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Purpose The objective of this study was to investigate the outcomes of selected patients with breast cancer liver metastases (BCLM) without extrahepatic metastases after hepatic resection. Methods Patients whose imaging findings did not show extrahepatic disease were selected for hepatic resection. If R0 resection was available and the operative risk was low in preoperative tests, the patients underwent surgery. Results Between 2011 and 2014, six patients underwent hepatic resection for BCLM. All patients received hepatic resection to achieve an R0 resection. The time interval between initial detection of breast cancer and that of liver metastases in the patients, excluding one patient with synchronous metastases, was 55.2 months. Major liver resection was performed in four patients. Differences were observed in the hormone receptor status between the primary breast tumor and liver metastases; however, no difference was observed in the human epidermal growth factor receptor 2 status. The 1-year and 3-year overall survival rates after hepatic resection were 100% and 83.3%, respectively. The 1-year and 3-year disease free survival rates after hepatic resection were 66.7% and 50.0%, respectively. Conclusion Curative resection may be considered as one of the multimodality treatments for BCLM. It shows benefit in selected patients; its selection criteria needs to be investigated.

Purpose: The aim of this study is to verify the feasibility of the 5th, 6th, and 7th editions of AJCC staging system by analyzing the 10-year overall survival (OS) and disease-free survival (DFS) of breast cancer patients according to the each editions of American Joint Committee on Cancer (AJCC) staging system that staged by 5th and 6th editions of AJCC staging system. Methods: A total of 419 breast cancer patients were analyzed who had received initial treatment between 1998 and 2003 at Pusan National University Hospital. Patients were restaged using 5th, 6th, and 7th editions of AJCC staging system with retrospective data and 10-year OS and DFS analysis were performed. Results: The mean age of patients was 51 years old and the mean follow-up period was 138 months. Ten-year OS was 89.9% and DFS was 88.3%. Ten-year DFS was affected significantly by the tumor size, lymph node metastasis, differentiation of tumor, lymphovascular invasion, HER2 gene and triple negative breast cancer. The stage of breast cancer according to the 5th, 6th, and 7th edition of AJCC staging system and the each T and N stage of breast cancer was statistically significant in 10-year OS and DFS. Although the significance was confirmed between 10-year DFS in each edition, higher significance were found in more recent edition. Conclusion: Restaging and predict prognosis based on 7th edition of AJCC staging system would be helpful to patients who had been previously staged based on 5th or 6th system.

Purpose: To determine and predict P-glycoprotein (Pgp) and multidrug-resistance-related protein (MRP) expression in untreated breast cancer patients by visual and quantitative indices of double-phase 99mTc MIBI scintimammography (DSMM). Patients and Methods: Eighty-two patients with untreated breast cancer received DSMM. Pgp and MRP expression was assessed by immunohistochemical (IHC) staining of surgical specimens. Visual and quantitative analyses were compared with the results of IHC to determine and predict Pgp and MRP. Results: The early and delayed tumor to normal tissue ratio (T/N) of the Pgp-negative and MRP-negative group had significantly higher values than those of the Pgp-positive and MRP-positive group. However, there were no statistically significant differences in washout rate (WR, in %) according to the expression of Pgp and MRP. The optimal T/N ratios were ≤2.23 for early and ≤1.75 for delayed image for Pgp expression and ≤2.45 for early and ≤1.96 for delayed image for MRP expression. The optimal visual grades of DSMM for the determination of Pgp and MRP expression were ≤3. With logistic regression analysis, potent predictors of DSMM were visual assessment for Pgp expression and early T/N for MRP expression. Conclusion: In conclusion, despite a moderate sensitivity and specificity, visual and quantitative indices of DSMM could be used to determine and predict Pgp and MRP expression in untreated breast cancer. However, these findings need confirmation in a larger patient cohort to enable a better validation of Pgp and MRP expression to determine optimal early and delayed T/Ns and to investigate predictors of Pgp and MRP expression in breast cancer. Copyright © 2006 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Tc-99m MIBI scintimammography (SMM) is known to be a useful diagnostic tool for primary breast cancer. We conducted this study to establish optimal visual grades for the detection of primary breast cancer and to investigate whether the quantitative indices of double phase SMM could provide incremental diagnostic value additive to visual analysis.Methods. Five hundred and twenty highly suspected breast cancer patients (malignant: 370; benign: 150) were included in this study. Double phase Tc-99m MIBI SMM (early: 10 min; delayed: 3 h) was performed after injection of 750 MBq of Tc-99m MIBI. For visual analysis, five scoring method was used. The early and delayed lesion to non-lesion ratios (L/N) and retention index (RI) were calculated. Receiver operating characteristic curve (ROC) analyses was performed to determine the optimal visual grade, to calculate cut-off value of quantitative indices for differentiation malignant and benign diseases and to investigate whether the quantitative indices could provide incremental diagnostic value additive to visual analysis. To investigate the incremental diagnostic value of quantitative index in variable tumor size groups, the patients were subdivided into four groups (group A: size ≤ 1 cm, group B: 1 cm < size ≤ 3 cm, group C: 3 cm < size ≤ 5 cm, group D: size > 5 cm).Results. When over visual grade 3 was used as the cut-off grade for the diagnosis of breast cancer, the sensitivity and specificity were 75.5, 86.4%, respectively. Early L/N of malignant breast disease was significantly higher than that of benign (2.00 ± 1.88 vs. 0.60 ± 0.7; p < 0.01). However, delayed L/N and RI had no significant difference between malignant and benign breast diseases. When early L/N of 1.27 was used as the cut-off value, the sensitivity and specificity of SMM were 77.6, 83.3%, respectively. When the early L/N was added to visual grade, the area under curve (AUC) of visual + quantitative analysis (V + Q) was higher than that of visual anlysis (V) alone (AUC 0.893 vs. 0.803; p < 0.01). In group A, the AUC of V + Q was higher than that of V alone (0.843 vs. 0.808; p = 0.029). In group B, the AUC of V + Q was also higher (0.913 vs. 0.781; p < 0.01). However, in groups C and D, the AUCs of V + Q and V were not different (0.926 vs. 0.915; p = 0.144: 0.663 vs. 0.570; p = 0.093). For axillary lymph node involvement, the sensitivity, specificity, and of SMM were 66.9, 70.1, and 68%, respectively.Conclusion. From this study, the optimal visual interpretation grades for diagnosis of breast cancer were grades 4 and 5 and cut-off value of early L/N was 1.27. Also, we found that delayed image was not required for breast cancer detection and quantitative index of early L/N provide incremental diagnostic value additive to visual analysis. Especially, when the tumor is small (size ≤ 3 cm), the early L/N should be obtained for the diagnosis of breast cancer. [ABSTRACT FROM AUTHOR]