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We conducted this single-center, retrospective study to identify predictors of upgrading to malignancy and to discuss the necessity of additional excision biopsy in patients who were diagnosed with atypical ductal hyperplasia (ADH) at ultrasound (US)-guided vacuum-assisted breast biopsy (VABB) based on our 18-year, single-center experience.The current study was conducted in a total of 12,160 patients who were evaluated at our medical institution during an 18-year period between January of 2003 and December of 2020. We included the patients who were diagnosed with ADH at US-guided VABB using the MammotomeOf 114 eligible patients, 36 underwent additional excision biopsy and the remaining 78 did not. Of these 36 patients, 15 were found to have an upgrading to malignancy at a rate of upgrading of 41.7%. These include 7 cases (46.6%) of low-grade ductal carcinoma in situ (DCIS), 3 cases (20.0%) of intermediate grade DCIS, 1 case (6.7%) of microinvasive DCIS, 3 cases (20.0%) of multifocal lobular carcinoma in situ, and 1 case (6.7%) of mucinous carcinoma. Finally, only suspicious microcalcification on mammography was a significant predictor of upgrading to malignancy (p=0.023).An additional excision biopsy is recommended to reduce the rate of upgrading to malignancy in patients who were diagnosed with ADH through a US-guided VABB.

BACKGROUND/AIM Recently, the development of ultrasonography (US)-guided vacuum-assisted breast biopsy (VABB) has enabled the excision of benign breast tumors with normal surrounding breast tissues; thus, complete excision is possible without residual tumor tissue. We sought to identify the clinicopathological characteristics and recurrence rates of benign phyllodes tumors diagnosed by US-guided VABB. PATIENTS AND METHODS Data from 11,221 US-guided VABBs performed at the Gangnam Cha Medical Center over 12 years were analyzed. Eighty-three lesions were diagnosed as benign phyllodes tumors; 67 with >24 months of follow-up data were investigated. All lesions were excised using an 8-gauge probe without residual tissue; patients underwent follow-up US every 3-6 months. RESULTS Five patients (7.46%) experienced local recurrence during a mean follow-up period of 27.8 months; no distant metastases occurred. The mean tumor size was 3.0 cm in the recurrence group and 1.87 cm in the non-recurrence group (p=0.05). CONCLUSION Benign phyllodes tumors excised and diagnosed using VABB showed a low recurrence rate during the follow-up period; thus, these tumors, particularly those

Neurofibromas are slow-growing, painless, benign nervesheath tumors. They occur most commonly in the dermis and subcutis, and are rarely found in the breast (1). Breast neurofibromas may develop as a result of inherited autosomal dominant neurofibromatosis type 1 (NF1) or randomly at a later time due to genetic mutations (2). They usually appear as well-circumscribed oval masses on both mammography and ultrasonography (US), and are usually located on the nipple-areolar area (2-4). We report a case of neurofibroma secondary to NF1 in the retromammary space resulting from endometrial cancer, which was detected on positron emission tomography-computed tomography (PET-CT) after hysterectomy. CASE REPORT

BACKGROUND/AIM To evaluate the usefulness and safety of vacuum-assisted breast biopsy (VABB) for breast lesion diagnosis and treatment. PATIENTS AND METHODS Clinical and histopathological data of 8,748 patients, who underwent 11,221 VABB procedures were analyzed. RESULTS Most patients (58.2%) were

Background and Objectives:The head-up tilt test (HUT) is widely used for the diagnosis of vasovagal syncope. To improve the sensitivity of the test, provocation with isoproterenol is frequently used. The aim of this study was to evaluate the values of isosorbide dinitrate spray as a provocation drug in the HUT. Subjects and Methods: Two hundred patients, undergoing baseline HUT (60°for 20 minutes) for suspected vasovagal syncope or presyncope and unexplained dizziness, were enrolled. If the baseline HUT was negative, isosorbide dinitrate (2.5 mg) spray was applied sublingually (group I, n=93), or isoproterenol (3 μg/min) infused (group II, n=93), in a randomized fashion. The values of isosorbide dinitrate and isoproterenol were compared in those patients that developed a positive vasovagal response or who completed the drug-provocative HUT. Results:Syncope was similarly reproduced in both groups (47.7 vs. 41.9%, p>0.05). Type I responses were most common in both groups, and types I and II responses were more common in group I than group II (78.0 vs. 55.6% and 12.2 vs. 5.6%, p

