OBJECTIVE: To support the establishment of lymphedema education plans and the actual practice of education by investigating the current lymphedema awareness status of Korean breast cancer patients. METHODS: cross-sectional population survey was conducted in 116 breast cancer patients in the Busan-Gyeongnam area. The survey included questions regarding demographic characteristics, breast cancer-related lymphedema (BCRL) risk factors, and characteristics and treatments of the disease. Some of the items were scored to determine the level of awareness. The items that affect the awareness of lymphedema were investigated by statistical analysis. RESULTS: Eighty-one of the 116 patients answered that they had heard of lymphedema, and 30 of them (25.86%) had received explanations about the possibility of lymphedema before surgery. Only 20 patients (17.25%) knew that lymphedema is not a completely curable disease, 24 patients (20.68%) thought that lymphedema does not require any treatment, and only 56 patients (48.27%) knew that lymphedema is treated in the Department of Rehabilitation Medicine. The main factors that affected patients' awareness of lymphedema were their age, chemotherapy, duration of breast cancer, and lymphedema treatment history. CONCLUSION: The majority of survey participants who were breast cancer patients either lacked awareness of BCRL or had false ideas about it, indicating the inadequate level of education provided for lymphedema. In the case of breast cancer diagnosis, early and continuous education for future management is essential, and the framework for the provision of education including education protocols related to age, disease duration, and lymphedema treatment is needed.
Breast Neoplasms* ; Breast* ; Drug Therapy ; Early Diagnosis ; Education ; Humans ; Korea* ; Lymphedema* ; Rehabilitation ; Risk Factors

PURPOSE: To determine the value of mammography compared to clinical examination in evaluating residual cancer of locally advanced breast carcinoma treated with neoadjuvant chemotherapy. MATERIALS AND METHODS: Among 67 patients with locally advanced breast carcinoma who were treated with neoadjuvant chemotherapy, 18 patients (age:35-67, mean:48) had taken the mammography before and after neoadjuvant chemotherapy. Those 18 sets of mammography were analyzed retrospectively and compared with the result of clinical examination on the basis of histologic diagnosis. RESULTS: On histologic examinations, 16 of 18 patients (88%) had residual cancer, one of them was diagnosed to have no residual cancer in mammography. On mammographic findings, 16 patients were determined to have residual cancer, and one of them was found not to have residual cancer on histologic examination. Clinically, there were 4 patients showed complete response, 11 patients with partial, and 3 with no response. 3 of 4 patients with complete clinical response were found to have residual cancer in histologic examination. In posttreatment mammographic findings, 11 patients were noted to have measurable mass, 8 patients had microcalcifications. All 11 patients with measurable mass in mammography had residual cancer (positive predictive value:100%). However, 5 of 7 patents who showed no measurable mass in mammography had residual cancer. 7 of 8 patients showing microcalcifications in mammography revealed to have residual cancer (positive predictable value: 88%). Sensitivity of mammography in predicting residual cancer was greater than that of clinical examination (94% vs 81%), even when microscopic residual cancer was considered as a complete response (92% vs 77%). Specificity of mammography were same as those of clinical examination (50% vs 50%, 20 % vs 20%). CONCLUSION: Mammography is more accurate and offers more information than clincal examination in evaluating residual cancer of locally advanced breast carcinoma after neoadjuvant chemotherapy. However, prediction of residual cancer with mammography is not accurate enough to replace histologic examination.
Breast Neoplasms* ; Breast* ; Diagnosis ; Drug Therapy* ; Humans ; Mammography* ; Neoplasm, Residual* ; Retrospective Studies ; Sensitivity and Specificity

In breast cancer, FDG PET is more accurate than conventional imaging methods for detecting distant metastases or local recurrences, and enables early ssessment of treatment response in patients undergoing primary chemotherapy. Though FDG PET has limited sensitivity in detecting tumor of small size, well differentiated tumor or lobar carcinoma, and regional lymph node metastasis, FDG PET is useful in cases with obscure MR images and axillary lymph node metastasis in locally advanced breast cancer. To minimize the side effects and cost of chemotherapy, imaging methods are required to monitor theresponse to chemotherapy, early and accurately. FDG PET is the appropriate method for this purpose. We reviewed the role of FDG-PET in diagnosis and initial staging of breast cancer, monitoring response to chemotherapy, and identifying metastatic and recurrent disease.
Breast Neoplasms* ; Breast* ; Diagnosis ; Drug Therapy ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Recurrence

