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A Case of Malignant Melanoma Presenting as a Breast Mass.

Tae Yun KIM ; Man Kyu CHAE ; Hyung Hwan KIM ; Sung Yong KIM ; Moo Jun BAEK ; Moon Soo LEE ; Chang Ho KIM ; Eui Han KIM ; Min Hyuk LEE ; Moo Sik CHO ; Ok Pyung SONG

Journal of Korean Breast Cancer Society.2003;6(1):35-38. doi:10.4048/jkbcs.2003.6.1.35

Malignant melanomas arising in the skin, buccal mucous membranes. and retina are encountered frequently. A malignant melanoma characteristically disseminates widely but infrequently metastasizes to the breast, and primary melanoma of the breast is even rarer. Primary melanomas can arise in the glandular tissue of the breast. We report a case of malignant melanoma either primary in the breast or metastatic from an unknown primary that presented initially as a left breast mass without a detectable cutaneous lesion.
Breast* ; Melanoma* ; Mucous Membrane ; Retina ; Skin

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The Necessity of Learning Period for Sentinel Lymphadenectomy in Breast Carcinoma.

Jin Wook CHOI ; Hy De LEE ; Byeong Woo PARK ; Woo Hee JUNG ; Ki Keun OH ; Yong Hoon RYU

Journal of Korean Breast Cancer Society.2003;6(1):29-34. doi:10.4048/jkbcs.2003.6.1.29

PURPOSE: Although an axillary lymph node dissection (ALND) has been considered as an ultimate procedure for axilla in the breast carcinoma, complications after ALND and conceptual revolution for the role of axillary nodes have made it necessary to look for an alternative. Recent studies of sentinel lymphadenectomy (SLND) have shown that SLND accurately predict axillary nodal status. However, for a satisfying outcome in SLND, a learning period would be required, as other surgical procedures do. In this study, the necessity of the learning period for SLND were examined. METHODS: From Nov. 1998 to Dec. 2001, 178 patients with invasive breast carcinoma were treated with SLND simultaneously followed by ALND. The period for the first 54 patients, Nov. 1998 to May. 1999, was set as a 'learning period'. Differences of the detection rate and the false negative rate for the 'learning period' and 'after the learning period' were compared. Also changes in the detection rate and the false negative rate with the accumulated experiences for SLND were evaluated. RESULTS: The sentinel lymph nodes were not identified in 5 patients through the whole period. Three of them occurred in the 'learning period' (5.6%, 3/54) and the rest occurred 'after the learning period' (1.6%, 2/124)(P=0.04). The false negative rate was 16.7% (4/24) in the 'learning period' and 0.0% in 'after the learning period' (P=0.00). The detection rate and the false negative rate improved with the accumulation of experiences for SLND. CONCLUSION: It is certain that 'learning period' for SLND is crucial. During this period, the improvement and stabilization of this skill is achieved.
Axilla ; Breast Neoplasms* ; Breast* ; Humans ; Learning* ; Lymph Node Excision* ; Lymph Nodes

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Decrease in Pulse Oximeter Readings Following Injection of Isosulfan Blue Dye.

Ji Kun KIM ; Soo Yong PARK ; Myung Kook LIM ; Choong Wun LEE ; Heung Dae KIM ; Koing Bo KWUN ; Soo Jung LEE

Journal of Korean Breast Cancer Society.2003;6(1):24-28. doi:10.4048/jkbcs.2003.6.1.24

