Purpose: Various incision techniques have been used in breast-conserving surgery (BCS) to reduce scar formation, including the frequently used periareolar incision technique. However, its applicability in removing large-size tumors or those distant from the nipple has remained limited. We performed periareolar zigzag (P-Z) incision to address these problems in BCS and to improve cosmetic outcomes. Methods: Patients who underwent P-Z incision in BCS between January 2016 and November 2017 were retrospectively analyzed in terms of clinicopathological features and surgical findings. Factors affecting the positive margin were analyzed. Results: A total of 305 patients were reviewed. The patients presented with a median age of 51 years, mean tumor size 1.9 cm, and mean tumor distance of 3.3 cm from the nipple. Intraoperative frozen biopsy and final pathologic findings showed 43 (14.1%) and 7 (2.3%) tumor-positive margins. There were no major complications associated with the surgery, and no re-operations were required due to bleeding or other reasons. Conclusion The P-Z incision technique was used to achieve sufficient operative field during BCS, and large tumors or those distant from the nipple could be removed without any complications. This technique is considered an oncologically safe surgical technique resulting in good cosmetic outcomes.

PURPOSE: Given the promising activity of capecitabine and vinorelbine in metastatic breast cancer, this randomized phase II trial evaluated the efficacy and safety of this combination as neoadjuvant chemotherapy in breast cancer. MATERIALS AND METHODS: Patients with operable breast cancer (n=75) were randomly assigned to receive either four cycles of adriamycin 60 mg/m2 plus cyclophosphamide 600 mg/m2 every 3 weeks followed by four cycles of docetaxel 75 mg/m2 every 3 weeks (AC-D) or four cycles of capecitabine 2,000 mg/m2 (day 1-14) plus vinorelbine 25 mg/m2 (days 1 and 8) every 3 weeks followed by four cycles of docetaxel 75 mg/m2 (CV-D). The primary endpoint was pathologic complete response (pCR) in the primary breast (ypT0/is). RESULTS: Most patients (84%) had locally advanced (n=41) or inflammatory breast cancer (n=22). pCR rates in the primary breast were 15% (95% confidence interval [CI], 7% to 30%) and 11% (95% CI, 4% to 26%) in the AC-D and CV-D groups, respectively. The overall response rates and 5-year progression-free survival rates in the AC-D and CV-D groups were 62% and 64%, and 51.3% (95% CI, 34.6% to 68.0%) and 30.2% (95% CI, 13.3% to 47.1%), respectively. Although both regimens were well tolerated, CV-D showed less frequent grade 3-4 neutropenia and vomiting than AC-D, whereas manageable diarrhea and hand-foot syndrome were more common in the CV-D group. CONCLUSION: CV-D is a feasible and active non-anthracycline-based neoadjuvant chemotherapy regimen for breast cancer.
Anthracyclines ; Breast ; Breast Neoplasms* ; Cyclophosphamide* ; Diarrhea ; Disease-Free Survival ; Doxorubicin* ; Drug Therapy* ; Hand-Foot Syndrome ; Humans ; Inflammatory Breast Neoplasms ; Neoadjuvant Therapy ; Neutropenia ; Polymerase Chain Reaction ; Vomiting

PURPOSE: Although most patients with stage I breast cancer have a good prognosis, their clinical outcomes may vary significantly. We assessed clinical outcomes and prognostic factors in stage I breast cancer patients with and without triple-negative breast cancer (TNBC) phenotype. METHODS: Of 2,489 patients undergoing breast cancer surgery between January 1998 and December 2002, 554 (22.3%) had stage I breast cancer (tumor size < or =2 cm, and lymph node-negative). TNBC was defined as a primary tumor negative for estrogen and progesterone receptors (Allred scores <3/8) and for HER2/neu (0-1+ by immunohistochemistry). RESULTS: Of the 554 patients with stage I breast cancer, 78 (14.1%) had TNBC. A significant proportion of TNBC patients had histologic grade 3 tumors (47.4% vs. 34.5%, p=0.031) and tumors >1 cm (87.2% vs. 75.8%, p=0.028) and received adjuvant chemotherapy (79.5% vs. 44.7%, p<0.001). During a median follow-up time of 8.7 years, 72 patients experienced tumor recurrences; 18 (23.1%) in the TNBC group and 54 (11.3%) in the non-TNBC group (p=0.010), with cumulative 3-year rate of recurrence of 12.8% and 5.3%, respectively (p=0.010). Ten-year relapse-free survival (RFS; 75.6% vs. 87.5%, p=0.004) and overall survival (OS; 83.0% vs. 91.4%, p=0.002) rates were significantly lower in the TNBC group. Multivariate analysis showed that triple negativity and histologic grade were independent predictors of shorter RFS and OS. CONCLUSION: TNBC had more aggressive clinicopathologic characteristics and was associated with poorer survival in patients with stage I breast cancer. More intensive adjuvant chemotherapy or a different therapeutic strategy targeting this population is warranted.
Breast ; Breast Neoplasms ; Chemotherapy, Adjuvant ; Estrogens ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Phenotype ; Prognosis ; Receptors, Progesterone ; Recurrence

