Search

Purpose: This study investigated the correlation between non-mass-like enhancement (NME) observed on preoperative breast magnetic resonance imaging (MRI) and the actual pathological size of breast cancer. We further examined the effect of NME on the positive resection margins during partial mastectomy.Methods: We retrospectively collected data from breast cancer patients who underwent surgery between January 2018 and September 2020. Patients were divided into two groups based on their MRI findings: NME and no-NME (mass-like lesion only) groups. The medical records, including MRI findings and clinicopathological information of patients, were collected retrospectively, and correlations with pathologic results were analyzed. Propensity score matching was applied to develop comparable cohorts of the NME group and no-NME group.Results: This study included a total of 317 patients, with 66 and 251 patients in the NME and no-NME groups, respectively. The mean pathologic size of invasive lesion was significantly smaller than the mean lesion size in the NME group (1.55±1.39 cm vs. 3.45±1.81 cm, p

Purpose: The malignancy rates within the Breast Imaging Reporting and Data System (BI-RADS) category 4a and 4b lesions were examined, and the correlations with the histopathology results were analyzed. In addition, the positive predictive value (PPV) and clinical utility of BIRADS category 4a and 4b lesions for predicting a malignancy were assessed. Methods : : From January 2017 to December 2019, patients with BI-RADS category 4a and 4b lesions on breast ultrasonography (US) who underwent a subsequent core needle biopsy in the authors’ institution were evaluated. The clinical, pathological, and sonographic features were assessed to identify the malignancy rate and pathologic factors predictive of malignancy. The sensitivity, specificity, PPV, and negative predictive value (NPV) were calculated. A Binary logistic regression test was used to estimate the odds ratio (OR) and 95% confidence interval (CI). Results : : The study population included 314 lesions in 275 patients (mean age, 45.3 years; range, 21–78 years). The overall malignancy rate was 9.8% (31 of 314). The malignancy rates among the BI-RADS category 4a and 4b lesions were 9.3% (28 out of 300) and 21.4% (3 out of 14), respectively. Compared to the well-defined margins, ill-defined margins were associated with an increased risk of breast cancer with a corresponding OR (95% CI) of 1.880 (1.304-2.554). The sensitivity, specificity, PPV, and NPV of the C4a and C4b lesions were as follows: 90.3%, 3.9%, 9.4%, and 78.6%, respectively, for C4a lesions and, 9.7%, 96.1%, 21.4%, and 90.6%, respectively, for C4b lesions. Only the equivocal elasticity on ultrasonography was associated with an increased risk of breast cancer with an OR (95% CI) of 2.357 (1.004-5.532). Conclusion : : BI-RADS categories 4a and 4b are useful for predicting malignancy. Nevertheless, further studies will be needed to identify more predictive factors for breast cancer.

Mammographic density (MD) of the breast and body mass index (BMI) are inversely associated with each other, but have inconsistent associations with respect to the risk of breast cancer. Skeletal muscle mass index (SMI) has been considered to reflect a relatively accurate fat and muscle percentage in the body. So, we evaluated the relation between SMI and MD. A cross-sectional study was performed in 143,456 women who underwent comprehensive examinations from 2012 to 2016. BMI was adjusted to analyze whether SMI is an independent factor predicting dense breast. After adjustment for confounding factors including BMI, the odds ratios for MD for the dense breasts was between the highest and lowest quartiles of SMI at 2.65 for premenopausal women and at 2.39 for postmenopausal women. SMI was a significant predictor for MD, which could be due to the similar growth mechanism of the skeletal muscle and breast parenchymal tissue. Further studies are needed to understand the causal link between muscularity, MD and breast cancer risk.

The impact of variations in serum thyroid hormone concentration within the euthyroid range on breast cancer risk remains unclear. We investigated the effect of serum thyrotropin (TSH) and thyroid hormone concentration on breast cancer risk. This cohort study involved 62,546 Korean women, aged ≥40 years, who were free of breast cancer at baseline and underwent health examination with determination of free thyroxine (FT4) and TSH. A parametric proportional hazard model was used to estimate the adjusted hazard ratio (aHR) and 95% confidence interval (CI). During a median follow-up of 4.8 years (interquartile range: 2.8-7.3 years), 834 incident breast cancers were identified. Compared to normal FT4 level, abnormally high serum FT4 level was associated with an increased risk of incident breast cancer with a corresponding multivariable aHR (95% CI) of 1.98 (1.02-3.83). This association tended to be stronger in postmenopausal women than in premenopausal women. Within the euthyroid range, the highest TSH tertile was associated with a lower risk of breast cancer than the lowest TSH tertile with a corresponding aHR (95% CI) of 0.68 (0.55-0.84). In contrast, highest FT4 tertile was associated with a higher risk of breast cancer than the lowest FT4 tertile. Abnormally high FT4 as well as higher FT4 within the euthyroid range were positively associated with breast cancer risk, while higher TSH concentration within the euthyroid range was negatively associated with breast cancer risk. Our findings indicate that thyroid function within both the abnormal and euthyroid ranges may contribute to the development of breast cancer.

BackgroundsLateral lymph node metastasis (LNM), which significantly impacts papillary thyroid carcinoma (PTC) patients’ prognosis. Papillary thyroid microcarcinoma (PTMC) is known to have a much better prognosis than non-PTMC, but it has not been known whether there is such a difference even with lateral LNM. MethodsThis retrospective study included a series of 3336 consecutive PTC patients who underwent thyroidectomy. Of them, 206 had lateral LNM and were divided into the PTMC and non-PTMC groups by tumor size (1-cm) for comparing the prevalence of prognostic factors. ResultsLNM was in 157/1131 (13.9%) non-PTMC patients and 49/2205 (2.2%) PTMC patients. Eleven of the 206 (5.3%) lateral LNM cases not found on US were only seen on computed tomography. The prevalence of prognostic factors which include an age of >55 years, >5 metastatic lymph nodes (LNs), high metastatic-to-examined LN ratio, and large metastatic LNs (>3 cm) were not significantly different between PTMC and non-PTMC group. ConclusionIn PTC with lateral LNM, the prognosis is likely to be similar regardless of tumor size. Considering the modest risk of lateral LNM in PTMC, FNA for small thyroid tumor and radiologic tests for lateral LNM should be encouraged.

Background: Preoperative evaluation of breast cancer using contrast-enhanced digital mammography (CEDM) as a possible alternative to contrast-enhanced magnetic resonance imaging (CEMRI) has gained acceptance. Our aim is to compare the diagnostic performance of CEDM and CEMRI for chemotherapeutic response in breast cancer patients who underwent neoadjuvant chemotherapy (NAC).Methods: From November 2017 to October 2018, 30 patients with invasive carcinoma who performed both CEDM and CEMRI were included. Residual malignancy sizes after NAC were compared with histopathological results. The diagnostic performances for detecting residual cancers were compared using Lin concordance and Pearson correlation coefficients.Results: Thirty patients were included for the analysis. Mean tumor size after NAC was 1.22 cm (range: 0–7.0 cm) for CEDM and 1.13 cm (range: 0–5.1cm) for CEMRI compared with 1.89 cm (range: 0–12.0 cm) at final pathology measurement. Sensitivity for identifying residual lesion was for CEDM and CEMRI is as follows (CEDM 62.5%, 95% CI 40.6–81.2, CEMRI 66.7%, 95% CI 44.7–84.4). The positive predictive value (PPV) for residual lesion was 93.8% (95% CI 69.8–99.8) for CEDM and 88.9% (95% CI 65.3–98.6) for CEMRI. CEDM had a mean difference from pathology measurement of 0.668 cm, with a concordance coefficient of 0.202 and a Pearson correlation coefficient of 0.231 (p=0.220).Conclusions: Diagnostic value of CEDM for detecting residual tumor extent after NAC was comparable to that of CEMRI.

