PURPOSE: Since the publication of the 5th edition of the AJCC cancer staging manual in 1997 (old stage), significant developments have occurred in the field of breast cancer diagnosis and management; therefore, it was revised at 2002 (new stage). There are few reports comparing the changes in prognosis in relation to the changes in the staging system. The aims of this study were to evaluate the changes in patient distribution and prognosis according to the changes in the staging system and to elucidate the efficacy of new staging system. METHODS: The records of 1, 275 patients who underwent an operation for breast cancer at Yeung-Nam University Hospital between 1987 and 2003 were reviewed. The pathological stage was assigned retrospectively according to the 5th and the 6th AJCC staging criteria. The patient distributions by stage, nodal status, 5-year relapse free survival (RFSR) and overall survival rates (OSR) were retrospectively compared. RESULTS: Five hundred and five of 616 stage II patients according to the 1997 classification system were also stage II according to the 6th AJCC staging system. The number of patients with stages IIA and IIB decreased from 370 and 246 (old stage) to 342 and 165 (new stage), respectively. Conversely, the number of patients with stage III increased from 158 (old stage) to 271 (new stage). The five-year RFSR for patients with stage I, IIA, IIB, and IIIA were 94.2, 87.1, 74.3, and 48.8% according to the old stage (P<0.0001), and 95.2, 87.8, 81.7, and 66.8%, respectively, according to the new stage (P<0.0001). The five-year OSR for patients with stage I, IIA, IIB, and IIIA were 98.7, 94.3, 86.1, and 63.5% according to the old stage (P<0.0001), and 98.7, 95.7, 96.5, and 72.9%, respectively, according to the new stage (P<0.0001). The RFSR and OSR for stage IIIC were 42.0 and 59.5%, respectively. There was significant difference in the five-year OSR for stages IIB and IIIA (P=0.0308 and P=0.0132, respectively). CONCLUSION: In our study, the 6th AJCC staging system shifted poorer prognostic cohort of each stage toward a higher stage compared to the 1997 version. Therefore, the survival rate for any one stage assigned by 2002 staging system was also improved. In conclusion, it is imperative that careful attention is devoted to this effect so that accurate conclusions regarding the efficacy of new treatment can be drawn.
Breast Neoplasms* ; Breast* ; Classification ; Cohort Studies ; Diagnosis ; Humans ; Joints* ; Neoplasm Staging ; Prognosis ; Publications ; Recurrence ; Retrospective Studies ; Survival Rate

Among many adverse effects of docetaxel, fluid retention is a well recognized, cumulative side effect, but severe fluid retention is rare. We report here on a case of docetaxel-induced severe fluid retention with peripheral edema, pleural effusion, severe ascites and pericardial effusion in a 41-year-old woman. She had been treated with 3 cycles of docetaxel 9 days previously and she was admitted to our hospital due to abdominal distention and mild dyspnea. Radiologic studies revealed pleural effusion, severe ascites and a small pericardial effusion. Diuretics were given for 21 days. The pleural effusion was resolved after treatment with diuretics for 2 days, but the ascites wasn't resolved until 14 days of diuretics. After treatment with diuretics for 21 days, all the symptoms of the patient were completely resolved. Early detection is mandatory and diuretics are very effective for patient suffering with docetaxel-induced severe fluid retention.
Adult ; Ascites ; Breast ; Breast Neoplasms ; Diuretics ; Dyspnea ; Edema ; Female ; Fluid Shifts ; Humans ; Pericardial Effusion ; Pleural Effusion ; Retention (Psychology) ; Stress, Psychological ; Taxoids

PURPOSE: The aims of this study were to evaluate the clinicopathologic characteristics and the prognosis of patients with estrogen receptor negative/progesterone receptor positive (ER-/PR+) breast cancer. METHODS: One thousand five hundred seventy patients were stratified according to ER/PR phenotype and our study focused on the ER-/PR+ phenotype. The clinicopathologic characteristics and the prognosis of patients with the ER-/PR+ phenotype were compared with those of patients with ER+ (ER+/PR- or ER+/PR+) breast cancer. RESULTS: The mean age at diagnosis was 47.1 years (range, 20-88) and the mean follow-up was 65.2 months. The horjmone receptor phenotype was ER-/PR+ in 75 cases (4.8%) and ER+ (ER+/PR+ or ER+/PR-) in 917 cases (58.4%). A patient age <50 (p=0.001), a high histologic grade (p=0.004) and C-erbB2 overexpression (p=0.006) were more frequent for the patients with the ER-/PR+ tumors. There was a significant difference between the two groups for the mean age (p<0.001). The 5 year and 10 year disease-free survival (DFS) rates of the ER-/PR+ group were 67.2% and 55.3%, respectively, and those of the ER+ group were 84.9% and 73.1%, respectively (p<0.001). The 5 year and 10 year overall survival (OS) of the ER-/PR+ group were 82.4% and 62.6%, respectively, and those of ER+ group were 93.4% and 83.3%, respectively (p=0.001). In the under 50 year old patients, the 5 year DFS and OS of the ER-/PR+ group were 67.5% and 85.8%, respectively, and those of ER+ group were 86.3% and 95.8%, respectively. There were significant differences between two groups for the DFS and OS (p<0.001). CONCLUSION: ER-/PR+ tumors have more aggressive clinicopathologic features than ER+ tumors. Furthermore, in the under 50 year old patients, ER-/PR+ tumors showed a worse prognosis than did the ER+ tumors. Consequently, treatment modality and the prognosis of the patients with ER-/PR+ tumors probably need to be altered from those of the patients with ER+ tumors.
Breast ; Breast Neoplasms ; Disease-Free Survival ; Estrogens ; Follow-Up Studies ; Humans ; Phenotype ; Progesterone ; Prognosis ; Receptors, Progesterone

