The role of the addition of ovarian suppression to tamoxifen in young women with hormone-sensitive breast cancer who remain premenopausal or regain menstruation after chemotherapy (ASTRRA): study protocol for a randomized controlled trial and progress.

BACKGROUND: Ovarian function suppression (OFS) has been shown to be effective as adjuvant endocrine therapy in premenopausal women with hormone receptor-positive breast cancer. However, it is currently unclear if addition of OFS to standard tamoxifen therapy after completion of adjuvant chemotherapy results in a survival benefit. In 2008, the Korean Breast Cancer Society Study Group initiated the ASTRRA randomized phase III trial to evaluate the efficacy of OFS in addition to standard tamoxifen treatment in hormone receptor-positive breast cancer patients who remain or regain premenopausal status after chemotherapy. METHODS: Premenopausal women with estrogen receptor-positive breast cancer treated with definitive surgery were enrolled after completion of neoadjuvant or adjuvant chemotherapy. Ovarian function was assessed at the time of enrollment and every 6 months for 2 years by follicular-stimulating hormone levels and bleeding history. If ovarian function was confirmed as premenopausal status, the patient was randomized to receive 2 years of goserelin plus 5 years of tamoxifen treatment or 5 years of tamoxifen alone. The primary end point will be the comparison of the 5-year disease-free survival rates between the OFS and tamoxifen alone groups. Patient recruitment was finished on March 2014 with the inclusion of a total of 1483 patients. The interim analysis will be performed at the time of the observation of the 187th event. DISCUSSION: This study will provide evidence of the benefit of OFS plus tamoxifen compared with tamoxifen only in premenopausal patients with estrogen receptor-positive breast cancer treated with chemotherapy. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT00912548 . Registered May 31 2009. Korean Breast Cancer Society Study Group Register KBCSG005 . Registered October 26 2009.

Clinical Features of Male Breast Cancer: Experiences from Seven Institutions Over 20 Years.

PURPOSE: Breast cancer treatment has progressed significantly over the past 20 years. However, knowledge regarding male breast cancer (MBC) is sparse because of its rarity. This study is an investigation of the clinicopathologic features, treatments, and clinical outcomes of MBC. MATERIALS AND METHODS: Clinical records of 59 MBC patients diagnosed during 1995-2014 from seven institutions in Korea were reviewed retrospectively. RESULTS: Over a 20-year period, MBC patients accounted for 0.98% among total breast cancer patients, and increased every 5 years. The median age of MBC patientswas 66 years (range, 24 to 87 years). Forty-three patients (73%) complained of a palpable breast mass initially. The median symptom duration was 5 months (range, 1 to 36 months). Mastectomy was performed in 96% of the patients. The most frequent histology was infiltrating ductal carcinoma (75%). Ninety-one percent of tumors (38/43) were estrogen receptor-positive, and 28% (11/40) showed epidermal growth factor receptor 2 (HER-2) overexpression. After curative surgery, 42% of patients (19/45) received adjuvant chemotherapy; 77% (27/35) received hormone therapy. Five out of ten patients with HER-2 overexpressing tumors did not receive adjuvant anti-HER-2 therapy, while two out of four patients with HER-2 overexpressing tumors received palliative trastuzumab for recurrent and metastatic disease. Letrozole was used for one patient in the palliative setting. The median overall survival durations were 7.2 years (range, 0.6 to 17.0 years) in patients with localized disease and 2.9 years (range, 0.6 to 4.3 years) in those with recurrent or metastatic disease. CONCLUSION: Anti-HER-2 and hormonal therapy, except tamoxifen, have been underutilized in Korean MBC patients compared to female breast cancer patients. With the development of precision medicine, active treatment with targeted agents should be applied. Further investigation of the unique pathobiology of MBC is clinically warranted.

Predictive Factors for Upgrading Patients with Benign Breast Papillary Lesions Using a Core Needle Biopsy.