Background The risk of breast cancer related to changes in breast density over time, including its regression and persistence, remains controversial. The authors investigated the relationship between breast density and its changes over time with the development of breast cancer in premenopausal and postmenopausal women. Methods The current cohort study included 74,249 middle-aged Korean women (aged ≥35 years) who were free of breast cancer at baseline and who underwent repeated screening mammograms. Mammographic breast density was categorized according to the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS). A dense breast was defined as heterogeneously dense or extremely dense, and changes in dense breasts between baseline and subsequent follow-up were classified as none, developed, regressed, or persistent dense breast. Results During a median follow-up of 6.1 years (interquartile range, 4.1-8.8 years), a total of 803 incident breast cancers were identified. Baseline breast density was found to be positively associated with incident breast cancer in a dose-response manner, and this association did not significantly differ by menopausal status. The multivariable-adjusted hazard ratios (HRs) for breast cancer comparing "heterogeneously dense" and "extremely dense" categories with the nondense category were 1.96 (95% confidence interval [95% CI], 1.40-2.75) and 2.86 (95% CI, 2.04-4.01), respectively. With respect to changes in dense breasts over time, multivariable-adjusted HRs for breast cancer comparing persistent dense breast with none were 2.37 (95% CI, 1.34-4.21) in premenopausal women and 3.61 (95% CI, 1.78-7.30) in postmenopausal women. Conclusions Both baseline dense breasts and their persistence over time were found to be strongly associated with an increased risk of incident breast cancer in premenopausal and postmenopausal women. Lay summary Both baseline breast density and its changes over time were found to be independently associated with the risk of breast cancer in both premenopausal and postmenopausal women. The risk of incident breast cancer increased in women with persistent dense breasts, whereas the breast cancer risk decreased as dense breasts regressed. The findings of the current study support that both dense breasts at baseline and their persistence over time are independent risk factors for developing breast cancer.

The aim of this study is to compare the feasibility and oncologic safety of Single-incision, gasless, Endoscopic trans-axillary bilateral Total thyroidectomy (SET) with open cervical total thyroidectomy in patients with papillary thyroid carcinoma (PTC).From March 2008 to December 2012, PTC patients underwent bilateral total thyroidectomy. Conventional, open surgery was performed on 538 patients (Group O) and endoscopic surgery was performed on 200 patients (Group E). We analyzed the patient's clinicopathologic, postoperative complications, and surgical completeness.The mean ages of the patients were 48.9 ± 0.5 (range = 24-77) in Group O and 39.5 ± 0.8 (range = 17-73) in Group E with statistical significance (P .001). Percentage of female patients were 74.3% in Group O and 96.0% in Group E with statistical significance (P .001). The postoperative hospital stay in Group O was significantly longer than Group E (4.60 ± 0.05 versus 3.30 ± 0.05; P .001). The operation time in Group E was significantly longer than Group O (93.9 ± 1.3 versus 142.6 ± 3.3; P .001). More transient hypocalcemia was found in Group O compared to Group E with statistical significance (28.1% versus 22.4%; P .001). There were no significant differences with respect to permanent hypocalcemia, permanent recurrent laryngeal nerve palsy, seroma, and hematoma. The mean 1 year-stimulated sTg was 0.23 ± 0.03 and 0.18 ± 0.02 in Group O and E, respectively. Tumor recurrence during short-term follow-up at neck ultrasonography (1 year) was detected in 4 patients in Group O.SET is safe and effective, not only for low-risk patients with early-detected cancer, but also for selected cases of advanced cancer.

The aim of this study was to determine the feasibility of image-guided marker-clip placement in axillary lymph nodes (ALNs) for breast cancer upon initial presentation and to assess the reliability of this method with sentinel lymph node biopsy (SLNB) for axillary restaging after neoadjuvant chemotherapy (NAC). Between June 2015 and August 2016, a marker clip was placed at a clinically positive ALN under ultrasonography (US) guidance before initiation of NAC in 20 patients. Preoperative localization of marker-clipped LNs was performed, and the localized LNs were removed by SLNB. We compared the postoperative results of the marker-clipped LNs, SLNs and ALNs. Image-guided marker-clip placements and localization of marker-clipped LNs were performed successfully in 20 patients. A total of 24 marker clips were inserted, and 23 marker-clipped LNs were successfully retrieved during surgery (identification rate, 23/24, 95.8%). In the 11 patients with pathologically confirmed metastatic marker-clipped LNs, four became negative after NAC, and seven maintained metastatic residues on the marker-clipped LNs. Three of the seven patients had metastatic residues on the ALNs, and two of the three patients also had negative SLNs. Marker-clipped nodes accurately predicted the axillary nodal status in these two patients compared with SLNs alone. Image-guided marker-clip placement on positive ALNs before NAC and removal with SLNB is technically feasible. This technique can improve the accuracy of the residual disease evaluation on the axilla, especially in patients with negative SLNB results, and can identify candidates for limited axillary surgery after NAC.

Background In patients diagnosed with ductal carcinoma in situ (DCIS) with needle biopsy before surgery, invasive component (IC) is often found in the postoperative tissue, which results in altered post-surgical care. However, there are no clinically available factors to predict IC, and few MRI studies are available for the detection of IC in DCIS patients. The purpose of this study was to evaluate which risk factors can predict IC preoperatively. Methods Patients with a DCIS diagnosis based on preoperative biopsy, who underwent breast surgery Kangbuk Samsung Hospital between Jan 2005 and June 2018, were retrospectively evaluated. Clinico-pathological and breast MRI factors were compared between DCIS and DCIS with IC in postsurgical specimens. Results Of the 431 patients with a preoperative diagnosis of DCIS, 34 (7.9%) showed IC during the postoperative pathological investigations, and 217 (50.3%) underwent breast MRI. Among MRI-related factors, Mass-like enhancement on MRI was the sole but significant predictor of IC (HR = 0.26, C.I. = 0.07–0.93, p = 0.038), while nipple-areolar complex invasion, enhancement peak and pattern were not statistically significant. Nuclear grade was the only significant predictor of IC in the analysis of other clinico-pathological factors (HR = 2.39, C.I. = 1.05–5.42, p = 0.038 in univariate analysis, HR = 2.86, C.I. = 1.14–7.14, p = 0.025 in multivariate analysis). Conclusions Mass-like enhancement on MRI and high nuclear grade were associated with IC in patients with preoperative diagnosis of DCIS. Considering the high sensitivity of breast MRI for IC, further evaluation of the predictive value of MRI in preoperative DCIS patients is desirable.

