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Detection of Axillary Lymph Node Micrometastasis using RT-PRC Comparison the results of MUC1, Cytokeratin 19 .

Ryung Ah LEE ; Han Sung KANG ; Hee Joon KANG ; Tae Seon KIM ; Seong Suk KIM ; Dong Young NOH ; Kuk Jin CHOE

Journal of Korean Breast Cancer Society.1999;2(2):128-137. doi:10.4048/jkbcs.1999.2.2.128

One of the most important prognostic factors in breast cancer is presence of axillary lymph node invasion. It is reported that 20-30% of node negative patients with conventional cstaining has a risk of relapse within five years after primary treatment. The status of lymph node can be determined by serial sectioning or immunohistochemical staining, the former was accurate but time consuming, troublesome method and the latter was unsatisfactory in accuracy and objectivity. RT-PCR is sensitive and accurate molecular method and has been used in detecting micrometastasis of lymph node, bone marrow and blood of the cancer patients. We conducted RT-PCR amplification of MUC1, cytokeratin (CK) 19 using total RNA samples of lymph nodes of 40 breast cancer patients and conducted immunohistochemical staining for cytokeratin. The results of histological examination and immunohistochemical staining of cytokeratin were compared with RT-PCR results for the detection of lymph node micrometastasis. Nineteen patients(47.5%) were lymph node positive and twenty one patients (52.5%) were lymph node negative. MUC1 and CK19 were expressed in all lymph node positive patients. Among the node negative patients, 4 cases and 5 cases were expressed MUC1 and CK19 with RT-PCR. But immunohistochemical staining method was ineffective in detecting micrometastasis because lymph nodes of negative node group were not stained for cytokeratin. This study could not rule out the false positivity of RT-PCR, so it should be conducted against variable tumor marker to overcome this fatal defect. We recommend that RT-PCR will be applied in sentinel lymph node for accuate prediction of whole lymph node status and that the patients revealed positive result in RT-PCR should be observed more closely than the other.
Bone Marrow ; Breast Neoplasms ; Humans ; Keratin-19* ; Keratins* ; Lymph Nodes* ; Neoplasm Micrometastasis* ; Recurrence ; RNA

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A Study for The Relationship between Steroid Receptor Expression and Histologic Findings in Breast Diseases.

Junghan YOON ; Youngjong JAEGAL ; Seungwhan LEE ; Woosuk YANG

Journal of Korean Breast Cancer Society.1998;1(1):61-68. doi:10.4048/jkbcs.1998.1.1.61

The role of steroid receptor has been widely studied and well established in the field of breast cancer. In contrast of breast cancer, the clinicopathological roles of steroid receptors in benign breast diseases were not established clearly until now. Authors evaluated steroid receptor expressions of benign breast diseases using the immuno-histochemical staining and analyzed their relationship with pathologic types and the correlation between the positivity of steroid receptor expression and the proliferative activity of ductal epithelial cells. The results were follows; 1) The assayed tissue specimens were 93 cases which consisted with fibrocystic disease, 39 cases and fibroadenoma, 54 cases. 2) The positivity rate of steroid receptor expression in fibroadenoma (ER: 59.2%, PR: 75.9%) seemed to be more higher than in fibrecystic diseases (ER: 46.1%, PR: 55.5%) without a statistical significance. 3) The positivity rate of ER expression of fibrocystic diseases developed in premenopausal women (54.8%) was significantly higher than in postmenopausal women (2.5%). 4) Any significant correlation was not noted between the positivity of steroid receptor expression in the tissue and ductal epithelial proliferative activity. In conclusion, fibrocystic disease and fibroadenomas possessed a significant amount of steroid receptor positive cells in their tissues. However, the positivity of steroid receptor expression in the tissues seemed to have few correlation with the ductal epithelial cellular proliferation.
Breast Diseases* ; Breast Neoplasms ; Breast* ; Cell Proliferation ; Epithelial Cells ; Female ; Fibroadenoma ; Humans ; Receptors, Steroid*

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The Prediction of Axillary Lymph Node Metastasis in T1 Breast Cancer.

