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Organ-Specific Recurrence or Metastatic Pattern of Breast Cancer according to Biological Subtypes and Clinical Characteristics

Jaeyoon KIM ; Yujin LEE ; Taeyong YOO ; Jungbin KIM ; Jonghee HYUN ; Inseok PARK ; Hyunjin CHO ; Keunho YANG ; Byungno BAE ; Kihwan KIM ; Kyeongmee PARK ; Geumhee GWAK

Journal of Breast Disease.2019;7(1):30-37. doi:10.14449/jbd.2019.7.1.30

PURPOSE: We aimed to investigate organ-specific recurrence or the metastatic pattern of breast cancer according to biological subtypes and clinical characteristics. METHODS: We retrospectively analyzed the medical records of 168 patients with recurrent breast cancer who were diagnosed between January 1, 2000 and April 30, 2017. Four biological subtypes were classified according to estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and Ki-67 expression: luminal A, luminal B, HER2-enriched, and triple negative breast cancer (TNBC). To analyze recurrence patterns according to biological subtypes, we accessed clinical variables including age at diagnosis, TNM stage, type of surgery in the breast and axilla, histologic grade, nuclear grade, lymphatic, vascular, and neural invasion, Ki-67 expression and recurrence to distant organs. RESULTS: The biological subtypes of recurrent breast cancer comprised the following luminal A (n=33, 19.6%), luminal B (n=95, 56.5%), HER2 enriched (n=19, 11.3%), and TNBC (n=21, 12.5%). Luminal A (7.7%) and B (6.5%) subtypes were associated with the increased rate of local recurrence compared to HER2-enriched (2.4%) and TNBC subtypes (1.8%) (p=0.005). The bone (53.6%) was the most common metastatic organ, followed by the lung (34.5%), liver (29.8%), brain (17.9%), and other visceral organ (7.7%). Bone metastasis was commonly observed in individuals with luminal B (63.2%), HER2-enriched (57.9%), and luminal A (42.4%) subtypes (p=0.005). Most liver metastases occur in individuals with luminal B (40.0%) and HER2-enriched subtypes (31.6%) (p=0.002). CONCLUSION: Luminal B subtype was commonly observed in individuals with recurrent breast cancer, and the bone is the most common target organ for breast cancer metastasis, followed by the lungs and liver.
Axilla ; Brain ; Breast Neoplasms ; Breast ; Diagnosis ; Estrogens ; Humans ; Liver ; Lung ; Medical Records ; Neoplasm Metastasis ; Organ Specificity ; Phenobarbital ; Receptor, Epidermal Growth Factor ; Receptors, Progesterone ; Recurrence ; Retrospective Studies ; Triple Negative Breast Neoplasms

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Prognostic Factors in Patients with Locally Advanced Breast Cancer Treated by Neoadjuvant Chemotherapy

Min JAEGAL ; Shin Jae KANG ; Young Jae RYU ; Jin Seong CHO ; Min Ho PARK ; Jung Han YOON

Journal of Breast Disease.2019;7(1):23-29. doi:10.14449/jbd.2019.7.1.23

PURPOSE: Neoadjuvant chemotherapy (NAC) has become the standard treatment for patients with locally advanced breast cancer. The purpose of this study was to evaluate prognosis according to molecular subtype and clinicopathologic factors in patients with locally advanced breast cancer treated by NAC. METHODS: We retrospectively analyzed the medical records of 91 patients with breast cancer who underwent NAC followed by surgery between January 2005 and January 2010. The patients were classified into four molecular subtype groups: luminal A, luminal B, HER2 enriched, and triple negative (TN). RESULTS: Thirty-five (38%) patients had luminal A, 13 (14%) patients luminal B, 22 (24%) patients HER2 enriched and 21 (21%) patients TN breast cancer. Patients with TN breast cancer tended to be more than 50 years of age and to have a higher histologic grade. There were statistically significant differences according to ypN stage (ypN0 vs. ypN1–3; p=0.019, 5-year disease-free survival [DFS]; p=0.005, 5-year overall survival [OS]) and lymphovascular invasion (LVI) (p=0.003, 5-year DFS; p=0.006, 5-year OS) in the univariate analysis. In the multivariate analysis, LVI was a significant factor in 5-year DFS (odds ratio 2.145, 95% confidence interval 1.064–4.324, p=0.033). There was no significant difference among molecular subtypes in DFS (p=0.161) or OS (p=0.084). CONCLUSION: LVI was associated with prognosis in patients with locally advanced breast cancer treated by NAC and surgery. However, molecular subtype had no effect on 5-year DFS or OS.
Breast Neoplasms ; Breast ; Disease-Free Survival ; Drug Therapy ; Humans ; Medical Records ; Multivariate Analysis ; Neoadjuvant Therapy ; Phenobarbital ; Prognosis ; Retrospective Studies