PURPOSE: This study aimed at evaluating the pattern of changes in estrogen receptor (ER), progesterone receptor (PR) and the HER2 expression in primary and recurrent breast cancer. METHODS: In the study, we analyzed the changes of the ER and PR and the HER2 immunohistochemical expression to identify the patterns of changes and the predictive factors for the changes in 153 patients with primary and recurrent breast cancer between 1991 and 2005. RESULTS: There was a significant decrease in the positive rate of ER (50.3% to 38.6%, p<0.001), PR (43.8% to 26.8%, p=0.0095) and the HER2 (40.3% to 36.3%, p<0.001) expression in the primary breast cancers and recurrent breast cancers. The rate of triple negativity (ER/PR/HER2: all negative) was increased from 25.8% to 43.5% (p<0.001). Among 44 (28.6%) patients with changes in ER and ER status changed from positive to negative in 31 patients (20.3%) and negative to positive in 13 patients (8.3%) (p=0.007). For 58 patients (37.9%) who showed a change of the PR, the PR status changed from positive to negative in 42 patients (27.5%) and vice versa in 16 patients (10.4%) (p=0.0006). Twenty one patients (16.9%) changed from HER2 positive to HER2 negative and vice versa in 9 patients (7.3%) (p=0.029) among the 30 patients (24.2%) with changes in the HER2 expression. A multivariate analysis indicated that hormonal therapy was a significant factor that had an influence on the ER (odds ratio, 4.4) and PR (odds ratio, 2.6) changes. There were no significant differences in the survival rates according to the changes of the ER and PR, and the HER2 expression. CONCLUSION: The more common changes from positive to negative among the ER, PR, and HER2 indicated poor tumor biology of recurrent tumor. Therefore, the assessment of the ER, PR, and HER2 statuses is important for effectively treating recurrent breast cancer and especially those who have a previous history of hormonal therapy although survival benefit was not observed in this study.
Biology ; Breast ; Breast Neoplasms ; Estrogens ; Humans ; Multivariate Analysis ; Receptors, Progesterone ; Recurrence ; Survival Rate

PURPOSE: Sentinel lymph node biopsy (SLNB) has been developed to accurately assess the axillary lymph node status accurately without having to remove most of the axillary contents in node negative early breast cancer patients. The aims of this study were to evaluate the accuracy, the false negative rate and the advantage of additional axillary sampling for SLNB with using radioisotope. METHODS: Between December 2003 and June 2005, we carried out SLNB for 574 breast cancer patients who were diagnosed and had operation at Asan Medical Center. For detection of the sentinel lymph node (SLN), radioisotope was injected into the periareolar area on the operating day, breast scintigraphy was performed and finally the biopsy was done using a gamma-detection probe in the operating room. If the SLN turned out to be positive for metastatic malignancy according to the frozen section histology, then additional axillary lymph nodes (LN) dissection was performed. But, if it was free of metastasis, then only axillary node sampling (n< or =5) or no further treatment was done. RESULTS: The mean number of resected SLNs was 2.67+/-0.98 (1-7) and the mean number of total LN was 8.5+/-5.0 (1-38). The SLN was detected 82.8% of the time on lymphoscintigraphy and 98.4% of the time with the gamma probe. Axillary metastasis was founded in 118 cases (20.9%). The accuracy was 98.2%, and the false negative rate was 7.89%. For the SLN positive cases, there were 73/78 cases (93.6%) of 1st SLN metastasis, there were 75/78 cases (93.6%) of 1st and 2nd SLN metastasis, and 75/78 (93.6%) of 1st to 3rd SLN metastasis. The false negative rate of the alternative frozen section was 40% and that of the full frozen section was 24.1%. The difference was statistically significant. CONCLUSION: SLNB using (99m)Tc-antimony trisulfide colloid (0.5 mCi) showed a high detection rate and a low false negative rate. The false negative rate was decreased by using full section H&E staining and at least 3 SLNs showed the exact LN status. Even if the SLN was free of metastasis, additional sampling may decrease the false negative rate.
Biopsy ; Breast Neoplasms* ; Breast* ; Chungcheongnam-do ; Colloids ; Frozen Sections ; Humans ; Lymph Nodes* ; Lymphoscintigraphy ; Neoplasm Metastasis ; Operating Rooms ; Radionuclide Imaging ; Sentinel Lymph Node Biopsy*

