PURPOSE: Endoscopic neck surgery has a smaller wound size and enables the positions of the wounds to be moved to places of cosmetic benefit. Therefore, it is strongly preferred by many patients, especially women. We applied this technique to the treatment of thyroid cancer. METHODS: An endoscopic thyroidectomy was performed on 17 female thyroid cancer patients with a mean age 35 years in our Department from January 1999 to January 2003. The selection criteria were a tumor size < or =2 cm, no thyroiditis, no previous neck surgery or irradiation, no lymphadenopathy on a preoperative imaging study. The preoperative or intraoperative diagnoses of these patients included 13 papillary cancers and 4 follicular cancers. The procedure was performed using the anterior chest approach with CO2 gas insufflation. RESULTS: Fourteen hemithyroidectomies and three total thyroidectomies were successfully performed. The mean operative time was 84.2+/-20.9 min for the 14 hemithyroidectomies and 148.3+/-32.5 min for the 3 total thyroidectomies. There was no conversion to conventional surgery. The mean tumor size was 1.6 cm (0.8~2.7) The mean hospital stay was 8.9 days. All the patients were satisfied with the cosmetic result except for one patient who underwent a conventional salvage operation due to an involved surgical margin on a permanent section. The postoperative complications included one case of transient recurrent nerve palsy and one case of transient symptomatic hypocalcemia. The mean follow up period was 30 months(13~59). One patient after a total thyroidectomy had a paratracheal lymph node metastasis on the thyroid scan 2 years after surgery and received 131I radioablation. CONCLUSION: With the advent of preoperative imaging study, an endoscopic thyroidectomy for thyroid cancer is feasible and safe in properly selected patients. In addition, this procedure has a better cosmetic outcome than conventional open surgery.
Diagnosis ; Female ; Follow-Up Studies ; Humans ; Hypocalcemia ; Insufflation ; Length of Stay ; Lymph Nodes ; Lymphatic Diseases ; Neck ; Neoplasm Metastasis ; Operative Time ; Paralysis ; Patient Selection ; Postoperative Complications ; Thorax ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy* ; Thyroiditis ; Wounds and Injuries

PURPOSE: We wished to determine the usefulness of ultrasound-guided vacuum-assisted biopsy (mammotome) for the removal of the breast lesions that had displayed benign evidence on sonography. METHODS: During an 11 month period, vacuum-assisted breast biopsy was performed for 186 probably benign lesions on sonography using 11-gauge (127 cases) and 8-gauge (59 cases) devices. The age of the patients ranged from 19 to 65 years, and the size of the lesions ranged from 0.4 to 3 cm. We retrospectively analyzed the clinical findings and medical history of the patients who underwent vacuum- assisted breast biopsy, and we then evaluated the complications, the histopathologic results, and the follow-up US findings. RESULTS: Of the 186 cases, the lesions were palpated in 95 cases (51%), and lesions were detected in women during a screening examination in 40 cases (36%), and lesions were detected in women having a history of benign breast biopsy or having a cancer operation in the remaining 18 cases (10%). Severe bleeding during or after the procedures was noted in 4 cases (2.2%). The lesions were pathologically proved as benign in 185 cases and malignant in 1 case. With vacuum-assisted breast biopsy, high-risk benign disease was found in 7 cases, but none of the lesions was pathologically upgraded on the subsequent open surgical biopsy. On the 3-month follow-up US, variable sized hematomas were observed in 6 of 24 cases (25%). We performed incidental treatment on four of the vacuum- assisted breast biopsy patients for nipple discharge that was caused by intraductal papilloma. CONCLUSION: US-guided vacuum-assisted breast biopsy is a minimally invasive, fast and convenient biopsy technique. In addition, it is safe and accurate to use for the histological diagnosis because it would remove all the sonographically demonstrated evidence of a probable benign lesion. This technique can potentially be a useful alternative to some forms of surgical biopsy for the properly selected patients.
Biopsy* ; Breast* ; Diagnosis ; Female ; Follow-Up Studies ; Hematoma ; Hemorrhage ; Humans ; Mass Screening ; Nipples ; Papilloma, Intraductal ; Retrospective Studies ; Ultrasonography

