Se Kyung Lee

The prognoses of metaplastic breast cancer patients compared to those of triple-negative breast cancer patients

Metaplastic breast carcinoma (MBC) is a rare, heterogeneous breast cancer characterized by admixture of adenocarcinoma with metaplastic elements, low hormone receptor expression, and poor outcomes. The authors retrospectively reviewed the medical records of 47 MBC patients and 1,346 invasive ductal carcinoma (IDC) patients. Two hundred eighteen of the IDC patients were triple-negative (TN-IDC) for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor-2 (ER-/PR-/HER2-). Patients were surgically treated at the Samsung Medical Center between 2005 and 2009. The MBC patients presented with a larger tumor size, lower lymph node involvement, higher histological and nuclear grades, higher triple negativity (ER-/PR-/HER2-) and higher p53, CK5/6, and EGFR expressions compared with those of the IDC group. However, there were no significant differences in clinicopathological characteristics between MBC and TN-IDC. During the follow-up period (median duration of 30.3xa0months, range 2.6–56.3xa0months), seven (14.9%) MBC patients, and 98 (7.1%) IDC patients had disease recurrence. The three-year disease-free survival (DFS) rate was 78.1% in the MBC group and 91.1% in IDC group (Pxa0<xa00.001). The three-year DFS rate was not significantly different between the MBC and TN-IDC groups (78.1 vs. 84.9%, Pxa0=xa00.114). However, in patients with lymph node metastasis who underwent adjuvant chemotherapy, the three-year DFS rate was 44.4% in the MBC group and 72.5% in the TN-IDC group (Pxa0=xa00.025). The authors found that MBC had a poorer clinical outcome than did IDC. In breast cancer patients with nodal metastasis, MBC had a poorer prognosis than did TN-IDC, despite adjuvant chemotherapy.

Analysis of factors that influence the accuracy of magnetic resonance imaging for predicting response after neoadjuvant chemotherapy in locally advanced breast cancer

PurposeThe purpose of this study was to evaluate the accuracy of breast magnetic resonance imaging (MRI) to predict residual lesion size after neoadjuvant chemotherapy (NAC) and to determine the factors that influence the accuracy of response prediction.MethodsThis study comprised 166 patients who underwent MRI before and after NAC, but before surgery. The longest diameter of the residual cancer was measured using MRI and correlated with pathologic findings. Patients were further divided into subgroups according to various radiologic and histopathologic factors. Pathologic complete response (pCR) was defined as the absence of residual invasive cancer cells. The Pearson correlation was used to correlate tumor size as determined by MRI and pathology, and the Mann-Whitney U test and Kruskal-Wallis test were used to compare MRI-pathologic size discrepancies according to various clinical, histopathologic factors, and MRI findings.ResultsOf the 166 women, 40 achieved pCR. The overall sensitivity, specificity, and accuracy for diagnosing invasive residual disease by using MRI were 96, 65, and 89xa0%, respectively. The Pearson’s correlation coefficient between the tumor sizes measured using MRI and pathology was 0.749 (Pxa0<xa00.001). The size discrepancy was significantly greater in patients with estrogen receptor-positive cancer (Pxa0=xa00.037), in cancers with low nuclear grade (Pxa0=xa00.007), and in cancers shown as diffuse non-mass–like enhancement on MRI (Pxa0=xa00.001).ConclusionsSize prediction is less accurate in cases with estrogen receptor-positive breast cancer, low nuclear grade, and diffuse non-mass–like enhancement on initial MRI.

Effects of exercise intervention in breast cancer patients: is mobile health (mHealth) with pedometer more effective than conventional program using brochure?

