Five-Year Oncologic Outcomes of Volume Displacement Procedures After Partial Mastectomy for Breast Cancer.

BACKGROUND: Volume displacement techniques that use remnant breast tissue are useful in reconstructive procedures after partial mastectomy. The authors analyzed the oncologic results of volume displacement surgery after partial mastectomy and their associations with various clinicopathologic factors. PATIENTS AND METHODS: One hundred fifty-eight eligible patients with breast cancer who underwent volume displacement procedures after partial mastectomy were included in this prospective study, in which associations between clinicopathologic factors and locoregional recurrence, distant metastasis, and death were analyzed. RESULTS: During a mean follow-up of 60.8 months, locoregional recurrence occurred in 3 cases (1.9%) and distant metastasis in 4 (2.5%). According to multivariate analysis, bilaterality of breast cancer (P = .035) and adjuvant chemotherapy (P = .042) were associated with distant metastasis. CONCLUSION: Volume displacement procedures after partial mastectomy have good oncologic results and are acceptable procedures for patients with breast cancer.

Effects of Quilting Suture Interval on Donor Site Seromas After Breast Reconstruction With Latissimus Dorsi Muscle Flap: A Randomized Trial.

BACKGROUND: Although breast reconstruction using a deep inferior artery perforator flap has been increasing, using a latissimus dorsi (LD) muscle flap is still the favored method for Asian female patients with breast cancer. However, because the incidence of donor site seromas has been relatively high, a quilting method on the donor cavity or insertion of drainage tube has been used to reduce the incidence and/or severity of postoperative seroma. We evaluated the effects of different intervals of quilting sutures on the postoperative drainage volume and components of seroma fluid. PATIENTS AND METHODS: A total of 36 patients with breast cancer underwent partial or total mastectomy with LD flap reconstruction. They were randomized into 3 groups according to the interval of quilting sutures: nonquilting (n = 10), 6-cm quilting (n = 14), and 3-cm quilting (n = 12). The clinicopathologic factors and time to drain removal, drainage volume, frequency of aspiration, and serous fluid components were investigated. RESULTS: No statistically significant differences were found in the clinicopathologic factors among the 3 groups. The time to drain removal was significantly shorter in the 6-cm quilting and 3-cm quilting groups than in the nonquilting group (P = .039 and P = .041, respectively). The total volume of drainage from the donor site was also decreased in the quilting groups (6-cm group, P = .046; 3-cm group, P = .021). The seroma components were not different among the 3 groups. CONCLUSION: Performing quilting sutures on LD flap donor sites is an effective method to reduce the volume of postoperative seroma. The present findings showed that a 6-cm suture interval is appropriate.

Non-stereotactic method involving combination of ultrasound-guided wire localization and vacuum-assisted breast biopsy for microcalcification.

BACKGROUND: Stereotactic breast biopsy is a standard intervention for evaluation of "microcalcification-only" lesions. However, an expensive stereotactic device and radiologic expertise are necessary for this procedure. We herein report a non-stereotactic technique involving the combination of wire localization and vacuum-assisted breast biopsy (VABB) under ultrasound (US) guidance. METHODS: Twenty-two consecutive patients with category 3 or 4a microcalcification only as shown by mammography underwent the above-mentioned non-stereotactic combination method involving US-guided wire localization and VABB. The location of the microcalcification was measured by manual stereotaxis, and the microcalcification was confirmed by specimen mammography after the procedure. RESULTS: The mean number ± standard deviation of removed cores and calcified cores was 28.4±13.4 and 2.2±0.9, respectively. In one case, the procedure was repeated 3 times. The histologic diagnoses were fibrocystic change (n=14), fibroadenoma (n=4), sclerosing adenosis (n=1), usual ductal hyperplasia (n=2), and atypical ductal hyperplasia (n=1). CONCLUSIONS: "Microcalcification-only" breast lesions can be easily evaluated with the combination of non-stereotactic US-guided wire localization and VABB. This would be an effective diagnostic technique for breast lesion which reveals only microcalcification.

Ultrasound-Guided Laser Ablation Using Multidirectional-Firing Fiber for Papillary Thyroid Carcinoma: An Ex Vivo Study with Evaluation of Tumor Cell Viability.