We describe here a case of localized polyarteritis nodosa that involved the unilateral breast in a 69-yr-old woman. She presented with a tender breast mass and had suffered for two months. On physical examination, an ill-defined 2 cm sized, firm mass was palpated. Ultrasonographic examination revealed a mass like lesion that contained microcalcifications. The mass was excised because of the suspicion of carcinoma. The histologic findings were vasculitis involving medium and small sized-arteries that showed marked neutrophilic and lymphocytic infiltrations with intimal fibroplasias and fragmentation of the internal elastic lamina. The patient progressed well after surgical excision. The discussion includes the importance of differential diagnosis between localized polyarteritis nodosa and other vasculitis, and review of previously reported cases of vasculitis of the breast. Only 13 cases of polyarteritis nodosa of the breast have been reported and this is the first case of polyarteritis nodosa with mammary duct ectasia.
Breast* ; Diagnosis, Differential ; Dilatation, Pathologic* ; Female ; Humans ; Neutrophils ; Physical Examination ; Polyarteritis Nodosa* ; Vasculitis

PURPOSE: This study was aimed at evaluating the recurrence rate and recurrence patterns after surgically treating for patients with operable breast cancer. METHODS: From 1992 to 2002, 3700 patients with breast cancer (stages 0-3) who underwent mastectomy or breast conservation surgery at Asan Medical Center, Seoul, were selected for this retrospective study. We analyzed the recurrence rate, the annual hazard rate, the risk factors, the time to recurrence and the recurrence patterns according to the clinicopathologic factors. RESULTS: During the median follow-up period of 45 months, 523 patients (14.1%) of the total 3700 patients developed recurrences: locoregional recurrences occurred in 148 patients (4.0%), distant recurrences occurred in 319 patients (8.6%), and both types occurred in 56 patients (1.5%). The 5-year and 10-year recurrence rates were 17.7% and 23.4%, respectively. The recurrence rate increased in proportion to the cancer stage. The annual hazard rate for recurrence had a peak at 2-years of follow-up. On multivariate analysis, the stage, progesterone receptor status, and c-erbB2 expression were the independent risk factors for recurrence. The median time to recurrence among the patients with recurrence was 24.0 months. 50.5% of recurrences were found within 2 years and 92.0% of recurrences were found within 5 years after surgery. A short time to recurrence was significantly associated with an increased stage, a negative progesterone receptor status, and locoregional recurrences. The common recurrence sites included the chest wall, SCLN and the axillary lymph nodes in a locoregional order, and the bone, lung and liver in a systemic order. Of note is that distant recurrences commonly occurred at multiple sites in a simultaneous manner. CONCLUSION: Our findings revealed that the 5 year-recurrence rate was 17.7% and the risk of recurrence was maintained 5 years later after surgery, although the annual hazard rate had the highest peak at 2 years after breast cancer surgery. Because the stage, progesterone receptor status, and c-erbB2 expression are independent risk factors, early detection of breast cancer is required for reducing recurrence.
Breast Neoplasms* ; Breast* ; Chungcheongnam-do ; Follow-Up Studies ; Humans ; Liver ; Lung ; Lymph Nodes ; Mastectomy ; Multivariate Analysis ; Receptors, Progesterone ; Recurrence* ; Retrospective Studies ; Risk Factors* ; Seoul ; Thoracic Wall

PURPOSE: The aim of this study was to assess the expression of VEGF-C (vascular endothelial growth factor-C) and LYVE-1 (lymphatic vessel endothelial HA receptor-1) mRNA in human breast cancer, and to compare the expression of VEGF-C protein and VEGF-C, LYVE-1 mRNA with the clinico-pathological outcomes. METHODS: RT-PCR was carried on the VEGF-C, LYVE-1 mRNA drawn from three samples of adjacent normal breast tissues, the MCF-7 breast cancer cell line and 39 breast cancer tissues. Immunohistochemical staining was done to detect the expression of VEGF-C protein in 39 cancer tissues and in 5 benign tissues with using well preserved, paraffin embedded tissues. The clinico-pathological findings were retrospectively reviewed for menopausal status, lymphatic invasion, hormonal status, the expression of p53 and c-erbB2. RESULTS: RT-PCR analysis revealed the expression of VEGF-C mRNA in 22 of 39 (56.4%) and LYVE-1 mRNA in 19 of 39 breast cancer tissues (48.7%). The expression of VEGF-C mRNA was positive in all cases except for one in LYVE-1 mRNA positive case, this revealed good correlation between the two molecules. Immunohistochemical analysis revealed that VEGF-C protein was expressed only in the breast cancer cells, with specific VEGF-C staining evident in 10 of 39 (25.6%). There was no significant correlation between VEGF-C, LYVE-1 mRNA expressions and the other pathologic variables. However, VEGF-C protein expression was negative in the group with a postmenopausal status, positive estrogen receptor and negative c-erbB2 significantly. CONCLUSIONS: VEGF-C mRNA seems to be related to the lymphangiogenetic marker-LYVE-1 mRNA and the amplification of the VEGF-C may be correlated with some clinico-pathological factors in the breast cancer.
Breast Neoplasms* ; Breast* ; Cell Line ; Estrogens ; Humans ; Paraffin ; Retrospective Studies ; RNA, Messenger ; Vascular Endothelial Growth Factor C*

