• Radiation Oncology Journal
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• 제22권1호
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• pp.11-16
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• 2004

목적: 유방 관상피내암 환자들의 유방 보존술 및 방사선 치료 후 생존율과 국소 재발률, 재발 양상 및 국소 재발에 영향을 준 인자들을 분석하고, 적절한 치료법을 결정하고자 하였다. 대상 및 방법: 1995년 6월부터 2001년 12월까지 유방 관상피내암으로 유방 보존술 후 방사선 치료를 받았던 96명의 환자를 대상으로 후향적 분석을 시행하였다. 수술은 국소 절제 또는 광범위 절제가 시행되었고, 일부에서 액와 림프절 곽청술이 시행되었다. 방사선 치료는 전 유방에 50.4 Gy /28회를 조사하였고, 절단면에 종양이 있거나 절단면에서 종양이 가까웠던 경우($\leq$ 2 mm) 일부에서 종양이 있었던 부위에 $10\~14$ Gy를 추가 조사하였다. 전체 환자의 중앙 추적 관찰기간은 43개월($12\~102$개월)이었다. 결과: 5년 국소 무병생존율, 생존율은 각각 $91\%,\;100\%$였다. 국소 재발은 6명($6.3\%$)에서 발생하였고, 이 중 침윤성 유방암으로 재발한 환자는 1명이었다. 수술에서 재발까지의 기간은 1명을 제외하고는 모두 2년 이상이었다. 주위 림프절 재발이나 원격전이는 없었다. 재발한 환자 중 5명은 유방 전절제술 후 무병생존 중이고, 1명은 구제 치료예정이다. 국소 재발에 영향을 준 인자들에 대해 분석했을 때, 연령, 절단면 상태, comedo type, 핵분화도 모두 국소 재발에 영향을 주지 않는 것으로 나타났다. 수술 범위에 따라서도 국소 재발에 차이를 보이지 않았고(p=0.30), 절단면이 종양에서 가까웠던 경우 초기 종양 부위에 추가 조사도 국소 재발에 영향을 주지 않았다(p=1.0). 결론: 유방 관상피내암의 치료로 유방 보존술 및 방사선 치료 시행 후 높은 국소 제어율과 생존율을 얻을 수 있었다. 종양이 절단면을 침범하지 않는 한 절단면과 종양과의 거리와 추가 방사선 조사는 국소 재발에 영향을 주지 않는 것으로 나타났으나 향후 더 많은 환자로 장기적인 추적관찰이 필요할 것으로 생각된다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권1호
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• pp.55-60
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• 2014

Background: Whether sentinel lymph node biopsy (SLNB) should be performed in patients with pure ductal carcinoma in situ (DCIS) of the breast has been a question of debate over the last decade. The aim of this study was to identify factors associated with microinvasive disease and determine the criteria for performing SLNB in patients with DCIS. Materials and Methods: 125 patients with DCIS who underwent surgery between January 2000 and December 2008 were reviewed to identify factors associated with DCIS and DCIS with microinvasion (DCISM). Results: 88 patients (70.4%) had pure DCIS and 37 (29.6%) had DCISM. Among 33 DCIS patients who underwent SLNB, one patient (3.3%) was found to have isolated tumor cells in her biopsy, whereas 1 of 14 (37.8%) patients with DCISM had micrometastasis (7.1%). Similarly, of 16 patients (18.2%) with pure DCIS and axillary lymph node dissection (ALND) without SLNB, none had lymph node metastasis. Furthermore, of 20 patients with DCISM and ALND, only one (5%) had metastasis. In multivariate analysis, the presence of comedo necrosis [relative risk (RR)=4.1, 95% confidence interval (CI)=1.6-10.6, P=0.004], and hormone receptor (ER or PR) negativity (RR=4.0, 95%CI=1.5-11, P=0.007), were found to be significantly associated with microinvasion. Conclusions: Our findings suggest patients presenting with a preoperative diagnosis of DCIS associated with comedo necrosis or hormone receptor negativity are more likely to have a microinvasive component in definitive pathology following surgery, and should be considered for SLNB procedure along with patients who will undergo mastectomy due to DCIS.

