유암환자에 있어서 수술술식의 변천에 대한 연구

윤명희 고신대학교 의학부 2001 高神大學校 醫學部 論文集 Vol.16 No.1

Background There is a steady increase in the incidence of breast cancer as women grow older. Early detection by screening test is most important. The minor operation is increased, the size of lump is smaller. Methods 352 patients with breast cancer confirmed by biopsy during 18 years from 1976 to 1993 were divided into two groups of before 1985 (group 1) and after 1985 (group 2). Clinical review and analysis of the operative procedures in accordance with clinical stages were carried out. Results The prevalent age was forties, which accounts 32.4% of total. The main presenting symptoms were palpable mass (90.1%), pain and tenderness (11.4%), nipple retraction (6.5%), and nipple discharge (5.1%). The most frequent site of the breast cancer was upper outer quadrant (49.7%). The size of tumor mass displayed less than 2㎝ in 29.7%, 2-5㎝ in 37.9%, and more 5㎝ in 25.7% in Group 1, and less than 2㎝ in 46.1%, 2-5㎝ in 47.1%, and more than 5㎝ in 4.9% in Group 2 Staging according to TNM system showed that stage Ⅱ was 37.8%, stage Ⅰ 29.7%, and stage Ⅲ 18.9% in Group Ⅰ, and stage Ⅱ 46.1%, stage Ⅰ 36.3%, stage Ⅲ 12.3%, and stage zero 2.9% in Group 2. The operative procedures performed were 38.5% of radical mastectomy, 34.5% of modified radical mastectomu in Group Ⅰ respectively and 42.2% of modified radical mastectomy 23.0% of simple mastectomy. 20.6% of radical mastectomy and 14.2% of lumpectomy in Group 2 respectively. Conclusions Analysis of these results shows modified radical mastectomy and simple mastectomy was carried out mainly after 1985. Also lumpectomy with adjuvant treatment is performed in early breast cancer nowadays.

Traumatic Neuroma in a Breast Cancer Patient After Modified Radical Mastectomy: A Case Report

김은영,강두경,김태희,김구상,임현이 대한영상의학회 2011 대한영상의학회지 Vol.64 No.5

Traumatic neuromas are rare benign lesions that develop from non-neoplastic proliferation of axons, schwann cells, and fibroblasts at the proximal end of transected or injured nerves as a result of trauma or surgery. We present the case of a traumatic neuroma in a 47-year-old female who was treated with a right modified radical mastectomy for breast cancer 14 years ago. Ultrasound examination revealed an oval-shaped hypoechoic nodule at the 9-o’clock position in the right chest wall. Color Doppler imaging showed no increased blood flow and a positron emission tomography-computed tomography examination revealed no fluorodeoxyglucose uptake in this nodule. The typical histologic findings were present.

1998, 1999년도 우리나라에서 시행된 근치적 유방 전절제술 후 방사선치료 현황 조사

금기창(Ki Chang Keum),심수정(Su Jung Shim),이익재(Ik Jae Lee),박원(Won Park),이상욱(Sang-wook Lee),신현수(Hyun Soo Shin),정은지(Eun Ji Chung),지의규(Eui Kyu Chie),김일한(Il Han Kim),오도훈(Do Hoon Oh),하성환(Sung Whan Ha),이형식(Hyung 대한방사선종양학회 2007 Radiation Oncology Journal Vol.25 No.1

