Management of Gestational Gigantomastia with Goldilocks Procedure after Mastectomy: A Case Report and Review of Literature.

Gestational gigantomastia is characterized by the rapid growth of breasts during pregnancy. The treatment method of gestational gigantomastia is unclear; if the medical treatment is ineffective, surgery is considered. However, sufficient research on which method is best to perform breast reconstruction for the gestational gigantomastia patient has not yet been conducted. Our patient was young and had aesthetic needs; thus, we did not recommend modified radical mastectomy. However, it was difficult for the patient to consider active reconstruction using an implant or autologous tissue because of the expected complications and economic problems. The patient had a thin body shape and very large breasts compared with the trunk. Therefore, breast volume was not significantly required after reconstruction. Additionally, we expected that a considerable portion of skin would remain after mastectomy as a tubular-shaped breast. It was expected that the Goldilocks technique would be sufficient to meet the patient's volume needs. Therefore, we proceeded with total mastectomy and reconstruction using the Goldilocks procedure. No complications were recorded after the operation; most of the patient's discomfort was resolved, and the shape and size of the breasts were satisfactory.

Omission of Breast Surgery in Predicted Pathologic Complete Response after Neoadjuvant Systemic Therapy: A Multicenter, Single-Arm, Non-inferiority Trial.

PURPOSE: Advances in chemotherapeutic and targeted agents have increased pathologic complete response (pCR) rates after neoadjuvant systemic therapy (NST). Vacuum-assisted biopsy (VAB) has been suggested to accurately evaluate pCR. This study aims to confirm the non-inferiority of the 5-year disease-free survival of patients who omitted breast surgery when predicted to have a pCR based on breast magnetic resonance imaging (MRI) and VAB after NST, compared with patients with a pCR who had undergone breast surgery in previous studies. METHODS: The Omission of breast surgery for PredicTed pCR patients wIth MRI and vacuum-assisted bIopsy in breaST cancer after neoadjuvant systemic therapy (OPTIMIST) trial is a prospective, multicenter, single-arm, non-inferiority study enrolling in 17 tertiary care hospitals in the Republic of Korea. Eligible patients must have a clip marker placed in the tumor and meet the MRI criteria suggesting complete clinical response (post-NST MRI size ≤ 1 cm and lesion-to-background signal enhancement ratio ≤ 1.6) after NST. Patients will undergo VAB, and breast surgery will be omitted for those with no residual tumor. Axillary surgery can also be omitted if the patient was clinically node-negative before and after NST and met the stringent criteria of MRI size ≤ 0.5 cm. Survival and efficacy outcomes are evaluated over five years. DISCUSSION: This study seeks to establish evidence for the safe omission of breast surgery in exceptional responders to NST while minimizing patient burden. The trial will address concerns about potential undertreatment due to false-negative results and recurrence as well as improved patient-reported quality of life issues from the omission of surgery. Successful completion of this trial may reshape clinical practice for certain breast cancer subtypes and lead to a safe and less invasive approach for selected patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05505357. Registered on August 17, 2022. Clinical Research Information Service Identifier: KCT0007638. Registered on July 25, 2022.

Feasibility of chest spiral 3D ultrashort echo time magnetic resonance imaging for intrathoracic metastasis work-up in breast cancer.

