No abstract available.

The gold standard for breast biopsy procedures is currently an open excision of the suspected lesion. However, an excisional biopsy inevitably makes a scar. The cost and morbidity associated with this procedure has prompted many physicians to evaluate less invasive, alternative procedures. More recently, image-guided percutaneous core-needle biopsy has become a frequently used method for diagnosing palpable and non-palpable breast lesions. Although sensitivity rates for core-needle biopsy are high, it has the disadvantage of histological underestimation, which renders the management of atypical ductal hyperplasia, papillary lesions, and fibroepithelial lesions somewhat difficult. Vacuum assisted breast biopsy (VABB) was developed to overcome some of these negative aspects of core-needle biopsy. VABB allows for a sufficient specimen to be obtained with a single insertion and can provide a more accurate diagnosis and completely remove the lesion under real-time ultrasonic guidance. The advantage of complete lesion removal with VABB is to reduce or eliminate sampling error, to decrease the likelihood of a histological underestimation, to decrease imaging-histological discordance, to decrease the re-biopsy rate, and to diminish the likelihood of subsequent growth on follow-up. In recent years, with the advancement of VABB instruments and techniques, many outcome studies have reported on the use of VABB for resecting benign breast lesions with a curative intent. VABB is highly accurate for diagnosing suspicious breast lesions and is highly successful at treating presumed benign breast lesions. Thus, in the near future, VABB will be routinely offered to all appropriately selected patients.
Biopsy ; Breast ; Breast Diseases ; Breast Neoplasms ; Cicatrix ; Follow-Up Studies ; Humans ; Hyperplasia ; Imidazoles ; Nitro Compounds ; Outcome Assessment (Health Care) ; Selection Bias ; Ultrasonics ; Vacuum

Although primary hyperparathyroidism is a rare disease in Korea, the incidence is increasing gradually due to increased concern and the development of laboratory and imaging techniques. Previous radiological imaging studies for localization of a parathyroid adenoma have been generally unreliable. Recently, preoperative administration of Tc-99m sestamibi has improved detection of parathyroid adenomas. Combining preoperative administration of the sestamibi radionuclide with an intraoperative gamma probe can identify the exact location of a parathyroid adenoma successfully and facilitate a safe and efficient operation under local anesthesia. Limited exploration provides a better cosmetic result while decreasing the potential complications of bilateral exploration. Also, an obvious indication for radio-guided para thyroid surgery with a minimal approach may well be the high-risk patient who cannot tolerate a general anesthestic or an extensive surgical approach. We report three cases of primary hyperparathyroidism which were successfully treated with intraoperative radio-guided parathyroid surgery. These parathyroid surgery can be enhanced especially in the future, when and if an efficient and cost-effective intraoperative PTH assay becomes available.
Anesthesia, Local ; Humans ; Hyperparathyroidism, Primary* ; Incidence ; Korea ; Parathyroid Neoplasms ; Parathyroidectomy* ; Rare Diseases ; Thyroid Gland

PURPOSE: The residual microscopic carcinoma after breast conserving surgery is the most important risk factor of local recurrence. As local recurrences usually develop around resected margins, it is ge nerally accepted that every effort should be made to achieve negative margins intraoperatively, and the presence of microscopically positive margins requires reexcision. Interestingly, sizable percentage of reexcisions results in a specimen free of residual tumor, and may not contribute to disease control, but do add morbidity, cost, and possibly compromise cosmetic result. The goal of our study was to identify which clinico-pathologic factors were associated with positive resection margin, and to identify the variables associated with no residual carcinoma on reexcision or total mastectomy specimens. METHODS: From Sepember 1994 to July 1999, 322 breast conserving surgery were performed on breast cancer patients at the Department of General Surgery, Samsung Medical Center. Among them, 13 patients had positive surgical margins and were treated with reexcision (reexcising the previous lumpectomy cavity with a margin of 1-2 cm of normal tissue) or total mastectomy. RESULTS: The factors associated with positive resection margins were large tumor size, the presence of extensive intraductal component (EIC), and suspicious mammographic microcalcifications without mass density. Six (46.3%) of these reoperation cases for positive margins were negative for residual tumor. The factors correlating with no residual carcinoma on reexcision or mastectomy specimens were small histologic primary tumor size and only one positive resection margin rather than 2 or more positive margins. CONCLUSION: The patients with above-mentioned factors associated with positive resection margins should be treated with more wide local excision or total mastectomy to avoid a second surgical procedure. If the patients with only one positive margin and small tumor size refuse second operation, they could be treated with irradiation only sparing an additional surgical procedure.
Breast Neoplasms ; Breast* ; Humans ; Mastectomy ; Mastectomy, Segmental* ; Mastectomy, Simple ; Neoplasm, Residual ; Recurrence ; Reoperation* ; Risk Factors

