Jeeyeon Lee

Oncologic outcomes of volume replacement technique after partial mastectomy for breast cancer: A single center analysis

BACKGROUND AND OBJECTIVES Volume replacement technique is a good option for Asian women with small to moderate-sized breasts undergoing partial mastectomy for breast cancer. We analyzed the oncologic outcomes of this procedure in a single center. METHODS Seventy-two patients with breast cancer underwent partial mastectomy with volume replacement technique in this prospective study. Volume replacement techniques were tailored individually according to the volume of excised breast and tumor location. The mean duration of follow-up was 40.9 months. We analyzed association between various clinicopathologic factors and locoregional recurrence, distant metastasis and assessed cosmetic outcomes. RESULTS The incidences of locoregional recurrence and distant metastasis were 2.8% and 5.6%, respectively. According to multivariate analysis, history of contralateral breast cancer (P < 0.001) and fat necrosis (P = 0.002) significantly associated with incidence of locoregional recurrence and pathologic tumor size (P = 0.037) and stage (P = 0.048) significantly influenced the incidence of distant metastasis. CONCLUSION From an oncologic perspective, volume replacement procedures after partial mastectomy are an appropriate form of surgical management of breast cancer.

Oncoplastic surgery for inner quadrant breast cancer: fish-hook incision rotation flap.

In oncoplastic breast surgery, the size and location of the defect are two of the major factors affecting the post‐operative cosmetic outcome after partial mastectomy. We introduce a modified superior‐based dermoglandular rotation flap technique, which can be applied for relatively large tumours and in cases of inner quadrant defects of the breast without surgery of the contralateral breast.

Ultrasound-Guided Restaging and Localization of Axillary Lymph Nodes After Neoadjuvant Chemotherapy for Guidance of Axillary Surgery in Breast Cancer Patients: Experience with Activated Charcoal

ObjectiveThe aim of this study was to review our experience with ultrasound (US)-guided localization of axillary lymph nodes using activated charcoal for the guidance of axillary surgery after neoadjuvant chemotherapy (NAC) in clinically node-positive breast cancer patients.MethodsBetween April 2016 and April 2017, US-guided localization of the most suspicious axillary lymph nodes at restaging US using activated charcoal (Charcotrace™) was performed in 45 consecutive, clinically node-positive breast cancer patients who had less than two suspicious nodes after NAC and axillary surgery with sentinel node biopsy. Sentinel nodes were defined as radioactive nodes or nodes containing blue dye. The concordance between final pathological results for both the tattooed and sentinel nodes was analyzed.ResultsSentinel node biopsy failed in five patients (11%) in whom axillary surgery was performed under the guidance of the tattooed node. The tattooed nodes were identified in the surgical field in 44 patients (98%). Of the 44 tattooed nodes, 25 (57%) were concordant with the sentinel nodes and 19 (43%) were non-sentinel nodes, including the five nodes with failed sentinel node biopsy. In the final pathological results, 18 patients (40%) had metastatic nodes. The sensitivities for detecting axillary metastasis of the sentinel node biopsy, tattooed node biopsy, and the sentinel and/or tattooed node biopsy were 61% (11/18), 67% (12/18), and 78% (14/18), respectively.ConclusionUS-guided localization of axillary lymph nodes using activated charcoal at restaging after NAC in clinically node-positive breast cancer patients is a useful technique to guide axillary surgery, with a high identification rate.

The role of preoperative breast magnetic resonance (MR) imaging for surgical decision in patients with triple-negative breast cancer

Several reliable randomized studies do not recommend routine preoperative breast MR imaging for patients with breast cancer. However, because the principle of MR imaging is based on the dynamics of contrast enhancement, a specific biologic subgroup of tumors should sensitively respond to the imaging process.

Ductal Carcinoma Arising from Ectopic Breast Tissue Following Microcalcification Observed on Screening Mammography: A Case Report and Review of the Literature

Ectopic breast tissue can occur anywhere along the incompletely regressed mammary ridge. Among the various types of breast choristoma, ectopic breast tissue, which has only glandular tissue without a nipple or areola, is most commonly detected in axillary areas. However, ectopic breast cancer is often not detected until significant clinical symptoms have been revealed, or diagnosis is delayed. Furthermore, an examination of ectopic breast tissue tends to be omitted from a screening mammography. Especially, the microcalcifications of ectopic breast tissue are difficult to delineate on mammography. Herein, the authors report a case of ectopic breast carcinoma that showed clustered microcalcifications on screening mammography, and discuss the interpretation and implications of microcalcification in ectopic breast tissue.