Background: Chest computed tomography (CT) is routinely performed to evaluate intrathoracic metastasis in patients with breast cancer, but radiation exposure and its potential carcinogenic risks are major drawbacks. Furthermore, pulmonary imaging by magnetic resonance imaging (MRI) is limited by low proton density, rapid signal decay, and sensitivity to respiratory and cardiac motions in lung tissue. Recently, a respiratory gating spiral three-dimensional (3D) ultrashort echo time (UTE) volume interpolated breath-hold examination (VIBE) sequence for lung MRI provides high spatial-resolution images with reasonable scan times. Our objective was to investigate the feasibility of chest spiral 3D UTE VIBE MRI to detect intrathoracic metastasis in breast cancer patients. Methods: This retrospective study of a prospectively collected database was conducted between February and July 2019 after institutional review board approval. All participants provided informed consent for MRI scans. Ninety-three female patients with breast cancer were retrospectively enrolled and underwent preoperative breast MRI, including a chest spiral 3D UTE VIBE sequence. Two chest radiologists evaluated image qualities of intrapulmonary vessels and bronchial wall visibilities, the presence of pulmonary nodules, significant lymph nodes (LNs), and other lung abnormalities on spiral 3D UTE magnetic resonance (MR) images and compared them using chest CT as a reference standard. Results: Intrapulmonary vessels and bronchial walls were visible up to sub-subsegmental and sub-subsegmental levels, respectively, on spiral 3D UTE MR images, and better than fair quality was obtained for artifact/noise and overall image quality for 95.7% and 98.9% of the patients, respectively. The overall detection rate for pulmonary nodules was 62.8% (59/94). Furthermore, 59 of the 81 solid nodules detected by CT were detected by spiral 3D UTE MRI (72.8%), and 31 of the 33 solid nodules (≥5 mm in diameter) detected by CT were identified by spiral 3D UTE MRI (93.9%). Significant LNs in the axillary area were similarly detected by spiral 3D UTE MRI and chest CT. Conclusions: Preoperative breast MRI with a chest spiral 3D UTE sequence could be used to evaluate breast cancer and axillary LNs and intrathoracic metastasis simultaneously and offers a potential alternative to chest CT for breast cancer patients without additional radiation exposure.

An observational, prospective, open label, multicenter study to evaluate the safety and effectiveness of pegfilgrastim as secondary prophylaxis to decrease the incidence of febrile neutropenia in Korean female patients with breast cancer.

PURPOSE: Pegfilgrastim is a widely used long-acting granulocyte colony-stimulating factor (G-CSF) that prevents febrile neutropenia (FN) in patients with breast cancer receiving chemotherapy. This study aimed to evaluate the incidence of chemotherapy-related FN events and other adverse events (AEs) during chemotherapy in Korean patients with breast cancer treated with pegfilgrastim as secondary prophylactic support. MATERIALS AND METHODS: This was a multicenter, open-label, prospective, observational study. A total of 1255 patients were enrolled from 43 institutions. The incidence of FN was evaluated as the primary endpoint. The secondary endpoints included (1) incidence of bone pain, (2) proportion of patients with a relative dose intensity (RDI) of ≥85%, and (3) proportion of patients with AE. RESULTS: Pegfilgrastim administration reduced FN by 11.8-1.6%. The highest incidence of bone pain was observed at the time point of the 1st day after the administration and mild bone pain was the most common of all bone pain severity. The mean RDI was 98.5 ± 7.3%, and the proportion of the patients with and RDI≥85% was 96.9% (1169/1233). AEs were reported in 52.6% of the patients, and serious drug reactions occurred in only 0.7%. CONCLUSION: The use of pegfilgrastim as secondary prophylaxis was effective and safe for preventing FN in patients with breast cancer who were treated with chemotherapy.

Analysis of Watson for oncology and clinicians' treatment recommendations for patients with breast cancer in Korea: A single center experience.

Background: Various clinical applications have been attempted using artificial intelligence (AI) clinical decision support system (CDSS), and it has become a starting point for personalized cancer treatment. We aimed to identify the degree of agreement between the AI-CDSS, Watson for Oncology (WFO), and the clinician in treatment recommendations for Korean breast cancer patients and to provide guidelines for future improvement. Methods: One hundred and eighty-three breast cancer patients who underwent treatment at the Pusan National University Hospital between January 1, 2016 and May 31, 2017 were enrolled in this study. The concordance between WFO's and clinicians' treatment recommendations were examined according to various factors. Results: WFO gave the same treatment option recommendations as clinicians in 74 (40.4%) of the cases. According to the logistic regression, the difference in recommendation concordance between stage I and stage III was statistically significant (P = 0.004), and there was no difference among other factors. Conclusion: The concordance of treatment recommendations was low overall. However, this is largely attributable to the differences of medical insurance system and healthcare environment between the United States and Korea. In the future, region-specific features should be considered or reflected during the development of AI-CDSS.

