Purpose: This study investigated the correlation between non-mass-like enhancement (NME) observed on preoperative breast magnetic resonance imaging (MRI) and the actual pathological size of breast cancer. We further examined the effect of NME on the positive resection margins during partial mastectomy. Methods: We retrospectively collected data from breast cancer patients who underwent surgery between January 2018 and September 2020. Patients were divided into two groups based on their MRI findings: NME and no-NME (mass-like lesion only) groups. The medical records, including MRI findings and clinicopathological information of patients, were collected retrospectively, and correlations with pathologic results were analyzed. Propensity score matching was applied to develop comparable cohorts of the NME group and no-NME group. Results: This study included a total of 317 patients, with 66 and 251 patients in the NME and no-NME groups, respectively. The mean pathologic size of invasive lesion was significantly smaller than the mean lesion size in the NME group (1.55±1.39 cm vs. 3.45±1.81 cm, p<0.001). The mean pathologic size of ductal carcinoma in situ (DCIS) lesions was larger than that in the NME group but without statistical significance (3.91±2.67 cm vs. 3.50±1.79 cm, p=0.326). In the NME group, NME estimated DCIS size to within 1 cm in 20 patients (30.3%) and overestimated invasive lesion size by more than 1 cm in 31 patients (46.9%). NME (vs. no-NME; odds ratio [OR], 2.967; 95% confidence interval [CI], 0.878-10.025) showed a tendency to predict positive resection margins, but this was not statistically significant (p=0.080). Conclusion NME findings on MRI showed a similar extent of DCIS lesions. NME findings on preoperative MRI should be considered an important factor for measuring the extent of tumors, especially in DCIS patients.

Purpose: In this trial, we investigated the efficacy and safety of adjuvant letrozole for hormone receptor (HR)-positive breast cancer. Here, we report the clinical outcome in postmenopausal women with HR-positive breast cancer treated with adjuvant letrozole according to estrogen receptor (ER) expression levels. Methods: In this multi-institutional, open-label, observational study, postmenopausal patients with HR-positive breast cancer received adjuvant letrozole (2.5 mg/daily) for 5 years unless they experienced disease progression or unacceptable toxicity or withdrew their consent. The patients were stratified into the following 3 groups according to ER expression levels using a modified Allred score (AS): low, intermediate, and high (AS 3–4, 5–6, and 7–8, respectively). ER expression was centrally reviewed. The primary objective was the 5-year disease-free survival (DFS) rate. Results: Between April 25, 2010, and February 5, 2014, 440 patients were enrolled. With a median follow-up of 62.0 months, the 5-year DFS rate in all patients was 94.2% (95% confidence interval [CI], 91.8–96.6). The 5-year DFS and recurrence-free survival (RFS) rates did not differ according to ER expression; the 5-year DFS rates were 94.3% and 94.1%in the low-to-intermediate and high expression groups, respectively (p = 0.6), and the corresponding 5-year RFS rates were 95.7% and 95.4%, respectively (p = 0.7). Furthermore, 25 patients discontinued letrozole because of drug toxicity. Conclusion Treatment with adjuvant letrozole showed very favorable treatment outcomes and good tolerability among Korean postmenopausal women with ER-positive breast cancer, independent of ER expression.

Gynecomastia is a proliferation of glandular tissue of the breast in male and it is the most commonly observed breast disease amongst male patients associated with the negative impact on body image and social health of man. Although the medical therapy is an option with long-standing gynecomastia patients, the less than desirable effectiveness leads to the surgery. Although various techniques have been described for the correction of gynecomastia, the common technique of surgery has been performed with a circumareolar incision. However, this technique has been associated with undesirable complications such as a visible scar on the chest, areola inversion, and nipple necrosis. To remedy such complications, the transaxillary techniques were used in an attempt to avoid scar and the complication of the nipple areola complex. In this study, the surgery for the two patients with Simon’s grade III gynecomastia were performed using the pull-through technique and through the axillary incision. The result of the transaxillary subcutaneous mastectomy technique produced esthetic appearance with little complications.

Purpose: In this trial, we investigated the efficacy and safety of adjuvant letrozole for hormone receptor (HR)-positive breast cancer. Here, we report the clinical outcome in postmenopausal women with HR-positive breast cancer treated with adjuvant letrozole according to estrogen receptor (ER) expression levels. Methods: In this multi-institutional, open-label, observational study, postmenopausal patients with HR-positive breast cancer received adjuvant letrozole (2.5 mg/daily) for 5 years unless they experienced disease progression or unacceptable toxicity or withdrew their consent. The patients were stratified into the following 3 groups according to ER expression levels using a modified Allred score (AS): low, intermediate, and high (AS 3–4, 5–6, and 7–8, respectively). ER expression was centrally reviewed. The primary objective was the 5-year disease-free survival (DFS) rate. Results: Between April 25, 2010, and February 5, 2014, 440 patients were enrolled. With a median follow-up of 62.0 months, the 5-year DFS rate in all patients was 94.2% (95% confidence interval [CI], 91.8–96.6). The 5-year DFS and recurrence-free survival (RFS) rates did not differ according to ER expression; the 5-year DFS rates were 94.3% and 94.1%in the low-to-intermediate and high expression groups, respectively (p = 0.6), and the corresponding 5-year RFS rates were 95.7% and 95.4%, respectively (p = 0.7). Furthermore, 25 patients discontinued letrozole because of drug toxicity. Conclusion Treatment with adjuvant letrozole showed very favorable treatment outcomes and good tolerability among Korean postmenopausal women with ER-positive breast cancer, independent of ER expression.

