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잠재성 유두상 갑상선암에서 원발종양의 크기에 따른 공격성 정도 분석
박해린(Hai-Lin Park),곽진영(Jin Young Kwak),강석선(Seok Seon Kang),김도연(Do Youn Kim),강형곤(Hyung Gon Kang),심정연(Jung Yeon Shim),김유리(Yoori Kim),박원근(Won Kun Park),최영길(Young Gil Choi) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.73 No.6
Purpose: Occult papillary thyroid carcinomas (OPC) are defined as tumors measuring <15 ㎜. These tumors are believed to be a less aggressive subset of papillary cancers. They generally behave more like benign lesions and are often more conservatively treated. However, it is unclear if a cancer 1.0 to 1.5 ㎝ in diameter will have a similar favorable clinical behavior as tumors <1.0 ㎝ (micropapillary thyroid carcinoma). Therefore, a retrospective chart review study of patients with OPC in order was carried out in order to answer this question and characterize the biology and optimal treatment for OPCs. Methods: From October 2001 to January 2007, Among the impalpable thyroid nodules detected incidentally during screening examinations, 260 patients underwent surgery for occult papillary thyroid cancer (OPC) at Kangnam Cha University hospital. The data from these patients was analyzed retrospectively. The mean follow up period was 25.6 ± 14.5 (max:63, min:1) months. Results: The mean age of these patients was 42.8 years, and 233 (89.5%) were female. 46.2% of patients underwent a total or neartotal thyroidectomy, and 54.6% underwent a central lymph node dissection. Of the 260 patients, 55 (21.2%) had lymph node metastases. The OPC presented with signs of aggressiveness including multifocality (34.2%), bilaterality (17.7%), capsular invasion (52.7%), and lymph node metastases (21.2%). A progressively increasing frequency of the signs of tumor aggressiveness was observed with increasing tumor size at presentation. LN metastases were associated with the tumor size (P=0.0063), extracapsular invasion (P=0.0015) and multfocallity (P=0.0020). However, there was no association with age and gender. With a follow-up of up to 63 months, 3 patients had a local recurrence (0.014%). No patients currently have active disease and no patients with OPC died during this period. Conclusion: In OPC patients, there is a progressively increasing frequency of the signs of tumor aggressiveness with increasing tumor size. Moreover, a small size itself cannot guarantee low risk and low recurrence rate. The prevalence of LN metastases and extracapsular invasion were higher in those with a tumor size >0.5 ㎝. A near-total or total thyroidectomy with a central lymph node dissection is the preferred treatment. The early detection and treatment of OPC might be warranted through the routine use of thyroid USG and USG-guided FNA.
선별검사 후 수술로 확진된 무증상의 잠재성 유두상 갑상선암 214예에 대한 분석
박해린(Hai-Lin Park),곽진영(Jin Young Kwak),유필문(Pil Mun Yu),조윤덕(Yun Duk Cho) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.72 No.3
Purpose: Occult papillary thyroid carcinomas (OPC) are defined as tumors measuring ≤15 ㎜ in size. They are believed to be a less aggressive subset of papillary cancers, which behave more like benign lesions, and are often treated more conservatively. However, some groups have reported a high incidence of metastases from papillary microcarcinomas and favor an aggressive surgical resection followed by radioiodine therapy. We review our experience in an attempt to characterize the biology and optimal treatment for OPCs. Methods: From October 2001 to March 2006, among impalpable thyroid nodules detected incidentally during screening exams, 214 patients underwent surgery for occult papillary thyroid cancer (OPC) at Kangnam Cha University hospital. The data from these patients were analyzed retrospectively. The mean follow up period was 19.9±11.7 (max:53, min:1) months. Results: The mean age of these patients was 41.4 year, and 188 (87.7%) were female. 41% of the patients underwent a total or neartotal thyroidectomy, 42% had a central lymph node dissection and 41% had radioiodine ablation therapy after surgery. Of the 214 patients, 40 (18.7%) had lymph node metastases. The LN metastases were associated with the tumor size (P=0.0007), extracapsular invasion (P=0.0268) and multifocality (P=0.0024), but there was no association with age and gender. The incidence of the LN metastases (20%) and extracapsular invasion (59.1%) were higher in the tumors between 0.5∼1.0 ㎝ in size. With a follow-up up to 53 months, 3 patients had a local recurrence (0.014%) but no patients currently has active disease. No patients with OPC died died during this period. Conclusion: In OPC patients, a progressively increasing frequency of signs of tumor aggressiveness with increasing tumor size was observed but a small size itself could not guarantee a low risk or low recurrence rate. The prevalence of LN metastases and extracapsular invasion were higher in tumors >0.5 ㎝ in size. Therefore, we prefer near-total or total thyroidectomy with central lymph node dissection. Early detection and treatment of OPC might be warranted by the routine use of thyroid USG and USG-guided FNA.
