PURPOSE: Micropapillary carcinoma in breast cancer was first described by Petersen in 1993, after which other reports from all over the world described their characteristics. In Korea, this type of carcinoma was first described in 1996. The purpose of our study was to find the clinicopathological characteristics of micropapillary carcinomas from our experiences and to compare the results with those of other studies. METHODS: We analyzed 19 patients, from Dec. 1999 to Dec. 2002, diagnosed with micropapillary carcinomas from postoperative pathological reports retrospectively, compared with 939 patients diagnosed with infiltrating duct carcinoma in the same period. RESULTS: The mean age and tumor size were 46.8 years (range 32~73) and 3.75cm (range 0.5~10.0), respectively. Micropapillary carcinoma showed the larger size (P=0.032) and more frequent rates of lymphovascular invasion (P= 0.007) and metastasis to axillary lymph nodes (P=0.003) than infiltrating duct carcinoma. But, in the T stage-matched analysis, the rates of axillary lymph node metastasis in micropapillary carcinoma and infiltrating duct carcinoma showed no significant differences (T1, T2, T3 : P=0.072, P= 0.080, P=0.575 ). Only in T2 stage, rates of lymphovascular invasion showed more frequent significantly in micropapillary carcinoma (P=0.012). Age, nuclear and histological grades showed no significant differences. The positive expressions of estrogen and progesterone receptors were more frequent in micropapillary carcinoma compared with infiltrating duct carcinoma, while the expressions of the C-erb-B2, p53, Ki-67 and bcl-2 showed no significant differences. CONCLUSION: The micropapillary carcinomas showed more frequent lymphovascular invasion and positive expressions of the estrogen and progesterone receptors in their immunohistochemistry.
Breast Neoplasms ; Breast* ; Estrogens ; Humans ; Immunohistochemistry ; Korea ; Lymph Nodes ; Neoplasm Metastasis ; Receptors, Progesterone ; Retrospective Studies

PURPOSE: This study was performed to show the several clinical variables before and after the surgery that need to be considered for patient selection and whether there is an increased possibility of recurrence after surgery and whether this possibility can be reduced when adjuvant treatment is applied. METHODS: The outcome of SSM with immediate breast reconstruction, using follow-up data of cases performed at Asan Medical Center between September, 1996 and December, 2002, were retrospectively assessed and pathologically advanced breast cancer patients (stage III) were analyzed separately. RESULTS: 191 patients had undergone SSM with immediate reconstruction during the study period. The percentage of cases stage III was 15.2% (29 cases). Among these patients, 6 (20.7%) were suspected of being in the early stages of breast cancer prior to the surgery. The mean age of the advanced breast cancer patients was 37 years. Immediate breast reconstruction consisted of a pedicled TRAM flap (n=24), a insertion of tissue expander (n=4) or direct implant (n=1). Radiotherapy was performed in 16 patients (53.3%) and chemotherapy was conducted without delay in all case. With a median length of follow-up of 36.1 months for 22 patients, who under went the operation until December, 2001, local recurrence was 4.5% (1/22) with successful local treatment, and distant metastasis was 13.7% (3/22). There was no difference in the disease free survival compared to that of the non-reconstruction group (P=0.093). CONCLUSION: SSM with immediate reconstruction seems safe and effective for patients with advanced breast cancer. However an accurate preoperative assessment of the extent of the disease and discussion for the planning of treatment between surgeon and patient is required.
Breast Neoplasms* ; Breast* ; Chungcheongnam-do ; Disease-Free Survival ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Mammaplasty* ; Mastectomy* ; Neoplasm Metastasis ; Patient Selection ; Radiotherapy ; Recurrence ; Retrospective Studies ; Tissue Expansion Devices

PURPOSE: Breast augmentation has recently become a common plastic surgical procedure performed in Korea. However, the incidence of re-operation has also increased due to various complications. The purpose of this study is to analyze the complications of primary augmentation mammoplasty and to demonstrate the reasons for re- operations. METHODS: Among augmentation mammoplasty cases operated in M.D. Clinic from Jan. 2002 to Jul. 2003, 42 cases of re-operations were reviewed. Age, interim primary operations, used implants, complications and reasons of re- operations and methods of re-operations were retrospectively evaluated. RESULTS: Patients from half of the cases were in their thirties. Almost halves of the patients were operated again within a year. Common reasons of re-operations were complications in shape and physical texture. For shape problems, they commonly complained of upper fullness or double bubble deformity and asymmetry. The author commonly used a periareolar incision (95.2%) and saline bag implants (81.0%) for re-operations. The usual size of the implant was between 151 and 250 cc. In 7 capsular contracture cases, 3 capsulotomy, 3 capsulectomy and 1 case of subpectoral conversion were performed, of which 1 case in capsulotomy and 1 subpectoral conversion recurred. CONCLUSION: Augmentation mammoplasty is not a simple procedure, making many complications in shape, physical texture, breast functions, and others that is related to breast diseases. For better outcomes in re-operation cases, exact understanding and evaluation of primary complications are essential.
Breast ; Breast Diseases ; Congenital Abnormalities ; Contracture ; Female ; Humans ; Incidence ; Korea ; Mammaplasty* ; Reoperation ; Retrospective Studies

