The Emerging Crisis of Stakeholders in Implant-based Augmentation Mammaplasty in Korea

Background@#Korea is no longer safe from the risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL); the first reported case was a Korean woman in her 40s who had a 7-year-history of receiving an implant-based augmentation mammaplasty using a textured implant. We conducted this study to discuss the emerging crisis of stakeholders in implant-based augmentation mammaplasty and to propose a multi-disciplinary approach to early detection of its complications. @*Methods@#We analyzed medical examination data that was collected from patients who visited us between August 12 and September 27, 2019. We evaluated a total of 114 women (n = 114) in the current study. They were evaluated for whether they were in healthy condition. Moreover, their baseline characteristics were also examined; these included age, gender, height (cm), weight (kg), duration since surgery (years), possession of a breast implant card, the site of surgical incision, side of symptoms and reasons for outpatient visit. Furthermore, the patients were also evaluated for their subjective awareness of the manufacturer, surface and shape of the breast implant. Potential complications include malrotation, folding, seroma, capsule thickening, upside-down rotation, rupture, capsule mass and breast mass. @*Results@#A majority of the patients had a past history of receiving textured implants. The corresponding percentage was 78.95% (90/114) and 85.09% (97/114) based on their subjective awareness of a breast implant and sonographic findings, respectively. That is, it was slightly increased with the use of a breast ultrasound. @*Conclusion@#Here, we propose the following approaches. First, patient data should be prospectively collected. By tracking outcomes and complications of an implant-based augmentation mammaplasty, both high-quality care and patient safety can be ensured. Second, stakeholders in implant-based augmentation mammaplasty should collaborate with customers and regulatory authorities. Third, surgeons should consider applying imaging modalities for early detection of postoperative complications.

Breast Imaging Reporting and Data System Category 3 Lesions Detected on Whole-Breast Screening Ultrasound / 한국유방암학회지

PURPOSE: This study assessed the incidence and cancer rate of probably benign lesions detected on bilateral whole-breast screening ultrasound (US), which corresponded to US Breast Imaging Reporting and Data System (BI-RADS) category 3, and evaluated the proper management of those lesions. METHODS: This study was approved by the Institutional Review Board in our institution, which waived informed patient consent. We retrospectively reviewed US images of 1,666 patients who underwent bilateral whole-breast screening US as a supplemental screening test to negative screening mammography or screening US only. The incidence, clinical course, and cancer rate of screening US-detected probably benign lesions corresponding to US BI-RADS category 3 were investigated, and the size and multiplicity of screening US-detected category 3 lesions were evaluated. RESULTS: Probably benign lesions corresponding to US BI-RADS category 3 were detected in 689 of 1,666 patients (41.4%) who underwent screening US. Among them, 653 had follow-up US images for at least 24 months, and among these 653, 190 (29.1%) had multiple bilateral category 3 lesions. Moreover, 539 of 1,666 patients (32.4%) had lesions ≤1 cm in size and 114 of 1,666 (6.8%) had lesions >1 cm (median, 0.82 cm; range, 0.3–4.2 cm). Four of the 653 patients (0.6%) showed suspicious interval changes and were categorized into BI-RADS category 4. Biopsy analysis confirmed only one lesion as invasive ductal carcinoma at the 6-month follow-up; another lesion was an intraductal papilloma and the remaining two were fibroadenomas. Overall cancer rate of the screening US-detected BI-RADS category 3 lesions was 0.2%. CONCLUSION: The incidence of category 3 lesions detected on screening US only was very high, but the cancer rate was very low. Therefore, in an average-risk population, routine screening US is preferable over short-term follow-up for BI-RADS category 3 lesions detected on whole-breast screening US.