PURPOSE: Little is known about long term results of nipple-areola preserving skin-sparing mastectomy (NASSM), and there are no such reports on this from South Korea. We studied 5 years follow up results of NASSM and skin sparing mastectomy (SSM) and compared clinical outcomes between NASSM and SSM. METHODS: Two hundred two patients who underwent SSM (69 patients) or NASSM (133 patients) from September 1996 to December 2006 were included. Frozen section analysis of retroareolar resection margin was done to make the decision on preserving or not preserving nipple-areolar complex (NAC). In the case of positive result on the frozen section, NAC was sacrificed. The local relapse (LR) rate and local relapse free survival (LFS) were analyzed for comparing between NASSM and SSM. RESULTS: The mean age was 40.2 years (range, 24-65), the mean follow-up was 67.6 months. 52 NACs (25.7%) were involved by tumor cells. The invasion to the NAC by tumor cell was more common for invasive carcinoma with extensive intraductal component (p<0.001), central located tumor (p=0.025) and invasive carcinoma with multiplicity (p=0.001). There were 12 cases (9.0%) of local relapse in NASSM group and 4 (5.8%) in SSM group, but there was no significant correlation for the LR rate (p>0.05). Regional or distant recurrence after surgical treatment for local relapse occurred in only one SSM case. Five years LFS rate of the NASSM group was 92.1% and that of the SSM group was 95.2%. There was no significant difference for the LFS (p>0.05). CONCLUSION: Our long term follow up study showed that NASSM and SSM are much alike for their LR rate and LFS. Even if relapse occurs in the NAC, this recurrence cannot affect the progression of relapse after adequate local treatment. Thus, NASSM is alternative method for SSM with oncological safety and better cosmetic outcome.
Breast ; Cosmetics ; Follow-Up Studies ; Frozen Sections ; Humans ; Mastectomy ; Nipples ; Prognosis ; Recurrence ; Republic of Korea ; Skin

PURPOSE: The aims of this study were to evaluate the clinicopathologic characteristics and the prognosis of patients with estrogen receptor negative/progesterone receptor positive (ER-/PR+) breast cancer. METHODS: One thousand five hundred seventy patients were stratified according to ER/PR phenotype and our study focused on the ER-/PR+ phenotype. The clinicopathologic characteristics and the prognosis of patients with the ER-/PR+ phenotype were compared with those of patients with ER+ (ER+/PR- or ER+/PR+) breast cancer. RESULTS: The mean age at diagnosis was 47.1 years (range, 20-88) and the mean follow-up was 65.2 months. The horjmone receptor phenotype was ER-/PR+ in 75 cases (4.8%) and ER+ (ER+/PR+ or ER+/PR-) in 917 cases (58.4%). A patient age <50 (p=0.001), a high histologic grade (p=0.004) and C-erbB2 overexpression (p=0.006) were more frequent for the patients with the ER-/PR+ tumors. There was a significant difference between the two groups for the mean age (p<0.001). The 5 year and 10 year disease-free survival (DFS) rates of the ER-/PR+ group were 67.2% and 55.3%, respectively, and those of the ER+ group were 84.9% and 73.1%, respectively (p<0.001). The 5 year and 10 year overall survival (OS) of the ER-/PR+ group were 82.4% and 62.6%, respectively, and those of ER+ group were 93.4% and 83.3%, respectively (p=0.001). In the under 50 year old patients, the 5 year DFS and OS of the ER-/PR+ group were 67.5% and 85.8%, respectively, and those of ER+ group were 86.3% and 95.8%, respectively. There were significant differences between two groups for the DFS and OS (p<0.001). CONCLUSION: ER-/PR+ tumors have more aggressive clinicopathologic features than ER+ tumors. Furthermore, in the under 50 year old patients, ER-/PR+ tumors showed a worse prognosis than did the ER+ tumors. Consequently, treatment modality and the prognosis of the patients with ER-/PR+ tumors probably need to be altered from those of the patients with ER+ tumors.
Breast ; Breast Neoplasms ; Disease-Free Survival ; Estrogens ; Follow-Up Studies ; Humans ; Phenotype ; Progesterone ; Prognosis ; Receptors, Progesterone