PURPOSE: There is ongoing controversy regarding the management of papillary lesions that are diagnosed by core needle biopsy (CNB). The development of vacuum assisted biopsy now permits non-operative removal of papillary breast lesions. Our aim was to evaluate whether the papillary lesions diagnosed by vacuum assisted breast biopsy (VABB) can be followed up without further diagnostic excision. METHODS: From January 2003 to July 2009, a total of 4,655 US-guided mammotome excision were performed in 3,714 patients at Kangnam CHA Hospital. Out of 4,655 lesions, 156 lesions were proved to be papillary lesions. Among these, 82 lesions that had histologic findings that were consistent with benign papillary lesions and that were followed up for more than 2 years without further diagnostic surgical excision were collected and retrospectively analyzed. Ultrasonographic follow-up was done at 3-6 month intervals to assess for recurrence. The mean follow up period was 49.6 months. RESULTS: The pathologic diagnoses for the 82 lesions obtained via VABB were benign intraductal papilloma and papillomatosis. Half of the lesions were palpable and 50.0% (41 cases) were nonpalpable. Twenty eight lesions (34.1%) were classified as BIRADS category 3, 50 lesions (61.0%) were category 4A, 3 lesions (3.7%) were category 4B and only 1 lesion (1.2%) was category 5 according to the ultrasound exams. No local recurrence developed during the follow up period that needed surgical re-excision or rebiopsy. None of those diagnosed as benign lesions at VABB were upgraded to a more advanced lesions. CONCLUSION: The benign papillary lesions that are diagnosed and excised by mammotome may not need further diagnostic surgical re-excision if surgeons are sure that the targeted lesions were excised completely.
Biopsy ; Biopsy, Large-Core Needle ; Breast ; Follow-Up Studies ; Humans ; Papilloma ; Papilloma, Intraductal ; Recurrence ; Retrospective Studies ; Vacuum

BACKGROUND: Green tea modulates neuropathic pain. Reactive oxygen species (ROS) are suggested as a key molecule in the underlying mechanism of neuropathic pain in the spinal cord. We examined the effect of epigallocatechin-3-gallate (EGCG), the major catechin in green tea, in neuropathic pain and clarified the involvement of ROS on the activity of EGCG. METHODS: Neuropathic pain was induced in male Sprague-Dawley rats by spinal nerve ligation (SNL). A polyethylene tube was intrathecally located. Nociceptive degree was estimated by a von Frey filament and expressed as a paw withdrawal threshold (PWT). To determine the role of ROS on the effect of EGCG, a free radical donor (tert-BuOOH) was pretreated before administration of EGCG. ROS activity was assayed by xanthine oxidase (XO) and malondialdehyde (MDA). RESULTS: SNL decreased the PWT compared to sham rats. The decrease remained during the entire observation period. Intrathecal EGCG increased the PWT at the SNL site. Intrathecal tert-BuOOH significantly decreased the effect of EGCG. The levels of both XO and MDA in the spinal cord were increased in SNL rats compared to sham. Intrathecal EGCG decreased the level of XO and MDA. CONCLUSIONS: EGCG may reduce neuropathic pain by SNL due to the suppression of ROS in the spinal cord.
Animals ; Catechin ; Humans ; Ligation ; Male ; Malondialdehyde ; Neuralgia ; Polyethylene ; Rats ; Rats, Sprague-Dawley ; Reactive Oxygen Species* ; Spinal Cord ; Spinal Nerves ; Tea ; Tissue Donors ; Xanthine Oxidase