Gynecomastia is a proliferation of glandular tissue of the breast in male and it is the most commonly observed breast disease amongst male patients associated with the negative impact on body image and social health of man. Although the medical therapy is an option with long-standing gynecomastia patients, the less than desirable effectiveness leads to the surgery. Although various techniques have been described for the correction of gynecomastia, the common technique of surgery has been performed with a circumareolar incision. However, this technique has been associated with undesirable complications such as a visible scar on the chest, areola inversion, and nipple necrosis. To remedy such complications, the transaxillary techniques were used in an attempt to avoid scar and the complication of the nipple areola complex. In this study, the surgery for the two patients with Simon’s grade III gynecomastia were performed using the pull-through technique and through the axillary incision. The result of the transaxillary subcutaneous mastectomy technique produced esthetic appearance with little complications.

During the Coronavirus Disease 2019 (COVID-19) pandemic, practices of gastrointestinal procedures within the digestive tract require special precautions due to the risk of contraction of severe acute respiratoy syndrome coronavirus-2 (SARS-CoV-2) infection. Many procedures in the gastrointestinal motility laboratory may be considered moderate to high-risk for viral transmission. Healthcare staff working in gastrointestinal motility laboratories are frequently exposed to splashes, air droplets, mucus, or saliva during the procedures. Moreover, some are aerosol-generating and thus have a high risk of viral transmission. There are multiple guidelines on the practices of gastrointestinal endoscopy during this pandemic. However, such guidelines are still lacking and urgently needed for the practice of gastrointestinal motility laboratories. Hence, the Asian Neurogastroenterology and Motility Association had organized a group of gastrointestinal motility experts and infectious disease specialists to produce a position statement paper based-on current available evidence and consensus opinion with aims to provide a clear guidance on the practices of gastrointestinal motility laboratories during the COVID-19 pandemic. This guideline covers a wide range of topics on gastrointestinal motility activities from scheduling a motility test, the precautions at different steps of the procedure to disinfection for the safety and well-being of the patients and the healthcare workers. These practices may vary in different countries depending on the stages of the pandemic, local or institutional policy, and the availability of healthcare resources. This guideline is useful when the transmission rate of SARS-CoV-2 is high. It may change rapidly depending on the situation of the epidemic and when new evidence becomes available.

PURPOSE: Several studies have reported the plausible association of neutrophil-to-lymphocyte ratio (NLR) with the prognosis of papillary thyroid cancer (PTC), but the results are inconsistent. In PTC, chronic inflammation is closely related to tumor progression, and the age of the patient has a great influence on prognosis. Therefore, considering the changes in the immune system with aging, we classified the patients according to age and assessed the prognostic value of individual hematologic parameters. METHODS: This retrospective analysis included 1,921 patients who underwent thyroidectomy for PTC. Patients were divided into 2 groups based on their age: Y-group (age < 45) and O-group (age ≥ 45). Blood counts were measured within 14 days before surgery. RESULTS: The Y-group consisted of 914 patients aged < 45 years and the O-group consisted of 932 patients aged ≥ 45. In both groups, the common prognostic factors related to disease recurrence were only 6 or more metastatic lymph node and grossly extrathyroidal extension, and hematologic parameters were different between the 2 groups. High Platelet-lymphocyte ratio (PLR) in the Y-group and high NLR in the O-group were identified as independent predictors of disease recurrence (NLR: hazard ratio [HR], 3.28; 95% confidence interval [CI], 1.23–8.73; P = 0.018; PLR: HR, 3.08; 95% CI, 1.26–7.52; P = 0.014). CONCLUSION: The results suggest that changes in immunity with aging may affect prognosis in patients with PTC, and thus hematologic parameters might be employed as prognostic markers depending on the age of the patients.
Aging ; Hematologic Tests ; Humans ; Immune System ; Inflammation ; Lymph Nodes ; Lymphocytes ; Neutrophils ; Prognosis ; Recurrence ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy

PURPOSE: This study aimed to compare the diagnostic performance of contrast-enhanced digital mammography (CEDM) and contrast-enhanced magnetic resonance imaging (CEMRI) in preoperative evaluations, and to evaluate the effect of each modality on the surgical management of women with breast cancer. METHODS: This single-center, prospective study was approved by the Institutional Review Board, and informed consent was obtained from all patients. From November 2016 to October 2017, 84 patients who were diagnosed with invasive carcinoma (69/84) and ductal carcinoma in situ (15/84), and underwent both CEDM and CEMRI, were enrolled. Imaging findings and surgical management were correlated with pathological results and compared. The diagnostic performance of both modalities in the detection of index and secondary cancers (multifocality and multicentricity), and occult cancer in the contralateral breast, was compared. The authors also evaluated whether CEDM or CEMRI resulted in changes in the surgical management of the affected breast due to imaging-detected findings. RESULTS: Eighty-four women were included in the analysis. Compared with CEMRI, CEDM demonstrated a similar sensitivity (92.9% [78/84] vs. 95.2% [80/84]) in detecting index cancer (p=0.563). For the detection of secondary cancers in the ipsilateral breast and occult cancer in the contralateral breast, no significant differences were found between CEDM and CEMRI (p=0.999 and p=0.999, respectively). Regarding changes in surgical management, CEDM resulted in similar changes compared with CEMRI (30.9% [26/84] vs. 29.7% [25/84], p=0.610). Regarding changes in surgical management due to false-positive findings, no significant differences were found between CEDM and CEMRI (34.6% [9/26] vs. 44.0% [11/25], p=0.782). CONCLUSION: CEDM demonstrated a diagnostic performance comparable with CEMRI in depicting index cancers, secondary cancers, and occult cancer in the contralateral breast. CEDM demonstrated similar changes in surgical management compared with CEMRI.
Breast Neoplasms* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Contrast Media ; Ethics Committees, Research ; Female ; Humans ; Informed Consent ; Magnetic Resonance Imaging* ; Mammography* ; Prospective Studies

PURPOSE: This study aimed to determine the clinical and pathological factors associated with a higher rate of positive or close margins after breast-conserving surgery (BCS) by comparing these patients to patients with a negative margin. The second aim was to evaluate intraoperative resection margin status and reoperation rates for margin control in patients who underwent BCS. METHODS: We reviewed the clinical and pathological data of all women diagnosed with invasive breast carcinoma (IBC) and ductal carcinoma in situ (DCIS) at our institution between January 2006 and December 2016. RESULTS: During the 10-year study period, 785 patients were diagnosed with either IBC or DCIS, and 402 of these patients had undergone a total mastectomy as the primary treatment. The remaining 383 patients who underwent BCS were included in the final analysis. Of these, 100 patients (26.1%) had intraoperative positive or close margins. The remaining 283 patients (73.9%) had a negative margin intraoperatively, but 32 of these patients had positive or close margins on permanent sections. In the multivariate analyses, microcalcifications on mammograms (vs. none; odds ratio [OR], 1.911; 95% confidence interval [CI], 1.156−3.160), in situ carcinomas larger than 2.0 cm (vs. ≤2.0 cm; OR, 3.106; 95% CI, 1.193−8.086), and lumpectomy (vs. quadrantectomy; OR, 2.863; 95% CI, 1.268−6.622) showed a significant association with a positive or close surgical margins. Patients with intraoperative positive or close margins underwent more reoperation than those with negative margins (5.0% vs. 2.8%). CONCLUSION: After BCS, microcalcifications on mammograms, large-sized in situ carcinomas, and lumpectomy were more likely to have positive or close margins.
Breast Neoplasms* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Female ; Humans ; Mastectomy ; Mastectomy, Segmental* ; Mastectomy, Simple ; Multivariate Analysis ; Odds Ratio ; Reoperation

PURPOSE: The incidence of thyroid cancer is relatively high, especially in young women, and postoperative scarring after thyroidectomy is an important problem for both patients and clinicians. Currently, there is no available product that can be used for wound protection during thyroid surgery. We used the EASY-EYE_C, a new silicone-based wound protector. METHODS: We conducted a double-blind randomized controlled trial to assess the efficacy of the EASY-EYE_C with surgical scars. We studied 66 patients who underwent conventional total thyroidectomy or hemithyroidectomy performed by a single surgeon from August 2015 to June 2016. At 6-week follow-up, a single blinded physician observed the wounds to make clinical assessments using the Patient and Observer Scar Assessment Scale (POSAS), the Vancouver Scar Scale (VSS), and a modified Stony Brook Scar Evaluation Scale (SBSES). RESULTS: There were no significant differences by sex, age, type of surgery, body mass index, length of wound, incision site (from sternal notch), or thyroid weight, but the duration of operation was significantly shorter in the experimental group (E group). The e-group also had better POSAS scores than the control group (C group), with means of 43.2 (standard deviation [SD], ±15.9) versus 68.3 (SD, ±21.5), respectively (P < 0.05). The modified SBSES and VSS scores were similar to those from the POSAS. CONCLUSION: In this study, all scores for evaluating outcomes were higher in the E group than in the C group. In addition, the operation time was significantly shorter in the E group. Therefore, the EASY-EYE_C may be useful for improving the cosmetic outcomes of conventional thyroid surgery.
Body Mass Index ; Cicatrix ; Female ; Follow-Up Studies ; Humans ; Incidence ; Silicones ; Surgical Instruments ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy* ; Wounds and Injuries