[Show abstract][Hide abstract] ABSTRACT: Background:
Despite the favorable prognosis for medullary breast cancer (MBC), the guidelines for the use of adjuvant chemotherapy for MBC have not been clearly established. This study investigated the prognostic role of adjuvant chemotherapy in Korean patients with node-negative (N0), triple-negative (TN) MBC patients.
We included data from 252 patients with N0 TN MBC, obtained from the Korean Breast Cancer Registry database. Patients were categorized as those who did not undergo adjuvant chemotherapy (group I) or those who did (group II). Clinicopathological characteristics, breast cancer-specific survival (BCSS), and overall survival (OS) were compared between the groups. In addition, a subgroup analysis for survival based on tumor size was conducted.
A total of 252 N0 TN MBC patients with tumor sizes >1 cm who were diagnosed between April 1997 and March 2011 were enrolled. The median age was 44.95 years (range, 25-72 years), and the median follow-up period was 93.94 months (range, 23-195 months). Overall, the BCSS and OS in group II (97.3% and 97.3%, respectively) were significantly better compared with those in group I (89.2% and 86.2%, respectively). In the subgroup analysis, in patients with tumors >2 cm in size, those in group II had significant better BCSS and OS (97.5% and 97.5%, respectively) compared with those in group I (78.3% and 73.9%, respectively). In contrast in those with tumors 1-2 cm in size, there were no significant differences in BCSS and OS between the groups (both 97.1% for group I, and 95.2% and 92.9%, respectively for group II). Multivariate analysis revealed that adjuvant chemotherapy significantly improved BCSS (P = 0.009) and OS (P = 0.007), but only for patients with larger tumors (>2 cm).
In patients with N0 TN MBC, adjuvant chemotherapy had a significant clinical survival benefit, but only in those with tumors >2 cm.
PLoS ONE 11/2015; 10(11):e0140208. DOI:10.1371/journal.pone.0140208 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Matrix metalloproteinases (MMPs) are proteolytic enzymes that play important roles in cancer progression and metastasis. Although serum MMP expression is known to correlate with the primary lesion of breast cancer, there has yet to be a study regarding the correlation between serum MMP expression and metastatic lesions, particularly lymph nodes. The present study evaluated the correlation of serum and lymph node MMP expression with axillary node metastasis. The preoperative serum levels of MMP-2 and MMP-9 in 77 patients with breast cancer and in 10 patients with benign breast tumor were determined by ELISA and zymography. One hundred and twelve axillary lymph nodes were collected for zymography during breast cancer surgery. Significantly higher serum levels of MMP-2 and MMP-9 were found in breast cancer patients compared to patients with benign tumor. High serum levels of MMP-2 and MMP-9 were significantly associated with node metastasis. ELISA and zymography results for serum MMP-2 and MMP-9 correlated significantly, with a Pearson correlation coefficient (r) of 0.76 for MMP-2 (P=0.001) and 0.81 for MMP-9 (P=0.001). In terms of lymph node, total MMP-2, MMP-9 and MMP-9 activity were significantly higher in metastatic than in non-metastatic nodes. There was a correlation between serum and lymph node MMP-9 levels on zymographic measurements (r=0.34, P=0.011), but not in terms of MMP-2 levels. Serum MMP-9 levels may have a diagnostic value for predicting axillary node metastasis.
[Show abstract][Hide abstract] ABSTRACT: We aimed to determine the sensitivity of computer-aided detection (CAD) applied to digital mammography in asymptomatic and symptomatic breast cancer patients.
We retrospectively analyzed digital mammography and CAD images from 210 patients diagnosed with breast cancer. The patients were divided into symptomatic and asymptomatic groups. The sensitivity of CAD in both groups was assessed in relation to breast tissue density, histopathological type of breast cancer, and tumor size.
