악성흑색종에서 감시림프절 생검술의 유용성 연구

허성모(Sung Mo Hur),김성훈(Sung Hoon Kim),이세경(Se Kyung Lee),김완욱(Wan Wook Kim),최재혁(Jae Hyuck Choi),김상민(Sangmin Kim),임소영(So Young Lim),변재경(Jai Kyung Pyon),문구현(Goo Hyun Mun),최준호(Jun-Ho Choe),이정언(Jeong Eon Lee) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.3

Purpose: The aim of this study was to evaluate the usefulness of sentinel lymph node (SLN) biopsy in the treatment of primary melanoma. Methods: Fifty-one cases that were diagnosed as malignant melanoma of the skin without clinical evidence of regional lymph node metastasis and underwent SLN biopsy at Samsung Medical Center were analyzed retrospectively. A lymphoscintigraphy with peritumoral injection of radionuclide was performed preoperatively. SLNs were identified using a hand-held gamma probe and by methylene blue dye injection intraoperatively. Results: Twenty patients (39%) had metastasis in the SLN and they underwent immediate complete radical dissection of the nodal basin. Among the 20 patients who had SLN metastasis, additional metastatic lymph nodes were detected in 5 patients after the complete lymph node dissection. When several clinico-pathologic parameters such as gender, age, primary tumor location, draining nodal basin, tumor depth and size of tumor were compared between SLN positive group and negative group, there was a significant difference in the mean thickness of melanoma between SLN (+) group (5±2.9 ㎜) and SLN (?) group (4.5±5.0 ㎜) (P<0.05). In the same way, as the thickness of melanoma increased, positive SLN were detected more frequently (P<0.05). Recurrences occurred in 18 patients (35.3%) during the follow-up period, but only one case in 31 patients with negative SLN recurred at the SLN basin without evidence of distant or loco-regional recurrence (false negative rate 4.8%). Lymphedema of extremity developed in 9 patients who underwent complete radical lymph node dissection and 2 patients who underwent only SLN biopsy had a very mild-form lymphedema. Conclusion: SLN biopsy in the treatment of cutaneous melanoma is a safe, useful and feasible method to identify status of regional lymph node with low false negative rates and low complications.

한국인에서 다발성 내분비선종 증후군의 초기 증상 및 임상 양상

김기호,구민영,허성모,이세경,최준호,이정언,김지수,정재훈<SUP>1<.SUP>,남석진,양정현,김정한,Ki-Ho Kim,M.D.,Min-Young Koo,M.D.,Sung-Mo Hur,M.D.,Se-Kyung Lee,M.D.,Jun-Ho Choe,M.D.,Jeong Eon Lee,M.D.,Jee Soo Kim,M.D.,Jae-Hoon Chung,M.D.<SU 대한갑상선-내분비외과학회 2010 The Koreran journal of Endocrine Surgery Vol.10 No.4

Purpose: Multiple endocrine neoplasia (MEN) syndrome is an inherited, autosomal dominant disease that presents as a combination of several endocrine tumors. Early diagnosis of this syndrome is difficult, because of the nonspecific symptoms and signs. This study analyzed early manifestations and clinical characteristics in patients with MEN syndrome. Methods: Medical records were retrospectively reviewed and telephone interviews were conducted with 35 patients diagnosed as MEN syndrome at Samsung Medical Center from December 1994 to December 2009. Results: The 35 patients had been diagnosed as MEN1 (n=14), MEN2A (n=19) and MEN2B (n=2). The early manifestations of the 14 MEN1 patients were related with hyperparathyroidism (n=5), pituitary tumor (n=3), and pancreatic endocrine tumor (n=2). There were tumors of the parathyroid gland in all 14 patients, anterior pituitary in eight patients, and pancreatic islet cells in seven patients. Four cases were incidentally detected during the screening examination. Six cases harbored a MEN1 gene mutation. The twenty-one patients diagnosed with MEN2 comprised medullary thyroid cancer (n=20), adrenal pheochromocytoma (n=15), and hyperparathyroidism (n=4). The MTC-related symptoms in the 21 MEN2 patients included neck mass or discomfort in 12 patients and pheochromocytoma-related symptoms in seven patients. Two cases were detected through familial genetic screening test. The RET gene mutationwas detected in 19 cases. Conclusion: Early manifestations of MEN syndrome were very different between the types of MEN and the types of its presenting tumor. The early diagnosis and proper management of MEN requires awareness of the clinical characteristics of each expressed tumor and is influenced by genetic screening methods. (Korean J Endocrine Surg 2010; 10:266-275)

하시모토 갑상선염 유무에 따른 갑상선 유두암의 임상병리학적 분석

강동현,한선욱,허성모,우희두,김성용,Dong Hyun Kang,Sun Wook Han,Sung Mo Hur,Hee Doo Woo,Sung Yong Kim 대한갑상선-내분비외과학회 2013 The Koreran journal of Endocrine Surgery Vol.13 No.4