A percutaneous coronary intervention (PCI) is known to be one of effective methods in the treatment of coronary artery disease. However, restenosis remains a major limitation to a PCI. Although neointimal cell proliferation is suspected to be the major cause of coronary stent restenosis, few histological characterizations of recurrent instent restenosis exist. We report a case of a 61-year-old man suffering from unstable angina due to secondary coronary in-stent restenosis in the proximal left anterior descending artery (LAD). An atherectomized tissue, obtained by a directional coronary atherectomy, showed myxoid tissue, characterized by a few stellate smooth muscle cells in the abundant extracellular matrix, which was blue-colored proteoglycan on modified Movat stain

Background and Objectives:Platelet activation and aggregation, with resultant arterial thrombus formation, play pivotal roles in the pathophysiology of acute coronary syndrome (ACS). The efficacy of tirofiban, a specific inhibitor of the platelet glycoprotein IIb/IIIa receptor, combined with heparin, or low molecular heparin (LMWH), in the management of ACS were evaluated. Subjects and Methods:One hundred seventeen patients (60.8± 10.9 years, 76 male), with unstable angina or non-ST elevation myocardial infarction, who had ST-T changes and elevated troponin, were divided into 4 groups:Group I (n=30:heparin alone), Group II (n=28:LMWH, dalteparin alone), Group III (n=29:tirofiban combined with heparin) and Group IV (n=30:tirofiban with LMWH). The major adverse cardiac events (MACE) among the 4 groups, during 6-month clinical follow-ups, were compared. Results:Percutaneous coronary intervention, or a coronary artery bypass graft, was performed in 23, 19, 19 and 22 patients from Groups I, II, III and IV, respectively (p=0.87). A minor bleeding complication developed in 2 (6.7%), 1 (3.6%), 1 (3.4%) and 2 patients (6.7%) in groups I, II, III and IV, respectively (p=0.79). During the six-month follow-up MACE occurred in 7 (30.4%), 6 (31.6%), 3 (15.8%) and 4 patients (18.2%) in groups I, II, III and IV, respectively (p=0.02:Group I and II vs. Group III and IV). Conclusion: Tirofiban combined with LMWH is safe and may improve the long-term prognosis of patients with ACS. (Korean Circulation J 2003;33 (7):559-567)

Background and Objectives:Previous studies examining the gender differences in patients undergoing percutaneous coronary intervention (PCI) have reported that women have a higher in-hospital mortality rate, and are at an increased risk for adverse outcomes compared to men. The aim of this study was to determine whether or not Korean women undergoing contemporary PCI have a higher risk than men. Subjects and Methods:Seventy eight elderly patients with 105 lesions, including 33 women (47 lesions, 81.9±1.97 year-old) and 45 men (58 lesions, 81.6±1.74 year-old) who underwent PCI from Jan 1996 to Apr 2001 were enrolled in this study. The demographics, angiographic findings and the clinical outcomes of each gender were compared. Results:Clinical diagnosis and risk factors for atherosclerosis for males and females were similar with the exception of their smoking status (36.7% vs. 14.8%, p=0.002) and stroke history (9.1% vs. 0%, p=0.038). There were no differences in the major in-hospital complications including cardiac death (12.1% vs 15.6%, p=0.75), acute myocardial infarction (AMI:3% vs. 0%, p=0.42), rescue PCI (3% vs. 0%, p=0.42) and emergent coronary artery bypass grafts (CABG:6.1% vs. 11.1%. p=0.44) between the two groups. A twelve-month clinical follow-up showed that the major adverse cardiac events including cardiac death (17.8% vs 28.9%, p=0.27), AMI (0% vs. 5.3%, p =0.5) and repeated revascularization (20.7% vs. 15.8%, p=0.6) in males and females were also similar. Conclusion:PCI in Korean female patients older than 80 years can be performed with a comparable procedural success rate and clinical outcomes to those of elderly male patients. (Korean Circulation J 2002;32 (10):864-871)