The detection rate of the CAD system was 87.8% in the asymptomatic group. The sensitivity in different tissue densities was 100% in fatty breasts (P1), 88.9% with scattered fibroglandular densities (P2), 94.4% in heterogeneously dense breasts (P3), and 66.7% in extremely dense breasts (P4). The detection rate of the CAD system in the symptomatic group was 87.2%, and the sensitivity was 90.5%, 90%, 86.6%, and 75% in P1-P4 breasts, respectively. In the asymptomatic group, the CAD system detected 90.3% of invasive ductal carcinomas, not otherwise specified (IDC-NOS) and 88.9% of ductal carcinomas in situ (DCIS), but did not detect other types of malignancy. In the symptomatic group, the CAD system detected 88.2% of IDC-NOS, 88.9% of DCIS and 75% of other types of malignancy. When analyzed according to tumor size, the sensitivity of CAD in the asymptomatic and symptomatic groups was 82.6% and 83.3% for tumors <1 cm, 76.5% and 82.4% for tumors between 1 and 2 cm, and 91.7% and 89% in tumors >2 cm.
The sensitivity of CAD was low in P4 breasts and high for tumors larger than 2 cm, with no statistically significant differences between the asymptomatic and symptomatic groups for IDC-NOS and DCIS. CAD showed greater sensitivity for other neoplasms in symptomatic patients.
Journal of Breast Cancer 09/2013; 16(3):322-8. DOI:10.4048/jbc.2013.16.3.322 · 1.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The article overviews some achievements and problems of Korean medical journals published in the highly competitive journal environment. Activities of Korean Association of Medical Journal Editors (KAMJE) are viewed as instrumental for improving the quality of Korean articles, indexing large number of local journals in prestigious bibliographic databases and launching new abstract and citation tracking databases or platforms (eg KoreaMed, KoreaMed Synapse, the Western Pacific Regional Index Medicus [WPRIM]). KAMJE encourages its member journals to upgrade science editing standards and to legitimately increase citation rates, primarily by publishing more great articles with global influence. Experience gained by KAMJE and problems faced by Korean editors may have global implications.
Journal of Korean medical science 05/2013; 28(5):648-50. DOI:10.3346/jkms.2013.28.5.648 · 1.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BRCAPRO and Myriad II are widely used models for predicting BRCA1/2 mutation probability before genetic testing. However, the accuracy of these models in Koreans is not known. This study was performed to evaluate the accuracy of the BRCAPRO and Myriad II models. Two hundred thirty-six women with breast cancer who underwent comprehensive BRCA1/2 genetic testing at our hospital between 2003 and 2010 were included in this study. We evaluated the performance of each model by comparing the numbers of observed versus predicted mutation carriers. We calculated sensitivity, specificity, and predictive values at 10 % estimated probability. Forty-six individuals were identified to carry a deleterious BRCA mutation. The prevalence of BRCA mutation (19.5 %) was significantly higher than that predicted by BRCAPRO (9.0 %, p = 0.001) and Myriad (5.6 %, p < 0.001). In familial breast cancer patients, BRCA mutation rate (observed 22.7 %) was underestimated by both BRCAPRO (expected 11.4 %, p = 0.006) and Myriad II (expected 6.4 %, p < 0.001). Subgroup analyses showed that both models underestimated the risk of BRCA mutation in patients with a family history of breast cancer (probands' age at breast cancer diagnosis >50 years), with only one relative with breast cancer, and with non-familial early-onset breast cancer or bilateral breast cancer. Using a 10 % cut-off, the sensitivities were 47.8 % (BRCAPRO) and 50.0 % (Myriad), and positive predictive values were 44.9 % (BRCAPRO) and 43.4 % (Myriad). Both BRCAPRO and Myriad II underestimated the risk of BRCA1/2 mutation in Koreans. Our findings suggest that these models are less sensitive in Korean women, and therefore a new BRCA mutation prediction model based on Korean data is needed for proper genetic counseling.
