Purpose: We evaluated the feasibility, safety, and learning curve of extraperitoneal single-port robot-assisted radical prostatectomy (SP-RARP) and introduced innovative surgical techniques to maintain the instrument positions during the procedures. Materials and Methods: A cohort of 100 patients underwent extraperitoneal SP-RARP at our institution from December 2021 to April 2023. The procedures were performed by an experienced urology surgeon utilizing two surgical techniques for dissecting the posterior aspect of the prostate—“changing instrument roles” and “using camera inversion”—to prevent positional shifts between the camera and instruments. Results: The mean operation time for SP-RARP was 93.58 minutes, and the mean console time was 65.16 minutes. The mean estimated blood loss during the procedures was 109.30 mL. No cases necessitated conversion to multi-port robot, laparoscopy, or open surgery, and there were no major complications during the hospital stay or in the short-term follow-up. Early outcomes of post-radical prostatectomy indicated a biochemical recurrence rate of 4.0% over a mean follow-up duration of 6.40 months, with continence and potency recovery rates of 92.3% and 55.8%, respectively. Analysis of the learning curve showed no significant differences in operation time, console time, and positive surgical margin rates between the initial and latter 50 cases. Conclusions Extraperitoneal SP-RARP is a feasible and safe option for the treatment of localized prostate cancer in skilled hands.Continued accrual of cases is essential for future comparisons of SP-RARP with multiport approaches.

PURPOSE: The aim of this study was to evaluate the correlation between central lymph node (CLN) metastasis and clinicopathologic characteristics of papillary thyroid cancer (PTC). In addition, we investigated the incidence and risk factors for contralateral CLN metastasis in unilateral PTC. This study suggests the appropriate surgical extent for CLN dissection. METHODS: A prospective study of 500 patients with PTC who underwent total thyroidectomy and prophylactic bilateral CLN dissection was conducted. RESULTS: Of 500 patients, 255 had CLN metastases. The rate of CLN metastasis was considerably higher in cases of younger patients (<45 years old) (P < 0.001; odds ratio [OR], 2.357) and of a maximal tumor size greater than 1 cm (P < 0.001; OR, 3.165). Ipsilateral CLN metastasis was detected in 83.1% of cases (133/160) of unilateral PTC, only contralateral CLN metastases in 3.7% of cases (6/160), and bilateral CLN metastases in 13.1% of cases (21/160). The rate of contralateral CLN metastasis was considerably higher in cases of PTC with a large tumor size (> or =1 cm) (P = 0.019; OR, 4.440) and with ipsilateral CLN metastasis (P = 0.047; OR, 2.613). CONCLUSION: Younger age (<45 years old) and maximal tumor size greater than 1 cm were independent risk factors for CLN metastasis. Maximal tumor size greater than 1 cm and presence of ipsilateral CLN macrometastasis were independent risk factors for contralateral CLN metastasis. Therefore, both CLN dissections should be considered for unilateral PTC with a maximal tumor size greater than 1 cm or presence of ipsilateral CLN macrometastasis.
Humans ; Incidence ; Lymph Nodes* ; Neoplasm Metastasis* ; Odds Ratio ; Prospective Studies ; Risk Factors ; Thyroid Neoplasms* ; Thyroidectomy

Medullary thyroid carcinoma and papillary thyroid carcinoma are different subtypes of thyroid carcinoma. The concomitant occurrence of medullary thyroid carcinoma and papillary thyroid carcinoma as a collision tumor is rare. We describe five cases of medullary and papillary thyroid carcinoma as a collision tumor. Four women and one man underwent thyroidectomy for treatment of thyroid cancer. Collision tumor was then detected by histopathologic finding. Genetic testing, point mutation of the BRAF gene or mutation of the RET gene was performed in three cases. However, only one case had point mutation of the BRAF gene. Exact diagnosis of this uncommon event is important because the strategies for treatment of papillary thyroid carcinoma and medullary thyroid carcinoma are different.
Diagnosis ; Female ; Genetic Testing ; Humans ; Point Mutation ; Thyroid Neoplasms* ; Thyroidectomy