Background: Lateral lymph node metastasis (LNM), which significantly impacts papillary thyroid carcinoma (PTC) patients’ prognosis, occurs not uncommonly in papillary thyroid microcarcinoma (PTMC). PTMC is known to have a much better prognosis than non-PTMC, but it has not been known whether there is such a difference even with lateral LNM. Methods: This retrospective study included a series of 3336 consecutive PTC patients who underwent thyroidectomy. Of them, 206 had lateral LNM and were divided into the PTMC and non-PTMC groups by tumor size (1-cm) for comparing the prevalence of prognostic factors. Results: LNM was in 157/1131 (13.9%) non-PTMC patients and 49/2205 (2.2%) PTMC patients. Eleven of the 206 (5.3%) lateral LNM cases not found on US were only seen on computed tomography. The prevalence of prognostic factors which include an age of >55 years, >5 metastatic lymph nodes (LNs), high metastatic-to-examined LN ratio, and large metastatic LNs (>3 cm) were not significantly different between PTMC and non PTMC group. Conclusions: In PTC with lateral LNM, the prognosis is likely to be similar regardless of tumor size. Considering the modest risk of lateral LNM in PTMC, FNA and detailed radiologic for small tumor should be encouraged.

Aims Breast cancers are heterogeneous, making it essential to recognise several biomarkers for cancer outcome predictions. Ki67 proliferation index and B cell lymphoma 2 (BCL2) proteins are widely used as prognostic indicators in many types of malignancies. While Ki67 is a marker of normal or tumour cell proliferation, BCL2 plays a central role in antiproliferative activities. A combination of these two biomarkers with contrary purposes can provide enhanced prognostic accuracy than an analysis using a single biomarker. Methods We evaluated Ki67 and BCL2 expression with 203 cases of breast cancer. The relative expression of each biomarker named as Ki67/BCL2 index was divided into two groups (low vs high) with the use of area under receiver operating characteristic curves. Results There were significant correlations between Ki67/BCL2 index and clinicopathological findings such as age, tumour stage, size and necrosis, histological grade, extensive intraductal component, lymphatic and vascular invasion, oestrogen receptor, progesterone receptor, human epithelial growth factor receptor 2 and p53 expression (all p Conclusions The Ki67/BCL2 index should be considered as a prognostic predictor in patients with early stage invasive ductal carcinoma.

Purpose In this trial, we investigated the efficacy and safety of adjuvant letrozole for hormone receptor (HR)-positive breast cancer. Here, we report the clinical outcome in postmenopausal women with HR-positive breast cancer treated with adjuvant letrozole according to estrogen receptor (ER) expression levels. Methods In this multi-institutional, open-label, observational study, postmenopausal patients with HR-positive breast cancer received adjuvant letrozole (2.5 mg/daily) for 5 years unless they experienced disease progression or unacceptable toxicity or withdrew their consent. The patients were stratified into the following 3 groups according to ER expression levels using a modified Allred score (AS): low, intermediate, and high (AS 3-4, 5-6, and 7-8, respectively). ER expression was centrally reviewed. The primary objective was the 5-year disease-free survival (DFS) rate. Results Between April 25, 2010, and February 5, 2014, 440 patients were enrolled. With a median follow-up of 62.0 months, the 5-year DFS rate in all patients was 94.2% (95% confidence interval [CI], 91.8-96.6). The 5-year DFS and recurrence-free survival (RFS) rates did not differ according to ER expression; the 5-year DFS rates were 94.3% and 94.1%in the low-to-intermediate and high expression groups, respectively (p = 0.6), and the corresponding 5-year RFS rates were 95.7% and 95.4%, respectively (p = 0.7). Furthermore, 25 patients discontinued letrozole because of drug toxicity. Conclusion Treatment with adjuvant letrozole showed very favorable treatment outcomes and good tolerability among Korean postmenopausal women with ER-positive breast cancer, independent of ER expression. Trial registration ClinicalTrials.gov Identifier: NCT01069211.

AIM To assess the predictive value of preoperative residual mammographic microcalcifications for residual tumours after neoadjuvant chemotherapy (NAC) for breast cancer. MATERIALS AND METHODS This single-centre retrospective study included breast cancer patients who underwent NAC and demonstrated suspicious microcalcifications within or near the tumour bed on mammography from June 2015 to August 2018. The residual microcalcifications and remnant lesion on magnetic resonance imaging (MRI) were correlated with histopathological findings of residual tumours and immunohistochemical markers. RESULTS A total of 96 patients were included. Ten patients achieved pathological complete response (pCR) and previous suspicious microcalcifications were associated with benign pathology in 10.4% (10/96) of the patients. In the remaining 86 patients who did not achieve pCR, 61.5% (59/96) of the residual microcalcifications were associated with invasive or in situ carcinoma and 28.1% (27/96) with benign pathology. Hormone receptor-positive (HR+) patients had the highest proportion of residual malignant microcalcifications compared to HR− patients (48.9% versus 13.5%, respectively; p=0.019). MRI correlated better than residual microcalcifications on mammography in predicting residual tumour extent in all subtypes (ICC=0.709 versus 0.365). MRI also showed higher correlation with residual tumour size for the HR−/HER2+ and HR−/HER2- subtype (ICC=0.925 and 0.876, respectively). CONCLUSION The extent of microcalcifications on mammography after NAC did not correlate with the extent of residual cancer in 38.5% of women. Regardless of the extent of microcalcifications, residual tumour extent on MRI after NAC and molecular subtype could be an accurate tool in evaluating residual cancer after NAC.

Purpose This study aimed to compare the diagnostic performance of contrast-enhanced digital mammography (CEDM) and contrast-enhanced magnetic resonance imaging (CEMRI) in preoperative evaluations, and to evaluate the effect of each modality on the surgical management of women with breast cancer. Methods This single-center, prospective study was approved by the Institutional Review Board, and informed consent was obtained from all patients. From November 2016 to October 2017, 84 patients who were diagnosed with invasive carcinoma (69/84) and ductal carcinoma in situ (15/84), and underwent both CEDM and CEMRI, were enrolled. Imaging findings and surgical management were correlated with pathological results and compared. The diagnostic performance of both modalities in the detection of index and secondary cancers (multifocality and multicentricity), and occult cancer in the contralateral breast, was compared. The authors also evaluated whether CEDM or CEMRI resulted in changes in the surgical management of the affected breast due to imaging-detected findings. Results Eighty-four women were included in the analysis. Compared with CEMRI, CEDM demonstrated a similar sensitivity (92.9% [78/84] vs. 95.2% [80/84]) in detecting index cancer (p=0.563). For the detection of secondary cancers in the ipsilateral breast and occult cancer in the contralateral breast, no significant differences were found between CEDM and CEMRI (p=0.999 and p=0.999, respectively). Regarding changes in surgical management, CEDM resulted in similar changes compared with CEMRI (30.9% [26/84] vs. 29.7% [25/84], p=0.610). Regarding changes in surgical management due to false-positive findings, no significant differences were found between CEDM and CEMRI (34.6% [9/26] vs. 44.0% [11/25], p=0.782). Conclusion CEDM demonstrated a diagnostic performance comparable with CEMRI in depicting index cancers, secondary cancers, and occult cancer in the contralateral breast. CEDM demonstrated similar changes in surgical management compared with CEMRI.