Breast Cancer Research and Treatment 03/2012; 134(3):1189-97. DOI:10.1007/s10549-012-2022-8 · 3.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study evaluated the prognostic impact of the lymph node ratio (LNR; i.e., the ratio of positive to dissected lymph nodes) on recurrence and survival in breast cancer patients with positive axillary lymph nodes (LNs).
The study cohort was comprised of 330 breast cancer patients with positive axillary nodes who received postoperative radiotherapy between 1987 and 2004. Ten-year Kaplan-Meier locoregional failure, distant metastasis, disease-free survival (DFS) and disease-specific survival (DSS) rates were compared using Kaplan-Meier curves. The prognostic significance of the LNR was evaluated by multivariate analysis.
Median follow-up was 7.5 years. By minimum p-value approach, 0.25 and 0.55 were the cutoff values of LNR at which most significant difference in DFS and DSS was observed. The DFS and DSS rates correlated significantly with tumor size, pN classification, LNR, histologic grade, lymphovascular invasion, the status of estrogen receptor and progesterone receptor. The LNR based classification yielded a statistically larger separation of the DFS curves than pN classification. In multivariate analysis, histologic grade and pN classification were significant prognostic factors for DFS and DSS. However, when the LNR was included as a covariate in the model, the LNR was highly significant (p<0.0001), and pN classification was not statistically significant (p>0.05).
The LNR predicts recurrence and survival more accurately than pN classification in our study. The pN classification and LNR should be considered together in risk estimates for axillary LNs positive breast cancer patients.
[Show abstract][Hide abstract] ABSTRACT: Purpose: This study was designed to investigate the reliability and validity of the World Health Organization Quality of Life Assessment Instrument (WHOQOL) in patients with breast cancer according to depressive symptoms. Methods: One-hundred seventeen patients with breast cancer who had undergone a radical operation were recruited. The 100 item-WHOQOL instrument and Hamilton Rating Scale for Depression were used to measure all the subjects. The five domain scores, except for the WHOQOL spiritual domain, were compared between patients with and without depressive symptoms, and then the reliability and validity of the five domains were calculated. Results: Depressed patients with breast cancer had lower scores in all five domains of the WHOQOL than those who were not depressed in all five domains of WHOQOL [df=(1, 115), F=46.6, p<0.001]. Reliability and validity in the physical domain of depressed patients with breast cancer decreased markedly. Conclusion: WHOQOL is a valid and useful instrument for evaluating the quality of life in patients with breast cancer, but is limited in scoring of depressed patients with breast cancer, particularly in the physical domain. Therefore, quality of life must be interpreted with carefully hand in depressed patients with breast cancer.
Journal of Breast Cancer 12/2010; 13(4):431. DOI:10.4048/jbc.2010.13.4.431 · 1.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Cutaneous metastasis from breast cancer can occur by direct invasion, lymphatic and vascular spread as well as iatrogenic implantation. Metastasis that occurs by iatrogenic implantation after needle biopsy is very rare but the potential risk must be considered. In this report, we describe a case of breast cancer cutaneous metastasis that occurred by iatrogenic implantation following core needle biopsy. A 53-year-old woman presented with a 1x1 cm sized erythematous nodule at the biopsy site after breast conserving surgery for primary cancer. Histopathological findings confirmed cutaneous metastasis. The possibility of this consequence must be considered when performing needle biopsies.
Annals of Dermatology 05/2010; 22(2):238-40. DOI:10.5021/ad.2010.22.2.238 · 1.39 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Soft tissue metastasis clinically presenting as either painless subcutaneous or painful intramuscular nodules is extremely rare and may lead to an errant clinical suspicion of sarcoma. In general, most soft tissue metastasis comes from lung carcinoma; however, to date, there have been no reports of a posterior thigh mass just beneath the skin metastasizing from breast cancer. Here, we report a case of distant soft tissue metastasis presenting as a painless solitary left posterior thigh mass measuring 1.5 cm in diameter, which was later shown by positron emission tomography-computed tomography (PET-CT) to have multiple simultaneous mediastinal lymph node metastases. Eleven months ago, the patient had undergone curative breast-conserving surgery (BCS) for cancer of her left breast. At that time, her tumor showed a triple negative phenotype. Initial PET-CT right before the BCS had shown no metastasis. After histological and radiologic evaluation for the metastases, she decided to have systemic chemotherapy.
