We report a case of metastatic thyroid-papillary carcinoma of the breast. A 42-year-old woman was admitted to our hospital due to palpable masses on both breasts. Past history revealed that she had three individual thyroid operations due to thyroid papillary carcinoma. The first was a left lobectomy 6 years ago, the second was a subtotal thyroidectomy 2 years ago, and the third was a excision of the neck mass due to last year's recurrence. The patient underwent mass excisions on both breasts under the impression of a benign tumor. Pathologic findings of the masses showed similar histologic findings of the thyroid papillary carcinoma and immunohistochemical stainings demonstrated that the tumors originated from the thyroid.
Adult ; Breast Neoplasms ; Breast* ; Carcinoma, Papillary ; Female ; Humans ; Neck ; Recurrence ; Thyroid Gland ; Thyroidectomy

PURPOSE: Tc-99m Tetrofosmin is a new alternative to Tc- 99m MIBI for nuclear breast imaging. A receiver operating characteristic (ROC) curve analysis was performed to evaluate the feasibility of Tc-99m Tetrofosmin quantitative scintimammography (SMM) (qSMM) and to compare with previously reported Tc-99m MIBI qSMM data [J Kor Surg 1999;57(5):638-644)]. METHODS: Prone anterior, lateral planar and supine SPECT images were taken from 135 cases in 131 female patients (mean ages=44 yr) with breast mass (size> or =0.2 cm) after 30mCi intravenous injection of Tc-99m Tetrofosmin. 70 malignant and 65 benign lesions were histologically proven. Three regions of interest (ROIs) were drawn over designated areas: the Lesion (L), the Normal breast opposite the lesion (NL) and the right Chest wall (CW). L/NL and L/CW ratios on both the SPECT and the planar images were analyzed. RESULTS: ROC curve analysis revealed that the planar L/NL ratio and the SPECT L/NL and L/CW ratios had higher diagnostic accuracy for detecting breast cancer than he planar L/CW ratio did (P<0.05). The qSMM (mean), which is an arithmetic mean of the planar L/NL ratio, the SPECT L/NL ratio and the SPECT L/CW ratio, the sensitivity, the specificity, accuracy and area under curve (AUC) were 82.9%, 81.5%, 82.2% and 0.879 respectively. Presence of axillary lymph node metastasis showed a slightly higher qSMM (mean) value (2.79 {n=23} vs 2.75 {n=27} P=0.06). These are comparable with previously reported Tc-99m MIBI qSMM data of 84.4%, 76.6%, 81.0% and 0.847 respectively, and the presence of axillary lymph node metastasis showed a higher qSMM(mean) value (4.09 {n=17} vs 3.09 {n=28}, P=0.06) [J Kor Surg 1999; 57(5):638-644)]. CONCLUSION: Tc-99m Tetrofosmin qSMM (mean) is a useful and objective method for differentiating malignant from benign breast lesion and has the comparable diagnostic accuracies of Tc-99m MIBI qSMM.
Area Under Curve ; Breast Neoplasms* ; Breast* ; Female ; Humans ; Injections, Intravenous ; Lymph Nodes ; Neoplasm Metastasis ; ROC Curve* ; Sensitivity and Specificity ; Thoracic Wall ; Tomography, Emission-Computed, Single-Photon