Ja Yun KOO ; Hy De LEE ; Woo Hee JUNG

Journal of Korean Breast Cancer Society.1998;1(1):54-60. doi:10.4048/jkbcs.1998.1.1.54

PURPOSE: The axillary lymph node status is the most important prognostic factor in breast cancer. The axillary node dissection is done are usually performed in infiltrating breast cancer for the information of therapeutic decision and prediction of prognosis. But this procedure results in lymphedema of affected upper extremity nearly about 25%, increased axillary drainage, sensory abnormality and pain. Many researches are focussed to find the patients group who do not need axillary dissection according to the status of tumor size, patient age, hormonal receptor and histologic grade. MATERIAL AND METHODS: We evaluated the axillary lymph node status related with tumor size less then 2 cm in and the correlation of other prognostic factor. We reviewed 127 women with histologically diagnosed infiltrating ductal carcinoma of breast who were treated by one surgeon at YongDong Severance Hospital, Yonsei University College of medicine between 1991 and 1996. RESULTS: Five patients (3.9%) had T1a lesion (< 5 mm), 24 patients (18.9%) had T1b tumors (6-10 mm), and 98 cases (77.2%) had T1c lesion (11-20 mm). The average numbers of dissected axillary lymph nodes were 14.2 We found that small tumor size, good histologic grade, estrogen receptor positivity, old age (over 50 years) showed tendency of decreased axillary node metastasis but without statistical significance. CONCLUSIONS: There are possibility of finding subset with low risk of axillary lymph node metastasis in small size tumor with addition of good prognostic indicators such as good histologic grade, hormonal receptors and old age.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Drainage ; Estrogens ; Female ; Humans ; Lymph Nodes* ; Lymphedema ; Neoplasm Metastasis* ; Prognosis ; Upper Extremity

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Prognostic Significance of Cathepsin-D Expression in Breast Cancer.

Yong Tae KWON ; Chap Joong JUNG ; Young Hoon KIM ; Sae Hun CHO ; Sang Soom KIM ; Sook Hee HONG

Journal of Korean Breast Cancer Society.1998;1(1):45-53. doi:10.4048/jkbcs.1998.1.1.45

Mouse monoclonal antibody was used for this study. This study was undertaken to define the prognostic value of the expression of Cathepsin-D in 121 breast cancer patients. The results were as follows: 1) Overall, 53.7% of patients were positive for Cathepsin-D 2) Positive staining did not correlate with age, estrogen receptor status,tumor size, axillary nodal status, tumor stage, menopausal status, pathologic grade, DNA ploidy and S-phase fraction.
Animals ; Breast Neoplasms* ; Breast* ; DNA ; Estrogens ; Humans ; Mice ; Ploidies

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Effectiveness of Sentinel Node Biopsy in the Prediction of Axillary Nodal Status in 111 Patients with Breast Cancer .

Jung Hyum YANG ; Hae Kyung LEE ; Seok Jin NAM

Journal of Korean Breast Cancer Society.1998;1(1):39-44. doi:10.4048/jkbcs.1998.1.1.39

