (55.8%) received surgical excision of their primary tumor and 88 (44.2%) did not. The mean survival was 67 months vs. 42 months for the surgically treated patients vs. the patients without surgery, respectively (p=0.0287). On a multivariate analysis with using the Cox model and after adjusting for the estrogen receptor status, visceral metastases, the number of metastatic sites and trastuzumab treatment, surgery was an independent factor for improved survival (hazard ratio, 0.55; 95% confidence interval, 0.31-0.97; p=0.041). CONCLUSION: Surgical resection of the primary tumor in stage IV breast cancer patients was independently associated with improved survival. Randomized prospective trials are needed to firmly recommend surgical resection of the primary tumor in stage IV breast cancer patients.

The Impact of Primary Tumor Resection on the Survival of Patients with Stage IV Breast Cancer / 한국유방암학회지

PURPOSE: The main treatment for stage IV breast cancer is currently systemic therapy. Surgical resection of the primary tumor is usually done for treating the tumor-related complications. Recent studies have suggested that surgery may improve the long-term survival of stage IV breast cancer patients. We evaluated the impact of the primary surgical resection site on the survival of stage IV breast cancer patients. METHODS: We reviewed the records of the stage IV breast cancer patients who were treated at Seoul University Hospital between April 1992 and December 2007. The tumor and clinical characteristics, the type of treatments and the overall survival were compared between the surgically versus nonsurgically treated patients. RESULTS: Of the 198 identified patients, 110 (55.8%) received surgical excision of their primary tumor and 88 (44.2%) did not. The mean survival was 67 months vs. 42 months for the surgically treated patients vs. the patients without surgery, respectively (p=0.0287). On a multivariate analysis with using the Cox model and after adjusting for the estrogen receptor status, visceral metastases, the number of metastatic sites and trastuzumab treatment, surgery was an independent factor for improved survival (hazard ratio, 0.55; 95% confidence interval, 0.31-0.97; p=0.041). CONCLUSION: Surgical resection of the primary tumor in stage IV breast cancer patients was independently associated with improved survival. Randomized prospective trials are needed to firmly recommend surgical resection of the primary tumor in stage IV breast cancer patients.

Factors Affecting the Ipsilateral Breast Tumor Recurrence after Breast Conserving Therapy in Patients with T1 and T2 Tumors / 한국유방암학회지

PURPOSE: Nearly half of all breast cancers are treated with breast conserving therapy (BCT). The purpose of this study was to identify the risk factors for ipsilateral breast tumor recurrence (IBTR) after BCT in T1 and T2 breast cancer patients. METHODS: The medical records of 294 T1 or T2 breast cancer patients who underwent BCT at Seoul National University Hospital between January 1998 and December 2002 were retrospectively reviewed. Kaplan-Meier curves and Cox proportional regression analysis were used to identify the significant clinicopathologic factors that influence IBTR. RESULTS: Among the 294 patients, 12 patients (4.8%) developed IBTR after a median follow-up of 82 months. Univariate analysis demonstrated that younger age (< or =35 year) had significant associations with IBTR (p=0.006). Tumor size, lymph node status, histologic grade, extensive intraductal component, lymphovascular invasion, and close resection margins were not significant factor associated with IBTR. The triple negative breast cancer subtype also did not have significant association with IBTR. Multivariate analysis showed that the younger age at diagnosis was a significant predictor of IBTR with a HR of 3.86 (p=0.036; 95% CI, 1.09-13.60). CONCLUSION: Younger age at diagnosis (< or =35) may be associated with an increased risk of IBTR in patients who underwent BCT.

Lateral Neck Lymph Node Metastasis in Papillary Thyroid Cancer / 대한내분비외과학회지

PURPOSE: Papillary thyroid carcinoma (PTC) is the most common thyroid cancer and lymph node (LN) metastasis is common in PTC. Lateral LN metastasis is associated with local recurrence of PTC. The aim of this study is to evaluate the patterns of lateral LN metastasis of PTC. METHODS: One-hundred seventy four patients who undergone total thyroidectomy, central LN and ipsilatereal or bilateral LN dissection due to PTC 'from 2007 to 2008 in Seoul National University Hospital were retrospectively reviewed. The average age of the patients was 50.4 years and the male to female ratio was 1:4.12. Sixty-seven patients (38.5%) had central LN metastasis and 47 patients (27.0%) had lateral node metastasis. RESULTS: The factors related with lateral LN metastasis of PTC are male gender, the tumor size, extrathyroidal extension, multifocality and central LN metastasis. The level III LN group was the most frequent site of lateral LN metastasis followed by the jugular, level IV, level II, and level V groups. The jugular LN metastasis is mainly related with the metastasis of the upper lateral neck area, including level II LNs, and the lymphatic pathway to the lower lateral neck area, including level IV, seems to be independent from the jugular LNs. Ten cases had lateral LN metastasis without central LN metastasis (skip metastasis). CONCLUSION: Lateral LN metastasis of PTC has a certain pattern. The operator must consider this pattern when managing patients with lateral LN metastasis of PTC.

