Journal Detail Information

1

Cite

Share

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

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.

2

Cite

Share

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.

3

Cite

Share

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.

4

Cite

Share

Clinicopathological Features and Prognosis of Lobular Carcinoma In Situ

Jeea LEE ; Ga Yoon KU ; Hyung Seok PARK ; Hae Min LEE ; Ja Seung KU ; Jee Ye KIM ; Seho PARK ; Seung Il KIM ; Byeong-Woo PARK

Journal of Breast Disease.2021;9(1):10-15. doi:10.14449/jbd.2021.9.1.10

Purpose: According to the American Joint Committee on Cancer’s 8th Edition Manual, lobular carcinoma in situ (LCIS) is no longer considered a malignant disease, although it may be a precursor to the development of breast cancer. The present study aimed to evaluate the clinicopathological features and prognosis of LCIS. Methods: This study retrospectively analyzed clinicopathological features and prognosis data of LCIS among patients who underwent breast surgery at Severance Hospital, Seoul, South Korea from 1991 to 2016. Results: Of the 47 patients, 49 cases of LCIS were confirmed by postoperative pathology. The mean patient age was 48.15±8.34 years. Most patients (81.6%) did not have palpable tumors at diagnosis, and 51.0% showed no microcalcification on mammography. Breast-conserving surgery was performed more frequently than total mastectomy (77.6% vs. 22.4%). The mean tumor size was 1.63±2.11 cm. There were only 3 cases of pleomorphic LCIS. Hormone receptor-positive tumors were noted in 47 cases, however, the hormone receptor status was unknown in the other 2 cases. There were no LCIS recurrences or deaths during the follow-up period (mean 56 months). Conclusion LCIS is often incidentally diagnosed without clinical symptoms, especially in women aged <50 years. The prognosis of LCIS is excellent in cases that are surgically treated.

5

Cite

Share

Characteristics of HER2-Positive Breast Cancer according to HER2 2+/ Low or 3+/High Classification by Immunohistochemistry Assay: Study of 205 Cases Treated in a Single Center

Changhee LEE ; Inseok PARK ; Jungbin KIM ; Hyunjin CHO ; Keunho YANG ; Yujin LEE ; Kyeongmee PARK ; Jiyoung KIM ; Youngjoo SHIN ; Geumhee GWAK

Journal of Breast Disease.2021;9(1):1-9. doi:10.14449/jbd.2021.9.1.1

Purpose: To investigate the characteristics of HER2-positive breast cancer according to HER2 low (2+) or high (3+) classification using immunohistochemistry (IHC). Methods: Data were collected from 205 HER2-positive breast cancer patients in the final assay, regardless of IHC or in situ hybridization (ISH). We thus classified patients into two groups: HER2 2+/low and HER2 3+/high based on the IHC assay. We subsequently compared the clinical and pathological characteristics between groups. Results: The median patient age was 49 years in the HER2 2+/low group and 53 years in the HER2 3+/high group. We observed a significantly lower Allred score for estrogen receptor (ER) and progesterone receptor (PR) (0-6) (p<0.001), less lymphatic invasion (LI), (p=0.010), neural invasion (p=0.041), higher Ki-67 (p=0.001), and lower Bcl-2 (p<0.001) in the HER2 3+/high group than in the HER2 2+/low group. Lymph node recurrence was more frequently observed in the HER2 2+/low group than in HER2 3+/high group (p=0.005). Disease-free survival (DFS) was better in the HER2 3+/high group than in the HER2 2+/low group (p=0.028), but there were no significant differences in overall survival between the groups (p=0.233). Conclusion The HER2 3+/high group was associated with lower ER and PR expression, less LI, higher Ki-67, and lower Bcl-2 than that in HER2 2+/low group in HER2-positive breast cancer. Furthermore, compared to the HER2 2+/low group, the HER2 3+/high group had an improved DFS.

6

Cite

Share

Iatrogenic Arteriovenous Fistula after Ultrasonography-Guided Core Needle Biopsy for Breast Lesion.