PURPOSE: With the increase of early breast cancer patients, the number of node negative breast cancer patients is also on the rise. However, reports show that there is a 20~30% recurrence in node negative breast cancer. Thus, we have attempted to determine the prognostic factors that may affect recurrence and relapse free survival. METHODS: From January, 1980, to June, 1999, 1110 node negative breast cancer patients who underwent curative surgery at the Severance Hospital, Yonsei University College of Medicine, were selected. A retrospective study was done to determine the effects of factors, such as operation method, age, size, type, histologic grade, intraductal components, ER, PR, c-erbB-2, number of lymph nodes removed, adjuvant chemotherapy, hormonal therapy and radiation therapy. RESULTS: The mean age was 47.2 years. The median follow- up period was 88 months. Recurrence occurred in 161 patients. Locoregional recurrence occurred in 64 patients, and systemic recurrence in 129 patients, while 32 patients had both. The 5 years overall survival rate was 93.3%. The rate of locoregional recurrence for a 10 year-period was significantly lower in the mastectomy group compared with that in the breast conservation therapy group (94.7% vs 79.6%, P=0.000). No other prognostic factors except the age affected in locoregional recurrence. There was less systemic recurrence in patients with the age greater than 35, with the histologic grade I, and with the intraductal components greater than 20%. Thus, 10-years distant relapse free survival rates were 87.4% vs 79.8% (P=0.039), 93.5% vs 85.5% (P=0.024), and 94.4% vs 82.0% (P=0.007), respectively. There was no statistical significance in the other prognostic factors that influence systemic recurrence. CONCLUSION: The patients' age was determined to be an independent prognostic value in the lymph node negative breast cancer. The histologic grade and intraductal components showed to have significance as prognostic factors for systemic recurrence.
Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; Humans ; Lymph Nodes* ; Mastectomy ; Recurrence ; Retrospective Studies ; Survival Rate

PURPOSE: NPI (Nottingham prognostic index) including tumor size, lymph node status and histological grade is widely used for the estimation of prognosis in breast carcinomas, and recently, the immunohistochemical index (IHPI) using ER, PR, c-erbB-2, and p53 expressions was suggested as an useful prognosticator. The aim of this study is to evaluate the reliability of NPI and IHPIs in 141 breast carcinomas. METHODS: Statistical analysis among size, lymph node status, histological grade, NPI, ER, PR, c-erbB-2, p53 and MIB-1 labelling index(LI) and IHPIs were performed. The IHPI-1 battery consisted of ER, PR, c-erbB-2 and p53. In the IHPI-2 battery, MIB-1 LI was added to the IHPI-1 battery. In the IHPI-3 battery, MIB-1 LI was also added, but ER and PR were not included. RESULTS: The prognostic estimation based on NPI showed significant relationships with PR, c-erbB-2, MIB-1, and the prognostic estimations according to IHPI-1, IHPI-2 and IHPI-3 battery. In addition, MIB-1 LI revealed a positive relationship to the histological grade. The prognostic estimation based on IHPI-3 showed a positive relationship to the lymph node status. CONCLUSION: The prognostic estimation based on NPI and a battery of immunohistochemical stains consisted of c-erbB-2, p53 and MIB-1 seem to be reliable in breast carcinomas.
Breast Neoplasms* ; Breast* ; Coloring Agents ; Immunohistochemistry ; Lymph Nodes ; Prognosis

PURPOSE: The isoflavones in soy are likely to contribute to the historically low incidence of breast cancer among Asian women who consume traditional diets. The possible role of isoflavones in controlling the expression of p27(kip1) and p57(kip2) has not been previously explored. In this study, the ability of the isoflavone, genistein, to regulate the expression of p27(kip1) and p57(kip2) in breast cancer cells was evaluated. METHODS: The effects of genistein was examined on the expression of p27(kip1) and p57(kip2) at the mRNA level, using the MDA-MB 231 human breast cancer cell lines. RESULTS: By genistein treatment, p27(kip1) mRNA increased significantly in comparison to the control group. In particular, p27(kip1) mRNA level in 10 micrometer and 50 micrometer genistein treated- groups increased about two-folds more than the control. p57(kip2) mRNA was not different from control group. p57(kip2) mRNA decreased slightly only in the 50 micrometer genistein treated-group. PPAR-gamma mRNA level increased slightly according to the concentration-dependent manner of genistein, but it was not significantly different. Conclusions: These results suggest that the up-regulated p27(kip1) by genistein might contribute to cancer prevention or inhibition.
Asian Continental Ancestry Group ; Breast Neoplasms* ; Breast* ; Cell Line ; Diet ; Female ; Genistein* ; Humans* ; Incidence ; Isoflavones ; RNA, Messenger

