Comparative Accuracy of Preoperative Tumor Size Assessment on Ultrasonography and Magnetic Resonance Imaging in Ductal Carcinoma In Situ

Purpose@#The purpose of this study was to compare the accuracy of preoperative breast tumor size measured by ultrasonography (US) and magnetic resonance imaging (MRI) in patients with ductal carcinoma in situ (DCIS). @*Methods@#Medical records of 74 patients postoperatively diagnosed with DCIS were retrospectively analyzed. Tumor size measurements obtained using the two imaging modalities were compared for accuracy with those obtained during the final pathologic examination. Patients with only microcalcification on imaging were excluded. @*Results@#For all patients, Lin’s concordance correlation coefficient (CCC) of MRI was 0.725, which was more accurate than 0.670 of US. In subgroup analysis, CCC of US was 0.757, more accurate than 0.697 of MRI in premenopausal DCIS patients. Background parenchymal enhancement (BPE) was the only risk factor deteriorating the accuracy of US and MRI examinations. Moderate and marked BPE was associated with the inaccurate tumor size estimations in both US and MRI (odds ratio [OR]:2.23, 95% confidence interval [CI]=1.12−3.52, p=0.001 in US, OR:8.16, 95% CI=1.17−15.2, p=0.031 in MRI). @*Conclusion@#MRI was more accurate for measuring tumor size in patients with DCIS. Moderate and marked BPE was a risk factor that prevented accurate measurement of preoperative tumor size. In premenopausal patients, US would help measure tumor size accurately.

Risk factor for contralateral occult carcinoma in patients with unilateral papillary thyroid carcinoma

Purpose@#The extent of surgery necessary in patients with unilateral papillary thyroid carcinoma (PTC) on preoperative radiologic imaging is still in doubt. In this study, we aimed to define risk factors that could be indicators for malignant nodules in the contralateral thyroid lobe. @*Methods@#We included 438 patients who underwent total thyroidectomy between January 2011 and December 2014 at our institution. In this study, patients were divided into two groups according to the presence of contralateral occult carcinoma identified by postoperative pathological examination. We analyzed the clinicopathologic factors including characteristics of coexistent nodules in the contralateral lobe based on preoperative radiological imaging. @*Results@#A total of 96 patients (21.9%) had PTC in the contralateral lobe. There were no significant differences between patients with or without contralateral occult carcinoma with respect to gender, age, primary tumor size, central lymph node metastasis, extrathyroidal extension and stage. The presence of Hashimoto’s thyroiditis was an independent predictive factor for contralateral occult carcinoma (P=0.01). @*Conclusion@#A risk factor for contralateral occult carcinoma in unilateral PTC patients is Hashimoto’s thyroiditis. Therefore, more caution is needed when determining optimal surgical methods for PTC patients with Hashimoto’s thyroiditis.

Relative Survival Benefit by Hormonal Receptor Status of Adding Trastuzumab to Neoadjuvant Chemotherapy in Breast Cancer Patients / 한국유방암학회지

Purpose@#Neoadjuvant chemotherapy (NAC) involving trastuzumab markedly increases pathologic complete response (pCR) rates in patients with human epidermal growth factor receptor 2-positive (HER2+) breast cancer. Despite increasing pCR rates, long-term survival gains are controversial owing to distinctive biologic behavior mediated by the presence of hormonal receptors (HRs) that may interact with HER2 receptors. We, therefore, investigated the differences in relative survival gain provided by neoadjuvant trastuzumab-based chemotherapy on HR positive (HR+) status of patients. @*Methods@#We retrospectively ana Patient clinical characteristics were compared usin lyzed women with stage II or III HER2+ breast cancer who underwent NAC followed by a breast cancer surgery between 2008 and 2013. The survival benefits of adding trastuzumab to NAC were analyzed by classifying patients into HR+ and HR negative (HR−) groups. @*Results@#Of 666 patients included in the study, 374 (52.1%) were HR+ and 319 (47.9%) were HR−. In the HR+ group, trastuzumab treatment led to higher pCR rates and significantly better breast cancer specific survival (BCSS) and overall survival (OS) than no trastuzumab treatment. However, among patients with HR− breast cancer, trastuzumab treatment showed no statistically significant difference between BCSS and OS following multivariate analysis. @*Conclusion@#We found that the addition of trastuzumab to NAC improved relative survival benefit in HER2+/HR+ patients than in HER2+/HR− patients, even though the pCR rate increases were lower. Although pCR has been regarded as a surrogate marker for estimating long-term survival benefits after NAC, it alone may not translate into real long-term oncologic outcomes in particular cancer subtypes after trastuzumab-based NAC. Further longer-term evaluation of the objective survival benefit after NAC driven by a dual HER2 block according to HR status is warranted.