PURPOSE: Intraductal papilloma (IDP) is a benign breast disease with malignant potential, for which complete surgical excision is usually recommended. The aim of the present study was to investigate predictive factors for upgrading patients with a benign papillary lesion (BPL). METHODS: This study was an observational study using a prospectively collected cohort. In total, 13,049 patients who underwent a core needle biopsy (CNB) for a breast lesion between January 2009 and May 2015 were enrolled. We reviewed all patients with pathologically confirmed BPL from a CNB. RESULTS: Surgical treatment was performed for 363 out of a total of 592 lesions. According to the pathological differences, the lowest upgrade rate was shown in IDP without atypia (without atypia, 6.0%; with atypia, 26.8%; papillary neoplasm, 31.5%; p<0.001). The univariate analysis showed that, in IDP without atypia, the age at diagnosis, size of BPL on ultrasonography, and density on mammography were associated with upgrading. The multivariate analysis revealed that age >54 years and lesion size >1 cm were significantly associated with upgrade to malignancy (odds ratio [OR]=4.351, p=0.005 and OR=4.236, p=0.001, respectively). CONCLUSION: The indications for surgical treatment can be defined as age >54 years and mass size >1 cm, even in IDP without atypia in the CNB results; this also includes cases of IDP with atypia or papillary neoplasm. Therefore, we suggest that close observation without surgery is sufficient for younger women with a small IDP without atypia.

Is adjuvant chemotherapy omissible in women with T1-2 stage, node-positive, luminal A type breast cancer?

PURPOSE: The aim of this study was to evaluate whether hormonal breast cancer therapy without systemic chemotherapy is feasible in adjuvant settings in luminal A breast cancer. METHODS: A database of 879 patients who underwent breast cancer surgery enrolled between January 2003 and December 2011 was reviewed. Patients with luminal A cancers were selected and grouped into those who received adjuvant hormonal therapy with (group C+) or without (group C - ) adjuvant systemic therapy. RESULTS: In a multivariable analysis, axillary lymph node (ALN) metastasis was the only independent factor that revealed significantly different between the two groups in disease-free survival (DFS). The 5-year cumulative DFS was 82.3 versus 76.2% (P = 0.700) and overall survival (OS) was 83.9 versus 100% (P = 0.483) for C+ versus C - breast cancer, respectively. CONCLUSION: In our study, adjuvant chemotherapy in luminal A, T1-2N+ cancer showed no significant difference for DFS. We believe that the role of adjuvant chemotherapy for these women with hormonal therapy might have little benefit.

The distance between breast cancer and the skin is associated with axillary nodal metastasis.

BACKGROUND AND OBJECTIVES: More superficially located tumors may be more likely than deeper tumors to metastasize to the axillary nodes via the lymphatics. The aim of this study was to determine whether breast cancer distance from the skin affects axillary node metastasis, ipsilateral breast cancer recurrence, or recurrence-free survival. MATERIALS AND METHODS: A total of 1,005 consecutive patients with breast cancer who underwent surgery between January 2003 and December 2009 were selected. The distance of the tumor from the skin was measured from the skin to the most anterior hypoechoic leading edge of the lesion. RESULTS: In total, 603 (68%) patients had no axillary nodal metastasis, and 288 (32%) had axillary nodal metastasis. A breast cancer distance from the skin <3 mm induced more axillary nodal metastasis (P = 0.039). However, no significant correlation was observed between breast cancer distance from the skin <3 mm and ipsilateral breast cancer recurrence (P = 0.788) or recurrence-free survival (P = 0.353). CONCLUSIONS: Breast cancers located closer to the skin had a higher incidence of axillary nodal metastasis. Therefore, tumor distance from the skin should be considered when evaluating a patient with breast cancer and considering the risk of nodal metastasis.

Correlation between obesity and clinicopathological factors in patients with papillary thyroid cancer.