Development of Individual Probabilities Estimating Program of Major Cancer in Koreans / 대한의료정보학회지

OBJECTIVE: This study was performed to develop a program for predicting individual cancer risk and to validate its discrimination power between case and control groups. METHODS: The author used the five databases for searching journals about risk factors of six major cancers in Koreans: stomach, liver, colorectal, breast, uterine cervix and lung cancer. The risk models were selected from journals presenting a multivariate linear logistic regression analysis. The baseline hazards which had no risk factors were calculated, and a cancer risk assessment program was developed using relative risks based on risk factors' combination and baseline hazards. Case-control study was performed for five years to validate the program. RESULTS: The discrimination power between case and control was 0.827 in stomach cancer, 0.949 in liver cancer, 0.594 in colorectal cancer, 0.587 in breast cancer, 0.708 in uterine cervix cancer and 0.663 in lung cancer. The estimated cancer probabilities were higher in all case groups compared to the control groups. CONCLUSION: The developed program is considered to be a valid tool for estimating probabilities of cancer development in Koreans. It is expected to be useful for the assessment of individual cancer risks, the selection of screening tools and preventive options for risk reduction.

Prognostic Factors Influencing Recurrence in Medullary Thyroid Cancer / 대한내분비외과학회지

PURPOSE: Medullary thyroid carcinoma (MTC) is an uncommon thyroid tumor and the clinical course is variable. Many prognostic factors for MTC have been studied, but the significance of some of these factors remains controversial. This study aimed to evaluate the prognosis of recurrent disease in patients suffering with MTC. METHODS: Fifty three patients who were operated for MTC from 1987 to 2006 in Seoul National University Hospital (SNUH) was retrospectively analyzed. Their medical records were reviewed for the demographic data, the laboratory data and the clinical course, the treatment and the long-term outcome. The median duration of follow-up was 66.5 months. Forty-two patients who were operated on primarily in this hospital were analyzed for their recurrence free survival. RESULTS: The mean age atdiagnosis was 41.8 years. There were 28 femaleand 25 male patients. Eleven patients (22.9%) had multifocal disease. There were 32 sporadic MTC patients, 15 MEN2A patients, 3 familial medullary thyroid carcinoma (FMTC) patients and 1 MEN 2B patient. The 10- and 15-year overall survival rates were 91.9% and 76.5%, respectively; the 5- and 10-year recurrence-free survival rates were 70.6% and 45.5%, respectively. By univariate statistical analysis, the stage (stage I/II vs. III/IV, P=0.025), extrathyroidal extension (P=0.039), cervical lymph node metastasis (P=0.044), and the postoperative calcitonin level (≥25 pg/ml) (P=0.003) were the significant factors that influenced recurrence. CONCLUSION: The overall prognosis of MTC is favorable. The significantfactors for a poor prognosis were the presence of lymph node metastasis, TNM stage III and IV, positive extrathyroidal extension at the first diagnosis and a high postoperative calcitonin level.

Detection of BRAF Mutation on Fine Needle Aspiration Biopsy Specimens Using the Colorimetric Mutation Detection Method

PURPOSE: The detection of papillary thyroid carcinoma (PTC) is increasing these days; however, there is currently no satisfactory definitive preoperative diagnostic method. Fine-needle aspiration cytology (FNAC) is now the most accurate method to diagnose PTC preoperatively. It is known that the specificity of BRAF mutation is high in papillary thyroid carcinoma. Therefore, detection of BRAF mutation using a FNAC slide can be helpful to diagnose PTC preoperatively. METHODS: 13 patients with benign disease, 36 patients with PTC and 23 patients with an indeterminate diagnosis as determined histologically on the FNAC slide were evaluated to detect BRAF mutation with using FNAC slides and intraoperative fresh tissue. RESULTS: Mutation was detected using direct sequencing and the colorimetric method. The frequency of BRAF mutation was 86.3% for all the PTC cases. The concordance between the colorimetric method and direct sequencing was 57.1%. During DNA extraction from the FNAC slide, the DNA damage is so severe that direct sequencing is succeeded in only one case. CONCLUSION: We have to take measures to overcome and prevention DNA damage during extraction. The colorimetric method is not reliable.