Accuracy of Radiological Axillary Staging for Breast Cancer Patients with Neoadjuvant Chemotherapy

Purpose@#Neoadjuvant chemotherapy (NACT) in breast cancer patients has the advantage of decreasing related morbidities by reducing the extent of axillary surgery. However, it remains a controversy with regards to the appropriate extent of axillary lymph node dissection after NACT. Therefore, this study aims to investigate the accuracy of breast ultrasonography (US) and breast magnetic resonance imaging (MRI) to assess the axillary nodal status after NACT. @*Methods@#We reviewed pre- and post-NACT axillary imaging and clinicopathological data of patients who received NACT for primary breast cancer and underwent surgery. After NACT, accuracy of imaging modalities were evaluated through the comparison of pathologic lymph node (LN) status and imaging LN status. @*Results@#Fifty seven patients completed NACT and underwent surgery. Breast US was found to have a sensitivity of 61.1%, specificity of 57.7%, negative predictive value (NPV) of 68.2%, and positive predictive value (PPV) of 50.0%. For breast MRI, sensitivity was 58.3%, specificity 75.8%, NPV 71.4%, and PPV 63.6%. For US combined with MRI, sensitivity was 66.7%, specificity 54.5%, NPV 69.2%, and PPV 51.6%. The accuracy of imaging modalities was 59.1% for US, 68.4% for MRI, and 59.6% for US combined with MRI. @*Conclusion@#In breast cancer patients who received NACT, MRI showed a higher specificity, NPV, and PPV than US, although it had a lower sensitivity. However, due to the low accuracy, breast MRI alone is not sufficient to determine the extent of axillary surgery. Therefore, determining the extent of axillary surgery based on the results of intraoperative sentinel lymph node biopsy may be the right method for accurate staging.

Hyperglycemia during Adjuvant Chemotherapy as a Prognostic Factor in Breast Cancer Patients without Diabetes / 한국유방암학회지

Purpose@#Breast cancer treatments, including chemotherapy, administered in combination with glucocorticoids can induce hyperglycemia. This study aimed to investigate the effect of hyperglycemia during adjuvant chemotherapy on the prognosis of breast cancer patients without a known history of diabetes. @*Methods@#In this study, 936 patients who underwent breast cancer surgery from 2010 to 2015 were initially selected as participants. Chemotherapy-related hyperglycemia was defined as fasting plasma glucose levels ≥ 100 mg/dL or random blood glucose levels ≥ 140 mg/dL during 2 or more cycles of adjuvant chemotherapy. After dividing the patients into the euglycemia and hyperglycemia groups, univariate and multivariate analyses were performed, and survival outcomes were analyzed by propensity score matching. @*Results@#The mean age of the patients was 47.4 ± 7.7 years, and the median follow-up period was 70.1 months. Eighty-two patients (19.4%) were diagnosed as having hyperglycemia.There were significant differences between the euglycemia and hyperglycemia groups with respect to age, hypertension, body mass index, axillary surgery extents, nodal stage, and total steroid dosage. T stage, vascular invasion, and hyperglycemia were identified as prognostic factors of relapse-free survival (RFS). The 5-year RFS rates were 92.0% and 82.3% in the euglycemia and hyperglycemia groups, respectively, and there was a statistically significant difference between the 2 groups (p = 0.011). The 5-year overall survival rates were 94.6% and 92.0% in the euglycemia and hyperglycemia groups, respectively, showing no statistically significant difference between the 2 groups (p = 0.113). @*Conclusion@#These data suggest that hyperglycemia during adjuvant chemotherapy is a prognostic factor for RFS in breast cancer patients without diabetes.