PURPOSE: A sentinel lymph node mapping with blue dye has been well accepted as a common procedure in breast cancer surgery. However, it is well known that blue dye absorbed into the circulation may interfere pulse oximetery reading. The aim of this study was to evaluate the change of pulse oximetery reading by isosulfan blue dye injection during sentinel lymph node mapping. METHODS: Thirteen breast cancer patients with normal preoperative cardiopulmonary functions were studied. Four ml of isosulfan blue dye was injected subdermally when the patient became stable after induction of general anesthesia. The pulse oximetery was monitored continuously. Multiple arterial blood gas analyses (ABGA) were performed before dye injection and 10, 30, 40 minutes after dye injection. The results of oxygen saturturation by oximetery (SpO2) and the results of arterial oxygen tension (SaO2) and arterial oxygen saturation (SaO2) by ABGA were compared. RESULTS: The value of both SaO2 and PaO2 measured by ABGA has not been altered by isosulfan dye injection. However SpO2 decreased by isosulfan dye injection. SpO2 decrease started 8.2+/-1.5 (2~0) minutes after dye injection and returned to preinjection level by 85.7+/-5.6 (60~126) minutes after injection. The lowest vaule of SpO2 was 95.6+/-1.2% (93~97). Mean duration of SpO2 decrease was 77.5+/-6.2 (40~117) minutes. The duration of SpO2 decrease was longer in the aged patients, but it was not statistically significant (p=0.3). There was no siginificant difference in duration of SpO2 decrease according to injection site, operation method, and body mass index (BMI). CONCLUSION: .Isosulfan dye injection using for sentinel lymph node mapping causes no change in true ABGA results but causes a mild reversible decrease in SpO2, It is important to look for other causes when SpO2 decrease is significant and persistent.
Anesthesia, General ; Blood Gas Analysis ; Body Mass Index ; Breast Neoplasms ; Humans ; Lymph Nodes ; Oxygen ; Reading*

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Detection of Breast Mass in Mammogram Using Computer-Aided Diagnosis System.

Myung Chul CHANG ; Chan Dong KIM ; Hye Rin ROH ; Gi Bong CHAE ; Dae Hyun YANG ; Won Jin CHOI

Journal of Korean Breast Cancer Society.2003;6(1):20-23. doi:10.4048/jkbcs.2003.6.1.20

PURPOSE: Computer-aided diagnosis system was developed to improve the accuracy and the efficacy of the image interpretation. This article is to provide a possibility of computer- aided diagnosis for detection of masses in mammograms. METHODS: The craniocaudal and mediolateral images of 120 mammograms from 30 patients that were histologically proven to be malignant and 30 patients that were histologically proven to be benign were analysed using the mammography softwere. The contralateral mammograms were used as control images. Correct marks of the lesions were scored as a true positive and marks not at the location of the lesions were scored as a false negative. Any marks of the normal images were scored as a false positive and no mark of normal images were scored as a true negative. RESULTS: It took approximately 2 min to scan and 1 min to process 24 by 18-cm mammograms. There was an average of 1.4, 2.0 and 2.1 marks per image in normal, benign and malignant mammograms respectively. Mass detection rate of malignant lesion was 90.0% (27 of 30) and that of benign lesion was 63.6% (21 of 33). Mass detection rate of dense breasts was 68.8% (22 of 32) and that of fatty breasts was 83.9% (26 of 31). Mass detection rate of BI-RADS category 4, 5 and 0 was 85.7% (42 of 49) and that of category 1, 2 and 3 was 42.9% (6 of 14). The overall sensitivity was 76.2% and specificity was 28.1%. CONCLUSION: In this study, mass detection rate for malignant lesions was higher than that of benign lesions and dense breast has lower detection rate than fatty breast. According to the BI-RADS category, mass detection rate was higher in the more malignant category. Computer-aided diagnosis system for this study had limited specificity but acceptable sensitivity.
Breast* ; Diagnosis* ; Humans ; Mammography ; Sensitivity and Specificity

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A Comparison Study between Compound Imaging and Conventional Ultrasonography in Subareolar Area.

Bo Kyoung SEO ; Hae Jeong JEON ; Jeong Hee PARK ; Kyu Ran CHO ; Ji Young LEE ; Bo Kyung JE ; Eun Jeong CHOI ; June Young LEE ; Jeoung Won BAE ; Seok Jin KIM

Journal of Korean Breast Cancer Society.2003;6(1):15-19. doi:10.4048/jkbcs.2003.6.1.15