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: Peritoneal metastasis is a crucial factor for the prognosis in gastric cancer, but its diagnosis is difficult before laparotomy. This study analyzed the usefulness of diagnostic imaging and various tumor markers in the detection of peritoneal metastasis in gastric cancer. MATERIALS AND METHODS: The sera from 768 patients with gastric cancer were measured for CEA, CA19-9 and CA125 levels using a commercial immunoradiometric assay. All the patients underwent diagnostic imaging with computed tomography (CT) and ultrasound (US) before laparotomy. RESULTS: Preoperative levels of CEA, CA19-9 and CA125 were above the cut-off levels in 15.4%, 8.7% and 5.7% of all cases, respectively. Eighty-eight patients were diagnosed with peritoneal metastasis by laparotomy. CT and US revealed peritoneal dissemination in 15 of 88 patients (17%). Among the three tumor markers, CA19-9 and CA125 showed similar detection rates of peritoneal metastasis (37.5% and 38.6%, respectively). In particular, the serum CA125 levels showed the best sensitivity (38.6%), specificity (98.4%), and diagnostic accuracy (91.5%), and the highest odd ratio (24.46, 95% CI: 11.17~53.57) for predicting peritoneal metastasis among the markers tested. CEA did not add significant predictive information (p=0.471). CONCLUSION: Preoperative serum CA19-9 and CA125 levels may provide a predictable value in determining peritoneal metastasis in patients with gastric cancer.
Diagnosis ; Diagnostic Imaging ; Humans ; Immunoradiometric Assay ; Laparotomy ; Neoplasm Metastasis* ; Prognosis ; Sensitivity and Specificity ; Stomach Neoplasms ; Biomarkers, Tumora ; Ultrasonography

PURPOSE: The choice of surgical strategy for patients with adenocarcinoma of the upper one third of the stomach is controversial. This study was performed to analyze the surgical results of a 11-year experience with these lesions. MATERIALS AND METHODS: From January 1990 to December 2000, 259 patients with upper third gastric cancer underwent proximal gastrectomy (n=74) or total gastrectomy (n=185) through an abdominal approach. Morbidity, mortality, recurrence patterns, and survival were compared between these two groups retrospectively. RESULTS: There were no significant differences in general complication and mortality rates between the two groups. However, the incidences of reflux esophagitis (16.2%) and anastomotic stricture (35.1%) were more common in the proximal gastrectomy group compared with the total gastrectomy group (0.5 and 8.1%). Regarding the main patterns of recurrence, local recurrence was dominant in the proximal gastrectomy group, whereas distant recurrence was dominant in the total gastrectomy group. Five-year overall survival (54.8 versus 47.8%) and survival according to tumor stage were no different between the groups. Multivariate analysis showed that the extent of resection was not an independent prognostic factor. CONCLUSION: The extent of resection for upper third gastric cancer did not appear to affect long-term outcome. However, proximal gastrectomy is associated with an increased risk of reflux esophagitis, anastomotic stricture, and local recurrence.
Adenocarcinoma* ; Constriction, Pathologic ; Esophagitis, Peptic ; Gastrectomy* ; Humans ; Incidence ; Mortality ; Multivariate Analysis ; Prognosis ; Recurrence ; Retrospective Studies ; Stomach Neoplasms ; Stomach*