Accuracy of Radiological Axillary Staging for Breast Cancer Patients with Neoadjuvant Chemotherapy

Purpose@#Neoadjuvant chemotherapy (NACT) in breast cancer patients has the advantage of decreasing related morbidities by reducing the extent of axillary surgery. However, it remains a controversy with regards to the appropriate extent of axillary lymph node dissection after NACT. Therefore, this study aims to investigate the accuracy of breast ultrasonography (US) and breast magnetic resonance imaging (MRI) to assess the axillary nodal status after NACT. @*Methods@#We reviewed pre- and post-NACT axillary imaging and clinicopathological data of patients who received NACT for primary breast cancer and underwent surgery. After NACT, accuracy of imaging modalities were evaluated through the comparison of pathologic lymph node (LN) status and imaging LN status. @*Results@#Fifty seven patients completed NACT and underwent surgery. Breast US was found to have a sensitivity of 61.1%, specificity of 57.7%, negative predictive value (NPV) of 68.2%, and positive predictive value (PPV) of 50.0%. For breast MRI, sensitivity was 58.3%, specificity 75.8%, NPV 71.4%, and PPV 63.6%. For US combined with MRI, sensitivity was 66.7%, specificity 54.5%, NPV 69.2%, and PPV 51.6%. The accuracy of imaging modalities was 59.1% for US, 68.4% for MRI, and 59.6% for US combined with MRI. @*Conclusion@#In breast cancer patients who received NACT, MRI showed a higher specificity, NPV, and PPV than US, although it had a lower sensitivity. However, due to the low accuracy, breast MRI alone is not sufficient to determine the extent of axillary surgery. Therefore, determining the extent of axillary surgery based on the results of intraoperative sentinel lymph node biopsy may be the right method for accurate staging.

Hyperglycemia during Adjuvant Chemotherapy as a Prognostic Factor in Breast Cancer Patients without Diabetes / 한국유방암학회지

Purpose@#Breast cancer treatments, including chemotherapy, administered in combination with glucocorticoids can induce hyperglycemia. This study aimed to investigate the effect of hyperglycemia during adjuvant chemotherapy on the prognosis of breast cancer patients without a known history of diabetes. @*Methods@#In this study, 936 patients who underwent breast cancer surgery from 2010 to 2015 were initially selected as participants. Chemotherapy-related hyperglycemia was defined as fasting plasma glucose levels ≥ 100 mg/dL or random blood glucose levels ≥ 140 mg/dL during 2 or more cycles of adjuvant chemotherapy. After dividing the patients into the euglycemia and hyperglycemia groups, univariate and multivariate analyses were performed, and survival outcomes were analyzed by propensity score matching. @*Results@#The mean age of the patients was 47.4 ± 7.7 years, and the median follow-up period was 70.1 months. Eighty-two patients (19.4%) were diagnosed as having hyperglycemia.There were significant differences between the euglycemia and hyperglycemia groups with respect to age, hypertension, body mass index, axillary surgery extents, nodal stage, and total steroid dosage. T stage, vascular invasion, and hyperglycemia were identified as prognostic factors of relapse-free survival (RFS). The 5-year RFS rates were 92.0% and 82.3% in the euglycemia and hyperglycemia groups, respectively, and there was a statistically significant difference between the 2 groups (p = 0.011). The 5-year overall survival rates were 94.6% and 92.0% in the euglycemia and hyperglycemia groups, respectively, showing no statistically significant difference between the 2 groups (p = 0.113). @*Conclusion@#These data suggest that hyperglycemia during adjuvant chemotherapy is a prognostic factor for RFS in breast cancer patients without diabetes.

Clinical Implications According to Diagnostic Methods of Human Epidermal Growth Factor Receptor 2 Positivity in Breast Cancer: A Retrospective Study

PURPOSE: According to American Society of Clinical Oncology/College of American Pathologists guidelines, breast cancer is human epidermal growth factor receptor 2 (HER2) positive if there is HER2 protein overexpression at a 3+ level on immunohistochemistry (IHC 3+) or gene amplification (more than six copies per nucleus) on fluorescence in situ hybridization (FISH+). However, there have been few reports on whether outcomes differ based on diagnosis by these two techniques. In this study, we compared outcomes based on the two methods in patients with HER2-positive breast cancer. METHODS: This study was a retrospective analysis of HER2-positive breast cancer in 18,304 patients, including 14,652 IHC 3+ patients and 3,652 FISH+ patients from the Korean Breast Cancer Society Registry. We compared breast cancer-specific survival and overall survival based on IHC 3+ and FISH+ status with or without trastuzumab. RESULTS: Breast cancer-specific survival was significantly different between the IHC 3+ and FISH+ groups, with 5-year cumulative survival rates of 95.0% for IHC 3+ and 98.5% for FISH+ patients who did not receive trastuzumab (p=0.001) in Kaplan-Meier methods. However, there were no significant differences in breast cancer-specific survival and overall survival between IHC 3+ and FISH+ groups regardless of trastuzumab treatment in Cox proportional hazards models. CONCLUSION: The survival outcomes were not affected by the different two diagnostic methods of HER2-positive breast cancer. Further research to evaluate differences in prognosis and other characteristics according to the diagnostic methods of HER2 positivity is needed in the future.