PurposeTo investigate and compare the effects of mobile health (mHealth) and pedometer with conventional exercise program using a brochure on physical function and quality of life (QOL).MethodsThe study was a prospective, quasi-randomized multicenter trial where 356 patients whose cancer treatment had been terminated were enrolled. All patients were instructed to perform a 12-week regimen of aerobic and resistance exercise. The mHealth group received a pedometer and a newly developed smartphone application to provide information and monitor the prescribed exercises. Those in the conventional group received an exercise brochure. Physical measurements were conducted at baseline, 6xa0weeks, and 12xa0weeks. Self-reported physical activity (international physical activity questionnaire-short form), general QOL (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30), and breast cancer-specific QOL (Quality of Life Questionnaire Breast Cancer Module 23) were assessed at baseline and 12xa0weeks. A user satisfaction survey was assessed in the mHealth group.ResultsBasic characteristics were not different between the two groups except for age and previous radiotherapy. Physical function, physical activity, and QOL scores were significantly improved regardless of the intervention method, and changes were not significantly different between the two groups. Additionally, the mean Likert scale response for overall satisfaction with the service was 4.27/5 in the mHealth group.ConclusionsOverall, both the mHealth coupled with pedometer and conventional exercise education using a brochure were effective in improving physical function, physical activity, and QOL. This study provides a basis of mHealth research in breast cancer patients for progressing further developing field, although superiority of the mHealth over the conventional program was not definitely evident.

The efficacy of lateral neck sentinel lymph node biopsy in papillary thyroid carcinoma.

BackgroundAlthough occult lymph node metastasis to the lateral neck compartment is common in papillary thyroid carcinoma, the incidence and patterns of lateral neck node metastasis in papillary carcinoma are not known. We hypothesized that sentinel lymph node biopsy (SLNB) with radioisotope in the detection of occult lateral neck node metastasis would be useful in characterizing metastasis in papillary carcinoma.MethodsNinety-four patients with papillary thyroid carcinoma were included from June 2009 to March 2010 for lateral neck SLNB. Preoperative lymphoscintigraphy was obtained after intratumoral injection of a 99mTc-tin colloid under ultrasound guidance. Total thyroidectomy or lobectomy preceded SLN detection to avoid radioactivity interference with the primary tumor, after which SLNB was performed in the lateral neck nodes. In the cases where metastasis was detected in SLNs upon frozen biopsy, an immediate modified radical neck node dissection was performed.ResultsA total of 174 SLNs were identified in 60 patients (63.8%). The identification rate of the SLNs with isotope increased with time. Sentinel lymph node metastasis was found in 19 patients (31.7%). This clinically occult metastasis was only related to the total number of metastatic LNs in the central compartment. Patient age, gender, tumor size, location, extent of tumor invasion, multiplicity, and presence of thyroiditis were not related to metastasis in the lateral compartment. Detection of lateral neck SLNs upon biopsy with radioisotope was also feasible in level II and contralateral neck.ConclusionsSentinel lymph node biopsy is a useful method for evaluating the occult lateral neck lymph node status in patients with papillary thyroid carcinoma, especially in the cases of central neck node metastasis.

A new subfascial approach in open thyroidectomy: efficacy for postoperative voice, sensory, and swallowing symptoms. A randomized controlled study.

AbstractBackgroundAfter open thyroidectomy, patients usually complain of voice, sensory, and swallowing symptoms. We approached the thyroid via the subfascial method to reduce these symptoms and compared postthyroidectomy symptoms with the conventional subplatysmal method.nMethodsEighty-six patients undergoing thyroidectomy were recruited and randomized into either a conventional subplatysmal approach group (subplatysmal, 42 patients) group or a subanterior fascia of strap muscle approach group (subfascial, 44 patients). Voice symptoms were assessed using the Voice Handicap Index questionnaire and acoustic voice analysis. Sensory alterations were evaluated by the light touch and pain touch methods. Swallowing symptoms were assessed using the Swallowing Impairment Score (SIS) questionnaire, barium swallowing time, and hyoid bone movement range. Each variable was measured preoperatively, and at 2xa0weeks and 3xa0months after thyroidectomy.nResultsIn both groups, the subjective symptoms of voice, sensation, and swallowing were significantly worsened at 2xa0weeks after operation, but improved 3xa0months after operation. Patients in the subplatysmal group had worse SIS scores than patients in the subfascial group (pxa0=xa00.016) and delayed barium swallowing time 2xa0weeks after operation (pxa0=xa00.008 compared to preoperative level). In the cohort over 50xa0years of age, SIS score did not recover to preoperative levels in the subplatysmal group 3xa0months after operation (pxa0=xa00.005 compared to preoperative level).ConclusionsThe subfascial approach may be an effective method for reducing postthyroidectomy swallowing symptoms based on swallowing impairment score, especially in patients over 50xa0years of age.

