한국인유전성유방/난소암고위험군에서난소암의 유병률

이지현,배영태,안세현,김성원,조영업,정성후,장명철,한세환,강은영,박보영,박수경,이희대,정준,이병길,황기태,김현아,김은규,백남선,윤찬석,한국유방암학회,이민혁 한국유방암학회 2011 Journal of breast cancer Vol.14 No.-

Purpose: Few studies have reported ovarian cancer risks in Korean patients with the BRCA1/2 mutation. We investigated the prevalence of ovarian cancer in Korean women at high risk for hereditary breast-ovarian cancer (HBOC) syndrome and reviewed the clinicopathological factors of ovarian cancer. Methods: Female subjects who were enrolled in the Korean Hereditary Breast Cancer study were included.The questionnaire included a personal and family history of cancer. The BRCA1/2 mutation and CA-125 level were tested at the time of enrollment. A transvaginal ultrasonogram (TVUS) was recommended for subjects with an elevated CA-125 level. Results: A total of 1,689 patients were included.No ovarian cancer was newly diagnosed by CA-125 level or TVUS during the enrollment. The prevalence of ovarian cancer was 1.71% in BRCA1/2 mutation carriers and 0.39% in non-carriers. Among 11 patients with ovarian cancer, five had the BRCA1 mutation and one had the BRCA2 mutation. The most common histopathological type was serous cystadenocarcinoma.No difference in clinicopathological findings between BRCA1/2 mutation carriers and non-carriers was observed. Conclusion: The prevalence of ovarian cancer was 58-fold elevated in women at high-risk for HBOC syndrome and 146-fold elevated in the BRCA1 subgroup, compared with the Korean general population. Further investigation with a long-term follow-up is required to evaluate BRCA1/2 gene penetrance.

유방암에서 뇌전이 예측인자와 생존율

이정아,배정원,우상욱,이재복,구범환 한국유방암학회 2008 Journal of breast cancer Vol.11 No.2

Purpose; The incidence of symptomatic brain metastases from breast cancerhas ranged from 10% to 16%. Brain metastases are traditionally viewed as a late complication of systemic disease, for which few effective treatment options exist. The aim of this study was to evaluate the factors that can predict brain metastases and to analyze the survival rate as compared with other systemic metastases. Methods; Between February 1983 and October 2005, 119 patient who developed systemic metastasis during the follow up period after optimal surgical treatment at Korea University Hospital were included in this study. 29 of these 119 patients had complaints of symptoms and they were consequently diagnosed as having brain metastases. Results; Estrogen receptor (-), progesterone receptor (-) and Her2 (-), and Triple negative were a significantly higher in the patients with brain metastases. (p=0.04) the other clinicopathologic factors showed no difference between the patients with brain metastases and the patients without brain metastases. Lung metastases existed previously more often than the other systemic metastases. (p=0.04) The overall survival of the patients with brain metastases was not significantly different from the patients with other systemic metastases. However, the disease specific survival of patients with brain metastases, as compared with other systemic metastases was poorer than that for patients with bone and lung metastases, respectively. (p=0.01 and 0.03) A poor prognosis was shown for the cases with brain metastases within 1 year after operation. Conclusion; Clinician should give attention to the possibility of brain metastases for the breast cancer patients with triple negative findings or the patients who have developed lung metastases as this represents a symptom of central nervous system.

국소, 구역, 그리고반대측유방암재발진단을위한 정기적 유방초음파 검사의 유용성

한원식,배동식,문형곤,문우경,조나리야,김한석,안수경,오승근,윤여규,노동영 한국유방암학회 2010 Journal of breast cancer Vol.13 No.4

Purpose: Breast ultrasonography (US) is not recommended for recurrence monitoring after breast cancer surgery due to the lack of evidence for its advantage. The purpose of this study was to evaluate the usefulness of US for detecting local recurrence (LR), regional recurrence (RR) and contralateral breast cancer (CBC) in breast cancer patients during follow-up. Methods: The medical records of 5,833 breast cancer patients who underwent breast cancer surgery between January 2003 and December 2009 were reviewed retrospectively. Physical examination (PE), mammography (MMG), and US were done routinely to detect recurrences. Detection rate for locoregional and contralateral recurrence was compared between the three modalities. Results:During the follow-up period, 125 LR, 46 RR, 83 CBC, and 29 synchronous local and regional recurrences developed in 245 patients among the study population of 5,833 breast cancer patients. Median time to recurrence was 34.7 months. The recurrence detection rate was 51.9%, 43.5%, and 90.1%for PE, MMG, and US, respectively. Mean size of the recurrent lesions detected by US (1.57 cm) was smaller than that of PE (2.69 cm) and MMG (2.03 cm) (p=0.002). Conclusion: Breast US had higher recurrence detection rate for LR, RR, and CBC than PE or MMG after breast cancer surgery.