Purpose: The causal association between Hashimoto’s thyroiditis (HT) and papillary thyroid cancer (PTC) remains controversial. This research attempted to analyze clinicopathological relationships between HT and PTC, and to determine what influence the former has on the latter. Methods: We retrospectively reviewed 773 patients who underwent thyroid surgery with PTC. These patients were divided into two groups, coexistent HT group and PTC alone group, and the clinicopathologic data were analyzed. Results: Out of 773 patients, the coexistent HT group included 269/773 (34.8%) patients and the control group included 504/773 (65.2%) patients. In comparison of these two groups, there were no significant differences in age, extent of surgery, serum T3, Free T4, number of tumors, multifocality, tumor size, extrathyroidal extension, and lymph node metastasis. In sex, women were at the higher rate in coexistent HT group than in the control group (P=0.008). Serum TSH level was higher in the coexistent HT group (P<0.001). In addition, using the AMES scoring system, the coexistent HT group showed a significantly higher rate of low risk than the control group (P=0.048). Multivariate analysis showed no significant association between HT and lymph node metastasis (P=0.081, odds ratio= 1.335; 95% CI, 0.965∼1.847). Conclusion: The rate of women and serum TSH level were higher in the coexistent HT group. In addition, the low-risk group showed the higher rate in the case of accompanying HT, and though the HT does not affect the lymph node metastasis but much more researches would be needed on that.

갑상선 여포암의 예후인자 및 치료

김완욱(Wan Wook Kim),허성모(Sung Mo Hur),김성훈(Sung Hoon Kim),이세경(Se Kyung Lee),김상민(Sangmin Kim),오영륜(Young Lyun Oh),최준호(Jun-Ho Choe),이정언(Jeong Eon Lee),김정한(Jung-Han Kim),남석진(Seok Jin Nam),양정현(Jung-Hyun Yang) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.78 No.3

Purpose: Follicular thyroid carcinoma (FTC) and papillary thyroid carcinoma (PTC) are two main subtypes of well-differentiated thyroid cancer. Sometimes FTCs present more aggressive features such as vascular invasion. The object of this study was to investigate the clinicopathologic features, prognostic factors and treatment outcome of FTC. Methods: This retrospective study enrolled 91 patients diagnosed with FTC between November 1994 and October 2008. The clinicopathologic characteristics, treatment outcome and follow up data were analyzed. Results: The median follow-up (f/u) period was 76.1 months. Distant metastases at the time of diagnosis were detected in 12 patients. During the f/u period, one local recurrence and 4 distant metastases developed. Local recurrence or distant metastasis were noticed in 12 out of 19 patients with widely invasive type and 5 out of 36 patients with minimally invasive type with vascular invasion were also noted. The median times to local recurrence or distant metastasis were 59.0 and 34.2 months, respectively. On analysis, according to the clinocopathologic factors, presence of vascular invasion, extrathyroidal extension, invasion to structure, incomplete excision and pathological classification were independent prognostic factors for recurrence or distant metastasis. Disease specific mortality was seen in one patient. Conclusion: This study shows that aggressive treatments such as total thyroidectomy followed by radioiodine therapy and close follow-up of patients with minimally invasive type with vascular invasion and widely invasive type of FTC should be considered due to the chance of local recurrence and distant metastasis.

유방암 환자의 수술 전 액와림프절 전이 여부 평가를 위한 영상의학적 검사의 효용성

김경덕(Kyeong Deok Kim),인정진(Jeong Jin In),장윤희(Yun Hee Jang),김지선(Zisun Kim),국중철(Jung Cheol Kuk),최규성(Kyu Sung Choi),정재홍(Jaehong Jeong),허성모(Sung Mo Hur),정귀애(Gui Ae Jeong),정준철(Jun Chul Chung),조규석(Gyu Seok Ch 대한종양외과학회 2015 Korean Journal of Clinical Oncology Vol.11 No.2

Purpose: The purpose of this retrospective study was to identify the diagnostic performance of positron emission tomography/computed tomography (PET/CT) compared to conventional modalities, such as ultrasonography (US) and contrast-enhanced computed tomography (CT) in detecting axillary lymph node metastasis (ALNM) in patients with breast cancer. Methods: Two hundred thirty-three consecutive patients diagnosed with primary breast cancer who had not been treated with neoadjuvant chemotherapy and had been examined by US, CT, and PET/CT before surgery were included. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each imaging modality and combinations of modality according to tumor size were obtained, and were compared with the histopathological results of sentinel lymph node biopsy or axillary lymph node dissection. Results: ALNM was confirmed in 32.6% (76/233) of patients. The sensitivity, specificity, PPV, NPV, and accuracy of US for detecting ALNM were 65.8%, 86.6%, 70.4%, 84.0%, and 79.8%, respectively. The sensitivity, specificity, PPV, NPV, and accuracy of CT were 72.4%, 72.6%, 56.1%, 84.4%, and 72.5%, respectively. The sensitivity, specificity, PPV, NPV, and accuracy of PET/CT were 69.7%, 86.0%, 70.7%, 85.4%, and 80.7%, respectively. The combination of US and PET/CT showed the most accurate results with specificity, PPV and accuracy values of 93.6%, 81.5%, and 82.0%, respectively. Conclusion: The diagnostic performance of PET/CT was comparable to that of US and CT. Combination of US and PET/CT could be a reliable strategy for determining preoperative ALNM in patients with operable breast cancer.