OBJECTIVE: The objective of this study was to evaluate the viability of tumor cells after laser ablation for papillary thyroid carcinoma and to determine if the laser ablation procedure using multidirectional-firing fiber had a therapeutic effect. BACKGROUND DATA: Many noninvasive techniques have been introduced for the treatment of thyroid cancer. Among them, the laser ablation technique has been proven its therapeutic effect for large benign thyroid nodules. MATERIALS AND METHODS: Three patients who were diagnosed with papillary thyroid carcinoma using fine-needle aspiration cytology were enrolled. All of the selected tumors were >2 cm in size and there was no case of extrathyroidal extension. A laser fiber was inserted into the tumor by means of ultrasound guidance and ablation was performed for 3 min at 7 W of output power. The specimens were stained using hematoxylin and eosin (H&E) and nicotinamide adenine dinucleotide (NADH), and were evaluated by a pathologist. RESULTS: The specimen showed three clearly distinct zones: zone 1, carbonized zone; zone 2, coagulated zone; and zone 3, normal thyroid tissue. No remaining thyroid tissue was visible in zone 1 after staining, because of complete necrosis of the tumor cells. Although thyroid tissue remained in zone 2, no viable tumor cells were detected using NADH staining. CONCLUSIONS: It was found that laser ablation using multidirectional-firing fiber could be an effective treatment technique for papillary thyroid carcinoma. This technique enables not only direct cancer treatment with cell necrosis but also the securement of a tumor safety margin in a similar manner to surgery.

The role of preoperative breast magnetic resonance (MR) imaging for surgical decision in patients with triple-negative breast cancer.

BACKGROUND: Several reliable randomized studies do not recommend routine preoperative breast MR imaging for patients with breast cancer. However, because the principle of MR imaging is based on the dynamics of contrast enhancement, a specific biologic subgroup of tumors should sensitively respond to the imaging process. METHODS: From 2008 to 2013, 918 eligible patients with breast cancer underwent breast surgery and were divided into two groups based on preoperative breast MR findings: patients in whom the surgical plan was changed and those in whom the surgical plan remained unchanged. We investigated the changing patterns of breast surgery based on routine mammography, ultrasound, and preoperative breast magnetic resonance (MR) findings and analyzed the association between additional suspicious lesions on breast MR imaging and clinicopathologic factors. RESULTS: Additional suspicious breast lesions were detected on preoperative MR imaging in 104 cases (11.3%), and the surgical strategy was changed as the final decision in 97 cases (10.6%). There was no difference between oncologic results between two groups. However, the triple-negative breast cancer (TNBC) was significantly associated with changing of the surgical strategy based on breast MR findings (P = 0.048). CONCLUSIONS: Additional preoperative breast MR imaging may be helpful in surgical decision for patients with TNBC.

Oncologic outcomes of volume replacement technique after partial mastectomy for breast cancer: a single center analysis.

BACKGROUND AND OBJECTIVES: Volume replacement technique is a good option for Asian women with small to moderate-sized breasts undergoing partial mastectomy for breast cancer. We analyzed the oncologic outcomes of this procedure in a single center. METHODS: Seventy-two patients with breast cancer underwent partial mastectomy with volume replacement technique in this prospective study. Volume replacement techniques were tailored individually according to the volume of excised breast and tumor location. The mean duration of follow-up was 40.9 months. We analyzed association between various clinicopathologic factors and locoregional recurrence, distant metastasis and assessed cosmetic outcomes. RESULTS: The incidences of locoregional recurrence and distant metastasis were 2.8% and 5.6%, respectively. According to multivariate analysis, history of contralateral breast cancer (P < 0.001) and fat necrosis (P = 0.002) significantly associated with incidence of locoregional recurrence and pathologic tumor size (P = 0.037) and stage (P = 0.048) significantly influenced the incidence of distant metastasis. CONCLUSION: From an oncologic perspective, volume replacement procedures after partial mastectomy are an appropriate form of surgical management of breast cancer.

Ductal carcinoma arising from ectopic breast tissue following microcalcification observed on screening mammography: a case report and review of the literature.

Ectopic breast tissue can occur anywhere along the incompletely regressed mammary ridge. Among the various types of breast choristoma, ectopic breast tissue, which has only glandular tissue without a nipple or areola, is most commonly detected in axillary areas. However, ectopic breast cancer is often not detected until significant clinical symptoms have been revealed, or diagnosis is delayed. Furthermore, an examination of ectopic breast tissue tends to be omitted from a screening mammography. Especially, the microcalcifications of ectopic breast tissue are difficult to delineate on mammography. Herein, the authors report a case of ectopic breast carcinoma that showed clustered microcalcifications on screening mammography, and discuss the interpretation and implications of microcalcification in ectopic breast tissue.