Toremifene as an Adjuvant Hormone Therapy for Estrogen Receptor Positive early Breast Cancer: Therapeutic Efficacy and Effect on Endometrium / 한국유방암학회지

PURPOSE: This study was conducted to evaluate the use of toremifene as an adjuvant hormonal therapy for estrogen recepter (ER) positive early breast cancer patients in terms of therapeutic efficacy and effect on endometrium as compared with tamoxifen. METHODS: Between January 2001 and December 2003, 451 patients with stage 0, I and II breast cancer, received adjuvant hormone therapy that consisted of either tamoxifen (N=387) or toremifene (N=64). The recurrence rate and survival rate were compared between two groups and the incidence of of endometrial event was evaluated in 273 of the patients. RESULTS: The median follow up period was 57 months and the median hormonal therapy period was 51 months. During the follow up period, there were 3 (2.0%) recurrence in the stage I tamoxifen group, 19 recurrences (8.7%) and 3 deaths (1.4%) in the stage II tamoxifen group (n=219), however there were no instances of recurrence or death in all of the toremifene group. In addition, endometrial cancer developed in 2 patients in the tamoxifen group, but in no patients in toremifene group during the follow up period. Further 21 of the patients who began treatment using tamoxifen changed to toremifene due to adverse side effects. The toremifene was well tolerated by 15 of the patients that changed treatment regimes. CONCLUSION: Toremifene was found to be as effective and safe as tamoxifen, when used as an adjuvant hormonal therapeutic agent in ER-positive early breast cancer, therefore toremifene may be a good option in place of tamoxifen for patients who are experiencing adverse effects as a result of tamoxifen treatment.

Primary Hyperparathyroidism: A 26-year Experience at Seoul National University Hospital / 대한내분비외과학회지

PURPOSE: As the incidence of primary hyperparathyroidism is on the increase, a 26-year experience of primary hyperparathyroidism is described along with a review of the literature. METHODS: A total of 113 patients underwent surgery at Seoul National University Hospital from 1981 to 2006. Age, sex, presenting symptoms, biochemical analyses, imagefindings, operative findings, histopathology, and information on follow-ups were retrospectively investigated. Furthermore, patients were divided into two period groups and comparative analysis was performed. RESULTS: Among the 113 patients, 41 patients (36.3%) were male and 72 patients (73.7%) were female. The mean age of the patients was 51 years. Thirty-two patients (28.3%) were incidentally discovered and among the symptomatic patients, the presence of a urinary stone was the most frequent presentation. The average serum calcium level and PTH level were 12.4 mg/dl and 452.36 pg/ml, respectively. The calcium level of all patients was normalized the day after surgery, and the PTH level of all patients was reduced remarkably after surgery. Preoperative imaging studies included ultrasonography, computer tomography (CT), and scans such as a (99m)Tc-sestamibi scan and a ²⁰¹Tl-⁹⁹Tc subtraction scan. The sensitivities of CT, the (99m)Tc-sestamibi scan and ²⁰¹Tl-⁹⁹Tc subtraction scan were 80.2%, 68.8% and 75.4%, respectively. Unilateral neck exploration was performed in 97 cases (85.8%), and bilateral neck exploration was carried out in the remaining 16 cases (14.2%). Histopathology revealed 102 cases (90.3%) of adenoma, 3 cases (2.7%) of hyperplasia, 7 cases (6.2%) of carcinoma, and one case that was indeterminate between adenoma and hyperplasia. Fifty-six patients (49.6%) developed transient hypocalcemia, and onepatient required a second surgery due to postoperative bleeding. There was one case of a recurrent carcinoma during a mean follow-up period of 18.7 months. CONCLUSION: Primary hyperparathyroidism is on the increase and is a surgically curative disease. Understanding the nature of the disease is necessary for detection and management.