Feasibility of Nipple-Sparing Mastectomy with Immediate Breast Reconstruction in Breast Cancer Patients with Tumor-Nipple Distance Less Than 2.0 cm

AbstractBackground and objectivenDebate continues concerning the oncological risk of nipple-sparing mastectomy (NSM) with immediate breast reconstruction (IBR) if the tumor-nipple distance (TND) is less than 2.0xa0cm. In this retrospective study, we analyzed oncological outcomes after NSM with IBR for the treatment of breast cancer to determine the risk posed by NSM in cases in which magnetic resonance imaging (MRI) showed a TND <2.0xa0cm but intraoperative frozen biopsy results were negative for tumor cells at the nipple base.Materials and methodsnWe conducted a retrospective review of patients with breast cancer who underwent NSM with IBR at Samsung Medical Center between 2008 and 2014. Preoperative MRI was done in all cases to define the TND, and frozen biopsy specimens were obtained intraoperatively.ResultsAmong the 266 NSMs performed, TND was <2.0xa0cm in 145 cases (54.5xa0%) and ≥2.0xa0cm in 121 cases (45.5xa0%). Median follow-up was 25.6xa0months. There were no significant differences between the two patient groups with respect to disease-free survival or local recurrence-free survival.ConclusionOur results suggest that NSM can be a feasible treatment option when the intraoperative frozen biopsy is negative for tumor cells even with a TND <2.0xa0cm in MRI.

Sentinel Lymph Node Biopsy Alone after Neoadjuvant Chemotherapy in Patients with Initial Cytology-Proven Axillary Node Metastasis

Purpose Neoadjuvant chemotherapy (NAC) has been recently used to downstage breast cancer. However, in patients with initial axillary lymph node (ALN) metastasis, ALN dissection regardless of the NAC response remains the standard treatment. The purpose of this study was to identify the feasibility and accuracy of sentinel lymph node biopsy (SLNB) after NAC in patients with ALN metastasis at diagnosis. Methods From January 2007 to August 2013, data of patients who were diagnosed with invasive breast cancer and ALN metastasis and treated with NAC followed by definitive surgery in two centers were collected retrospectively. A total of 386 patients were enrolled and classified into five groups according to surgical procedure for the ALNs and pathologic results. Results At SLNB after NAC, sentinel lymph nodes (SLNs) that stained blue or were hot, including suspicious nodes, were identified; the SLN identification and false-negative rates was 96% and 10%, respectively. There was no difference in the overall survival among the groups. For patients who revealed a pathologic complete node response, there was a significant difference in the disease-free survival rate between the SLNB only and complete ALN dissection groups (p=0.031). However, the rate of axillary recurrence demonstrated no significant differences among the groups (p>0.050). Conclusion SLNB after NAC in breast cancer patients with initial ALN metastasis may help identify downstaging to negative nodal status and thereby reduce the surgical morbidity by avoiding standard ALN dissection.

The Clinical Meaning of Intramammary Lymph Nodes

Objective: The clinical meaning of intramammary lymph nodes (iMLNs) is uncertain. We wanted to describe the clinical characteristics and understand the implications of iMLNs detected by sentinel LN biopsy (SLNB). Methods: We reviewed the clinical, radiological and pathological records of women diagnosed with invasive carcinoma of the breast at the Samsung Medical Center between January 2001 and January 2011. A total of 69 patients were identified, and SLNB was performed in 31 patients. Results: Of the 69 patients included in the study, 22 (31.9%) had metastases in iMLNs. The presence of lymphovascular invasion and the number of axillary LN metastases were associated with iMLN metastasis. Of the 31 patients who underwent SLNB, there were no cases with axillary LN metastasis when axillary SLNB was negative, even in cases of iMLN-positive patients. Of the 10 patients in whom intramammary SLNs (iMSLNs) were detected during SLNB, 8 patients without iMLN metastases were also negative for axillary LNs. Conclusion: Patients with metastatic iMLNs had more aggressive cancers with lymphovascular invasion and increased axillary LN metastases. When iMSLN was detected by SLNB, performing of axillary dissection could be determined by the status of the iMSLN itself.