Assessment of Quality of Life and Safety in Postmenopausal Breast Cancer Patients Receiving Letrozole as an Early Adjuvant Treatment / 한국유방암학회지

PURPOSE: There are few reports from Asian countries about the long-term results of aromatase inhibitor adjuvant treatment for breast cancer. This observational study aimed to evaluate the long-term effects of letrozole in postmenopausal Korean women with operable breast cancer. METHODS: Self-reported quality of life (QoL) scores were serially assessed for 3 years during adjuvant letrozole treatment using the Korean version of the Functional Assessment of Cancer Therapy-Breast questionnaires (version 3). Changes in bone mineral density (BMD) and serum cholesterol levels were also examined. RESULTS: All 897 patients received the documented informed consent form and completed a baseline questionnaire before treatment. Adjuvant chemotherapy was administered to 684 (76.3%) subjects, and 410 (45.7%) and 396 (44.1%) patients had stage I and II breast cancer, respectively. Each patient completed questionnaires at 3, 6, 12, 18, 24, 30, and 36 months after enrollment. Of 897 patients, 749 (83.5%) completed the study. The dropout rate was 16.5%. The serial trial outcome index, the sum of the physical and functional well-being subscales, increased gradually and significantly from baseline during letrozole treatment (p<0.001). The mean serum cholesterol level increased significantly from 199 to 205 after 36 months (p=0.042). The mean BMD significantly decreased from −0.39 at baseline to −0.87 after 36 months (p<0.001). CONCLUSION: QoL gradually improved during letrozole treatment. BMD and serum cholesterol level changes were similar to those in Western countries, indicating that adjuvant letrozole treatment is well tolerated in Korean women, with minimal ethnic variation.

Troglitazone Inhibits Matrix Metalloproteinase-9 Expression and Invasion of Breast Cancer Cell through a Peroxisome Proliferator-Activated Receptor γ-Dependent Mechanism / 한국유방암학회지

PURPOSE: Peroxisome proliferator-activated receptor γ (PPARγ) is involved in the pathology of numerous diseases including atherosclerosis, diabetes, obesity, and cancer. Matrix metalloproteinases (MMPs) play a significant role in tissue remodeling related to various processes such as morphogenesis, angiogenesis, tissue repair, invasion, and metastasis. We investigated the effects of PPARγ on MMP expression and invasion in breast cancer cells. METHODS: MCF-7 cells were cultured and then cell viability was monitored in an MTT assay. Western blotting, gelatin zymography, real-time polymerase chain reaction, and luciferase assays were performed to investigate the effect of the synthetic PPARγ ligand troglitazone on MMP expression. Transcription factor DNA binding was analyzed by electrophoretic mobility shift assay. A Matrigel invasion assay was used to assess the effects of troglitazone on MCF-7 cells. RESULTS: Troglitazone did not affect MCF-7 cell viability. 12-O-tetradecanoylphorbol-13-acetate (TPA) induced MMP-9 expression and invasion in MCF-7 cell. However, these effects were decreased by troglitazone. TPA increased nuclear factor κB and activator protein-1 DNA binding, while troglitazone inhibited these effects. The selective PPARγ antagonist GW9662 reversed MMP-9 inhibition by troglitazone in TPA-treated MCF-7 cells. CONCLUSION: Troglitazone inhibited nuclear factor κB and activator protein-1-mediated MMP-9 expression and invasion of MCF-7 cells through a PPARγ-dependent mechanism.

