Assessment of Mastectomy Skin Flaps for Immediate Implant-Based Breast Reconstruction.

Objectives: The aim of this study is to identify the appropriate preoperative evaluation methods for the quality of the skin flaps and subcutaneous breast layer using different imaging techniques in correlation with the intraoperative findings and also their importance for the outcome in immediate implant-based breast reconstruction. Materials and Methods: Clinical evaluation, mammography, breast ultrasound and breast MRI were used for the assessment of the mastectomy skin flaps which enhanced the selection of the adequate surgical technique for breast reconstruction. The evaluation started with the skin flap measurement of 50 patients with breast cancer, who were candidates for modified radical mastectomy (MRM) in 2014, using the above-mentioned methods, without immediate breast reconstruction. Consequently, 46 nipple-sparing mastectomies (NSM) and 21 skin-sparing mastectomies (SSM) with immediate breast reconstruction with implants were performed between 2014 and 2017 after having such a preoperative subcutaneous tissue thickness evaluation. Results: The intraoperative findings of the MRM group showed a 90% accuracy for the MRI preoperative evaluation, 87% for the ultrasound, 81% for the mammography and 71% for the pinch test. The preoperative measurements for the patients undergoing SSM or NSM were a criterion for choosing the surgical technique for breast reconstruction. The rate of postoperative complications was low. Conclusion: Preoperative clinical measurements, breast ultrasound, breast MRI and mammography can enhance the prediction of the skin flap thickness and thus lead to a low rate of complications and good aesthetic results in implant-based immediate breast reconstruction.

Modulating the extension of axillary lymphadenectomy for early stage breast cancer.

Axillary lymph node evaluation remains essential in breast cancer surgery, first as a prognostic factor, because it indicates the degree of dissemination of the disease to the main lymphatic drainage basin of the breast, and, on the other hand, as an element of preventing the local relapse. In the era of the sentinel lymph node, complete axillary lymphadenectomy, considered valuable until recently, but as therapeutic and diagnostic, has become an intervention performed increasingly rare in selected cases. Axillary lymphatic tissue resections are accompanied by morbidity (lymphedema, paresthesia, limitations of arm movement) and symptom magnitude is proportional to the extension of the intervention. For this reason, a solution to avoid these kinds of complications was looked for. Since Gould, in 1960, who mentioned cancer parotid and continuing with Cabanas, Morton, or Veronesi, many surgeons have contributed to the development of safe techniques with which the multidisciplinary team involved in the surgical treatment for breast cancer could perform a safe oncological intervention and at the same time could conserve the healthy tissue, thus limiting morbidity. To achieve this standard, axillary lymphadenectomy has passed through several stages, from over radical interventions that followed the Halsted era, in which, besides axillary lymph nodes, the internal mammary and jugulo-carotidian lymph nodes were excised, to the absence of axillary surgery and replacing it with radiation therapy.

Impact of gender and primary tumor location on outcome of patients with cutaneous melanoma.

Background. The survival of patients with cutaneous malignant melanoma (MM) depends on multiple factors whose role is continuously updated, as the molecular mechanisms underlying the disease progression are understood. This study intended to assess whether the patient's gender and tumor location affect the disease outcome. Methods. Between 2008 and 2012, 155 patients with cutaneous MM underwent various types of surgeries in our clinic. Patients were staged according to the 2009 TNM classification. There were 90 women and 65 men. Primary tumors were located as it follows head and neck region - 4.5%, limbs - 50.7% and trunk - 44.8%. The disease free and overall survival rates (DFS, OS) were estimated by using the Kaplan-Meier method. Results. Metastases developed in 52.3% of the males and 31.1% of the females (p=0.008). In univariate analysis, distant metastasis risk was significantly higher in men (p = 0.0472 for stage II patients and p = 0.0288 for stage III). In multivariate analysis, male gender almost doubled the risk of relapse (p = 0.044) and death (p = 0.022). Consequently, DFS and OS were significantly higher among females. Primary tumor location seemed to influence the melanoma spreading ability. Half of the trunk MM developed metastases while only a third of limbs MM did. The association between MM location and the recurrence risk was not random (p = 0.033). Conclusions. The patient gender represents an independent prognostic factor for both relapse and death. Although trunk MM had a significantly higher risk of metastasis than limbs MM, the location per se was not an independent prognostic factor for survival (p = 0.078). Abbreviations: MM = malignant melanoma, DFS = disease free survival, OS = overall survival, p = p value, AJCC = American Joint Commission on Cancer, CI = confidence interval.