Psychometric Properties of Assessment Tools for Depression, Anxiety, Distress, and Psychological Problems in Breast Cancer Patients: A Systematic Review.

OBJECTIVE: Various and accurate psychiatric assessments in patients with breast cancer who frequently suffer from psychological problems due to long-term survivors are warranted. This systematic review aimed to investigate the current evidence on psychometric properties of psychiatric assessment for evaluating psychological problems in breast cancer patients. METHODS: This systematic review progressed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Four electronic databases such as Web of Science, PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature were searched. This study protocol was registered on Open Science Framework. RESULTS: Of the 2,040 articles, 21 papers were finally included. Among them, only five studies showed the performance of psychiatric assessment tools. Among 13 assessment tools used in the selected articles, the Hospital Anxiety and Depression Scale (HADS), Distress Thermometer (DT), or Mini-Mental Adjustment to Cancer Scale was frequently used for the evaluation of psychological problems. The DT and Psychosocial Distress Questionnaire-Breast Cancer showed acceptable performances for the prediction of depression and anxiety assessed by the HADS. CONCLUSION: This systematic review found psychiatric assessment tools with acceptable reliability and validity for breast cancer patients. However, comparative studies on reliability and validity of various scales are required to provide useful information for the selection of appropriate assessment tools based on the clinical settings and treatment stages of breast cancer. Joint research among the fields of psychiatry and breast surgery is needed for research to establish the convergent, concurrent, and predictive validity of psychiatric assessment tools in breast cancer patients.

Policy Analysis for Implementing Neuroethics in Korea's Brain Research Promotion Act.

In 1998, Korea implemented the Brain Research Promotion Act (BRPA), a law to revamp the field of neuroscience at the national level. However, despite numerous revisions including the definition and classification of neuroscience and the national plans for the training and education systems, the governance for neuroethics has not been integrated into the Act. The ethical issues raised by neuroscience and neurotechnology remain unchallenged, especially given the focus on the industrial purpose of the technology. In the current study, we analyzed the BRPA revision process by using Kingdon's Multiple Streams Framework to determine the problems faced by the process. We propose a new strategy, including neuroethics governance and a national committee, to promote interdisciplinary neuroscience research and strengthen neuroethics in Korea.

Cervical and scapula-focused resistance exercise program versus trapezius massage in patients with chronic neck pain: A randomized controlled trial.

OBJECTIVE: The purpose of this study was to investigate the effects of resistance exercise in comparison with those of common exercise on chronic neck pain (CNP) to provide useful clinical guidelines for reducing pain or increasing cervical range of motion (ROM), upper trapezius tone, disability level, and quality of life (QOL). METHODS: The subjects were randomized into a cervical and scapula-focused resistance exercise group (CSREG, n = 21) or trapezius massage group (TMG, n = 20). All groups received a 4-week, five times per week CSRE or TM program for CNP. The visual analogue scale (VAS) score, cervical ROM, myotonometer measures (upper trapezius tone, stiffness, and elasticity), neck disability index (NDI), and short form-36 (SF-36) were identified as the primary outcomes. RESULTS: Within-group changes in VAS, cervical ROM, myotonometer measures, NDI, and SF-36 were significant in the CSREG and TMG (P < .05). The between-group changes in VAS, cervical rotation, myotonometer (upper trapezius tone and stiffness), NDI, and SF-36 after intervention showed significant differences between the CSREG and TMG (P < .05). CONCLUSION: These results suggest that the CSRE program is effective in improving pain, cervical ROM, upper trapezius tone, disability level, and QOL in patients with CNP. More comprehensive studies with longer follow-up durations are needed to better understand the potential effects of the CSRE program in patients with CNP.

Temporary blindness caused by corneal edema after a local anesthetic injection in the eyebrow region: a case report.

