Analysis of Tumor Size between Imaging of Preoperative Ultrasound, MRI and Pathologic Measurements in Early Breast Carcinoma

Purpose@#Preoperative tumor size is associated with clinical stage, treatment plan and even survival rate of patient. We investigated the accuracy of tumor size estimation between magnetic resonance imaging (MRI) and ultrasonography (US) findings, comparing these with pathologic tumor size in the diagnosis of early breast carcinoma. @*Methods@#Between 2011 and 2016, 136 patients with early breast cancer were analyzed and their tumor size on US and MRI findings were compared with their pathologic tumor size retrospectively. The background parenchymal enhancement of MRI was categorized as minimal, mild, moderate, and extreme. The patients who underwent neoadjuvant chemotherapy, had positive resection margins, underwent excisional biopsy for cancer diagnosis, and had non-mass lesions on MRI scans, were excluded. @*Results@#In all, 83.1% of the cases showed concordance between MRI findings and pathologic tumor size within 0.5cm. MRI overestimated the findings by 10.3% and underestimated them by 6.6%; 78.7% showed concordance between US findings and pathologic tumor size within 0.5cm. US overestimated the findings by 5.9% and underestimated them by 15.4%. The tumor size on MRI (r=0.87) showed a stronger correlation to the pathologic tumor size than that on US (r=0.64) in early breast cancer patients. US had a tendency to underestimate the tumor size. The degree of breast parenchyma did not affect the accuracy of the measurement of preoperative tumor size. @*Conclusion@#MRI is relatively more accurate than US for assessing preoperative tumor size in breast cancer patients. US tends to underestimate tumor size.

Comparison of the Clinical Outcomes between Angiojet Pharmacomechanical Thrombectomy and Hybrid Surgical Thrombectomy for Thrombotic Occlusion of Hemodialysis Access

Purpose@#This retrospective study aimed to compare the clinical outcomes between hybrid surgical thrombectomy (ST) and AngioJet pharmacomechanical thrombectomy (PMT) for thrombotic occlusion of arteriovenous graft. @*Materials and Methods@#This study enrolled patients who underwent either hybrid ST or AngioJet PMT in Presbyterian Medical Center from July 2018 to December 2018. We primarily compared the technical and clinical success rates between the two groups immediately after the procedures. Subsequently, the postprocedure clinical outcomes, including the primary and secondary patency rates and complications, were also compared. @*Results@#The hybrid ST group had a significantly higher bleeding amount than the AngioJet PMT group (P=0.02). The technical and clinical success rates were 96.7% and 93.3% in the AngioJet PMT group and 100% and 100% in the hybrid ST group, respectively. There was no significant difference in complications between the groups. The primary and secondary patencies at 12 months were not statistically different between the groups. @*Conclusion@#Comparable clinical outcomes were observed between the AngioJet PMT and hybrid ST groups, highlighting an equivalent efficacy of these two methods. Although the cost is more expensive, AngioJet PMT lowered the bleeding amount. Therefore, it can be considered in selected patients who are at risk of bleeding or reluctant to surgery.

Comparison of the Clinical Outcomes between Angiojet Pharmacomechanical Thrombectomy and Hybrid Surgical Thrombectomy for Thrombotic Occlusion of Hemodialysis Access

Purpose@#This retrospective study aimed to compare the clinical outcomes between hybrid surgical thrombectomy (ST) and AngioJet pharmacomechanical thrombectomy (PMT) for thrombotic occlusion of arteriovenous graft. @*Materials and Methods@#This study enrolled patients who underwent either hybrid ST or AngioJet PMT in Presbyterian Medical Center from July 2018 to December 2018. We primarily compared the technical and clinical success rates between the two groups immediately after the procedures. Subsequently, the postprocedure clinical outcomes, including the primary and secondary patency rates and complications, were also compared. @*Results@#The hybrid ST group had a significantly higher bleeding amount than the AngioJet PMT group (P=0.02). The technical and clinical success rates were 96.7% and 93.3% in the AngioJet PMT group and 100% and 100% in the hybrid ST group, respectively. There was no significant difference in complications between the groups. The primary and secondary patencies at 12 months were not statistically different between the groups. @*Conclusion@#Comparable clinical outcomes were observed between the AngioJet PMT and hybrid ST groups, highlighting an equivalent efficacy of these two methods. Although the cost is more expensive, AngioJet PMT lowered the bleeding amount. Therefore, it can be considered in selected patients who are at risk of bleeding or reluctant to surgery.

