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.

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

We report a case of breast gigantism in a patient with Wilson's disease treated with penicillamine. A 19-year-old female with alleged Wilson's disease visited our hospital due to diffuse enlargement of both breasts. She had been treated with penicillamine 1,000 mg/day since her age of 15 after diagnosis of Wilson's disease. At the initial presentation, there were diffuse skin thickenings in both lower inner breasts and huge lesion which replaced almost all the breast parenchyma. After gun biopsy and excision for tissue diagnosis, fibroadenoma with ductal epithelial hyperplasia was diagnosed. Although daily dose of penicillamine was lowed to 500 mg/day, her symptom progressed. After 1 year of follow up, she and her parents strongly wanted to remove her breasts because of distorted body shape and weight of breasts. The patients underwent subcutaneous mastectomy with the designed incision of the reduction mammoplasty for the future mammoplasty. Although the breast gigantism is a rare side effect of penicillamine, female patients should be followed up cautiously for the possible change of breasts. Because penicillamine is no more the first choice for Wilson's disease, it would be better to avoid using penicillamine for Wilson's disease patients especially for the young females.
Biopsy ; Breast* ; Diagnosis ; Female ; Fibroadenoma ; Follow-Up Studies ; Gigantism* ; Hepatolenticular Degeneration* ; Humans ; Hyperplasia ; Mammaplasty ; Mastectomy, Subcutaneous ; Parents ; Penicillamine* ; Skin ; Young Adult

We report a case of breast gigantism in a patient with Wilson's disease treated with penicillamine. A 19-year-old female with alleged Wilson's disease visited our hospital due to diffuse enlargement of both breasts. She had been treated with penicillamine 1,000 mg/day since her age of 15 after diagnosis of Wilson's disease. At the initial presentation, there were diffuse skin thickenings in both lower inner breasts and huge lesion which replaced almost all the breast parenchyma. After gun biopsy and excision for tissue diagnosis, fibroadenoma with ductal epithelial hyperplasia was diagnosed. Although daily dose of penicillamine was lowed to 500 mg/day, her symptom progressed. After 1 year of follow up, she and her parents strongly wanted to remove her breasts because of distorted body shape and weight of breasts. The patients underwent subcutaneous mastectomy with the designed incision of the reduction mammoplasty for the future mammoplasty. Although the breast gigantism is a rare side effect of penicillamine, female patients should be followed up cautiously for the possible change of breasts. Because penicillamine is no more the first choice for Wilson's disease, it would be better to avoid using penicillamine for Wilson's disease patients especially for the young females.
Biopsy ; Breast* ; Diagnosis ; Female ; Fibroadenoma ; Follow-Up Studies ; Gigantism* ; Hepatolenticular Degeneration* ; Humans ; Hyperplasia ; Mammaplasty ; Mastectomy, Subcutaneous ; Parents ; Penicillamine* ; Skin ; Young Adult

PURPOSE: To evaluate the independent prognostic value of Ki-67 in lymph node-negative breast cancer and the usefulness of Ki-67 when it combined with St. Gallen classification as a guidance of adjuvant chemotherapy for node-negative cancer. METHODS: We retrospectively reviewed the data of 534 patients with lymph node-negative breast cancer who underwent curative surgery between 1998 and 2001 at our institution. Patients were classified according to the guideline of risk groups of St. Gallen consensus and the level of Ki-67 expression. Distant metastasis-free survival (DFS) rates were compared between groups. RESULTS: With a median follow-up of 55 months, the overall 5-year DFS rate was 91.5%. The 5-year DFS rates for patients with high and low Ki-67 tumors (cut-off value: > or = 10%) were 84.6% and 93.7%, respectively (p < 0.001). In a Cox regression model involving potential prognostic factors, high Ki-67 expression could independently predict the risk of distant recurrence (odds ratio = 2.0 [95% confidence interval, 1.03-3.93]). The 5-year DFS rates for patients with average and minimal risk group of St. Gallen classification were 89.3% and 97.5%, respectively. The average risk group was further divided into two subgroups with significantly different prognosis according to the Ki-67 expression (DFS rate: 84.2% vs. 91.5%; p = 0.007). CONCLUSIONS: Ki-67 was an independent prognostic factor in lymph node-negative breast cancer and the combination of Ki-67 expression and the St. Gallen classification could provide a more useful therapeutic guideline for lymph node-negative breast cancer patients.
Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; Classification ; Consensus ; Follow-Up Studies ; Humans ; Prognosis ; Recurrence ; Retrospective Studies