Clinical value of visually identifiable 18F-fluorodeoxyglucose uptake in primary papillary thyroid microcarcinoma.

OBJECTIVE: This study evaluates the relationship between visually identifiable (18)F-fluorodeoxyglucose (FDG) uptake in primary papillary thyroid microcarcinoma (PTMC) and tumor aggressiveness. STUDY DESIGN: Historical cohort study. SETTING: Tertiary care center. METHODS: Clinicopathological factors and PET/CT findings of 219 PTMC surgical patients who underwent preoperative (18)F-FDG positron emission tomography/computed tomography (PET/CT) were retrospectively reviewed. RESULTS: (18)F-FDG uptake was observed in the tumors of 124 (56.6%) patients. Tumor size (odds ratio [OR] = 1.774; 95% confidence interval [CI], 1.416-2.223; P < .0001) and Hashimoto thyroiditis (OR = 2.815; CI, 1.237-6.404; P = .014) independently predicted (18)F-FDG uptake. Tumor size (OR = 1.495; CI, 1.217-1.835; P < .0001) and BRAF(V600E) mutation (OR = 3.320; CI, 1.056-10.432; P = .040) independently predicted extrathyroidal invasion. Multiplicity (OR = 2.375; CI, 1.278-4.415; P = .006) independently predicted central lymph node metastasis. CONCLUSION: (18)F-FDG uptake in PTMC depends on tumor size and Hashimoto thyroiditis. Therefore, preoperative PET/CT for PTMC may not help in evaluating tumor aggressiveness.

A Prospective, Randomized Study between the Small Jaw® and the Harmonic Focus® in Open Thyroidectomy.

OBJECTIVES: LigaSure Small Jaw(®) (LSJ) was recently developed and applied to thyroid surgery along with Harmonic Focus(®) (HF). We compared the 2 devices in open total thyroidectomy for papillary thyroid carcinoma (PTC). STUDY DESIGN: A prospective, randomized study. SETTING: Tertiary care center. METHODS: This prospective, randomized study included 126 patients enrolled between December 2011 and June 2012. The numbers of patients in the LSJ group and the HF group were 64 and 62, respectively. Operative times, drain output, parathyroid status, complications, laboratory data, hospital stay, and analgesia requirements were analyzed. RESULTS: Operation time, parathyroid status, postoperative complications including hypocalcemia, oral calcium supplement, calcium, parathyroid hormone, usage count of painkiller, and hospital stay were not different among the 2 groups. Ionized calcium on postoperative days 1, 2, and 10 was higher in the LSJ group (P = .04, P = .04, P = .01), and drain output was lower in the LSJ group (106.8 vs 123.6 mL, P = .01). CONCLUSIONS: Open thyroidectomy for PTC using the HF or the LSJ was safe and effective and was not associated with any increase in complications. Surgical outcomes and operative morbidity were equivalent between the 2 groups.

The Comparative Study of Ultrasonography, Contrast-Enhanced MRI, and (18)F-FDG PET/CT for Detecting Axillary Lymph Node Metastasis in T1 Breast Cancer.

PURPOSE: A more noninvasive evaluation of axillary lymph node in breast cancer is one of the principal challenges of breast cancer treatment. To detect axillary lymph node metastasis (ALNM) in T1 breast cancer, we have compared the axillary ultrasonography (AUS), contrast-enhanced magnetic resonance imaging (cMRI), and (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) to determine the most adequate test or a combination of tests. METHODS: Retrospectively, 349 T1 breast cancer patients who were preoperatively examined using AUS, cMRI, and PET/CT between 2008 and 2011 and whom underwent pathological evaluations of axillary lymph nodes were reviewed and analyzed. RESULTS: In total, 26.4% (92/349) of patients exhibited ALNM. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of AUS for determining ALNM were 44.6%, 88.7%, 58.6%, 81.7%, and 77.1%, respectively. cMRI was similar to AUS. The sensitivity, specificity, PPV, NPV, and accuracy of PET/CT were 44.5%, 94.2%, 73.2%, 82.6%, and 81.1%, respectively. The combination including cMRI and PET/CT was the most accurate with sensitivity, specificity, PPV, NPV, and accuracy values of 39.1%, 98.8%, 92.3%, 81.9%, and 83.1%, respectively. The mean number (3.5±4.2) of ALNMs in the patients who were positive based on cMRI and PET/CT and also pathologically proven to exhibit ALNM was significantly larger than the number (2.16±2.26) in other patients who exhibited ALNM (p=0.035). CONCLUSION: There are no definitive modalities for detecting ALNM in T1 breast cancers to replace sentinel lymph node biopsy (SLNB). If ALNM is suspected based on cMRI and PET/CT, the axillary dissection without SLNB might be a better option because it is related to high possibilities of ALNM and large axillary metastatic volumes.