Journal of Breast Cancer 01/2010; 13(4):448. DOI:10.4048/jbc.2010.13.4.448 · 1.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Radiation therapy (RT) including tomotherapy has been widely used to treat primary tumors, as well as to alleviate the symptoms of metastatic cancers.
The primary purpose of this study was to examine the characteristics of the clinical features and pathophysiological mechanisms associated with acute radiation dermatitis in cancer patients that received tomotherapy, and compare the results to patients treated by conventional radiation therapy.
The study population consisted of 11 patients that were referred to the dermatology department because of radiation dermatitis after receiving tomotherapy; all patients were evaluated for clinical severity. The patients were assessed and identified using the National Cancer Institute Common Toxicity Criteria version (CTC) 3.0. We performed biopsies of the skin lesions that were examined for apoptosis using the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end-labelling (TUNEL) assay and stained immunohistochemically with monoclonal antibodies to CD8, CD4 and TGF-beta. As a positive control, patients with radiation dermatitis treated with conventional radiation therapy were also studied.
THE RESULTS OF THE CLINICAL FEATURES OF THE SKIN OF TOMOTHERAPY PATIENTS WERE THE FOLLOWING: grade 1 (36%), grade 2 (55%) and other changes (9%). Among the population that had skin lesions due to acute radiation dermatitis, the mean number of positive cells per high power field (HPF) was the following: there were 30.50+/-7.50 TUNEL-positive cells, 34.60+/-12.50 CD8+ T cells, 5.19+/-3.17 CD4+ T cells and 9.95+/-1.33 TGF-beta positive cells measured per HPF. The mean number of positive cells per HPF for the patients that received conventional radiation therapy was: TUNLEL-positive cells in 7.5+/-1.64, CD8-, CD4- and TGF-beta-positive cells in 12.50+/-3.73, 3.16+/-1.47, 6.50+/-1.97.
We found that the number of TUNEL-positive cells and CD8+ T cells were higher in the lesions of patients receiving tomotherapy compared to the lesions of the patients receiving conventional radiation therapy. These findings suggest that tomotherapy without dose modification may cause significantly more severe forms of radiation dermatitis by apoptosis and cytotoxic immune responses than conventional radiation therapy.
Annals of Dermatology 11/2009; 21(4):358-63. DOI:10.5021/ad.2009.21.4.358 · 1.39 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Malignant peripheral nerve sheath tumors (MPNSTs) are malignant variants of peripheral nerve sheath tumors that develop at major or minor peripheral nerve branches or at the sheaths of peripheral nerve fibers. These tumors are derived from Schwann cells or pluripotent cells of a neural crest origin. Malignant tumors of the peripheral nerve sheath are most commonly seen in deeper soft tissues, and usually in the proximity of a nerve trunk. MPNSTs of the breast are very uncommon and they have rarely been reported on. We report here on a case of MPNST of the breast in a 59-year-old female who presented with a painless breast lump for two months. The excisional biopsy revealed a malignant peripheral nerve sheath tumor based on the microscopic findings and immunohistochemical staining. We performed wide excision of breast tissue around the biopsy site and thereafter the patient underwent radiation therapy. The patient remains well without signs of recurrence 1 year following surgery.
Journal of Breast Cancer 09/2009; 12(3):223. DOI:10.4048/jbc.2009.12.3.223 · 1.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Laparoscopic appendectomy is generally performed with the three-port system. In this study, we performed a unique single-port laparoscopic appendectomy, which we refer to as the transumbilical single-port laparoscopic appendectomy (TUSPLA).