Plastic surgery around the eyes is usually performed under local anesthesia, using a mixture of lidocaine and epinephrine. Blindness is a rare but devastating complication after the injection of local anesthesia in this region. Most cases reported to date have been caused by occlusion of the ophthalmic artery or central retinal artery. In this case report, however, we present a highly unusual case of blindness caused by corneal edema after a local anesthetic injection. A patient visited the emergency room with a laceration on the eyebrow, and local anesthesia was injected before suturing. Immediately after the injection, severe corneal edema developed, making it impossible to observe the structures in the anterior chamber in detail or check the light reflex and visual acuity of the naked eye. An antibiotic (moxifloxacin hydrochloride) and high-concentration steroid eyedrops were promptly applied. High-concentration steroids were also administered orally. On day 13 post-injury, the visual acuity of the naked eye improved to 1.0, and no recurrence of corneal lesions was observed. Although the cause of corneal edema after the local injection could not be conclusively identified, we hope that this report will help raise clinicians' awareness of this complication and appropriate treatment methods.

Identifying pollution sources of sediment in Lake Jangseong, Republic of Korea, through an extensive survey: Internal disturbances of past aquaculture sedimentation.

Lake sediments are important sinks of various pollutants and preserve historical pollution records caused by anthropogenic activities. Recently, the sediments of Lake Jangseong, South Korea were first detected with high concentrations of organic matter (ignition loss [IL]; total organic carbon [TOC]), nutrients (total nitrogen [TN]; total phosphorus [TP]), and some heavy metals (Zn, Cu, Cd, and Hg). Here, we identified the origins of these concentrations accumulated in the sediments using extensive surveys and various assessments. Sediment pollution assessed by sediment quality guidelines, pollution load index, and potential ecological risk index was found to be of serious concern for IL, TN, TP, and Cd. Thus, we assessed pollution sources through spatial, grid, and vertical distributions and found that the high pollutant concentrations detected in 2020 were confirmed only at a certain location in the lake. Additionally, similar results were detected in the sedimentary layer below a sediment core at a depth of 15.0 cm. The high pollutant concentrations locally occurred around a "hotspot" site that was previously frequently used for aquaculture activities, indicating that the pollutants were accumulated in sediments owing to past cage fish farming rather than from influx of externally sourced pollution. Furthermore, chemical fractionation of phosphorus and heavy metals and assessment of stable isotopes (13C and 15N) of organic matter suggested that the pollutants in the sediments at the "hotspot" sites had different origins than those found at other sites. Accordingly, the by-products discharged after cage fish farming, such as residual feed, fish meal, and waste, accumulated in the sediments and were then exposed to natural internal disturbances caused by the effects of climate change-induced drought. This local distribution and the phosphorus and heavy metal chemical fraction results with low elution potential indicated that the pollutants in the sediments of Lake Jangseong had negligible impact on water quality.

Relationship between aging-related pulmonary function, cognition, motor function, and activities of daily living in older adults with dementia.

BACKGROUND: The aging process is related to cerebrovascular dysfunction and physiological changes, such as reduced pulmonary function. This ultimately induces cognitive impairment or dementia. OBJECTIVE: This study aimed to determine the relationship between aging-related pulmonary function, cognition, motor function, and activities of daily living (ADLs) in older adults with dementia. METHODS: This cross-sectional study included 69 older adults diagnosed with dementia. Aging-related pulmonary function and cognition were measured using a hand-held spirometer and the Korean version of the Mini-Mental State Examination (MMSE-K), respectively. To assess motor function and ADLs, the Berg Balance Scale (BBS), 10-meter walk test (10-MWT), 6-minute walk test (6-MWT), and modified Barthel index (MBI) were used to measure balance, walking speed, physical functional capacity (or walking tolerance), and ADLs, respectively. All data were analyzed using the Pearson's product correlation coefficient (r). RESULTS: Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) as measures of aging-related pulmonary function correlated only with the 6-MWT (FVC: r = 0.483, p = 0.002; FEV1: r = 0.512, p = 0.001). In cognitive function, MMSE-K was associated with BBS (r = 0.283, p = 0.022) and MBI (r = 0.454, p = 0.000). Additionally, there were significant correlations (r = 0.425-0.671, p = 0.000) between all motor function and ADLs measures in older adults with dementia. CONCLUSIONS: Our findings demonstrated that aging-pulmonary function was related to a lower physical functional capacity, and hence, suggested that the reduced pulmonary function were unable to walk for longer distance in older adults with dementia.

