Efficacy of Breast Ultrasonography for Detection of Local, Regional, and Contralateral Recurrence of Breast Cancer

Purpose: Breast uttrasonography (US) is not recommended for recurrence monitoring after breast cancer surgery due to the lack of evidence for its advantage. The purpose of this study was to evaluate the usefulness of US for detecting local recurrence (LR), regional recurrence (RR) and contralateral breast cancer (CBC) in breast cancer patients during follow-up. Methods: The medical records of 5,833 breast cancer patients who underwent breast cancer surgery between January 2003 and December 2009 were reviewed retrospectively. Physical examination (PE), mammography (MMG), and US were done routinely to detect recurrences. Detection rate for locoregional and contralateral recurrence was compared between the three modalities. Results: During the follow-up period, 125 LR, 46 RR, 83 CBC, and 29 synchronous local and regional recurrences developed in 245 patients among the study population of 5,833 breast cancer patients. Median time to recurrence was 34.7 months. The recurrence detection rate was 51.9%, 43.5%, and 90.1% for PE, MMG, and US, respectively. Mean size of the recurrent lesions detected by US (1.57 cm) was smaller than that of PE (2.69 cm) and MMG (2.03 cm) (p=0.002). Conclusion: Breast US had higher recurrence detection rate for LA, RR, and CBC than PE or MMG after breast cancer surgery. 유방암은 2007년 우리나라 여성 암 발생률 2위(15.1%), 발생 환자 수는 11,606명을 차지하고 있고, 연간 6,6%의 높은 발생률의 증가를 보이고 있다.(1) 또한 지난 10년간 국내의 유방암 치료 성적도 지속적으로 개선되어 5년 생존율은 77.9%에서 89.5%로 11.5% 증가하였다. 이러한 유병률의 증가와 장기 생존율의 향상으로 인해 1999년 이후 9년 동안 유병자 수도 68,136명(11.2%)으로 빠르게 증가하고 있다.(1,2) 이러한 유방암 발생률 증가와 사망률 감소 및 유방암 수술 후 장기생존자의 증가에 따라 동측 유방 내 재발을 포함한 국소재발과 반대측 유방암이 발생하는 환자의 빈도가 최근 증가하고 있다. National Surgical Adjuvant Breast and Bowel Project(NSABP) B-06의 경우 20년의 추적 관찰기간 동안 14.3%의 동측 유방 재발(ipsilateral breast tumor recurrence)을 보고하였고,(3) 10년의 추적 기간 동안 단독 국소-구역 재발(locoregional recurrence)은 12.4%, 4개월 이내 전신재발을 동반한 국소-구역 재발은 19.8% 보고되었다.