PURPOSE: Epidemiological studies have shown that obesity is associated with an increased risk of thyroid cancer. However, the exact nature of the relationship, especially with respect to the behavior of the cancer, remains uncertain. The objective of this study was to evaluate the correlation between the body mass index (BMI) and clinicopathological features of thyroid cancer patients. METHODS: From January 2009 to April 2010, 716 consecutive patients (602 females and 114 males; mean age 47.02 ± 11.73 years) with papillary thyroid cancer (PTC) were analyzed retrospectively. Patients were divided into two subgroups according to age (<45 years, ≥45 years). The BMI groupings were based on standardized categories set by the World Health Organization. The relationships between the BMI and these parameters were assessed. RESULTS: A non-overweight BMI was associated with a younger age and female gender. Tumor multiplicity was related to a higher BMI. In an age-related subgroup analysis, a higher BMI was correlated with more lymph node involvement (p = 0.004), lymphatic invasion (p = 0.003) and tumor multiplicity (p = 0.008) in patients ≥45 years of age. The absence of an association between the BMI and T stage, nodal status, vascular invasion, lymphatic invasion, and extrathyroidal extension was noted in a statistical analysis. In the subgroup of patients <45 years of age, no positive associations were observed between the BMI and any parameters other than age and sex. CONCLUSIONS: In PTC patients ≥45 years of age, a higher BMI was associated with more aggressive tumor features, such as lymph node metastasis, lymphatic invasion, and tumor multiplicity.

The potential role of estrogen receptor ß2 in breast cancer.

Endocrine therapy is provided to all patients with estrogen receptor (ER)-positive breast cancer, but only a subset of them derives clinical benefit. The discovery of ERß and its five isoforms added another layer of complexity in the regulation of estrogen activity in breast cancer cells. Two large retrospective studies showed conflicting results with regard to the prognostic value of the different ERß isoforms in patients treated with tamoxifen in an adjuvant setting. This study tested the hypothesis that ERß1 and, or ERß2 are correlated with clinical outcome. We identified patients with breast cancer who had undergone surgery at Bucheon St. Mary's Hospital, the Catholic University of Korea, between January 2004 and March 2006. We evaluated 101 consecutive cases for ERß1 and ERß2 expression using immunohistochemical staining and obtained other clinicopathology by reviewing medical records. ERß1 was expressed in 81.2% (79 of 97) and ERß2 was expressed in 50.5% (51 of 101) of primary breast cancer tissues. Disease-free survival (DFS) and overall survival (OS) of patients with cancers expressing ERß2 was significantly worse. Moreover, in subgroup analysis according to the tamoxifen treatment, ERß2 expression was significantly associated with shorter DFS of tamoxifen-treated patients. This study indicates that breast cancer with ERß2 expression was associated with worse DFS and OS, especially in tamoxifen treated patients. Our results suggest a role for ERß2 as an independent prognostic marker and might serve as a new therapeutic target.

Does papillary thyroid carcinoma have a better prognosis with or without Hashimoto thyroiditis?

BACKGROUND: It has been reported that the BRAF (V600E) mutation is related to a low frequency of background Hashimoto thyroiditis (HT); however, there are not many factors known to be related to the development of HT. The aim of this study was to determine whether patients with both papillary thyroid carcinoma (PTC) and HT show aggressive features, by investigating the clinicopathological features of HT in patients with PTC. METHODS: A database of patients with PTC who underwent thyroidectomy between October 2008 and August 2012 was collected and reviewed. All 2464 patients were offered a thyroidectomy, and DNA was extracted from the atypical cells in the surgical specimens for detection of the BRAF (V600E) mutation. Clinical and pathological characteristics were also investigated. RESULTS: Four hundred and fifty-two of 1945 (23.2%) patients were diagnosed with HT, and of these, 119 (72.1%) had a BRAF (V600E) mutation. HT was not significantly associated with the BRAF (V600E) mutation (P < 0.001) and extrathyroidal extensions (P = 0.005) but was associated with a low stage (P = 0.011) and female predominance (P < 0.001). In a subgroup analysis for gender, HT was associated with a low probability of BRAF (V600E) mutations in both genders (P < 0.001 for both females and males). Also, recurrence was significantly associated with HT (OR 0.297, CI 0.099-0.890, P = 0.030), lymph node ratio (OR 2.545, CI 1.092-5.931, P = 0.030), and BRAF (V600E) mutation (OR 2.075, CI 1.021-4.217, P = 0.044). However, there was no relationship with clinicopathological factors or with death. CONCLUSIONS: Our results show that HT in patients with PTC is associated with a low probability of BRAF (V600E) mutations. Moreover, HT was correlated with some factors that were associated with less aggressive clinical features and inversely related to recurrence. Therefore, these results may be useful to predict whether PTC concurrent with HT exhibits a better prognosis than PTC alone.