Background Carcinogenesis and tumor growth are associated with chronic inflammation and the host immune system. Here, we investigated the clinical significance and relationship between tumor-infiltrating lymphocytes (TILs) and hematologic parameters in patients with breast cancer. Methods Invasive ductal breast cancer patients (N = 145) who underwent surgery were retrospectively evaluated. Samples were obtained using a core needle biopsy for CD8+, FOXP3+ TIL assessment. Blood lymphocytes, neutrophils, monocytes, and platelets were obtained by peripheral venous punctures. Results CD8 + TILs were significantly associated with absolute lymphocyte count (ALC) and the absolute monocyte count (AMC). Low LMR (ALC/AMC) (cut-off - 5.3, range = 0.73–12.31) was associated with poor overall survival (OS) (p = 0.010), disease-free survival (DFS) (p = 0.005). However, in subgroup analysis, LMR did not have any value as a prognostic factor in HER2-positive breast cancers. TILs had different prognostic impacts across breast cancer subtypes, although they were not statistically significant. The treatment response after NAC tended to improve in breast cancer patients with high FOXP3+ TILs, low NLR (neutrophil count/ALC) (FOXP3 p for trend = 0.006, NLR p for trend = 0.063). Conclusions A relevance between TILs and hematologic parameters in breast cancer was demonstrated. The influence of the immune system on breast cancer progression may differ by subtype. Electronic supplementary material The online version of this article (10.1186/s12885-018-4832-5) contains supplementary material, which is available to authorized users.

GATA3 and fascin proteins are known prognostic markers in several cancers. GATA3 is a key regulator of mammary gland morphogenesis and luminal cell differentiation, whereas fascin is a pro-metastatic actin-bundling protein. In this study, we analyzed and compared the predictive abilities of GATA3 and fascin for clinical outcomes of patients with breast cancer. The combined expression pattern based on GATA3-/+ and fascin-/+ was evaluated by immunostaining using a tissue microarray, and relationships between protein expression and several clinicopathological parameters were analyzed. GATA3 expression was associated with good prognostic parameters, but fascin was correlated with poor prognostic parameters. On comparing GATA3 and fascin, we found an inverse relationship between fascin and GATA3 expressions. On analysis of combined markers, GATA3+/fascin- was correlated with improved clinical outcomes compared to GATA3-/fascin+. Univariate and multivariate analyses revealed significant differences in relapse-free and overall survival between GATA3+/fascin- and GATA3-/fascin+. Combined marker analysis of GATA3/fascin showed an inverse association and improved prognostic information for patients with breast cancer.

Purpose: The purpose of the current study was to evaluate the usefulness of second-look ultrasonography (US) for evaluating incidental enhancing lesions identified on preoperative breast magnetic resonance imaging (MRI) performed to stage malignant lesions. Methods: We studied 88 patients with suspected breast malignancy on conventional mammography and/or whole-breast US and invasive carcinoma subsequently confirmed by cytology or core biopsy, who underwent preoperative breast MRI for accurate breast cancer staging between January 2011 and July 2014. Patients’ demographic, clinical and pathological characteristics were assessed. Results: Seven hundred fortynine patients underwent preoperative breast MRI, and the imaging detected incidental enhancing lesions in 257 patients. Second-look US was performed to evaluate 126 incidental enhancing lesions in 88 patients. We evaluated the frequency of malignancy as a function of lesion size on MRI, lesion size on second-look US, menstrual status, and age. The frequency of malignancy was higher for lesions 0.6 cm or larger on MRI than for smaller lesions (25.9% vs. 0%), and this difference was statistically significant (p=0.032). Conclusion: In conclusion, we found that the frequency of malignancy increased with the size of incidental enhancing lesions detected by MRI. On the basis of our results, biopsy is warranted in cases of incidental enhancing lesions 0.6 cm or larger on MRI. Further study with a larger series of cases and including more detailed subgroup analyses is necessary to develop reliable management guidelines for these lesions.

Brachyury is a T-box transcription factor characterized as a driver of the epithelial-to-mesenchymal process, which is associated with poor prognosis of patients with breast cancer. The present study investigated expression of brachyury in breast cancer including primary tumor, metastatic and recurred tumor tissues, and the clinical significance and value of brachyury as a prognostic biomarker. This retrospective study included a series of 102 consecutive patients surgically resected between January 2005 and December 2011. Brachyury expression in tumor cell was evaluated using immunohistochemistry and scored as the immunoactivity. Of 102 patients, 62 primary tumors were positive for brachyury expression and 40 were negative. Multivariate analysis of disease-free survival (DFS) revealed brachyury expression, HER2 and lymphovascular invasion as independent prognostic factors [brachyury negative vs. positive hazard ratio (HR), 3.0; P=0.024; HER2 negative vs. positive HR, 4.9; P=0.003; lymphovascular invasion absent vs. present HR, 3.5; P=0.020]. These results were particularly observed in triple-negative breast cancer (TNBC), no recurrence or mortality occurred in brachyury negative group during the follow-up period, and therefore a significantly improved prognosis was demonstrated in these patients compared with the brachyury positive group [overall survival (OS), P=0.022; DFS, P=0.002]. Brachyury expression in metastatic lymph node/recurred tumors was not significantly associated with prognosis (OS, P=0.745; DFS, P=0.189). Therefore, Brachyury expression in primary tumor independently is a potential predictor of poor prognosis, particularly in TNBC, where it appears to serve a crucial function in recurrence and mortality. Brachyury vaccines under clinical trials are likely to be useful in patients with breast cancer.

The role of androgen receptor (AR) as a prognostic marker has been proposed in breast cancer. This study investigated AR status and its clinical significance in breast cancer, especially in triple negative breast cancer (TNBC). We also evaluated discordant AR status during the process of lymph node metastasis, locoregional recurrences (LRR) and distant metastasis. From January 2005 to December 2010, we retrospectively reviewed 120 patients including 55 TNBC patients diagnosed as invasive carcinoma with no special type (NST), who were treated at the Kangbuk Samsung Hospital. Tissue microarray was constructed and immunohistochemical expression of AR was performed for 120 invasive carcinomas, NST specimens and matching samples from 28 lymph node metastasis, 2 LRR and 8 distant metastases. AR expression was found in 35.0% (42/120) of the total patients and 14.5% (8/55) of those diagnosed as TNBC. Positive expression of AR was significantly correlated with smaller tumor size, early T stage, fewer lymph node metastases, early AJCC stage, lower histologic grade, estrogen receptor/progesterone receptor positivity, more luminal A type, less TNBC, longer disease-free survival and overall survival, fewer distant metastasis and no deaths from breast cancer (all P < 0.05). AR was a favorable prognostic marker for disease free survival in univariate analysis (P = 0.041). The discordance rate of AR status between primary and recurrent/metastatic disease was 21.6%. AR expression was associated with favorable clinicopathological outcomes in the whole study population. AR status can be altered during tumor progression.