BACKGROUND: Recently, results of many trials that intend to decide the axillary status through more conservative procedures are reported. One of these is sentinel node biopsy. This method is regarded as reasonable and selective. Some investigators tend to omit axillary dissection in the patient who is determined to have negative node clinically and negative result in sentinel node biopsy procedure. This study was designed to know how accurate the sentinel node biopsy method can predict axillary nodal status. MATERIALS AND METHODS: The patients group was selected from Department of Surgery at SMC, consisting of 111patients with surgically curable breast cancer from Sept. 1995 to Apr. 1997. Isosulfan blue was injected in the center of mass and the margins of 4 quadrant under the general anesthesia. Axillary dissection was done 5 minutes after injection to identify the stained lymphatics. When stained lymphatics were identified, dissection was performed along the lymphatics bidirectionally to detect the stained lymph node nearest to the primary tumor (sentinel node). After frozen biopsy of sentinel node, routine axillary node dissection was performed. Results of frozen biopsy were compared with the final pathologic results. RESULTS: Sentinel node was detected in 80 of the 111 cases (72.1%) and there were 44 (55.0%) axillary metastasis cases in sentinel node detection group. In 14 of 44 cases, sentinel node was isolated positive node. In 5 of 44, sentinel node were falsely negative for malignancy. Sensitivity and specificity of the method are 88.6% (39/44), 100% (36/36), respectively. CONCLUSIONS: Sentinel node biopsy method can predict the axillary nodal status in patients with breast cancer. This method can lead to more conservative treatment, eventually omitting axillary nodal dissection in selected patients.
Anesthesia, General ; Biopsy* ; Breast Neoplasms* ; Breast* ; Humans ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Research Personnel ; Sensitivity and Specificity

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The Dye-injection Microdochectomy for Intraductal Papilloma of the Breast.

Yong Lai PARK ; Won Kil PAE

Journal of Korean Breast Cancer Society.1998;1(1):33-38. doi:10.4048/jkbcs.1998.1.1.33

Intraductal papillary tumors of the breast exhibit bloody discharge with often no evidence of a palpable tumor, making discrimination between benign and malignant lesions sometimes difficult for pathologists and surgeons. So the technique used in removing the offending ductal system should be fully diagnostic, adequately therapeutic and cosmetically. Microdochectomy has been accepted treatment for intraductal papilloma of the breast. We performed dye-injection microdochectomy on intraductal papilloma of the breast in 15 patients. This procedure utilizes lacrimal probe and 24-gauge medicut that are gently advanced into the offending duct and methylene blue dye is injected to outline the involved duct for easy dissection through a circumareolar incision. Because we could perform dye-injection microdochectomy safely, rapidly and effectively, we think that this procedure is standard treatment of intraductal papilloma of the breast.
Breast* ; Discrimination (Psychology) ; Humans ; Methylene Blue ; Papilloma, Intraductal*

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Skin-sparing Mastectomy with Circumareolar Incision and Immediate Reconstruction in Breast Cancer.

Sei Hyun AHN ; Ho Sung YOON ; Sang Hoon HAN ; Taik Jong LEE ; Jong My PARK ; Gyoungyub GONG

Journal of Korean Breast Cancer Society.1998;1(1):24-32. doi:10.4048/jkbcs.1998.1.1.24

BACKGROUND: Now, breast reconstruction is being performed in many cases after mastectomy by using tissue expander or TRAM flap. But conventional mastectomy leaves a long linear scar tissue which is also seen on the breast skin after breast reconstruction. Skin spring mastectomy with immediate reconstruction leaves a minimal scar tissue, even though, with circumareolar incision, it makes no visible scar tissue. PURPOSE: The purpose of this study is 1) to identify the clinical indications for Skin-spring mastectomy (SSM) with immediate reconstruction, 2) to evaluate the clinical results and 3) to encourage the application of this method. MATERIALS AND METHODS: During recent 20 months, breast cancer surgery were 467 cases, mastectomy were 368 (78.8%, 368/467), mastectomy with breast reconstruction were 30 case (8.2%, 30/368), Among 30 reconstruction cases, Skin-spring mastectomy (SSM) with circumareolar incision and immediate reconstruction were performed in 9 patient. Our patient selection criteria was as follows; 1) patient's desire of reconstruction on cosmetic aspect 2) clinically early breast cancer 3) moderate breast size 4) central locating tumor 5) no Skin involvement. RESULTS: 1) we performed 9 cases of Skin-spring mastectomy (SSM) with circumareolar incision and immediate reconstruction. 2) Three patient who complainted palpable mass were diagnosed by FNA for breast cancer and the other 6 patient were proved by ductal biopsy in 4 cases whose complaint was bloody nipple discharge, a H-wire biopsy in whose mammography revealed multiple microcalcifications and a punch biopsy in whose nipple was eczematous. All cases were suspected for early breast cancer preoperatively. 3) Four cases were stage 0, 3 cases were stage I lesions and 2 cases were stage III in postoperative pathologic staging. 4) All the patients were satisfied with their cosmetic results. CONCLUSIONS: Skin-spring mastectomy (SSM) with immediate reconstruction is new method for breast cancer operation with modified skin incision and shows good aesthetic results. we propose more frequent application of this method for indicated patient, but we need futher follow-up of local recurrence rate and detection rate in these patients.
Biopsy ; Breast Neoplasms* ; Breast* ; Cicatrix ; Female ; Follow-Up Studies ; Humans ; Mammaplasty ; Mammography ; Mastectomy* ; Nipples ; Patient Selection ; Recurrence ; Skin ; Tissue Expansion Devices