목 적: 유방암에 대한 방사선치료의 적정성과 안전성을 보장하고 궁극적으로 치료효과를 향상시키기 위한 방사선 치료 기술 표준화를 위하여 우리나라 전국 병원을 대상으로 하는 치료형태 조사연구(patterns of care study, PCS) 를 계획하였다. 그 두 번째 단계로 근치적 유방 전절제술 후 시행한 방사선치료 방법에 대하여 조사하고 분석하였다. 대상 및 방법: 조사하고자 하는 입력 문항을 개발하였고 동시에 인터넷을 통하여 조사자가 직접 입력할 수 있도 록 Web 기반 입력 프로그램(www.pcs.re.kr)을 개발하였다. 대상 환자들은 1998년도에 근치적 유방 전절제술 후 방 사선치료를 받은 환자로 전수 조사를 하지 않고 임의 추출하여 조사하였다. 입력 문항은 149개로 병력과 이학적 소견, 수술 소견과 병리소견, 항암화학요법, 호르몬요법, 방사선치료계획, 방사선치료, 치료 중 부작용, 치료 효과, 합병증 등 9군으로 나누어져 있다. 17개 병원에서 입력된 286명의 데이터를 분석하였다. 결 과: 연령은 20∼81세(중앙값 44세)였다. 환자의 병기는 AJCC (American Joint Committee on Cancer) 6판에 따라 분류하였으며 T1: 9.7%, T2: 59.2%, T3: 25.6%, T4: 5.2%이었으며 T0가 1예 있었다. 액와림프절 곽청술에서 떼어낸 림프절이 10개 미만인 환자가 10.5%, 10개 이상인 환자가 86.7%이었으며 7.3% 환자에서 림프절 전이가 없었고, 림프절 전이가 3개 이하인 경우가 14%, 4∼9개가 38.8%, 10개 이상 전이된 경우가 38.5%였다. 따라서 병기 I기: 0.7%,IIa기: 3.8%, IIb기: 9.8%, IIIa기: 43.0%, IIIb기: 2.8%, IIIc기: 38.5%이었다. 방사선치료가 시행된 시기에 따라서는 수술후에 항암약물치료를 마치고 방사선치료를 한 경우가 47.9%로 가장 많았고, 수술 후 약물치료를 시행하고 방사선 치료를 시행한 후에 다시 약물치료를 시행한 경우가 35.0%로 그 다음으로 많았다. 수술 전 약물치료를 시행하고 그 후에 방사선치료를 시행한 경우도 12.5%였다. 방사선치료 범위는 전체의 5.6%가 흉벽만 치료받았고 20.3%는 흉벽과 쇄골상 림프절을, 27.6%는 흉벽과 쇄골상 림프절과 내유방림프절을, 25.9%에서는 흉벽과 쇄골상 림프절을 치료하면서 액와 후방조사를, 19.9%에서는 흉벽과 쇄골상 림프절과 내유방림프절을 치료하면서 액와 후방조사를 시행하였다. 2예(0.7%)에서는 내유방림프절만 치료하였다. 흉벽의 방사선치료 방법에 있어서는 57.3%에서 양쪽 접선조사를 사용하였고, 42%에서는 전자선으로 치료하였다. 양쪽 접선조사를 시행한 경우에는 54.8%에서 조직보상체를 사용하였고, 전자선으로 치료한 경우는 52.5%에서 사용하였으며 흉벽에 조사된 방사선량은 91.3%에서 45∼50.4 Gy이었으며, 5.9%에서 그 이상이 2.8%에서 그 미만이 조사되었다. 쇄골상 림프절에 조사된 방사선량은 89.5% 에서 45∼50.4 Gy이었으며, 2.4%에서 그 이상이 8%에서 그 미만이 조사되었다. 결 론: 유방 보존술 후 방사선치료와는 달리 근치적 유방 전절제술 후 방사선치료는 다양한 형태로 시행되고 있음을 알 수 있었다. 향후 치료방법에 따른 치료성적을 분석함으로써 적절한 방사선 치료 방법을 제시할 수 있을 것이다. P urpose: To determine the patterns of evaluation and treatment in patients with breast cancer after mastectomy and treated with radiotherapy. A nationwide study was performed with the goal of improving radiotherapy treatment. Materials and Methods: A web- based database system for the Korean Patterns of Care Study (PCS) for 6 common cancers was developed. Randomly selected records of 286 eligible patients treated between 1998 and 1999 from 17 hospitals were reviewed. R esults: The ages of the study patients ranged from 20 to 80 years (median age 44 years). The pathologic T stage by the AJCC was T1 in 9.7% of the cases, T2 in 59.2% of the cases, T3 in 25.6% of the cases, and T4 in 5.3% of the cases. For analysis of nodal involvement, N0 was 7.3%, N1 was 14%, N2 was 38.8%, and N3 was 38.5% of the cases. The AJCC stage was stage I in 0.7% of the cases, stage IIa in 3.8% of the cases, stage IIb in 9.8% of the cases, stage IIIa in 43% of the cases, stage IIIb in 2.8% of the cases, and IIIc in 38.5% of the cases. There were various sequences of chemotherapy and radiotherapy after mastectomy. Mastectomy and chemotherapy followed by radiotherapy was the most commonly performed sequence in 47% of the cases. Mastectomy, chemotherapy, and radiotherapy followed by additional chemotherapy was performed in 35% of the cases, and neoadjuvant chemoradiotherapy was performed in 12.5% of the cases. The radiotherapy volume was chest wall only in 5.6% of the cases. The volume was chest wall and supraclavicular fossa (SCL) in 20.3% of the cases; chest wall, SCL and internal mammary lymph node (IMN) in 27.6% of the cases; chest wall, SCL and posterior axillary lymph node in 25.9% of the cases; chest wall, SCL, IMN, and posterior axillary lymph node in 19.9% of the cases. Two patients received IMN only. The method of chest wall irradiation was tangential field in 57.3% of the cases and electron beam in 42% of the cases. A bolus for the chest wall was used in 54.8% of the tangential field cases and 52.5% of the electron beam cases. The radiation dose to the chest wall was 45∼59.4 Gy (median 50.4 Gy), to the SCL was 45∼59.4 Gy (median 50.4 Gy), and to the PAB was 4.8∼38.8 Gy, (median 9 Gy) Conclusion: Different and various treatment methods were used for radiotherapy of the breast cancer patients after mastectomy in each hospital. Most of treatment methods varied in the irradiation of the chest wall. A separate analysis for the details of radiotherapy planning also needs to be followed and the outcome of treatment is needed in order to evaluate the different processes.

