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Purpose: Little is known about long term results of nippleareola preserving skin-sparing mastectomy (NASSM), and there are no such reports on this from South Korea. We studied 5 years follow up results of NASSM and skin sparing mastectomy (SSM) and compared clinical outcomes between NASSM and SSM. Methods: Two hundred two patients who underwent SSM (69 patients) or NASSM (133 patients) from September 1996 to December 2006 were included. Frozen section analysis of retroareolar resection margin was done to make the decision on preserving or not preserving nippleareolar complex (NAC). In the case of positive result on the frozen section, NAC was sacrificed. The local relapse (LR) rate and local relapse free survival (LFS) were analyzed for comparing between NASSM and SSM. Results: The mean age was 40.2 years (range, 24-65), the mean follow-up was 67.6 months. 52 NACs (25.7%) were involved by tumor cells. The invasion to the NAC by tumor cell was more common for invasive carcinoma with extensive intraductal component p<0.001), central located tumor (p=0.025) and invasive carcinoma with multiplicity (p=0.001). There were 12 cases (9.0%) of local relapse in NASSM group and 4 (5.8%) in SSM group, but there was no significant correlation for the LR rate (p>0.05). Regional or distant recurrence after surgical treatment for local relapse occurred in only one SSM case. Five years LFS rate of the NASSM group was 92.1% and that of the SSM group was 95.2%. There was no significant difference for the LFS (p>0.05). Conclusion: Our long term follow up study showed that NASSM and SSM are much alike for their LR rate and LFS. Even if relapse occurs in the NAC, this recurrence cannot affect the progression of relapse after adequate local treatment. Thus, NASSM is alternative method for SSM with oncological safety and better cosmetic outcome.
Purpose: Performance of a skin-sparing mastectomy with immediate reconstruction provides psychological satisfaction and good cosmetic outcome for patients with breast cancer. However, this is a lengthy procedure to perform, and there is increased risk of pulmonary thromboembolism (PTE). The purpose of this study was to evaluate the efficiency of the use of low molecular weight heparins (enoxaparin) for prophylaxis against a pulmomary thromboembolism followed by mastectomy with an immediate transverses rectus abdominis myocutaneous flap (TRAM) in breast cancer. Methods: A total of 123 patients underwent a skin-sparing mastectomy with an immediate TRAM. The “non-enoxaparin group” wore compression stockings for PTE prophylaxis and the “enoxaparin group” received enoxaparin (40 mg SQ injection, once daily starting 2 hours before surgery and continuing for 6 days postoperatively) in conjunction with the use of compression stockings. Lung perfusion, inhalation scans, and serum D-dimer assays were performed on postoperative day 3. If findings were clinically suspicious or intermediate to high probability of a PTE in a lungs scan, embolism computed tomography was performed. Patients were prospectively investigated according to the clinicopathological data. We compared the incidence of PTE and hemorrhagic complications between the two groups. Results: There were no significant clinicopathological differences between the two groups. Eleven patients developed a PTE (nine patients in the non-enoxaparin group and two patients in the enoxaparin group). The prevalence rate of a PTE was 17.3% and 3.2% for each group, respectively (p=0.01). One patient in the non-enoxaparin group required a second operation for bleeding control and three patients in the enoxaparin group needed transfusions. There were minor hemorrhagic complications in the enoxaparin group that improved after supportive management. Conclusion: Although there were minor hemorrhagic complications, enoxaparin is safe and effective in a preventing PTE in patients that undergo immediate reconstruction after a skin-sparing mastectomy.
