PURPOSE: A sentinel lymph node biopsy (SLNB) has become the standard care for the staging of axilla in breast cancer and the increase in body weight with age has an inverse relationship to its success. Therefore, the characteristics of patients who underwent a SLNB, and the relationship of the influences of Body Mass Index (BMI) and age, were evaluated using lymphoscintigram visualization in a sentinel lymph node biopsy (SLNB) for breast cancer. METHODS: Between Sept. 1995 and Dec 2003, 238 patients underwent lymphoscintigraphy and SLNB (including full axillary node dissection with SLNB). 205 (86.1%) cases were able to be visualized by lymphoscintigraphy, But the remaining 33 (13.9%) were not. A combined technique (radioisotope and blue dye) was used to detect the SLNs. The BMI for each patient was calculated from height and weight data (kg/m2). RESULTS: A SLNB was attempted in all cases, but 5 failed. Of the 238 cases, the lymphoscintigraphy visualization was successful in 205 (86.1%) and failed in 33 (13.9%). The mean weight and BMI were significantly higher in the failure group. The success of a SLNB was inversely related to the BMI. When the subjects were divided into two group ac-coding to age (<50 year-old versus > or =50 year-old), this relationship was more pronounced in the > or =50 year-old group. CONCLUSION: The age and BMI of the patient influences the detection of the sentinel lymph node on a lymphoscintigram. There was no influence on the sentinel lymph node biopsy with increasing BMI and age. Therefore, increased age and/or BMI alone do not appear to be contraindication for a sentinel lymph node biopsy in older or overweight patients.
Axilla ; Body Mass Index* ; Body Weight ; Breast Neoplasms* ; Breast* ; Humans ; Lymph Nodes* ; Lymphoscintigraphy* ; Overweight ; Sentinel Lymph Node Biopsy

PURPOSE: For the accurate diagnosis of non-palpable breast lesions with microcalcification, a localization and biopsy procedure should be performed by using mammography. Recently, a stereotactic vacuum-assisted biopsy has been reported as a convenient and accurate method for a procedure. This study was performed to determine whether the upright add-on type stereotactic biopsy was suitable for the diagnosis of microcalcified breast lesions in Korean women. METHODS: Between April 2002 and March 2003, an upright add-on type stereotactic vacuum-assisted biopsy was performed in 21 cases with microcalcification; that had been categorized from 2 to 5 according to the BI-RADS (Breast Imaging Reporting and Data System). The microcalcified lesions in biopsy specimens were confirmed with tissue mammogram and a pathological review performed. RESULTS: The pathological findings revealed fibrocystic changes in 15 cases, intraductal papilloma in 1 and ductal carcinoma in situ (DCIS) in 5. There were no malignancy among the BI-RADS category 2 & 3 cases, but DCIS was found in 2 (25%) out of 8 BI-RADS category 4 cases, and in all 3 (100%) of BI-RADS category 5 cases. The malignancy detection rate among the cases with microcalcification with a BI-RADS category above 4 was 45.4% (5/11). CONCLUSION: An upright add-on type stereotactic vacuum assisted biopsy is an accurate, safe and very convenient tool for the diagnosis of breast lesions with microcalcification.
Biopsy* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Diagnosis* ; Female ; Humans ; Mammography ; Papilloma, Intraductal ; Vacuum

PURPOSE: The main clinical significance of HER-2/neu gene amplification is derived from its use as (a) a prognostic indicator, (b) a predictive factor for the sensitivity to chemotherapy, and (c) the identification of cases that are eligible for a specific therapy targeting the HER-2/neu protein. Over- expression of HER-2/neu has been shown to be associated with a poor prognosis for patients with node-positive breast cancer and also possibly for patients with node-negative breast cancer. The purpose of this work was to analyze the HER-2/neu gene amplification and correlate it with other clinico-pathologic parameters. METHODS: The study population consisted of 194 patients with breast cancer who had been treated with curative surgery at the Kangdong Sacred Hospital, Seoul, Korea from 1995 to 2000. Paraffin-embedded tissue samples from the primary tumors were obtained from the hospital archives and the tissue microarray was then constructed. We analyzed the amplification of HER-2/neu gene by the two-color FISH (Fluorescence in situ hybridization) method, and we correlated the results with other clinico-pathologic parameters such as tumor size, stage, histologic grade, lymph node status and hormonal receptor status. RESULTS: For 44 cases (22.7%) of a total 194 cases, the HER-2/neu gene was amplified. HER-2/neu gene amplification was positively correlated with TNM stage and lymph node status, and it was inversely correlated with estrogen receptor positivity. CONCLUSION: For breast cancer, the analysis of the HER-2/neu gene by FISH based on a tissue microarray may be useful.
Breast Neoplasms* ; Breast* ; Drug Therapy ; Estrogens ; Gene Amplification ; Humans ; Korea ; Lymph Nodes ; Prognosis ; Seoul