Dermatofibrosarcoma Protuberans in Breast

Dermatofibrosarcoma protuberans is a slow-growing, but locally aggressive fibrous tumor that has a high rate of local recurrence after surgical resection. This tumor most commonly occurs in the trunk and proximal extremities. In this report we present a case of a 47-year-old woman with dermatofirbosarcoma protuberans in her breast, which is a very unusual site. Complete and careful resection is recommended for this type of tumor to prevent its recurrence.

Retroperitoneal Tumors Preoperatively Misdiagnosed as Adrenal Tumor

PURPOSE: Despite of recent advances in the resolution of computed tomography (CT) and magnetic resonance imaging (MRI), there are different kinds of peri-adrenal retroperitoneal tumors that can hardly be differentiated from adrenal tumor preoperatively. By reviewing certain tumors and their characteristics, we may increase the preoperative diagnostic accuracy and so may perform the proper operation when facing this situation. METHODS: We retrospectively reviewed fourteen cases of non-adrenal origin retroperitoneal tumors that were preoperatively diagnosed as adrenal tumors during a seven-year period at Seoul National Universiry Hospital. RESULTS: The fourteen retroperitoneal tumors preoperatively misdiagnosed as adrenal tumors were extra-adrenal ganglioneuroma (6 cases), schwannoma (2 cases), retroperitoneal paraganglioma (1 case), bronchogenic cyst (2 cases), Castleman's disease (1 case), idiopathic retroperitoneal fibrosis (1 case) and leiomyosarcoma (1 case). All of them were large (> 6 cm), and most were solid. CONCLUSION: For the correct preoperative diagnosis and appropriate operation of peri-adrenal retroperitoneal tumors, and especially when the tumors are large and solid, the disease entities mentioned above should be excluded, and the application of additional diagnostic measures such as preoperative fine needle aspiration cytologic examination or biopsy, endoscopic ultrasound (EUS), intraoperative frozen biopsy, laparoscopic ultrasound (LUS), as well as preoperative CT and MRI, should be considered when the diagnosis is not conclusive.

Alteration of Estrogen Receptor, Progesterone Receptor, and HER-2 Expression in Breast Cancer after Neoadjuvant Chemotherapy / 한국유방암학회지

PURPOSE: We aimed to assess the concordance of the immunohistochemical profiles of core biopsy before administrating neoadjuvant chemotherapy with that of the surgical specimens after a definitive operation for breast cancer. METHODS: We retrospectively reviewed the estrogen receptor (ER), progesterone receptor (PR), and HER-2 expressions in 130 consecutive patients who received neoadjuvant chemotherapy and were followed by surgery during the period between February 2002 and March 2006. The pathologic complete tumor response rate for this group was 4.6% (6/130). Both the pre- and post-operative immunohistochemical profiles were available in 32 of the 124 patients (25.8%). Immunohistochemical staining was done on the core biopsies before chemotherapy and on the surgical specimens after operation. RESULTS: There were 12 markers from 11 patients that were altered out of the 96 total markers (ER, PR, or HER-2) from 32 patients: 2 ER (2/12, 16.7%), 4 PR (4/12, 33.3%), and 6 HER-2 (6/12, 50.0%). One patient simultaneously had changes in the expressions of PR and HER-2. Conversion of the hormone receptor status occurred in 3 patients (3/32, 9.4%): this was positive to negative in two, and vice versa in one. In addition, there were 6 conversions (6/32, 18.8%) of the HER-2 status from negative to positive. CONCLUSION: The hormone receptor status changed in 9.4% of the 32 patients and the HER-2 status changed in 18.8% of the 32 patients after neoadjuvant chemotherapy. We have concluded that conducting only a single immunohistochemical study about ER, PR, and HER-2 may not be enough to exactly estimate the tumor marker status in the neoadjuvant setting.

The Clinical and Histopathological Characteristics of Male Breast Cancer Patien / 한국유방암학회지

PURPOSE: Breast cancer in male is uncommon, accounting for approximately 1% of all breast cancer and less than 1.5% of all the malignant neoplasms in males. The information concerned with the treatment of male breast cancer is limited. The objective of this study is to evaluate the histopathologic characteristics and clinical outcome of male breast cancer patients. METHODS: We retrospectively analyzed the medical record of 17 male breast cancer patients who had been operated on Seoul National University Hospital between 1996 and 2006. RESULTS: The peak age of incidence was the 6th decade and the mean age of the patients was 56.2 yr. The most common symptom was a palpable mass and the mean duration of symptoms was 13 months. Fifty-three percent of the patients were stage 0 or I. Mastectomy was performed in 15 cases and lumpectomy was performed in 2 cases. Twelve patients received adjuvant hormonal therapy. The median duration of follow up was 28 months. Of the two patients with distant relapse, one patient died due to multiple metastasis and the other patient is still alive. The other patients are still alive without any evidence of metastasis or recurrence. CONCLUSION: Active diagnosis, appropriate treatments (surgery and adjuvant therapy) and close follow up are necessary for male patients who have a palpable mass in their breast.