Learning curve for gasless endoscopic thyroidectomy using the trans-axillary approach: CUSUM analysis of a single surgeon's experience.

BACKGROUND: Endoscopic thyroidectomy and endoscopic parathyroidectomy were first reported in the 1990s. However, there have been few studies reporting on the learning curve of endoscopic thyroidectomy. We used the moving average method and cumulative sum (CUSUM) analysis to assess the learning curve of gasless endoscopic thyroidectomy. METHODS: Three hundred consecutive patients with thyroid carcinoma underwent gasless endoscopic thyroidectomy between September 2008 and February 2012. Patients were divided into two groups according to the type of operation they underwent; group L included hemithyroidectomy patients, and group T included total thyroidectomy patients. Endoscopic total thyroidectomy was performed mostly after the time endoscopic lobectomy could be done without difficulty. The results of surgical outcome were analyzed for changes over the case sequence in each group by using the moving average method and CUSUM analysis. RESULTS: The mean operation time of group T (131 ± 41 min) was longer than that of group L (102 ± 33 min; p < 0.05). The moving average method showed that the operation time began to decrease from the 60th case and the 38th case in groups L and T, respectively. However, other factors such as transient hypocalcemia, transient vocal cord palsy and the number of the retrieved lymph nodes had no learning curves based on the moving average method and CUSUM analysis. CONCLUSIONS: The learning curve duration of gasless endoscopic thyroidectomy is about 60 cases for unilateral lobectomy. Thereafter, the learning curve of endoscopic total thyroidectomy is 38 cases. Careful dissections must be carried out to avoid surgical complications even after the surgeon mastered endoscopic thyroidectomy.

Clinicopathologic characteristics and surgical outcomes of elderly patients with thyroid cancer.

OBJECTIVE: Age is one of the important prognostic factors in thyroid cancer, and old age is generally related to higher rate of post-operative morbidity and mortality. The study analyzed the characteristics of thyroid cancer in elderly patients compared with those in younger patients. METHODS: Patients who underwent surgery between 1992 and 2011 were enrolled. The patients were divided into those ≥70 years of age (older group) and <70 years of age (younger group). Data including clinicopathological features and post-operative complications was analyzed. Molecular markers including Galectin-3, Cyclooxygenase-2, bcl-2, Cyclin D1, Epidermal growth factor receptor and BRAF mutation were reviewed. Survival analyses including recurrence-free survival and overall survival were examined. RESULTS: Of 1867 patients, 98 were age-classified in older group and the remaining 1769 were in younger group. Older group displayed larger tumor size, and increased extrathyroidal extension, vascular invasion and neural invasion than younger group, and all were statistically significant. Molecular marker analyses revealed no significant differences between the groups. Post-operative complication rates were not significantly different between the older and younger groups in both univariate and multivariate analyses. Elderly patients showed poor recurrence-free survival and overall survival than younger patients in univariate analyses. However, age ≥70 years was not associated with poor recurrence-free survival after adjustment of confounding factors. CONCLUSION: Molecular features of elderly patients may be similar with younger patients. Even though aggravated clinicopathological features of thyroid carcinoma are more prevalent in elderly patients, thyroid surgery in elderly patients can be performed with favorable surgical and oncological outcomes.

Expression of receptor activator of nuclear factor kappa-B as a poor prognostic marker in breast cancer.

PURPOSE: Receptor activator of nuclear factor kappa-B and its ligand (RANK/RANKL) and Osteoprotegerin (OPG) are key molecules for regulating osteoclastic activity in bone. However, little is known about the role of RANK-related molecules in breast cancer prognosis. We aimed to evaluate RANK, RANKL, and OPG expression and the associated clinical impact in breast cancer. METHODS: Tissue microarray (TMA) from 185 patients with primary breast cancer was established. Immunohistochemistry for RANK, RANKL, and OPG was performed. Clinicopathologic features and survival outcomes associated with expression of RANK, RANKL, and OPG were analyzed. RESULTS: RANK, RANKL, and OPG were expressed in 74.1%, 78.4%, and 45.9% of patients, respectively. RANKL expression was associated with lower Ki-67 level. OPG expression was related to small tumor size, node negativity, and low Ki-67. There was no significant difference in clinicopathologic features between tumors with RANK and those without RANK. RANK expression was significantly associated with poor disease-free survival in univariate analysis (P = 0.04) and multivariate analysis (P = 0.02). RANKL expression was associated with improved skeletal disease-free survival in multivariate analysis (P = 0.03). CONCLUSIONS: The RANK/RANKL pathway regulated by OPG may have a role in predicting progression and prognosis of breast cancer.