Purpose: This study was to investigate the clinical significance of diffusely increased F-18 FDG uptake in the thyroid gland as an incidental finding on F-18 FDG PET/CT imaging in patients with breast carcinoma. Methods: One hundred four patients with breast carcinoma who had no prior history of thyroid disease were enrolled. All patients underwent F-18 FDG PET/CT, ultrasound and thyroid function test (TFTTSH, FT4, and T3), anti-TPO antibody test within 2 weeks. Also we checked estrogen (ER) and progesterone receptors (PR). We classified all patients into subgroups according to the existence and degree of F-18 FDG uptake in the thyroid gland, and evaluated the difference between subgroups. Results: Of the 104 patients, 42 (40.4%) subjects showed diffusely increased thyroid uptakes. There was no significant difference in rate of abnormality in TFT and thyroid US, and existence of anti-TPO antibody and ER/PR between two groups. Of 42 patient who showed diffuse uptake, 12 (28.5%), 13 (31.0%), and 17 (40.5%) subjects demonstrated hypointense, isointense, and hyperintense thyroid uptake compared with activity of mediastinal blood pool. Thirteen (76.4%) of 17 subjects in the hyperintense thyroid uptake group revealed abnormality in various tests (US, TFT, and anti-TPO antibody). The rate of abnormality in this group was significantly different with the other two groups (p=0.002). Conclusion: Our data suggested that the rate of diffuse thyroid uptakes on F-18 FDG PET/CT imaging of patients with breast carcinoma was higher than healthy subjects. In case of someone who had no prior thyroid disease showed diffuse thyroid uptakes more than activity of mediastinal blood pool on F-18 FDG PET/CT imaging, it should be considered further evaluation about the thyroid gland.
Purpose: This study aimed to investigate clinical outcomes of breast cancer patients who underwent mastectomy with or without immediate breast reconstruction. Methods: Of 1,847 patients undergoing total mastectomy, 371 (20.1%) underwent immediate reconstruction between January 2005 and December 2011. Clinicopathological characteristics and survival were compared by performing univariate and multivariate analysis. Results: The proportion of reconstruction had been gradually increasing since 2009. Reconstruction group showed younger age at diagnosis and lower cancer stages. Adjuvant chemotherapy and radiation therapy were more frequently administered in the mastectomy alone group. During a median follow-up period of 57 months, locoregional relapse-free survival (LRRFS) was similar regardless of type of surgery. However the reconstruction group showed a more favorable overall survival (OS). Multivariate analysis for LRRFS revealed no statistical significance but the OS was higher in the reconstruction group. In the mastectomy alone group, two-thirds died of breast cancer, while all patients in the reconstruction group died of breast cancer. Stage-matched breast cancer specific survival was similar between both groups. Conclusion: Immediate breast reconstruction is oncologically safe after mastectomy for breast cancer. Considering the quality of life, the patient should be preoperatively counseled by a multidisciplinary team regarding possible immediate reconstruction.
Purpose: To estimate the cumulative risk till each age (penetrance) of breast and ovarian cancers among female family members with BRCA1 and BRCA2 mutation. Methods: Among the 61 BRCA1 mutation carriers in the 42 families and 47 BRCA2 mutation carriers in 31 families identified at 5 academic breast clinics, the probands were excluded to estimate the cumulative risk till each age of breast cancer in the Korean BRCA1 and BRCA2 carriers. Using Kaplan-Meier analyses, cumulative cancer risk estimates were determined. Results: By the age 70, the female breast cancer risk for the BRCA1 and BRCA2 mutation carriers was 72.1% (95% confidence interval [CI]=59.5% to 84.8%) and 66.3% (95% CI=41.2% to 91.5%), respectively, and the ovarian cancer risk was 24.6% (95% CI=0% to 50.3%) and 11.1% (95% CI=0% to 31.6%), respectively. The contralateral breast cancer risk at 5 years after primary breast cancer was estimated as 16.2% (95% CI=9.3% to 23.1%) for the 52 breast cancer patients with the BRCA1 mutation and 17.3% (95% CI=9.7% to 24.0%) for the 35 breast cancer patients with the BRCA2 mutation. Conclusion: The penetrance of BRCA mutations in Korea is largely consistent with the previous studies on Western populations. However, the small number of the cases, the high proportions of probands in the study subjects, the short term follow-up, and large confidence intervals are the limitations of the current study. The Korean Hereditary Breast Cancer Study (KOHBRA Study) may definitely answer this question.
Purpose: Accurate preoperative assessment of breast cancer is important to determine the extent of disease and the plan for surgery. The purpose of this study was to evaluate the efficacy of preoperative breast MRI in breast cancer patients. Methods: Between January 2001 and October 2007, 457 consecutive patients who had undergone surgical treatment for breast cancer were retrospectively studied. We compared 303 patients from the non-preoperative MRI group (group A) to 154 patients from the preoperative MRI group (group B). The impact of preoperative MRI was evaluated for each patient with regard to changes in therapeutic intervention. Results: MRI alone revealed 17 new lesions. The results of the MRI led to a change in 9.1% of the planned surgical procedures. Tumor size was more accurately defined in patients undergoing MRI than in those undergoing ultrasound imaging. Conclusion: Breast MRI could be recommended as a preoperative diagnostic procedure in patients allocated to receive breast conservation surgery, because MRI may reveal unsuspected multifocal or multicentric tumors or carcinoma infiltrations and may result in changes in therapy.