Evolution of radical mastectomy for breast cancer.

Surgical treatment of breast cancer has been marked by a constant evolution since the Halsted radical mastectomy described in the late 19th century has become the current standard Madden radical mastectomy, a breast surgery that involves the ablation of tissue with the axillary lymphatic preserving both pectoral muscles. The purpose of this paper was to present the stages that have marked the evolution of this intervention and to provide an overview of the way breast cancer has been understood and treated in the last century.

Sentinel lymph node biopsy (SLNB) vs. axillary lymph node dissection (ALND) in the current surgical treatment of early stage breast cancer.

The identification and biopsy of the sentinel lymph node has become a standard method of treatment for stage I and II breast cancer in the last decades, taking into account the fact that the management of the axilla in patients with breast cancer has evolved from the routine lymphadenectomy to a selective attitude, based on the histopathological evaluation of the sentinel lymph node, as well as on the tumor and on the patients' characteristics. Since the introduction of the method into clinical practice, in 1994, different methods of identification have been used (radioisotope injection, vital blue dye, or, more recently, lipophilic contrast agent for ultrasound visualization or paramagnetic nanoparticles (NPs) or the method of indocyanine green fluorescence), each presenting certain limits, but the radioisotopic method proving the most accurate. Moreover, during the development of the method, beside the standard indications specific for T1 or T2 breast tumor, without clinical or imagistic axillary adenopathies, their extension to a series of other particular situations such as the following, has been tried: ductal carcinoma in situ, multicentre tumors, after excisional biopsy or tumors preoperatively treated by neoadjuvant chemotherapy. The aim of the paper is to present the progress made regarding the current stage in the use of sentinel lymph node technique in breast cancer, while mentioning the established indications, as well as the ones that are still debating and need further studies. Likewise, the cases in which the axillary lymph node dissection remains the major indication for treatment of the axilla, in patients with early stage breast cancer, will be discussed.

Pain-associated biomarkers in breast cancer.

Breast cancer represents a major public health problem, being the highest incidence neoplasia in females in Romania. The most important step in the treatment of this neoplasia is the surgical procedure; the biggest problem associated with this form of treatment in these patients is pain-related. Pain is a complex symptom with an impact on quality of life and psychology of cancer patient and can only be monitored verbally and subjectively. Consequently, the purpose of our work is to identify some biochemical parameters involved in the events cascade associated with inflammation and pain in breast cancer female patients, monitored in dynamics of anesthesia and surgical procedure. Measurements of lipid peroxides, ceruloplasmin and immune circulating complexes in mentioned dynamics have been performed. The recorded values are in concordance with the inflammatory processes and pain intensity, thus we can allege that these measurements can complete the pain-associated clinical picture in female breast cancer patients.

Types of radical hysterectomies : From Thoma Ionescu and Wertheim to present day.

The treatment for cervical cancer is a complex, multidisciplinary issue, which applies according to the stage of the disease. The surgical elective treatment of cervical cancer is represented by the radical abdominal hysterectomy. In time, many surgeons perfected this surgical technique; the ones who stood up for this idea were Thoma Ionescu and Ernst Wertheim. There are many varieties of radical hysterectomies performed by using the abdominal method and some of them through vaginal and mixed way. Each method employed has advantages and disadvantages. At present, there are three classifications of radical hysterectomies which are used for the simplification of the surgical protocols: Piver-Rutledge-Smith classification which is the oldest, GCG-EORTC classification and Querlow and Morrow classification. The last is the most evolved and recent classification; its techniques can be adapted for conservative operations and for different types of surgical approaches: abdominal, vaginal, laparoscopic or robotic.

Postoperative surgical complications of lymphadenohysterocolpectomy.

