PURPOSE: To explain the concept and procedure of random allocation as used in a randomized controlled study. METHODS: We explain the general concept of random allocation and demonstrate how to perform the procedure easily and how to report it in a paper.
Humans ; Random Allocation ; Randomized Controlled Trials as Topic/*methods

PURPOSE: We investigated the prognostic impact of discordance between the receptor status of primary breast cancers and corresponding metastases. METHODS: A total 144 patients with breast cancer and distant metastasis were investigated. The estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status of primary tumor and corresponding metastases were assessed. Tumor phenotype according to receptor status was classified as triple-negative phenotype (TNP) or non-TNP. Concordance and discordance was determined by whether there was a change in receptor status or phenotype between primary and metastatic lesions. RESULTS: The rates of discordance between primary breast cancer and metastatic lesions were 18.1%, 25.0%, and 10.3% for ER, PR, and HER2, respectively. The rates of concordant non-TNP, concordant TNP and discordant TNP were 65.9%, 20.9%, and 13.2%, respectively. Patients with concordant ER/PR-negative status had worse postrecurrence survival (PRS) than patients with concordant ER/PR-positive and discordant ER/PR status (p=0.001 and p=0.021, respectively). Patients who converted from HER2-positive to negative after distant metastasis had worst PRS (p=0.040). Multivariate analysis showed that concordant TNP was statistically significant factor for worse PRS (p<0.001). CONCLUSION: Discordance in receptor status and tumor phenotype between primary breast cancer and corresponding metastatic lesions was observed. Patients with concordant TNP had worse long-term outcomes than patients with concordant non-TNP and discordant TNP between primary and metastatic breast cancer. Identifying the receptor status of metastatic lesions may lead to improvements in patient management and survival.
Breast Neoplasms ; Breast* ; Estrogens ; Humans ; Multivariate Analysis ; Neoplasm Metastasis* ; Phenotype* ; Prognosis* ; Receptor, Epidermal Growth Factor ; Receptors, Progesterone

The use of neoadjuvant chemotherapy in older patients is increasing. However, chemotherapy should be administered considering the medical comorbidities of the patients and the toxicity of chemotherapeutic agents. Here, we present a case of abdominal wall hematoma with spontaneous inferior epigastric artery injury caused by coughing in a 70-year-old woman who was treated with neoadjuvant chemotherapy. Abdominal computed tomography demonstrated an abdominal wall hematoma with active bleeding. However, angiography with selective embolization of the right inferior epigastric artery and the right internal mammary artery was performed successfully. Scheduled chemotherapy was discontinued over concerns of rebleeding and breast-conserving surgery was performed. When deciding on chemotherapy for older patients, attention should be paid to the various complications.

Purpose: To evaluate the axillary recurrence rate and usefulness of axillary ultrasound (AUS) during supplementary whole-breast ultrasound (US) screening in women with a personal history of breast cancer (PHBC). Methods: A retrospective database search identified consecutive asymptomatic women who underwent postoperative supplemental whole-breast US screening, including that of the bilateral axillae, after negative findings on mammography between January and June 2017. Using the pathologic data or at least 1-year follow-up data as reference standards, the axillary recurrence rate, cancer detection rate (CDR), interval axillary recurrence rate per 1,000 screenings, sensitivity, specificity, and abnormal interpretation rate (AIR) were estimated. Results: From the data of 4,430 women (mean age, 55.0 ± 10.1 years) analyzed in this study, there were five axillary recurrence cases (1.1/1,000) in the median follow-up period of 57.2 months. AUS showed a CDR of 0.2 (1/4,430; 95% confidence interval [CI], 0.01–1.3) and an interval axillary recurrence rate of 0.9 (4/4,402; 95% CI, 0.2–2.3) per 1,000 examinations. The sensitivity and specificity were 20.0% (1/5; 95% CI, 0.5–71.6), and 99.4% (4,398/4,425; 95% CI, 99.1–99.6), respectively, while the AIR was 0.6% (28/4,430; 95% CI, 0.4–0.9%). Conclusion In asymptomatic women with a PHBC and negative findings on mammography, axillary recurrence after breast cancer and axillary treatment was uncommon, and the supplemental AUS screening yielded 0.2 cancers per 1,000 examinations.