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Clinical Implication of Intraoperative Sonography in Localized Excision Biopsy for Mammographic Microcalcifications

Joon Young CHOI ; Donghui CHO ; Jiwoong JUNG

Journal of Breast Disease.2019;7(1):16-22. doi:10.14449/jbd.2019.7.1.16

PURPOSE: Ultrasonography plays a supplementary role in detecting breast microcalcifications as localizing these microcalcifications without mammographic aid is not always successful. This study aimed to evaluate the clinical implications of intraoperative sonography (IOUSG) in localized excisions after mammographically guided wire insertion. METHODS: Between May 2011 and December 2017, 90 localized excisional biopsies were included. All excisions were preceded by mammographically guided wire insertion. We divided them into two groups according to the use of IOUSG and compared the surgical outcomes between the two groups. RESULTS: Of the 90 localized excisions analyzed, IOUSG was performed in 40 (the USG group) localized excisions and not in the remaining 50 (the no USG group) localized excisions. The median cluster size of the target microcalcifications and the median specimen volume were smaller in the USG group than that in the no USG group (1.4 cm vs. 2.0 cm, p=0.02; 10.9 cm3 vs. 30.3 cm3, p<0.001, respectively). Additional excisions due to the incomplete coverage of the target microcalcifications on the specimen mammography were more frequent in the no USG group than in the USG group (30% vs. 15%, respectively, p<0.001). In the multivariate analyses, performing an IOUSG was the only significant risk factor, reducing the need for additional excision after adjusting the other risk factors (adjusted hazard ratio, 0.203; 95% confidence interval, 0.078–0.529). Performing an IOUSG significantly reduced the specimen volume excised after adjusting the cluster size of the microcalcifications. CONCLUSION: IOUSG could be helpful in improving the accuracy of surgical excision for breast microcalcifications localized with mammographically guided wire insertion.
Biopsy ; Breast ; Calcinosis ; Mammography ; Multivariate Analysis ; Risk Factors ; Surgery, Computer-Assisted ; Ultrasonography

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Oncologic Results of Breast Conserving Surgery under Procedural Sedation in Elderly Patients

Jeeyeon LEE ; Jin Hyang JUNG ; Wan Wook KIM ; Yang Soo LIM ; Ryu Kyung LEE ; Kyung Hwa KWAK ; Ho Yong PARK

Journal of Breast Disease.2019;7(1):9-15. doi:10.14449/jbd.2019.7.1.9

PURPOSE: Although surgery is the most frequently implemented treatment modality for breast cancer, many older patients with breast cancer are under- or untreated because of their high incidence of postoperative complications. We assessed the efficacy and safety of breast surgery under procedural sedation in older patients (aged >70 years) by comparing selected clinical and oncologic factors after surgery for breast cancer under general anesthesia versus procedural sedation. METHODS: Of 79 older patients with breast cancer, 49 underwent breast-conserving surgery, 30 under general anesthesia and 19 under procedural sedation, and relevant clinical and oncologic variables were compared and analyzed between groups. RESULTS: The mean age was younger in the general anesthesia group and the mean operation time, hospital stay, and fasting time shorter in the procedural sedation group. There were no statistically significant differences in oncologic results between the two groups during follow-up. CONCLUSION: Breast surgery under procedural sedation is a safe and effective means of reducing tumor burden in older patients with breast cancer when their American Society of Anesthesiologists (ASA) physical status indicates a high risk of life-threatening perioperative complications associated with general anesthesia. And we also found that the oncologic results may be not inferior to same procedure under general anesthesia.
Aged ; Anesthesia, General ; Breast Neoplasms ; Breast ; Fasting ; Follow-Up Studies ; Humans ; Incidence ; Length of Stay ; Mastectomy, Segmental ; Postoperative Complications ; Tumor Burden

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Treatment Outcomes of Weakly Positive Hormone Receptor Breast Cancer and Triple-Negative Breast Cancer