UNLABELLED: Rationale The current standard surgical treatment for the cervix and uterine cancer is the radical hysterectomy (lymphadenohysterocolpectomy). This has the risk of intraoperative accidents and postoperative associated morbidity. Objective The purpose of this article is the evaluation and quantification of the associated complications in comparison to the postoperative morbidity which resulted after different types of radical hysterectomy. METHODS AND RESULTS PATIENTS WERE DIVIDED ACCORDING TO THE TYPE OF SURGERY PERFORMED AS FOLLOWS: for cervical cancer - group A- 37 classic radical hysterectomies Class III Piver - Rutledge -Smith ( PRS ), group B -208 modified radical hysterectomies Class II PRS and for uterine cancer- group C -79 extended hysterectomies with pelvic lymphadenectomy from which 17 patients with paraaortic lymphnode biopsy . All patients performed preoperative radiotherapy and 88 of them associated radiosensitization. Discussion Early complications were intra-abdominal bleeding ( 2.7% Class III PRS vs 0.48% Class II PRS), supra-aponeurotic hematoma ( 5.4% III vs 2.4% II) , dynamic ileus (2.7% III vs 0.96% II) and uro - genital fistulas (5.4% III vs 0.96% II).The late complications were the bladder dysfunction (21.6% III vs 16.35% II) , lower limb lymphedema (13.5% III vs 11.5% II), urethral strictures (10.8% III vs 4.8% II) , incisional hernias ( 8.1% III vs 7.2% II), persistent pelvic pain (18.91% III vs 7.7% II), bowel obstruction (5.4% III vs 1.4% II) and deterioration of sexual function (83.3% III vs 53.8% II). PRS class II radical hysterectomy is associated with fewer complications than PRS class III radical hysterectomy , except for the complications of lymphadenectomy . A new method that might reduce these complications is a selective lymphadenectomy represented by sentinel node biopsy . In conclusion PRS class II radical hysterectomy associated with neoadjuvant radiotherapy is a therapeutic option for the incipient stages of cervical cancer. ABBREVIATIONS: PRS- Piver Rutledge-Smith, II- class II, III- class III.

Peculiarities of lymphatic drainage in cutaneous malignant melanoma: clinical experience in 75 cases.

UNLABELLED: In the recent years, the identification and biopsy of the sentinel lymph node (SLN) has become standard in the treatment of cutaneous malignant melanoma (CMM). In order to correctly apply the technique and to decrease the risk of false negatives,it is compulsory to track the lymphatic drainage of the primary tumor and to detect all SLN, regardless of their site. METHOD: At the Bucharest Oncologic Institute, over the last three years, selective lymphadenectomy was performed in 75 patients with CMM, stages I and II (AJCC). In 39 cases, the primary tumor was at the level of the upper and lower limbs and in 36 on the trunk. In all patients, lymphoscintigraphy was performed through intradermal injection of Nanocoll,with dynamic follow up of the radiotracer, with the purpose of finding the possible unusual locations of the SLN. RESULTS: The sentinel lymph nodes were identified in 100%of the cases. In 63 patients (84%), the primary tumor drained in only one lymphatic field and in the other 12 the drainage was towards 2 or more lymphatic basins. The CMM situated on the trunk had a particular behaviour, presenting more often (33%) with multiple nodal basin drainage. CONCLUSIONS: CMM of the trunk, mostly those situated close to the midline, but others as well, tend to drain into several lymphatic areas. The existence of interval lymph nodes and atypical lymphatic drainage, in a minor lymphatic basin,must be determined preoperatively in order to allow the biopsy of all SLN and establish the right therapy.

Survival rates of patients with metastatic malignant melanoma.

RATIONALE: Malignant melanoma (MM) is the cutaneous neoplasia with the greatest mortality rates and one of the malignancies with the highest potential of dissemination. The prognosis of patients with metastatic MM is grim, with a 5-years survival rate between 5-19%, and is dictated by the location and the number of metastases. OBJECTIVE: We aimed to estimate the survival of patients with metastatic MM from our study and find out if the metastasis' location influences survival. METHODS AND RESULTS: Between 2008 and 2013, 155 patients with cutaneous MM were diagnosed in our clinic. All the patients were staged according to 2009 AJCC staging system. The median follow-up period was of 24 months. Survival was calculated by using the Kaplan-Meier method with a confidence level of 95%. 40.5% of the patients developed metastases in different organs, especially the brain. 80.6% of those with metastases died during the study. The median overall survival, estimated for the entire group of patients who developed metastases, was of 5.3 months. DISCUSSION: The influence of metastases distribution on the overall survival was examined and it was noticed that there were statistically significant differences between the risks of death of various groups of patients, depending on metastasis topography. Thus, the death probability of a patient with brain metastases is twice that of a patient with digestive metastasis, about 7 times higher than that of a patient with lung metastasis (p=0.0004) and 12 times higher than the death risk of a patient with extra-regional lymph nodes or subcutaneous metastasis (p=0.0000).