(4) 유방암으로 치료받은 환자에서 반대측 유방암(contralateral breast cancer)이 생길 확률은 2-11%로 유방암에 걸리지 않은 여성에 비해 2-6배의 높은 위험도를 가진다.(5) 2008년 한국유방암학회 유방암 진료권고안을 비롯하여 서구의 다양한 유방암 진료권고안에서는 국소, 구역, 그리고 반대측 유방암 재발을 진단함에 있어서 1년마다의 추적 관찰과 함께 유방촬영술을 시행하는 것을 권고하고 있다. 그러나 유방초음파나 유방 자기공명영상 등의 추가적 영상검사의 효용은 아직 불확실하여 고위험 환자에서 선택적으로 시행하는 것을 권하고 있다.(6-11)최근 여러 국내외의 연구에서 유방암 수술 후 국소재발이나 액와부 림프절 재발을 조기 발견하는 데 있어 유방초음파의 잠재적 효용성이 보고되고 있다.(12-15) 이에 본 연구에서는 유방암의 국소, 구역, 그리고 반대측 유방암 재발을 진단하는 데 있어서 유방 초음파의 유용성을 단일기관에서 수술받고 추적 관찰받은 한국인 유방암 환자군에서 분석해보고자 하였다.본 논문은 2010년도 정부(교육과학기술부)의 재원으로 한국연구재단의 기초 연구사업 지원을 받아 수행된 것임(2010-0004148).Kelly KM, 2010, EUR RADIOL, V20, P2557, DOI 10.1007/s00330-010-1844-1Kim HJ, 2010, ANN SURG ONCOL, V17, P2670, DOI 10.1245/s10434-010-1087-zJung KW, 2010, J KOREAN MED SCI, V25, P1113, DOI 10.3346/jkms.2010.25.8.1113Aebi S, 2010, ANN ONCOL, V21, pv9, DOI 10.1093/annonc/mdq159Lehman CD, 2009, J NATL COMPR CANC NE, V7, P1109Houssami N, 2009, ANN ONCOL, V20, P1505, DOI 10.1093/annonc/mdp037Moon HJ, 2009, RADIOLOGY, V252, P673, DOI 10.1148/radiol.2523081977Yarnold J, 2009, CLIN ONCOL-UK, V21, P159, DOI 10.1016/j.clon.2008.12.008Kim MJ, 2009, AM J ROENTGENOL, V192, P221, DOI 10.2214/AJR.07.4048Montgomery DA, 2007, BRIT J CANCER, V96, P1802, DOI 10.1038/sj.bjc.6603815Yilmaz MH, 2007, DIAGN INTERV RADIOL, V13, P13Khatcheressian JL, 2006, J CLIN ONCOL, V24, P5091, DOI 10.1200/JCO.2006.08.8575Shin JH, 2005, J ULTRAS MED, V24, P643Taghian A, 2004, J CLIN ONCOL, V22, P4247, DOI 10.1200/JCO.2004.01.042Ciatto S, 2004, EUR J CANCER, V40, P1496, DOI 10.1016/j.ejca.2004.03.010Fisher B, 2002, NEW ENGL J MED, V347, P1233KIM SH, 2000, J KOREAN RADIOL SOC, V42, P1009Chen Y, 1999, CANCER EPIDEM BIOMAR, V8, P855GORDON PB, 1995, CANCER, V76, P626GIUSEPPETTI GM, 1989, RADIOL MED, V78, P339*NAT COMPR CANC NE, NCCN CLIN PRACT GUID*AM COLL RAD, ACR BREAST IM REP DA*NAT CANC INF CTR, CANC STAT*KOR BREAST CANC S, 3 BREAST CANC MAN RE