Matrix metalloproteinases (MMPs) are matrix-degrading enzymes that play a pivotal role in aggressive behaviours, such as rapid tumour growth, invasion, and metastasis, of several types of solid tumours. In particular, stromal MMP-2 plays important roles in the progression of malignant tumours, but most clinical studies have focused on tumoural MMP-2 and -9 expression, and not stromal MMP-2 expression. One hundred and seventy-seven cases diagnosed as invasive ductal carcinoma of the breast between 2000 and 2005 were included in this study. Expressions of tumoural MMP-2 and -9 and stromal MMP-2 were analysed by immunostaining on a tissue microarray. Subsequently, the associations between those results and various clinicopathological parameters were evaluated. Stromal MMP-2 expression correlated significantly with clinicopathological parameters such as advanced T category, larger tumour size, high histological grade, tumour necrosis, ER- and PR-negative, and HER-2-positive (all p < 0.05). In univariate and multivariate analyses, overall survival was linked with stromal MMP-2 expression as well as dual expression of stromal MMP-2 and tumoural MMP-2 and -9 (all p < 0.05). Stromal MMP-2 expression may play a crucial role in predicting aggressive clinical behaviour in breast cancer patients.

Cullin 1 (Cul1) is a rigid scaffold protein of a major class of E3 ubiquitin ligase, also known as the Skp1/cullin1/F-box (SCF) complex, which is involved in cell-cycle progression. The aberrant expression of Cul1 is involved in the dysfunction of SCF E3 ligase. Previous studies have revealed an association between increased Cul1 expression and tumor progression and poor outcome in several different tumors. We constructed a tissue microarray containing 103 papillary carcinoma tissues of the thyroid and 66 normal thyroid tissues. Cul1 expression and Cyclin D1 expression were evaluated by immunohistochemistry staining, and the relationship between their expression and clinicopathological parameters were analyzed. Cytoplasmic expression of Cul1 was correlated with tumor occurrence (p < 0.001), N stage (p = 0.027), and Cyclin D1 expression (p < 0.001). Cyclin D1 expression showed a correlation with tumor occurrence (p < 0.001) and T stage (p = 0.009). On the other hand, nuclear expression of Cul1 showed a negative correlation with tumor occurrence (p < 0.001) and Cyclin D1 expression (p < 0.001). Cytoplasmic Cul1 expression was associated with tumor development and higher nodal metastasis status, supporting the idea that the SCF complex is involved in cell-cycle regulation and promotes cell proliferation. Nuclear expression of Cul1 showed inverse relationship between tumor aggressiveness factors. Our data suggest that the expression site of Cul1 may affect the function of the SFC complex and play a role in tumor progression.

Background To better define the prognostic role of nodal disease, evaluation of metastatic lymph node ratio (MLR) has been performed, and this method has recently gained prominence in various gastrointestinal cancers. The present study attempts to identify prognostic factors and evaluate the independent prognostic influence of MLR in patients who have undergone curative pancreaticoduodenectomy. Methods In our institution within the study period, 111 patients received curative pancreaticoduodenectomy for periampullary cancers. Clinicopathologic data were collected and MLR was calculated for each of the patients. Patients were then divided into four groups based on MLR value: MLR 1 = 0; MLR 2 = 0.01–0.2; MLR 3 0.21–0.4; and MLR 4 >0.4. Results Increasing MLR correlates with high recurrence rate and lower overall survival (OS) with significance (P < 0.001, P < 0.001). The recurrent group showed significantly lower OS than the non-recurrent group (P < 0.001). In the multivariate analysis for recurrence, MLR was identified as the only independent prognostic factor (P < 0.001). Conclusions The simple and easily obtainable MLR is well qualified as a prognostic factor in patients who undergo curatively radical resection for periampullary cancer. Furthermore, MLR can overcome the limitations of evaluation of lymph nodes status, allowing it to be used as a potential prognostic factor.

Purpose: The measurement of serum thyroglobulin (Tg) of papillary thyroid carcinoma patients, 12 months after total thyroidectomy and radioactive iodine (RAI) ablation following thyroxine hormone withdrawal (T4-off Tg) or recombinant human thyroid-stimulating hormone stimulation (rhTSH-Tg), is standard method for monitoring disease status. The aim of this study was to find predictive factors for detectable T4-off Tg during follow-up. Methods: A retrospective review was conducted of 329 patients who underwent total thyroidectomy and RAI ablation between October 2008 and August 2012. Subjects were assigned to high (>1 ng/mL, n = 53) and low (≤1 ng/mL, n = 276)groups, based on T4-off Tg measured 12 months postoperatively. Demographic and clinicopathological characteristics at diagnosis and follow-up were compared between the 2 groups. Results: The low and high T4-off Tg groups differed with respect to tumor size, preoperative Tg, ablative Tg, cervical lymph node metastasis, thyroglobulinemia out of proportion to results of diagnostic whole body scan, and American Thyroid Association 3-level stratification and restratification. Multivariate analysis confirmed that ablative Tg > 1.0 ng/mL (odds ratio [OR], 10.801; P = 0.001), more than 5 cervical lymph node metastasis (OR, 6.491; P = 0.003), and thyroglobulinemia out of proportion (OR, 9.221; P = 0.000) were risk factors. Conclusion: Ablative Tg >1.0 ng/mL, more than 5 cervical lymph node metastasis, and thyroglobulinemia out of proportion were independent factors for T4-off Tg >1 ng/mL 12 months postoperative. In low-risk patients without these risk factors, the possible omission of Tg measurements could be considered during follow-up.

Purpose The aim of this study was to compare postoperative pain between single-incision, gasless, endoscopic transaxillary thyroidectomy (SET), and conventional open thyroidectomy. Methods From March to December 2015, patients with thyroid disease underwent total thyroidectomy or lobectomy. Patient's clinical and pathological characteristics, postoperative pain score using visual analog scale (VAS) were compared between the 2 groups. The primary endpoint was postoperative pain evaluated by VAS score and postoperative analgesic use. Operation time and length of postoperative hospital stay were secondary outcome measures. Results Conventional, open cervical surgery was performed on 30 patients (group O) and SET was performed on 27 patients (group E). Pain scores in shoulder area, which is the ipsilateral side of the tumor location at 1 hour and 24 hours after surgery, were higher in group E patients (P < 0.05). Pain scores 7 days after surgery did not differ between the 2 groups according to the locations (P < 0.05). Conclusion In conclusion, endocrine surgeons should be concerned about immediate higher postoperative pain scores in patients who undergo SET.