PURPOSE: The subareolar area is often difficult to evaluate ultrasonographically due to tissue shadowing, which obscures visualization of ducts and parenchymal tissue. The purpose of this study is to determine if real-time compound imaging improves evaluation of normal subareolar tissue and solid nodules in subareolar area compared to conventional ultrasonography. METHODS: 190 images of the subareolar area were obtained from 135 patients from March 2001 to July 2002. Thirty-three of 190 images showed solid nodules, extraductal nodules in 30 and intraductal nodules in three. We scanned both conventional and compound imaging with a stationary probe, to maintain an identical projection and tissue pressure. We used two compound techniques; survey mode (S) is made by 3 coplanar images and target mode (T) by 9 coplanar images. The evaluating points were 1) reduction in the density of shadowing, 2) resolution of duct wall, 3) resolution of duct lumen, 4) margin of nodule, and 5) internal echoes of nodule. In a blinded fashion, three radiologists graded the quality of images on a 5-point scale. RESULTS: For reviewer 1/2/3, S showed grade improvements in 1) reduction in the density of shadowing (0.4+/-0.6/1.1 0.6/0.5+/-0.5), 2) resolution of duct wall (0.9+/-0.2/1.5+/-0.6/1.0+/-0.5), 3) resolution of duct lumen (0.9+/-0.2/1.6 +/-0.6/0.7+/-0.6), 4) margin of nodule (1.0+/-0.3/1.5+/-0.5/1.2+/-0.5), and 5) internal echoes of nodule (1.1+/-0.3/1.5+/- 0.5/1.2+/-0.4) and T showed grade improvements in 1) reduction in the density of shadowing (0.4+/-0.6/1.2+/-0.6/0.7+/-0.7), 2) resolution of duct wall (1.0+/-0.3/1.5+/-0.6/1.1+/-0.5), 3) resolution of duct lumen (0.9+/-0.3/1.6+/-0.6/0.8+/-0.6), 4) margin of nodule (1.0+/-0.3/1.5+/-0.6/1.2+/-0.5), and 5) internal echoes of nodule (1.1+/-0.3/1.5+/-0.6/1.3+/-0.4). In all evaluating points, two modes of real-time compound imaging were superior to conventional imaging (P<0.05). There was no significant difference between two modes of compound imaging. CONCLUSION: Real-time compound imaging improves evaluation of normal subareolar tissue and subareolar solid nodules compared to conventional ultrasonography by reducing shadowing and increasing anatomic resolution of ducts.
Breast ; Humans ; Shadowing (Histology) ; Ultrasonography*

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Translational Regulation: A Novel Target for Breast Cancer Therapy.

Woo Chul NOH ; Nam Sun PAIK

Journal of Korean Breast Cancer Society.2003;6(1):8-14. doi:10.4048/jkbcs.2003.6.1.8

Translational initiation is regulated in response to nutrient availabilty and growth stimuli and is coupled with cell cycle progression and cell growth. There is now growing body of evidence which suggests links between translational regulation and the disruption of cell behavior that results in the development and progression of cancer. mRNA translation can be overactivated in breast cancer through eIF4E overexpression or abnormal activation of signal transduction pathways. Among them, rapamycin-sensitive signal transduction pathway (mTOR signaling pathway) is now being studied as a novel target for cancer therapy. In this article, the basic principles of translational control, the alterations encountered in cancer and selected therapy targeting mTOR signaling pathway are reviewed and the preclinical study regarding the determinants of rapamycin sensitivity in breast cancer is presented in order to help elucidate new avenues for breast cancer therapy.
Breast Neoplasms* ; Breast* ; Cell Cycle ; Eukaryotic Initiation Factor-4E ; Protein Biosynthesis ; Signal Transduction ; Sirolimus

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The Effects of Tibolone in Breast Cancer Cell Lines: The Role of Tibolone in Phospholipase D Signal Transduction Pathway.

Ki Wook CHUNG ; Soo Jung AHN ; Sung Won KIM ; Wonshik HAN ; Hee Joung KIM ; Ji Yeon BAE ; Joong Soo HAN ; Dong Young NOH

Journal of Korean Breast Cancer Society.2003;6(1):1-7. doi:10.4048/jkbcs.2003.6.1.1