PURPOSE: Whether they are mammographically visible or not, breast ultrasonography is widely used for differential diagnosis of palpable breast masses. The aim of this study is to evaluate the usefulness of cytological examinations and ultrasonographical follow-ups in the management of non-palpable, mammographically non-visible breast masses incidentally detected only by ultrasonography screening. METHODS: One hundred forty-six lesions of non-palpable and mammographically non-visible, but ultrasonographically detected solid masses (sonic masses) from 120 female patients were examined at the Breast Clinic, Chungbuk National University Hospital from January, 2000, to February, 2003. We performed ultrasonogram-guided percutaneous fine-needle aspiration biopsy in all sonic masses and proceeded all sonic masses by sequential ultrasonography at 3-, 6- and 12-month intervals if there was no suspicion of malignancy. RESULTS: One hundred thirty-eight lesions (94.5%) were ultrasonographically diagnosed as benign and eight lesions (5.5%) as malignant. Eight ultrasonographically malignant lesions were all proved to be benign by cytological examinations or ultrasonogram-guided needle localization biopsies and not palpable during the follow-up period. Cytological interpretations revealed 127 lesions (87.0%) as benign, 5 lesions (3.4%) as atypical epithelial cells and 14 lesions (9.6%) as nondiagnostic. Five atypical epithelial lesions were found benign through ultrasonogram-guided needle localization biopsies or core needle biopsies in the final diagnosis. The ultrasonography was used for follow-up in all lesions. There was no evidence of malignancy in any lesion during the follow-up. CONCLUSION: In our study, there was no evidence of malignancy in breast sonic masses during the follow-up period. Our data showed that sequential ultrasonographical follow-up is sufficient for ultrasonographically benign sonic masses.
Biopsy ; Biopsy, Fine-Needle ; Biopsy, Large-Core Needle ; Breast* ; Chungcheongbuk-do ; Diagnosis ; Diagnosis, Differential ; Epithelial Cells ; Female ; Follow-Up Studies ; Humans ; Mass Screening ; Needles ; Ultrasonography* ; Ultrasonography, Mammary

PURPOSE: Small breast cysts, which can be resolved by fine-needle aspiration, are often presented as hypoechoic masses on ultrasound examinations. They can be misinterpreted as benign tumors and cause unnecessary follow-ups or biopsies. The aim of this study was to find out the proportion of atypical breast cysts, which can be resolved by needle aspiration, among hypoechoic masses less than 1 cm in size and to investigate the relationship between the characteristics of a mass and its probability of being cystic. METHODS: Between March 2003 and May 2003, we found and aspirated 119 hypoechoic masses less than 1 cm in size from 104 consecutive patients. RESULTS: Mass size ranged from 2.5 mm to 9.8 mm, with a median size of 5.5 mm. Among the 119 hypoechoic masses, 40 masses (33.6%) were cystic and 79 masses (66.4%) were solid. Among the 40 cystic masses, 37 were completely resolved by needle aspiration, one mass was reduced to half, and the 2 remaining masses were reduced to a third of their sizes. In patients in their 20's, 11.1% of the hypoechoic masses were cystic masses, the ratios for patients in their 30's, 40's, 50's, and 60's were 11.4%, 32.0%, 76.2%, and 75%, respectively (P<0.001). With decreasing internal echo of mass, the likelihood of being a cyst increased (P=0.026). However predicting the probability of being a cyst by the margin, the degree of posterior acoustic enhancement, and the location of the mass was difficult (P>0.05). CONCLUSION: Needle aspiration must be considered in small hypoechoic masses not speculated as definite solid masses.
Acoustics ; Biopsy ; Biopsy, Fine-Needle* ; Breast Cyst ; Follow-Up Studies ; Humans ; Needles ; Ultrasonography ; Ultrasonography, Mammary

PURPOSE: Imaging studies for the diagnosis of breast cancer such as ultrasonography or mammography, play an essential role; however, it is well known that they have some limitations; the low specificity of ultrasonography and the low sensitivity of mammography, especially in the dense breasts of Korean women. Recently, 99mTc-MIBI scintimammography was introduced for the detection of breast cancer, and showed acceptable results in its diagnostic accuracy. In this study, the clinical usefulness of 99mTc-MIBI scintimammography was evaluated for the determination of a better imaging study for the diagnosis of breast cancer. METHODS: This study included 75 patients with breast masses, and 3 imaging studies were performed; mammography, ultrasonography and 99mTc-MIBI scintimammography and the results compared on the basis of the pathological reports from core needle or excisional biopsies of the patients. RESULTS: From the pathological reports of 75 patients, 45 cases were confirmed as malignant and 30 as benign diseases. Based on the pathological reports, the sensitivities of mammography, ultrasonography and 99mTc-MIBI scintimammiography were 62.2, 88.9, and 86.7%, and the specificites of 3 imaging studies were 90.0, 76.7, and 90.3% respectively. The positive predictive values were 90.3, 85.1, and 92.9% and the negative predictive values were 61.4, 82.1, and 81.8%, respectively. 99mTc-MIBI mammoscintigraphy showed a comparable sensitivity to ultra-sonography, and a similar specificity to mammography, in the diagnosis of breast cancer. CONCLUSION: Clinically, as a primary imaging tool, 99mTc-MIBI mammoscintigraphy showed acceptable results in the diagnosis of breast cancer. Considering the weak points of ultrasonography and mammography, 99mTc-MIBI mammoscintigraphy would be a very useful tool in the diagnosis of breast cancer.
Biopsy ; Breast Neoplasms* ; Breast* ; Diagnosis* ; Female ; Humans ; Mammography ; Needles ; Sensitivity and Specificity ; Ultrasonography

