Optimal Sampling Number of Sentinel Lymph Nodes in Invasive Breast Cancer: Results of 1,026 Sentinel Lymph Node Biopsies Done by Radioisotope / 한국유방암학회지

PURPOSE: For isotope mapping, many authors have defined the sentinel lymph node (SLN) as the one containing isotope counts higher than the axillary background. However, no study has sought to define an optimal guideline, and the number of SLNs needed for precise detection of metastatic SLNs is still a subject of debate. Accordingly, we set out to determine the optimal sampling number of SLNs. METHODS: Between January 2005 and December 2008, we enrolled 1,026 patients with primary invasive breast cancer. These patients had received sentinel lymph node biopsy (SLNB) using radioisotopes at Yeungnam University Hospital. During SLNB, ex vivo isotope counts were measured for each SLN. And, the number and metastatic status of harvested SLNs were investigated. We defined SLNs as lymph nodes that show an isotope count > or = 10 times that of the axillary background. Each SLN was labeled as S1 (highest isotope count), S2 (second highest), or S3 and so on, in descending isotope-count-order. If an SLN was positive for metastasis, completion axillary lymph node dissection was performed. RESULTS: The mean age of patients was 48.9 years (ranges, 22-83 years). The mean number of removed SLNs was 2.8 (ranges, 1-11). Of the 1,026 patients enrolled, 311 (30.3%) had SLN metastasis: S1 was positive (S1+) in 258 patients (82.9%), S2 was positive (S1-, S2+) in 40 patients (12.3%), and S3 was positive (S1-, S2-, S3+) in 13 patients (3.9%). There was no metastasis in SLNs defined as S4, S5 and so on. The average number of sampling SLNs until detecting metastasis in S1, S2, and S3 was 1.24 (1-4), 2.45 (2-4), and 3.46 (3-5). CONCLUSION: During SLNB done using radioisotopes, for accurate axillary lymph node staging, up to the 3rd isotope-count-order of SLNs should be removed. The average number of SLNs needed for detecting metastasis in S3 is four.

Solitary Small Bowel Metastasis from Breast Cancer / 한국유방암학회지

The common sites of metastasis of breast cancer are bone, lung, and liver, but gastrointestinal metastasis from breast cancer is rare. We experienced a case of solitary ileal metastasis from breast cancer. A 45-years-old woman presented with melena for several weeks. She showed no other abdominal symptoms. Colonoscopy findings showed an ulcerative mucosal lesion in the terminal ileum, and biopsy was performed. Pathologic examination revealed metastatic carcinoma, originated from breast. The tumor cells were positive for estrogen receptor and negative for Cdx-2. She had had a previous medical history of bilateral breast cancer and undergone breast conserving surgery with sentinel lymph node biopsy for both breasts. The torso positron emission tomography scan at 19 months after surgery showed mildly increased uptake in the terminal ileum which was considered as inflammation. Finally, she was diagnosed with solitary ileal metastasis from breast cancer at 22 months after surgery.

Intrapleural Paclitaxel Chemotherapy in the Treatment of Breast Cancer-Related Metastatic Malignant Pleural Effusion / 한국유방암학회지

Malignant pleural effusion in breast cancer has been associated with poor prognosis. The response rate of local treatment has been very low and in some case, complications have resulted in death. We investigated the efficacy and safety of paclitaxel, as an intrapleural chemotherapeutic agent. From January 2006 to December 2009, ten breast cancer patients who had developed malignant pleural effusion were infused with intrapleural paclitaxel through a chest tube, which was clamped for 48 hours. The chest tube was maintained until drainage was reduced to less than 50-100 mL/day. The average time spent with a chest tube attached following intrapleural chemotherapy was 9.3 days. During the follow-up period, six patients had no recurrent pleural effusion and two received a second round of intrapleural chemotherapy following which no further pleural effusion recurred. There were no severe side effects except for mild toxicity. It is suggested that intrapleural paclitaxel chemotherapy may be superior to conventional local treatment and may represent an effective treatment modality with low toxicity.

Clinical review of bilateral breast cancer / 한국유방암학회지

PURPOSE: Bilateral breast cancer is categorized as synchronous or metachronous. The aim of this study was to evaluate the characteristics of synchronous and metachronous breast cancers. METHODS: Between 1989 and 2003, 1111 patients were treated for breast cancer at Yeung-Nam University Hospital. We retrospectively analyzed 27 women with bilateral breast cancer. RESULTS: Among the 27 cases (2.4% of the patients) of bilateral cancers, 7 (0.6%) were synchronous and 20 (1.8%) were metachronous. The mean age of the patient with synchronous and metachronous cancer was 46.9 and 41.1 years, respectively. Eighty percent (16/20) of the metachronous cases were under the age of 50. For the metachronous cancers, 65% of the cases (13/20) were down-staged, and 20% and 15% of the patients were up-staged and at same stage, respectively, compared to the primary cancer. The ER, PR, C-erbB2 and p53 positivity was 20% (4/20), 15%, 21.1% and 52.9% in metachronous cancers, respectively, compared to 65%, 60%, 31.6% and 41.2% in the primary cancers, respectively. During the mean follow up of 74.3 months, the recurrence rate and mortality rate was 42.9% and 28.6%, respectively, for the synchronous cancers, and 5% and 5%, respectively, for the metachronous cancers. CONCLUSION: The stage of the metachronous cancer was lower than that of the primary cancer, and this was probably due to careful follow-up. The lower proportion of ER and/or PR positive tumor in metachronous cancer might be associated with the effect of tamoxifen treatment. The prognosis was less favorable for the synchronous cases than for the metachronous second breast cancers in this study.