PURPOSE: The expression of Annexin A1 (ANXA1) is known to be reduced in human breast cancer; however, the role of ANXA1 expression in the development of breast cancer remains unclear. In this study, we determined the relationship between the expression features of ANXA1 and the prognostic factors of breast cancer. METHODS: Human breast tissues were obtained from patients specimens who had undergone breast surgery or core needle biopsies. The patterns of ANXA1 expression were analyzed by immunohistochemical staining in relation to histopathological diagnosis, clinical characteristics and outcomes. RESULTS: One hundred eighty-two cases were included and the mean age of the patients was 46.34 +/- 11.5 years. A significant loss of ANXA1 expression was noted in both ductal carcinoma in situ (DCIS) and invasive carcinomas compared to normal breast tissues (p<0.001) and benign breast diseases (p<0.001). There was a significant alteration in ANXA1 expression according to hormone receptor status (p<0.001), cancer intrinsic type (p<0.001), and nuclear grade (p=0.004) in invasive cancer. In a univariate analysis, ANXA1 positivity tended to be related with poor breast cancer-related survival (p=0.062); however, the same results was not realized in multivariate results (p=0.406). HER2 overexpression and TNM staging were significantly associated with relapse-free survivals (RFS) in the multivariate analysis (p=0.037, p=0.048, respectively). In particular, in node-positive patients (p=0.048), HER2 overexpressed patients (p=0.013), and non-triple negative breast cancer patients (p=0.002), ANXA1 overexpression was correlated with poor RFS. CONCLUSION: Although significant loss of ANXA1 expression was noted in breast cancer including DCIS and invasive carcinoma, in cases of invasive cancer, overexpression of ANXA1 was related to unfavorable prognostic factors. And these results imply that ANXA1 plays dualistic roles and is involved in variable mechanisms related to cancer development and progression.
Annexin A1 ; Biopsy, Large-Core Needle ; Breast ; Breast Diseases ; Breast Neoplasms ; Carcinoma, Intraductal, Noninfiltrating ; Humans ; Multivariate Analysis ; Neoplasm Staging

The RUNX3 gene is regarded as a tumor suppressor gene in many human solid tumors, and its inactivation is believed to be related with solid tumor carcinogenesis. As little information is available about the role of the RUNX3 gene in breast cancer, we investigated the relationship between the RUNX3 gene and breast cancer. We performed reverse transcriptase-polymerases chain reaction (RT-PCR), methylation specific PCR, and bicolor fluorescent in situ hybridization analysis in an effort to reveal related mechanisms. Forty breast tissue samples and 13 cell lines were used in this study. Eighty-five percent of breast cancer tissues showed downregulated RUNX3 gene expression, whereas it was downregulated in only 25% of normal breast tissues by RT-PCR assay. Sixty-seven percent of breast cancer cell lines showed downregulated RUNX3 expression, but the RUNX3 gene was not expressed in two normal breast cell lines. Hypermethylation was observed in 53% of breast cancer tissues and 57% of breast cancer cell lines. Hemizygous deletion was observed in 43% of breast cancer cell lines. Hypermethylation and/or hemizygous deletion was observed in 5 of 7 breast cancer cell lines, and the four of these five examined showed no RUNX3 gene expression. We suggest that various mechanisms, including methylation and hemizygous deletion, could contribute to RUNX3 gene inactivation.
Base Sequence ; Breast Neoplasms/*genetics ; Carcinoma, Ductal, Breast/*genetics ; Case-Control Studies ; Cell Line, Tumor ; Core Binding Factor Alpha 3 Subunit/*genetics ; DNA Methylation ; DNA, Neoplasm/genetics ; Down-Regulation ; Female ; Gene Deletion ; Humans ; In Situ Hybridization, Fluorescence ; Promoter Regions, Genetic ; Reverse Transcriptase Polymerase Chain Reaction