PURPOSE: The aims of this study were to evaluate the prognostic roles of bcl-2 and apoptosis in patients with breast cancer after long term follow-up, and the correlation with the known clinicopathological parameters. METHODS: 88 primary breast cancers were selected between March 1988 and February 1994. These cases were clinically followed up over 10 years (median follow-up 139 months). The immunohistochemical expression of bcl-2 protein and apoptosis were studied, and the findings compared to the clinicopathological parameters, such as estrogen receptor (ER), progesterone receptor (PR) and clinical stage. RESULTS: The bcl-2 protein was identified in 42 (47.7%) cases. The bcl-2 expression correlated positively with large tumor sizes, well differentiated tumors, and ER expression. No significant associations were seen between the apoptosis index and the clinicopathological parameters. The expression of bcl-2 and apoptosis were not correlated with the survival rate. The clinical stage and status of lymph node metastases were correlated with the survival rate, but no other clinicopathological parameters were correlated. CONCLUSION: Long term follow-up for breast cancer patients revealed that the expression of bcl-2 and apoptosis was not correlated with the survival rate.
Apoptosis* ; Breast Neoplasms* ; Breast* ; Estrogens ; Follow-Up Studies* ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Receptors, Progesterone ; Survival Rate

PURPOSE: Breast carcinomas are highly malignant tumor that the angiogenesis factor, vascular endothelial growth factor and its receptors are overexpressed. To elucidate the role of Angiopoietin-2 (ANG2) and ANG2 receptor Tie-2 in invasive ductal carcinoma, we examined the expression of ANG2, and Tie-2 at the mRNA and protein levels in human breast cancer cell lines and samples. METHODS: Total RNA from 22 breast cancer patient biopsies were extracted. ANG2 and Tie-2 mRNA expression was measured by means of reverse transcription-PCR assay. RESULTS: RT-PCR indicated that the ANG2 and Tie-2 mRNA levels in carcinoma samples were significantly higher than those of the adjacent non-neoplastic breast tissues. For ANG2 and Tie-2, 41 of 71 invasive ductal carcinomass (58%) showed high expressions in Immunohistochemistry. Immunohistochemical analysis demonstrated that ANG2 and Tie-2 were expressed by both tumor cells and endothelial elements. Expression in tumor cells were confirmed by studying a panel of human breast carcinoma cell lines cultured by RT-PCR. Our study showed that the ANG2 positivity was correlated with axillary lymph node metastasis among the clinicopathological parameter and confirmed that high expressions of ANG2 correlated highly with the axillary lymph node metastases, histological grade, positive PR status, and age, and Tie-2 expression correlated significantly with the p53 status. Moreover, ANG2 and Tie-2 co-expression correlated significantly with the axillary lymph node metastases, compared with ANG2(-)/Tie-2 (-) and ANG2 (+)/Tie-2 (-) or ANG2 (-)/Tie-2 (+) cases. CONCLUSION: These findings suggested that ANG2 and Tie-2 might be involved in the progression of invasive ductal carcinomas through autocrine and paracrine signaling and that it may be clinically useful in selecting patients who could benefit from adjuvant treatment by further study.
Angiogenesis Inducing Agents ; Angiopoietin-2* ; Biopsy ; Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Cell Line ; Humans ; Immunohistochemistry ; Lymph Nodes ; Neoplasm Metastasis ; Paracrine Communication ; RNA ; RNA, Messenger ; Vascular Endothelial Growth Factor A

Breast conservation treatment (BCT) is a combination of breast conservation surgery (BCS) and radiotherapy (RT). Conventional radiotherapy after BCS requires 5~6 weeks of RT to whole breast followed by 1~2 weeks of RT to tumor bed. This lengthy tretment modality is one of the difficulties in performing BCT. Recently, irradiation to the tumor bed only (partial breast irradiation, PBI) in selected patients was examined as a way to shorten the period of RT because a local recurrence after a BCT occurs mainly around the primary tumor bed. PBI with a large fractional dose might shorten the treatment time to one week. There are various methods of PBI including interstitial brachytherapy, balloon brachytherapy, external beam radiotherapy such as three-dimensional conformal radiotherapy, intensity modulated radiotherapy and proton therapy, and intraoperative radiotherapy. The results of the phase I/II studies using these new techniques have reported a similar local control rate and cosmetic results compared with the historical data using whole breast irradiation (WBRT). However, a long-term follow-up of the phase III randomized trials will be needed in order to determine the equivalence of PBI alone to WBRT in the treatment of selected patients with early breast cancer.
Brachytherapy ; Breast Neoplasms ; Breast* ; Follow-Up Studies ; Humans ; Proton Therapy ; Radiotherapy ; Radiotherapy, Conformal ; Recurrence

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