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Variety of Immediate Breast Reconstruction after Mastectomy for Breast Cancer.

Byoung Chul CHOI ; Sang Hyun WOO ; Jae Ho JEONG ; Jung Hyun SEUL ; Soo Jung LEE

Journal of Korean Breast Cancer Society.1998;1(1):13-23. doi:10.4048/jkbcs.1998.1.1.13

Breast cancer of women is the most common major cancer in Caucasian. and it is steadily increasing in Korean. The main causes are westernized dietary habit and medication of oral contraceptives. A women's breasts are the symbol of her femininity and loss of a breast can be a major impairment to her body image and self-confidence. This loss can have devastating sequelae, causing a marked impact on her emotional stability and social adjustment. When the loss of a breast is the result of her local treatment of breast cancer, she mast not only confront the reality of the tumor prognosis but also has to face the mastectomy deformity. Immediate breast reconstruction following mastectomy of breast cancer are being done more often nowadays in Korea. The advantages of immediate breast reconstruction are, avoiding the stress of breast loss, reduced hospitalization and medical cost and easy reconstruction without any underlying scar tissue. The approach was multidisciplinary with involvement of oncologists, general surgeons, and plastic surgeons. Various reconstructive methods were used, and the operations were adjusted for each patient. This study included 15 female patients, treated at Yeungnam University Hospital between January, 1996 and November, 1996. The mean age of the patient was 38.5 years, and most of the tumors were stage 0 to 2 at the time of the operation. One breast prosthesis, two tissue expander with breast prosthesis, one latissimus dorsi musculocutaneous flap, eleven transverse rectus abdominis musculocutaneous (TRAM) flaps (conventional TRAM flap, bipedicle TRAM flap, super-charging TRAM flap, turbo-charging TRAM flap, free TRAM flap) were used for reconstruction. There were 5 postoperative complications; partial flap necrosis, hematoma, incisional hernia, seroma, fat necrosis, epigastric fullness. Our experiences of 15 cases of immediate breast reconstruction were presented with relatively short-term follow-up.
Body Image ; Breast Neoplasms* ; Breast* ; Cicatrix ; Congenital Abnormalities ; Contraceptives, Oral ; Fat Necrosis ; Female ; Femininity ; Follow-Up Studies ; Food Habits ; Free Tissue Flaps ; Hematoma ; Hernia ; Hospitalization ; Humans ; Korea ; Mammaplasty* ; Mastectomy* ; Myocutaneous Flap ; Necrosis ; Postoperative Complications ; Prognosis ; Prostheses and Implants ; Rectus Abdominis ; Seroma ; Social Adjustment ; Superficial Back Muscles ; Tissue Expansion Devices

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The Diagnostic Value of Positron Emission Tomography in Detecting the Breast Cancer.