PURPOSE: Although it is widely accepted that hormone receptor (HR) status is associated with later post-diagnostic periods, a debate exists as to whether the association is independent of age. The aim of our study was to confirm the impact of HR status on later period breast cancer-specific death (LP-BCSD) and later period non-breast cancer-specific death (LP-non-BCSD) in different age subgroups. METHODS: Surveillance, Epidemiology, and End Results databases were utilized to identify 181,108 breast cancer patients with > 5 years survival. The cumulative incidence of LP-BCSD and LP-non-BCSD was calculated using the Gray method. The subdistribution hazard ratio (SHR) of variables was estimated via the Fine and Gray proportional hazard regression model. Subgroup analyses for LP-BCSD and LP-non-BCSD were performed according to the HR status. RESULTS: The risk of LP-BCSD was exceeded by that of LP-non-BCSD at > 5 years since the diagnosis, particularly in old women. The competing risk regression model indicated that hormone receptor-positive (HR+) was an independent factor for more LP-BCSD (hazard ratio, 1.54; 95% confidence interval, 1.44–1.54; p < 0.001). However, stratified analysis indicated that HR+ was only associated with more LP-BCSD in the young women subgroup. Although HR+ was associated with more LP-non-BCSD, the predictive value of HR+ for LP-non-BCSD was eliminated after adjusting for age. CONCLUSIONS: HR+ was related to LP-BCSD in the premenopausal population. LP-BCSD should be an optimal endpoint in future trials designed to evaluate the role of extended adjuvant endocrine therapy.
Breast Neoplasms ; Breast ; Diagnosis ; Drug Therapy ; Epidemiology ; Female ; Humans ; Incidence ; Methods ; Prognosis ; Receptors, Estrogen

Primary angiosarcoma of the breast is extremely rare and is observed in 0.0005% to 0.05% of primary breast tumor cases. The diagnosis of this tumor is difficult due to its undefined characteristics. Radiologic findings are often nonspecific and appear completely normal in one-third of patients with primary angiosarcomas. The prognosis is usually poor, and the treatment choices include mastectomy or wide excision. Radiotherapy and chemotherapy produce varying results. We report a patient with primary angiosarcoma of the breast to further our understanding of the characteristics of this tumor and facilitate the correct diagnosis of breast angiosarcoma.
Breast Neoplasms ; Breast* ; Diagnosis ; Drug Therapy ; Hemangiosarcoma* ; Humans ; Lymphangiosarcoma ; Mastectomy ; Prognosis ; Radiotherapy ; Sarcoma

Atypical medullary carcinomas and carcinosarcoma have unique histopathological features. Here we present a case with a breast malignancy that had pathological characteristics of both. A 54-year old patient with a malignant breast mass received 6 cycles of adriamycin-based chemotherapy, followed by 3 cycles of paclitaxel monotherapy, and had a poor clinical response to treatment. A modified radical mastectomy was performed. The pathological diagnosis was complicated by an inability to distinguish between atypical medullary carcinoma and carcinosarcoma. The findings included a tumor that was well-circumscribed, high grade and a syncytial growth pattern as well as biphasic sarcomatous and carcinomatous characteristics. In conclusion, atypical medullary carcinoma and carcinosarcoma of the breast have entirely different prognoses and should be managed differently. Both should be treated by surgical resection, and additional therapy should be considered based on the cancer with the poorer prognosis.
Breast Neoplasms* ; Breast* ; Carcinoma, Medullary* ; Carcinosarcoma* ; Diagnosis ; Diagnosis, Differential* ; Drug Therapy* ; Humans ; Mastectomy, Modified Radical ; Middle Aged ; Paclitaxel ; Prognosis