PURPOSE: Most tests developed for the determination of the HER2 status still require validation, although identification of the HER2 status is important for predicting the response to specific systemic therapy in breast cancer. Fluorescence in situ hybridization (FISH) and immunohistochemistry (IHC) were performed for the HER2 expression on the tissue microarray (TMA) from primary breast cancers to validate the feasibility of IHC for HER2 assay. METHODS: A TMA was constructed from 134~231 primary breast cancers. FISH and IHC were repeated more than twice, and the results were analyzed. Three kinds of primary antibody for IHC were used and compared. RESULTS: The HER2 was amplified by FISH in 24~28% of breast cancer with a concordance between multiple assays of 92~100% (kappa=0.994-0.965), while the HER2 was overexpressed in 21~27% by IHC. The HER2 was amplified in 70~100% of the IHC 3+ cases, but was observed in only 45~78% and 5~12% of the IHC 2+ and IHC 0~1+ cases, respectively. The results from the IHC, using 3 different primary antibodies to HER2, were in good agreement each other at 88~92% (kappa=0.902-0.799). CONCLUSION: The results of the FISH appeared to be more reproducible than those of the IHC in the current study. The results of the IHC were not different from each other according to primary antibody used. However, a considerable proportions of the IHC positive cases were not confirmed by the FISH. This report indicates a need to improve the laboratory quality control measures when using the IHC for the HER2 assay, including the periodic testing for the concordance with FISH.
Antibodies ; Breast Neoplasms* ; Breast* ; Fluorescence* ; Immunohistochemistry* ; In Situ Hybridization* ; Quality Control

PURPOSE: Early detection and treatment of cancer is a primary focus of health care. Many serum markers are available for breast cancer, but are not good enough for screening. Cancer antigen CA 15-3 is the most widely used biomarker for breast cancer. However, CA 15-3 has low sensitivity and specificity. This study was performed to analyze the serum proteomic pattern in breast cancer patients by surface-enhanced laser desoption/ionization time- of-flight (SELDI-TOF). METHODS: We screened for potential tumor biomarkers in 42 serum samples, including samples from a group of 23 breast cancer patients at different clinical stages [stage I (n=3), stage II (n=11), stage III (n=6), and stage IV (n=1)], and a control group of 19 healthy women. Diluted serum samples were applied to a C16 hydrophobic interaction chip (H4). Complex protein profiles of different groups were compared and analyzed using the Protein Chip software 2.1 (Ciphergen Biosystems). RESULTS: There were 7 significant protein peaks in the breast cancer group and 5 in the control group. Scoring the expression of each peak, the mean score was 8.5 in the cancer group and 3.5 in the control. The results of the combination of each peak were highly sensitive (91.2%) and specific (94.7%). These proteomic patterns did not correlate with tumor stage and hormonal receptor, c-erb B2. CONCLUSION: In this preliminary report, we identified protein profiles that were differentiated in breast cancer patients. After proper validation, serum proteomic pattern analysis may ultimately be applied in screening breast cancer as a stand-alone or combined with current options.
Biomarkers ; Breast Neoplasms* ; Breast* ; Delivery of Health Care ; Female ; Humans ; Hydrophobic and Hydrophilic Interactions ; Mass Screening ; Protein Array Analysis ; Proteomics ; Sensitivity and Specificity