Perioperatory pain in oncological patient - physiopathological and therapeutical implications.

Perioperatory pain in oncological patients represents a witness of anesthetic-surgical aggression, frequently exacerbated by the complementary radio-chemotherapy and also a predictive factor for postoperatory evolution. The objectivation of perioperative pain by scales of clinical evaluation does not offer a certain and objective quantification; so, the dosing of some hormonal and acute phase inflammation mediators could realize a more realistic projection. Clinical and biological correlation can offer a support for an adequate and well-balanced treatment.

Occult breast lesion localization and concomitant sentinel lymph node biopsy in early breast cancer (SNOLL).

AIMS: Mammographic screening and the increasing resolution output of mammography have raised the identification number of small-size mammary lesions without clinical expression. The aim of this study was to evaluate in a prospective study the localization techique and concomitent sentinel lymph node biopsy for breast cancer (SNOLL - Sentinel lymph Node biopsy and Occult Lesion Localization). METHODS: We identified by means of imaging techniques a number of 107 patients with clinically occult suspicious breast tumors. All patients preoperatively underwent a protocol in which the injection of 99mTc-nannocolloid under imaging procedures was performed. Surgical excision was performed, guided by the hand held gammaprobe. The sentinel lymph node was identified as an axillary hot spot on the probe. RESULTS: All primary lesions were identified and were clear of invasive margins needing excision. 98 tumors proved to be malignant on frozen sections. 7 lesions could not be clearly examined through frozen section and 2 proved to be benign. 6 out of 7 suspicious lesions confirmed to be malignant on parrafin embedded sections. Sentinel lymph node was identified in a number of 95 out of 98 patients. In 14 cases complete axillary lymphadenectomy was performed. The average specimen weight was 40 grams. CONCLUSIONS: Using this technique, we removed the lesions identified prior to surgery in all cases, achieving a complete pathologic diagnostic, the necessary surgical treatment and also prognostic data by axillary lymph node assessment.

Immunological aspects predicting metastatic sentinel lymph node in early breast cancer patients.

Tumour antigens are poorly expressed, heterogeneous and they modulate rapidly. As a result, their recognition and elimination by the immune system is very difficult. There are several mechanisms, by means of which, the host can neutralize oncogenesis and prevent it from occurring. The sentinel lymph node concept has brought about a revolution in the surgical treatment of the regional lymphatic basin while preserving the prognostic value of the regional lymph node status in breast cancer. This prospective study included 93 women with early breast cancer with initial indication for surgery in whom the sentinel lymph node technique was employed. Cell immune response was assessed prior to surgery by means of in vitro mononuclear cells blastic transformation assay (BLT), of immunoglobulin (Ig) and interleukin 2 (IL-2) measurements. The results were correlated with tumour size, presence of positive sentinel lymph node, tumour proliferation and growth markers (Ki-67, c-erbB2, bcl-2). Even in its less advanced stages, breast cancer is more aggressive and associates with an increased rate of sentinel lymph node metastases in patients below 50 years old, the tumour size exceeds 20 mm, with the presence of peritumoral lymphocytic infiltrate, positive Ki-67 and bcl-2, an alteration of T helper (Th) lymphocytes function, increased immune suppression through IL-2 decrease, signalled by blastic transformation indexes modifications and a drop in IL-2 production (p<0.01).

[Latest approaches in the surgical treatment of cutaneous malignant melanoma]. / Actualitati în tratamentul chirurgical al melanomului malign cutanat.

Malignant melanoma is a disease with an unpredictable evolution. Detected in stage I and II has a great chance to cure, if it is correctly treated: excisional biopsy with safety margins in accordance with tumor thickness. Lymphoscintigraphy with sentinel node identification and biopsy became compulsory for staging malignant melanoma, the role of complete lymphadenectomy would be established by publishing the MSLTII data. The sentinel node is analysed using more and more sophisticated techniques (RT-PCR) in order to detect isolated tumoral cells, although their clinical significance is not known yet. Metastases occurrence is a dramatic phenomenon because chemotherapy, radiotherapy or biologic therapy have insignificant results. The only therapeutic modality which may increase survival in this situation is surgery for some carefully selected patients.