Comparative Results of Modified Radical Neck Dissection and Level I Preserving Selective Neck Dissection for Metastatic Papillary Carcinoma of the Thyroid

PURPOSE: The level I lymph node group is not a usual drainage site for papillary carcinoma of the thyroid. Dissection of the level I lymph nodes may result in injury to the marginal mandibular branch of the facial nerves and the submandibular gland. The aim of this study was to clarify the possibility of a conservative neck dissection without performing a level I dissection. METHODS: From January 1985 to December 1989 a total of 244 patients underwent an operation for papillary carcinoma of the thyroid at Seoul National University Hospital. Eighty-two out of 244 patients who had palpable lateral cervical nodes were treated by a modified radical neck dissection. Between January 1985 and December 1986, a level I dissection was performed. However, in the latter three years, selective neck dissection that preserved the level I lymph nodes was carried out. Thirty-three patients who underwent a classical modified radical neck dissection were compared with 49 patients who underwent a selective neck dissection without a level I dissection. RESULTS: There were no differences in gender and the extent of disease between the groups. One case of injury to the marginal mandibular branch of the facial nerve occurred in the level I dissected group. There were no differences in the recurrence rate and survival rate. CONCLUSION: We concluded that a level I lymph node dissection is not necessary in a modified radical neck dissection for treating metastatic papillary carcinoma of the thyroid.

Preoperative Evaluation of Lymph Node Metastasis with Using Ultrasonography for Examining the Axilla in Early Stage Breast Cancer / 한국유방암학회지

PURPOSE: The axillary lymph node status is the most significant prognostic factor in breast cancer. The development of tools to accurately evaluate the axillary lymph node status with less morbidity has been the important treatment issue. Although sentinel lymph node biopsy is the promising alternative to axillary lymph node dissection, the high false negative rate of this procedure is a considerable problem. This study aimed to evaluate the efficacy of performing preoperative axillary ultrasonography (US) for predicting axillary lymph node metastasis. METHODS: Between January 2003 and December 2004, preoperative axillary US was performed in 646 patients who were suffering with T1 or T2 infiltrating ductal carcinoma and they had no palpable axillary lymph nodes. RESULTS: The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of preoperative axillary US findings were 82.8%, 93.2%, 86.3%, 91.2%, and 89.6%, respectively. The positive and negative predictive values for performing axillary US findings for tumors with a size 2cm, the positive and negative predictive values were 90.6 and 89.4, respectively. CONCLUSION: We found that performing preoperative axillary US is a relatively accurate and useful non-invasive method for assessing axillary lymph node metastasis. It showed the potential to replace sentinel lymph node biopsy in tumors > or = 2cm in size with low false negative rate. If we can improve the positive predictive value of US finding by using strict decision criteria, and especially for the tumors >2cm in size, then axillary lymph node dissection might be recommended for the cases with positive US finding.

Data Management of Surgical Patients Using Excel Macro

PURPOSE: A management of patient data is important for clinical research and statistics. The data from an order communication system (OCS) is not easily accessible, but the data can be duplicated with a previously developed patient database system. Therefore, we tried to develop a new patient data management program linked with an OCS, which is suitable to clinicians' need. METHODS: We developed a program using a Macro function in Microsoft Excel. The program consisted of two parts: a data-retrieving part from an OCS and a report-making part. From an OCS, the patient data was retrieved and stored in an Excel sheet format for further clinical research. The program analyzed the data and made daily, monthly and yearly reports. RESULTS: The program consisted of data-storing excel sheets and program codes. It made a daily inpatient report, a weekly surgical patient report and a yearly statistical report according to the name of the operations and the subspecialties. Pressing buttons linked with codes controlled the operation of the program. The program was easily modified according to the user's needs. CONCLUSION: We developed an easy-to-use spreadsheet based on a patient data management program. This program will be helpful for clinical work, including research and statistics.