Comparison of laser ablation using multidirectional and forward-firing fibers in breast cancer

Abstract Background: The aim of this study was to compare the therapeutic effect of laser ablation using the forward-firing fiber and the multidirectional-firing fiber for breast cancer treatment with pathologic results. Material and methods: An ex vivo study of laser ablation was conducted using normal breast and breast cancer tissue. Each ablated area was demarcated into three zones, and the temperature was measured. Laser ablations using multidirectional and forward-firing types of fiber were compared regarding the shape, diameter and aspect ratio of the ablated lesions. Results: The ablated lesions were classified into three zones: a carbonized zone with complete tissue loss; a coagulated zone with no viable cells; and a non-damaged zone. The shape of the ablated lesion was elliptical using the forward-firing fiber and round using the multidirectional-firing fiber. Compared with normal breast tissue, breast cancer tissue required a more powerful setting for laser ablation to achieve necrosis, and the aspect ratio of the thermal lesion was higher for laser ablation using the multidirectional-firing fiber. Conclusions: The experimental results on breast tissue have shown that multidirectional-firing fiber is more effective than using forward-firing fibers and that this may prove to be another feasible therapeutic option for management of breast cancer.

A comparison study of the transoral and bilateral axillo-breast approaches in robotic thyroidectomy: KIM et al.

Transoral robotic thyroidectomy (TORT) is a new remote access approach to avoid cervical incision. The purpose of this study is to compare two approaches used to avoid cervical incision: transoral approach and bilateral axillo‐breast approach (BABA) in robotic thyroidectomy.

Comparison of 5‐year oncological outcomes of breast cancer based on surgery type

A standardized classification system for breast surgery that incorporates oncoplastic techniques is needed. We classified the surgical techniques for breast cancer treatment into five groups according to the extent of surgery and reconstructive methods, i.e. conventional breast‐conserving surgery, partial mastectomy with volume displacement, partial mastectomy with volume replacement, simple mastectomy and total mastectomy with immediate reconstruction. We then evaluated the oncological outcomes for each of the five groups.

Five-Year Oncologic Outcomes of Volume Displacement Procedures After Partial Mastectomy for Breast Cancer.

Micro‐Abstract Although volume displacement procedures after partial mastectomy for breast cancer are increasingly being performed, few studies have comprehensively reported the oncologic outcomes of these procedures and the associations of those outcomes with clinicopathological variables. This study addresses that deficit in part and presents data concerning the efficacy of these procedures. Background: Volume displacement techniques that use remnant breast tissue are useful in reconstructive procedures after partial mastectomy. The authors analyzed the oncologic results of volume displacement surgery after partial mastectomy and their associations with various clinicopathologic factors. Patients and Methods: One hundred fifty‐eight eligible patients with breast cancer who underwent volume displacement procedures after partial mastectomy were included in this prospective study, in which associations between clinicopathologic factors and locoregional recurrence, distant metastasis, and death were analyzed. Results: During a mean follow‐up of 60.8 months, locoregional recurrence occurred in 3 cases (1.9%) and distant metastasis in 4 (2.5%). According to multivariate analysis, bilaterality of breast cancer (P = .035) and adjuvant chemotherapy (P = .042) were associated with distant metastasis. Conclusion: Volume displacement procedures after partial mastectomy have good oncologic results and are acceptable procedures for patients with breast cancer.

Role of breast magnetic resonance imaging in predicting residual lobular carcinoma in situ after initial excision

BACKGROUND Breast magnetic resonance (MR) imaging is a useful screening modality in detecting suspicious lesions in patients with a history of lobular carcinoma in situ (LCIS). This study aimed to evaluate the effectiveness of breast MR imaging in detecting remnant LCIS lesions after initial excision. METHODS Between 2011 and 2015, 29 patients with LCIS who underwent initial excision were enrolled. Breast ultrasonography and breast MR imaging was conducted after initial excision. Imaging findings were compared with pathologic results. RESULTS There were nine (31.0%) cases with positive margins after initial excision; they were LCIS (n=8) and atypical lobular hyperplasia (n=1). Residual lesions were identified in 12 cases; they were invasive lobular carcinoma (n=1; 3.4%), LCIS (n=9; 31.0%), atypical lobular hyperplasia (n=1; 3.4%), and papillary carcinoma in situ (n=1; 3.4%). Prior to the second operation, these lesions could be detected in seven cases using ultrasonography (sensitivity, 53.3%; specificity, 100%) and in 10 cases using breast MR imaging (sensitivity, 83.3%; specificity, 100%). CONCLUSIONS Breast MR imaging showed higher sensitivity than breast ultrasonography in detecting remnant LCIS lesions. If a suspicious lesion was found using breast MR imaging, a second operation should be considered because of the possibility of multifocality, even if LCIS was confirmed at the initial operation.