PURPOSE: Breast mass - the most common occurences in the breast must be managed by a method that provides both the best medical and cosmetic results. METHODS: Two hundred seventy-eight patients evaluated and managed for breast mass at our center between January 1998 and December 1999 were analysed. In this study, we compare the results of the triple test score (TTS; sum of physical examination, mammography, and fine needle aspiration cytology) with those from each separate diagnostic test according to a standard formula incorporating sensitivity, specificity, positive predictive value, and negative predictive value. The TTS was modified to substitute sonography for mammography-TTSs. The TTS was also compared to the TTS-2 that double weighted the results of fine needle aspiration (FNA), but was otherwise the same as the TTS. RESULTS: The sensitivity and specificity of breast sonography were 90% and 84% whereas those of mammography were 84% and 73%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of the TTSm (triple test score-mammography) were 99%, 97%, 99% and 97% respectively. The scores of the TTSm-2 were 99%, 100%, 100% and 97%. And those of the TTSs were 100%, 100%, 100% and 100%. CONCLUSION: The TTS was more accurate than each of the elements separately in evaluating breast masses. The TTSs was also more effective than the TTSm. The TTS-2 was more useful than the TTS, being less likely to miss malignancy due to the high accuracy of FNA.
Biopsy, Fine-Needle ; Breast* ; Diagnostic Tests, Routine ; Humans ; Mammography ; Physical Examination ; Sensitivity and Specificity

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: It is difficult at times to differentiate between a papillary carcinoma and benign papilloma of the breast, and papillomas can undergo malignant transformation. The authors investigated the expression of cyclin D1 and MIB-1 to assess the diagnostic value of these markers in distinguishing papillary carcinomas from papillomas of the breast, and in determining the clinical relevance of these markers as prognostic predictors. METHODS: The medical records of 38 patients treated for benign and malignant papillary lesions of the breast at Inje University Pusan Paik Hospital between January 1992 and December 1997 were reviewed. Immunohistochemical stains for cyclin D1 and MIB-1 were performed in 30 cases of papilloma and eight cases of papillary carcinoma of the breast. The authors performed a statistical analysis of the relationship between cyclin D1 and MIB-1 with respect to the size of tumors, pathologic lymph nodes, and postsurgical residual lesions, and the recurrence and survival rates. RESULTS: Breast cancer or ADH was associated with six cases (15.79%) of papillary lesions of the breast. The incidence of postsurgical residual lesions and their recurrence were 2.63% and 2.63% in all the patients with papillary lesions of the breast. The labeling index of cyclin D1 was significantly higher in the eight papillary carcinomas (36.7+/-27.0) than in the 30 papillomas (3.5+/-4.2) (P=0.001). There was a statistically significant difference betweenn the MIB-1 labeling index of the eight papillary carcinomas (4.9+/-5.9) and that of the 30 papillomas (0.4+/-1.4) (P=0.0225). The cyclin D1 and MIB-1 expressions of the single intraductal papillomas and multiple papillomas were not different. In addition, there was no statistically significant difference of cyclin D1 and MIB-1 in the eight papillary carcinomas with respect to the associated pathologies, size, positive lymph nodes, recurrence or survival. CONCLUSION: These results suggest that cyclin D1 and MIB-1 might be useful markers for distinguishing papillary carcinomas from papillomas of the breast.
Breast Neoplasms ; Breast* ; Busan ; Carcinoma, Papillary ; Coloring Agents ; Cyclin D1 ; Cyclins* ; Humans ; Incidence ; Lymph Nodes ; Medical Records ; Papilloma ; Papilloma, Intraductal ; Pathology ; Recurrence ; Survival Rate

PURPOSE: PTEN is a novel tumor suppressor gene located on chromosomal band 10q23.3. The detection of PTEN mutations in Cowden disease and in breast carcinoma cell lines suggests that PTEN may be involved in mammary carcinogenesis. Among several series of breast carcinomas, the frequency of loss of flanking markers around PTEN is approximately 30 to 40% and the somatic intragenic PTEN mutation frequency is less than 5%. METHODS: The expression of PTEN was stuided immunohistochemically studied in 41 invasive ductal carcinomas of the breast. We examined the correlation between PTEN expression and clinicopathologic factors such as age, tumor size, lymph node metastasis, histologic grade, nuclear grade, stage, as well as estrogen and progesteron receptors. RESULTS: Among the 41 infiltrating ductal carcinomas, studied 7 (17.1%) were immunohistochemically negative, and 19 (46.3%) demonstrated reduced expression. Among the clinicopathologic factors, tumor size, lymph node metastasis, high stage, and negative progesteron receptor displayed a significant relationship with the decrease of PTEN expression, however age, nuclear grade, and estrogen receptor had less of a relationship with PTEN expression. CONCLUSION: These results suggest that PTEN does play some role as a prognostic factor for carcinogenesis, but this hypothesis requires further study.
Breast Neoplasms ; Breast* ; Carcinogenesis ; Carcinoma, Ductal* ; Cell Line ; Estrogens ; Genes, Tumor Suppressor ; Hamartoma Syndrome, Multiple ; Lymph Nodes ; Mutation Rate ; Neoplasm Metastasis