PURPOSE: We evaluated the efficacy of breast magnetic resonance imaging (MRI) for detecting additional malignancies in breast cancer patients newly diagnosed by breast ultrasonography and mammography. METHODS: We retrospectively reviewed the records of 1,038 breast cancer patients who underwent preoperative mammography, bilateral breast ultrasonography, and subsequent breast MRI between August 2007 and December 2010 at single institution in Korea. MRI-detected additional lesions were defined as those lesions detected by breast MRI that were previously undetected by mammography and ultrasonography and which would otherwise have not been identified. RESULTS: Among the 1,038 cases, 228 additional lesions (22.0%) and 30 additional malignancies (2.9%) were detected by breast MRI. Of these 228 lesions, 109 were suspected to be malignant (Breast Imaging-Reporting and Data System category 4 or 5) on breast MRI and second-look ultrasonography and 30 were pathologically confirmed to be malignant (13.2%). Of these 30 lesions, 21 were ipsilateral to the main lesion and nine were contralateral. Fourteen lesions were in situ carcinomas and 16 were invasive carcinomas. The positive predictive value of breast MRI was 27.5% (30/109). No clinicopathological factors were significantly associated with additional malignant foci. CONCLUSION: Breast MRI was useful in detecting additional malignancy in a small number of patients who underwent ultrasonography and mammography.
Breast ; Breast Neoplasms* ; Humans ; Information Systems ; Korea ; Limit of Detection ; Magnetic Resonance Imaging* ; Mammography* ; Retrospective Studies ; Ultrasonography* ; Ultrasonography, Mammary

PURPOSE: Transient hypocalcemia is frequently observed after thyroid operation for most cases. The symptoms are recovered through calcium administration, but some patients suffer from permanent hypocalcemia. METHODS: We analyzed the medical records of 723 cases who underwent thyroidectomy from Mar 2001 to Dec 2002. Hypocalcemia is defined as case of decreased ionized calcium, and hypoparathyroidism as case of decreased PTH for more than 1 year or decreased ionized calcium despite of administration of calcium more than 1 year. RESULTS: Out of 723 cases of operation; 139 cases (19.2%) were presented with hypocalcemia after operation. But patients with hypocalcemic symptoms were only 67 cases (9.3%) and with hypoparathyroidism were 15 cases (2.1%). On the basis of operation range, hypocalcemia and hypoparathyroidism were observed more frequently in case of total thyroidectomy (46.9%) than in the cases of operation less than total thyroidectomy (53.1%). Out of total patients, 285 cases(39.4%) were benign while 438 cases (60.6%) were malignant histologically. Hypocalcemia were observed from 22 benign cases and 117 malignant cases, indicating significant difference between the two groups of patients (P <0.001). 2 benign cases and 13 malignant cases had hypoparathyroidism, also indicating significant difference between two groups of patients (P=0.037). In cases of extrathyroidal extension, more frequent hypocalcemia (P<0.004) and hypoparathyroidism were observed (P=0.048). On lo gistic analysis, total thyroidectomy (P=0.004) and extrathyroidal extension (P=0.048) constituted independent risk factor for immediate hypocalcemia and completion thyroidecotmy (P=0.018) and extrathyroidal extension (P=0.037) for permanent hypoparathyroidism. CONCLUSION: Postoperative hypocalcemia is affected substantially by the extent of thyroidectomy. Therefore close attention is necessary to check and preserve parathyroid glands in case that extent of surgery is more than total thyroidectomy.
Calcium ; Humans ; Hypocalcemia ; Hypoparathyroidism* ; Medical Records ; Parathyroid Glands ; Risk Factors ; Thyroid Gland* ; Thyroidectomy