Pheromone trap and population model-based control of the codling moth, Cydia pomonella L., in Romanian apple culture.

Like in most parts of the world, the codling moth, Cydia pomonello (L.), is one of the most important pests in apple orchards in the Romanian Banat region. There, the control of this pest is often inadequate and the damage and economic losses are therefore enormous. This lack of control is caused by structural problems such as the absence of an advanced distribution network for phytopharmaceutical products, obsolete spraying equipment and the insufficient exchange of knowledge and expertise of those products and the pest itself between the local research facilities and the apple growers. The purpose of this research project is rather demonstrative, because a change in the Romanian pome culture's attitude is urgently needed. Pheromone trapping and the computerized population model RIMpro Cydia, which predicts important phenological events such as adult flight and egg hatch, were used to determine the optimal spray timing. These modern pest management techniques would not only minimize pressure on the environment, but also on the income of the Romanian apple grower, for whom phytopharmaceuticals are a high-priced investment. In July 2006 a comparative study between the supervised pest control program using Calypso, Runner and Reldan, all easily obtainable and commercially available insecticides in the region, and a conventional Romanian management programme was conducted. The control plot and the two test plots were all three located in a high codling moth pressure orchard in Timisoara. In the control plot 9,44 % of the fruits were damaged by codling moth larvae. In the plot containing the trees that were treated according to the traditional Romanian management programme 5,56 % damage was recorded, while the supervised management plot showed only 1,1% damage. Additionally damage was measured in another orchard in Periam, about 60 km away from the other plots. There, an intensive control program using Reldan, Calypso, Actare, Karate and Insegar was applied and damage measured only 0.2%. While at first glance that approach seems most efficient, it has to be noticed that it used twice as much insecticide treatments as were used in the supervised control program. Furthermore, 1 % damage is suggested by most references as being the economical threshold for treatments. The results of this comparative study clearly show that supervised codling moth control proofs to be the most profitable. Starting from August the same year, all of the control programmes in Timisoara were stopped. Therefore the second and possibly the third generation of codling moth larvae could develop freely. In the plot which was earlier sprayed according to the warnings of RIMpro Cydia and the pheromone trap this resulted in 27.5% damaged fruits during harvest in September. In the control plot damage reached 60.95%. These results highlight the necessity of the development of an efficient codling moth control program. Once that program is fine-tuned it should be presented to the local apple growers in order to give the Romanian pome culture a boost.

Management of apple scab (Venturia inaequalis) in Romania based on electronic warnings.

Apple scab, Venturia inaequalis (Cke) Wint., is a major problem in Romanian apple orchards and is responsible for serious economic losses. The purchase of spraying equipment and phytopharmaceutical products is very expensive in comparison to the income of local apple growers. This is one of the reasons why reduced fungicide sprayings are becoming more and more important. That's why a project was started to investigate the influence of West-European control measures and to improve interaction between local apple growers and research facilities. This experiment took place in an orchard of the university of Timisoara (USABT), where occurrence of apple scab was very high, and in a well managed commercial orchard, both in the Banat region. In July 2006, a comparative study between a traditional Romanian management program, a calendar-based program and a computerized weather-based management program was conducted. Four test plots were taken. The sprayments in plot 1 happened according to the integrated computerized model. No sprayings took place in plot 2. In plot 3 were some sprayments done with sulphur according to the traditional Romanian program. The sprayings in plot 4 were done following a calendar-based spraying program. The products that were used for the sprayments were all easy to obtain in Romania such as dodine (Sillit flow), dithianon (Delan flow), difenoconazole (Score), pyrimethanil (Scala), metiram (Polyram), kresoxim-methyl (Stroby). The occurrence of scab in plot 1 was very low in comparison to the other plots. Analysing the data, on average, the treatments done in plot 1 caused about 50% less damage than the traditional sprayings. This indicated that with a relative small amount of well timed sprayings a enormous amount of damage can be prevented. A calendar-based management program seems to be less effective (more sprayings needed and the results are worse). These results also emphasize the importance of the development of an adequate apple scab management program that should be presented to local apple growers.

