The discovery of a breast lump is one of the most anxiety-provoking occurrences in a woman's life. The initial purpose of a surgical consultation is to determine whether a true mass exists. The majority of breast masses are self-discovered or are identified by a primary care provider. Once a breast mass has been identified, the first determination to be made is whether it is benign or malignant by using breast imaging techniques or pathologic examination. Once a breast lesion has been shown to be benign on pathologic examination, the most improtant clinical consideration is the risk of subsequent breast cancer associated with that lesion. The diagnosis of a fibroadenoma can be made using excisional biopsy or the combined modalities of CBE, ultrasound, and FNA. A true intraductal papilloma develops in one of the major subareolar ducts and is the most common lesion causing a serous or serosanguinous discharge. A mass may be felt on examination in as many as one-third of cases. The treatment of choice is microdochectomy. Hamartomas can produce a classic mammographic image that is virtually diagnostic. Because the clinical and radiologic characteristics of fat necrosis resemble those of carcimoma in the majority of cases, a needle localization or excisional biopsy is required.
Biopsy ; Breast Neoplasms ; Breast* ; Diagnosis ; Fat Necrosis ; Fibroadenoma ; Hamartoma ; Needles ; Papilloma, Intraductal ; Primary Health Care ; Ultrasonography

No abstract available.
Breast Neoplasms* ; Breast* ; Drug Therapy*

No abstract available.
Breast Neoplasms* ; Breast* ; Lymph Node Excision* ; Lymph Nodes*

No abstract available.
Breast Neoplasms* ; Breast* ; Drug Therapy*

No abstract available.
Stomach Neoplasms* ; Stomach*

No abstract available.
Nipples*

PURPOSE: The study was to evaluate the various risk factors related to local recurrence and distant metastasis in early breast cancer treated by lumpectomy with axillary dissection MATERIALS AND METHODS: Forty nine patients with early breast cancer were treated by lumpectomy with axillary dissection between January, 1990 and December, 1996. We analysed the risk factors such as age, tumor size, axillary lymph node metastasis, stage, pathologic classification and radiotherapy for local recurrence and distant metastasis RESULTS: The peak incidence was in the fifth decade (15 cases, 31%) and the average age was 47. The most common tumor size was 0~2 cm in 27 of 49 cases (55%). The preoperative chemotherapy was performed in 25 of 49 cases. The axillary lymph node metastasis was absent in 41 of 49 cases (84%). The most common pathologic type was invasive ductal carcinoma (29 cases, 60%). The breast skin incision was performed with curvilinear incision in 40 cases (85%), radial incision in 7 cases (15%). The axillary skin incision was performed with seperated incision in 45 cases (96%), nonseperated incision in 2 cases (4%). The most common complication was wound seroma (6 cases, 12%). By the time of follow-up, crude local recurrence rate was 10% (5 out of 49 cases) and crude distant metastasis rate was 6% (3 out of 49 cases). CONCLUSION: The factors such as age, tumor size, positive axillary nodes and stage were not statistically significantly related to local recurrence. Postoperative radiation therapy and preoperative chemotherapy were the significant factor related to local recurrence (2.6% for 39 cases with radiation therapy vs. 40.0% for 10 cases without radiation therapy, p<0.05; 0% for 25 cases with preoperative chemotherapy vs. 20.8% for 24 cases without preoperative chemotherapy, p<0.05).
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Classification ; Drug Therapy ; Follow-Up Studies ; Humans ; Incidence ; Lymph Nodes ; Mastectomy, Segmental* ; Neoplasm Metastasis ; Radiotherapy ; Recurrence ; Risk Factors ; Seroma ; Skin ; Wounds and Injuries

PURPOSE: Nodal involvement has long been known to represent the single most reliable indicator of the prognosis in early-stage breast cancer. In common parlance, high-risk node-positive breast cancer has generally been used to describe patients who have involvement of ten or more axillary lymph nodes (10 LN). Patients with 10 LN clearly have a strikingly high risk of recurrence and death. Thus we tried to evaluate the clinical courses of breast cancer patients with more than 10 positive axillary lymph nodes. METHODS: Of 587 breast cancer patients operated on at Chungnam National University Hospital from Feb. 1992 to Nob. 1999, 31 cases (5.3%) showed involvement of more than 10 axillary lymph nodes. We evaluated the clinical courses of these patients and differences in survival related to clinical and pathologic vaiables. Survival was calculated using the Kaplan-Meier method. RESULTS: The mean age of the patients was 50 14 years. A mastectomy was performed in 28 cases (90.3%), and a breast conserving operation in 3 cases (9.7%). The mean tumor size was 4.8 2.5 cm. The mean number of removed axillary LN was 23.5 10.2 (10-52), and the mean number of positive axillary LN was 20.0 10.1 (10-51). At a median follow-up of 30.5 months, 23 cases (74.2%) of recurrence were noted. Among these 69.6% (16/23) showed distant metastases as a first recurrence. The 3-year and 5-year disease-free survivals were 28.6% and 22.9%, respectively. The 3-year and 5-year expected overall survivals were 53.7% and 41.8%, respectively. There were significantly more recurrences in patients who had given up adjuvant chemotherapy than patients who had completed 6 cycles of FEC or MMM. Also, significant survival benefits were noted in patients who were treated using combination chemotherapy with taxane plus cisplatin after recurrence. CONCLUSION: Breast cancer patients with 10 LN have a strikingly high risk of recurrence. Six (6) cycles of adjuvant chemotherapy with FEC or MMM was a controllable variable for lowering the risk of recurrence. Also, combination chemotherapy with taxane and cisplatin was a controllable variable for increasing survival after recurrence.
Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; Chungcheongnam-do ; Cisplatin ; Disease-Free Survival ; Drug Therapy, Combination ; Follow-Up Studies ; Humans ; Lymph Nodes* ; Mastectomy ; Neoplasm Metastasis ; Prognosis ; Recurrence