Comparison of survival outcomes between modified radical mastectomy and breast conserving surgery in early breast cancer patients

김윤석,류동원,이충한 고신대학교(의대) 고신대학교 의과대학 학술지 2016 고신대학교 의과대학 학술지 Vol.31 No.1

Objectives: Breast conserving surgery (BCS) for early breast cancer is now an accepted treatment, but there are controversies about its comparability with mastectomy. Thus, we investigated the survival outcomes who underwent BCS and modified radical mastectomy (MRM). Methods: In this retrospective review, we analyzed the survival outcomes of 618 patients with early breast cancer who underwent two different surgery from January 2002 to December 2009. Postoperative pathologic difference, disease free survival period, overall survival period, recurrence pattern, recurrent rate and site were compared. In addition, preoperative patients data are also collected. Results: Disease free survival period of MRM and BCS was 108.46 months and 80.82 months, respectively (P < 0.01). However, there was no significant correlation between overall survival period and operative methods (P = 0.67). In addition, recurrence pattern (P = 0.21), recurrent rate (P = 0.36) and site (P = 0.45, P = 0.09) were not associated with operative method. Conclusions: In this study, we can suggest that early breast cancer patients could improve their disease free survival if they underwent MRM. So, when we operate high risk breast cancer patients, MRM could be considered for their disease free life. Further studies may be required to establish appropriate strategy of surgery for early breast cancer.

고위험 유방암 환자의 수술 후 방사선치료

이경자(Kyung-ja Lee) 대한방사선종양학회 2001 Radiation Oncology Journal Vol.19 No.4

목적: 고위험 유방암 환자의 수술 후 방사선치료 후 국소 재발율, 생존율 및 예후인자를 후향적 분석하여 방사선 치료의 역할을 규명하고자 하였다. 대상 및 방법: 1984년부터 1995년까지 유방암으로 변형 근치적 유방절제술 후 종야의 크기가 4cm 이상이거나, 4cm미만이나 액와 림프절의 전이가 있는 환자 중 방사선치료를 완료한 48명을 대상으로 하였다. 중앙 연령은 47세 (31~79세)이었으며, 종양의 크기가 2cm미만 1명, 2~5cm 15명, 5cm이상이 32명이었다. 액와림프절에 전이된 환자는 32명이었다. 흉벽과 국소림프절에 방사선치료를 받은 환자는 42명, 흉벽만 받은 환자는 6명이었으며 방사선량은 1일 1회(1.8Gy)로 총 선량은 50.4Gy이었다. 48명중 18명(38%)은 50FU를 기본으로 하는 항암화학요법을 방사선치료 전 혹은 후에 투여하였다. 중앙 추적기간은 61개월이었다. 결과: 국소 재발율은 8%, 원격전이율은 14%이었다. 전체환자의 5년 생존율은 63%, 무병생존율은 62%이었으며 중앙생존기간은 67개월이었다. 병기에 따른 5년 생존율은 IIB는 70%, IIIA는 58%이었으며, 생존율에 미치는 예후인자는 병기이었다(p=0.0076). 결론: 고 위험군의 유방암 환자의 수술 후 방사선치료는 국소재발율은 감소시키고 생존율을 향상시킬 수 있으며, 생존율에 영향을 주는 인자는 병기이었다. Purpose: To assess the locoregional recurrence rate, survival rate and prognostic factors after modified radical mastectomy and postoperative adjuvant radiation therapy with or with chemotherapy in high-risk breast cancer patients. Method: Between 1984~1995, 48 patients underwent postoperative irradiation to the regional lymphatics and chest wall due to large tumor size (≥5 cm) or small tumor size (<5 cm) with axillary lymph node involvement after modified radical mastectomy. The median age of the patients was 47 years (range, 31~79 years). The clinical tumor size was <2cm in 1 patient, 2~5 cm in 15 patients, and >5 cm in 32 patients. Thirty two patients had positive axillary lymhp nodes. Forty two patients were irradiated to the chest wall and regional lymph node and 6 patients were irradiated in the chest wall only. Radiation dose to the chest wall and regional lymph node was 5040 cGy/28 fraction. The median follow-up time was 61months. Results: Locoregional recurrence rate was 8% and distant metastatic rate was 14%. The actuarial overall survival rate and disease-free survival rate was 63% and 62% at 5 years, respectively. The median survival time was 67 months. Five-year overall survival rate by the stage in 70% in IIB and 58% in IIIA. The significant prognostic factor for survival on multivariate analysis was the stage. Conclusion: Postoperative adjuvant radiation therapy in high-risk breast cancer can reduce the locoregional recurrence rate and increase the survival time by combined chemotherapy. The significant prognostic factor for survival rate was the stage.