PURPOSE: Tibolone is a tissue specific steroid hormone newly recognized as an estrogenic agent for hormone replacement therapy (HRT). The aim of the study is to characterize the basic mechanism of tibolone in the PLD signal transduction pathway of breast cancer cell lines. METHODS: The levels of phospholipase D (PLD), caspase 3 mRNA and protein, and the cell counts were measured in estrogen receptor positive MCF-7 and negative MDA-MB-231 cell lines treated with estradiol, tamoxifen and tibolone and three metabolite forms of tibolone (3 beta-OH-tibolone, delta4 isomer, 3 alpha-OH-tibolone). Multimodality methods such as RT-PCR, immunoblot analysis and in vivo enzyme activity assay were used. RESULTS: The addition of estradiol to MCF-7 cell line resulted in cell proliferation in a time-dependent manner while that of tamoxifen and tibolone showed antiproliferative effects. The addition of tamoxifen or tibolone to MCF-7 and MDA- MB-231 cell lines resulted in the elevation of caspase 3 mRNA levels, indicating the induction of apoptosis. PLD mRNA level was elevated in both cell lines treated with tamoxifen, but decreased in those treated with the various tibolones, except for 3 beta- OH-tibolone. In immunoblot analysis, while MCF-7 cell line treated with tamoxifen showed an increased level of PLD expression, in MDA-MB-231 cell line the expression was decreased. Similar results were observed in the addition of tibolones, which resulted in an increase of PLD expression level in MCF-7 cell line and a decrease in MDA-MB-231 cell line. In vitro PLD activity assay showed decreased activity after estradiol treatment and increased activity after tamoxifen and tibolone treatment in MDA-MB231 cell line. In MCF-7 cell line, among the tibolones only delta4 isomer increased PLD activity. Tiboloneshowed antiproliferative and apoptosis-inducing effects on MCF-7 and MDA-MB-231 cell lines. But its influence on the signal transduction pathway varied slightly between the two cell lines. CONCLUSION: we were able to find the antiestrogenic properties of the estrogenic agent tibolone.
Apoptosis ; Breast Neoplasms* ; Breast* ; Caspase 3 ; Cell Count ; Cell Line* ; Cell Proliferation ; Estradiol ; Estrogen Receptor Modulators ; Estrogens ; Hormone Replacement Therapy ; MCF-7 Cells ; Phospholipase D* ; Phospholipases* ; RNA, Messenger ; Signal Transduction* ; Tamoxifen

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A Case of Metastatic Thyroid-Papillary Carcinoma to the Breast.

Yong Hwan PARK ; Tae Gil HEO ; Ki Hong KIM ; Young Jin PARK ; Myung Soo LEE ; Chul Nam KIM ; Min Kyung KIM ; Surk Hyo CHANG

Journal of Korean Breast Cancer Society.2004;7(1):55-58. doi:10.4048/jkbcs.2004.7.1.55

We report a case of metastatic thyroid-papillary carcinoma of the breast. A 42-year-old woman was admitted to our hospital due to palpable masses on both breasts. Past history revealed that she had three individual thyroid operations due to thyroid papillary carcinoma. The first was a left lobectomy 6 years ago, the second was a subtotal thyroidectomy 2 years ago, and the third was a excision of the neck mass due to last year's recurrence. The patient underwent mass excisions on both breasts under the impression of a benign tumor. Pathologic findings of the masses showed similar histologic findings of the thyroid papillary carcinoma and immunohistochemical stainings demonstrated that the tumors originated from the thyroid.
Adult ; Breast Neoplasms ; Breast* ; Carcinoma, Papillary ; Female ; Humans ; Neck ; Recurrence ; Thyroid Gland ; Thyroidectomy

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Diagnostic Accuracy of Quantitative Scintimammography Using Tc-99m Tetrofosmin according to ROC Curve Analysis for Breast Cancer.

Sang Hyun PARK ; Heung Gyu PARK ; Sang Hoon HAN ; Young Don LEE ; Min JUNG ; Tae Hoon LEE ; Jae Hwan OH ; Jung Nam LEE ; Woon Khi LEE ; Yeon Ho PARK ; Seung Kee MIN ; Jeong Heum BAEK ; Jong Ho KIM ; Kyung Hoon HWANG

Journal of Korean Breast Cancer Society.2004;7(1):49-54. doi:10.4048/jkbcs.2004.7.1.49