BACKGROUND: The accurate staging of patients with breast cancer is essential to its management and prognosis. Sentinel node biopsy appears to offer an alternative to routine axillary lymph node dissection for staging breast cancer patients. Current method of routine histopathologic analysis of dissected lymph nodes may be inadequate because up to 30% of patients free of lymph node metastases develop a relapse in 5 to 10 years. Recently, the development of amplification of MUC1 mRNA and keratin 19 mRNA by RT-PCR for detection of micrometastases in breast cancer has been shown to be a sensitive and useful diagnostic method. This study was performed to evaluate the usefulness of MUC1 mRNA and keratin 19 mRNA markers by RT-PCR to detect micrometastases in frozen sections of sentinel lymph nodes from breast cancer patients and to identify which histopathologic prognostic factors were related to RT-PCR detected micrometastases. METHODS: The incidence of axillary micrometastases in 15 sentinel lymph node specimens from 15 patients who underwent breast cancer surgery with sentinel lymphadenectomy was from June 1999 to July 1999 was studied. Complete axillary dissection was made in all of the patients. Each sentinel lymph node specimen was examined by hematoxylin and eosin (H&E) staining, immunohistochemical cyto keratin (IHC) staining and RT-PCR on adjacent sections to determine the expression of the mRNA tumor marker of MUC1 and keratin 19. All of the dissected lymph nodes were examined by serial sectioning. RESULTS: Fourteen out of 15 sentinel lymph nodes were histologically negative in usual H&E staining. Serial sectioning, immunohistochemical (IHC) staining for cytokeratin demonstrated micrometastases in one, two histologically negative sentinel nodes, respectively, and MUC1 mRNA was detected in all of them. Of the 12 sentinel lymph nodes that were diagnosed to be devoid of micrometastases by IHCand serial sectioning, MUC1 mRNA was expressed in 6 nodes, indicating the presence of micrometastases. Micrometastases detected by RT-PCR were significantly correlated with tumor size, expression of p53 and negative PR in conventionally lymph node-negative staged patients. CONCLUSION: The MUC1 mRNA RT-PCR was more sensitive than immunohistochemistry and serial sectioning for the detection of micrometastases in axillary lymph nodes, but keratin 19 was not specific. Sentinel lymph node biopsy with RT-PCR is a more useful means of detecting micrometastases and may have a role in identifying a group of patients who will benefit from earlier adjuvant chemotherapy, but the prognostic significance must be determined after a longer follow-up.
Biopsy ; Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; Eosine Yellowish-(YS) ; Frozen Sections ; Hematoxylin ; Humans ; Immunohistochemistry ; Incidence ; Keratin-19 ; Keratins ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Neoplasm Micrometastasis* ; Prognosis ; Recurrence ; RNA, Messenger ; Sentinel Lymph Node Biopsy

PURPOSE: Fine needle aspiration cytology (FNA) and frozen section (FS) have been extremely valuable tools in the evaluation of thyroid nodules. However, in follicular carcinomas, it is often difficult to distinguish between a benign and a malignant lesion. The aims of this study were to evaluate the characteristic clinicopathologic findings and sensitivities of FNA and FS examination in the diagnosis of follicular carcinomas and to delineate the influence of preoperative and intraoperative clinicopathologic findings and the prognostic factors on the extent of surgery. METHODS: The cases of 33 patients who had undergone thyroid surgery and who had been histologically diagnosed as having follicular thyroid carcinomas were reviewed for age, sex, laboratory findings, FNA findings, frozen-section results, extent of surgery, completion thyroidectomy, and coexistent pathology. RESULTS: There were 28 women and 10 men (2.3:1 ratio) whose ages ranged from 14 to 75 years with a mean of 40.8 years. The mean follow-up was 27.2 months. The most prominent sign was an asymptomatic palpable anterior neck mass, which was present in 29 (87.8%) cases. Fine needle aspiration cytology was performed in 31 patients, revealing a follicular neoplasm in 16 patients (sensitivity=51.6%), an adenomatous goiter in 6 (19.4%), a papillary carcinoma in 5 (16.1%), and an anaplastic carcinoma in 1 (3.2%); the specimens were inadequate in 3 patients (9.7%). Among the 32 patients having an intraoperative frozen sections, only 7 patients (sensitivity=21.2%) were correctly diagnosed as having cancer. The diagnoses were deferred (reported as a follicular neoplasm) in 21 patients (65.6%) and were changed from benign at frozen section to malignant on final diagnosis in 4 patients (12.6%). Among the 21 patients diagnosed as having a follicular neoplasm on frozen section, 10 patients (47.6%) were treated with a subtotal thyroidectomy, 6 patients (28.6%) with a total thyroidectomy taking into consideration the gross findings at operation and prognostic factors such as AGES and AMES to reduce the incidence of a completion thyroidectomy.Only 5 patients (23.8%) underwent a lobectomy followed by a reoperation (a completion thyroidectomy). CONCLUSION: Fine needle aspiration cytology and frozen section results are not good indicators in making the decision regarding the extent of the thyroidectomy. A definitive decision to avoid a completion thyroidectomy should be made during the initial operation based on gross findings, frozen-section results, and prognostic factor such as age, tumor grade, tumor size, and the presence of extracapsular spread or distant metastasis.
Adenocarcinoma, Follicular ; Biopsy, Fine-Needle* ; Carcinoma ; Carcinoma, Papillary ; Diagnosis ; Female ; Follow-Up Studies ; Frozen Sections* ; Goiter ; Humans ; Incidence ; Male ; Neck ; Neoplasm Metastasis ; Pathology ; Reoperation ; Thyroid Gland ; Thyroid Nodule ; Thyroidectomy

