Insertion of Totally Implantable Central Venous Access Devices by Surgeons

PURPOSE: The aim of this study is to evaluate the results for the insertion of totally implantable central venous access devices (TICVADs) by surgeons. METHODS: Total 397 patients, in whom TICVADs had been inserted for intravenous chemotherapy between September 2008 and June 2014, were pooled. This procedure was performed under local anesthesia in an operation room. The insertion site for the TICVAD was mainly in the right-side subclavian vein. In the case of breast cancer patients, the subclavian vein opposite the surgical site was used for insertion. RESULTS: The 397 patients included 73 males and 324 females. Primary malignant tumors were mainly colorectal and breast cancer. The mean operation time was 54 minutes (18-276 minutes). Operation-related complications occurred in 33 cases (8.3%). Early complications developed in 15 cases with catheter malposition and puncture failure. Late complications, which developed after 24 hours, included inflammation in 6 cases, skin necrosis in 6 cases, hematoma in 3 cases, port malfunction in 1 case, port migration in 1 case, and intractable pain at the port site in 1 case. CONCLUSION: Insertion of a TICVAD under local anesthesia by a surgeon is a relatively safe procedure. Meticulous undermining of the skin and carefully managing the TICVAD could minimize complications.

Simultaneous Chest Wall Reconstruction after Sternectomy and Modified Radical Mastectomy in Locally Advanced Breast Cancer with Solitary Sternal Metastasis / 한국유방암학회지

Bone is the most common metastatic organ in patients with breast cancer. The most significant clinical symptom of bone metastasis is pain which reduces quality of life in cancer patients. We report a case of chest wall reconstruction after partial sternal resection for solitary sternal metastasis and modified radical mastectomy in a patient with locally advanced breast cancer. The sternal defect was reconstructed with a 2 mm thick Gore-Tex patch. Postoperative pain was acceptable and the patient was discharged without any complications. The patient received the endocrine and bisphosphonate therapy combined with chemotherapy and radiotherapy. No recurrence or complications were observed during a follow-up period of 36 months. We describe our good surgical management results of sternal metastatic lesion in a patient with locally advanced breast cancer. We suggest that simultaneous sternectomy is a safe and curative surgical method for a solitary sternal metastasis when no evidence of systemic spread is noted.

Pattern of Cervical Neck Lymph Node Metastasis in Papillary Thyroid Carcinoma according to Tumor Size / 대한내분비외과학회지

PURPOSE: Prognosis of papillary thyroid carcinoma (PTC) is very favorable, but PTC frequently invade adjacent soft tissue and metastases to cervical lymph node. We evaluated the pattern of cervical neck lymph node metastasis in PTC according to tumor size. METHODS: From August 2005 to January 2009, 353 patients were underwent surgery for PTC. Among these patients, total thyroidectomy with cervical neck lymph node dissection were done in 266 patients. We subdivided patients into four groups according to size and compared the clinicopathologic characters between groups. And we confirmed the factors affecting central neck node metastasis. RESULTS: The mean age of patients of diagnosis was 49.1 years and female to male ratio was 5.8:1. Cervical lymph node metastasis were in 47.0% of the total cases. Cervical lymph node metastases and invasion to adjacent structure increased with tumor size. But, there were no significant differences in tumor size, invasion to adjacent structure, multifocality or bilaterality according to cervical lymph node metastasis. Early diagnostic age and sexuality were significantly related to cervical lymph node metastasis of PTC. CONCLUSION: PTC showed the aggressiveness with increasing tumor size. Tumor size was not related to cervical lymph node metastasis. These findings suggest that tumor size can help treat PTC, can`t be used by prediction factor of cervical lymph node metastasis.

