OBJECTIVE: To evaluate the occurrence of residual or recurrent disease after conization for adenocarcinoma in situ (AIS) of the uterine cervix. METHODS: Medical records of 99 patients with a histologically diagnosis of AIS of the uterine cervix by conization between 1991 and 2008 were reviewed retrospectively. RESULTS: Seventy eight of 99 patients (78.8%) had negative and 18 (18.2%) had positive resection margins of the conization specimen, and 3 (3.0%) had unknown margin status. Of the 78 patients with negative margins, 45 underwent subsequent hysterectomy and residual AIS were present in 4.4% (2/45) of patients. Ten of the 18 patients with positive margins received subsequent hysterectomy and 3 patients (30%) had residual AIS. Twenty-eight patients had conservative treatment and during the median follow-up time of 23.5 months (range, 7 to 124 months), only one patient (3.6%) had recurrent AIS and was treated with a simple hysterectomy. Eight patients became pregnant after conization, 4 of them delivered healthy babies, one had a spontaneous abortion and 3 were ongoing pregnancies. CONCLUSION: Patients with positive resection margins after conization for AIS of the uterine cervix are significantly more likely to have residual disease. However, negative resection margin carries a lower risk for residual AIS, therefore conservative management with careful surveillance seems to be feasible in women who wish to preserve their fertility.
Abortion, Spontaneous ; Adenocarcinoma ; Cervix Uteri ; Conization ; Female ; Fertility ; Follow-Up Studies ; Humans ; Hysterectomy ; Medical Records ; Pregnancy

OBJECTIVE: The aim of this study was to evaluate the correlation between the results of preoperative PAP smears and known poor prognostic factors in patients with endometrial carcinoma. METHODS: Between Jan. 2000 and Dec. 2003, preoperative evaluation of PAP smears were done in 111 patients with endometrial carcinoma who underwent surgical staging. Pathologic parameters of permanent specimens were evaluated and correlated with the results of PAP smears. chi-square-test was used for statistical analysis and p-values <0.05 was considered as statistically significant result. RESULTS: The mean age of patients was 49 years with range between 24 and 75 years old. The results of preoperative PAP smears were normal in 70 patients (57.7%), atypical glandular cells of undetermined significance (AGUS) in 22 patients (22.5%), adenocarcnoma in 19 patients (19.8%) on preoperative PAP smears. Statistically significant associations were found between preoperative PAP smears and poor histologic grade (p=0.000), depth of myometrial invasion (p=0.000), lymph-vascular space invasion (p=0.003), cervical involvement (p=0.004), adnexal involvement (p=0.024), positive peritoneal cytology (p=0.042). However, old age, poor histologic type, higher surgical staging, pelvic nodes metastasis and para-aortic lymph node metastases were not statistically significant. CONCLUSION: This study revealed glandular cell abnormalities on preoperative PAP smears in patients with endometrial carcinoma were significantly associated with poor histologic grade, deep myometrial invasion, lympho-vascular invasion, cervical involvement, adnexal involvement, positive peritoneal cytology. Therefore, the results of preoperative PAP smears could be considered as an important part of the preoperative evaluation in patients with endometrial carcinoma.
Aged ; Endometrial Neoplasms* ; Female ; Humans ; Lymph Nodes ; Neoplasm Metastasis

OBJECTIVE: This study was performed to investigate the efficacy of DNA chip method for detection and genotyping of various human papillomavirus in the patients with invasive cervical cancer in Korea. METHODS: The study subjects included 38 cases of cervical cancer for HPV detection and genotyping, and the commercially available DNA chip was used. Retrospectively cervical specimens of thirty eight patients with pathologically confirmed invasive cancer of the uterine cervix were tested for HPV typing performed by DNA chip method in Samsung Cheil Hospital from September 1999 to October 2000. RESULTS: Among 38 cervical carcinomas, histological examination revealed that 34 (89.5%) cases were squamous cell carcinoma, three (7.9%) were adenocarcinoma and one (2.6%) was small cell carcinoma. In carcinoma patients thirty two cases (84.2%) of invasive carcinoma were positive for at least one type of high risk HPV. Only two woman (5.3%) among the healthy group had HPV positive. We compared the results in HPV DNA chip with those in sequencing. The concordance rate between the two methods for the detection of HPV was 95.7% (67 of 70 cases). CONCLUSION: We confirmed that DNA chip method was a simple, convenient, and effective method for detecting HPV in cervical carcinoma and health women.
Adenocarcinoma ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; DNA* ; Female ; Humans* ; Korea ; Oligonucleotide Array Sequence Analysis* ; Retrospective Studies ; Uterine Cervical Neoplasms*