PURPOSE: The precise mechanisms of tumorigenesis of breast cancer remains unknown in spite of major efforts. Recent studies have shown that High Mobility Group I (Y) Proteins [HMGI(Y)] have an important role in the regulation of chromatin structure and function, and that HMGI(Y) protein expression is generally correlated with a malignant phenotype. This study was undertaken to define the relationship of the HMGI(Y) protein expression between malignant breast tissue and non-malignant breast tissue in human, and clinico- pathologic findings were reviewed for this purpose. METHODS: Using Reverse Transcription-Polymerase Chain Reaction (RT-PCR) for HMGI(Y) with beta-actin, this study demonstrated the expression of HMGI(Y). The p53, ER, and PR. were defined by immunohistochemical staining. RESULTS: The HMGI(Y) expression was increased in the malignant tissue (90%), than in benign (76.9%) or normal (65%) tissue (p=0.031). As for the invasive ductal cancers, there was no difference between the HMGI(Y) expression and histopathologic parameters. CONCLUSION: These results suggest that the HMGI(Y) expression may be of little pathogenetic prognostic importance in human breast cancer.
Actins ; Breast Neoplasms* ; Breast* ; Carcinogenesis ; Chromatin ; Humans* ; Phenotype

PURPOSE: Micropapillary carcinoma in breast cancer was first described by Petersen in 1993, after which other reports from all over the world described their characteristics. In Korea, this type of carcinoma was first described in 1996. The purpose of our study was to find the clinicopathological characteristics of micropapillary carcinomas from our experiences and to compare the results with those of other studies. METHODS: We analyzed 19 patients, from Dec. 1999 to Dec. 2002, diagnosed with micropapillary carcinomas from postoperative pathological reports retrospectively, compared with 939 patients diagnosed with infiltrating duct carcinoma in the same period. RESULTS: The mean age and tumor size were 46.8 years (range 32~73) and 3.75cm (range 0.5~10.0), respectively. Micropapillary carcinoma showed the larger size (P=0.032) and more frequent rates of lymphovascular invasion (P= 0.007) and metastasis to axillary lymph nodes (P=0.003) than infiltrating duct carcinoma. But, in the T stage-matched analysis, the rates of axillary lymph node metastasis in micropapillary carcinoma and infiltrating duct carcinoma showed no significant differences (T1, T2, T3 : P=0.072, P= 0.080, P=0.575 ). Only in T2 stage, rates of lymphovascular invasion showed more frequent significantly in micropapillary carcinoma (P=0.012). Age, nuclear and histological grades showed no significant differences. The positive expressions of estrogen and progesterone receptors were more frequent in micropapillary carcinoma compared with infiltrating duct carcinoma, while the expressions of the C-erb-B2, p53, Ki-67 and bcl-2 showed no significant differences. CONCLUSION: The micropapillary carcinomas showed more frequent lymphovascular invasion and positive expressions of the estrogen and progesterone receptors in their immunohistochemistry.
Breast Neoplasms ; Breast* ; Estrogens ; Humans ; Immunohistochemistry ; Korea ; Lymph Nodes ; Neoplasm Metastasis ; Receptors, Progesterone ; Retrospective Studies

PURPOSE: This study was performed to show the several clinical variables before and after the surgery that need to be considered for patient selection and whether there is an increased possibility of recurrence after surgery and whether this possibility can be reduced when adjuvant treatment is applied. METHODS: The outcome of SSM with immediate breast reconstruction, using follow-up data of cases performed at Asan Medical Center between September, 1996 and December, 2002, were retrospectively assessed and pathologically advanced breast cancer patients (stage III) were analyzed separately. RESULTS: 191 patients had undergone SSM with immediate reconstruction during the study period. The percentage of cases stage III was 15.2% (29 cases). Among these patients, 6 (20.7%) were suspected of being in the early stages of breast cancer prior to the surgery. The mean age of the advanced breast cancer patients was 37 years. Immediate breast reconstruction consisted of a pedicled TRAM flap (n=24), a insertion of tissue expander (n=4) or direct implant (n=1). Radiotherapy was performed in 16 patients (53.3%) and chemotherapy was conducted without delay in all case. With a median length of follow-up of 36.1 months for 22 patients, who under went the operation until December, 2001, local recurrence was 4.5% (1/22) with successful local treatment, and distant metastasis was 13.7% (3/22). There was no difference in the disease free survival compared to that of the non-reconstruction group (P=0.093). CONCLUSION: SSM with immediate reconstruction seems safe and effective for patients with advanced breast cancer. However an accurate preoperative assessment of the extent of the disease and discussion for the planning of treatment between surgeon and patient is required.
Breast Neoplasms* ; Breast* ; Chungcheongnam-do ; Disease-Free Survival ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Mammaplasty* ; Mastectomy* ; Neoplasm Metastasis ; Patient Selection ; Radiotherapy ; Recurrence ; Retrospective Studies ; Tissue Expansion Devices

