No abstract available.

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

PURPOSE: Phyllodes tumors are characterized by a double-layered epithelial component arranged in cleft-like ducts surrounded by a hypercellular spindle-celled stroma. Currently, phyllodes tumors are classified as benign, borderline, or malignant based on microscopic features. The relatively high rate of recurrence is an unsolved management problem. If a malignant phllodes tumor is treated inadequately, it may show a propensity for rapid growth and metastatic spread. However, benign phyllodes tumor are often indistinguishable from fibroadenoma, and can be cured by local surgery. Percutaneous removal of benign breast tumors using the Mammotome system has recently been regarded as a feasible, safe method without serious complications. The Mammotome system has an expanding role in the surgical treatment of benign breast disease, and may further extend its role to the excision of small malignant lesions. The aim of this study was to evaluate the efficacy and the safety of the Mammotome biopsy device in the treatment of benign phyllodes tumor, and to identify whether surgical excision is necessary for benign phyllodes tumors diagnosed and excised by Mammotome. METHODS: From Jan. 2003 to Feb. 2007, a total of 2,751 US- guided mammotome excisions were performed in 2,226 patients at Kangnam Cha hospital. Out of 2,751 lesions, 30 lesions were proved to be benign phyllodes tumors. All lesions were removed using an 8-gauge probe without any residual lesions. Ultrasonographic follow-up was performed at a 3- to 6-month interval to assess recurrence. The mean follow-up period was 33.2 months (max, 51 months; min, 2 months). RESULTS: The mean patient age was 31.4 years. The average size of the lesion was 1.5 cm (SD+0.43 cm). The majority of lesions, 73.3% (22 cases), were palpable, and 26.7% (8 cases) were nonpalpable. Twenty-two lesions (73.8%) were classified as BIRADS category 3, eight lesions (26.7%) were classified as category 4A by ultrasound. During the follow-up period, local recurrence developed in only one patient, making the local recurrence rate 3.3%. No distant metastasis was observed. CONCLUSION: Benign phyllodes tumors found on mammotome excision may not require surgical reexcision if surgeons are sure that the targeted lesions were excised completely and the follow-up ultrasound does not show any residual lesions, especially in small phyllodes tumors, the greatest dimension of which is less than 3 cm.
Biopsy* ; Breast Diseases ; Breast Neoplasms ; Breast* ; Fibroadenoma ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Phyllodes Tumor* ; Recurrence ; Ultrasonography

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

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

PURPOSE: Male breast cancer is a rare type of neoplasm, account for 1 % of all breast tumors. A retrospective review of the clinical and histological characteristics, types of treatment, pathological staging, and adjuvant treatment was completed. The objective of this study was to make an early diagnosis of male breast cancer and reduce the mortality. METHODS: Over a 5-year period, from Oct. 1994 to July 2000, 10 male breast cancer patients were operated on in the breast cancer clinic of the Samsung Medical Center. Their duration of follow up ranged from 6 to 76 months with a mean of 26 months. The clinical and histological characteristics, associations of the risk factors, type of treatment, and results were studied. RESULTS: Their ages ranged from 40 to 67 years with a mean of 51 years, with 5, 3 and 2 cases in their 5th, 6th, and 7th decades, respectively. A palpable breast lump was the most common presenting symptom. A pathological assessment disclosed 8 infiltrating ductal carcinoma, 1 ductal carcinoma in situ, and 1 invasive adenoid cystic carcinoma. The tumor sizes ranged from 0.5 to 3.7 cm (median, 1.9 cm in diameter). Of the 10 patients, there were 3 T1b, 3 T1c, and 4 T2 in the tumor staging. 4 Patients had axillary node involvement (lymph node positivity, 40%), and of these 4, the metastasis involved 2 lymph nodes and more than 3 lymph nodes in 1 and 3 case, respectively. No distant metastasis was observed in any of the patients. Pathological stages of the patients 0, I, IIIA, and IIIB in 1, 5, 1 and 2 cases, respectively. All the patients underwent surgery, 7 with a modified radical mastectomy and 3 with a radical mastectomy, due to gross invasion of the pectoralis major muscle. CONCLUSION: A subareolar palpable breast mass was the most common presenting symptom of the male breast cancer patients. The optimal treatment for male breast cancer patients is a modified radical mastectomy, combined with radiotherapy, chemotherapy, and hormonal therapy, due to the higher hormone receptors positivity.
Breast Neoplasms ; Breast Neoplasms, Male ; Breast* ; Carcinoma, Adenoid Cystic ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Drug Therapy ; Early Diagnosis ; Follow-Up Studies ; Humans ; Lymph Nodes ; Male* ; Mastectomy, Modified Radical ; Mastectomy, Radical ; Mortality ; Neoplasm Metastasis ; Neoplasm Staging ; Radiotherapy ; Retrospective Studies ; Risk Factors

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: We wanted to evaluate the clinical utility of performing bilateral whole breast US as a subsequent diagnostic method along with mammography in asymptomatic women. MATERIALS AND METHODS: From May 2002 to Dec 2004, we conducted 3998 examinations on 3638 patients with negative findings on the clinical examination and negative mammographic results, and those breast tissues having a BI-RADS category 2, 3, or 4 density were further evaluated by performing bilateral whole breast US. The patients' age distribution ranged from 24 to 66 years (mean age: 43.6 yrs). The abnormalities were compared with core or vacuum assisted core biopsy, operations, and follow up US. For the normal cases, we used the clinical notes and the statistical data from the Korean Central Cancer Registry. RESULTS: For 3998 examinations of 3638 women who were examined with bilateral whole breast US, pathologic confirmations were available for 433 patients and follow-up data were available for 35 patients. The sensitivity, specificity, the positive predictive value and the cancer detection rate of using additional whole breast US were 50, 92.6, 0.6 and 0.5, respectively. The two cancers that were detected only on US were minimal breast cancer. CONCLUSION: Although all the breast cancers that were detected only on US were minimal breast cancers, performing bilateral whole breast US revealed a low cancer detection rate and a high false positive. Therefore, further studies will be needed to investigate the role of US as a screening tool.
Age Distribution ; Biopsy ; Breast Neoplasms ; Breast* ; Female ; Follow-Up Studies ; Humans ; Mammography ; Mass Screening ; Sensitivity and Specificity ; Vacuum

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