Heeseung PARK ; Seong Hwan BAE ; Jin You KIM ; Taewoo KANG

Journal of Breast Disease.2018;6(1):29-33. doi:10.14449/jbd.2018.6.1.29

Ultrasonography-guided core needle biopsy has been standard of care for diagnosing suspicious breast lesion. The procedure is safe and has a low rate of complications. Most common complication might be bleeding or hematoma, which could be avoided by careful process or changing it to excisional biopsy or managed by proper management. Rarely, Post-procedural arteriovenous fistula is reported in almost all body fields, which is life quality threatening, not life-threatening. Most of them occur with obvious vessel injury, and their primary end-point of management is the obliteration of fistula by thrombosis. However, we experienced a case of iatrogenic arteriovenous fistula after core needle biopsy for breast lesion with small vessel injury which was not but small ones, and its thrill did not disappear even after thrombosis. We would like to share our clinical learnings from surgical management process of this rare complication.
Arteriovenous Fistula* ; Biopsy ; Biopsy, Large-Core Needle* ; Breast* ; Fistula ; Hematoma ; Hemorrhage ; Iatrogenic Disease ; Quality of Life ; Standard of Care ; Thrombosis

7

Cite

Share

A Case of Scalp Metastasis from Breast Cancer without Other Distant Metastases.

Hyunjoo YOO ; Sang Uk PARK ; Jun Yong LEE ; Jiyoung KIM ; Se Jeong OH

Journal of Breast Disease.2018;6(1):25-28. doi:10.14449/jbd.2018.6.1.25

Cutaneous metastases of malignant tumors are relatively rare, and breast cancer is the most common malignancy in women with cutaneous metastases. Since newly developed cutaneous lesions can be the first signs of metastases in breast cancer patients, it is crucial to rule out the possibility of malignancy. Although only a few cases have been reported, breast cancer contributes to a large portion of scalp metastases. This case report demonstrates a rare case of breast cancer metastasis only confined to the scalp. The patient was a 55-year-old woman who was diagnosed with scalp metastasis from breast cancer 10 years after the first curative surgery. The scalp lesion was palpable for 4 years and showed a sudden increase in size over a few months. The patient underwent wide excision with flap coverage. After surgery the patient received radiotherapy, but she has refused additional hormonal therapy. To date, there is no evidence of disease recurrence.
Breast Neoplasms* ; Breast* ; Female ; Humans ; Middle Aged ; Neoplasm Metastasis* ; Radiotherapy ; Recurrence ; Scalp Dermatoses ; Scalp*

8

Cite

Share

Clinical Significance of Non-Mass-Like Enhancement of Preoperative Magnetic Resonance Imaging in Breast Cancer Considering Breast-Conserving Surgery.

Min Ji PARK ; Min Young PARK ; Jin Ok KWON ; Kyoung Sik PARK ; Yeong Beom YU ; Jung Hyun YANG ; Soo Min JUNG

Journal of Breast Disease.2018;6(1):20-24. doi:10.14449/jbd.2018.6.1.20

PURPOSE: The purpose of this study was to investigate the significance of non-mass enhancement (NME) findings on preoperative breast magnetic resonance imaging (MRI) when invasive breast cancer patients with single lesions underwent breast-conserving surgery (BCS). METHODS: We reviewed the preoperative MRI findings of 252 patients who underwent BCS from January 2014 to September 2016. Based on the MRI findings, we divided the patients into two groups, those who did and did not have NME, and we retrospectively analyzed the clinical outcomes of the two groups. RESULTS: The NME group had 57 patients, and the no-NME group had 195 patients. The incidence of in situ lesions was higher in the NME group than in the no-NME group (p<0.001). Additionally, the positive resection margin rate on frozen biopsy was higher in the NME group than in the no-NME group (p=0.002). CONCLUSION: When preoperative MRI had NME findings, in situ lesions were more likely to accompany invasive breast cancer lesions, and the positive resection margin rate for frozen biopsy during BCS was high. Therefore, in these cases, the lesion should be excised more widely when BCS is performed, or frozen biopsy for resection margin during BCS should be performed if possible.
Biopsy ; Breast Neoplasms* ; Breast* ; Humans ; Incidence ; Magnetic Resonance Imaging* ; Mastectomy, Segmental* ; Retrospective Studies

9

Cite

Share

Predictors of Positive or Close Surgical Margins in Breast-Conserving Surgery for Patients with Breast Cancer.

