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유방 관상피내암에 있어서 병변의 범위와 예후 결정을 위한 수술 전 자기공명영상의 역할
정유승,이연수,제수경,송병주,김정수,전해명,정상설,박우찬 한국유방암학회 2009 Journal of breast cancer Vol.12 No.2
Purpose: Magnetic Resonance Imaging (MRI) is widely used for the preoperative staging of breast cancer. In this study, we investigated a role of preoperative breast MRI for detecting the extent of disease and predicting the prognosis of ductal carcinoma in situ (DCIS). Methods: From January 2002 to April 2008, preoperative MRI was performed for evaluating the extent of disease in 26 patients with DCIS. The MRI findings, the modified Van Nuys scores and the clinicopathological results were reviewed. The accuracy of breast MRI was analyzed with respect to the detection of tumor multiplicity and disease extending into the nipple, and this was compared with that of mammography. Results: For detecting multiple lesions, the sensitivity and specificity of breast MRI were 25.0% and 86.4%, respectively, and the results of mammography were 0.0% and 86.4%, respectively. The accuracy of breast MRI was 76.9% and that of mammography was 73.1%. For detecting tumor extension into the nipple, the sensitivity and specificity of breast MRI was 100.0% and 80.0%, respectively, and that for mammography was 0.0% and 92.0%. respectively. The accuracy of MRI was 80.8% and that for mammography was 88.5%. The MRI final assessment was not associated with the modified Van Nuys score (p=0.474). Conclusion: For detecting the disease extent of DCIS, preoperative breast MRI is not superior to mammography due to the low specificity and accuracy of MRI. MRI did not show a definite ability to predict the prognosis of DCIS in this study.
Level V Lymph Node Dissection in PTMC Patients: Is This Necessary?
정유승,오은미,이영돈 대한갑상선-내분비외과학회 2012 The Koreran journal of Endocrine Surgery Vol.12 No.3
Purpose: Cervical lymphadenectomy is frequently performed in papillary thyroid carcinoma (PTC) patients with lateral node metastasis to improve regional control, but the cervical levels that require dissection remain controversial. We conducted this study to investigate the necessity of the routine dissection of level V in papillary thyroid microcarcinoma (PTMC). Methods: To identify the relation between PTMC and level V metastases, we analyzed 90 patients who underwent lateral neck dissection (ND). Twenty-five patients underwent lateral ND when metastasis was detected during follow-up, whereas the other 65 patients underwent total thyroidectomy with central and lateral ND at initial surgery. Results: There were 18 PTMC patients and 72 patients with a PTC of >1 cm. Metastasis at level III or IV was detected in 80.0% and 78.9%, respectively, whereas metastasis at level V was only detected in 12.2%, and metastasis at level II occurred in 30%. In PTMC patients, metastatic rates at levels II, III, IV, and V were 11.1%, 61.1%, 61.1%, and 5.6%, respectively, and in patients with a PTC of >1 cm, metastatic rates at levels II, III, IV, and V were 34.7%, 84.7%, 83.3% and 13.9%, respectively. PTMC was not found to be significantly associated with level V metastasis (P=0.452). Conclusion: The level V metastatic rate in PTMC was no different from that of PTC>1 cm statistically. However, the metastatic rate was only 5.6% in PTMC. Therefore, we recommend that care be taken when deciding whether to perform level V dissection when dissecting the lateral cervical nodes in PTMC.
수술이 불가능한 전이성 또는 국소 진행성 위암 환자에서 선행화학요법의 효과
정유승,박도중,이혁준,김세형,한준구,김태유,방영주,허대석,김노경,김우호,양한광,이건욱,최국진,Chung Yoo-Seung,Park Do Joong,Lee Hyuk-Joon,Kim Se Hyung,Han Joon Koo,Kim Tae-You,Bang Yung-Jue,Heo Dae Seog,Kim No Kyung,Kim Woo Ho,Yang Han-Kwang 대한위암학회 2004 대한위암학회지 Vol.4 No.1
Purpose: The purpose of this study was to evaluate the treatment result of surgical resection after preoperative chemotherapy in inoperable gastric cancer patients. Materials and Methods: We analyzed 18 gastric cancer patients who underwent gastric resection after preoperative chemotherapy because they showed some clinical response to chemotherapy (15 with distant metastasis and 3 with locally advanced lesions). The mean postoperative follow-up period was $15.3\pm15.5$ ($1\∼56$) months. Results: In 15 patients with distant metastasis, 2 ($13.3\%$) showed complete response (CR), 10 ($66.7\%$) partial response (PR), 2 ($13.3\%$) stable disease (SD), and 1 ($6.7\%$) progressive disease (PD). The clinical response rate was $80.0\%$ Five subtotal gastrectomies, 4 total gastrectomies, and 6 extended total gastrectomies were performed. Two cases of CR were alive without recurrence for 4 and 26 months, respectively. Mean survival period in PR case was 37.7 months, but 2 cases of SD and 1 case of PD died after 11.7, 17.9, and 0.9 months, respectively. Postoperative survival was significantly associated with the response to chemotherapy (P<0.01). The mean survival period of the 10 patients with a complete resection was 44.1 months, which was significantly better than that of the 5 patients with an incomplete resection (9.8 months, P=0.03). Among 3 patients with locally advanced gastric cancer, 2 cases showed PR to chemotherapy, and complete resection was possible only by gastrectomy for those patients. Conclusion: In some selected cases, surgical resection was achievable after preoperative chemotherapy for patients with inoperable metastatic or locally advanced gastric cancer.