Significance of ¹⁸F FDG PET-CT for Preoperative Diagnosis of Cervical Lymph Nodes Metastasis in Papillary Thyroid Carinoma / 대한내분비외과학회지

PURPOSE: To compare the diagnostic accuracy of US/CT with US/CT/¹⁸F-FDG PET-CT in the diagnosis of cervical lymph nodes metastasis in papillary thyroid carcinoma. METHODS: From July 2008 to May 2010, 36 patients with papillary thyroid carcinoma, confirmed by aspiration cytology analysis, underwent neck US, neck CT and ¹⁸F-FDG PET-CT preoperatively. The sensitivity, specificity and diagnostic accuracy of the US/CT, US/CT/PET-CT was analyzed according to lymph node level (all: levels I~VI, central: level VI, lateral: levels I~V). RESULTS: At all lymph nodes group (level I~VI), US/CT/ PET-CT showed a sensitivity of 66.6%, a specificity of 61.9% and a diagnostic accuracy of 63.8%. The corresponding values for US/CT were 60.0%, 85.7%, 75.0% respectively. Considering the central cervical nodes group (level VI), US/CT/PET-CT showed a sensitivity of 57.1%, a specificity of 68.1%, and a diagnostic accuracy of 63.8%. The corresponding values of US/CT were 57.1%, 90.9%, 77.7% respectively. Considering the lateral cervical nodes group (level I~V), US/CT/PET-CT showed a sensitivity of 100%, a specificity of 84.3%, and a diagnostic accuracy of 86.1%. The corresponding values of US/CT were 75.0%, 84.3%, 83.3% respectively. The diagnostic results of US/ CT, US/CT/PET-CT in initial evaluation of the cervical nodes metastasis did not differ significantly. CONCLUSION: Our preliminary results suggest that additional PET-CT evaluation in US/CT does not provide statistically significant benefit for initial diagnosis of cervical lymph nodes metastasis in papillary thyroid carcinoma.

The Relatioships Between Tumor-related Gene Expression and Tumor Budding, Tumor Nodule and Lymph Node Extracapsular Extension in Colorectal Cancer

PURPOSE: Despite the similar lymph node metastasis observed in patients with advanced colorectal cancer (CRC), there was a different clinical outcome. The relationships between tumor-related gene expression and prognostic factors such as tumor budding, tumor nodule and extracapsular extension (ECE) of lymph nodes in patients with CRC remain unclear yet. The purpose of this study was to evaluate the relationship between expression of molecular markers such as vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), matrix metalloproteinases (MMPs) and E-cadherin and the tumor budding, tumor nodule and ECE of lymph nodes in patients with stage III CRC. METHODS: The tissue of 87 patients with stage III CRC were investigated for expressions of molecular markers using immunohistochemical methods. RESULTS: VEGF and MMP-9 expression in tumor tissue were positively associated with the colorectal cancer prognostic factors such as tumor budding, tumor nodule and extracapsular lymph node extension (P<0.05). But, MMP-2, EGF and E-cadherin expression were of no value with regard to them. CONCLUSION: Our results suggest that molecular markers, in particular VEGF and MMP-9, may provide additional prognostic information regarding tumor budding, ECE and tumor nodule.

Comparison of Neck CT and ¹⁸F-FDG PET-CT for Making the Preoperative Diagnosis of Lymph Node Metastasis in Papillary Thyroid Cancer / 대한내분비외과학회지

PURPOSE: Lymph node metastasis is one of the most important prognostic factors for patients with papillary thyroid cancer. In this study we compared the diagnostic accuracy of neck CT with that of ¹⁸F-FDG PET-CT for the preoperative evaluation of lymph node metastasis. METHODS: We reviewed the medical records of 56 patients who received surgery for papillary thyroid cancer at the Department of Surgery, Konkuk University Medical Center, from August, 2006 to January, 2009. All the patients were checked with neck CT and ¹⁸F-FDG PET-CT preoperatively for evaluating their lymph node status. RESULTS: Neck CT showed a sensitivity of 40%, a specificity of 74.2%, a positive predictive value of 55.6%, a negative predictive value of 60.5% and an accuracy of 58.9%. ¹⁸F-FDG PET-CT showed a sensitivity of 48%, a specificity of 80.6%, a positive predictive value of 66.7%, a negative predictive value of 65.8% and an accuracy of 66.1%. ¹⁸FFDG PET-CT had greater sensitivity, specificity, positive predictive value, negative predictive value and accuracy than did neck CT (P=0.02) for predicting lymph node metastasis in patients with papillary thyroid cancer. CONCLUSION: ¹⁸F-FDG PET-CT can be more dependable than neck CT for preoperatively assessing lymph node metastasis in patients with papillary thyroid cancer.