Background parenchymal enhancement on breast MRI: association with recurrence-free survival in patients with newly diagnosed invasive breast cancer

PurposeTo determine whether BPE in preoperative breast MRI influences patients’ recurrence-free survival (RFS).MethodsBetween February 2010 and December 2011, 804 consecutive women with invasive breast cancer who had undergone preoperative breast MRI and curative cancer surgery were identified. BPE was visually graded by two reviewers. We determined the correlation between BPE grade and other clinicopathological variables, including age, adjuvant therapy, menopausal status, histologic grade, T stage, N stage, lymphovascular invasion, molecular subtype, surgical margin status, and mammographic density. A Cox proportional hazards model was used to analyze the effects of clinicopathological variables and radiological findings (BPE grade, mammographic density) on RFS.ResultsHigh BPE was associated with premenopausal status (Psxa0<xa00.0001), higher mammographic density (Psxa0<xa00.0001), progesterone receptor positivity (Psxa0=xa00.039, 0.007, respectively), presence of lymphovascular invasion (Psxa0=xa00.008, 0.001, respectively), and close surgical margin (Psxa0<xa00.0001). Recurrences were observed in 75 patients after a mean follow-up period of 61.8xa0months (range 4–81xa0months). Non-minimal BPE grade (RFS hazard ratioxa0=xa03.086, Pxa0=xa00.003 for reader 1; RFS hazard ratioxa0=xa02.221, Pxa0=xa00.075 for reader 2) and T3 stage were associated with worse outcomes in postmenopausal women. In premenopausal women, non-minimal BPE grade by readers 1 and 2 did not affect the patients’ outcomes.ConclusionsIncreased BPE on preoperative breast MRI in postmenopausal women has potential as a predictor of poor RFS.

Breast cancer-specific mortality in small-sized tumor with node-positive breast cancer: a nation-wide study in Korean breast cancer society

Tumor size and number of lymph node (LN) metastases are well known as the most important prognostic factors of breast cancer. We hypothesized that very small breast cancers with LN metastasis represent a progressive biologic behavior and evaluated tumor size stratified by LN metastasis. Data between 1990 and 2010 were obtained retrospectively from the Korean Breast Cancer Society Registry with inclusion criteria of female, non-metastatic, unilateral, and T1/2 breast cancer. We collected the following variables: age at surgery, tumor size, number of LN metastases, nuclear grade (NG), lymphovascular invasion (LVI), estrogen receptor status, progesterone receptor status, and epidermal growth factor receptor-2 status. Patient characteristics were compared by means of independent t-tests for continuous variables and the Chi-square or Fisher’s exact test for categorical variables. Kaplan–Meier curves, with corresponding results of log-rank tests, were constructed for breast cancer-specific survival (BCSS). Five- and eight-year breast cancer-specific mortality (BCSM) was obtained in groups of 300 patients, followed by smoothing according to the confidence interval using the lowess method. We identified 39,826 breast cancer patients who met the inclusion criteria. Among them, 1433 (3.6xa0%) patients died due to breast cancer. The median follow-up duration was 63.4 (3–255) months. In the multivariate analysis, age at surgery, NG, LVI, subtype, and tumor size–nodal interactions were independently associated with BCSM. The N1 group had lower BCSS for T1a than T1b. The N2+xa0group also had lower BCSS for T1b than T1c or T2. In the N1 group of tumors smaller than 10xa0mm, 5- and 8-year BCSM decreased with larger tumor size. Patients with very small tumors with LN metastasis have decreased BCSM according to increase tumor size. Small tumors with LN metastasis could have aggressive biological behavior.