PURPOSE: Axillary lymph node (ALN) status is the single most reliable indicator of the prognosis in early-stage breast cancer. However, downstaging of both the primary tumor and ALN involvement by neoadjuvant chemotherapy results in loss of traditional prognostic criteria. This study was performed to evaluate the prognostic significance of various clinicopathologic features in patients with operable breast cancer treated with neoadjuvant chemotherapy. METHODS: From Feb. 1991 to Oct. 1998, 73 patients with breast cancers (tumor size>3 cm, or clinically axillary node positive) were treated with preoperative combination chemotherapy comprised of preoperative 3 cycles and postoperative 3 cycles of FEC or MMM. The median follow-up period was 53 months. To analyze the potential simultaneous effect of the significant predictors of disease-free survival (DFS) and overall survival (OS) identified by univariate analysis, those factors were entered into a Cox multivariate regression model. RESULTS: Clinical responses to neoadjuvant chemotherapy were as follows, CR, 17.8% (13/73); PR, 57.5% (42/73); SD, 21.9% (16/73); and PD, 2.7% (2/72). The clinical response to neoadjuvant chemotherapy and the number of residual metastatic ALN were the only independent predictors of disease-free survival and overall survival. Patients with clinically complete response to neoadjuvant chemotherapy had a excellent 3-year DFS (100%) and 5-year OS (100%). In patients with a partial response, the number of metastatic ALN further stratified the patients with respect to DFS (p=0.003). Also, in patient with a stable disease, the number of metastatic ALN further stratified the patients with respect to DFS (p=0.000) and OS (p=0.000). Those with a progressive disease had a poor DFS and OS. CONCLUSION: Only the clinical response to neoadjuvant chemotherapy and the absolute number of metastatic ALN identified at surgical staging were the independent predictors of DFS and OS. Thus patients with partial or minor response can be further stratified with respect to DFS and OS by the number of involved ALNs.
Breast Neoplasms* ; Breast* ; Disease-Free Survival ; Drug Therapy* ; Drug Therapy, Combination ; Follow-Up Studies ; Humans ; Lymph Nodes ; Prognosis

One hundred twenty-nine patients with breast cancer were treated by breast-conserving surgery between January 1990 and December 1996 at the Department of Surgery, College of Medicine, Chungnam National University. Clinical results, various risk factors for local recurrence and distant metastasis were analyzed retrospectively. The median follow up period was 25 months, ranging from 6 months to 72 months. The most prevalent age was the fifth decade in 45 cases (35%). The most common tumor size was 2~5 cm (T2) in 52 cases (40%). The distance from the nipple to the tumor mass was 2~4 cm in 52 cases (40%), followed by 4~6 cm in 45 cases (35%) and 6~10 cm in 20 cases (16%). The breast skin incision for breast-conserving surgery was performed with a curvilinear incision in 72 cases (56%), followed by a radial incision in 57 cases (44%). The axillary skin incision was performed with separated incision in 103 cases (80%), continuous incision in 26 cases(20%). We performed a quadrantectomy in 83 cases (64%) and a lumpectomy in 46 cases (36%). A clear resection margin was obtained in all cases (129 cases). The most common complication was wound seroma (13 cases, 10%). By the time of follow up, the crude local recurrence rate was 8% (10 out of 129 cases) and the crude distant metastasis rate was 11% (15 out of 129 cases). Postoperative radiation therapy was the only factor significantly related to the local recurrence (2.4% for radiation therapy vs. 17.4% for no radiation therapy, p<0.05). Stage, positive axillary nodes, preoperative chemotherapy, distance from the nipple to the mass, age, and operation method were not significantly related to the local recurrence. Of the 10 patients with a local recurrence, salvage mastectomy was performed in five and a wide excision in two. A these patients are still alive with no evidence of disease at their last follow up. One patient refused on operation, and fellow ups were lost in two cases. Distant metastasis developed in 11% of the patients (15/129). Only pathologic stage was related significantly to the development of metastatic disease (2.2% for stage I and IIa vs. 33.3% for stage IIb, p<0.05).
Breast Neoplasms* ; Breast* ; Chungcheongnam-do ; Drug Therapy ; Follow-Up Studies ; Humans ; Mastectomy ; Mastectomy, Segmental* ; Neoplasm Metastasis ; Nipples ; Recurrence ; Retrospective Studies ; Risk Factors ; Seroma ; Skin ; Wounds and Injuries