수질성유방암의 임상병리학적 특성과 예후

오재원,박세호,김주희,구자승,허호,양우익,박병우,이경식 한국유방암학회 2009 Journal of breast cancer Vol.12 No.1

Purpose: Medullary carcinoma of the breast is a variant of breast cancer characterized by the histologic appearance of poorly differentiated cells surrounded by a prominent lymphoid stroma. Medullary carcinoma has been reported to carry a prognosis better than other invasive breast carcinomas, but it is frequently overdiagnosed due to the difficulty in diagnosis. The aim of this study was to assess the clinical manifestations and outcome of medullary carcinoma of the breast. Methods: We reviewed the data of 91 patients diagnosed with medullary carcinoma and 3,743 patients with invasive ductal carcinoma, not otherwise specified (NOS) from January 1980 to December 2005 at Yonsei University Severance Hospital. The clinicopathologic features, disease free survival (DFS) and overall survival (OS) for patients with medullary carcinoma were compared with those of the NOS patients. Results: With reviewing the pathologic slides, 69 (75.8%) patients had findings compatible with typical medullary carcinoma (TMC) and the remaining 22 (24.2%) patients were reclassified as atypical medullary carcinoma (AMC). Early stage cancer was more frequent at medullary carcinoma and lymph node positive cancer was less frequent at medullary carcinoma. The expression of ER/PR was positive in either the TMC (18.9%/16.2%) and AMC (15.0%/20.0%) as compared to the NOS (63.2%/57.2%), and the difference was significant (p<0.001). In contrast, the HER-2/neu expression rate was significantly higher in the TMC (47.4%) and AMC (45.5%) than in the NOS (28.3%, p=0.001). The 10-year disease free survival and 10-year overall survival of the atypical medullary carcinoma patients (67.8%, 77.8%) were in fact similar to the NOS carcinoma patients (68.3%, 74.7%). There was significant difference in 10-year disease free survival and 10-year overall survival between the TMC (77.8%, 86.0%) and NOS carcinoma (68.3%, 74.7%) patients (p=0.002, p=0.006). Conclusion: The clinical outcome of typical medullary carcinoma is favorable in spite of its aggressive pathologic features and it differs from atypical medullary carcinoma. For precise prediction of prognosis of medullary cancer, we should apply strict criteria for the diagnosis of subtype with medullary features.

유방암 수술 결정을 위한 수술 전 자기공명영상의 임상적 의의

박우찬 한국유방암학회 2006 Journal of breast cancer Vol.9 No.4

Purpose: Currently MRI (Magnetic Resonance Imaging) is widely used for the preoperative staging of breast cancer. In this study, we assessed the impact of preoperative breast MRI on the surgical management of breast cancer in women. Methods: From March 2004 to October 2006, 162 cases were enrolled for preoperative MRI for the staging of breast cancer. The MRI findings and clinicopathological results were investigated and the accuracy of breast MRI was analyzed with respect to the detection of multiplicity, nipple involvement and bilaterality of the breast cancers. Results: For detecting multifocal lesions, the sensitivity and specificity of breast MRI were 100% and 48.5%, respectively, and the results of bresat ultrasound were 100% and 63.4%, respectively. For detecting nipple invasion, the sensitivity and specificity of breast MRI was 80% and 74.6%, and for ultrasound was 33.3% and 86.4%. In 27 cases (16.7%) the type of surgery was changed according to the preoperative MRI findings; however, in only 6 cases were the MRI findings in concordance with the pathological findings of the mastectomy specimen. Conclusion: In clinical application of breast MRI for preoperative staging, the decision to undertake surgery for breast cancer based on a MRI findings should be prudent due to its low specificity.

유방암 선별검사: 선별 유방촬영술에 대한 한 기관에서의 10년간 의학적 감사

허민희,이해경,강완남,윤찬석,고승상,이유진,이경상,조병제,강성수 한국유방암학회 2008 Journal of breast cancer Vol.11 No.4

Purpose: Screening for breast cancer has constantly been increasing since the benefit of screening for breast cancers was established. The purpose of this study was to investigate the efficacy of annual breast cancer screening at one institution for 10 years by conducting a medical audit. Methods: From March 1995 to July 2004, we performed 110,588 annual clinical examinations and mammographies on 58,024 women, who wanted to undergo breast cancer screening. Two hundred fourteen breast cancers were detected during screening, and one hundred sixty one of these patients were operated on. We then compared these results with the ideal rates for medical audits. Results: Of the 110,588 cases that were screened, the recall rate for further examination was 12.1% (n=13,423). The biopsy rate was 1.01% (n=1,116). Two hundred fourteen breast cancers were detected for a detection rate of 0.19%. The percent of stage 0 cancer among all the cancer was 23.6%, stage I was 40.4%, stage IIa was 19.9%, stage IIb and IIIa were a combined 6.2%, stage IIIc was 3.1%, and stage IV was 0.6%. The positive predictive value (PPV) based on the abnormal findings on the screening examinations was 1.6% (PPV1). The PPV when a biopsy or surgical consultation was recommended was 15.1% (PPV2). The percent of tumor found as stage 0 or I was 64% (103/161). The tumor found as minimal cancer (stage 0 or tumor lesser than 1 cm) was 38.5% (62/161). There were 38 cases of axillary lymph node metastasis (23.6%). The number of cases of cancers found per 1,000 cases was 1.7. The prevalence of cancer found per 1,000 first examinations was 2.3. The incidental cancer found per 1,000 follow-up examinations was 1.2. The recall rate for further evaluation was 12.1%. These results were compatible with the ideal rates for medical audits, except for the recall rate, the PPV1, the PPV2, and the cancers found per 1,000 cases. Conclusion: On the base of these results, breast cancer screening was properly performed in this institution. Breast cancer screening using a clinical examination and a mammography is effective for the early detection of breast cancer.