Background: Smad4 and GATA3 proteins are known prognostic markers in various cancers. Smad4 is a mediator linked to both tumour suppression and progression. GATA3 is a regulator of development and morphogenesis of the mammary gland. We assessed and compared the predictive performance of Smad4 and GATA3 for clinical outcomes in patients with breast cancer. Methods: The combined expression pattern based on Smad4+/- and GATA3+/- was evaluated by immunostaining using breast cancer tissue microarray, and the relationships between protein expression and clinicopathological variables were analysed. Results: Smad4 expression was only associated with an ill-defined tumour border, whereas GATA3 was associated with several good prognostic factors. On analysis of combined markers, there was a significant difference in the expression of fascin (an important factor for cancer invasiveness) between the Smad4+/GATA3- and Smad4-/GATA3+ groups. Smad4+/GATA3- was correlated with worse clinicopathological parameters, relapse-free survival (RFS), and overall survival (OS), compared to Smad4-/GATA3+. Conclusion: Combined markers of Smad4/GATA3 showed a superior performance compared to single markers for predicting RFS and OS in patients with breast cancer.

A standard procedure for single-port laparoscopic adrenal surgery has not been established. We retrospectively investigated intraoperative and postoperative outcomes after laparoscopic adrenalectomy through mono port (LAMP) and conventional laparoscopic adrenalectomy to assess the feasibility of LAMP. Between March 2008 and December 2009, 22 patients underwent adrenalectomy at the Department of Surgery, Kangbuk Samsung Hospital. Twelve patients underwent conventional laparoscopic adrenalectomy and 10 patients underwent LAMP. The same surgeon performed all the surgeries. The 2 procedures were compared in terms of tumor size, operating time, time to resumption of a soft diet, length of hospital day, and postoperative complications. The 2 groups were similar in terms of tumor size (30.08 vs. 32.50 mm, P=0.796), mean operating time (112.9 vs. 127 min, P=0.316), time to resumption of a soft diet (1.25 vs. 1.30 d, P=0.805), and length of hospital day (4.08 vs. 4.50 d, P=0.447). Despite 1 patient in the LAMP group experiencing ipsilateral pleural effusion as a postoperative complication, this parameter was similar for the 2 groups (P=0.195). Perioperative mortality, blood transfusion, and conversion to open surgery did not occur. Perioperative outcomes for LAMP were similar to those for conventional laparoscopic adrenalectomy. LAMP appears to be a feasible option for adrenalectomy.

BACKGROUND Surgical scars are a common cosmetic problem that occurs in various surgical fields including dermatology. Diverse trials have been made to prevent this annoying scar formation. Recently, 585- and 595-nm pulsed dye laser irradiation presented satisfactory cosmetic outcome for the treatment of surgical scars. Other fractionated lasers or light devices were also applied for scar treatment. OBJECTIVE To determine the effectiveness and safety of a newly developed 1,550-nm fractional erbium–glass laser in the prevention of scar formation after total thyroidectomy. MATERIALS AND METHODS Twenty-seven ethnic South Korean patients with linear surgical suture lines after total thyroidectomy operation were treated with a 1,550-nm fractional erbium–glass laser. The same surgeon performed all of the operations using the same surgical techniques. Each patient was treated four times at 1-month intervals using the same parameters (5- × 10-mm spot size, 10 mJ, 1,500 spot/cm2, static mode). Initiation of the first irradiation was made approximately 2 to 3 weeks after the thyroidectomy. The scar prevention effects were evaluated each month for 6 months after thyroidectomy. Two kinds of assessment methods were applied in this evaluation. First, the Vancouver Scar Scale (VSS) was used. Second, three independent physicians gave a global assessment valuation to the final cosmetic results: poor (1), fair (2), good (3), or excellent (4). These results were compared with the surgical scars of a control group (patients who denied laser treatments and had no other treatments during the 6 months after total thyroidectomy by the same surgeon). RESULTS The average VSS score was lower in the laser treatment group. The global assessment also presented better cosmetic outcomes in the treatment group than in the controls. CONCLUSION A new 1,550-nm fractional erbium–glass laser may efficiently repress the formation and hypertrophy of thyroidectomy scars on the neck, and it can be safely applied in relatively dark Asian skin without noticeable adverse effects. CONCLUSION The authors have indicated no significant interest with commercial supporters.

Purpose In the present study, we evaluated the levels of urokinase-type plasminogen activator (uPA) and plasminogen activator inhibitor 1 (PAI-1) by performing immunohistochemical staining to determine whether they were reliable prognostic markers in patients with breast cancer. Methods Demographic and clinicopathological parameters of 214 patients with invasive ductal carcinoma (IDC) and 80 patients with ductal carcinoma in situ (DCIS) who were diagnosed and treated from 2006 to 2010 were analyzed. Tissue microarray was constructed and immunohistochemical staining was performed for each specimen. Results Univariate analyses showed that age at diagnosis, history of hormone replacement therapy, radiation therapy, skin and chest wall invasion, Paget disease, lymphovascular invasion, estrogen receptor positivity, and triple-negative subtype were significantly associated with patient prognosis (p

Purpose We investigated the feasibility of using surgical clips as markers for tumor localization and their effect on the imaging evaluation of treatment responses after neoadjuvant chemotherapy (NAC). Methods A total of 16 breast cancers confirmed by needle biopsy in 15 patients were included in this study from October 2012 to June 2014. Under ultrasonography (US)-guidance, the surgical clips were placed prior to NAC. Additional mammography, breast US, and breast magnetic resonance examinations were performed within 10 days before surgery. The time period from marker insertion to operation date was documented. Images acquired via the three modalities were evalu-ated for the following parameters: location of clip, clip migration (>1 cm), the presence of complications from clip placement, and the effect of clips on the assessment of treatment. Results The mean time period was 128.6±34.4 days (median, 132.0 days) from the date of clip insertion to the date of surgery. The mean number of inserted clips was 2.3±0.7 (median, 2.0). Clip migration was not visualized by imaging in any patient, and there were no complications reported. Surgical clips did not negatively affect the assessment of treatment responses to NAC. Conclusion Surgical clips may replace commercial tissue markers for tumor localization in breast cancer patients undergoing NAC without migration. Surgical clips are well tolerated and safe for the patient, easily visualized on imaging, do not interfere with treatment response, and are cost-effective.

Purpose We compared the abilities of power and conventional color Doppler sonography to depict the vascularity of solid breast lesions and evaluated the usefulness of power Doppler sonography in differentiating between benign and malignant breast lesions. Methods One hundred two solid breast lesions (59 benign and 43 malignant lesions) were studied with power and color Doppler sonography. Power and color Doppler sonograms were retrospectively compared for the depiction of blood flow signals. Power Doppler images were also reviewed for the amount of Doppler signals, pattern of vascularity, and morphology of vessels. The sensitivity, specificity, and accuracy of the 2 techniques were calculated. Results Compared with color Doppler sonography, power Doppler sonography depicted flow superiorly in 61 cases (60%) and equally in 41 cases (40%). On power Doppler sonography, the incidence of marked blood flow in malignant lesions (65%) was higher than that in benign lesions (39%). The pattern of vascularity was predominantly central (86%) and/or penetrating (65%) more often in malignant lesions than in benign lesions (51% and 34%, respectively). Branching (56%) and disordered vessels (42%) were seen more often in malignant lesions than in benign lesions (22% and 8%, respectively). The sensitivity, specificity, and accuracy in diagnosing malignancy were 64%, 76%, and 71%, respectively, for power Doppler sonography and 77%, 76%, and 76% for color Doppler sonography. Conclusions Power Doppler sonography was more sensitive than color Doppler sonography in the detection of flow in solid breast lesions. Although power Doppler sonography was not more effective in diagnosing malignant lesions, central and penetrating vascularity patterns and branching and disordered vessels seem to be helpful findings in predicting malignancy. © 1999 John Wiley & Sons, Inc. J Clin Ultrasound 27:231–237, 1999.