PURPOSE: In the present study, we aimed to evaluate the initial tumor location as a prognostic factor in breast cancer patients treated with neoadjuvant chemotherapy (NAC). METHODS: Between March 2002 and January 2007, a total of 179 patients with stage II/III breast cancer underwent NAC followed by breast surgery. Using physical and radiologic findings, patients were grouped by their initial tumor location into inner/both quadrant (upper/lower inner quadrant involvement +/− multicentric tumor involving outer quadrant; n=97) and outer quadrant (n=82) tumor groups. All patients received neoadjuvant docetaxel/doxorubicin chemotherapy. One hundred two patients underwent modified radical mastectomy and 77 patients underwent breast-conserving surgery. Adjuvant radiotherapy (RT) and hormonal therapy were administered after surgery when indicated. While 156 patients underwent postoperative RT, 23 did not. The median follow-up duration was 61.1 (12–106) months. RESULTS: The 5-year disease-free survival (DFS) and overall survival rates of all patients were 74.8% and 89.9%, respectively. Patients with inner/both quadrant tumors had lower 5-year DFS than those with outer quadrant tumors (67.7% vs. 83.4%, respectively; hazard ratio [HR]=1.941, p=0.034). A nodal ratio >25% was also an independent adverse prognostic factor for DFS (HR=3.276; p<0.001). There was no significant difference in DFS (p=0.592) after RT on the internal mammary node (IMN). Treatment failed in 44 out of 179 patients (24.6%), of which 27 patients had inner/both quadrant tumors. Twenty-one out of 27 patients had distant failures. CONCLUSION: Among breast cancer patients treated with NAC, those with inner/both quadrant tumors had lower DFS than those with outer quadrant tumors. More aggressive neoadjuvant and/or adjuvant chemotherapy with IMN RT is required for improved disease control and long-term survival.
Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; Disease-Free Survival ; Drug Therapy* ; Follow-Up Studies ; Humans ; Mastectomy, Modified Radical ; Mastectomy, Segmental ; Neoadjuvant Therapy ; Prognosis ; Radiotherapy, Adjuvant ; Survival Rate

PURPOSE: In this study we evaluated the significance of false positive screening bone scintigraphy (BS) in primary invasive breast cancer patients. Lymphatic vessel invasion (LVI), estrogen receptor (ER), progesterone receptor (PR), nuclear grade, histology grade, epidermal growth factor receptor (EGFR) and C-erb-B2 values were examined in terms of their abilities to predict the accuracy of abnormal BS. We also examined the incidence of bone metastasis in primary invasive breast cancer patients according to the 1988 and 2003 AJCC classifications. METHODS: A retrospective review was performed on 2,044 primary invasive breast cancer patients that had received BS screening, and who were treated by mastectomy or breast conserving surgery at the Seoul National University Hospital between Jan 1995 and Jul 2003. Abnormal screening BS results were divided into "less suspicious" and "highly suspicious" groups. Patient's stages according to the 1988 AJCC classification were reclassified according to the 2003 AJCC classification. Bone metastasis was confirmed by further radiological examination or follow-up BS. All statistical analyses were two-tailed. RESULTS: The incidences of bone metastasis and an abnormal screening BS result were 1.7% (35/2,044) and 13.8% (283/2,044), respectively. The false positive rate of screening BS was 87.6% (248/283). LVI was the only significant predictive factor of bone metastasis in 283 of the abnormal BS patients (p <.001). c-erb-B2 showed no significance to predict bone metastasis in the "less suspicious" group, but was Bone is the most common site of distant metastasis in invasive breast cancer at the time of primary diagnosis. The vertebrae are the most common sites of bone metastasis and the ribs, skull, sternum and proximal long bones are also frequently involved. Bone metastases affect 8% of patients marginally significant in the "highly suspicious" group (p = .046). ER, PR, nuclear grade, histology grade, and EGFR showed no significance in terms of predicting the accuracy of an abnormal BS result. The incidences of bone metastasis were 0.6, 1.3 and 7.6% in stages I, II and III, respectively, according to the 1988 AJCC classification, while these incidences were 0.6, 0.7 and 5.8% according to the 2003 AJCC classification. CONCLUSION: The use of screening bone scintigraphy as a routine screening test is hard to justify due to its high false positive rate. LVI may be a useful factor in that it predicts the accuracy of an abnormal BS result. The incidences of bone metastasis in stages II and III were lower for the 2003 AJCC staging system.
Breast Neoplasms* ; Breast* ; Classification ; Diagnosis ; Estrogens ; Follow-Up Studies ; Humans ; Incidence ; Lymphatic Vessels ; Mass Screening* ; Mastectomy ; Mastectomy, Segmental ; Neoplasm Metastasis* ; Radionuclide Imaging* ; Receptor, Epidermal Growth Factor ; Receptors, Progesterone ; Retrospective Studies ; Ribs ; Seoul ; Skull ; Spine ; Sternum