PURPOSE: Breast conserving surgery is now accepted as one of the standard therapeutic options for stage I and II breast cancers. Although breast conserving surgery can retain a good breast shape, a long marked operation scar would be a disadvantage. To improve the cosmetic outcome of the breast, endoscopy-assisted breast conserving surgery which can be performed through minimal axillary and periareolar semicircular incisions, was undertaken. METHODS: Between October 2002 and May 2003, 19 breast cancer patients whose tumor sizes were less than 3 cm and clinically node negative without invasion to the skin and pectoralis major underwent endoscopy-assisted breast conserving surgery. Firstly, an endoscopic dye-guided sentinel node biopsy was performed through a low transverse axillary incision laterally to the pectoralis major. A subpectoral pocket was gently created by Vein Harvest under the view of endoscopic monitor. A periareolar semicircular incision was made to create the skin flap and the tumor-containing quadrant resected with a Visiport and PowerStar Scissors. Frozen section biopsies were carried out to rule out tumor invasion to the resection margin. The patients and tumor characteristics, operation time and amounts of bleedings were evaluated. RESULTS: The mean age of patients was 45 years (35~64). The mean tumor size was 2.2 cm (0.2~5.0 cm). The average operation time of the initial 8 cases, with the exception of the 3 that underwent axillary node dissection was 168 minute, and that of latter 8 was 138 minute (P<0.001). The mean amounts of operative bleeding were 184 ml. There were no major complications. CONCLUSION: Endoscopy-assisted breast conserving surgery is a new technique that can minimize the long operation scar obtained with classic breast conserving surgery. In properly selected cases, our results shows maximized cosmetic satisfaction of breast cancer patients, with a shortened operation time after the learning period, and shows promise as an alternative to the classic breast conserving surgery.
Biopsy ; Breast Neoplasms* ; Breast* ; Cicatrix ; Endoscopy ; Frozen Sections ; Hemorrhage ; Humans ; Learning ; Mastectomy, Segmental* ; Skin ; Veins

PURPOSE: Breast conserving surgery is now accepted as one of the standard therapeutic options for stage I and II breast cancers. Although breast conserving surgery can retain a good breast shape, a long marked operation scar would be a disadvantage. To improve the cosmetic outcome of the breast, endoscopy-assisted breast conserving surgery which can be performed through minimal axillary and periareolar semicircular incisions, was undertaken. METHODS: Between October 2002 and May 2003, 19 breast cancer patients whose tumor sizes were less than 3 cm and clinically node negative without invasion to the skin and pectoralis major underwent endoscopy-assisted breast conserving surgery. Firstly, an endoscopic dye-guided sentinel node biopsy was performed through a low transverse axillary incision laterally to the pectoralis major. A subpectoral pocket was gently created by Vein Harvest under the view of endoscopic monitor. A periareolar semicircular incision was made to create the skin flap and the tumor-containing quadrant resected with a Visiport and PowerStar Scissors. Frozen section biopsies were carried out to rule out tumor invasion to the resection margin. The patients and tumor characteristics, operation time and amounts of bleedings were evaluated. RESULTS: The mean age of patients was 45 years (35~64). The mean tumor size was 2.2 cm (0.2~5.0 cm). The average operation time of the initial 8 cases, with the exception of the 3 that underwent axillary node dissection was 168 minute, and that of latter 8 was 138 minute (P<0.001). The mean amounts of operative bleeding were 184 ml. There were no major complications. CONCLUSION: Endoscopy-assisted breast conserving surgery is a new technique that can minimize the long operation scar obtained with classic breast conserving surgery. In properly selected cases, our results shows maximized cosmetic satisfaction of breast cancer patients, with a shortened operation time after the learning period, and shows promise as an alternative to the classic breast conserving surgery.
Biopsy ; Breast Neoplasms* ; Breast* ; Cicatrix ; Endoscopy ; Frozen Sections ; Hemorrhage ; Humans ; Learning ; Mastectomy, Segmental* ; Skin ; Veins