Factors Affecting the Ipsilateral Breast Tumor Recurrence after Breast Conserving Therapy in Patients with T1 and T2 Tumors

본 논문은 2008년 대한외과학회 추계학술대회에서 구연 발표되었음.Purpose: Nearly half of all breast cancers are treated with breast conserving therapy (BCT). The purpose of this study was to identify the risk factors for ipsilateral breast tumor recurrence (IBTR) after BCT in T1 and T2 breast cancer patients. Methods: The medical records of 294 T1 or T2 breast cancer patients who underwent BCT at Seoul National University Hospital between January 1998 and December 2002 were retrospectively reviewed. Kaplan-Meier curves and Cox proportional regression analysis were used to identify the significant clinicopathologic factors that influence IBTR. Results: Among the 294 patients, 12 patients (4.8%) developed IBTR after a median follow-up of 82 months. Univariate analysis demonstrated that younger age (<= 35 year) had significant associations with IBTR (p=0.006). Tumor size, lymph node status, histologic grade, extensive intraductal component, lymphovascular invasion, and close resection margins were not significant factor associated with IBTR. The triple negative breast cancer subtype also did not have significant association with IBTR. Multivariate analysis showed that the younger age at diagnosis was a significant predictor of IBTR with a FIR of 3.86 (p=0.036; 95% CI, 1.09-13.60). Conclusion: Younger age at diagnosis (<= 35) may be associated with an increased risk of IBTR in patients who underwent BCT.Han W, 2010, BREAST CANCER RES TR, V119, P193, DOI 10.1007/s10549-009-0388-zBenson JR, 2009, LANCET, V373, P1463Luini A, 2009, BREAST CANCER RES TR, V113, P397, DOI 10.1007/s10549-008-9929-0Nguyen PL, 2008, J CLIN ONCOL, V26, P2373, DOI 10.1200/JCO.2007.14.4287Lee JW, 2007, J BREAST CANCER, V10, P206Dent R, 2007, CLIN CANCER RES, V13, P4429, DOI 10.1158/1078-0432.CCR-06-3045KANG SH, 2007, J KOREAN SURG SOC, V73, P385Haffty BG, 2006, J CLIN ONCOL, V24, P5652, DOI 10.1200/JCO.2006.06.5664Ahn SH, 2006, BREAST CANCER RES TR, V99, P209, DOI 10.1007/s10549-006-9188-xWapnir IL, 2006, J CLIN ONCOL, V24, P2028, DOI 10.1200/JCO.2005.04.3273Komoike Y, 2006, CANCER, V106, P35, DOI 10.1002/cncr.21551Abe O, 2005, LANCET, V366, P2087Noh WC, 2005, WORLD J SURG, V29, P1001, DOI 10.1007/s00268-005-7928-4Kim KJ, 2005, JPN J CLIN ONCOL, V35, P126, DOI 10.1093/jjcolyhi039Han WS, 2004, BMC CANCER, V4, DOI 10.1186/1471-2407-4-82MORROW M, 2004, DIS BREAST, P719Arriagada R, 2003, ANN ONCOL, V14, P1617, DOI 10.1093/annonc/mdg452Singletary SE, 2002, AM J SURG, V184, P383Veronesi U, 2002, NEW ENGL J MED, V347, P1227Fisher B, 2002, NEW ENGL J MED, V347, P1233Freedman GM, 2002, J CLIN ONCOL, V20, P4015, DOI 10.1200/JCO.2002.03.155Haffty BG, 2002, LANCET, V359, P1471Jobsen JJ, 2001, EUR J CANCER, V37, P1820Sasson AR, 2001, CANCER, V91, P1862Voogd AC, 2001, J CLIN ONCOL, V19, P1688Park CC, 2000, J CLIN ONCOL, V18, P1668Freedman G, 1999, INT J RADIAT ONCOL, V44, P1005Peterson ME, 1999, INT J RADIAT ONCOL, V43, P1029SUH CO, 1997, J KOREAN SOC THER RA, V15, P331BORGER J, 1994, J CLIN ONCOL, V12, P653WAZER DE, 1992, J CLIN ONCOL, V10, P356SOLIN LJ, 1991, INT J RADIAT ONCOL, V21, P279JACQUEMIER J, 1990, BRIT J CANCER, V61, P873VERONESI U, 1990, EUR J CANCER, V26, P671FOURQUET A, 1989, INT J RADIAT ONCOL, V17, P719LOCKER AP, 1989, BRIT J SURG, V76, P890

Clinical Observation on Total and Subtotal Thyroidectomy for Thyroid cancer Patients

We got following results by analyzing 36 cases of subtotal thyroidectomies and 26 cases of total thyroidectomies for thyroid cancers which were operated at the Department of General Surgery in Seoul National University Hospital for recent 2 years. 1. The frequency of In\llticentricity was 16% (in 8 of 51 cases) papillary ca., however, there was no case of multicentricity in follicular ca. (of 6 cases) and medullary ca. (of 1 case). But we can not conelude because of scanty samples in this case. 2. There was little difference in the frequency of postoperative hoarseness due to injury of recurrent laryngeal nerves between subtotal and total thyroid" ectomy (each 3% and 4%). 3. The frequency of permanent hypocalcemia due to injury of parathyroid glands was higher in total thyroidectomies than in subtotal thyroidectomies(each 996 and 0%). 4. A group which had reoperation because of recurrence after the first minor procedure has higher incidence of permanent hoarseness and hypocalcemia than a group which had thyroidectomy once (hoarse ness: each 4% and 22%; hypocalcemia: each 4% and 22%). Most of thyroid cancers were papillary ca. (80%), and multicentricity of it was high. The incidence of postoperative complications of reoperation because of recurrence after minor procedure (simple lobectomy) was higher than that of the first operation. This result suggests that more extensive procedures(subtotal or total thyroidectomy) are more desirable than the minor procedures in the treatment of thyroid cancer. We are going to support this conclusion by longterm comparative follow-up studies of recurrence rates and survival rates between minor procedure group and more extensive procedure- group