Purpose: We introduce a new technique using a Vicryl® mesh made with Polyglactin 910 for breast reconstruction after performing endoscopy-assisted breast conserving surgery. Methods: From July 2006 to July 2008, we performed endoscopiy-assisted breast surgery in 30 patients with early breast cancer. (Thirty [fourteen] patients [who] underwent endoscopy-assisted breast conserving surgery). Of the total patients, 14 underwent reconstruction procedure (volume replacement with the use of a Vicryl® mesh) and 16 underwent reconstuction without Vicryl® mesh. We were evaluated for their quality of life (QOL), the surgery-related complications and the cosmetic outcomes. Three patients were excluded from the study; two patients required mesh removal due to infection and the other patient had a total mastectomy performed due to a positive resection margin. Results: The median age of the patient was 49.4 year (range 36-60 year) and all of the patients had a diagnosis of early breast cancer (less than stage IIb). In general, the patients were satisfied with the outcome for their QOL. The patients were especially satisfied with the cosmetic outcome. The patients' satisfaction increased with longer follow-up, as compared to that for the shorter intervals. At 10 months after surgery, there was encapsulated granulation tissue within a collection of tissue fluid, as seen on ultrasonography. At 20 months after surgery, the skin and breast shape both recovered. Conclusion: The results of this study showed that for relatively short followup period, breast reconstruction with using Polyglactin 910 mesh, which is made from oxidized regenerated cellulose, resulted in satisfactory cosmetic results and a good quality of life after breast conservative surgery.
Purpose: Nearly half of all breast cancers are treated with breast conserving therapy (BCT). The purpose of this study was to identify the risk factors for ipsilateral breast tumor recurrence (IBTR) after BCT in T1 and T2 breast cancer patients. Methods: The medical records of 294 T1 or T2 breast cancer patients who underwent BCT at Seoul National University Hospital between January 1998 and December 2002 were retrospectively reviewed. Kaplan-Meier curves and Cox proportional regression analysis were used to identify the significant clinicopathologic factors that influence IBTR. Results: Among the 294 patients, 12 patients (4.8%) developed IBTR after a median follow-up of 82 months. Univariate analysis demonstrated that younger age (≤35 year) had significant associations with IBTR (p=0.006). Tumor size, lymph node status, histologic grade, extensive intraductal component, lymphovascular invasion, and close resection margins were not significant factor associated with IBTR. The triple negative breast cancer subtype also did not have significant association with IBTR. Multivariate analysis showed that the younger age at diagnosis was a significant predictor of IBTR with a HR of 3.86 (p=0.036; 95% CI, 1.09-13.60). Conclusion: Younger age at diagnosis (≤35) may be associated with an increased risk of IBTR in patients who underwent BCT.
Purpose: The objective of this study was to evaluate the change in the practice patterns for managing hereditary breast and ovarian cancer (HBOC) among Korean physicians after the Korean Hereditary Breast Cancer (KOHBRA) study. Methods: The first survey was performed from July to August 2007, at the initiation of the KOHBRA study, and the followup survey was conducted from July to December 2009. Members of the Korean Breast Cancer Society were invited to participate in the study by e-mail. The 2009 survey was conducted with a self-administered questionnaire concerning HBOC management and was identical to the previous questionnaire. Results: According to the 2009 survey, most physicians (60.0%) tended to draw a pedigree (48.0% in 2007 survey). The rate of genetic test recommendations for patients at risk for HBOC was higher in the 2009 survey (84.0%) than that in the 2007 survey (64.0%). Physicians tended to select a BRCA genetic testing candidate more appropriately than in the previous survey (42.4% answered right in 2007 survey; 74.4% in 2009 survey). Fifteen of 25 participants (60.0%) provided genetic counseling before their patients underwent a genetic test, which was higher than that (40.0%) in the 2007survey. According to the 2009 survey, half of the genetic counseling was being conducted by KOHBRA study research nurses; whereas most of the genetic counseling was conducted by physicians in 2007. Conclusion: The KOHBRA study has played an important role in the appropriate selection of candidates for genetic testing. However, more effort should be placed on improving the pre-test genetic counseling rate.