Characteristics of BRCA1/2 Mutation-Positive Breast Cancers in Korea: A Comparison Study Based on Multicenter Data and the Korean Breast Cancer Registry.

PURPOSE: Mutations in BRCA genes are the main cause of hereditary breast cancer in Korea. The aim of this study was to investigate the characteristics of breast cancers involving BRCA1 (BRCA1 group) and BRCA2 (BRCA2 group) mutations. METHODS: We retrospectively reviewed the medical records of patients with BRCA1 (BRCA1 group) or BRCA2 (BRCA2 group) mutation positive breast cancer from multiple centers and compared the data to that of the Korean Breast Cancer Society registry (registry group). RESULTS: The patients of the BRCA1 group were diagnosed at a younger age (median age, 37 years) and had tumors of higher histological (61.3% with histological grade 3) and nuclear (37.5% with nuclear grade 3) grade than those of the registry group. In addition, the frequency of ductal carcinoma in situ in the BRCA1 group was lower (3.7%) than in the registry group, and the BRCA1 group were more likely to be triple-negative breast cancer (61.3%). Patients in the BRCA2 group were also younger at diagnosis (mean age, 41 years) and were more likely to have involvement of the axillary node than the registry group (45.5% vs. 33.5%, p=0.002). The BRCA1 and BRCA2 groups did not show a correlation between tumor size and axillary node involvement. CONCLUSION: We report the characteristics of BRCA mutation positive breast cancer patients in the Korean population through multicenter data and nation-wide breast cancer registry study. However, BRCA-mutated breast cancers appear highly complex, and further research on their molecular basis is needed in Korea.

Comparison of surgical outcomes between papillary thyroid cancer patients treated with the Harmonic ACE scalpel and LigaSure Precise instrument during conventional thyroidectomy: a single-blind prospective randomized controlled trial.

BACKGROUND: The aim of this study was to evaluate the safety and efficacy of thyroidectomy using the Harmonic ACE scalpel (HS) or the LigaSure Precise (LS) instrument in conventional thyroidectomy. MATERIALS AND METHODS: A prospective, randomized controlled trial was performed. Between August 2011 and June 2012, 832 patients who required thyroidectomy for papillary thyroid cancer were randomized into groups treated with either the HS or the LS instrument. Operative time and surgical morbidities were analyzed. RESULTS: A total of 320 patients (HS group, N = 164; LS instrument group, N = 156) were randomized for analysis according to the intention-to-treat principle. There were no statistically significant differences in the operative times (HS group versus LS instrument group: 71.93 ± 18.26 versus 75.15 ± 20.13; P = 0.423), postoperative transient hypoparathyroidism (13.4% versus 14.1%; P = 0.858), and permanent recurrent laryngeal nerve injuries between the two groups. CONCLUSIONS: In this study, both hemostatic devices were safe and effective in terms of postoperative results and complications without any differences.

Effect of axillary lymph node dissection after sentinel lymph node biopsy on overall survival in patients with T1 or T2 node-positive breast cancer: report from the Korean Breast Cancer Society.

BACKGROUND: The effect of axillary lymph node dissection (ALND) after sentinel lymph node biopsy (SLNB) in patients with clinically node-negative patients in preoperative evaluations on overall survival (OS) is uncertain. The study aimed to evaluate the difference of survival between node-positive patients who underwent SLNB alone and those who received ALND after SLNB using the Korean Breast Cancer Society registry. METHODS: We enrolled 2,581 patients who met the eligibility criteria. All enrolled patients had T1 or T2 breast cancer, and received mastectomy or breast-conserving treatment followed by documented adjuvant systemic therapy. RESULTS: There were 197 patients with SLNB alone and 2,384 patients with ALND after SLNB. Smaller tumor size, lower number of nodal metastasis, and higher proportion of breast-conserving surgery were found in patients with SLNB alone than in those with ALND after SLNB. There was no significant difference in OS between the two groups by the log-rank test. ALND after SLNB showed no significant improvement in OS in multivariate analysis. CONCLUSIONS: ALND in patients with sentinel metastasis who have T1 or T2 breast cancer receiving adjuvant systemic therapy may not have improved OS.