Comparison of laser ablation using multidirectional and forward-firing fiber in human thyroid gland: experimental study.

The aim of this study is to evaluate the differences between forward-firing and multidirectional lasers and to evaluate the effects of exposure times and power on laser ablation of thyroid tissue. This is an experimental, ex vivo study. The experiments were conducted on 3 thyroid glands using 2 power levels (3 and 5 W) and exposure times (3 and 5 minutes) with forward-firing and multidirectional lasers. The length and width of the demarcated zone were measured to assess the size of thermal effect. NADPH staining was performed to determine tissue viability. Thermal transformation caused by the forward-firing laser produced oval necrotic zones, whereas thermal transformation caused by the multidirectional-firing laser produced clear round necrotic zones, which clearly demarcated in both hematoxylin and eosin staining and NADH staining.

Surgical techniques for personalized oncoplastic surgery in breast cancer patients with small- to moderate-sized breasts (part 1): volume displacement.

Despite the popularity of breast-conserving surgery (BCS), which constitutes 50-60% of all breast cancer surgeries, discussions regarding cosmetic results after BCS are not specifically conducted. The simple conservation of breast tissue is no longer adequate to qualify for BCS completion. The incorporation of oncological and plastic surgery techniques allows for the complete resection of local disease while achieving superior cosmetic outcome. Oncoplastic BCS can be performed in one of the following two ways: 1) volume displacement techniques and 2) volume replacement techniques. This study reports volume displacement surgical techniques, which allow the use of remaining breast tissue after BCS by glandular reshaping or reduction techniques for better cosmetic results. Thorough understanding of these procedures and careful consideration of the patient's breast size, tumor location, excised volume, and volume of the remaining breast tissue during the surgery in choosing appropriate patient and surgical techniques will result in good cosmetic results. Surgery of the contralateral breast may be requested to improve symmetry and may take the form of a reduction mammoplasty or mastopexy. The timing of such surgery and the merits of synchronous versus delayed approaches should be discussed in full with the patients. Because Korean women have relatively small breast sizes compared to Western women, it is not very easy to apply the oncoplastic volume displacement technique to cover defects. However, we have performed various types of oncoplastic volume displacement techniques on Korean women, and based on our experience, we report a number of oncoplastic volume displacement techniques that are applicable to Korean women with small- to moderate-sized breasts.

Surgical techniques for personalized oncoplastic surgery in breast cancer patients with small- to moderate-sized breasts (part 2): volume replacement.

Oncoplastic breast surgery has become a popular choice of treatment for breast reconstruction after mastectomy. There are two different techniques in oncoplastic surgery depending on the volume of the excised breast tissue. One is the volume displacement procedure, which combines resection with a variety of different breast-reshaping and breast-reduction techniques; the other is the volume replacement procedure in which the volume of excised breast tissue is replaced with autologous tissue. In this study, current authors performed various volume replacement techniques based on the weight of the excised tumor and its margin of resection. We used a latissimus dorsi myocutaneous flap for cases in which the resection mass was greater than 150 g, and for cases in which the resection mass was less than 150 g, we used a regional flap, such as a lateral thoracodorsal flap, a thoracoepigastric flap, or perforator flaps, such as an intercostal artery perforator flap or a thoracodorsal artery perforator flap. In the patients with small to moderate-sized breasts, when a postoperative deformity is expected due to a large-volume tumor resection, the replacement of non-breast tissue is required. Many of whom have small breasts, oncoplastic volume replacement techniques in breast-conserving surgery allow an extensive tumor excision without concern of compromising the cosmetic outcome and can be reliable and useful techniques with satisfactory aesthetic results.