유방암 수술 후 발생한 외상성 신경종: 증례 보고

신수영 대한영상의학회 2013 대한영상의학회지 Vol.69 No.5

A traumatic neuroma is a tangle of neural fibers and connective tissues which develop at the end of a proximal nerve stump following the nerve injury. The incidence of traumatic neuroma after breast cancer surgery is extremely low, and so far, there are only 11 cases being reported in literature. We present sonographic and pathologic features of a traumatic neuroma that mimics the recurrent breast carcinoma identified on follow-up ultrasound examinations after breast cancer surgery. 외상성 신경종은 신경 손상 후 근측의 신경 말단에 발생하는 신경섬유와 결체조직의 결절이다. 특히 유방암 수술 후 발생한 외상성 신경종은 보고된 증례가 11예로 극히 드물다. 저자는 유방암으로 유방절제술을 시행 받고 추척 관찰하던 중 재발로 오인된 외상성 신경종 1예를 경험하여 초음파와 병리소견을 보고한다.

[P342] Recurrence of mammary Paget`s disease after radical mastectomy

( Won Seon Koh ),( Dong Uk Cheon ),( Eui Hyun Oh ),( Jeong Eun Kim ),( Joo Yeon Ko ),( Young Suck Ro ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Mammary Paget`s disease (MPD) is a rare intraepithelial adenocarcinoma. Although the etiology of MPD remains controversial, epidermotropic theory that suggests ductal cancer cells migrate along the basal membrane of the nipple are the origin of Paget`s cells is generally accepted. According to literatures, MPDs as a local recurrence after breast conservative surgery or nipple sparing mastectomy for breast cancer have been reported, but there is no case of MPD that develops after radical mastectomy due to breast cancer. A 69-year-old woman presented with solitary erythematous scaly plaque with stinging on the radical mastectomy scar of left chest. The lesion developed 1 month ago and gradually increased in size. About 16 months ago, she received radical mastectomy for treatment of ductal carcinoma in situ with MPD. In radiologic study, there was no significant finding. With a suspicion of local recurrence, we excised the plaque lesion with about 1 cm margin. Histologic examination showed randomly dispersed Paget`s cells throughout the epidermis without evidence of underlying breast cancer. Based on these findings, the diagnosis of MPD recurrence after radical mastectomy was made. To the best of our knowledge, a case of MPD that develop as local recurrence after radical mastectomy has not been reported. Herein, we report a first case of MPD after radical mastectomy that may raise a point for discussion in the pathogenesis of MPD.