The Impact of Primary Tumor Resection on the Survival of Patients with Stage IV Breast Cancer

Purpose The main treatment for stage IV breast cancer is currently systemic therapy. Surgical resection of the primary tumor is usually done for treating the tumor-related complications Recent studies have suggested that surgery may improve the long-term survival of stage IV breast cancer patients We evaluated the impact of the primary surgical resection site on the survival of stage IV breast cancer patients. Methods We reviewed the records of the stage IV breast cancer patients who were treated at Seoul University Hospital between April 1992 and December 2007 The tumor and clinical characteristics, the type of treatments and the overall survival were compared between the surgically versus nonsurgically treated patients. Results. Of the 198 identified patients, 110 (55 8%) received surgical excision of their primary tumor and 88 (44 2%) did not The mean survival was 67 months vs. 42 months for the surgically treated patients vs the patients without surgery, respectively (p=0 0287) On a multivariate analysis with using the Cox model and after adjusting for the estrogen receptor status, visceral metastases, the number of metastatic sites and trastuzumab treatment, surgery was an independent factor for improved survival (hazard ratio, 0.55; 95% confidence interval, 0.31-0.97; p=0.041). Conclusion Surgical resection of the primary tumor in stage IV breast cancer patients was independently associated with improved survival. Randomized prospective trials are needed to firmly recommend surgical resection of the primary tumor in stage IV breast cancer patients본 연구는 폐암, 유방암/난소암 유전체 연구센터의 연구비를 지원받아 수행 되었음(01-PJ3-PG6-01GN07-0004).Bafford AC, 2009, BREAST CANCER RES TR, V115, P7, DOI 10.1007/s10549-008-0101-7Blanchard DK, 2008, ANN SURG, V247, P732, DOI 10.1097/SLA.0b013e3181656d32*KOR BREAST CANC S, 2008, BREAST CANC FACTS FI, V1, P5Fields RC, 2007, ANN SURG ONCOL, V14, P3345, DOI 10.1245/s10434-007-9527-0Gnerlich J, 2007, ANN SURG ONCOL, V14, P2187, DOI 10.1245/s10434-007-9438-0Rapiti E, 2006, J CLIN ONCOL, V24, P2743, DOI 10.1200/JCO.2005.04.2226Morrow M, 2006, J CLIN ONCOL, V24, P2694, DOI 10.1200/JCO.2006.05.9824Babiera GV, 2006, ANN SURG ONCOL, V13, P776, DOI 10.1245/ASO.2006.03.033Hotta T, 2006, ANTICANCER RES, V26, P1377Abe O, 2005, LANCET, V366, P2087Andre F, 2004, J CLIN ONCOL, V22, P3302, DOI 10.1200/JCO.2004.08.095Giordano SH, 2004, CANCER, V100, P44, DOI 10.1002/cncr.11859Khan SA, 2002, SURGERY, V132, P620, DOI 10.1067/msy.2002.127544Flanigan RC, 2001, NEW ENGL J MED, V345, P1655Demicheli R, 2001, BRIT J CANCER, V85, P490Dauplat J, 2000, SEMIN SURG ONCOL, V19, P42Overgaard M, 1999, SEMIN RADIAT ONCOL, V9, P292DOGHETTO GB, 1999, AM SURGEON, V65, P352BLAND KI, 1998, BREAST COMPREHENSIVE, V2Ragaz J, 1997, NEW ENGL J MED, V337, P956OREILLY MS, 1994, CELL, V79, P315FISHER B, 1989, CANCER RES, V49, P1996*NAT CANC I, BREAST CANC TREATM P