마늘 성분인 diallyl disulfide의 유방암 세포주(MCF-7)에 대한 세포사멸 유도기전에 관한 연구
박해린(Hai-Lin Park),서정민(Jung-Min Suh),박경숙(Kyungsook Park),장항석(Hang-Seok Chang),남석진(Seok-Jin Nam),배정원(Jungp-Won Bae),이경포(Kyung-Po Lee),양정현(Jung-Hyun Yang),구범환(Bum-Hwan Koo) 대한외과학회 2001 Annals of Surgical Treatment and Research(ASRT) Vol.61 No.2
맘모톰 시술에 의해 진단된 양성 엽상낭 종양은 반드시 재수술이 필요한가?
박해린(Hai-Lin Park),강석선(Seok Seon Kang),김도연(Do Youn Kim),심정연(Jung Yeon Shim) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.73 No.3
Purpose: Phyllodes tumors are characterized by a double-layered epithelial component arranged in cleft-like ducts surrounded by a hypercellular spindle-celled stroma. Currently, phyllodes tumors are classified as benign, borderline, or malignant based on microscopic features. The relatively high rate of recurrence is an unsolved management problem. If a malignant phllodes tumor is treated inadequately, it may show a propensity for rapid growth and metastatic spread. However, benign phyllodes tumor are often indistinguishable from fibroadenoma, and can be cured by local surgery. Percutaneous removal of benign breast tumors using the Mammotome system has recently been regarded as a feasible, safe method without serious complications. The Mammotome system has an expanding role in the surgical treatment of benign breast disease, and may further extend its role to the excision of small malignant lesions. The aim of this study was to evaluate the efficacy and the safety of the Mammotome biopsy device in the treatment of benign phyllodes tumor, and to identify whether surgical excision is necessary for benign phyllodes tumors diagnosed and excised by Mammotome. Methods: From Jan. 2003 to Feb. 2007, a total of 2,751 US- guided mammotome excisions were performed in 2,226 patients at Kangnam Cha hospital. Out of 2,751 lesions, 30 lesions were proved to be benign phyllodes tumors. All lesions were removed using an 8-gauge probe without any residual lesions. Ultrasonographic follow-up was performed at a 3- to 6-month interval to assess recurrence. The mean follow-up period was 33.2 months (max, 51 months; min, 2 months). Results: The mean patient age was 31.4 years. The average size of the lesion was 1.5 ㎝ (SD+0.43 ㎝). The majority of lesions, 73.3% (22 cases), were palpable, and 26.7% (8 cases) were nonpalpable. Twenty-two lesions (73.8%) were classified as BIRADS category 3, eight lesions (26.7%) were classified as category 4A by ultrasound. During the follow-up period, local recurrence developed in only one patient, making the local recurrence rate 3.3%. No distant metastasis was observed. Conclusion: Benign phyllodes tumors found on mammotome excision may not require surgical reexcision if surgeons are sure that the targeted lesions were excised completely and the follow-up ultrasound does not show any residual lesions, especially in small phyllodes tumors, the greatest dimension of which is less than 3 ㎝.