유암환자에 있어서 수술술식의 변천에 대한 연구

윤명희 고신대학교(의대) 고신대학교 의과대학 학술지 2001 고신대학교 의과대학 학술지 Vol.16 No.1

Background : There is a steady increase in the incidence of breast cancer as women grow older. Early detection by screening test is most important. The minor operation is increased, the size of lump is smaller. Methods : 352 patients with breast cancer confirmed by biopsy during 18 years from 1976 to 1993 were divided into two groups of before 1985 (group 1) and after 1985 (group 2). Clinical review and analysis of the operative procedures in accordance with clinical stages were carried out. Results : The prevalent age was forties, which accounts 32.4% of total. The main presenting symptoms were palpable mass (90.1%), pain and tenderness (11.4%), nipple retraction (6.5%) and nipple discharge (5.1%). The most frequent site of the breast cancer was upper outer quadrant (49.7%). The size of tumor mass displayed less than 2 cm in 29.7%, 2-5cm in 37.9% and more 5cm in 25.7% in Group 1, and less than 2cm in 46.1%, 2-5cm in 47.1% and more than 5cm in 4.9% in Group 2. Staging according to TNM system showed that stage 2 was 37.8%, stage 1 29.7%, and stage 3 18.9% in Group 1, and stage 2 46.1%, stage 1 36.3%, stage 3 12.3% and stage zero 2.9% in Group 2. The operative procedures performed were 38.5% of radical mastectomy, 34.5% of modified radical mastectomu in Group 1 respectively and 42.2% of modified radical mastectomy 23.0% of simple mastectomy, 20.6% of radical mastectomy and 14.2% of lumpectomy in Group 2 respectively. Conclusions : Analysis of these results shows modified radical mastectomy and simple mastectomy was carried out mainly after 1985. Also lumpectomy with adjuvant treatment is performed in early breast cancer nowadays.

Dexmedetomidine infusion as an anesthetic adjuvant to general anesthesia for appropriate surgical field visibility during modified radical mastectomy with i-gelⓇ : a randomized control study

Kumkum Gupta,Bhawana Rastogi,Prashant K Gupta,Ivesh Singh,Vijendra Pal Singh,Manish Jain 대한마취통증의학회 2016 Korean Journal of Anesthesiology Vol.69 No.6

Background: Modified radical mastectomy is associated with appreciable blood loss, while endotracheal intubation leads to elevated hemodynamic responses. The present study aimed to evaluate the clinical efficacy of dexmedetomidine infusion as an anesthetic adjuvant to general anesthesia during modified radical mastectomy with I-Gel. Methods: Sixty adult consenting female patients, of American Society of Anesthesiologists physical status 1 to 2 and aged 4,065 years, were blindly randomized into two groups of 30 patients each. The patients in Group I received intravenous dexmedetomidine at a loading dose of 1 μg/kg over 10 min, followed by maintenance infusion of 0.4 to 0.7 μg/kg/h, while patients in Group II were administered an identical amount of saline infusion until 15 min prior to the end of surgery. The primary end point was bleeding at the surgical field and hemodynamic changes; requirement of isoflurane, intraoperative fentanyl consumption and recovery time were assessed as secondary outcomes. Results: The patients receiving dexmedetomidine infusion showed significantly less bleeding at the surgical field (P < 0.05). A statistically significant reduction was also observed in the percentage of isoflurane required (0.82 ± 0.80%) to maintain the systolic blood pressure between 100 and 110 mmHg in patients receiving dexmedetomidine infusion compared with the Group II (1.50 ± 0.90%). The mean intraoperative fentanyl consumption in patients in the Group I was also significantly lower compared with that of the Group II (38.43 ± 5.40 μg vs. 75.12 ± 4.60 μg). The mean recovery time from anesthesia did not show any clinically significant difference between the groups. Conclusions: Dexmedetomidine infusion can be used safely to decrease the bleeding at the surgical field with smooth recovery from anesthesia.

사회경제적 위치와 유방암 수술 후 총 사망위험과의 관련성

박미진,정우진,이선미,박종혁,장후선,Park, Mi-Jin,Chung, Woo-Jin,Lee, Sun-Mi,Park, Jong-Hyock,Chang, Hoo-Sun 대한예방의학회 2010 예방의학회지 Vol.43 No.4

Objectives: This study aims to evaluate and explain the socioeconomic inequalities of all-cause mortality after breast cancer surgery in South Korea. Methods: This population based study included all 8868 females who underwent radical mastectomy for breast cancer between January 2002 and June 2003. Follow-up for mortality continued from January 2002 to June 2006. The patients were divided into 4 socioeconomic classes according to their socioeconomic status as defined by the National Health Insurance contribution rate. The relationship between socioeconomic status and all-cause mortality after breast cancer surgery was assessed using the Cox proportional hazards model with adjusting for age, the Charlson’s index score, emergency hospitalization, the type of hospital and the hospital ownership. Results: Those in the lowest socioeconomic status group had a significantly higher hazard ratio of 2.09 (95% CI =1.50 - 2.91) compared with those in the highest socioeconomic group after controlling for all the identifiable confounding variables. For allcause mortality after radical mastectomy, all the other income groups showed significantly higher 3-year mortality rates than did the highest income group. Conclusions: The socioeconomic status of breast cancer patients should be considered as an independent prognostic factor that affects all-cause mortality after radical mastectomy, and this is possibly due to a delayed diagnosis, limited access or minimal treatment leading to higher mortality. This study may provide tangible support to intensify surveillance and treatment for breast cancer among low socioeconomic class women.