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

Purpose: Breast cancer is one of the most frequent malignant tumors in American and European countries, with incidences increasing every year. In Korea it was the second most frequent cancer in 2002, followed by stomach cancer. However, in 2001 the incidence of breast cancer was first, followed by colon cancer, with incidences increasing every year. Conversely, breast cancer in men is not frequent, with an incidence of less than 1%, according to studies from both Korea and abroad. Studies on the treatment methods and prognostic factors of breast cancer in men are limited, with little clinical experience. Although there was difficulty in collecting complete data, due to lack of awareness of male breast cancer, the clinical characteristics could be determined from the experience and treatment outcomes of male breast cancer patients. Methods: The medical records of 13 male patients with breast cancer, who could be followed up, were retrospectively evaluated from 4809 patients with breast cancer, evaluated between 1989 and 2003. Results: The average age of the subjects was 64.3 years, with the breast masses with no pain situated at the center of the breast in most cases. The affected period in most patients was 1 year, with most having stage II breast cancer. Conclusion: Although asymptomatic unilateral subareolar breast mass in old ages is the most frequent symptom, most missed the period for early treatment due to lack of awareness of male breast cancer, therefore, their breast cancer had been for more than a year. Despite the difficulty due to the lack of data, attention needs to paid, and continuous studies required, toward male breast cancer.
Breast Neoplasms ; Breast Neoplasms, Male ; Breast* ; Colonic Neoplasms ; Humans ; Incidence ; Korea ; Male* ; Medical Records ; Multiple Endocrine Neoplasia Type 1 ; Retrospective Studies ; Stomach Neoplasms

The histological distinction between benign and malignant phyllodes tumors (PT) is often difficult and arbitrary. We analyzed clinical, histological features and expressions of Ki-67 and p53 using immunohistochemistry and estimate its significance in assessing the grade of malignancy and in predicting the clinical behavior of these tumors on 20 cases of PT of the breast (11 benign, 3 low-grade malignancy and 6 high-grade malignancy). Statistically significant differences between benign, low-grade malignant, and high-grade malignant PT by size of tumor, cellular atypism, stromal cellularity, margin of tumor, and number of mitotic figures. The mean labeling index (LI) of Ki-67 in high-grade malignant PT (9.6+/-9.6) was three-fold higher than that in benign PT (2.7+/-2.2), but this difference was not statistically significant (P=0.074). None of the benign PT were positive for p53, whereas 2 of 3 low-grade malignant and 3 of 6 high-grade malignant PT were positive for p53. Statistically significant differences in the pattern of p53 expression existed among the benign, low-grade malignant, and high-grade malignant lesions (P=0.018). Ki-67 LI and p53 expression were associated with numbers of mitotic figure, but were not associated with metastasis (P=0.546 and 0.216). Increased p53 immunoreactivity is present in high-grade and low-grade malignant PTs in contrast to benign PTs, and malignant PT had a higher Ki-67 LI than benign PT. Thus, p53 and Ki-67 expression may assist in distinguishing benign from malignant PT in diagnostically difficult cases.
Breast* ; Immunohistochemistry ; Neoplasm Metastasis ; Phyllodes Tumor* ; Prognosis

PURPOSE: The development of publicized screening methods for breast carcinoma detection has led to a marked increase in the discovery of ductal carcinoma in situ (DCIS) or DCIS with microinvasion (DCIS-MI). Axillary lymph node status has been believed to be not only an indicator of prognosis, but also a direction of adjuvant therapy. But the incidence of axillary metastasis in DCIS or DCIS-MI has diversely found in from 0% to 20%. This study was performed to analyze the incidence of axillary metastasis and the predictive factors associated with axillary lymph node metastasis in DCIS or DCIS-MI. METHODS: Patients with DCIS or DCIS-MI and axillary lymph node dissection from 1987 to 2004 were selected from Korea University Medical Center. We reviewed their medical records for age, palpability and size of the tumor, histolgic subtype, nuclear grade, hormone receptor status, and pathologic slides. RESULTS: Fifty two patients in DCIS and Thirty eight patients in DCIS-MI were included in the study. Axillary lymph node metastases were identified in 2 patients (3.8%) in DCIS and 4 patients (10.5%) in DCIS-MI. Tumor size and nuclear grade in DCIS had a borderline significance in association with microinvasion. We could not be able to find any predictive factor associated with axillary lymph node metastasis in DCIS and DCIS-MI. CONCLUSION: Axillary lymph node metastasis in DCIS or DCIS-MI appeared to be not low and there was no predictive factor associated with axillary lymph node metastasis in DCIS and DCIS-MI. But DCIS patients with large tumor size and poor nuclear grade have the high possibility associated with microinvasion, therefore, in that cases, there is a need to consider the possibility of axillary metastasis.
Academic Medical Centers ; Breast ; Breast Neoplasms ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Humans ; Incidence ; Korea ; Lymph Node Excision ; Lymph Nodes* ; Mass Screening ; Medical Records ; Neoplasm Metastasis* ; Prognosis