PURPOSE: To evaluate the independent prognostic value of Ki-67 in lymph node-negative breast cancer and the usefulness of Ki-67 when it combined with St. Gallen classification as a guidance of adjuvant chemotherapy for node-negative cancer. METHODS: We retrospectively reviewed the data of 534 patients with lymph node-negative breast cancer who underwent curative surgery between 1998 and 2001 at our institution. Patients were classified according to the guideline of risk groups of St. Gallen consensus and the level of Ki-67 expression. Distant metastasis-free survival (DFS) rates were compared between groups. RESULTS: With a median follow-up of 55 months, the overall 5-year DFS rate was 91.5%. The 5-year DFS rates for patients with high and low Ki-67 tumors (cut-off value: > or = 10%) were 84.6% and 93.7%, respectively (p < 0.001). In a Cox regression model involving potential prognostic factors, high Ki-67 expression could independently predict the risk of distant recurrence (odds ratio = 2.0 [95% confidence interval, 1.03-3.93]). The 5-year DFS rates for patients with average and minimal risk group of St. Gallen classification were 89.3% and 97.5%, respectively. The average risk group was further divided into two subgroups with significantly different prognosis according to the Ki-67 expression (DFS rate: 84.2% vs. 91.5%; p = 0.007). CONCLUSIONS: Ki-67 was an independent prognostic factor in lymph node-negative breast cancer and the combination of Ki-67 expression and the St. Gallen classification could provide a more useful therapeutic guideline for lymph node-negative breast cancer patients.
Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; Classification ; Consensus ; Follow-Up Studies ; Humans ; Prognosis ; Recurrence ; Retrospective Studies

PURPOSE: Metaplastic carcinomas of the breast (MCBs) are rare diseases. The aim of this study is to evaluate the clinicopathologic characteristics of MCBs and to compare them with those of infiltrating ductal carcinoma (IDC). METHODS: Thirty-eight patients who underwent surgery at Seoul National University Hospital from May 1982 to December 2002 were retrospectively analyzed on the basis of the medical records and the pathology reports. These patients were compared with 3578 IDC patients that we experienced during the same period. RESULTS: The histologic subtypes of MCBs were 7 squamous, 6 matrix-producing, 7 sarcomatous, 4 mixed, 1 osteogenic, and 13 unclassified tumors. The mean tumor size was 4.4+/-3.1 cm. The operations' methods were a modified radical mastectomy in 26 patients, breast conserving surgery in 11 patients and only an incisional biopsy in one patient. Lymph node metastases and distant metastases were detected in 11 (29.7%) and 5 (13.2%) patients respectively. Lymph node metastases of MCBs were significantly lower than that for the IDC group (p = 0.030). Otherwise, the distant metastases were significantly higher than that of the IDC group (p = 0.019). The MCBs group also showed a significantly higher nuclear grade and histologic grade than did the IDC group (p = 0.001, p = 0.001). Estrogen receptor and progesterone receptor positivity was 5.3% and 5.3% respectively, which were significantly lower than that for the IDC group (p < 0.001, p = 0.002). The overall 5 year survival rate was 65% and the 5 year disease-free survival rate was 68%. After exclusion of patients with distant metastasis, the overall survival rates were not significantly different between the two groups (p = 0.291). CONCLUSION: MCB is a rare pathological entity. Compared with IDC, MCB displays a larger size, less lymph node metastasis, more distant metastasis, a higher histologic grade, and less hormone receptor expression. MCB has a poorer overall survival rate, which is probably due to its frequent distant metastasis.
Biopsy ; Breast* ; Carcinoma, Ductal ; Disease-Free Survival ; Estrogens ; Humans ; Lymph Nodes ; Mastectomy, Modified Radical ; Mastectomy, Segmental ; Medical Records ; Metaplasia ; Neoplasm Metastasis ; Pathology ; Prognosis ; Rare Diseases ; Receptors, Progesterone ; Retrospective Studies ; Seoul ; Survival Rate