Characterization of breast cancer subtypes based on quantitative assessment of intratumoral heterogeneity using dynamic contrast-enhanced and diffusion-weighted magnetic resonance imaging.

OBJECTIVE: To investigate whether intratumoral heterogeneity, assessed via dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI), reflects the molecular subtypes of invasive breast cancers. MATERIAL AND METHODS: We retrospectively evaluated data from 248 consecutive women (mean age ± standard deviation, 54.6 ± 12.2 years) with invasive breast cancer who underwent preoperative DCE-MRI and DWI between 2019 and 2020. To evaluate intratumoral heterogeneity, kinetic heterogeneity (a measure of heterogeneity in the proportions of tumor pixels with delayed washout, plateau, and persistent components within a tumor) was assessed with DCE-MRI using a commercially available computer-aided diagnosis system. Apparent diffusion coefficients (ADCs) were obtained using a region-of-interest technique, and ADC heterogeneity was calculated using the following formula: (ADCmax-ADCmin)/ADCmean. Possible associations between imaging-based heterogeneity values and breast cancer subtypes were analyzed. RESULTS: Of the 248 invasive breast cancers, 61 (24.6%) were classified as luminal A, 130 (52.4%) as luminal B, 25 (10.1%) as HER2-enriched, and 32 (12.9%) as triple-negative breast cancer (TNBC). There were significant differences in the kinetic and ADC heterogeneity values among tumor subtypes (p < 0.001 and p = 0.023, respectively). The TNBC showed higher kinetic and ADC heterogeneity values, whereas the HER2-enriched subtype showed higher kinetic heterogeneity values compared to the luminal subtypes. Multivariate linear analysis showed that the HER2-enriched (p < 0.001) and TNBC subtypes (p < 0.001) were significantly associated with higher kinetic heterogeneity values. The TNBC subtype (p = 0.042) was also significantly associated with higher ADC heterogeneity values. CONCLUSIONS: Quantitative assessments of heterogeneity in enhancement kinetics and ADC values may provide biological clues regarding the molecular subtypes of breast cancer. KEY POINTS: • Higher kinetic heterogeneity was associated with HER2-enriched and triple-negative breast cancer. • Higher ADC heterogeneity was associated with triple-negative breast cancer. • Aggressive breast cancer subtypes exhibited higher intratumoral heterogeneity based on MRI.

Prognostic value of metabolic activity of the psoas muscle evaluated by preoperative 18F-FDG PET-CT in breast cancer: a retrospective cross-sectional study.

BACKGROUND: This study aimed to evaluate the potential of metabolic activity of the psoas muscle measured by 18F-fluorodeoxyglucose positron emission tomography-computed tomography to predict treatment outcomes in patients with resectable breast cancer. METHODS: The medical records of 288 patients who had undergone surgical resection for stages I-III invasive ductal carcinoma of the breast between January 2014 and December 2014 in Pusan National University Hospital were reviewed. The standardized uptake values (SUVs) of the bilateral psoas muscle were normalized using the mean SUV of the liver. SUVRmax was calculated as the ratio of the maximum SUV of the average bilateral psoas muscle to the mean SUV of the liver. SUVRmean was calculated as the ratio of the mean SUV of the bilateral psoas muscle to the mean SUV of the liver. RESULTS: Univariate analyses identified a higher T stage, higher N stage, estrogen receptor negativity, progesterone receptor negativity, human epidermal growth factor receptor 2 positivity, triple-negative breast cancer, mastectomy (rather than breast-conserving surgery), SUVRmean > 0.464, and SUVRmax > 0.565 as significant adverse factors for disease-free survival (DFS). Multivariate Cox regression analysis revealed that N3 stage (hazard ratio [HR] = 5.347, P = 0.031) was an independent factor for recurrence. An SUVRmax > 0.565 (HR = 4.987, P = 0.050) seemed to have a correlation with shorter DFS. CONCLUSIONS: A higher SUVRmax of the psoas muscle, which could be a surrogate marker of insulin resistance, showed strong potential as an independent prognostic factor for recurrence in patients with resectable breast cancer.