PURPOSE: The purpose of this study is to evaluate imaging and histopathologic findings including the immunohistochemical characteristics of invasive micropapillary carcinoma (IMPC) of the breast. METHODS: Twenty-nine patients diagnosed with IMPC were included in the present study. Mammographic, sonographic, and magnetic resonance imaging (MRI) findings were analyzed retrospectively according to the American College of Radiology Breast Imaging Reporting and Data System lexicon. 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) findings were also evaluated. Microscopic slides of surgical specimens were reviewed in consensus by two pathologists with a specialty in breast pathology. RESULTS: Most IMPCs presented as a high density irregular mass with a non-circumscribed margin associated with microcalcifications on mammography, as an irregular hypoechoic mass with a spiculated margin on ultrasound, and as irregular spiculated masses with washout patterns on MRI. PET-CT showed a high maximum standardized uptake value (SUVmax) (mean, 11.2). Axillary nodal metastases were identified in 65.5% of the patients. Immunohistochemical studies showed high positivities for estrogen receptor and c-erbB-2 (93.1% and 51.7micro, respectively). CONCLUSION: Even though the imaging characteristics of IMPCs are not distinguishable from typical invasive ductal carcinomas, this tumor type frequently results in nodal metastases and high positivities for both estrogen receptor and c-erbB-2. The high SUVmax value that is apparent on PET-CT might be helpful in the diagnosis of IMPC.
Breast ; Carcinoma, Ductal ; Consensus ; Electrons ; Estrogens ; Humans ; Information Systems ; Magnetic Resonance Imaging ; Mammography ; Neoplasm Metastasis ; Retrospective Studies

PURPOSE: The purpose of this study is to evaluate imaging and histopathologic findings including the immunohistochemical characteristics of invasive micropapillary carcinoma (IMPC) of the breast. METHODS: Twenty-nine patients diagnosed with IMPC were included in the present study. Mammographic, sonographic, and magnetic resonance imaging (MRI) findings were analyzed retrospectively according to the American College of Radiology Breast Imaging Reporting and Data System lexicon. 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) findings were also evaluated. Microscopic slides of surgical specimens were reviewed in consensus by two pathologists with a specialty in breast pathology. RESULTS: Most IMPCs presented as a high density irregular mass with a non-circumscribed margin associated with microcalcifications on mammography, as an irregular hypoechoic mass with a spiculated margin on ultrasound, and as irregular spiculated masses with washout patterns on MRI. PET-CT showed a high maximum standardized uptake value (SUVmax) (mean, 11.2). Axillary nodal metastases were identified in 65.5% of the patients. Immunohistochemical studies showed high positivities for estrogen receptor and c-erbB-2 (93.1% and 51.7micro, respectively). CONCLUSION: Even though the imaging characteristics of IMPCs are not distinguishable from typical invasive ductal carcinomas, this tumor type frequently results in nodal metastases and high positivities for both estrogen receptor and c-erbB-2. The high SUVmax value that is apparent on PET-CT might be helpful in the diagnosis of IMPC.
Breast ; Carcinoma, Ductal ; Consensus ; Electrons ; Estrogens ; Humans ; Information Systems ; Magnetic Resonance Imaging ; Mammography ; Neoplasm Metastasis ; Retrospective Studies