Invasive Lobular Carcinoma: MRI Features and Clinicohistological Characteristics According to the ER, PR, and HER2 Statuses

PURPOSE: To investigate correlations of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor type 2 (HER2) statuses with magnetic resonance imaging (MRI) features and clinicohistological characteristics in patients with invasive lobular carcinoma (ILC). MATERIALS AND METHODS: Data from 64 histologically confirmed ILCs were analyzed retrospectively. Preoperative breast MRI was reviewed for morphology and dynamic contrast-enhanced kinetics of the tumor. Pathologic reports were reviewed for ER, PR, and HER2 positivity, tumor size, lymph node metastasis, and the number of metastatic lymph nodes. Furthermore, there was an investigation of the MRI features and clinicohistologic characteristics, according to the ER, PR, and HER2 statuses. RESULTS: A significant difference in MRI features and clinicohistological tumor characteristics were observed only in relation to PR status. Of the 64 ILCs, 10 (15.6%) were PR negative. PR negative cancers, compared with PR positive cancers, were more likely to present as non-mass enhancement (P = 0.027); have a significantly larger mean tumor size (5.00 +/- 1.05 cm vs. 2.57 +/- 0.21 cm, P = 0.021); and have significantly more metastatic lymph nodes (P = 0.010). CONCLUSIONS: PR negative ILC presented more frequently as non-mass enhancement on MRI, with larger tumors and increased numbers of metastatic lymph nodes. Therefore, the PR status plays an important role in determining MRI features and clinicohistological characteristics of ILC.

A comparison of lymphocytic thyroiditis with papillary thyroid carcinoma showing suspicious ultrasonographic findings in a background of heterogeneous parenchyma

PURPOSE: The aim of this study was to compare ultrasonographic features in patients with lymphocytic thyroiditis (LT) and papillary thyroid carcinoma (PTC) having suspicious thyroid nodule(s) in a background of heterogeneous parenchyma and to determine the clinical and radiological predictors of malignancy. METHODS: We reviewed the cases of 100 patients who underwent ultrasonography between April 2011 and October 2012, and showed suspicious thyroid nodule(s) in a background of heterogeneous parenchyma. Eight patients who did not undergo ultrasonography-guided fineneedle aspiration cytology (FNAC) and 34 cases of follow-up ultrasonography after initial FNAC were excluded. We compared the benign and malignant nodules in terms of their clinical and radiological factors. RESULTS: For the 58 nodules including 31 LTs (53.4%) and 27 PTCs (46.645 years is the most important predictor of malignancy in this condition.

MR Spectroscopy and Diffusion Weighted Imaging Findings of Primary Non-Hodgkin Lymphoma of the Breast: Two Case Reports

Primary non-Hodgkin lymphoma (NHL) of the breast is a very rare disease, and the mammographic and ultrasonographic findings of breast lymphoma are variable. There are several reports of magnetic resonance (MR) imaging findings in patients with breast lymphomas; however, few reports have described the findings observed on MR spectroscopy or the features of diffusion weighted (DW) imaging. The authors report the findings of classical MR imaging, MR spectroscopy and DW imaging of a 48-year-old woman and a 40-year-old woman with primary non-Hodgkin's lymphoma of breasts. Mammography and breast ultrasonography revealed a mass with circumscribed margin. The mass showed strong enhancement after contrast injection on MR imaging. DW imaging showed reduced diffusion and high-amplitude choline (Cho) peak at 3.22 ppm was detected by single voxel MR spectroscopy which was consistent with malignancy.

MR Findings of Hamartoma of the Breast: A Report of Two Cases

Breast hamartoma is a relatively rare pathology, composed of various amount of mammary glandular, fatty and fibrous tissue. Here, we report MR findings of two cases of hamartomas; one of them was incidentally found in her left breast during preoperative MRI in a woman with right breast cancer, and the other was presented as a large palpable mass. Both of them were confirmed by surgical excision. Breast hamartoma shows a well-defined mass with mixed signal intensity on T2-weighted image MRI and a little or focal enhancement on contrast-enhanced MRI.

Role of BRAF(V600E) Mutation Analysis for Thyroid Nodules Classified as Indeterminate on Ultrasonography

