• Asian Pacific Journal of Cancer Prevention
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• 제17권12호
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• pp.5309-5314
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• 2016

Background: Breast cancer is the most common type of cancer amongst women throughout the world. Currently, there are various follow-up strategies implemented in Iran, which are usually dependent on clinic policies and agreement among the resident oncologists. Purpose: A cost-effectiveness analysis was performed to assess the cost-effectiveness of intensive follow-up versus standard models for early breast cancer patients in Iran. Materials and methods: This cross sectional study was performed with 382 patients each in the intensive and standard groups. Costs were identified and measured from a payer perspective, including direct medical outlay. To assess the effectiveness of the two follow-up models we used a decision tree along with indicators of detection of recurrence and metastasis, calculating expected costs and effectiveness for both cases; in addition, incremental cost-effectiveness ratios were determined. Results: The results of decision tree showed expected case detection rates of 0.137 and 0.018 and expected costs of US$24,494.62 and US$6,859.27, respectively, for the intensive and standard follow-up models. Tornado diagrams revealed the highest sensitivity to cost increases using the intensive follow-up model with an ICER=US$148,196.2. Conclusion: Overall, the results showed that the intensive follow-up method is not cost-effective when compared to the standard model.

• BMB Reports
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• 제52권3호
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• pp.214-219
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• 2019

The role of tumor-proximal factors in tumor plasticity during chemoresistance and metastasis following chemotherapy is well studied. However, the role of endothelial cell (EC) derived paracrine factors in tumor plasticity, their effect on chemotherapeutic outcome, and the mechanism by which these paracrine factors modulate the tumor microenvironment are not well understood. In this study, we report a novel mechanism by which endothelial miR-125a and let-7e-mediated regulation of interleukin-6 (IL-6) signaling can manipulate vasculogenic mimicry (VM) formation of MDA-MB-231 breast cancer cells. We found that endothelial IL-6 levels were significantly higher in response to cisplatin treatment, whereas levels of IL-6 upon cisplatin exposure remained unchanged in MDA-MB-231 breast cancer cells. We additionally found an inverse correlation between IL-6 and miR-125a/let-7e expression levels in cisplatin treated ECs. Interestingly, IL-6, IL-6 receptor (IL-6R), and signal transducer and activator of transcription 3 (STAT3) genes in the IL-6 pathway are closely regulated by miR-125a and let-7e, which directly target its 3' untranslated region. Functional analyses revealed that endothelial miR-125a and let-7e inhibit IL-6-induced adhesion of monocytes to ECs. Furthermore, conditioned medium from cisplatin treated ECs induced a significantly higher formation of VM in MDA-MB-231 breast cancer cells as compared to that from intact ECs; this effect of cisplatin treatment was abrogated by concurrent overexpression of miR-125a and let-7e. Overall, this study reveals a novel EC-tumor cell crosstalk mediated by the endothelial miR-125a/let-7e-IL-6 signaling axis, which might improve chemosensitivity and provide potential therapeutic targets for the treatment of cancer.

• Investigative Magnetic Resonance Imaging
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• 제26권2호
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• pp.135-149
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• 2022

Purpose: To assess clinically significant imaging findings of malignant intramammary lymph nodes (IMLNs) in breast cancer patients and to evaluate their diagnostic performance in predicting malignant IMLN. Materials and Methods: A total of 110 cases with IMLN of BI-RADS category 3 or more, not typical benign IMLN, in MR of breast cancer patients between January 2016 and January 2021 were retrospectively reviewed. After excluding 33 cases, 77 cases were finally included. Among them, 58 and 19 were confirmed as benign and malignant, respectively. Qualitative and quantitative MR imaging features of the IMLN were retrospectively analyzed. Sizes and final assessment categories of IMLN on MRI, mammography, and ultrasound were reviewed. Diagnostic performances of imaging features on MRI, mammography, and ultrasound were then evaluated. Results: For qualitative MR features, shape, margin, and preserved central hilum were significantly different between benign and malignant groups (P < 0.05). For quantitative MR features, long diameter over 6 mm, short diameter over 4 mm, and cortical thickening over 3 mm showed high sensitivities in predicting malignant IMLNs (89.5%, 94.7%, and 100%, respectively). Size exceeding 1 cm showed high specificity and accuracy in predicting malignant IMLN on MR, mammography, and ultrasound (91.4% and 80.5%; 96.6% and 79.25; 98.3% and 80.5%, respectively). Conclusion: Various MR imaging features and size can be helpful for predicting malignant IMLN in breast cancer patients.