Postmenopausal squamous atypia (PSA) is a phenomenon characterized by cellular alterations mimicking condyloma in the uterine cervix of postmenopausal women. It is not associated with human papillomavirus (HPV) infection. The aim of this study is to correlate findings with HPV infection and the cytohistologic findings of PSA. Eighty-three smears from postmenopausal women, initially interpreted as ASCUS and low-grade squamous intraepithelial lesions(LSIL), were reviewed according to the criteria of PSA. Fifty-eight cases were subsequently reclassified as PSA. Forty cases categorized as PSA were available for HPV-DNA detection by a nested polymerase chain reaction. Eight of these 40 cases(20%) showed biopsy-proven LSIL lesions. The HPV-DNA was detected in 42.5%(17/40), compared to 25%(5/20) of control cases. The HPV-DNA detection rate of biopsy-proven LSIL was 62.5%(5/8). It has been concluded that cytologic differential diagnosis of PSA from LSIL is difficult due to because of poor histologic and viral correlation.
Cervix Uteri ; Diagnosis, Differential ; Female ; Humans* ; Papillomavirus Infections* ; Polymerase Chain Reaction

PURPOSE: This study was performed to evaluate the efficacy and safety of sentinel lymph node biopsy alone (SLNB) without axillary lymph node dissection. METHODS: Between Jun. 1999 and Dec. 2002, we carried out SLNB in 85 consecutive patients with T1 breast cancer whose sentinel lymph node(s) were tumor-free on intra- operative frozen section. Even when sentinel lymph node(s) turned out to be positive by permanent pathology, additional axillary lymph node dissection was not performed. Patients underwent total mastectomy or partial mastectomy and received an appropriate adjuvant therapy according to the characteristics of the primary tumor. All patients who had breast conserving surgery received postoperative radiotherapy to the remaining breast, but not to the axilla. RESULTS: SLNB only took 14 minutes and yielded no postoperative complications. Among the 85 patients whose sentinel lymph nodes were tumor-free on frozen section, 11 patients were diagnosed as metastatic in the permanent pathology. One of them had a macro-metastasized (2.5 cm) sentinel lymph node, and the rest had micro-metastasized sentinel lymph nodes. For 23.1 months of mean follow-up period, all the patients including a patient who died of liver metastases at 17 months showed no evidence of axillary recurrence. CONCLUSION: No axillary recurrence following SLNB suggests that SLNB may be a good alternative to routine axillary lymph node dissection while providing less surgical morbidity in women with a small breast cancer. However, more patients accumulation and follow-up period will be needed for the final conclusion.
Axilla ; Breast Neoplasms* ; Breast* ; Female ; Follow-Up Studies ; Frozen Sections ; Humans ; Liver ; Lymph Node Excision* ; Lymph Nodes ; Mastectomy, Segmental ; Mastectomy, Simple ; Neoplasm Metastasis ; Pathology ; Postoperative Complications ; Radiotherapy ; Recurrence ; Sentinel Lymph Node Biopsy

OBJECTIVE: The aim of this study was to evaluate the correlation between preoperative Pap smears and known poor prognostic factors in patients with endometrial carcinoma. METHODS: Between January 1989 and June 2000, preoperative evaluation of Pap smears were done in 163 patients with endometrial carcinoma who underwent total abdominal hysterectomy with bilateral salpingo- oophorectomy, peritoneal cytology, and pelvic and/or para-aortic lymphadenectomy. All Pap smears and histologic sections were reviewed. Pathologic parameters of hysterectomy specimens were evaluated and correlated with the findings of Pap smears. Chi-square test was used for statistical analysis. p-values<0.05 were considered significant. RESULTS: The mean age of patients was 49 years with range between 24 and 75 years old. 72 patients (44.2%) had normal, 38 patients (23.3%) had atypical glandular cells of undetermined significance (AGUS), and 53 (32.5%) had adenocarcinoma on preoperative Pap smears. Statistically significant associations were found between Pap smears and age (p=.014), histologic grade (p=.000), cervical involvement (p=.015), depth of myometrial invasion (p=.000), lymph-vascular space invasion (p=.000), and surgical stage (p=.049). Patients with malignant cytology were more likely to have older age, poorly differentiated malignancies, deeper myometrial invasion, cervical metastases, lymphvascular invasion and higher surgical stage. However, histologic subtypes (p=.328), peritoneal cytology (p=.067), adnexal involvement (p=.602) and pelvic and/or para-aortic lymph node metastases (p=.266 and p=.220) were not statistically significant. CONCLUSION: This study revealed that preoperative abnormal Pap smears in patients with endometrial carcinoma were significantly associated with age, histologic grade, cervical involvement, depth of myometrial invasion, lymphvascular space invasion and surgical stage. Therefore, Pap smears could be an important part of the preoperative evaluation in patients with endometrial carcinoma.
Adenocarcinoma ; Aged ; Endometrial Neoplasms* ; Female ; Humans ; Hysterectomy ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Ovariectomy