PURPOSE: Breast cancer is a common malignant tumor for Korean women. Various oncogenes have been demonstrated in malignant tumor cells. There were many reports on the relationship between the prognosis and the tumor markers, and particularly for HER-2/neu; however, this relationship is controversial. The aim of this study was to perform immunohistochemical staining for the HER-2/neu antigenic protein in breast cancer patients to evaluate the expression rate of this antigenic protein, and to compare the correlations with the patients' prognosis. METHODS: The medical records of 100 patients who were diagnosed with breast cancer and who were treated with mastectomy between January 1996 and December 1999 at Soonchunhyang University Cheonan Hospital were selected according to the tissue condition of the paraffin block fixations. The prognostic factors were then investigated. The immunohistochemical expression of HER-2/neu was examined and compared with the survival rate using a Kaplan-Meier estimate and a log rank test. RESULTS: One hundred patients were included in this study, had a mean (SD) age of 47.9 (plus or minus 10.5) years and a follow-up duration of 59.9 (plus or minus 13.3) moths The overall mortality was 35% (35/100) and the mean survival time (SD) was 64.4 (plus or minus 12.0) months. The overall 5-year survival rate was 77.0%. Among the study variables, the tumor stage was a significant predictor of survival, and it as associate with a significantly low survival rate for stage III tumor. Lymph node metastasis, hormonal receptor status, histologic grade and HER-2/neu overexpression were significantly associated with the survival rate for patients with breast cancer. CONCLUSION: HER-2/neu is a very useful prognostic factor, and statistical significance was achieved for this factor.
Breast Neoplasms* ; Breast* ; Chungcheongnam-do ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Lymph Nodes ; Mastectomy ; Medical Records ; Mortality ; Moths ; Neoplasm Metastasis ; Oncogenes ; Paraffin ; Prognosis ; Survival Rate ; Biomarkers, Tumor

PURPOSE: Survivin is a member of the inhibitor of apoptosis (IAP) family, which is also involved in the regulation of cell division and is also overexpressed and associated with parameters of poor prognosis in most human cancers, including carcinomas of the lung, breast, colon, stomach, esophagus and pancreas. This study examined the expression patterns of survivin in normal breast tissue, atypical hyperplasia, primary breast cancer and lymph node tissues involved with breast cancer and to determined whether the expression of survivin is associated with the characteristics and prognosis of breast cancer. METHODS: Formalin-fixed paraffin-embedded samples from 80 breast cancer, 20 atypical hyperplasia and 20 malignant lymph node tissue cases were immunostained using polyclonal survivin (Novus Biologicals, CO). The degree of immunostaining was recorded on a scale of 0-3 according to the percentages of staining and distributions within the cytoplasm & nucleus. RESULTS: Survivin was expressed in 52, 14 and 17 of the 80 breast cancer (65%), atypical hyperplasia (70%) and breast cancer lymphoid (85%) specimens respectively. Among those expressing cancer, 11.3, 31.3 and 22.5% demonstrated nuclear staining only, cytoplasmic staining only and both nuclear and cytoplasmic staining respectively. A statistical analysis revealed that cytoplasmic survivin expression was correlated with the stage, histological grade and L/N metastasis. In a Cox proportional hazard model analysis, the expression of survivin was not identified as a significant independent predictor of overall survival (P=0.168), although the decrease in the survival rate of survivin-positive patients did reach statistical significance (P=0.048). CONCLUSION: Our results show that survivin is frequently overexpressed in primary breast cancer and its expression gradually increased from normal breast tissue to malignant lymph nodes. The expression of cytoplasmic survivin was common in breast cancer and could be both a useful diagnostic marker and important source of prognostic information.
Apoptosis ; Breast Neoplasms* ; Breast* ; Cell Division ; Colon ; Cytoplasm ; Esophagus ; Humans ; Hyperplasia ; Lung ; Lymph Nodes ; Neoplasm Metastasis ; Pancreas ; Prognosis ; Proportional Hazards Models ; Stomach ; Survival Rate