• Clinical Endoscopy
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• 제56권3호
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• pp.353-366
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• 2023

Background/Aims: This study aimed to clarify the efficacy and safety of pancreatic duct lavage cytology combined with a cell-block method (PLC-CB) for possible pancreatic ductal adenocarcinomas (PDACs). Methods: This study included 41 patients with suspected PDACs who underwent PLC-CB mainly because they were unfit for undergoing endoscopic ultrasonography-guided fine needle aspiration. A 6-Fr double lumen catheter was mainly used to perform PLC-CB. Final diagnoses were obtained from the findings of resected specimens or clinical outcomes during surveillance after PLC-CB. Results: Histocytological evaluations using PLC-CB were performed in 87.8% (36/41) of the patients. For 31 of the 36 patients, final diagnoses (invasive PDAC, 12; pancreatic carcinoma in situ, 5; benignancy, 14) were made, and the remaining five patients were excluded due to lack of surveillance periods after PLC-CB. For 31 patients, the sensitivity, specificity, and accuracy of PLC-CB for detecting malignancy were 94.1%, 100%, and 96.8%, respectively. In addition, they were 87.5%, 100%, and 94.1%, respectively, in 17 patients without pancreatic masses detectable using endoscopic ultrasonography. Four patients developed postprocedural pancreatitis, which improved with conservative therapy. Conclusions: PLC-CB has an excellent ability to detect malignancies in patients with possible PDACs, including pancreatic carcinoma in situ.

• 대한의용생체공학회:의공학회지
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• 제18권4호
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• pp.357-364
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• 1997

유방암은 그 조기 발견이 암환자의 사망률을 줄이는 데 있어서 가장 중요한 요소임을 알려져 있다. 스크리닝 검사에 의해 발견되는 유방암의 20%정도를 차지하는 DCIS(ductal carcinoma in situ)의 경우 미세석회화만이 필름 상에서 볼 수 있는 유일한 소견이다. 따라서 미세석회화를 발견하고 그 형태와 분포의 분석을 통한 진단이 암의 조기 발견에 매우 중요하다. 이 검출과정을 자동화하려는 시도가 디지털 영상처리 기술의 관심이 되어 왔다. 본 연구에서는 상관계수를 특징(feature)으로 사용하여 성능을 향상시킨 통계적 패턴 분류법을 제안하였다. 결과적인 검출율은 통계적 문턱치 설정에 의한 이진호 방법과 비교하여 48%에서 83%로 향상되었다. 성능은 TP와 FP로 평가되었으며 클래스 구분시의 오차도 함께 나타내었다.

• Asian Pacific Journal of Cancer Prevention
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• 제17권5호
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• pp.2673-2678
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• 2016

Background: It is unclear as to whether the size ratio elastographic technique is useful for assessing ultrasound-detected ductal carcinoma-in-situ (DCIS) masses since they commonly lack a significant desmoplastic reaction. The objectives of this study were to determine the accuracy of this elastographic technique in DCIS and examine if there was any histopathological correlation with the grey-scale strain patterns. Materials and Methods: Female patients referred to the radiology department for image-guided breast biopsy were prospectively evaluated by ultrasound elastography prior to biopsy. Histological diagnosis was the gold standard. An elastographic size ratio of more than 1.1 was considered malignant. Elastographic strain patterns were assessed for correlation with the DCIS histological architectural patterns and nuclear grade. Results: There were 30 DCIS cases. Elastographic sensitivity for detection of malignancy was 86.7% (26/30). 10/30 (33.3%) DCIS masses demonstrated predominantly white elastographic strain patterns while 20/30 (66.7%) were predominantly black. There were 3 (10.0%) DCIS masses that showed had a co-existent bull's-eye sign and 7 (23.3%) other masses had a co-existent toothpaste sign, a strain pattern that has never been reported in the literature. Four out of 4/5 comedo DCIS showed a predominantly white strain pattern (p=0.031) while 6/7 cases with the toothpaste sign were papillary DCIS (p=0.031). There was no relationship between the strain pattern and the DCIS nuclear grade. Conclusions: The size ratio elastographic technique was found to be very sensitive for ultrasound-detected DCIS masses. While the elastographic grey-scale strain pattern should not be used for diagnostic purposes, it correlated well with the DCIS architecture.