Occurrence and Prognosis of Symptomatic Venous Thromboembolism in Colorectal Cancer Surgery Patients.

PURPOSE: Colorectal cancer (CRC) has a high risk for postoperative thromboembolic complications such as venous thromboembolism (VTE) compared to other surgical diseases, but the relationship between VTE and CRC in Asian patients remains poorly understood. The present study examined the incidence of symptomatic VTE in Korean patients who underwent surgery for CRC. We also identified risk factors, incidence and survival rate for VTE in these patients. MATERIALS AND METHODS: The patients were identified from the CRC database treated from January 2011 to December 2012 in a single institution. These patients were classified into VTE and non-VTE groups, their demographic features were compared, and the factors which had significant effects on VTE and mortality between the two groups were analyzed. RESULTS: We analyzed retrospectively a total of 840 patients and the incidence of VTE was 3.7% (31 patients) during the follow-up period (mean, 17.2 months). Histologic subtype (mucinous adenocarcinoma) and previous history of VTE affected the incidence of VTE on multivariate analysis. There was a statistically significant difference in survival rate between the VTE and non-VTE group, but VTE wasn't the factor affecting survival rate on multivariate analysis. Comparing differences in survival rate for each pathologic stage, there was only a significant difference in stage II patients. CONCLUSION: Among CRC patients after surgery, the incidence of VTE was approximately 3% within 1 year and development of VTE wasn't a significant risk factor for death in our study but these findings are not conclusive due to our small sample size.

Feasibility of sentinel lymph node biopsy in breast cancer patients clinically suspected of axillary lymph node metastasis on preoperative imaging.

BACKGROUND: Generally, sentinel lymph node biopsy (SLNB) is performed in patients with clinically negative axillary lymph node (LN). This study was to assess imaging techniques in axillary LN staging and to evaluate the feasibility of SLNB in patients clinically suspected of axillary LN metastasis on preoperative imaging techniques (SI). METHODS: A prospectively maintained database of 767 breast cancer patients enrolled between January 2006 and December 2009 was reviewed. All patients were offered preoperative breast ultrasound, magnetic resonance imaging, and positron emission tomography scanning. SI patients were regarded as those for whom preoperative imaging was "suspicious for axillary LN metastasis" and NSI as "non-suspicious for axillary LN metastasis" on preoperative imaging techniques. Patients were subgrouped by presence of SI and types of axillary operation, and analyzed. RESULTS: For 323 patients who received SLNB, there was no statistically significant difference in axillary recurrence (P=0.119) between SI and NSI groups. There also was no significant difference in axillary recurrence between SLNB and axillary lymph node dissection (ALND) groups in 356 SI patients (P=0.420). The presence of axillary LN metastasis on preoperative imaging carried 82.1% sensitivity and 45.9% specificity for determining axillary LN metastasis on the final pathology. CONCLUSIONS: SLNB in SI patents is safe and feasible. Complications might be avoided by not performing ALND. Therefore, we recommend SLNB, instead of a direct ALND, even in SI patients, for interpreting the exact nodal status and avoiding unnecessary morbidity by performing ALND.

Breast cancer after kidney transplantation: a single institution review.

BACKGROUND: Improvements in immunosuppression have resulted in long life expectancy of kidney transplants. Unfortunately, the incidence of post-transplant malignancy (PTM) is increasing. The aim of this study was to evaluate the nature and stage-specific prognosis of post-transplant breast cancer (PTBC) compared with breast cancer in the general population, and to suggest optimal treatment strategies. METHODS: A database of 2,139 consecutive kidney transplant patients was reviewed;11 of the patients developed breast cancer. These 11 PTBC cases underwent operations between 1999 and 2011. Next, 2,554 breast cancer patients treated in the same period were reviewed. Kaplan-Meier curves and the log-rank test were used to assess stage-specific survival of breast cancer in our hospital. RESULTS: In total, 142 cases experienced post-transplant malignancy (PTM; 6.6%) and 11 (0.5%) developed PTBC. No one required an adjusted dose of immunosuppressive agent. Two stage III patients died. For all breast cancer patients, 5-year survival by stage was 97.7% for stage I, 92.9% for stage II, 78.6% for stage III, and 49.9% for stage IV. The 5-year survival for expected stage III-specific survival was 66.7% and no significant statistical difference was seen compared to that of the total breast cancer patients (P = 0.213). CONCLUSIONS: The prognosis of PTBC was comparable to that of the general population. These results suggest that the use of immunosuppressants per se does not adversely affect breast cancer.