PURPOSE: Drug resistance plays an important role in the failure of chemotherapy in breast cancer. The purpose of the study was to investigate the chemosensitive and chemoresistance indices of breast carcinomas and see if the in vitro chemosensitivity test correlated with the prognostic indices. METHODS: The immunohistochemical expressions of MDR1, MRP1 and topoisomerase IIalpha(topo IIalpha) were studied and then correlated these with the in vitro chemosensitivities using the histoculture drug response assay (HDRA) and clinicopathological factors in 51 breast carcinomas. RESULTS: In the breast carcinomas examined, the immunohistochemical expressions of MDR1, MRP1 and topo II alpha were strongly observed in 26 (51.0%), 16 (32.0%), 15 (31.3%) carcinomas, respectively. The MRP1 was more frequently expressed in poorly differentiated carcinomas (P= 0.006), and those of MDR1 and topo II alpha were more frequently observed in tumor overexpressing cerbB2 (P=0.038, P=0.036). The expression of MDR1 was related to that of topo II alpha (P=0.015). Comparing these markers with the in vitro chemosensitivities to cyclophosphamide, 5-FU, adriamycin, taxol and taxotere, no correlations were found between the expression of MDR1, MRP1, and topo II alpha but from the chemosensitivity using the HDRA, the growth inhibition rate for cyclophosphamide was higher in MRP1 expressing carcinomas (P=0.009). CONCLUSION: MDR1, MRP1 and topo II alpha were all found to be associated with the poor prognostic indices, but assessment of their immunohistochemical expressions did not allow for prediction of the response to chemotherapy by the in vitro chemosensitivity test in breast carcinomas.
Breast Neoplasms* ; Breast* ; Cyclophosphamide ; Doxorubicin ; Drug Resistance ; Drug Therapy ; Fluorouracil ; Paclitaxel

PURPOSE: The extent of the loss of heterozygosity (LOH) has been used as the genetic parameter for the classification and staging of some solid tumors. Breast cancers such as ductal carcinoma in situ (DCIS), and invasive and metastatic lesions, are frequently observed to contain heterogeneous tumor foci. To delineate the relation between the LOH and the progression of breast cancers, three successive histological sites in a tumor lesion were analyzed for LOH events. METHODS: We tested 111 tumor site including DCIS, and invasive, and metastatic lymph nodes from 50 breast cancers for LOH using 5 microsatellite makers on 8 chromosomal arms (3p, 4p, 5q, 8p, 9p, 13q, 17p, & 18q). RESULTS: Twenty-four of 34 breast cancers showing intratumoral histological heterogeneity had common chromosomal losses in the heterogeneous tumor sites, as well as having divergent losses that were restricted to a part of tumor lesion (mean divergent loss, 2.32). The number and frequency of heterogeneous chromosomal losses were not significantly related with age, tumor size, and stage. Overall, at least one chromosomal loss was detected in 48 cases, and incidences of LOH in each chromosome were 27.1~63.3%. A large fraction (58%) of breast cancer patients had 2 to 4 chromosomal losses, and chromosome 8p was most frequently lost (63%). When comparing the number of chromosomal losses in nine cases with all of three progressive lesions, the lost extent was greater in the DCIS (mean losses, 4.44) than in the invasive sites (mean losses, 3.1) and the metastatic lymph nodes (mean losses, 2.9). Moderate-level chromosomal losses involving 3-5 chromosomes were significantly related with lymph node metastasis (p=0.006) and the advanced tumor stage (p<0.005), whereas low-level losses involving 1~2 chromosomes and high-level losses involving 6~7 chromosomes were more common in DCIS and early-stage diseases. CONCLUSION: The DCIS, invasive, and metastatic sites of a breast cancer patient contained common and divergent chromosomal losses. This indicates the concurrent expansion of different subclones was derived from a common ancestor clone, in which an optimal range of chromosomal losses, rather than high-level chromosomal losses, was more frequently associated with lymph node metastasis and the advanced tumor stages.
Arm ; Breast Neoplasms* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Classification* ; Clone Cells ; Humans ; Incidence ; Loss of Heterozygosity ; Lymph Nodes ; Microsatellite Repeats ; Neoplasm Metastasis ; Population Characteristics

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

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

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