PURPOSE: Diallyl disulfide (DADS), an organosulfur compound in garlic, has been reported to be effective in inhibiting the growth of several human tumor cell lines. The aim of this study was to determine whether DADS induced growth inhibition in MCF-7 breast cancer cell lines and to understand the molecular mechanism by which DADS acts. METHODS: MCF-7 cell lines were incubated with various concentrations of DADS for various time intervals and the cytotoxicity was determined by MTT assay. We examined the changes of intracellular proteins related to apoptosis, such as bcl-2, bax and PARP in cells treated with DADS. To study the expression level of bcl-2 and bax, which serve as modulators of apoptosis, we performed RT-PCR and western blot analysis. RESULTS: MCF-7 cells treated with DADS led to the suppression of viability and proliferation in both a time and concentration dependent manner. Microscopic observation revealed typical features of apoptosis in the DADS-treated cells, further verified in nuclear DAPI staining. Flow cyto-metry analysis with FITC-annexinV and propidium iodide (PI) demonstrated that the apoptotic cell population with AnnexinV+/PI- increased dramatically from ~0.8% to ~75% after 24h exposure to 500 microM DADS in MCF-7 cells. Cell cycle analysis demonstrated that the number of apoptotic cells increased with the increasing time of the DADS treatment. Additionally, thermore, we investigated the effects of DADS on apoptosis related gene expression in MCF-7 cells. PARP cleavage was markedly increased in the DADS treated cells with time. This result indicated that DADS induced the caspase-dependent apoptotic pathway. We also found down-regulation of bcl-2, however no significant change of Bax expression was observed after DADS treatment. Conclusion: Taken together, these results indicate that DADS induces apoptosis by activating a caspase pathway involving the activation of Bcl-2 but not of Bax. Our findings suggest chemotherapeutic potentials of DADS in human breast cancer.
Apoptosis ; Blotting, Western ; Breast Neoplasms* ; Breast* ; Cell Cycle ; Cell Line* ; Cell Line, Tumor ; Down-Regulation ; Garlic* ; Gene Expression ; Humans* ; MCF-7 Cells ; Propidium

PURPOSE: Occult papillary thyroid carcinomas (OPC) are defined as tumors measuring < or =15 mm in size. They are believed to be a less aggressive subset of papillary cancers, which behave more like benign lesions, and are often treated more conservatively. However, some groups have reported a high incidence of metastases from papillary microcarcinomas and favor an aggressive surgical resection followed by radioiodine therapy. We review our experience in an attempt to characterize the biology and optimal treatment for OPCs. METHODS: From October 2001 to March 2006, among impalpable thyroid nodules detected incidentally during screening exams, 214 patients underwent surgery for occult papillary thyroid cancer (OPC) at Kangnam Cha University hospital. The data from these patients were analyzed retrospectively. The mean follow up period was 19.9+/-11.7 (max : 53, min : 1) months. RESULTS: The mean age of these patients was 41.4 year, and 188 (87.7%) were female. 41% of the patients underwent a total or neartotal thyroidectomy, 42% had a central lymph node dissection and 41% had radioiodine ablation therapy after surgery. Of the 214 patients, 40 (18.7%) had lymph node metastases. The LN metastases were associated with the tumor size (P=0.0007), extracapsular invasion (P=0.0268) and multifocality (P=0.0024), but there was no association with age and gender. The incidence of the LN metastases (20%) and extracapsular invasion (59.1%) were higher in the tumors between 0.5~1.0 cm in size. With a follow-up up to 53 months, 3 patients had a local recurrence (0.014%) but no patients currently has active disease. No patients with OPC died died during this period. CONCLUSION: In OPC patients, a progressively increasing frequency of signs of tumor aggressiveness with increasing tumor size was observed but a small size itself could not guarantee a low risk or low recurrence rate. The prevalence of LN metastases and extracapsular invasion were higher in tumors > 0.5 cm in size. Therefore, we prefer near-total or total thyroidectomy with central lymph node dissection. Early detection and treatment of OPC might be warranted by the routine use of thyroid USG and USG-guided FNA.
Biology ; Female ; Follow-Up Studies ; Humans ; Incidence ; Lymph Node Excision ; Lymph Nodes ; Mass Screening ; Neoplasm Metastasis ; Prevalence ; Recurrence ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroid Nodule ; Thyroidectomy