Results of Absorbable Mesh Insertion and Patient Satisfaction in Breast-Conserving Surgery

PURPOSE: Breast-conserving surgery (BCS) is a standard treatment for breast cancer. Occasionally, patients may be dissatisfied with the breast shape due to deformity after BCS. To ensure satisfactory cosmetic results, a procedure with absorbable mesh after BCS was introduced in 2005. The purpose of this study was to identify the safety and effectiveness of this procedure. METHODS: From November 2013 to December 2015, patients who underwent BCS for a malignant breast mass at Jeonju Presbyterian Medical Center were reviewed, and 63 patients were included in this study. Based on data collected from medical records and telephone interviews, the subjects were divided into two groups as follows and retrospectively compared and analyzed: BCS with absorbable mesh (n=31) and BCS without absorbable mesh (n=32). Patient data included age, body mass index, underlying disease, tumor location and size, specimen size, operative time, axillary dissection based on frozen biopsy results, postoperative wound infection, postoperative radiotherapy, adjuvant chemotherapy, and follow-up period. To compare patient satisfaction between the two groups, a brief questionnaire consisting of four items was administered. RESULTS: Infection occurred in six patients (19.4%) in the absorbable mesh group and one (3.1%) in the BCS only group; however, the difference was not significant (p=0.053). Overall satisfaction, postoperative pain and postoperative motion limitation between the two groups were also not statistically significantly different. However, patients who underwent BCS with absorbable mesh insertion were better satisfied with the breast shape than those who underwent BCS without mesh from 1 year after operation (p=0.011). CONCLUSION: BCS with absorbable mesh is a simple and easy method to improve patient satisfaction for breast shape.

The Effect of Lumbar Spinal Stenosis on Results of Treatment in Peripheral Arterial Disease / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the result of percutaneous transluminal angioplasty (PTA) in patients with concurrent lumbar spinal stenosis (LSS) and peripheral arterial disease (PAD). MATERIALS AND METHODS: Patients who underwent PTA for intermittent claudication were evaluated retrospectively. Twenty-two patients with severe LSS were included in group A and 23 patients with no or mild LSS in group B. The symptomatic improvement after PTA was comparatively evaluated. RESULTS: Visual analogue scale (VAS) and Walking Impairment Questionnaire (WIQ) scores showed significant improvement after PTA in both groups (p<0.001, <0.001). However, according to VAS, WIQ and modified MacNab scores, results of group A were less satisfactory (p<0.001, <0.001, p=0.03). Only 2 patients underwent additional spine surgery. CONCLUSION: In results of PTA, the PAD associated LSS group showed less improvement than the PAD only group, but most patients showed symptomatic improvement with conservative treatment.

Clinical Experience with a Hybrid Procedure Using the Adherent Clot Catheter for Salvage of Thrombosed Hemodialysis Access: A Comparison with the Standard Fogarty Balloon Catheter

PURPOSE: This study aimed to compare the efficacy of two different catheters in hybrid surgery for salvage of thrombosed hemodialysis accesses. MATERIALS AND METHODS: The hybrid salvage procedure (surgical thrombectomy followed by endovascular angioplasty) of the thrombosed hemodialysis access, was performed using adherent clot (AC) catheter in 140 cases and Fogarty balloon catheter in 68 cases. Procedure-related outcomes such as the clot removal status, clinical success, complications, and primary patency rates were analyzed retrospectively. RESULTS: The proportion of cases with good clot removal scores in the AC catheter and Fogarty balloon catheter groups was 77.9% and 91.2%, respectively (P=0.018). Clinical success was achieved in 90.7% of the cases in the AC catheter group and in 98.5% of the cases in the balloon catheter group (P=0.035). The mean patency rates of the two groups were 50.7% and 63.2% at 3 months, 40.7% and 47.1% at 6 months, and 17.9% and 19.1% at 12 months. The complication rates (12.1% and 5.9%) and primary patency rates between the two catheters were not statistically different (P=0.328). On the analysis of the patency rate on access type of autologous (P=0.169) and prothetic graft (P=0.423), there was no significant difference between the two catheter groups. CONCLUSION: In terms of clot removal and clinical success, the AC catheter did not demonstrate better outcomes than the Fogarty balloon catheter. However, primary patency was not related to the type of catheter. Adherent clot catheter can be a useful alternative to Fogarty balloon catheter for thrombosed hemodialysis access.