PURPOSE: Phyllodes tumors (PTs) of the breast have been classified as benign, borderline, or malignant based on their histopathologic features. However, predicting clinical behavior based on these features has proven to be difficult given that local recurrence occurs in both benign and malignant PTs. Recurrence has been shown to mirror the histologic pattern of the primary tumor or to show dedifferentiation. The aim of this study was to assess the value of the histopathologic parameters, expression or mutation of c-Kit and platelet derived growth factor receptor alpha (PDGFRA) in predicting tumor recurrence. METHODS: Representative areas from 39 benign, 16 borderline, and 12 malignant PTs were selected for construction of tissue microarrays. Immunohistochemical analyses for p53, Ki-67, c-Kit, and PDGFRA were performed and SSCP-PCR analysis was carried out to identify mutations in exons 9, 11, 13, and 17 of the c-Kit gene and exons 12 and 18 of the PDGFRA gene. Clinicopathologic features, including tumor recurrence and margin status, were also evaluated. RESULTS: Of the 67 PTs, 11 cases (16.4%) recurred from 3 to 92 months following initial diagnosis (4 benign, 2 borderline, and 5 malignant). One benign PT case recurred as a borderline tumor and two borderline PT cases recurred as malignancies. Three patients died of malignant PT. No mutations of the c-Kit or PDGFRA genes were found and there was no statistically significant association of either p53 or p16 immunostaining with recurrent disease (p>0.05). However, histologic grade (p=0.033), margin status (p<0.001), Ki-67 (p=0.012), c-Kit (p=0.002), and PDGFRA (p=0.007) stromal immunopositivity were significantly correlated with recurrence. CONCLUSION: Even though positive or close margins were significantly associated with tumor recurrence, stromal c-Kit, PDGFRA positivity, and the Ki-67 index were useful for predicting recurrent PTs. Despite this, no c-Kit or PDGFRA mutations were found.
Breast ; Exons ; Humans ; Phyllodes Tumor ; Proto-Oncogene Proteins c-kit ; Receptors, Platelet-Derived Growth Factor ; Recurrence

PURPOSE: The axillary lymph node status is an important prognostic factor for recurrence and survival of patients who have primary breast cancer. This study determined the accuracy of ultrasonography and 18F-FDG positron emission tomography (PET)/computed tomography (CT) in preoperative staging in axilla in patients with breast cancer. METHODS: One hundred seventy-one patients with primary breast cancer were recruited from January 2007 to August 2008. All the patients underwent axillary ultrasonography and 18F-FDG PET/CT for the axillary staging before their operation. RESULTS: The overall sensitivity, specificity, and the positive and negative predictive values and the accuracy of axillary ultrasonography for making the diagnosis of axillary metastasis were 73.07%, 84.87%, 67.85%, 87.82%, and 81.28%, respectively. On a visual assessment of 18F-FDG PET/CT, the diagnostic accuracy was 85.38% with 69.23% sensitivity, 92.43% specificity, a positive predictive value of 80.00%, and a negative predictive value of 87.30%. By the combined use axillary ultrasonography and 18F-FDG PET/CT to the axilla, the sensitivity, specificity, the positive and negative predictive values and the diagnostic accuracy were 82.35%, 97.91%, 93.33%, 94.00%, and 93.84%, respectively. CONCLUSION: The combination of 18F-FDG PET/CT and ultrasonography improves preoperative axillary staging in breast cancer that are often not found if only one imaging modalities are applied.
Axilla ; Breast ; Breast Neoplasms ; Fluorodeoxyglucose F18 ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Positron-Emission Tomography ; Recurrence ; Sensitivity and Specificity

Cancer-associated rheumatic disorders are sometimes present concurrently with a tumor, but are not recognized initially. We report a case of dermatomyositis with breast cancer. A 46 year-old woman diagnosed with breast cancer with axillary lymph node metastasis had been treated by neoadjuvant chemotherapy and a lumpectomy with axillary lymph node dissection. She presented with a red rash on her face, eyelids, neck, and shoulders. A skin biopsy did not rule out dermatomyositis. Laboratory values were within normal limits, except muscle enzymes (Creatine kinase). Electromyography showed the presence of early myopathy. A PET CT-scan showed muscle uptake in left infraspinatus, r/o myositis. No abnormalities were presented in the muscle biopsy. Symptoms were improved by steroid therapy.
Biopsy ; Breast ; Breast Neoplasms ; Dermatomyositis ; Electromyography ; Exanthema ; Eyelids ; Female ; Humans ; Lymph Node Excision ; Lymph Nodes ; Mastectomy, Segmental ; Muscles ; Muscular Diseases ; Myositis ; Neck ; Neoplasm Metastasis ; Shoulder ; Skin