From April 19, 2008, 33 cases of TUSPLA were performed. A surgical glove was used as the "single-port" with an extra-small wound retractor, which was set up through a small umbilical incision. The surgical glove attached with one trocar and two pipes were then fixed to the outer ring of the wound retractor, which served as a single port with three working channels. Using this single-port system, TUSPLA was performed. The overall procedure was similar to that used for the three-port laparoscopic appendectomy.
TUSPLA was attempted in 33 patients (11 males and 22 females), with an average age of 31.2 years (range, 14-73). Average patient body mass index was 22.8 kg/m2 (range, 16.8-35.8). TUSPLA was successfully completed in 31 patients. In 2 cases, the operation was converted to the conventional three-port laparoscopic appendectomy due to a gangrenous change at the base of the appendix in 1 case and the need for drainage in another. Mean operation time was 40.8 minutes (range, 15-90), and mean postoperative hospital stay was 2.5 days (range, 1-11). Postoperative complications occurred in 3 cases; 2 cases were of localized pericecal abscess and 1 case was of omphalitis, and all were treated conservatively.
TUSPLA is a safe, effective technique that allows nearly scarless abdominal surgery.
[Show abstract][Hide abstract] ABSTRACT: It is well known that the amplification of the HER2 gene is closely associated with poor prognosis of breast cancer. However, there is controversy about the clinical significance of HER2 according to lymph node status in breast cancer. The aim of this study was to identify the differences in the prognostic significance of HER2 gene amplification according to the stages of breast cancer. We prepared a tissue array for fluorescence in situ hybridization (FISH) with breast cancer specimens from the surgery in 1994 to 1999. Total 338 cases of breast cancer were enrolled and the median follow-up period was 6.3 yr. The detection rates of HER2 gene amplification were as follows: 10.3% in stage I, 22.3% in stage II, and 43.8% in stage III. On survival analyses HER2-positive groups showed worse prognosis in stage III of breast cancer, but not in stage I or II. Multivariate analyses with a Cox-regression model also revealed that HER2 amplification was an independent prognostic factor only in stage III breast cancer. Regarding HER2 gene amplification as a prognostic factor of breast cancer, the clinical significance of the gene was found to be confined to advanced breast cancer.
Journal of Korean Medical Science 07/2008; 23(3):414-20. DOI:10.3346/jkms.2008.23.3.414 · 1.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We investigate the current status of endoscopic thyroidectomy in Korea. A representative questionnaire was sent to 21 members of the Korean Association of Endocrine Surgeons who were thought to be performing endoscopic thyroidectomy. All the reply letters were collected and analyzed. The response rate was 95%. A total of 1616 cases of endoscopic thyroidectomy were performed from the year 1998 to the year 2005. The patients included 71 men and 1545 women, with a mean age of 36.17 years. The mean operation time was 124.18 minutes and overall length of hospital stay was 4.31 days. Thyroid lobectomy and nodular hyperplasia were the most common procedures and prominent pathologic findings. Axillary approach was the most popular operative approach method. Gas insufflation and skin-lifting gasless method were used in 800 cases and 816 cases, respectively. Postoperative complication rate was 14.2%. Skin paresthesia was the most common complication. Conversion rate to conventional thyroidectomy was 2.2%. Korean experiences show that endoscopic thyroidectomy is a technically safe and feasible procedure. It is considered to be an important surgical tool that can be further progressed and that also has an excellent potential in a management of thyroid neoplasm.
[Show abstract][Hide abstract] ABSTRACT: Currently MRI (Magnetic Resonance Imaging) is widely used for the preoperative staging of breast cancer. In this study, we assessed the impact of preoperative breast MRI on the surgical management of breast cancer in women.