Crotonis Fructus Extract Inhibits 12-O-Tetradecanoylphorbol-13-Acetate-Induced Expression of Matrix Metalloproteinase-9 via the Activator Protein-1 Pathway in MCF-7 Cells / 한국유방암학회지

PURPOSE: Metastatic cancers spread from the primary site of origin to other parts of the body. Matrix metalloproteinase-9 (MMP-9) is essential in metastatic cancers owing to its major role in cancer cell invasion. Crotonis fructus (CF), the mature fruits of Croton tiglium L., have been used for the treatment of gastrointestinal disturbance in Asia. In this study, the effect of the ethanol extract of CF (CFE) on MMP-9 activity and the invasion of 12-O-tetradecanoylphorbol-13-acetate (TPA)-treated MCF-7 cells was examined. METHODS: The cell viability was evaluated using the 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay. The expression of MMP-9 was examined by Western blotting, zymography, and real-time polymerase chain reaction. An electrophoretic mobility gel shift assay was performed to detect activator protein-1 (AP-1) DNA binding activity and cell invasiveness was measured by an in vitro Matrigel invasion assay. RESULTS: CFE significantly suppressed MMP-9 expression and activation in a dose-dependent manner. Furthermore, CFE attenuated the TPA-induced activation of AP-1. CONCLUSION: The results indicated that the inhibitory effects of CFE against TPA-induced MMP-9 expression and MCF-7 cell invasion were dependent on the protein kinase C δ/p38/c-Jun N-terminal kinase/AP-1 pathway. Therefore, CFE could restrict breast cancer invasiveness owing to its ability to inhibit MMP-9 activity.

Non-recurrent Laryngeal Nerve Identified During Robotic Thyroidectomy in a Patient with Papillary Thyroid Carcinoma / 대한내분비외과학회지

A non-recurrent laryngeal nerve is a rare anatomical variant that entails considerable risk for iatrogenic injury during thyroid surgery. We encountered a patient with a non-recurrent laryngeal nerve that went unnoticed on preoperative imaging but was discovered incidentally during robotic thyroidectomy. A 44 year old woman presented at our department with papillary thyroid microcarcinoma, diagnosed by ultrasonography-guided fine needle aspiration cytology. During robotic right thyroidectomy and central lymph node dissection, we could not detect any structure resembling the recurrent laryngeal nerve around the inferior thyroid artery. Thus, we suspected the existence of a non-recurrent laryngeal nerve, and successfully identified a nerve entering the larynx directly from the vagus nerve without recurring. A three-dimensional high magnification view via a robotic endoscope can aid thyroid surgeons to safely identify and preserve a non-recurrent laryngeal nerve.

The Prognostic Significance of the Metastatic Lymph Node Ratio in Patients with Papillary Thyroid Carcinoma / 대한내분비외과학회지

PURPOSE: Metastatic lymph node ratio (MLNR) is known as an important prognostic factor in many solid carcinomas; however, the role of MLNR in papillary thyroid carcinoma (PTC) is unclear. The purpose of this study was to determine whether MLNR has prognostic significance for recurrence in patients with pathological N1a PTC. METHODS: A retrospective analysis was conducted of 1,198 patients with PTC who underwent total thyroidectomy with central neck dissection between 2006 and 2011. Only patients with central lymph node metastasis were included in this study. Patients with lateral neck lymph node metastasis or extrathyroidal involvement were excluded. Finally, this study included 282 patients with N1a patients. MLNR was defined as the number of metastatic lymph nodes divided by the number of removed lymph nodes. RESULTS: Median age was 47.3 years (17~73 years). There were 209 female patients and 41 male patients, respectively. Median follow-up period was 53 months (36~114 months). Median value of MLNR was 0.36 (0.04~1.000). Of 250 patients, 20 patients (8.0%) developed recurrent disease. MLNR independently predicted PTC recurrence (odds ratio [OR], 6.385; 95% confidence interval [CI], 2.523-16.158; P 0.47 should be monitored closely for recurrence.

Clinical Significance of Blood Neutrophil-to-Lymphocyte Ratio in Patients with Papillary Thyroid Carcinoma / 대한내분비외과학회지