PURPOSE: The natural history of patients with ductal carcinoma in situ (DCIS) with microinvasion is poorly defined, and the clinical management of these patients, with particular reference to management of the axilla, has been controversial. Previous studies of this lesion have used arbitrary criteria for the evaluation of microinvasion. METHODS: In order to compare the clinicopathologic features and treatment outcomes between DCIS and DCIS with microinvasion, the medical records of 101 patients of DCIS with or without microinvasion who had been treated at Yongdong Severance hospital from April 1991, to October 1998, were reviewed retrospectively. RESULTS: The mean age of the DCIS with microinvasion group was 44.8 years-old and that of the DCIS group was 47.4 years-old. The peak age group within both study groups was the 5th decade. The primary tumors of the DCIS-MI group were larger (2.16 vs 1.93 cm) and more easily palpated (66.3% vs 36.6%) upon the physical examination than that of the DCIS group. The rate of axillary lymph node metastasis was higher in the DCIS-MI group (10% vs 1.3%). In terms of nuclear grade, comedo type, hormone receptor status, and c-erbB2 immunohistochemical positivity, there were no statistically significant differences between the DCIS and DCIS-MI groups. The recurrence rate within the DCIS-MI group was higher than that of DCIS group (10% vs 1.4%). The 5-year disease free survival rate of the DCIS and DCIS-MI groups were 98% and 89% respectively. CONCLUSION: Ductal carcinoma in situ with microinvasion is thought to be a transitional disease entity between ductal carcinoma in situ and invasive ductal carcinoma. However, the treatment options for ductal carcinoma in situ with microinvasion have been similar to that of the invasive carcinoma. More long-term follow-up and a multicenter study seem to be necessary to identify differences in the clinical features and to determine the optimal methods of treatment.
Axilla ; Breast Neoplasms ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Disease-Free Survival ; Humans ; Lymph Nodes ; Medical Records ; Natural History ; Neoplasm Metastasis ; Physical Examination ; Recurrence ; Retrospective Studies

PURPOSE: Epidemiological and laboratory studies suggest that nonsteroidal antiinflammatory drugs (NSAIDs) reduce the risk of colon cancer and that the inhibition of colon cancer is mediated through modulation of eicosanoid production. The present study examined the effect of cyclooxygenase (COX) and lipoxygenase (LOX) inhibitors on colon cancer cell growth and prostaglandin E(2) (PGE(2)) or leukotriene B(4) (LTB(4)) secretion by these cells. MATERIALS AND METHODS: The human colon adenocarcinoma cell lines, Caco-2 and HT-29 cells, were cultured in serum-free medium with various concentrations of indomethacin, piroxicam or esculetin in the presence of 0.15nM or 10nM linoleic acid. Cell number was estimated by MTT assay and PGE(2) and LTB(4) were analyzed by enzyme immunoassay. RESULTS: The NSAIDs inhibited cell proliferation in a concentration-dependent manner. However, the potency and efficacy of each drug varied in the two cell lines. In Caco-2 cells, the effect of esculetin was higher than that of indomethacin, and piroxicam had no effect. In HT-29 cells, only indomethacin significantly inhibited cell proliferation. All three agents inhibited PGE(2) secretion in a dose-dependent manner; the effect of indomethacin was highest and that of esculetin lowest. The secretion of LTB4 was increased by indomethacin and piroxicam but decreased by esculetin. The effects of these drugs on cell proliferation and eicosanoid secretion were not influenced by linoleic acid concentrations in the culture media. Neither exogenous PGE2 nor LTB4 affected cell proliferation. The results of Pearson correlation analyses revealed that changes in cell proliferation were somewhat related to both concentrations of NSAIDs in the culture medium and production of PGE(2) and LTB(4). CONCLUSION: The present data suggests that the anti-proliferative effect of NSAIDs may not be entirely attributed to changes in the production of PGE2 and/or LTB4 in the two colon cancer cell lines. These NSAIDs may inhibit cell proliferation largely independent of their ability to modulate eicosanoid synthesis.
Adenocarcinoma ; Anti-Inflammatory Agents, Non-Steroidal ; Caco-2 Cells ; Cell Count ; Cell Line ; Cell Proliferation ; Colon* ; Colonic Neoplasms* ; Culture Media ; Dinoprostone ; Eicosanoids* ; HT29 Cells ; Humans ; Immunoenzyme Techniques ; Indomethacin ; Leukotriene B4 ; Linoleic Acid ; Lipoxygenase Inhibitors* ; Lipoxygenase* ; Piroxicam ; Prostaglandin-Endoperoxide Synthases*