PURPOSE: We aimed to evaluate a possible role for BRAF(V600E) mutation analysis of aspiration specimens in the work up of thyroid nodules classified as indeterminate on US. MATERIALS AND METHODS: A total of 122 nodules from 122 patients were prospectively classified as indeterminate nodules based on US findings. US-guided fine needle aspiration (FNA) was done for all 122 nodules. The presence of a BRAF(V600E) mutation in FNA specimens was determined by allele-specific PCR. RESULTS: US-indeterminate nodules were confirmed as malignant in 20.5% (25/122) of cases and benign in 76.2% (93/122) after FNA or surgery. A few (3.3% (4/122), remained indeterminate. A BRAF(V600E) mutation was identified in 14.8% (18/122) of USindeterminate nodules. Of those 18 nodules, three were benign and 13 were malignant after the initial FNA. One (0.8%, 1/122) with an initially benign cytology and a BRAF(V600E) mutation was confirmed to be malignant after surgery. The remaining two benign nodules with a mutation were not followed-up. All 9 initial FNA-nondiagnostic nodules were mutation negative but 2 (11.8%) of 17 indeterminate nodules on initial FNAs were mutation positive. CONCLUSION: BRAF(V600E) mutation analysis prevents false negative cytology for only 0.8% of cases and reduces ambiguous diagnoses for 1.6% of all US-indeterminate thyroid nodules. Therefore, adding BRAF(V600E) mutation analysis to FNA for US-indeterminate nodules is of limited usefulness.

The Usefulness of Trunk Accelerometry in Evaluating Walking Ability of Hemiparetic Patients

OBJECTIVE: Accelerometer is a convenient device that can easily measure human movement. The purpose of this study was to evaluate its usefulness in the assessment of hemiparetic gait after stroke. METHOD: Twenty hemiparetic stroke patients were enrolled in the study. A portable accelerometer was attached between L3,4 intervertebral area. Vertical and medio-lateral acceleration was measured while walking 10 m. Walking ability of each subject was classified by Functional Walking Category (FWC). RESULTS: Accelerometric parameters, such as walking speed, a mean amount of peak vertical acceleration in one gait cycle, mean peak value of unaffected side, peak vertical acceleration ratio, step time ratio were significantly higher in groups of FWC 4, 5, 6 than in groups of FWC 2, 3. In subjects using cane there was an extra peak other than peaks observed in non-users. Mean peak value, step length of unaffected side and cadence were significantly higher in non-users than in users. CONCLUSION: Trunk accelerometer can be used as an objective method to evaluate walking ability in hemiparetic patients after stroke.

Standing and Gait of the Paraplegics by Spinal Cord Injury after Discharge

OBJECTIVE: The purpose of this follow-up study was to evaluate the status of standing and gait for the paraplegics at their home after discharge. METHOD: A medical doctor interviewed 93 paraplegics by spinal cord injury, who visited the outpatient clinic of the National Rehabilitation Hospital, or who were admitted for the follow up urologic evaluation. RESULTS: Out of 93 paraplegics, 90 patients had done a standing exercise in hospitals, but 42 patients continued a standing exercise after discharge. Seventy-nine patients had done a gait exercise in hospitals, but only 24 patients continued a gait exercise after discharge. Seventy-five patients were prescribed KAFO (Knee-Ankle-Foot orthosis), but only 11 patients used the KAFO continuously after discharge. The reasons to stop using KAFO were loss of motivation, lack of time, no helper, difficulties with wearing orthoses, and etc. The continuous using rates of other standing or exercise equipments were higher than that of KAFO. CONCLUSION: Many paraplegics had done gait training and had been prescribed KAFO in hospitals. But only 14.7% of them had used KAFO for any purpose after discharge. We believe that more careful consideration and explanation are needed to each patient. We think that standing or exercise equipments are good alternatives.

Long-term Effects of Day Hospital Program in Stroke Rehabilitation

OBJECTIVE: Comprehensive poststroke rehabilitation includes continuum of care after discharge from hospital. Day hospital is a milieu-oriented outpatient rehabilitation program that offers continuous rehabilitation service to promote psychosocial adaptation and quality of life. This study is to evaluate long-term effects of day hospital program in stroke patients. METHOD: Forty-eight stroke patients who received day hospital program for 2 or more months after inpatient rehabilitation program and 42 control stroke patients, who received only inpatient rehabilitation program, responded telephone interview for the study. Outcome measurement included the Korean Activities of Daily Living (K-ADL), the Korean Instrumental Activities of Daily Living (K- IADL) and the Medical Outcome Study 8-item Short Form Survey (SF-8). RESULTS: There was no difference in many item scores of K-ADL between day hospital group and control group, but the item scores of dressing, washing face and hands were significantly higher in control group. Among the item scores of K-IADL, except managing money, most item scores of K-IADL were no significant difference between day hospital group and control group. All item scores of SF-8 were significantly higher in day hospital group than control group. CONCLUSION: Day hospital is an effective rehabilitation program to enhance health-related quality of life for stroke patients.