PURPOSE: The neutrophil-to-lymphocyte ratio (NLR) is a strong predictor of poor prognosis in patients with various types of cancer. To date, the utility of NLR for prediction of prognosis in thyroid cancer patients has not been studied. Therefore, the aim of our study was to determine whether NLR is associated with other prognostic factors of papillary thyroid carcinoma and predictive of recurrence. METHODS: We conducted a retrospective review of 367 patients who underwent thyroidectomy for papillary thyroid carcinoma from January 2005 to December 2007. We measured the white blood cell count including neutrophil and lymphocyte within one month preoperatively. The NLR was defined as the absolute neutrophil count divided by absolute lymphocyte count. Logistic regression analysis was applied for comparison of NLR with other prognostic factors, including tumor size, lymph node metastasis, multiplicity, extrathyroidal invasion, and TNM stage. We also determined the cut-off value of NLR with a prediction for recurrence. RESULTS: Median age of patients was 47 years (16~86 years) and the rate of papillary thyroid microcarcinoma was 65.7% (241/367 cases). Median follow-up period was 1,841 days (506~3,135 days). The median value of NLR was 1.68 (0.66~6.36). NLR was not related to any other prognostic factors of papillary thyroid carcinoma. The cut-off value of NLR for prediction of recurrence was 1.73, where the sensitivity was 66.7% and specificity was 69.8%. CONCLUSION: Patients with NLR equal to or higher than 1.73 showed significantly higher recurrence of papillary thyroid carcinoma. Further validation study should be conducted for clinical use of NLR as a prognostic marker.

Reliability and Validity of the Korean Version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire to Assess Chemotherapy-induced Peripheral Neuropathy

PURPOSE: This study was performed to assess the reliability and validity of the Korean version of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Chemotherapy-induced peripheral neuropathy 20 items (EORTC QLQ-CIPN20) in patients receiving neurotoxic chemotherapy. METHODS: A convenience sample of 249 Korean cancer patients, previously or currently, being treated with peripheral neurotoxic chemotherapeutic agents were asked to fill in the questionnaire. Collected data were analyzed using SPSS 21.0 and AMOS 21.0. Construct validity, known-group validity, concurrent validity, and internal consistency reliability of the Korean version of the QLQ-CIPN20 were evaluated. RESULTS: Factor analysis confirmed 3 dimensions of CIPN: sensory, motor, and autonomic. The factor loadings of the 20 items on the 3 subscales ranged from .38 to .85. The 3 subscale-model was validated by confirmatory factor analysis (GFI=.90, AGFI=.86, RMSR=.05, NFI=.87, and CFI=.94), and concurrent validity was demonstrated with the EORTC QLQ-C30. Furthermore, the QLQ-CIPN20 established known-group validity. The Cronbach's alpha coefficients for internal consistency of the subscales ranged from .73 to .89. CONCLUSION: The Korean version of the EORTC QLQ-CIPN20 showed satisfactory construct, concurrent, and known-group validity, as well as internal reliability.

Clinicopathological Relevance between Body Mass Index and Papillary Thyroid Carcinoma / 대한내분비외과학회지

PURPOSE: Obesity is a known risk factor for several cancers, including breast, colon, esophagus, kidney, uterus, and thyroid. Recent studies have reported that higher body mass index (BMI) is also associated with more advanced stage. The aim of this study was to investigate the clinicopathological relevance between BMI and papillary thyroid carcinoma (PTC). METHODS: A total of 798 patients surgically treated for PTC from January 2006 to June 2010 were included in this study. Medical records and pathologic reports were reviewed retrospectively. According to BMI, patients were divided into four groups: underweight (3.1%), normal (57.3%), overweight (31.6%), and obese (8.0%). Clinicopathological factors were analyzed and compared between normal and other groups. RESULTS: According to the results, 709 patients were women (89.0%) and mean age was 48.5 years; mean follow-up period was 1,721+/-464.2 days. In comparison between the normal and underweight groups, there was significantly more extra-thyroidal invasion [Odds ratio (OR) 3.923, P=0.006] in the underweight group. In the obese group, tumor size was significantly larger (OR 1.794, P=0.007). However, there was no significant difference between the normal and overweight group. CONCLUSION: In the obese group, tumor size was the only clinical significant factor between high BMI and PTC. Interestingly, more extra-thyroidal invasion was seen in the underweight group. To confirm this result, further studies with long-term follow-up and more patients are required.

The Predictive Value of Serum Parathyroid Hormone Levels for the Occurrence of Hypocalcemia Following Total Thyroidectomy / 대한내분비외과학회지