유방암 조직에서 ATP를 이용한 항암제 반응성 검사의 유용성

이희대,최석경,정준,이승아,황승현,안성귀,정우희 한국유방암학회 2010 Journal of breast cancer Vol.13 No.2

Purpose: Breast cancer is heterogeneous disease and the response to chemotherapeutic agents is also heterogeneous from patient to patient. Chemotherapy response assay is in vitro test that is performed to evaluate the degree of tumor growth inhibition by chemotherapy drugs. In this study, we performed the chemotherapy response assay using adenosine triphosphate (ATP-CRA) in breast cancer patients and assessed the clinical availability. Methods: Sixty five breast cancer patients were enrolled in this study. Cancer cells were evenly divided and treated with commonly used chemotherapeutic drugs in breast cancer (doxorubicin, epirubicin, 5-fluorouracil, paclitaxel, docetaxel, vinorelbine, and gemcitabine). To verify in vitro ATP-CRA indirectly, we analyzed the correlation between cell death rate (CDR) of doxorubicin and epirubicin, and between doxorubicin and paclitaxel. We also analyzed the mean CDR of doxorubicin, epirubicin and paclitaxel by HER2 status. Results: We could successfully perform the ATP-CRA in 60 patients (95.2%). In all cases, we can get the results within 7 days. The range of CDR was very wide, from 0 to more than 50%, except gemcitabine. Epirubicin showed the highest mean CDR (39.9%) and doxorubicin, paclitaxel in order. According to the chemosensitivity index, paclitaxel is the most frequently first-ranked and doxorubicin, epirubicin in order. Correlation coefficient between the cell death rate of doxorubicin and epirubicin is 0.4210 and 0.1299 between paclitaxel and doxorubicin. In HER2 positive group, mean CDR of paclitaxel, epirubicin and doxorubicin was higher than in HER2 negative group, even though epirubicin and doxorubicin were not statistically significant (p=0.018, p=0.114, p=0.311, respectively). Conclusion: ATP-CRA showed heterogeneous results in individual patients. ATP-CRA was successful and can be performed within short time period. According to our in vitro study, it showed similar results with in vivo study but for the clinical use, the prospective randomized controlled trial should be preceded.

유방암의 수신자판단특성곡선(ROC) 분석에 의한 정량적 Tc-99m Tetrofosmin Scintimammography의 진단적 정확도

박상현,박흥규,한상훈,이영돈,정민,이태훈,오재환,이정남,이운기,박연호,민승기,백정흠,김종호,황경훈 한국유방암학회 2004 한국유방암학회지 Vol.7 No.1

세침흡인을 통한 저에코성 종괴의 소멸

이동석,이종기,김지화 한국유방암학회 2004 한국유방암학회지 Vol.7 No.1

에스트로겐 수용체 양성 조기 유방암에서 보조 호르몬 치료제로서 토레미펜의 효과와 자궁내막에 미치는 영향

노동영 한국유방암학회 2007 Journal of breast cancer Vol.10 No.4

Purpose: This study was conducted to evaluate the use of toremifene as an adjuvant hormonal therapy for estrogen recepter (ER) positive early breast cancer patients in terms of therapeutic efficacy and effect on endometrium as compared with tamoxifen. Methods: Between January 2001 and December 2003, 451 patients with stage 0, I and II breast cancer, received adjuvant hormone therapy that consisted of either tamoxifen (N=387) or toremifene (N=64). The recurrence rate and survival rate were compared between two groups and the incidence of of endometrial event was evaluated in 273 of the patients. Results: The median follow up period was 57 months and the median hormonal therapy period was 51 months. During the follow up period, there were 3 (2.0%) recurrence in the stage I tamoxifen group, 19 recurrences (8.7%) and 3 deaths (1.4%) in the stage II tamoxifen group (n=219), however there were no instances of recurrence or death in all of the toremifene group. In addition, endometrial cancer developed in 2 patients in the tamoxifen group, but in no patients in toremifene group during the follow up period. Further 21 of the patients who began treatment using tamoxifen changed to toremifene due to adverse side effects. The toremifene was well tolerated by 15 of the patients that changed treatment regimes. Conclusion: Toremifene was found to be as effective and safe as tamoxifen, when used as an adjuvant hormonal therapeutic agent in ER-positive early breast cancer, therefore toremifene may be a good option in place of tamoxifen for patients who are experiencing adverse effects as a result of tamoxifen treatment.