• 한국정보과학회:학술대회논문집
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• 한국정보과학회 2001년도 가을 학술발표논문집 Vol.28 No.2 (2)
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• pp.340-342
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• 2001

본 논문은 유방질환 중에서 Duct(관)에 발생하는 유방 종양을 benign(양성종양)/DCIS (Ductal Carcinoma In Situ)/NOS(Invasive ductal carcinoma)로 자동 분류하기 위한 분류방법을 제안한다. 분류기 생성에서 가장 중요한 단계인 특징 추출단계에서는 wavelet 변환을 적용하였으며, wavelet 변환의 각 depth에 따라 분류기를 생성하여, depth와 생성된 분류기의 분류 정확도와의 상관관계를 비교.분석하였다. 현미경 100배 배율과 400배 배율의 유방 질환 영상을 1, 2, 3, 4단계(depth)의 wavelet 변환을 적용한 후, 분할된 서브밴드에서 GLCM을 이용하여 질감 특징(Entropy, Energy, Contrast, Homogeneity)을 추출하여, 이 특징값들을 조합하여 판별분석에 의해 분류기(classifier)를 생성한 후, 분류 정확도를 검증하였다. Benign/DCIS/NOS를 분류하려면 최소 3단계 이상의 wavelet 변환을 적용해야 하고, 400배 배율 영상보다는 100배 배율의 영상이 더 나은 결과를 보였다.

• 융합신호처리학회논문지
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• 제2권4호
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• pp.22-30
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• 2001

본 논문은 유방질환 중에서 유관(duct )에 발생하는 유방종양을 Benign, DCIS(ductal carcinoma in situ) NOS (invasive ductal carcinoma)로 분류하기 위해 3가지 분류기 (classifier) 를 생성한 후, 비교 분석하였다. 분류기 생성에서 가장 중요한 단계인 특징 추출 단계에서 세포핵의 기하학적 특징을 형태학적 특징을 추출하여 분류기를 생성하고 염색질 패턴의 내부적 변화를 나타내는 질감 특징을 추출하여 2가지 배율(100/400배)에서 2개의 분류기를 생성하였다. 400배 배율의 유방질환 영상에서 세포핵을 추출하여 핵의 형태학적 특징값인 핵의 면적, 둘레. 가로, 세로(장. 단축) 의 길이, 원형성의 비율을 구한 후 이 특징값들을 조합하여 판별분석에 의해 분류기를 생생하고, 분류 정확도를 검증하였다. 100배 배율과 400배의 배율의 유방질환 영상에서 1, 2, 3, 4 단계(level)의 wavelet 변환를 적용한 후, 분할된 서브밴드에서 GLCM(Gray Level Co-occurrence Matrix)을 이용하여 질감 특징(entropy Energy, Contrast, Homogeneity)를 추출하고, 이 특징값들을 조합하여 판변 분석에 의해 분류기를 생성한 후 분류 정확도를 검증하였다. 이 세 분류기를 비교 분석 하였을때 현민경 100배 배율의 영상을 3단계 wavelet 변환을 적용하고 질감 특징을 추출하여 생성한 분류기가 다른 두 분류기보다 유방 질환 Benign, DCIS; NOS를 분류하는데 더 나은 결과를 보였다.

• Asian Pacific Journal of Cancer Prevention
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• 제17권5호
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• pp.2593-2596
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• 2016

Background: Male breast cancer (MBC) is a rare disease that accounts for less than 1% of all cancers in men and less than 1% of all diagnosed breast cancers. In this study, we retrospectively evaluated the clinicopathological features, treatment options and overall survival in Kurdish MBC cases. Materials and Methods: Seventeen MBC were referred to Department of Radiation Oncology in Imam Reza Hospital, Kermanshah, Iran, between 2010 and 2016. Immunohistochemical analysis was performed for ER, PR and Her2 biomarkers and FISH for those with Her2 2+. Median follow-up period was 30 months (2-65 months). We excluded from the study patients who did not have follow-up after initial diagnosis. Treatment methods were chemotherapy, radiotherapy, hormonal therapy, target therapy and palliative care. Survival was estimated by the Kaplan Meier method (Prism 5). Results: The mean age at diagnosis was $49.24{\pm}17$ years (range, 24-85 years). Grade II was the most grade in MBC (65%). Fourteen patients (82%) had invasive ductal carcinoma, one (6%) had ductal carcinoma in situ and 2 (12%) had invasive papillary. ER, PR and Her2 were significantly positive in 14/17, 8/17 and 2/17 cases, respectively. The treatment included modified radical mastectomy for most patients. Chemotherapy with TAC and CEF regimens was delivered to 15/17 cases. Tamoxifen therapy was delivered to 14/17 cases. Three stage IV patients received Avestin and two with Her2 3+ were given Trastuzumab (Herceptin). Patients received adjuvant radiotherapy following surgery and chemotherapy. The site of metastasis was the bone in 2 cases, lung in 1 case and liver in 1 case. Zoledronic acid (Zometa) was prescribed for patients with bone metastasis. Five-year overall survival rate was 64%. Conclusions: MBC is rare. Thus, we need larger studies are in collaboration with several research centers in the field of breast cancer. ER positive, grade II of invasive ductal carcinoma, stage II and right side happened more with MBC. Overall survival is similar to other studies.