Sang Min HONG ; Eun Young KIM ; Kwan Ho LEE ; Yong Lai PARK ; Chan Heun PARK

Journal of Breast Disease.2018;6(1):11-19. doi:10.14449/jbd.2018.6.1.11

PURPOSE: This study aimed to determine the clinical and pathological factors associated with a higher rate of positive or close margins after breast-conserving surgery (BCS) by comparing these patients to patients with a negative margin. The second aim was to evaluate intraoperative resection margin status and reoperation rates for margin control in patients who underwent BCS. METHODS: We reviewed the clinical and pathological data of all women diagnosed with invasive breast carcinoma (IBC) and ductal carcinoma in situ (DCIS) at our institution between January 2006 and December 2016. RESULTS: During the 10-year study period, 785 patients were diagnosed with either IBC or DCIS, and 402 of these patients had undergone a total mastectomy as the primary treatment. The remaining 383 patients who underwent BCS were included in the final analysis. Of these, 100 patients (26.1%) had intraoperative positive or close margins. The remaining 283 patients (73.9%) had a negative margin intraoperatively, but 32 of these patients had positive or close margins on permanent sections. In the multivariate analyses, microcalcifications on mammograms (vs. none; odds ratio [OR], 1.911; 95% confidence interval [CI], 1.156−3.160), in situ carcinomas larger than 2.0 cm (vs. ≤2.0 cm; OR, 3.106; 95% CI, 1.193−8.086), and lumpectomy (vs. quadrantectomy; OR, 2.863; 95% CI, 1.268−6.622) showed a significant association with a positive or close surgical margins. Patients with intraoperative positive or close margins underwent more reoperation than those with negative margins (5.0% vs. 2.8%). CONCLUSION: After BCS, microcalcifications on mammograms, large-sized in situ carcinomas, and lumpectomy were more likely to have positive or close margins.
Breast Neoplasms* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Female ; Humans ; Mastectomy ; Mastectomy, Segmental* ; Mastectomy, Simple ; Multivariate Analysis ; Odds Ratio ; Reoperation

10

Cite

Share

Necessity of In Situ Hybridization Test of Human Epidermal Growth Factor Receptor 2 (HER2) Status in Breast Cancer Patients with Equivocal HER2 Immunohistochemistry Results.

Hyun June PAIK ; Hee Jun CHOI ; Jai Min RYU ; Sungmin PARK ; Isaac KIM ; Se Kyung LEE ; Jonghan YU ; Seok Won KIM ; Seok Jin NAM ; Jeong Eon LEE

Journal of Breast Disease.2018;6(1):1-10. doi:10.14449/jbd.2018.6.1.1

PURPOSE: Accurate human epidermal growth factor receptor 2 (HER2) status is important in predicting prognosis and providing treatment for HER2-positive breast cancer patients. However, performing in situ hybridization (ISH) can be an economic burden on developing countries. This study aimed to find an alternative to the ISH test by predicting the HER2 status in patients with equivocal immunohistochemistry (IHC) results. METHODS: We retrospectively reviewed the clinical data of 15,535 patients who underwent curative surgery for invasive breast cancer between February 2005 and April 2015 at the Samsung Medical Center. Equivocal HER2 IHC results were obtained for 461 patients. Logistic regression analysis using stepwise selection was performed to identify the clinicopathological factors related to silver in situ hybridization (SISH) status. We analyzed the data by dividing the estrogen receptor and progesterone receptor (PR) into three groups according to Allred score. RESULTS: Multivariable analysis identified poorly differentiated histological grade, lower PR score, higher expression of Ki-67 and p53, and lower expression of cytokeratin 5/6 and epidermal growth factor receptor as predictors of SISH-positive results. The area under the curve for the receiver-operating characteristic curve was 0.74. CONCLUSION: We identified factors related to a positive HER2 status by SISH. However, there was insufficient power in the prediction model for diagnosis and evaluation. Therefore, the SISH test is essential in determining the HER2 status of breast cancer patients when the IHC result is equivocal.
Breast Neoplasms* ; Breast* ; Developing Countries ; Diagnosis ; Epidermal Growth Factor* ; Estrogens ; Humans* ; Immunohistochemistry* ; In Situ Hybridization* ; Keratins ; Logistic Models ; Prognosis ; Receptor, Epidermal Growth Factor* ; Receptors, Progesterone ; Retrospective Studies ; Silver

DISPLAY OPTIONS

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share