• 대한영상의학회지
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• 제82권4호
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• pp.1000-1004
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• 2021

경피적 흉부 생검은 폐 병변을 병리학적으로 진단하는 데 있어서 필수적인 최소 침습 시술이다. 매우 드물기는 하지만 흉막과 흉벽에 종양의 파종이 경피적 흉부 생검의 합병증으로 생길 수 있다. 유방은 흉곽의 앞쪽에 위치하기 때문에 경피적 흉부 생검 시 흉곽의 앞쪽에서 접근할 때 바늘이 유방을 지나는 것을 피할 수 없는 경우가 있다. 이에 저자들은 유방의 만져지는 종괴로 내원한 51세 여성에서 경피적 흉부 생검 경로를 따라 생긴 전이성 폐 법랑모세포종의 파종을 경험하였기에 영상 소견과 함께 증례 보고한다.

• Korean Journal of Radiology
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• 제24권7호
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• pp.626-639
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• 2023

Objective: To investigate the association of clinical, pathologic, and magnetic resonance imaging (MRI) variables with progressive disease (PD) during neoadjuvant chemotherapy (NAC) and distant metastasis-free survival (DMFS) in patients with triple-negative breast cancer (TNBC). Materials and Methods: This single-center retrospective study included 252 women with TNBC who underwent NAC between 2010 and 2019. Clinical, pathologic, and treatment data were collected. Two radiologists analyzed the pre-NAC MRI. After random allocation to the development and validation sets in a 2:1 ratio, we developed models to predict PD and DMFS using logistic regression and Cox proportional hazard regression, respectively, and validated them. Results: Among the 252 patients (age, 48.3 ± 10.7 years; 168 in the development set; 84 in the validation set), PD was occurred in 17 patients and 9 patients in the development and validation sets, respectively. In the clinical-pathologic-MRI model, the metaplastic histology (odds ratio [OR], 8.0; P = 0.032), Ki-67 index (OR, 1.02; P = 0.044), and subcutaneous edema (OR, 30.6; P = 0.004) were independently associated with PD in the development set. The clinical-pathologic-MRI model showed a higher area under the receiver-operating characteristic curve (AUC) than the clinical-pathologic model (AUC: 0.69 vs. 0.54; P = 0.017) for predicting PD in the validation set. Distant metastases occurred in 49 patients and 18 patients in the development and validation sets, respectively. Residual disease in both the breast and lymph nodes (hazard ratio [HR], 6.0; P = 0.005) and the presence of lymphovascular invasion (HR, 3.3; P < 0.001) were independently associated with DMFS. The model consisting of these pathologic variables showed a Harrell's C-index of 0.86 in the validation set. Conclusion: The clinical-pathologic-MRI model, which considered subcutaneous edema observed using MRI, performed better than the clinical-pathologic model for predicting PD. However, MRI did not independently contribute to the prediction of DMFS.

• 대한영상의학회지
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• 제84권2호
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• pp.460-466
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• 2023

일반적으로 신경내분비암은 소화기나 호흡기에서 발생하고 그 외 장기에서 발견되는 경우는 전이에 의한 경우가 많다. 유방에서 원발성 신경내분비암종은 매우 드물게 발생하여 정확한 임상양상, 영상의학적 소견, 치료와 예후에 대해 잘 알려져 있지 않다. 또한 지금까지 발표된 문헌 보고는 소수에 불과하다. 본 증례에서는 51세 여자의 유방에서 보인 원발성 신경내분비 암종에 대한 영상 소견을 문헌고찰과 함께 보고하고자 한다.

