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한세환,곽금희,박경미,신은아,김지영,김홍용,김영덕,김홍주,김기환,배병노,양근호,박성진,임승우 한국유방암학회 2010 Journal of breast cancer Vol.13 No.3
Purpose: Axillary lymph node metastasis (ALNM) can occur even in breast cancer smaller than 2 cm in size. This study was performed to investigate the clinicopathologic factors that affect node metastasis in T1 breast cancer. Methods: We reviewed the medical record of 206 T1 breast cancer patients and we divided them into two groups according to the presence or absence of lymph node metastasis. We analyzed the association between ALNM and various clinicopathological predictive factors such as age, tumor size (T1a,T1b, T1c), multiplicity, the histologic grade, the nuclear grade, the presence of lymphovascular invasion (LVI), the estrogen and progesterone receptor status, an HER2/neu expression, the Ki-67 labeling index and the bcl-2 expression. Results: One hundred and thirty-nine were the node negative group (T1N0) and the remaining 67 cases were allotted to the node positive group (T1N1-3). On the univariate analysis, age (p=0.011), LVI (p <0.001), histologic grade (p=0.019), HER2/neu (p<0.005), Ki-67 (p=0.012) and bcl-2 (p=0.026) were the statistically significant predictive factors related to node metastasis. But on the multivariate analysis, LVI (p <0.001) and HER2/neu (p=0.009) were the statistically significant factors related to node metastasis. Conclusion: LVI and HER2/neu overexpression were related to the increased incidence of ALNM in T1 breast cancer patients. LVI was the most predictive factor of ALNM.
양성 및 악성 갑상성 결절의 임상적 특징 및 외과적 치료법에 대한 비교 분석
한세환,배병노,이명수,김홍주,김영덕,김홍용 인제대학교 1996 仁濟醫學 Vol.17 No.2
양성 및 악성 갑상선 결절의 임상적 특성 및 조직형태학적 유형에 따른 임상적 특징과 외과적 치료법의 차이를 후향적으로 분석하였다. 양성 갑상선 결절 103례와 갑상선암 105례를 대상으로 분석한 결과 양성 갑상선 결절은 20대가 호발 연령군이었고 갑상선 암은 30대에서 가장 높은 빈도를 보였다. 남녀 비는 양성 및 악성 결절 모두 8:1로 여자에서 호발하였다. 연령, 성비, 갑상선 스캔의 소견에서 양성 결절과 악성 결절의 유의한 차이를 관찰할 수 없었다. 결절의 감별에 있어서 세침흡인술에 의한 세포 검사가 정확한 수술 전 진단을 가능하게 하였으나 여포성 종양의 경우 결과의 판독에 세심한 주의가 요구되는 것으로 밝혀졌다. 양성 결절에서는 편엽의 전절제술이 주된 수술법이었으나 갑상선암의 경우 보다 적극적인 갑상선전절제술 및 아전절제술이 주된 수술법이었다. 갑상선 암의 조직학적 형태를 분석한 결과 여포성암이 31.4%로 다른 보고에 비하여 상대적으로 많은 특징을 나타냈다. Retrospective clinical analysis was carried out on 208 patients with thyroid nodule. One hundred and three cases had benign nodule and there were 105 cases with thyroid cancer. Patients at their thirties and forties exhibited peak incidence and female predominance was remarkable(8:1). Period of medical management before surgery was variable from 1 month to 3 years. Fine needle aspiration cytology was valuable diagnostic tool but its regiability was limited in follicular neoplasms. Unilateral lobectomy with isthmectomy was the preferred operative procedure in benign disease while total or near total thyroidectomy was undertaken for thyroid cancers. Adenomatous goiter was the most common disease entity of benign thyroid nodule followed by diffuse toxic goiter and follicular adenoma. Larger proportion of follicular carcinoma(31.4%) in thyroid cancer was the remarkable finding in our study.
수술 전 항암화학요법 후 임상적으로 림프절 음성인 환자에서 감시림프절 생검
한세환 한국유방암학회 2007 Journal of breast cancer Vol.10 No.4
Purpose: We wanted to evaluate the accuracy of sentinel lymph node biopsy (SLNB) in patients with clinically negative lymph node after neoadjuvant chemotherapy. Methods: Fifty-nine women underwent 4 cycles of neoadjuvant chemotherapy with epirubicin (75mg/m2) plus docetaxel (75mg/m2), or with doxorubicin (50mg/m2), cyclophosphamide (600mg/m2)and 5-fluorouracil (500mg/m2) for their primary breast cancer. Their median age was 41 years (range: 29-62) and all the tumors were larger than 3 cm in maximum diameter. SLNB was performed 3 min after periareolar injection of 1% isosulfan blue dye. All the patients underwent lymph node dissection at the level 1 and 2 axillary areas irrespective of their nodal status. Results: A clinical response after neoadjuvant chemotherapy was observed in 46 patients (88%) and 11 (18.7%) patients had a complete pathologic response. Thirty-five patients (62.7%) underwent breast conserving surgery. The sentinel lymph node was identified in 96.6% and the median number of sentinel nodes was 3 (range: 1-6). The median number of dissected nodes was 14 (range: 11-47). Metastasis to the lymph node was observed in 56% of the patients. The sentinel lymph node was the only metastatic node in 12 patients. Three patients with a negative sentinel lymph node were confirmed to have metastasis to non-sentinel nodes after the final histologic examination (false negative rate: 9.1%). The overall accuracy of SLNB was 94.7%. Conclusion: SLNB after neoadjuvant chemotherapy was a safe method in patients with clinically negative lymph node.