In conventional open thyroidectomy, it is necessary to create a sub-platysma muscle flap in front of the strap muscle to provide working space. Adhesion between the flap and the strap muscle can occur after the operation, disrupting strap muscle movement and causing a swallowing disorder. Gasless transaxillary endoscopic thyroidectomy approaches the thyroid through the posterior of the strap muscle and does not require a sub-platysma muscle flap. The present study compared flap/muscle adhesion and occurrence of swallowing disorder following gasless transaxillary endoscopic thyroidectomy versus conventional open thyroidectomy. Patients (N = 47) receiving thyroidectomy at the Kangbuk Samsung Medical Center, Seoul, Korea, were divided into two groups: group O (24 patients) underwent conventional open thyroidectomy, and group E (23 patients) underwent gasless transaxillary endoscopic thyroidectomy. The subjective Swallowing Impairment Index (SIS)-6 was used to evaluate the degree of post-operative swallowing disorder. Video recordings of swallowing movement were used to determine the contraction/relaxation (CR) ratio and evaluate adhesion, pre-operation, 3 days post-operation, and 1 month post-operation. Barium videofluoroscopy was used to measure movement of the hyoid bone and strap muscle. Group O had significantly higher post-operative SIS-6 scores than group E (p

To better define the prognostic role of nodal disease, evaluation of metastatic lymph node ratio (MLR) has been performed, and this method has recently gained prominence in various gastrointestinal cancers. The present study attempts to identify prognostic factors and evaluate the independent prognostic influence of MLR in patients who have undergone curative pancreaticoduodenectomy.In our institution within the study period, 111 patients received curative pancreaticoduodenectomy for periampullary cancers. Clinicopathologic data were collected and MLR was calculated for each of the patients. Patients were then divided into four groups based on MLR value: MLR 1 = 0; MLR 2 = 0.01-0.2; MLR 3 0.21-0.4; and MLR 40.4.Increasing MLR correlates with high recurrence rate and lower overall survival (OS) with significance (P0.001, P0.001). The recurrent group showed significantly lower OS than the non-recurrent group (P0.001). In the multivariate analysis for recurrence, MLR was identified as the only independent prognostic factor (P0.001).The simple and easily obtainable MLR is well qualified as a prognostic factor in patients who undergo curatively radical resection for periampullary cancer. Furthermore, MLR can overcome the limitations of evaluation of lymph nodes status, allowing it to be used as a potential prognostic factor.

1 Pathology, 2 Radiology and 3 Purpose: The molecular mechanisms that are responsible for the initiation and progression of breast cancers are largely unknown. This study was to analyze the cyclin B1, cdc2, p53 and p16 tumor suppressor genes in human breast cancer. Materials and Methods: To investigate the role of cyclin B1, cdc2, p53 and p16 in the pathogenesis and progression of breast carcinomas, 98 cases of breast can- cers were examined by immunohistochemical method. The correlations of cyclin B1, cdc2, p53 and p16 expression with various clinico-pathologic findings were analysed. Results: In the normal breast tissues, cyclin B1, cdc2 and p16 were weakly expressed, while p53 was not expressed. On the other hand, cyclin B1, cdc2, p53 and p16 were overexpressed in breast cancer, showing correlation be- tween the expression of cyclin B1 and cdc2 and breast cancers (p=0.00). The over- expressions of cdc2 and p16 were correlated with an infiltrative tumor border pat - tern and this was statistically significant ( p

The goals of this study were to analyze clinical factors that affect cervical lymph node metastasis (LNM) in papillary thyroid cancer (PTC), and to evaluate the diagnostic accuracy of preoperative ultrasound (US) and computed tomography (CT) of the neck.The study sample included 589 consecutive patients who underwent surgery for PTC. Patient age and sex, number, size, and location of tumors, lymphovascular invasion, and extrathyroidal extension were evaluated as risk factors for central and lateral LNM.Increased risk of lymph node metastasis was found for male patients,45 years old, with tumor size1 cm, lymphovascular invasion, and extrathyroidal invasion. Cancers located in the upper neck had a higher relative risk of lateral metastasis than cancers located in the lower neck. Sensitivity of both US and CT imaging was higher for lateral (70-80%) than for central (42-47%) LNM. Specificity of US and CT was high (92-97%) for both central and lateral LNM. Using central lymph node size of greater than 5 mm as an indicator of metastasis, preoperative US had 58.3% sensitivity and 71.4% specificity.Preoperative US and CT imaging are useful for identifying features that indicate a high risk of LNM and for determining appropriate management of PTC.

We analyzed insulin-like growth factor receptor I (IGF-IR) and insulin growth factor binding protein-3 (IGFBP-3) expression with respect to overall survival and relapse-free survival (RFS) in 460 patients with primary invasive breast cancer using immunohistochemistry. IGF-IR expression had a significant positive correlation with positive estrogen receptor (ER), positive progesterone receptor (PR) and Bcl-2 expression. Univariate analysis showed significantly better overall survival (p=0.000) and RFS (p=0.004), in the IGF-IR-positive group. Multivariate analysis showed a significant reduction in relative risk for overall survival (p=0.019, HR=0.221, 95% CI=0.062-0.780) and RFS (p=0.026, HR=0.462, 95% CI=0.234-0.913) in the IGF-IR-positive group. IGF-IR expression in primary breast cancer is an independent favorable prognostic factor. IGFBP-3 expression in breast cancer is associated with poor outcome.

Background: The excision of breast lesions using an ultrasound-guided vacuumassisted biopsy device (VABD) is a widely used technique for the diagnosis and treatment of breast disease, but the results of long-term follow-up after VABD excision of benign breast tumours have not been reported. The purpose of this study was to evaluate the results of long-term follow-up after complete excision of benign breast tumours using an ultrasound-guided VABD. Methods: This is a retrospective clinical study. Between January 2001 and December 2004, patients who had undergone VABD excision of benign breast tumours and been followed up by clinical examination and ultrasonography for 2 years or more were included. Results: One hundred eighty-four cases representing 153 patients were studied. The median follow-up period was 33 months (range, 24–67 months). All lesions were histologically benign. The mean size of the lesions was 1.09 0.57 cm (range, 0.3–3.03 cm). Within 2 years after VABD excision, residual lesions were detected in 10% of patients sonographically, but after 2 years or more, residual masses were found in 6.5% of patients. Scar changes also decreased from 36.0% to 15.8% during the period of follow-up. Finally, the benign breast tumours were completely excised without residual masses in 93.5% of the participant patients. Residual masses developed in two fibroadenoma cases (1.08%); one was re-excised and the other was followed serially. Conclusion: Ultrasound-guided VABD excision is a minimally invasive technique for the complete removal of benign breast tumours. The results of this long-term follow-up of VABD excisions are comparable to conventional methods.