The Comparative Analysis between Surgical Thrombectomy and Hybrid Treatment in Salvage Operation / 대한혈관외과학회지

PURPOSE: Salvage operation is performed to improve the functional deficit of vascular access. This study is planned to evaluate the utility of the hybrid surgery through a comparative analysis between the results of surgical thrombectomy and those of hybrid surgery, combining surgical methods and endovascular treatments. METHODS: From January 2007 to December 2008, surgical thrombectomy had been done to 55 patients, whereas hybrid surgery had been done to 111 patients from January 2009 to December 2011. We have done a comparative analysis on the patency rate after the salvage operation for each group, retrospectively. Medical records were reviewed for patient information and radiographic data was used for checking the stenosis site in the hybrid surgery group. RESULTS: There were no statistically significant differences between the two groups, including age, gender, diabetes status, hypertension, and vascular access site or type. The primary patency rate was significantly higher in arteriovenous fistulas (65%) compared with arteriovenous grafts group (55%), at 12 months (P<0.01). At one year after the salvage operation, the secondary patency rate was higher in the hybrid surgery group compared to the surgical thrombectomy group (43.8% vs. 23.7%, P<0.01). CONCLUSION: This study shows that hybrid surgery combining surgical methods and endovascular treatments can be more useful for the salvaging of thrombosed vascular access than performing only surgical thrombectomy.

Radiofrequency Ablation for Benign Thyroid Nodules Performed by Surgeon / 대한내분비외과학회지

PURPOSE: The ability to apply radiofrequency ablation (RFA) has provided for a greater diversity of approaches for treatment of benign thyroid nodules. This study evaluated the efficacy and safety of RFA performed by a surgeon. METHODS: From January 2009 to November 2010, a total of 47 benign thyroid nodules were treated with RFA performed by one surgeon. Nodular patterns were divided into mainly cystic, mixed, and mainly solid (soft solid, hard solid) nodules, and ultrasonography was performed for assessment of the volume-reduction radio (VRR) of each nodule. Follow-up ultrasonography was performed three to 19 months after ablation. And complication was observed. One session of RFA was performed. RESULTS: The median volume before ablation was 7.8 cm³ (range 1.3~43.2 cm³). After ablation, the median volume was 0.9 cm³ (range 0.0-21.6 cm³) and VRR was 81.5±17.3%. RFA in mainly cystic nodules resulted in significant decreases in VRR (93.7±5.0%, P=0.009). It was the largest among the nodular types. VRR was 81.4±13.1% in mixed nodules, 77.2±19.2% in mainly solid nodules, 85.9±11.0% in soft solid nodules, and 54.2±17.3% in hard solid nodules 95.7% of nodules (45 nodules) showed more than 50% reduction, while the two remaining nodules, which were hard solid nodules, showed less than 50% reduction. Complications included pain, voice change, nausea, and transient voice change. CONCLUSION: Results of this study demonstrated the safety and effectiveness of RFA performed by a surgeon for reducing nodule volume.

The Diagnostic Value of High Resolution Ultrasonography as Examined by Surgeons for the Differentiation of Thyroid Nodules / 대한내분비외과학회지

PURPOSE: High resolution ultrasonography has recently become a useful tool to differentiate malignant thyroid nodules from benign thyroid nodules. We performed this study in order to determine the usefulness of an ultrasonography examination that's performed by endocrinologic surgeons through the analysis of the sonographic characteristics. METHODS: A retrospective review was undertaken for 312 patients who underwent surgery and a US examination by the operator before surgery due to thyroid nodules at Jesus Hospital from February 2006 to March 2008. The review consisted of the characteristics of the sonographic parameters, such as the margin, structure, shape, echogenicity, homogeneity, calcification, sponge sign and the width/height ratio. RESULTS: On univariate analysis of the non-follicular neoplasm, the significant parameters were the margin, structure, shape, echogeneity, homogeneity, calcification and the width/height ratio. On the logistic regression analysis, the margin, structure, shape and echogenecity were significant parameters. On a univariateanalysis of the follicular neoplasm, the significant parameters were the shape, echogenecity, homogeneity and calcification. On the logistic regression analysis of the total thyroid nodules, the margin, structure, shape and echogenecity were significant parameters. Especially, hypoechoic and solid structures are the most potent malignant characteristics. CONCLUSION: Among the ultrasonographic characteristics checked by surgeons before surgery, the hypoechogenecity and solid structures are the most useful ones when planning operative management of thyroid nodules.