Mi Ran YOON ; Ji Young RHU ; Byung Joo SONG ; Byung Joo CHAE ; Tae Kyung YOO

Journal of Breast Disease.2019;7(1):1-8. doi:10.14449/jbd.2019.7.1.1

PURPOSE: In breast cancer, response to endocrine therapy depends on estrogen receptor and progesterone receptor status. However, poor prognosis is conferred on patients with hormone receptor (HR)-positive breast cancer. We aimed to examine weakly positive HR breast cancer by comparing weakly positive HR to strongly positive HR and negative HR breast cancer. METHODS: We examined the clinical and biological features of 1,496 women with breast cancer, and these patients were categorized according to HR status as weakly positive, strongly positive, and negative HR breast cancer. RESULTS: In this study, among 1,496 patients with breast cancer, negative HR breast cancer was found in 374, weakly positive HR breast cancer in 90 and strongly positive HR breast cancer in 1,032 patients. Our multivariate analysis showed that there were differences in T stage, tumor-node-metastasis stage, vascular invasion, histologic grade and type, and Ki-67 index. Patients with weakly positive HR breast cancer had an increased risk of death and recurrence compared with those with strongly positive HR breast cancer and had similar prognosis as patients with negative HR breast cancer. CONCLUSION: Patients with weakly positive HR breast cancer received endocrine therapy because they were regarded as having positive HR breast cancer. However, their prognosis of overall survival and relapse-free survival was similar to that in patients with negative HR breast cancer. Therefore, we need to closely observe and consider active treatment for patients with weakly positive breast cancer.
Breast Neoplasms ; Breast ; Estrogens ; Female ; Humans ; Multivariate Analysis ; Prognosis ; Receptors, Estrogen ; Receptors, Progesterone ; Recurrence ; Triple Negative Breast Neoplasms

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Newly Arising Contralateral Granular Cell Tumor after Wide Excision of Large Breast Granular Cell Tumor: A Case Report.

Hyuk Mun KIM ; Ok Pyeng SONG ; Jong Min KIM

Journal of Breast Disease.2017;5(1):35-38. doi:10.14449/jbd.2017.5.1.35

Granular cell tumor (GCT) of the breast is a rare neoplasm that is usually benign in nature. The results of physical examination and ultrasonographic findings of GCT of the breast often mimic those of other malignancies. A 46-year-old woman underwent wide excision for removal of a large mass in the left breast (about 10 cm in diameter). The pathologic finding of the excised mass was benign GCT. A year after initial surgery, recurrence of the left breast mass was found along with a newly developed mass in the contralateral right breast, which was excised. In this study, we describe the case of a newly developed GCT in the contralateral breast 1 year after excision of a larger breast GCT.
Breast* ; Female ; Granular Cell Tumor* ; Humans ; Middle Aged ; Physical Examination ; Recurrence

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Synchronously Diagnosed Gastric Metastasis from Invasive Lobular Breast Carcinoma, Mimicking Primary Gastric Carcinoma.

Young Duck SHIN ; Seung Myoung SON ; Young Jin SONG ; Sung Su PARK ; Young Jin CHOI

Journal of Breast Disease.2017;5(1):28-34. doi:10.14449/jbd.2017.5.1.28

Gastric metastasis from invasive lobular breast carcinoma is rare. Mostly gastrointestinal metastasis presents as one among multiple metastases, several years after primary diagnosis of breast carcinoma. Herein, we report a synchronously diagnosed gastric metastasis from invasive lobular carcinoma, mimicking primary gastric linitis plastica with pyloric obstruction. We reviewed clinical and pathological findings of gastric carcinoma metastatic from the breast. In particular, we focused on immunohistochemical studies of selected antibodies, including those for estrogen receptors, gross cystic disease fluid protein-15, and caudal-type homeobox transcription factor 2, for accurate differential diagnosis. Clinical suspicion, repeat endoscopic biopsy, and detailed histological analysis including immunohistochemistry are necessary for diagnosis of gastric carcinoma metastatic from the breast.
Antibodies ; Biopsy ; Breast Neoplasms* ; Breast* ; Carcinoma, Lobular ; Diagnosis ; Diagnosis, Differential ; Genes, Homeobox ; Immunohistochemistry ; Linitis Plastica ; Neoplasm Metastasis* ; Receptors, Estrogen ; Stomach ; Transcription Factors

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Management of Simon’s Grade III Gynecomastia through a Single Axillary Incision: A Report of 2 Cases