The aim of this study was to evaluate the difference in outcomes based on p53 overexpression of patients with breast cancer who received adjuvant therapy following local treatment for invasive ductal carcinoma, not otherwise specified. We analyzed data from 4,683 patients with cancer enrolled in two institutions between 1997 and 2006. We analyzed the correlation between p53 overexpression and relapse, response to adjuvant therapy, breast cancer-specific survival (BCSS), and relapse-free survival (RFS) in patients with primary breast cancer. Overexpression of p53 was noted in 1,091 patients (23.3%). A significant correlation existed between p53 overexpression and poor prognostic factors, an increased frequency of regional recurrence, visceral metastasis, and worse BCSS and RFS. Based upon subgroup analyses, combined age (35, 35-50, and50 years) and adjuvant therapy (hormone therapy only, chemotherapy only, and hormone therapy following chemotherapy), the greatest reduction of survival based on p53 overexpression was noted in patients 35-50 years of age who received hormone therapy following chemotherapy (P0.05). Multivariate analysis showed that p53 overexpression is an independent prognostic factor in patients treated with hormone therapy and chemotherapy (relative risk for BCSS, 2.003; 95% CI, 1.105-3.631; P = 0.022). The p53-overexpressing patients with breast cancer between 35 and 50 years of age who received tamoxifen following chemotherapy had the greatest adverse effect on outcome. Overexpression of p53 is significantly associated with tamoxifen resistance in premenopausal women with breast cancer.

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.

Breast-conserving surgery is now accepted as one of the standard therapeutic options for stages I and II breast cancers. Although breast-conserving surgery can help retain a good breast shape, a long marked scar would be a disadvantage. Endoscopic surgery can be performed via a small and remote incision that becomes inconspicuous after surgery. To improve the cosmetic outcome, endoscopic breast-conserving surgery, which can be performed through minimal axillary and periareolar semicircular incisions, was undertaken. From October 2002 to October 2004, 20 breast cancer patients whose tumor sizes were less than 3 cm and who were clinically node negative without invasion to the skin and pectoralis major muscle underwent endoscopic breast-conserving surgery. First, endoscopic dye-guided sentinel node biopsy was done through a low transverse axillary incision lateral to the pectoralis major muscle. The subpectoral pocket was gently created by Vein Harvest under the view of endoscopic monitor. We made the periareolar semicircular incision to create the skin flap and to resect the tumor-containing quadrant by using Visiport and PowerStar scissors. Frozen-section biopsies were done to rule out tumor invasion to the resection margin. Patient characteristics, tumor characteristics, operation time, and amount of bleedings were all evaluated. The mean age of patients was 45 (range: 25–64). The mean tumor size was 2.2 cm (range: 0.2–4.0 cm). The average operation time of the early 9 cases, except the 3 cases that underwent axillary-node dissection, was 178 minutes, and that of the later 8 cases was 130 minutes (P < 0.001). The mean amount of operative bleeding was 184 ± 130 ml. There were no major complications. Endoscopic breast-conserving surgery is a new technique that can minimize the long operation scar of classic breast-conserving surgery. In properly selected cases, our results showed the maximized cosmetic satisfaction of the breast cancer patients and a shortened operation time after the learning period, promising it could be an alternative to the classic breast-conserving surgery.

Schwannoma is a slow-growing tumor that frequently occurs in the extremities, the trunk and the head region. Its occurrence in the breast is rare with only a few cases being reported. We present here the case of breast schwannoma in a 41-year-old woman who presented with a palpable mass in her right breast. This is the first report of breast schwannoma that showed massive exophytic growth with invasion of the skin, and it was initially presumed to be a breast cancer on preoperative mammography, ultrasonography and breast MRI examinations. Complete excision of the mass was done and pathology revealed a plexiform schwannoma.

Leptin plays an important role in the regulation of body fat homeostasis, and potential associations of leptin receptor gene (LEPR) polymorphisms with obesity have been suggested. Obesity is considered to relate to breast cancer. We assessed the role of leptin in relation to breast cancer. We measured the serum leptin concentrations of 45 Korean pre-treatment patients with breast cancer and 45 age-matched controls. By direct sequencing, we investigated four leptin receptor gene (LEPR) polymorphisms at codons 109, 223, 656, and 1019. There was no significant difference between the mean leptin concentrations of the patient and control groups in both pre- and post-menopausal women. The frequencies of the wild-type for LEPR codons 109, 223, and 1019 were very low. No increased risk estimate was found for the four LEPR polymorphisms. Our results indicate that it is difficult to explain breast cancer on the basis of serum leptin concentrations or polymorphisms in the LEPR gene.

Neck surgery is one of the newest fields of endoscopic surgical application. One hundred patients underwent endoscopic thyroidectomy. We used 3 incisions: 1 on both upper circumareolar areas and 1 approximately 3 cm below the clavicle on the tumor side. Subplatysmal and subcutaneous operative space was created with CO2 insufflation at 6 mm Hg of pressure. The thyroidal vessels and the parenchyma of the gland were dissected and divided with ultrasonic scalpel and commonly used laparoscopic instruments. The mean (+/-SD) operation time was 136 +/- 10 minutes before the year 2000 and 67 +/- 9 in the year 2000 (P < 0.05). There were six cases of conversion to conventional thyroidectomy. Postoperative complications occurred in five cases. There was no subcutaneous emphysema. The patients were satisfied with the cosmetic result. On the basis of our experience with these 100 patients, we believe that endoscopic thyroidectomy is feasible and safe for resection of thyroid tumors. Thus, this procedure will provide another surgical technique for treatment of thyroid tumors, with maximized cosmetic effect.(2)

Purpose Nipple sparing mastectomy provides good cosmetic results and low local recurrence rates for breast cancer patients. However, there is a potential risk of leaving an occult tumor within the nipple, which could lead to cancer relapse and poor prognosis for the patient. The objective of this study was to investigate the occult nipple involvement rate in mastectomy specimens, and to identify preoperative magnetic resonance imaging (MRI) findings and the clinicopathological characteristics of the primary tumor that may correlate with nipple invasion. Methods Four hundred sixty-six consecutive mastectomy samples with grossly unremarkable nipples were evaluated. Demographic and clinicopathological data were collected. Nipple involvement was evaluated using serial histological sections. The tumor size and tumor-nipple distance were measured using preoperative MRI images. Results Thirty-six of the 466 therapeutic mastectomy specimens (7.7%) were found to have occult nipple involvement. In univariate analysis, tumor size, tumor-nipple distance, lymph node status, p53 mutation, and lymphovascular invasion (LVI) were found to influence the likelihood of nipple involvement. Multivariate logistic regression analysis, adjusted by lymph node status, p53 mutation, and LVI, showed that tumor size and tumor-nipple distance were predictive factors indicating nipple involvement. With regard to tumor location, only tumors in the central area of the breast showed a significant association with nipple involvement. Conclusion In this study, a statistically significant association was found between occult nipple involvement and tumor size, tumor-nipple distance, axillary lymph node status, LVI, and p53 mutation. A cutoff point of 2.2 cm for tumor size and 2 cm for tumor-nipple distance could be used as parameters to predict occult nipple involvement.