Dong Young NOH ; Ik Jin YUN ; Han Sung KANG ; Ji Soo KIM ; Dong Soo LEE ; June Key CHUNG ; Myung Chul LEE ; Yeo Kyu YOUN ; Seung Keun OH ; Kuk Jin CHOE

Journal of Korean Breast Cancer Society.1998;1(1):6-12. doi:10.4048/jkbcs.1998.1.1.6

Positron Emission Tomography (PET) is a new imaging method employing radionuclide and tomography technique. In breast cancer PET has high sensitivity in detecting primary tumor and axillary node metastasis. From 1995 June to 1996 November, 27 patients had undergone breast operations following PET under impression of breast cancer in Seoul National University Hospital (SNUH). Whole body PET images were obtained beginning 60 minutes after infection of 370 MBq (10 mCi) F-18 FDG (fluorodeoxy glucose). Regional scans were also obtained with transmission images. We compared PET results with those of physical examination and mammography. All cases were histologically confirmed. For primary tumor mass, diagnostic accuracy of PET was excellent (97%) compared with the physical examination (78%) and mammography (67%). For axillary lymph node metastasis, PET had an outstanding detection accuracy (96%), compared with the physical examination and mammography (74%, 60%, respectively). And whole body PET scan made it possible to see the all metastatic lesions at a glance in cases of metastatic or recurred breast cancer. There was likely correlation between Standard Uptake Value (SUV) and the number of axillary lymph node metastasis, but in this study, statistical significance was not proven because of small number of cases. PET also could detect breast cancer in paraffin augmented breast. We concluded that PET is very sensitive and accurate diagnostic tool for breast cancer and SUV, after more studies, could be used as an important prognostic factor.
Breast Neoplasms* ; Breast* ; Electrons* ; Humans ; Lymph Nodes ; Mammography ; Neoplasm Metastasis ; Paraffin ; Physical Examination ; Positron-Emission Tomography* ; Prognosis ; Seoul ; Statistics as Topic

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Differential Diagnosis between Malignant and Benign Breast Diseases Using Localized Proton Magnetic Resonance.

Sung Hwan PARK ; Ki Ho PARK ; Han Il LEE ; Dae Hyun JOO ; Ki Hyuk PARK ; Yong Oon YOO ; Jong Ki KIM

Journal of Korean Breast Cancer Society.1998;1(1):1-5. doi:10.4048/jkbcs.1998.1.1.1

Proton magnetic rcsonance spectroscopy (1H MRS) has demontrated its abilities to detect an increase of choline containing compounds (Cho) in various brain tumors and prostatic cancer tissues. Based on preclinical works done by other authors using multinuclei MRS, it is reasonable to assume malignant breast tumors will have elevated level of Cho compared to that of normal tissues and benign breast lesions. Several challenges must be met to obtain clinically useful 1H breast spectrum. Good water and fat suppression, Bo homogeneity are required to detect low level metabolic signals like choline if any. In this study, we investigated the clinical utility of 1H MRS with simultaneous suppression of water and fat signals, using breast imaging surface coil for evaluating breast cancer with small lesions. All studies were performed using a GE signa MRI unit (1.5 T, Ver 5.5) and 2-channel breast coil (GE). Water suppression was achieved by chemical selective saturation, and fat signal was attenuated using inversion recovery sequence. Spectroscopic data were acquired with PRESS sequence. Twenty-three patients, age 14-75, were examined. Eleven of these patients presented with invasive ductal carcinoma. The remaining patients presented with benign processes including fibroadenoma, fibrocystic change, galactocele, adenosis, ductal ectasia and dystrophic calcification. The size of lesions were variable (8-90 mm in diameter). Choline at 3.25 ppm was visible in the spectra of all cancer patients, while invisible in the spectra of all benign lesions except a lesion of dystrophic calcification. We concluded that in vivo detection of choline containing compounds in breast carcinomas using proton magnetic resonance spectroscopy demonstrated its potential as a noninvasive tool for differential diagnosis of malignant and benign breast lesions larger than 7 mm in diameter.
Brain Neoplasms ; Breast Diseases* ; Breast Neoplasms ; Breast* ; Carcinoma, Ductal ; Choline ; Diagnosis, Differential* ; Dilatation, Pathologic ; Fibroadenoma ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Prostatic Neoplasms ; Protons* ; Spectrum Analysis ; Water

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