Optical Filter-Embedded Fiber-Optic Radiation Sensor for Ultra-High Dose Rate Electron Beam Dosimetry.

FLASH radiotherapy is an emerging radiotherapy technique used to spare normal tissues. It employs ultra-high dose rate radiation beams over 40 Gy/s, which is significantly higher than those of conventional radiotherapy. In this study, a fiber-optic radiation sensor (FORS) was fabricated using a plastic scintillator, an optical filter, and a plastic optical fiber to measure the ultra-high dose rate electron beams over 40 Gy/s used in FLASH radiotherapy. The radiation-induced emissions, such as Cherenkov radiation and fluorescence generated in a transmitting optical fiber, were spectrally discriminated from the light outputs of the FORS. To evaluate the linearity and dose rate dependence of the FORS, the outputs of the fiber-optic radiation sensor were measured according to distances from an electron scattering device, and the results were compared with those of an ionization chamber and radiochromic films. Finally, the percentage depth doses were obtained using the FORS as a function of depth in a water phantom. This study found that ultra-high dose rate electron beams over 40 Gy/s could be measured in real time using a FORS.

Tracking nitrate sources in agricultural-urban watershed using dual stable isotope and Bayesian mixing model approach: Considering N transformation by Lagrangian sampling.

A dual isotopes approach and the Bayesian isotope mixing model were applied to trace nitrogen pollution sources and to quantify their relative contribution to river water quality. We focused on two points to enhance the applicability of the method: 1) Direct measurement on the end-members to distinguish "sewage" and "manure" which used to be grouped in one pollution source as their isotope ranges overlap; 2) The Lagrangian sampling method was applied to consider the transport of nitrogen pollutants in a long river so that any fractionation process can be dealt with in the given Bayesian modeling framework. The results of the analysis confirmed the NO3- isotope composition in the river of interest to be within the range of NO3- with origins in "NH4+ in fertilizer", "Soil N", and "Manure and sewage" pollution. This suggests that nitrogen pollution is mostly attributed to anthropogenic sources. The δ18O NO3 value follows the range +2.5∼+15.0‰, implying that NO3- in the river is mainly derived from nitrification, and possible nitrification in groundwater or waterfront other than surface water. The ratio of the concentration of δ15N NO3 to that of δ18O NO3, and the corresponding regression equation indicates that the denitrification effect in surface water was insignificant during the study period. From the results of the contribution ratio of each source, improving the water quality of the discharge from the sewage treatment plants was proved to be the key factor to reduce nitrogen pollution in the river.

Assessing heavy metals in surface sediments of the Seomjin River Basin, South Korea, by statistical and geochemical analysis.

We investigated particle size distribution and heavy metal concentrations in surface sediments of streams and lakes in the Seomjin River Basin by comparison with Sediment Quality Guidelines (SQGs). Origins were identified using statistical and geochemical approaches. Sand was prevalent in mean particle size of surface sediments (except lakes). Mean concentrations of Pb, Zn, Cd, and Hg were similar for the Seomjin and Boseong rivers, while those of Cu, As, Cr, and Ni were approximately 1.5-2.0 times higher in the Boseong. SQGs revealed no serious pollution in the basin's site concentrations, although As and Ni levels in the Boseong had some potential for benthos toxicity. Correlation and principal component/factor analysis showed that concentrations of Cu, As, Cr, and Ni were dominant from geological origins rather than anthropogenic. The reducible fraction bound to Fe and Mn-oxides was prevalent in Pb, while the water- and acid-soluble fractions were easily exchangeable or bound to high Cd carbonates. The fraction bound to the highest lattice in residual prevailed in Zn, Cu, Cr, and Ni, accounting for 64%, 65%, 87%, and 86%, respectively. Similarly, results indicated geological origins. Risk assessment to benthos based on labile fractions (F1 + F2 + F3) were Cd (72%) < Pb (66%) < Zn (36%) ≈ Cu (35%) < Ni (14%) ≈ Cr (13%). While Cd and Pb showed the highest risk, their concentrations were relatively lower. However, Cr and Ni showed the highest concentrations but low risk levels, suggesting their pollution is unlikely to have adverse effects on benthos.