PURPOSE: This study evaluated the benefit of radiation therapy in high-risk breast cancer patients who have received immediate transverse rectus abdominis myocutaneous (TRAM) flap reconstruction. The evaluation involved examining the effect of radiation therapy on postmastectomy flap fat necrosis and tumor recurrence. METHODS: A retrospective review was performed on 102 patients who underwent mastectomy and immediate TRAM flap reconstruction between 1996 and 2001 at the Asan Medical Center (Seoul, Korea). The mean patient age was 41 years, and the median follow-up time was 33 months. Skin-sparing mastectomy was con ducted in 82 patients (80.4%) and classical mastectomy in 20 patients (19.6%). Of the 21 high-risk patients needing postmastectomy radiation therapy, nine received it. RESULTS: Moderate or severe TRAM flap fat necrosis occurred more frequently in patients receiving radiation therapy than those not receiving radiation therapy (55.6% vs. 19.4%, P=0.026). In the group with high-risk patients, two tumor recurrences occurred (one-locoregional and one-systemic). Among the 102 patients, thirteen had recurrences, including only two high-risk patients, with almost of them being systemic recurrences except four locoregional recurrences. CONCLUSION: Our findings showed that radiation therapy increased flap fat necrosis in high-risk patients underwent immediate TRAM flap reconstruction. Such necrosis can result in poor outcomes for reconstruction. We recommend careful consideration prior to using radiation therapy on high-risk breast cancer patients after immediate TRAM flap reconstruction, where clinicians need to balance the possible positive effects on recurrence with the possible negative effects on flap tissue.
Breast Neoplasms* ; Breast* ; Chungcheongnam-do ; Fat Necrosis* ; Follow-Up Studies ; Humans ; Mastectomy* ; Necrosis ; Rectus Abdominis ; Recurrence ; Retrospective Studies

PURPOSE: Aberrant methylation of promoter cytosine guanine dinucleotide (CpG) islands is known to be responsible for the alteration and silencing of cancer genes. The data presented here show that most methylations of Estrogen Receptoralpha (ERalpha) and ERbeta are found at or near the transcriptional factor binding sites in the breast cancer tissues. METHODS: Fifty archival breast cancer tissues and twenty-five normal tissues were selected and the status of the methylation and the transcription were investigated by bisulfite genomic sequencing and reverse transcription (RT) PCR. RESULTS: Consequently, the hypermethylation of ERalpha and ERbeta genes was found in 66.0% and 50.0% of 50 breast cancers, respectively. In particular, the methylation sites were frequently located near the CCAAT box (-363 and -375) for the ERalpha gene, and at or adjacent to binding sites of GATA (-217, -302) and Sp1 (+224, +227, +160) for the ERbeta gene. The methylations at or near the binding sites were observed in most of the methylated cancers (ERalpha 87.9%, and ERbeta 84.0%). The methylated cases were negatively correlated with the expression of ERalpha and ERbeta RNA (P<0.01). In particular, tumors with CpG methylation of ERalpha and ERbeta at or near the binding sites did not express mRNA, whereas those CpG methylation outside the sites showed moderate expression. Four tumors with methylated ERalpha genes at sites unrelated to the binding sites showed higher levels of protein expression than those with methylation at or near the sites (P=0.01). CONCLUSION: Although the number of samples was relatively small, our results suggest that DNA methylation in ERalpha and ERbeta appears to take significant effect on transcriptional silencing and is most often present in the CpG sites at or near the putative transcriptional factor binding sites. We believe this finding offers a clue to the initiation or spread pattern of CpG methylation in human breast cancer.
Binding Sites ; Breast Neoplasms* ; Breast* ; Cytosine ; DNA Methylation ; Estrogen Receptor alpha* ; Estrogen Receptor beta* ; Estrogens ; Genes, Neoplasm ; Guanine ; Humans ; Islands ; Methylation* ; Polymerase Chain Reaction ; Reverse Transcription ; RNA ; RNA, Messenger

Mammary gland development and function would not be possible without tissue-specific stem cells. The mammalian reproductive cycles of pregnancy-associated proliferation, lactational differentiation, apoptosis and remodelling following weaning may occur many times during a female's reproductive years. Such processes necessitate a population of tissue-specific stem cells that have a near unlimited capacity to generate the short-lived, differentiated breast cells. In contrast to the functional cells, breast stem cells must last throughout the life of an organism. Because of this longevity, stem cells may accumulate genetic alterations that eventually lead to cancer. Breast tumors contain a population with stem-cell characteristics. Current tumour therapy modalities target proliferative cells, and be successful in causing tumor regression. Targeting these tumor stem cells will be an important goal of future research.
Apoptosis ; Breast Neoplasms ; Breast* ; Longevity ; Mammary Glands, Human ; Neoplastic Stem Cells ; Stem Cells* ; Weaning