• 대한핵의학회지
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• 제38권4호
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• pp.311-317
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• 2004

목적 : 유방암 환자에서 근치적 유방 절제술 후 재발의 발견에 대한 CA 15-3의 역할을 평가하고 재발된 환자에서 전이 부위에 따른 CA 15-3의 관계를 비교하였다. 대상 및 방법 : CA 15-3 값이 측정된 환자 중 원발성 유방암으로 근치적 유방 절제술을 시행 받았으며 분석하고자 하는 모든 임상적, 병리학적 인자에 대한 정보가 의무 기록에 기재되고 최소한 3개월간 외래 추적이 가능하였던 202명을 대상으로 분석하였다. CA 15-3은 IRMA 15-3 키트(CIS BIO INTERNATIONAL, France)로 정량적으로 측정하여 정상 상한값을 30 U/ml으로 정하였다. 결과: 근치적 유방 절제술 후 재발을 진단하는 CA 15-3의 진단 성적은 예민도 31%(5/16), 특이도 100%(186/186), 양성 예측도 100%(5/5), 음성 예측도 94%(186/197)이었다. 재발 환자에서 전이 부위에 따른 CA 15-3의 진단 성적을 비교하면 간전이가 관찰된 환자의 CA 15-3값은 모두 상승하여 간전이의 진단에 대한 CA 15-3의 예민도는 100%로 매우 좋았다. 그러나 골전이 또는 국소지역전이만 관찰된 환자의 CA 15-3 값은 정상으로 골전이 또는 국소지역전이의 진단에 대한 CA 15-3 검사는 유용하지 않았다. 결론: 유방암 환자에서 근치적 유방 절제술 후 재발의 발견에 대한 CA 15-3의 진단 성적은 매우 좋은 특이도를 보였으나 예민도는 낮았다. 그러나 비교적 예후가 불량하다고 알려진 간전이로 첫 재발한 환자의 CA 15-3 값은 모두 증가되어 유방암 환자에서 CA 15-3의 측정은 간전이 발견에 매우 유용하였다.

• 대한핵의학회지
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• 제34권6호
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• pp.478-486
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• 2000

목적: 조직 검사에서 유방암으로 확진된 환자 15명 (평균 연령 50.4세)을 대상으로 수술 전에 시행한 유방림프신티그라피(lymphoscintigraphy)와 수술 중 감마프로우브를 이용하여, 림프관 유입형태 및 전초림프절(sentinel lymph node)을 찾아, 전초 및 액와림프절을 각각 절제, 생검하여, 전초 림프절의 림프신티그라피 발현율, 전초림프절 전이와 액와림프절 전이의 상관 관계 등을 보고자 하였다. 대상 및 방법: 환자의 임상병기는 병기 I-II 이었고, 4례에서 액와림프절이 촉지되었다. 침습성 관암 13명, 수질암 및 포도당 풍부암이 각각 1명씩이었다. 유방림프신티그라피는 다음과 같이 시행하였다. 방사성의약품 Tc-99m antimony sulfide colloid $30{\sim}37MBq$을 총 0.4 ml 용량으로 만들어, 원발 종괴에서 $2{\sim}3mm$ 떨어진 위치의 12, 3, 6, 9시 방향에 각각 0.1 ml를 피내 주사하고 약 2분 동안 마사지하였다. 저에너지, 고해상도 평행 조준기를 이용하여 초기 동적 영상(10 sec/frame)을 10분간 시행하였으며, 이어서 5분 간격으로 $30{\sim}60$분에 걸쳐 초기 정적영상을 얻었고, 주사 후 2시간에 지연영상을 획득하였으며, 각각의 영상을 비교하여 전초림프절과 유입 림프관을 확인하였다. 유방림프신티그라피검사가 끝나면 즉시 수술실로 옮겨 전초림프절이라고 판독된 부위를 감마프로우브로 찾아 림프절의 계수와 배후 방사능을 측정하였고, 이 부위를 절개하여 조직을 떼어내 표지하고 생검하였으며, 그 외에 배후 방사능보다 높은 계수를 보인 부위가 있으면 따로 표지하여 조직 검사를 하였다. 모든 환자에서 원발 종양의 절제술과 액와림프절 절제술을 시행하였다. 결과: 전체 환자 15명 가운데 14명에서 유방림프신티그라피 및 수술 중 감마 프로우브로 전초림프절이 발견되었다(전초 림프절 검출율: 93.3%). 유방림프신티그라피로 발견된 평균 전초림프절수는 $2.47{\pm}2.00$개였으며, 감마프로우브를 이용하여 수술로 절제된 평균 전초림프절 수는 $2.36{\pm}1.96$개였다. 초기 동적 유방림프신티그라피에서 전초림프절로 유입되는 림프관이 총 15명 중 3명에서 관찰 할 수 있었으며(20%), 3명에서는 전초림프절이 2시간 지연 영상에서만 발견되었다(20%). 유방림프신티그라피에서 전초림프절이 나타난 시간은 평균 $33.4{\pm}48.4$분이었다. 전초림프절의 조직 생검 결과 14명 가운데 7명의 전초림프절에서 전이 소견이 관찰되었고(50%), 이 중 5명 환자의 액외림프절에서 전이가 보였다(예민도: 71.2%). 그러나 전초림프절에 전이가 있었던 7명 가운데 2명은 액와림프절에서 전이 소견은 관찰되지 않았다. 전초림프절에 전이가 없었던 7명 환자에서는 모두 액와림프절에서도 전이 소견을 관찰 할 수 없었다(특이도: 100%). 유방림프신티그라피 및 수술 중 감마프로우브로 전초림프절을 발견 할 수 없었던 1명에서 액와절제술 후 액와림프절 조직에서 림프절에 전이가 관찰되었다. 결론: 따라서 유방암 환자에서 유방림프신티그라피와 수술 중 감마프로우브를 이용한 전초림프절 생검은 액와림프절 전이 평가에 있어 높은 예민도와 특이도를 나타내므로 불필요한 액와림프절 절제술을 줄이는데 도움이 될 것이다.