PURPOSE: Breast augmentation has recently become a common plastic surgical procedure performed in Korea. However, the incidence of re-operation has also increased due to various complications. The purpose of this study is to analyze the complications of primary augmentation mammoplasty and to demonstrate the reasons for re- operations. METHODS: Among augmentation mammoplasty cases operated in M.D. Clinic from Jan. 2002 to Jul. 2003, 42 cases of re-operations were reviewed. Age, interim primary operations, used implants, complications and reasons of re- operations and methods of re-operations were retrospectively evaluated. RESULTS: Patients from half of the cases were in their thirties. Almost halves of the patients were operated again within a year. Common reasons of re-operations were complications in shape and physical texture. For shape problems, they commonly complained of upper fullness or double bubble deformity and asymmetry. The author commonly used a periareolar incision (95.2%) and saline bag implants (81.0%) for re-operations. The usual size of the implant was between 151 and 250 cc. In 7 capsular contracture cases, 3 capsulotomy, 3 capsulectomy and 1 case of subpectoral conversion were performed, of which 1 case in capsulotomy and 1 subpectoral conversion recurred. CONCLUSION: Augmentation mammoplasty is not a simple procedure, making many complications in shape, physical texture, breast functions, and others that is related to breast diseases. For better outcomes in re-operation cases, exact understanding and evaluation of primary complications are essential.
Breast ; Breast Diseases ; Congenital Abnormalities ; Contracture ; Female ; Humans ; Incidence ; Korea ; Mammaplasty* ; Reoperation ; Retrospective Studies

PURPOSE: With the increase of early breast cancer patients, the number of node negative breast cancer patients is also on the rise. However, reports show that there is a 20~30% recurrence in node negative breast cancer. Thus, we have attempted to determine the prognostic factors that may affect recurrence and relapse free survival. METHODS: From January, 1980, to June, 1999, 1110 node negative breast cancer patients who underwent curative surgery at the Severance Hospital, Yonsei University College of Medicine, were selected. A retrospective study was done to determine the effects of factors, such as operation method, age, size, type, histologic grade, intraductal components, ER, PR, c-erbB-2, number of lymph nodes removed, adjuvant chemotherapy, hormonal therapy and radiation therapy. RESULTS: The mean age was 47.2 years. The median follow- up period was 88 months. Recurrence occurred in 161 patients. Locoregional recurrence occurred in 64 patients, and systemic recurrence in 129 patients, while 32 patients had both. The 5 years overall survival rate was 93.3%. The rate of locoregional recurrence for a 10 year-period was significantly lower in the mastectomy group compared with that in the breast conservation therapy group (94.7% vs 79.6%, P=0.000). No other prognostic factors except the age affected in locoregional recurrence. There was less systemic recurrence in patients with the age greater than 35, with the histologic grade I, and with the intraductal components greater than 20%. Thus, 10-years distant relapse free survival rates were 87.4% vs 79.8% (P=0.039), 93.5% vs 85.5% (P=0.024), and 94.4% vs 82.0% (P=0.007), respectively. There was no statistical significance in the other prognostic factors that influence systemic recurrence. CONCLUSION: The patients' age was determined to be an independent prognostic value in the lymph node negative breast cancer. The histologic grade and intraductal components showed to have significance as prognostic factors for systemic recurrence.
Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; Humans ; Lymph Nodes* ; Mastectomy ; Recurrence ; Retrospective Studies ; Survival Rate

PURPOSE: NPI (Nottingham prognostic index) including tumor size, lymph node status and histological grade is widely used for the estimation of prognosis in breast carcinomas, and recently, the immunohistochemical index (IHPI) using ER, PR, c-erbB-2, and p53 expressions was suggested as an useful prognosticator. The aim of this study is to evaluate the reliability of NPI and IHPIs in 141 breast carcinomas. METHODS: Statistical analysis among size, lymph node status, histological grade, NPI, ER, PR, c-erbB-2, p53 and MIB-1 labelling index(LI) and IHPIs were performed. The IHPI-1 battery consisted of ER, PR, c-erbB-2 and p53. In the IHPI-2 battery, MIB-1 LI was added to the IHPI-1 battery. In the IHPI-3 battery, MIB-1 LI was also added, but ER and PR were not included. RESULTS: The prognostic estimation based on NPI showed significant relationships with PR, c-erbB-2, MIB-1, and the prognostic estimations according to IHPI-1, IHPI-2 and IHPI-3 battery. In addition, MIB-1 LI revealed a positive relationship to the histological grade. The prognostic estimation based on IHPI-3 showed a positive relationship to the lymph node status. CONCLUSION: The prognostic estimation based on NPI and a battery of immunohistochemical stains consisted of c-erbB-2, p53 and MIB-1 seem to be reliable in breast carcinomas.
Breast Neoplasms* ; Breast* ; Coloring Agents ; Immunohistochemistry ; Lymph Nodes ; Prognosis