PURPOSE: Tumor-infiltrating lymphocyte (TIL), programmed death-ligand 1 (PD-L1) expression and neutrophil-to-lymphocyte ratio (NLR) is associated to immunogenicity and prognosis of breast cancer. We analyzed baseline NLR, changes of NLR, TIL, and PD-L1 during neoadjuvant chemotherapy (NAC) and their clinical implication in triple-negative breast cancer (TNBC). MATERIALS AND METHODS: Between January 2008 to December 2015, 358 TNBC patients were analyzed. Baseline NLR, 50 paired NLR (initial diagnosis, after completion of NAC) and 34 paired tissues (initial diagnosis, surgical specimen after completion of NAC) were collected. Changes of TIL, CD4, CD8, forkhead box P3 (FOXP3), and PD-L1 expression were assessed with immunohistochemical stain. RESULTS: Low NLR (≤ 3.16) was associated to superior survival (overall survival: 41.83 months vs. 36.5 months, p=0.002; disease-free survival [DFS]: 37.85 months vs. 32.14 months, p=0.032). Modest NLR change after NAC (–30% < NLR change < 100%) showed prolonged DFS (38.37 months vs. 22.37 months, p=0.015). During NAC, negative or negative conversion of tumor PD-L1 expression was associated to poor DFS (34.77 months vs. 16.03 months, p=0.037), and same or increased TIL showed trends for superior DFS, but without statistical significance. Positive tumor PD-L1 expression (H-score ≥ 5) in baseline or post-NAC tissue was associated to superior DFS (57.6 months vs. 12.5 months, p=0.001 and 53.3 months vs. 18.9 months, p=0.040). Positive stromal PD-L1 expression in baseline was also associated to superior DFS (50.2 months vs. 20.4 months, p=0.002). CONCLUSION: In locally advanced TNBC, baseline NLR, changes of NLR during NAC was associated to survival. Baseline PD-L1 expression and changes of PD-L1 expression in tumor tissue during NAC also showed association to prognosis.
Breast Neoplasms ; Diagnosis ; Disease-Free Survival ; Drug Therapy ; Humans ; Lymphocytes, Tumor-Infiltrating ; Prognosis ; Triple Negative Breast Neoplasms

OBJECTIVETo assess the diagnostic value of core needle biopsy (CNB) before neoadjuvant chemotherapy for breast cancer.

METHODSOne hundred and nineteen breast cancer cases underwent neoadjuvant chemotherapy in our hospital during the period from June, 2005 to January, 2007 were analyzed. CNB was carried out before starting chemotherapy. The hematoxylin and eosin-stained slides of CNB taken before and after neoadjuvant chemotherapy were reviewed independently by two pathologists, and the rate of consistency was verified.

RESULTSAmongst the 119 cases studied, 110 cases were confirmed to be carcinoma, including 105 cases of invasive carcinoma and 5 cases of ductal carcinoma-in-situ. The rate of consistency was 97.22% (105/108).

CONCLUSIONCNB has important value in distinguishing benign from malignant lesions, as well as in confirming the diagnosis of invasive carcinoma before starting neoadjuvant chemotherapy.

Biopsy, Needle ; methods ; utilization ; Breast ; pathology ; Breast Neoplasms ; diagnosis ; drug therapy ; Carcinoma, Ductal, Breast ; diagnosis ; pathology ; Female ; Humans ; Neoadjuvant Therapy ; methods

The breast cancer is the second most common malignancy in pregnancy after cervical cancer. Pregnancy- associated breast caner tends to show unfavorable prognosis, because it is diagnosed at more advanced stage due to delay of diagnosis and treatment. For appropriate management, collaboration with physicians and obstetricians should make precise decisions considering gestational weeks and cancer stage at the time of diagnosis in a point of view from mother and fetus. A case of successful gestation and delivery after chemotherapy in a woman with inflammatory breast cancer diagnosed in the second trimester is presented with review of literature.
Breast Neoplasms* ; Breast* ; Cooperative Behavior ; Diagnosis ; Drug Therapy ; Female ; Fetus ; Humans ; Inflammatory Breast Neoplasms ; Mothers ; Pregnancy ; Pregnancy Trimester, Second ; Prognosis ; Uterine Cervical Neoplasms

Breast Neoplasms ; diagnosis ; drug therapy ; surgery ; Female ; Humans ; Lymph Node Excision