• 성인간호학회지
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• 제14권1호
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• pp.135-143
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• 2002

Purpose: To explore what particular types of information were important to patients diagnosed with cancer. Methods: Seventy three patients with cancer at an outpatient clinic and hospitalized patients in W Christian Hospital Korea, responded. The structured questionnaire developed by the investigator based on previous studies. Results: There was a significant negative relationship between age and the score of informational need (r=-.307, p<.05). Level of education, and level of monthly income were related to level of informational need. The top three informational priorities according to the time since diagnosis were 'Self care during treatment', 'Health food and diet', 'Likelihood of recurrence', 'Follow up care' and 'Side effects'. The top three informational priorities for patients with breast cancer were 'Likelihood of recurrence', 'Metastasis possibility', 'Treatment options', and 'Side effects. For patients with stomach cancer, they were 'Follow up care', 'Healthy food and diet', 'Likelihood of recurrence', and 'Metastasis possibility', and for patients with colon/rectal cancer, they were 'Side effects', 'Healthy food and diet', 'Likelihood of recurrence', and 'Self care during treatment'. Conclusion: The assessment of information needs based on demographic factors and disease-related factors is critical in helping patients with cancer to manage their illness.

• Biomolecules & Therapeutics
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• 제22권6호
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• pp.540-546
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• 2014

The high mortality rates associated with cancer reflect the metastatic spread of tumor cells from the site of their origin. Metastasis, in fact, is the cause of 90% of cancer deaths. Therefore, considerable effort is being made to inhibit metastasis. In the present study, we screened ketotifen for anti-migratory and anti-invasive activities against MDA-MB-231 breast cancer and HT-1080 fibrosarcoma cancer cells. Cancer cell migration and invasion were measured using multi-well chambers. Additionally, western blots were used to examine the effects of ketotifen on the expressions of CDC42, Rho, Rac, and matrix metalloproteinase 9 (MMP-9). The results showed that ketotifen dose-dependently suppressed the migration and invasion of MDA-MB-231 and HT-1080 cells. Ketotifen also suppressed the expressions of CDC42, Rac, and Rho, which, significantly, are involved in MDA-MB-231 and HT-1080 cancer cell migration. Moreover, ketotifen suppressed the expression and activity of MMP-9, which is involved in degradation of the extracellular matrix leading to invasion. The overall data suggested that ketotifen suppresses the migration and invasion of MDA-MB-231 and HT-1080 cancer cells via inhibition of CDC42, Rac, Rho, and MMP-9 expression.