Effect of tamoxifen with or without gonadotropin-releasing hormone analog on DXA values in women with breast cancer.

The purpose of this study was to compare the changes in DXA values including trabecular bone score (TBS) and bone mineral density (BMD) of lumbar spine (LS) and femur according to the hormone therapies including tamoxifen (TMXF) treatment with or without gonadotropin releasing hormone analog (GnRH analog) in women with breast cancer. We enrolled 119 women with breast cancer who had undergone breast-conserving surgery or mastectomy followed by TMXF treatment for postmenopausal women (TMXF group, n = 63, 52.9%) or by combination therapy of TMXF combined with GnRH analog for premenopausal women (TMXF + GnRH group, n = 56, 47.1%) from December 2013 to December 2017. The median follow-up period was 13 months (interquartile range [IQR], 12.0-14.75) for TMXF group and 13.5 months (IQR, 12.00-16.00) for TMXF + GnRH group, respectively. Patients did not receive bone-modifying therapy. The baseline dual-energy X-ray absorptiometry (DXA) scan before breast cancer surgery and follow-up DXA during hormone therapy. Comparing the first and follow-up DXA results, BMD in LS were significantly decreased in both TMXF (P < 0.001, mean difference: - 0.06) and TMXF + GnRH (P < 0.001, mean difference: - 0.09) groups. BMD values of femoral neck (P = 0.0011, mean difference: - 0.01) and total femur (P < 0.001, mean difference: - 0.03) was significantly changed between the baseline and follow-up DXA in TMXF + RnRH group. In the TMX group, a significant changed occurred in the BMD in total femur (P < 0.001, mean difference: - 0.030) but not the BMD of femoral neck (P = 0.095, mean difference: - 0.007). Regarding TBS, no significant change was found in the TMXF (P = 0.574, mean difference: - 0.004) group, whereas there was a significant decrease in TBS in the TMXF + GnRH (P < 0.001, mean difference: - 0.02) group during follow-up. TBS is more sensitive in reflecting the bone microarchitecture changes by TMXF or GnRH agonist in breast cancer patients than BMD. This finding demonstrates that TBS can be a useful parameter to detect bone microarchitectural changes in clinical applications.

Usefulness of using additional ultrasonic dissection device in breast cancer surgery: a retrospective cohort study.

BACKGROUND: In breast cancer surgery, electrocautery (EC) is commonly used with the basic method of knot tying, and there are few reports of using other devices such as ultrasonic dissection device (UDD). This study was designed to compare the case of using EC with the basic method of knot tying and the case of using UDD in breast cancer surgery. METHODS: From April 2019 to March 2020, 376 patients who underwent breast cancer surgery at Pusan National University Hospital were enrolled. We compared operation time, complications, and blood loss volume between surgery with and without UDD. RESULTS: We included 306 patients for the final analysis, 142 in the control group and 164 in the trial group. The operation time [minutes (min)] was significantly reduced in the trial group compared to the control group (111.2 vs. 95.5 min, P<0.001). In subgroup analysis, the operation time in the trial group was significantly reduced. There was no significant difference in intraoperative blood loss (P=0.999) and complications [seroma (P=0.965), hematoma (P=0.999), cellulitis (P=0.999)]. CONCLUSIONS: Our study showed that the use of a UDD for surgeons to select instruments for breast cancer surgery may be a good option for both patients and surgeons.