PURPOSE: Little is known about long term results of nipple-areola preserving skin-sparing mastectomy (NASSM), and there are no such reports on this from South Korea. We studied 5 years follow up results of NASSM and skin sparing mastectomy (SSM) and compared clinical outcomes between NASSM and SSM. METHODS: Two hundred two patients who underwent SSM (69 patients) or NASSM (133 patients) from September 1996 to December 2006 were included. Frozen section analysis of retroareolar resection margin was done to make the decision on preserving or not preserving nipple-areolar complex (NAC). In the case of positive result on the frozen section, NAC was sacrificed. The local relapse (LR) rate and local relapse free survival (LFS) were analyzed for comparing between NASSM and SSM. RESULTS: The mean age was 40.2 years (range, 24-65), the mean follow-up was 67.6 months. 52 NACs (25.7%) were involved by tumor cells. The invasion to the NAC by tumor cell was more common for invasive carcinoma with extensive intraductal component (p<0.001), central located tumor (p=0.025) and invasive carcinoma with multiplicity (p=0.001). There were 12 cases (9.0%) of local relapse in NASSM group and 4 (5.8%) in SSM group, but there was no significant correlation for the LR rate (p>0.05). Regional or distant recurrence after surgical treatment for local relapse occurred in only one SSM case. Five years LFS rate of the NASSM group was 92.1% and that of the SSM group was 95.2%. There was no significant difference for the LFS (p>0.05). CONCLUSION: Our long term follow up study showed that NASSM and SSM are much alike for their LR rate and LFS. Even if relapse occurs in the NAC, this recurrence cannot affect the progression of relapse after adequate local treatment. Thus, NASSM is alternative method for SSM with oncological safety and better cosmetic outcome.
Breast ; Cosmetics ; Follow-Up Studies ; Frozen Sections ; Humans ; Mastectomy ; Nipples ; Prognosis ; Recurrence ; Republic of Korea ; Skin

PURPOSE: The aim of this study was to evaluate the prognostic significance of the breast volume in primary breast cancer patients with the same T stage. METHODS: The study population consisted of 358 patients with T1 and T2 primary breast cancer, who underwent preoperative mammography and surgery in our institution from March 1992 to December 2006. The patients were divided into three groups based on the calculated breast volume as the following: Group A: <285 cc (n=117), Group B: 285-460 cc (n=121) and Group C: > or =460 cc (n=120). Overall survival (OS) and disease free survival (DFS) of the patients in the three groups in each T stage were analyzed. RESULTS: The mean age was 46.3 years (age range, 22-85 years) and the mean calculated breast volume was 403.1 cc (volume range, 94-1,231 cc). As the age of patients was increased, the breast volume was increased (r=0.184, p<0.001). With a mean follow up period of 80.8 months, there was no significant difference in DFS or OS among patients in Groups A, B, and C (p>0.05). For patients with T1 stage disease, Group A patients showed the highest DFS and OS, and patients in Group C showed the lowest DFS and OS; however, the difference was not statistically significant (p>0.05). For patients with T2 disease, patients in Group C showed the highest DFS and OS, though the difference with the two other groups did not have statistical significance (p>0.05). CONCLUSION: The breast volume was not a significant predictor of DFS and OS for patients with T1 and T2 breast cancer. However it should be noted that this was the first study to evaluate the correlation between breast volume and survival in breast cancer patients.
Breast ; Breast Neoplasms ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Mammography ; Organ Size ; Prognosis