PURPOSE: In breast cancer, the single most important prognostic indicator is the axillary nodal status of the metastasis. This study was designed to discern the accuracy of sentinel node biopsy using radioactive material for the prediction of axillary nodal status. METHODS: The study group was selected from the Department of Surgery at Yonsei University Yongdong Severance hospital, and comprised 54 patients diagnosed with breast cancer with clinical stages I or II from Nov. 1998 to May. 1999. We performed lymphoscintigraphy and gamma-probe with 99mTc-antimony trisulfide colloid for the detection of sentinel nodes. The radiotracer was injected peritumorily 2 hours prior to the operation. During, surgery and after the sentinel node biopsy was performed, level I and II axillary lymph node dissection was completed. The sentinel node was divided into 3 pieces evenly. One piece was tested for frozen section diagnoses and the others were fixed for H&E staining and immunohistochemistry (IHC) using cytokeratin antibody to detect metastasis. RESULTS: The mean number of the sentinel nodes was 1.59. The detection rate of the sentinel node was 94.4% (51/54). Among 35 patients with negative sentinel nodes on frozen section, 4 patients (11.4%) demonstrated tumor metastasis on both permanent serial H&E sections and IHC using cytokeratin. Of the 31 patients with negative sentinel node by permanent serial section, 4 patients displayed metastasis in nonsentinel axillary nodes. These results revealed that thesensitivity of the sentinel node biopsy was 83.3% and the negative predictive value was 81.1%. The false negative rate of the sentinel node biopsy was 16.7% with the permanent H&E and IHC section and 33.3% with the frozen section. In particular, in cases with tumors less than 2 cm, the sensitivity was 100% in frozen section as well as permanent section. CONCLUSION: A combination of preoperative lymphoscintigraphy and gamma probe-guided methods achieves high success rates in the identification of sentinel nodes. Multiple serial sections and IHC of the nodes are required to detect the micrometastasis of the sentinel nodes. The sentinel node biopsy is significantly accurate and may be considered as an alternative to replace the routine axillary node dissection, particularly in T1 breast cancer patients.
Predictive Value of Tests ; Biopsy ; Breast Neoplasms

BACKGROUND: The natural history of the patients of ductal carcinoma in situ(DCIS) with microinvasion is poorly defined, and the clinical management of these patients, with particular reference to management of the axilla, has been controversial. Previous studies of this lesion have used and/or arbitrary criteria for the evaluation of microinvasion. METHODS: To compare the clinicopathologic features and the outcomes of treatment between DCIS and DCIS with microinvasion, the medical records of 101 patients of DCIS with/without microinvasion who had been treated at Yongdong Severance hospital from Apr. 1991, to Oct 1998, were reviewed retrospectively. RESULTS: The mean age of the patients of DCIS with microinvasion group was 44.8 years and that of the patients of DCIS group was 47.4 years. The peak age group of both was 5th decade. The primary tumors of DCIS-MI group were larger(2.16 vs 1.93cm) and more easily palpated(66.3% vs 36.6%) on the physical examination than that of DCIS group. The rate of the axillary lymph node metastasis was higher in DCIS-MI group.(10% vs 1.3%) In terms of nuclear grade, comedo type, hormone receptor status, and c-erbB2 immunohistochemical positivity, there were no statistical significances between DCIS group and DCIS-MI group. The recurrence rate of DCIS-MI group was higher than that of DCIS group.(10% vs 1.4%) The 5-year disease free survival rate of the DCIS group and DCIS-MI group were 98% and 89% respectively. CONCLUSIONS: Ductal carcinoma in situ with microinvasion is thought to be transitional disease entity between ductal carcinoma in situ and invasive ductal carcinoma. But the treatment options of ductal carcinoma in situ with microinvasion were similar to that of the invasive carcinoma. More long-term follow-up and multicenter studies seem to be necessary to identify differences in clinical features and to determine the optimal methods of treatment.
Axilla ; Breast Neoplasms ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Lymph Nodes ; Medical Records ; Natural History ; Neoplasm Metastasis ; Physical Examination ; Recurrence ; Retrospective Studies