초음파 검사에 의한 태아체중 예측방법에 관한 연구

김구상,강병문 최신의학사 1989 最新醫學 Vol.32 No.5

암진료의 양극화

김구상 대한의사협회 2017 대한의사협회지 Vol.60 No.3

유방암

김구상 대한종양외과학회 2011 KSCO News&Education Vol.9 No.-

‘한국인 유전성유방암의 진료현황’에 대한 설문조사결과

김구상,김성원,이민혁,안세현,박수경 한국유방암학회 2008 Journal of breast cancer Vol.11 No.2

Purpose: The aim of this study is to examine surgeons’ practice patterns for management of hereditary breast cancer in Korea. Methods: The structured questionnaire was circulated to the members of Korean Breast Cancer Society through e-mail between July 6 and August 14 in 2007 and 43 surgeons from 42 hospitals responded in the survey. Results: An 81.4% of respondents (n=35) has been asking the information related to family histories of cancer and a 58.1% of respondents (n=25) has been recommending genetic testing to their patients. The indications for genetic testing of 25 surgeons who have been recommending genetic testing were as follows: breast cancer patients with family histories of breast or ovarian cancer (96%); bilateral breast cancer (80%); early-onset (64%) or male breast cancer (52%); and double primary with breast and ovarian cancer (36%). A 52% of respondents (13/25) have been doing genetic counseling before genetic testing and the genetic counseling was given by the surgeons (81.3%, 13/16) or genetic counselors (18.7%, 3/16). Although 154 BRCA1/2 mutation carriers of 95 families were identified so far, only 12 family members were managed for prophylaxis: tamoxifen chemoprevention (n=2); contralateral prophylactic mastectomy (n=2); prophylactic oophorectomy (n=8). There was no report of bilateral prophylactic mastectomy. Conclusion: Although BRCA1/2 mutation carriers for high risk patients with hereditary breast cancer have been identifying in Korea, the practices and managements for cancer prevention seems not to perform actively. The Korean Hereditary Breast Cancer (KOHBRA) Study will serve in establishing the Korean guidelines of evidence-based clinical practice for Hereditary Breast Cancer.

Thalidomide Associated Gynecomastia in a Patient with Malignant Histiocytosis: A Case Report

김구상,박지민,김태희,박준성,임현이,신현주,김지영,강두경,강석윤,정용식 한국유방암학회 2013 Journal of Breast Disease Vol.1 No.1

Thalidomide has become a novel agent in the treatment of multiple myeloma and many other hematological and solid malignancies. Thalidomide has various adverse effects including neurologic, hematologic, cardiovascular, gastrointestinal, and endocrinologic toxicities. However, with strict regulations for use, there have been few case reports of thalidomide toxicity. A 42-year-old man presented with both breast engorgement and tenderness for 1 year. Six years ago, he had been diagnosed malignant histiocytosis at left palpable axillary mass lesion. He was treated with chemotherapy according to Langerhans cell histiocytosis. But, 6 months later, the response of chemotherapy was refractory and then, he has been received thalidomide salvage therapy (25-100 mg/day) for 5 years. Mammography and ultrasonography revealed a bilateral heterogeneous mixed echoic lesion suggesting a fibroglandular tissue under the nipple and subcutaneous layer. We have treated him with bromocriptine. With a follow-up of 15 months, gynecomastia and breast discomforts were improved.

랑거 액와궁 (액와흉근) – 증례보고

김구상,한상아,김새리,임재영,김선미,장미정,한원식,노동영,김성원 한국유방암학회 2008 Journal of breast cancer Vol.11 No.2

The axillary arch of Langer (Axillopectoral muscle) is the most common anatomical variant of the axillary musculature. The incidence of the variant is about 7% or less in the population and despite the reported frequency, its presence has been rarely reported. A 33-year-old woman visited our institution due to the presence of a right breast mass and was diagnosed with right breast cancer by an ultrasound guided core biopsy. Previously, the patient had had no complaints of sensory and motor dysfunction of the right arm. The patient underwent a modified radical mastectomy and we identified an abnormal muscle that originated from the latissimus dorsi, and was inserted in the trilaminar tendon of the pectoralis major during axillary lymph node dissection. The muscle interfered the level I area due to its longitudinally oblique direction. We separated this muscle, and carefully dissected the medial axillary group and lateral axillary group. After follow-up for two years, there was no evidence of axillary recurrence, lymphedema or any limitation of motion of the right arm. We discuss the definition, clinical complications and clinical importance of the axillary arch of Langer. We report here the first case of axillary arch of Langer that was identified during surgery in Korea.