PURPOSE: Serum prostate specific antigen (PSA) is widely used for the early detection of prostate cancer, with biopsies often being performed when the serum concentration exceeds a defined threshold. The concept of prostate specific antigen density (PSAD) was introduced to enhance the specificity of serum PSA for cancer. We investigated the change in serum PSA and PSAD in patients with clinical prostatitis after antibiotic treatment. MATERIALS AND METHODS: A series of 39 patients with chronic prostatitis whose serum PSA and PSAD exceeded 4.0 ng/ml and 0.15 ng/ml/cm3, respectively, were reviewed retrospectively. After they received 4 to 8 weeks of antibiotics, the serum PSA concentration was remeasured. Men with persistently elevated serum PSA concentrations underwent prostate biopsy. RESULTS: The mean pretreatment serum PSA and PSAD was 8.73 ng/ml and 0.24 ng/ml/cm3, respectively. After antibiotic treatment, the mean values decreased significantly, to 4.55 ng/ml and 0.13 ng/ml/cm3, respectively (p<0.05). The mean decrease in serum PSA was 4.19 3.78 ng/ml, a mean relative change 44.3 31.7%. Among 39 men, 22 (56.4%) had their serum PSA and PSAD values return to the normal ranges. Prostate biopsy in 24 patients with persistently elevated serum PSA or PSAD after antibiotic therapy revealed prostate cancer in 4. CONCLUSIONS: Prostatitis is one of the most important factors in serum PSA and PSAD elevation in men without clinically detectable prostate cancer. A decrease in PSA and PSAD after antibiotic treatment can help in avoiding unnecessary prostate biopsies.
Anti-Bacterial Agents ; Biopsy ; Humans ; Male ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Prostatitis* ; Reference Values ; Retrospective Studies ; Sensitivity and Specificity

PURPOSE: The aim of this study was to confirm the feasibility of the technique, the so called "axillary reverse mapping (ARM)", and to test the hypothesis that the arm lymphatics are never involved by the metastatic process of breast cancer. METHODS: We reviewed the prospectively maintained database of 129 patients who underwent an operation for breast cancer. Blue dye was injected in the upper inner arm to identify the draining lymphatics or lymph nodes from the arm. During the axillary procedure, we found the "blue" ARM node and the "hot" sentinel lymph node (SLN). The histological results of the ARM nodes were compared with those of the other nodes harvested in SLN biopsy (SLNB) or axillary lymph node dissection (ALND). RESULTS: The ARM nodes were identified in 78.3% (101/129) of the patients. The ARM nodes were identified in 71.6% (58/81) of the patients with SLNB and in 88.4% (38/43) of the patients with SLNB followed by ALND and in all cases with ALND. In 19 of the 96 SLNB cases, the ARM nodes were hot or the SLNs were blue (concordant case), yielding an 18.9% concordant rate between the ARM node and the SLN. Among these 19 concordant cases, 7 ARM nodes contained metastasis (36.8%). But in the 77 non-concordant cases, only one ARM node was positive for metastasis (1.3%) in a heavily metastasized axilla. The ARM nodes were identified in all five ALND cases, and one ARM node was positive for metastasis. CONCLUSION: It is thought that lymphatic drainage from the arm can share common lymphatic channels in the axilla with lymphatic flow from breast, and these concordant ARM nodes may be involved by the metastatic process of breast cancer. However in the non-concordant cases, ARM nodes will be free from the danger of axillary dissection.
Arm ; Axilla ; Biopsy ; Breast ; Breast Neoplasms ; Drainage ; Humans ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Nitriles ; Pyrethrins ; Sentinel Lymph Node Biopsy

PURPOSE: The aim of this study was to evaluate the safety of robotic or endoscopic thyroidectomy via bilateral axillo-breast approach (BABA) without a drainage procedure. METHODS: A total of 64 patients who underwent robotic or endoscopic thyroidectomy via BABA without a close suction drain between February and March 2012 were enrolled. We checked postoperative symptoms or signs including change of vital signs, dyspnea, swelling or fluctuation of anterior chest and neck and compression symptoms at 1, 6, 24, and 48 hours and 1 month after surgery. Postoperative ultrasonography was performed in patients with at least one or more postoperative symptoms or signs in order to confirm hematoma or fluid collection. RESULTS: None of the enrolled patients had dyspnea or change of vital signs. Two of 64 patients had swelling, 1 of 64 patients had fluctuation on the anterior chest, and 1 of 64 patients had compression symptoms. Fluid collection was confirmed in 2 of 4 of the above mentioned patients and the collected fluid was aspirated. The amounts of aspirated fluid were 25 mL and 8 mL. Thereafter, the follow up ultrasonography showed no more fluid collection in all patients. In addition, we rechecked the above mentioned symptoms or signs at 1 month after surgery; none of the enrolled patients had symptoms or signs. CONCLUSION: Robotic or endoscopic thyroidectomy via BABA without a closed suction drain shows no serious seroma or hematoma collection. Therefore, we expect that robotic or endoscopic thyroidectomy via BABA without a closed suction drain can reduce the pain, discomfort or longer hospital stay as a result of closed suction drain using this method.
Drainage* ; Dyspnea ; Follow-Up Studies ; Hematoma ; Humans ; Length of Stay ; Neck ; Seroma ; Suction ; Thorax ; Thyroidectomy* ; Ultrasonography ; Vital Signs