PURPOSE: Aberrant DNA methylation of tumor suppressor genes has been accepted as a common feature and early event in human cancer. The aim of this study was to analyze the methylation profiles of 50 well established methylation-associated genes in relation to various clinico-pathological features in breast cancer. METHODS: The methylation status of 50 genes were determined in two breast cancer cell lines, MCF7 and MDA- MB231, using HpaII-MspI-PCR. 8 genes (APC, CALCA, CDH13, MTHFR, S100A2, H19, EDNRB and MUC2) were found to be methylated in at least 1 cell line. The methylation of all 8 genes was observed in tumor tissues, but with different methylation frequencies. RESULTS: The methylation frequencies of five genes in breast cancer were as follows: MTHFR (41.9%), APC (51.6%), EDNRB (77.4%), CALCA (80.6%), S100A2 (87.1%), CDH13 (93.5%), H19 (93.5%) and MUC2 (96.8%). The results indicate that a panel of these 8 genes would be useful in the detection of breast cancer. The prognostic significance of DNA methylation in this breast cancer series, the conventional markers of LN status (P=0.05), histologic grade (P= 0.007) and P53 gene status (P=0.049) showed significant prognostic value. CONCLUSION: The methylation of APC, MTHFR, CALCA, CDH13, H19, MUC2, EDNRB and S00A2 would be useful in the detection of breast cancer. Detection of these abnormalities may be useful in the risk assessment and early detection of breast cancer.
Breast Neoplasms* ; Breast* ; Cell Line ; DNA Methylation ; Genes, p53 ; Genes, Tumor Suppressor ; Humans ; Methylation* ; Risk Assessment

PURPOSE: Stereotactic vacuum-assisted breast biopsy (SV AB) has recently been introduced as an alternative to the traditional surgical excisional biopsy with needle localization (NLBB). Although SVAB has excellent sensitivity and specificity with very low false negative results, patients might complain about the uncomfortable table and the painful breast compression that is done during SVAB. Furthermore, the cost of SVAB is too expensive to be widely adopted in Korea. So we developed a new technique of vacuum-assisted breast biopsy with air localization (VAB-AL) for the patients suffering with microcalcifications. METHODS: From April 2005 to Oct 2005, 10 microcalcification patients, whose lesions were difficult to be seen on breast ultrasonography, underwent vacuum-assisted breast biopsies with air localization (VAB-AL). First, classical NL was done to localize the mammographic abnormalities. Instead of insertion of the wire, 1 cc amounts of air were injected through a needle. The injected air could be easily visualized as a hyperechogenic density on breast sonography. Vacuum-assisted breast biopsy for the air-induced hyperechogenic densities was then done under sonographic guidance. The specimen radiography was performed to confirm that the lesion was removed. RESULTS: The mean age of the patients was 46 (range: 37~55). The upper-outer quadrant of the breast was the most common site of the lesions (6/10, 60%); the upper-inner quadrant (2/10, 20%), and then the lower-inner quadrant (1/10, 10%) followed. The specimen radiology for all 10 patients showed that the mammographic abnormalities were successfully removed. The most common pathologic type was fibrocystic disease (6/10, 70%); intraductal carcinoma (3/10, 30%), and then atypical ductal hyperplasia (1/10, 10%) followed. There were no major complications. CONCLUSION: Vacuum-assisted breast biopsy with air localization is a new technique that can minimize the complaints of patients with microcalcifications about the uncomfortable table, the painful breast compression and the economic burden of SVAB. This new procedure was successfully performed in our 10 patients, and we believe this procedure shows a lot of promise as one of alternatives to classical NLBB and SVAB.
Biopsy* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Humans ; Hyperplasia ; Korea ; Needles ; Radiography ; Sensitivity and Specificity ; Ultrasonography ; Ultrasonography, Mammary