• Asian Pacific Journal of Cancer Prevention
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• 제14권12호
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• pp.7381-7383
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• 2013

Background: Male breast cancer accounts for less than 1% of all cancer in men and only around 1% of all diagnosed breast cancer. Despite a significant raise in the last 25 years, it still remains a rare disease. Materials and Methods: We conducted a retrospective study from 2004-2011 with 21 male breast cancer patients. We aimed to analyze the epidemiologic data (age, personal and family history), tumor characteristics (size, histological type, location, TNM stage, receptors), surgery, adjuvant chemotherapy and radiation therapy, hormonal therapy and survival (relapse, follow up, death) who reffered to our center with breast cancer. Results: The median age was $49.2{\pm}14.2$ years (range 30-83 years). A family history of breast cancer was noted in four cases. The main clinical complaint was a retroareolar mass in 85.7%of patients (n=18). Histologically, 85.7% (n=18)were invasive ductal carcinoma and 4.7% (n=1) had ductal carcinoma in situ and 9.4% (n=2) had mixed histology including invasive medullary and ductal carcinoma. Hormonal therapy was delivered to 16 cases (76.1%) due to ER or PR positivity. During median follow up of 30 months (3-84 month), distant metastases were evident in 4 cases (19%). During the follow-up period, only one patient died due to metastatic disease. The mean time to recurrence detection was 30 months. Conclusions: The percentage of cases of male breast cancer is very low compared to breast cancer in females, explaining why very few investigations have been conducted in Iran. Limited coverage in the literature make gender-specific findings difficult so future research of this entity involving multi-institutional cooperation and longer follow up is essential to provide new insights about the biological and clinical factors of this rare cancer.

• Asian Pacific Journal of Cancer Prevention
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• 제16권12호
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• pp.4863-4867
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• 2015

Background: Triple negative breast cancer (TNBC), characterized as estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 Her2 negative and accounting for 10-17% of all breast carcinomas, is only partially responsive to chemotherapy and suffers from a lack of clinically established targeted therapies. The aim of the current study was to evaluate the patterns of treatment and clinicopathology figures in Kurdish patients with triple-negative breast cancer, and to compare these to other reports. Materials and Methods: Between 2001 and 2014, 950 breast cancer patients were referred to our clinic. There were 74 female patients with TNBC, including 70 patients was invasive ductal carcinoma entered into our study. ER and PR positivity was defined as positive immunohistochemical staining in more than 10% of tumor cells. Immunohistochemistry assay with anti-HER2 antibodies was used to identify HER negative (0 and 1+) or positive (2+ and 3+). HER2 gene amplification was determined by fluorescent in situ hybridization (FISH). Overall survival (OS) was plotted with GraphPad Prism 5 Software using Kaplan-Meier and log-rank tests for comparison of results. Results: The mean age in the first diagnosis for 70 patients with triple TNBC and invasive ductal carcinoma was 49.6 years that range of age was 27-82 years. All of the patients were female. Of 70 patients, 23 patients had metastasis. Thirty-two patients (45.7%) were treated with tamoxifen and 39 (55.7%) with radiotherapy. Three-year, 5-year and 10-year OS rates for all patients were 82%, 72% and 64%, respectively. Conclusions: The OS in our West Iran TNBC patients is less than reported elsewhere. However, treatment with combination of tamoxifen plus radiation increases the OS and reduces the mortality rate.