산부인과영역에 있어서 접촉형 자궁내시경(Contact Hiysteroscopy)의 임상적 이용에 관한 연구

김구상,이효표 대한산부인과학회 1984 대한산부인과학회 학술대회 Vol.54 No.-

Usefulness of Fine-Needle Aspiration Biopsy before Performing Ultrasound-Guided Vacuum-Assisted Excision

김구상,김라미,임현이,강두경,김태희,신현주,김지영,정용식 한국유방암학회 2013 Journal of Breast Disease Vol.1 No.1

Purpose: Ultrasound-guided vacuum-assisted excision (US-VAE) is considered the less invasive method for the histological assessment of breast lesions than surgical excision and also used for removing benign lesions. Some benign lesions require further excision after removing them by US-VAE, because pathologic diagnosis with specimen obtained by US-VAE cannot be confirmative. However, a well-targeted fine-needle aspiration biopsy (FNAB) before US-VAE can provide preoperative diagnosis. The aim of this study is to evaluate the accuracy and safety of FNAB to minimize further excision after performing US-VAE. Methods: From June 2007 to December 2009, US-VAE was performed on 321 patients with benign breast lesions which diagnosed by FNAB. Clinicopathological data, medical records and imaging studies were reviewed. We estimated the further excision rate after carrying out US-VAE and evaluated effectiveness of FNAB for pathologic diagnosis of breast lesions before performing US-VAE. Results: Of 321 lesions, 118 (27.1%) were diagnosed as specific benign, 201 patients (57.9%) as other nonspecific benign or negative malignant cell, 2 (0.6%) as atypical ductal hyperplasia (ADH) at FNAB. The pathologic diagnoses after US-VAE were usually specific benign diseases; fibroadenoma (190 cases, 59.2%), fibrocystic change (51 cases, 15.9%), other benign (68 cases, 21.2%). As indeterminate lesions, ADH (5 cases, 1.6%), borderline phyllodes tumor (4 cases, 1.2%) were diagnosed. Of 321, only three patients (0.9%) were underwent further excision for malignancy. They were diagnosed as malignant after taking US-VAE, two lobular carcinoma in situ and one invasive ductal carcinoma. Conclusion: US-VAE is relatively accurate and effective for removing benign lesion of breast. To reduce the further excision rate, the cytological and pathological confirmation using FNAB should be performed precisely before performing the US-VAE.

[Symposium] Challenges in HER-2 positive breast cancer

김구상 대한외과학회 2011 대한외과학회 학술대회 초록집 Vol.2011 No.11

‘유방수술에 있어서 외과용 메시 사용현황’ 에대한 국내 설문조사 결과

김구상,박만영,김우재,나국영,정용식,최영진,박용래,오세정,신혁재,한국유방암학회 한국유방암학회 2009 Journal of breast cancer Vol.12 No.3

The aim of this study is to investigate the use of absorbable mesh in breast surgery in Korea. We conducted a survey from members of Korea Breast Cancer Society by phone, E-mail, and notice on the website from 6th to 20th April 2009. A total of 54 breast surgeons had responded to the survey. Of these, 40 surgeons (74.1%) had used absorbable mesh during breast surgery, with Vicryl mesh being the choice of every surgeon and Interceed having been used by 36 (90%) of the surgeons. In responding to the indications for mesh use, 26 surgeons (65%) indicated that mesh use was effective when a deformity was expected regardless of T stage. Contraindications for mesh use principally included existing patients’ comorbidity such as a wound healing problem, diabetes mellitus and immunocompromised condition. Thirty one surgeons (77.5%) had experienced an infection in the mesh insertion site. However, on a case basis, only 39 of 843 cases (4.6%) had resulted in an infection. In the follow up after mesh use, 33 of the 37 responding surgeons (89.2%) used breast ultrasonography. Nineteen of the 38 respondents (50%) replied that the mesh was absorbed in 6 months and it did not confuse diagnostic imaging. The cited merits of mesh included maintenance of breast shape following surgery (n=38/49, 77.6%) and ease of surgical use (n=35/49, 71.4%). However, the high price of mesh was cited as a disadvantage by 33 of the 48 respondents (68.8%). In summary, survey results mentioned above show that surgical mesh use in breast surgery is increasing by times and the procedures greatly varies by surgeons. Thereby, we suggest that a guideline for mesh use should be made in the near future.