PURPOSE: The aim of study was to determine the cut-off value of serum parathyroid hormone levels with a predictive value for the occurrence of clinical hypocalcemia following total thyroidectomy. METHODS: We performed a retrospective review, of 150 patients who underwent total thyroidectomy for papillary thyroid carcinoma from January 2010 to July 2010. We measured the serum levels of parathyroid hormone and phosphate within 18~24 hours postoperatively. The serum levels of ionized calcium were measured immediately and within 18~24 hours postoperatively. We also determined the cut-off value, sensitivity and specificity of serum levels of parathyroid hormone, ionized calcium, and phosphate with a predictive value for the occurrence of clinical hypocalcemia. RESULTS: Serum levels of parathyroid hormone were 2.0±1.7 pg/ml in the clinical hypocalcemia group, 9.9±10.7 pg/ml in the asymptomatic hypocalcemia group, and 15.3±10.7 pg/ml in the normal control group (P<0.001). Serum levels of ionized calcium were also significantly lower in the clinical hypocalcemia group (0.92±0.16 mmol/L) compared with the normal control group (P=0.002). On the other hand, serum levels of phosphate were significantly higher in the clinical hypocalcemia group (P=0.009). The cut-off value of serum parathyroid hormone levels for the prediction of clinical hypocalcemia was 4.5 pg/ml, where the sensitivity, specificity, positive predictive value, and negative predictive value were 87.5%, 63.4%, 89.3% and 59%, respectively. CONCLUSION: Serum parathyroid hormone levels following total thyroidectomy are the most powerful predictive factors for the occurrence of clinical hypocalcemia. Our results show that the incidence of clinical hypocalcemia is relatively higher at postoperative serum levels of parathyroid hormone ≤4.5 pg/ml.

Metastatic Hemangiopericytoma of the Thyroid Gland / 대한갑상선학회지

Hemangiopericytoma (HPC) is a mesenchymal neoplasm constituting a minor portion of vascular tumors. Although HPCs are generally benign, some progress in a malignant course, leading to recurrence and metastasis even after radical surgery. We present a case of metastatic HPC of the thyroid gland, a very rare site of occurrence. Histological findings revealed a single, well-margined mass with high cellularity. Tumor cells were tightly packed spindle-shaped to round cells arranged around numerous thin-walled vessels. Tumor cells showed cytoplasmic immunoreactivity for CD34 and CD99. To our knowledge, this is the eleventh case reported worldwide and the first case in South Korea.

The Clinical Utility of Automated Breast Volume Scanner: A Pilot Study of 139 Cases / 한국유방암학회지

PURPOSE: The aim of this study is to evaluate the clinical utility of automated breast volume scanner (ABVS) for detecting and diagnosing the breast lesions. METHODS: From December 2010 to January 2012, bilateral whole breast examinations were performed with ABVS for 139 women. Based on the Breast Imaging Reporting and Data System (BI-RADS) categories, the breast lesions were evaluated on coronal multiplanar reconstruction images using the ABVS workstation. Then, the imaging results were compared with those on conventional handheld ultrasound (HHUS) images. Histological diagnoses were performed on BI-RADS category 4 and 5 lesions. RESULTS: A total of 453 lesions were detected by ABVS. On the HHUS, 33 new lesions were detected but 69 lesions were not detected. BI-RADS category 2 and 3 matched to those on ABVS at 73.5% (61/83) and 85.4% (276/323). In 47 lesions of BI-RADS category 4 or 5, there was an exact match to those on ABVS. In addition, 47 lesions were classified as BI-RADS category 4 and 5, for which an ultrasound-guided core needle biopsy was performed. The malignant lesions of BI-RADS category 4 and 5 showed the following: 2/27 (7.4%) in 4A, 4/5 (80%) in 4B, 2/2 (100%) in 4C, and 13/13 (100%) in 5. The ABVS showed 21 true positives and a positive predictive value of 44.7% (21/47). CONCLUSION: There was considerable agreement in the assessment of the breast lesions by ABVS and HHUS. The ABVS had advantages of high diagnostic accuracy, examiner-independence, multislice visualization of the whole breast and less time-consuming. Our results indicate that ABVS might be a useful modality in diagnosing breast lesions.

Primary cutaneous malignant melanoma of the breast / 대한외과학회지

Cutaneous malignant melanoma of the breast can be divided into two categories: primary and metastatic lesions. Cutaneous malignant melanoma of the breast is a rare tumor, accounting for less than 5% of all malignant melanomas. Clinical features and diagnostic methods of primary cutaneous malignant melanoma of the breast are similar to those arising from other cutaneous areas. Treatment of choice is wide local excision with adequate resection margin according to tumor thickness. Sentinel lymph node biopsy should be performed because the presence of lymph node metastasis is the most important prognostic factor. There have been only limited reports involving primary cutaneous malignant melanoma of the breast. Thus, we report a case of primary cutaneous malignant melanoma in a 59-year-old woman with a review of the recent literature.