PURPOSE: The aim of this study was to assess the expression of VEGF-C (vascular endothelial growth factor-C) and LYVE-1 (lymphatic vessel endothelial HA receptor-1) mRNA in human breast cancer, and to compare the expression of VEGF-C protein and VEGF-C, LYVE-1 mRNA with the clinico-pathological outcomes. METHODS: RT-PCR was carried on the VEGF-C, LYVE-1 mRNA drawn from three samples of adjacent normal breast tissues, the MCF-7 breast cancer cell line and 39 breast cancer tissues. Immunohistochemical staining was done to detect the expression of VEGF-C protein in 39 cancer tissues and in 5 benign tissues with using well preserved, paraffin embedded tissues. The clinico-pathological findings were retrospectively reviewed for menopausal status, lymphatic invasion, hormonal status, the expression of p53 and c-erbB2. RESULTS: RT-PCR analysis revealed the expression of VEGF-C mRNA in 22 of 39 (56.4%) and LYVE-1 mRNA in 19 of 39 breast cancer tissues (48.7%). The expression of VEGF-C mRNA was positive in all cases except for one in LYVE-1 mRNA positive case, this revealed good correlation between the two molecules. Immunohistochemical analysis revealed that VEGF-C protein was expressed only in the breast cancer cells, with specific VEGF-C staining evident in 10 of 39 (25.6%). There was no significant correlation between VEGF-C, LYVE-1 mRNA expressions and the other pathologic variables. However, VEGF-C protein expression was negative in the group with a postmenopausal status, positive estrogen receptor and negative c-erbB2 significantly. CONCLUSIONS: VEGF-C mRNA seems to be related to the lymphangiogenetic marker-LYVE-1 mRNA and the amplification of the VEGF-C may be correlated with some clinico-pathological factors in the breast cancer.
Breast Neoplasms* ; Breast* ; Cell Line ; Estrogens ; Humans ; Paraffin ; Retrospective Studies ; RNA, Messenger ; Vascular Endothelial Growth Factor C*

PURPOSE: Infiltrating lobular carcinoma (ILC) represents approximately 10% of all breast cancers. Its detection and staging for appropriate surgical planning may be difficult on account of its unique growth pattern, including a linear file arrangement of the tumor cells and a planar growth pattern and the resulting low density of the lesions. The purpose of this study was to evaluate the clinicopathological features of an ILC of the breast including multifocality, the preoperative accuracy of the pathological diagnostic tools, and its impact on the surgical procedure. METHODS: Between 1997 and 2003 at the Asan Medical Center, a group of 63 patients with a pathologically proven invasive lobular carcinoma who had undergone surgery were included. They were all in stage I~III, and their medical records, mammographic and sonographic results, and pathologic findings were reviewed retrospectively. RESULTS: Of the 63 patients with a mean age of 48 years (range 35 to 70), multifocal lesions were identified in 27.0% by a pathological examination. For a preoperative evaluation of a multifocal lesion, the sensitivity and positive prediction value were 21.4% and 50% by mammography, and 92.9% and 52.0% by ultrasonography, respectively. Only 27.0% of all patients were confirmed as having an ILC preoperatively; surgical excision or incision biopsies 75%, core-needle biopsy 36.4%, frozen biopsy 22.7%, FNA 5.9%. Conservative surgery was performed in only 14.3% and a mastectomy was performed on 85.5%. The mean tumor size was 3.0 cm, and according to the TNM stage, stage I was found in 22.2%, stage II in 58.7%, stage III in 19.1%. ER-positive was found in 83.9% and PR-positive was found in 74.2%. Seven out of 11 patients, who underwent the planed conserving surgery, had a positive resection margin, 1 case had re- excision, 2 cases underwent mastectomies, and 4 cases underwent radiation therapy without additional surgery. CONCLUSION: Since invasive lobular carcinomas have more often multifocal lesions and a preoperative accurate evaluation may be difficult pathologically or radiologically, a careful evaluation of the accurate tumor extent as well as the multifocal lesion is needed particularly for patients with an ILC considering conserving surgery.
Biopsy ; Breast* ; Carcinoma, Lobular* ; Chungcheongnam-do ; Diagnosis* ; Humans ; Mammography ; Mastectomy ; Medical Records ; Retrospective Studies ; Ultrasonography