PURPOSE: Sentinel node biopsy has emerged recently as an alternative to routine axillary node dissection in predicting axillary nodal metastasis. However there have been some controversies in clinical application because of its various identification rates and false negative rates. We present the usefulness of dye-guided endoscopic sentinel node biopsy. METHODS: Between October 2002 and June 2003, 30 breast cancer patients with clinically node negative results underwent endoscopic blue dye-guided sentinel node biopsy from the Department of Surgery at Kangbuk Samsung Hospital. The technique involved the injection of 5 ml of 1% isosulfan blue into subareolar plexus. The Visiport docked with Telescope was inserted through a low transverse axillary incison lateral to pectoralis major. During the dissection, we identified sentinel nodes by following blue-stained lymphatics directly into blue (or nonblue) lymph nodes. The identification rate and false negative rate was evaluated. RESULTS: The mean number of sentinel nodes was 2.2. The identification rate of th sentinel node was 93.3% (28/30). Among 22 patients with negative sentinel nodes on frozen section, 10 patients underwent axillary node dissection and the results were negative in all cases, indicating false negative rate of 0% (0/10). The overall accuracy, sensitivity and specificity were 100%. CONCLUSION: The endoscopic technique of sentinel node biopsy can minimize the operative bleeding by handling the knife of Visiport pallelel to exposed vessels under endoscopic monitor analysis and and keep better operative visual field and less invasiveness. With the bright illumination of the endoscopic light, blue-stained sentinel lymphatics could be identified more easily. Our technique of dye-guided endoscopic sentinel node biopsy demonstrates a high sentinel node identification rate and absent false negative rate, promising it could be an alternative to the classic sentinel node biopsy.
Biopsy* ; Breast Neoplasms ; Frozen Sections ; Hemorrhage ; Humans ; Lighting ; Lymph Nodes ; Neoplasm Metastasis ; Sensitivity and Specificity ; Telescopes ; Visual Fields

PURPOSE: Little is known about local recurrence following proximal gastrectomy in patients with upper third gastric cancer. We performed this study to evaluate the long-term results of a proximal gastrectomy, and to analyze the risk factors of local recurrence affecting survival in these patients. MATERIALS AND METHODS: We undertook a retrospective study of 63 patients who underwent potentially curative proximal gastrectomy between 1990 and 1999, with special reference to local recurrence. RESULTS: During a median follow-up period of 37 months, 25 of the 63 patients (39.7%) developed a recurrence of cancer, with local recurrence in 15 patients (23.8%), the majority of these occurring at the remnant stomach or anastomosis. The median time to local recurrence was 38 months (8~78 months). Univariate analysis of risk factors for local recurrence revealed an infiltrative or diffuse gross type, with a tumor sizes>5 cm, a distal resection margin Diagnosis ; Follow-Up Studies ; Gastrectomy* ; Gastric Stump ; Humans ; Prognosis ; Recurrence* ; Reoperation ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms*

PURPOSE: To evaluate the usefulness of contrast-enhanced power Doppler ultrasonography (PDUS) in differentiating small benign from small malignant breast lesions. MATERIALS AND METHODS: Thirty-one solid breast lesions (<2 cm in size; 17 benign and 14 malignant) prospectively underwent US and PDUS before and after the injection of contrast agent (SH U 508A). Morphologic analysis involved independent assessment of the findings of US and the patterns of Doppler signals before and after contrast enhancement at PDUS, and sensitivity and specificity were thus evaluated. The diagnostic accuracy of US accompanied by PDUS was also determined before and after contrast enhancement. Hemodynamic analysis involved measurement of the time lapse between contrast injection at PDUS and observed change in Doppler signals. For this, a sonic VIOR computer-assisted program was used and the results were correlated with the pathologic findings. RESULTS: The sensitivities of US before and after contrast enhanced PDUS were 100%, 35.7%, and 57%, with specificities of 47%, 88.2% and 76%, respectively. The diagnostic accuracy of US was 35% with noncontrast PDUS, and 77% before and after contrast enhanced PDUS. The recorded time lapse between contrast injection at PDUS and observed change in Doppler signals did not correlate closely with the pathologic findings. CONCLUSION: In that it improved visualization of the morphology of vascular Doppler signals, microbubble contrast-enhanced PDUS complemented US and PDUS in differentiating between small benign and small malignant breast lesions.
Breast* ; Complement System Proteins ; Hemodynamics ; Microbubbles ; Prospective Studies ; Sensitivity and Specificity ; Ultrasonography, Doppler