The Clinical Significance of Preoperative MRI for Determination of Surgery in Breast Cancer / 한국유방암학회지

PURPOSE: Currently MRI (Magnetic Resonance Imaging) is widely used for the preoperative staging of breast cancer. In this study, we assessed the impact of preoperative breast MRI on the surgical management of breast cancer in women. METHODS: From March 2004 to October 2006, 162 cases were enrolled for preoperative MRI for the staging of breast cancer. The MRI findings and clinicopathological results were investigated and the accuracy of breast MRI was analyzed with respect to the detection of multiplicity, nipple involvement and bilaterality of the breast cancers. RESULTS: For detecting multifocal lesions, the sensitivity and specificity of breast MRI were 100% and 48.5%, respectively, and the results of bresat ultrasound were 100% and 63.4%, respectively. For detecting nipple invasion, the sensitivity and specificity of breast MRI was 80% and 74.6%, and for ultrasound was 33.3% and 86.4%. In 27 cases (16.7%) the type of surgery was changed according to the preoperative MRI findings; however, in only 6 cases were the MRI findings in concordance with the pathological findings of the mastectomy specimen. CONCLUSION: In clinical application of breast MRI for preoperative staging, the decision to undertake surgery for breast cancer based on a MRI findings should be prudent due to its low specificity.

Breast Paraffinoma Coexisting Breast Cancer / 한국유방암학회지

A paraffin injection is regarded as to be a simple and effective method of breast augmentation. However, there are few reports on the long-term complication of a paraffin injected breast. The generation of breast cancer from a paraffinoma of the breast is rare, even though there is no clear evidence to suggest any relationship between a paraffin injection and breast cancer. We encountered a case of infiltrative ductal carcinoma arising from paraffinoma tissues. A 49-year-old woman had undergone bilateral breast augmentation by paraffin injection 20 years earlier. She presented with bilateral diffuse painless palpable masses with reddish discoloration and painful swelling in her left breast. She had been managed with a bilateral simple mastectomy including the mass. After discharge, the pathology report showed infiltrative ductal carcinoma of the left breast mass. The patient was readmitted for additional surgery, and she underwent a modified radical mastectomy. Ultrasonography is a useful diagnostic tool for detecting a breast mass, particularly in a dense breast. However, ultrasonography has a limitation in the case of a paraffinoma. Through this case, it is necessary to review the radiological (mammography, ultrasonography, magnetic resonance imaging, plain film) appearances and the histopathological feature to help make an accurate diagnosis and to differentiate between a carcinoma and a paraffinoma. In rare cases, a breast ductal carcinoma can be combined with a paraffinoma. Therefore, a paraffinoma must be carefully managed due to the potential risk of a carcinoma.

Breast Paraffinoma Coexisting Breast Cancer / 한국유방암학회지

A paraffin injection is regarded as to be a simple and effective method of breast augmentation. However, there are few reports on the long-term complication of a paraffin injected breast. The generation of breast cancer from a paraffinoma of the breast is rare, even though there is no clear evidence to suggest any relationship between a paraffin injection and breast cancer. We encountered a case of infiltrative ductal carcinoma arising from paraffinoma tissues. A 49-year-old woman had undergone bilateral breast augmentation by paraffin injection 20 years earlier. She presented with bilateral diffuse painless palpable masses with reddish discoloration and painful swelling in her left breast. She had been managed with a bilateral simple mastectomy including the mass. After discharge, the pathology report showed infiltrative ductal carcinoma of the left breast mass. The patient was readmitted for additional surgery, and she underwent a modified radical mastectomy. Ultrasonography is a useful diagnostic tool for detecting a breast mass, particularly in a dense breast. However, ultrasonography has a limitation in the case of a paraffinoma. Through this case, it is necessary to review the radiological (mammography, ultrasonography, magnetic resonance imaging, plain film) appearances and the histopathological feature to help make an accurate diagnosis and to differentiate between a carcinoma and a paraffinoma. In rare cases, a breast ductal carcinoma can be combined with a paraffinoma. Therefore, a paraffinoma must be carefully managed due to the potential risk of a carcinoma.