Present condition analysis of physician assistant in Korea.

This study intended to identify the need for the legalization and development of a systematic program for physician assistants (PAs) by understanding the actual state of PA operation in hospitals. In 114 hospitals assigned as resident training hospitals for surgery, a survey was conducted on the personnel working as PAs in those hospitals; the survey included general personal information, working conditions, training time, and satisfaction. A total of 192 PAs in surgery at 35 hospitals responded to the survey. The types of PAs are Surgical Assistant, Clinical Physician Assistant, Wound Ostomy Care Nurse, Coordinator, and Clinical Research Coordinator. Types of work PAs preformed are surgical assistance, wound dressing, educating patients, overlooking consultation, doing paper works, writing operation records, and confirming examination results which were ordered. The satisfaction level for the position which PAs hold were 29.1% and and satisfaction level which doctors see towards PA was 15%. The role and the job descriptions of PAs are not clear cut, there are many discrepancies among hospitals we studied. As a result, legalization and the implementation of standardized role of PAs will lead to increase level of satisfactions in the work force and the quality of work which PAs perform will be greater.

Multidisciplinary team approach in breast cancer: a nationwide survey in Korea.

PURPOSE: This assesses the current workings of multidisciplinary team (MDT) meetings across Korea through surgeons' reports and their current commitments to MDT meetings pertaining to breast cancer, and to determine any perceived areas of potential improvement. METHODS: A questionnaire was sent out to 307 members of The Korean Breast Cancer Society (KBCS) who worked at comprehensive or university medical centers in Korea. The mailing lists of the KBCS members were obtained with the approval of the society. From December 2008 to February 2009, the survey was distributed by surface and electronic mail, with an initial mailing followed by another distribution to non-responders eight weeks later. RESULTS: Sixty-five individuals (21.2%) returned the completed survey. Of these, 38 responders (62.3%) participated in MDT meetings. Most (97.4%) breast health specialists regarded MDT meetings as an effective method for treatment planning. Most responders (94.7%) reported that the MDT leader was a breast surgeon. CONCLUSION: The MDT approach is perceived as an effective method for breast cancer treatment planning and is a feature in most major centers in Korea. Further work is needed to ensure that the MDT approach operates as intended and that all breast cancer patients have access to an MDT.

Role of sonographic elastography in the differential diagnosis of papillary lesions in breast.

PURPOSE: The purpose of this study was to compare the diagnostic performance of elastography, conventional ultrasonography (US) and combined conventional US and elastography for differentiation of papillary breast lesions. MATERIALS AND METHODS: A total of 95 papillary lesions (69 benign, 20 atypical and 6 malignant) in 87 patients were examined with conventional US and elastography. We evaluated conventional US images according to the Breast Imaging Reporting and Data System and internal composition (solid vs. cystic) and elastographic images according to elasticity scores. We compared diagnostic performances of elastography, conventional US and the combined method. RESULTS: Areas under the receiver-operating curve were 0.794 for elastography, 0.875 for conventional US and 0.787 for the combined method. When the elasticity score cutoff was between 2 and 3, the sensitivity, specificity, positive predictive value and negative predictive value were 100, 55.1, 13 and 100 %, respectively. The combined method showed similar sensitivity (100 vs. 100 %) to and higher specificity (57.3 vs. 5.6 %) than conventional US alone. No significant difference was found in the elasticity scores of cystic papillary lesions according to pathology. CONCLUSION: Elastography improved the specificity of conventional US in differentiating between benign or atypical and malignant papillary breast lesions when it was combined with conventional US.