[Validation protocol of sentinel node biopsy for breast cancer using radioactive tracer at the Institute of Oncology Bucharest "Prof. Dr. Alexandru Trestioreanu"]. / Rezultatele protocolului de validare a tehnicii de identificare si biopsie a ganglionului santinela în cancerul glandei mamare folosind trasor radioactiv la Institutul Oncologic Bucuresti "Prof. Dr. Alexandru Trestioreanu".

The sentinel ganglion concept originates in the assumption according to which the primary tumor drains into a specific lymph node area and then runs through the lymphatic nodes in an orderly, sequential mode. When neoplastic dissemination along the lymphatic pathway occurs, there is an initial invasion of a specific lymph node (rarely more than one) located on the drainage route. That first lymph node has been identified as the sentinel node, which mirrors the regional lymph node status. In order to establish the indication for lymphadenectomy and avoid the situations in which such a surgical procedure would be of no use (N-), the only correct method consists in the identification and biopsy of the sentinel node which can be performed using vital staining (blue dye), radioactive tracers or both. The technique of sentinel lymph node identification and biopsy by means of radioactive tracing includes: -pre-surgical lymphoscintigraphy, -identification of the sentinel lymph node and its excisional biopsy, -intra-operative histopathological examination, paraffin embedded sections and immunohistochemical stains of the sentinel lymph node. The paper presents the refinement of the technique and the validation of the method for identification and biopsy of the sentinel lymph node in breast cancer with the intra-operative use of NEOPROBE 2000 gamma probe at the "Prof. Dr. Alexandru Trestioreanu" Oncological Institute in Bucharest. It is a prospective study which enrolled 93 patients with breast cancer between September 2003-December 2005, who underwent sentinel node biopsy. Complete axillary dissection (back-up lymphadenectomy) was performed in all cases. By comparing the pathological results of the frozen section of the sentinel node, with the paraffin embedded and immunohistochemical ones of the remaining axillary nodes, we present the following results: sensibility 97,15% (34/35), specificity 100% (93/93), positive predictive value 100% (34/34), negative predictive value 98,3% (58/59).

MMP-9 and MMP-2 gelatinases and TIMP-1 and TIMP-2 inhibitors in breast cancer: correlations with prognostic factors.

The goal of our study was to analyse the prognostic values for some matrix metalloproteinases (MMPs) and tissue inhibitors of matrix metalloproteinases (TIMPs) in breast cancer. We evaluated the activity and the expression levels of MMP-9, MMP-2, TIMP-1 and TIMP-2 in malignant versus benign fresh breast tumor extracts. For this purpose, gelatinzymography, immunoblotting and ELISA were used to analyse the activity and expression of MMPs and TIMPs. We found that MMP-9 expression level and activity are increased in malignant tumors. In addition, MMP-9/TIMP-1 and MMP-2/TIMP-2 ratio values obtained by us were significantly different in malignant tumors compared to benign tumors. We suggest that the abnormal MMP-9/TIMP-1 balance plays a role in the configuration of breast invasive carcinoma of no special type and also in tumor growth, while altered MMP-2/TIMP-2 ratio value could be associated with lymph node invasion and used as a prognostic marker in correlation with Nottingham Prognostic Index. Finally, we showed that in malignant tumors high expression of estrogen receptors is associated with enhanced activity of MMP-2 and increased bcl- 2 levels, while high expression of progesterone receptors is correlated with low TIMP-1 protein levels.

Serum levels of matrix metalloproteinases MMP-2 and MMP-9 and their tissue natural inhibitors in breast tumors.

In this study, the levels of matrix metalloproteinases MMP-2 and MMP-9 were simultaneously analyzed with the levels of their tissue natural inhibitors TIMP-1 and TIMP-2 in sera of patients with breast tumors. At the same time, the activity of these two matrix metalloproteinases was evaluated. The decrease of TIMP-2 level in sera from patients with breast cancer as well as an imbalance between MMP-2 and TIMP-2 in neoplasic processes were found. The serum levels of MMP-2, MMP-9 and TIMP-1 were comparable between the patients with breast cancer and benign tumors. These experimental studied parameters were found to correlate with some of clinicopathological disease variables (TNM or pTNM staging system, tumor size and node invasion) suggesting their potential value for diagnosis and prognosis of breast cancer. Matrix metalloproteinases or their natural inhibitors and tumor markers (CA15.3 and CEA) not correlated between but, each of them correlated with another clinicopathological disease variable, suggesting their usefulness in the evaluation.