As a consequence of the incomplete resolution of embryologic mammary ridges, ectopic breast tissue can be present anywhere along the "milk line", including the axillary region. Aberrant breast tissue can develop with any disease that affects the normal breast, including a breast carcinoma. A carcinoma of aberrant breast tissue is rare, but should still be investigated and treated properly with respect to other breast cancers in the embryonic milk-line. Herein is reported our recent experience of a carcinoma originating from aberrant breast tissue in the right axilla. An abnormal nodule around the periphery of the normal breast should be suspected as a breast carcinoma and differential diagnosis and properly treated.
Axilla ; Breast Neoplasms ; Breast* ; Carcinoma, Ductal* ; Diagnosis, Differential

PURPOSE: This study was designed to explore the quality of life (QOL) for breast cancer patients who survived after operation by using the World Health Organization Quality of Life (WHOQOL) instrument-Korean version. METHODS: Fifty patients with breast cancer were recruited after their operations, and an informed consent was obtained from each of them. Hospital staff members served as the controls. The 100 item-WHOQOL instrument included questions on the physical, psychological, social, independence, environmental and spiritual domains, and it was employed for testing the all subjects. RESULTS: The physical, psychological, independence and social domains were shown to have a worsened quality of life for patients with breast cancer who survive after their operations. Quality of life in the physical and social domains were perceived as worse by patients having advanced stage tumor, with mastectomy. Patients with mastectomy who survived their cancer felt a worse quality of life in the psychological domain. The quality of life scores for patients having advanced stage tumor with mastectomy, during the early postoperative period (< or =2 years) was lower for the independence domain. Patients at middle postoperative period (2~5years) felt a better quality of life in spiritual domain. CONCLUSION: Not only is the objective medical success important to female breast cancer survivors, but the individual subjective perception of their condition is also important. The psychological status of these women needs to be considered when managing patients with breast cancer after their surgical operation. In this context, the WHOQOL reflects a measurement of a multi-dimensional state of well- being, and it could be a useful tool across a variety of cultural and value systems in the world.
Breast Neoplasms* ; Breast* ; Female ; Humans ; Informed Consent ; Mastectomy ; Postoperative Period ; Quality of Life* ; Survivors ; World Health Organization

PURPOSE: Breast cancer risk assessment tools have been developed in western countries as a result of large scaled epidemiological studies. These tools have been used as a rationale for breast cancer screening and to determine the selection criteria of NSABP P-1 and P-2. The aim of this study was to develop a breast cancer risk assessment tool for Korean women, which would be helpful for screening and preventing breast cancer. METHODS: The breast cancer risk model was used published by Sue Kyung Park in 2003. The report was a case- control study of 1687 breast cancer patients and 1155 normal populations in 3 hospitals from 1996 to 2000. The risk factors used in this model were age, family history of the first and second relatives, body mass index, age at the first delivery, breast-feeding and a special test on the breasts. A computer program was developed using the Borland Delphi on a personal computer using a windows 98 operating system. The program consisted of three parts; an input window of the risk factors, a calculation part of the relative risks, an output window of the results. RESULTS: The program was a 308K byte sized single executable file. In the initial window, a simple explanation of the program and a reference of the risk model were displayed. The age, height and weight were entered as continuous variables in the input window. The family history of the first and second relatives, the age at the first delivery, breast-feeding and a special test on the breasts were selected by the radio buttons. In the output window, the relative risks were calculated according to each risk factor. The overall relative risk was calculated in a given age group and the overall age group. CONCLUSION: In this study, a computer program for a breast cancer risk assessment was developed using the relative risk model of breast cancer. This program was found to be useful for making an individual breast cancer risk assessment of Korean women.
Body Mass Index ; Breast Neoplasms* ; Breast* ; Epidemiologic Studies ; Female ; Humans ; Mass Screening ; Microcomputers ; Patient Selection ; Risk Assessment ; Risk Factors

PURPOSE: The optimal sequence of chemotherapy (CT) and radiotherapy (RT) remains uncertain although both can reduce breast cancer recurrence after breast-conserving surgery (BCS). The current study was performed to evaluate whether concurrent RT with CT increases chemotherapy-associated toxicities. METHODS: Two hundred and thirty-eight patients with stage I and II breast cancers were prospectively allocated concurrent CT and RT (N=133) or sequential CT and RT (N= 105) after BCS. In the sequential group, the RT was started after completion of 3 cycles of CT with an additional 3 cycles of CT delivered after the RT. All patients underwent intravenous CMF chemotherapy composed of cyclophosphamide (500 mg/m2), methotrexate (50 mg/m2) and 5-FU (500 mg/ m2), every 3 weeks for 6 cycles following surgery. RESULTS: There were no significant differences between the two groups with regard to the grade 3 or 4 hematologic toxicities during chemotherapy or in abnormal liver enzyme elevation. Radiation related adverse effects, such as moist desquamation and pneumonitis symptom, were no different between the two groups. During the median 42 month follow-up period, range 16- to 60 months, 18 (13.5%) and 20 (19.1%) patients in the concurrent and sequential groups had systemic recurrences of breast cancer. The disease-free survival and local recurrence rates were no different between the two groups. CONCLUSION: Concurrent CT and RT were not associated with an increased toxicity and reasonable cosmetic results were achieved in this current study. The current study indicates that concurrent RT with CT after BCS is a feasible treatment modality, with the advantage of a shortening treatment time.
Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant* ; Cyclophosphamide ; Disease-Free Survival ; Drug Therapy ; Fluorouracil ; Follow-Up Studies ; Humans ; Liver ; Mastectomy, Segmental* ; Methotrexate ; Pneumonia ; Prospective Studies ; Radiotherapy* ; Recurrence