PURPOSE: Tc-99m Tetrofosmin is a new alternative to Tc- 99m MIBI for nuclear breast imaging. A receiver operating characteristic (ROC) curve analysis was performed to evaluate the feasibility of Tc-99m Tetrofosmin quantitative scintimammography (SMM) (qSMM) and to compare with previously reported Tc-99m MIBI qSMM data [J Kor Surg 1999;57(5):638-644)]. METHODS: Prone anterior, lateral planar and supine SPECT images were taken from 135 cases in 131 female patients (mean ages=44 yr) with breast mass (size> or =0.2 cm) after 30mCi intravenous injection of Tc-99m Tetrofosmin. 70 malignant and 65 benign lesions were histologically proven. Three regions of interest (ROIs) were drawn over designated areas: the Lesion (L), the Normal breast opposite the lesion (NL) and the right Chest wall (CW). L/NL and L/CW ratios on both the SPECT and the planar images were analyzed. RESULTS: ROC curve analysis revealed that the planar L/NL ratio and the SPECT L/NL and L/CW ratios had higher diagnostic accuracy for detecting breast cancer than he planar L/CW ratio did (P<0.05). The qSMM (mean), which is an arithmetic mean of the planar L/NL ratio, the SPECT L/NL ratio and the SPECT L/CW ratio, the sensitivity, the specificity, accuracy and area under curve (AUC) were 82.9%, 81.5%, 82.2% and 0.879 respectively. Presence of axillary lymph node metastasis showed a slightly higher qSMM (mean) value (2.79 {n=23} vs 2.75 {n=27} P=0.06). These are comparable with previously reported Tc-99m MIBI qSMM data of 84.4%, 76.6%, 81.0% and 0.847 respectively, and the presence of axillary lymph node metastasis showed a higher qSMM(mean) value (4.09 {n=17} vs 3.09 {n=28}, P=0.06) [J Kor Surg 1999; 57(5):638-644)]. CONCLUSION: Tc-99m Tetrofosmin qSMM (mean) is a useful and objective method for differentiating malignant from benign breast lesion and has the comparable diagnostic accuracies of Tc-99m MIBI qSMM.
Area Under Curve ; Breast Neoplasms* ; Breast* ; Female ; Humans ; Injections, Intravenous ; Lymph Nodes ; Neoplasm Metastasis ; ROC Curve* ; Sensitivity and Specificity ; Thoracic Wall ; Tomography, Emission-Computed, Single-Photon

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Management of Breast Masses Detected only by Ultrasonography.

Woo Yeong SUN ; Young Jin SONG ; Hyo Young YUN ; Dong Hee RYU

Journal of Korean Breast Cancer Society.2004;7(1):43-48. doi:10.4048/jkbcs.2004.7.1.43

PURPOSE: Whether they are mammographically visible or not, breast ultrasonography is widely used for differential diagnosis of palpable breast masses. The aim of this study is to evaluate the usefulness of cytological examinations and ultrasonographical follow-ups in the management of non-palpable, mammographically non-visible breast masses incidentally detected only by ultrasonography screening. METHODS: One hundred forty-six lesions of non-palpable and mammographically non-visible, but ultrasonographically detected solid masses (sonic masses) from 120 female patients were examined at the Breast Clinic, Chungbuk National University Hospital from January, 2000, to February, 2003. We performed ultrasonogram-guided percutaneous fine-needle aspiration biopsy in all sonic masses and proceeded all sonic masses by sequential ultrasonography at 3-, 6- and 12-month intervals if there was no suspicion of malignancy. RESULTS: One hundred thirty-eight lesions (94.5%) were ultrasonographically diagnosed as benign and eight lesions (5.5%) as malignant. Eight ultrasonographically malignant lesions were all proved to be benign by cytological examinations or ultrasonogram-guided needle localization biopsies and not palpable during the follow-up period. Cytological interpretations revealed 127 lesions (87.0%) as benign, 5 lesions (3.4%) as atypical epithelial cells and 14 lesions (9.6%) as nondiagnostic. Five atypical epithelial lesions were found benign through ultrasonogram-guided needle localization biopsies or core needle biopsies in the final diagnosis. The ultrasonography was used for follow-up in all lesions. There was no evidence of malignancy in any lesion during the follow-up. CONCLUSION: In our study, there was no evidence of malignancy in breast sonic masses during the follow-up period. Our data showed that sequential ultrasonographical follow-up is sufficient for ultrasonographically benign sonic masses.
Biopsy ; Biopsy, Fine-Needle ; Biopsy, Large-Core Needle ; Breast* ; Chungcheongbuk-do ; Diagnosis ; Diagnosis, Differential ; Epithelial Cells ; Female ; Follow-Up Studies ; Humans ; Mass Screening ; Needles ; Ultrasonography* ; Ultrasonography, Mammary

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