Journal of Breast Cancer 01/2006; 9(4). DOI:10.4048/jbc.2006.9.4.343 · 1.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Pregnancy and hCG treatments are considered essential for inhibiting breast cancer. The effect of hCG is accompanied by the synthesis of inhibin, a transforming growth factor involved in cell differentiation and proliferation. Inhibin is considered a tumor suppressor, but its role in the breast is unclear. The aim of this study was to determine the frequency and tissue distribution of the expressions of inhibin-alpha and beta-hCG in breast cancer, and their prognostic relevance with other biological parameters.
334 of formalin-fixed, paraffin embedded tissue blocks were selected, and then immunostained for inhibin-alpha and beta-hCG. The inhibin-alpha expression was compared with those of beta-hCG, ER, PR and HER-2/neu, as well as the tumor characteristics and recurrences.
Inhibin-alpha and beta-hCG were expressed in 87 (26.0%) and 44 cases (13.2%), respectively. Inhibin-alpha was found in 25.1% of infiltrating ductal carcinomas (67/267), 26.7% of intraductal carcinomas (8/30), 33.3% of lobular tumors (3/9), 80.0% of apocrine carcinomas (4/5) and 21.7% of the other types (5/23). Inhibin-alpha was correlated with beta-hCG (p<0.0001), PR (p=0.010) and HER-2/neu (p=0.021). HCG was focally expressed in the cytoplasm of the conventional types, but the apocrine type displayed diffusely intense cytoplasmic staining, which correlated with histological tumor types (p<0.001).
Inhibin was significantly correlated with the expressions of hCG, PR and HER-2/neu. Therefore, it might be a useful marker in the prevention and hormonal treatment of breast cancer, such as hCG and progesterone. HCG was expressed significantly higher in the apocrine type than the conventional types, suggesting it can be a useful adjunct in differentiating other cancer types.
Cancer Research and Treatment 08/2005; 37(4):241-6. DOI:10.4143/crt.2005.37.4.241 · 3.32 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A case of primary malignant fibrous histiocytoma of the breast is reported. The patient was a 48-yr-old woman with a huge tumor involving almost the entire left breast. The central portion of her left breast was already rotted by extensive necrosis and inflammation. She was treated by radical mastectomy and axillary lymphadenectomy to level I. Pathologic examination supported by an immunohistochemical staining confirmed the tumor as malignant fibrous histiocytoma of giant cell type. Axillary lymph nodes were free from tumor metastasis. She had not taken any postoperative adjuvant therapy. The metastasis to lungs was found 2 months after the operation, and she died within 6 months.
Journal of Korean Medical Science 07/2004; 19(3):477-80. DOI:10.3346/jkms.2004.19.3.477 · 1.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose: For the accurate diagnosis of non-palpable breast lesions with microcalcification, a localization and biopsy procedure should be performed by using mammography. Recently, a stereotactic vacuum-assisted biopsy has been re-ported as a convenient and accurate method for a pro-cedure. This study was performed to determine whether the upright add-on type stereotactic biopsy was suitable for the diagnosis of microcalcified breast lesions in Korean women. Methods: Between April 2002 and March 2003, an upright add-on type stereotactic vacuum-assisted biopsy was per-formed in 21 cases with microcalcification; that had been categorized from 2 to 5 according to the BI-RADS (Breast Imaging Reporting and Data System). The microcalcified lesions in biopsy specimens were confirmed with tissue mammogram and a pathological review performed. Results: The pathological findings revealed fibrocystic changes in 15 cases, intraductal papilloma in 1 and ductal carcinoma in situ (DCIS) in 5. There were no malignancy among the BI-RADS category 2 & 3 cases, but DCIS was found in 2 (25%) out of 8 BI-RADS category 4 cases, and in all 3 (100%) of BI-RADS category 5 cases. The malig-nancy detection rate among the cases with microcalcifi-cation with a BI-RADS category above 4 was 45.4% (5/11). Conclusion: An upright add-on type stereotactic vacuum assisted biopsy is an accurate, safe and very convenient tool for the diagnosis of breast lesions with microcalcifica-tion.