PURPOSE: A subcutaneous mastectomy has been proven to be oncologically safe for early breast cancer. Although a subcutaneous mastectomy and reconstruction are well established, most incisions are made directly on the breast. To improve the cosmetic outcome, an endoscopic subcutaneous mastectomy and immediate reconstruction was undertaken, which can be performed through minimal axillary and periareolar semicircular incisions. METHODS: Between October 2002 and December 2003, 9 patients with early breast cancer, whose tumors were less than 4 cm in size and more than 2 cm-apart from the nipple-areolar complex, and who were clinically node negative without invasion to skin and pectoralis muscle, underwent 10 endoscopic subcutaneous mastectomies with immediate reconstruction employing saline bag implants. Firstly, an endoscopic dye-guided sentinel node biopsy was performed through a low transverse axillary incision lateral to the pectoralis major. A subpectoral pocket was gently created under the view of endoscopic monitor by Vein Harvest. A periareolar semicircular incision was made to create the skin flap using Visiport and PowerStar Scissors. Frozen section biopsies were performed to rule out tumor invasion to the resection margin. After resection of the entire breast tissue, a saline bag prosthesis was inserted. The patients and tumor characteristics, operation times, amounts of bleeding, and cosmetic results were evaluated. RESULT: The mean patient age was 45 years (25~55). The mean tumor size was 2.5 cm, ranging from 0.7 to 5.0cm. The average operation time was 112 minutes (80~150). The mean amounts of operative bleeding was 232 ml. There was one case of transient necrosis of the nipple-areolar complex. An early implant removal was performed in one patient due to a suspected microperforation. Excellent or good cosmetic results were obtained in 8 patients (88.8%). CONCLUSION: An endoscopic subcutaneous mastectomy with immediate reconstruction, is a new technique that can minimize the direct operation scar on the breast skin following a classic operation. In properly selected cases, our results show maximized cosmetic satisfaction of breast cancer patients, so offers a promising alternative to a classic subcutaneous mastectomy with immediate reconstruction.
Biopsy ; Breast Neoplasms* ; Breast* ; Cicatrix ; Frozen Sections ; Hemorrhage ; Humans ; Mastectomy, Subcutaneous* ; Necrosis ; Pectoralis Muscles ; Prostheses and Implants ; Skin ; Veins

PURPOSE: The presence of lymph node metastasis is a key factor for deciding upon radical axillary dissection during a breast cancer operation. We performed prospective research to assess the accuracy and effectiveness of ex vivo ultrasound for detecting sentinel node metastasis during the operation. METHODS: 183 fresh sentinel lymph nodes from 30 breast cancer patients had sonographic examination performed on them by a specialized radiologist immediately after surgical resection. The sonographic criteria for malignant lymph nodes were uneven cortical thickness, a node more than 3 mm in diameter, the absence of the hilum and a round hypoechoic node. After sonographic evaluation, the specimen were delivered to the department of pathology for frozen biopsy and permanent staining. RESULTS: Among 133 lymph nodes that were examined on frozen sectioning, 12 (9.0%) were revealed as metastatic nodes and 121 (90.9%) were revealed as benign. On US examination, 150 (81.9%) among the detected 183 nodes were read as benign and 33 (18.1%) were read as metastatic. Among 150 benign nodes, four (2.6%) were proven as metastasis on permanent pathology, and 20 (60.6%) among the 33 sonographic cancerous nodes were reported as metastatic nodes. The sensitivity, specificity, positive predictive value, negative predictive value, false positive rate, false negative rate and accuracy of ex vivo ultrasound were 83.3%, 91.8%, 60.6%, 97.3%, 8.2%, 16.7% and 90.7% respectively. CONCLUSION: Ex vivo ultrasound evaluation for detecting sentinel lymph node metastasis during the operation may be helpful to decide the extent of lymph node dissection.
Biopsy ; Breast Neoplasms* ; Breast* ; Humans ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis* ; Pathology ; Prospective Studies ; Sensitivity and Specificity ; Ultrasonography*

PURPOSE: The need for completion axillary lymph node dissection, even in early breast cancer patients with a positive sentinel lymph node, has been questioned. The purpose of this study was to determine the factors that predict the presence of metastasis in non-sentinel lymph nodes (NSLNs) when the sentinel lymph node (SLN) was positive. METHODS: Between December 1998 and June 2004, the records of 104 early breast cancer patients with a positive SLN and who underwent completion axillary lymph node dissection were reviewed. The clinicopathological features in SLN-positive patients were evaluated as possible predictors of metastatic NSLN. RESULTS: Forty four (42.3%) of the 104 patients with positive SLN had metastatic NSLNs. In a univariate analysis, unicentric multifocality (P=0.016), lymphovascular invasion (P=0.006) and SLN metastasis larger than 2 mm (P= 0.003) were associated with positive NSLN findings. The number of SLNs removed was significantly associated as a negative predictor (P=0.043). A multivariate analysis revealed that SLN metastasis >2 mm (P=0.021) and lymphovascular invasion (P=0.040) were independent predictors of metastatic NSLN. CONCLUSION: The likelihood of metastatic NSLNs correlates with the size of the largest SLN metastasis and the presence of lymphovascular invasion of the primary tumor. Even though in early breast cancer with positive SLNs, incorporating these factors may help determining which patients would benefit from additional axillary lymph node dissection.
Breast Neoplasms* ; Breast* ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Multivariate Analysis ; Neoplasm Metastasis

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