Ho Kyun MIN ; Yong-Lai PARK

Journal of Breast Disease.2021;9(1):30-35. doi:10.14449/jbd.2021.9.1.30

Gynecomastia is a proliferation of glandular tissue of the breast in male and it is the most commonly observed breast disease amongst male patients associated with the negative impact on body image and social health of man. Although the medical therapy is an option with long-standing gynecomastia patients, the less than desirable effectiveness leads to the surgery. Although various techniques have been described for the correction of gynecomastia, the common technique of surgery has been performed with a circumareolar incision. However, this technique has been associated with undesirable complications such as a visible scar on the chest, areola inversion, and nipple necrosis. To remedy such complications, the transaxillary techniques were used in an attempt to avoid scar and the complication of the nipple areola complex. In this study, the surgery for the two patients with Simon’s grade III gynecomastia were performed using the pull-through technique and through the axillary incision. The result of the transaxillary subcutaneous mastectomy technique produced esthetic appearance with little complications.

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Optimized Criteria for Sentinel Lymph Node Biopsy in Patients with Clinically Node Negative Breast Cancer

Jeong Suk KIM ; Moo Hyun LEE ; Sun Hee KANG ; Jihyoung CHO

Journal of Breast Disease.2021;9(1):26-29. doi:10.14449/jbd.2021.9.1.26

Purpose: Sentinel lymph node biopsy (SLNB) is a well-established staging procedure for patients with early breast cancer who have clinically negative axillary lymph node. However, no consensus exists about the number of sentinel lymph nodes (SLN) that should be removed based on radioactivity counts in breast cancer. We reviewed and analyzed cases in which more than one SLN was detected and there was at least one pathologically positive node. Methods: We retrospectively studied breast cancer patients who underwent lymphoscintigraphy with injection of a radioactive colloid and SLNB along with intraoperative determination of radioactive counts of lymph nodes using a gamma probe between 2006 and 2018. In total 326 patients with more than one radioactive SLN were enrolled in this study. Results: Fifty-four patients had nodal metastases, of whom 46 (85.2%) had metastases in the hottest lymph node. All metastatic SLNs were identified as one of the first three lymph nodes dissected. The lowest radioactive count of a positive SLN corresponded to 10% of that of the hottest node. Conclusion We suggest that removal of the first three lymph nodes or nodes covered by the “10% rule” is sufficient in SLNB for patients with breast cancer.

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Evaluation of Tumor Elasticity and Clinicopathologic Factors Affecting Neoadjuvant Chemotherapy Response in Patients with Breast Cancer

Young Ah KIM ; Jeong Yeong PARK ; Jung Eun CHOI ; Su Hwan KANG ; Young Kyung BAE ; Mi Soo HWANG ; Soo Jung LEE

Journal of Breast Disease.2021;9(1):16-25. doi:10.14449/jbd.2021.9.1.16

Purpose: This study aimed to determine the clinicopathologic factors, including tumor elasticity, affecting neoadjuvant chemotherapy response in breast cancer. Methods: Among 95 patients who received neoadjuvant chemotherapy for clinical stage IIa-IIIc primary breast cancer, 75 underwent strain elastography assessments. The patients were divided into soft and hard tumor groups based on the Tsukuba elasticity scoring system. Pathologic factors, including tumor cellularity and stromal characteristics, were evaluated using core needle biopsy specimens collected before neoadjuvant chemotherapy. Pathologic complete response (pCR) was defined as the absence of invasive carcinoma in the breast and axillary lymph nodes. Residual cancer burden (RCB) was also calculated in 79 cases. Results: Twenty-two patients achieved pCR (23.2%). The rates of estrogen receptor (ER) negativity (p=0.04), progesterone receptor (PR) negativity (p=0.03), and nuclear grade 3 (p=0.03) were higher in patients with pCR than those in patients without pCR. The rates of PR negativity (p=0.03), nuclear grade 3 (p=0.01), and high tumor-infiltrating lymphocyte (TIL) levels (p=0.04) were significantly higher in the favorable RCB group (RCB-0 and I) than those in the unfavorable RCB group (RCB-II and III). No significant difference in tumor elasticity was observed between the groups (p=0.30). Hormone receptor (HR) negativity was an independent predictor of favorable RCB in the multivariate analysis (p=0.04). Conclusion Tumor elasticity was not associated with pCR or RCB. HR negativity was an independent predictor of favorable RCB.

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