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Purpose: Robot-assisted nipple-sparing mastectomy (RANSM) improves cosmetic outcomes compared to conventional nipple-sparing mastectomy (CNSM) since RANSM is performed with minimal incisions. However, there are few studies on the feasibility and surgical outcome of RANSM. The aim of this study was to compare the surgical outcomes of RANSM and CNSM in breast cancer patients. Method: A retrospective observational study was conducted at our institution between January 2021 and December 2021. A total of 54 patients diagnosed with breast malignancy that underwent either a robotic-assisted or conventional nipple-sparing mastectomy were included. The demographics of the patient’s sex, age, body mass index (BMI), breast weight, and preoperative diagnosis were investigated. The surgical method, operation time (including docking time and console time in the case of robotic surgery), postoperative complications, length of hospital stay, pain score, and adjuvant therapy were analyzed. Result: A total of 57 breasts in 54 female patients were included in the study: 36 invasive ductal carcinoma patients, 11 ductal carcinoma cases, 6 invasive lobular carcinoma, 2 mucinous carcinoma, one solid papillary carcinoma and one lobular carcinoma in situ. A median age of 49(27-66), mean BMI of 22 (18.89-26.28), and mean breast weight was 246 g (120-305g). The mean operation time was 122 minutes (robotic 140 vs. conventional 118), and the average docking time was five minutes and console time 60 minutes in the robot-assisted surgery. There was only one postoperative complication in the robot group and ten cases in the conventional group. The mean hospital stay was 12.6 days (RANSM 10.75 vs. CNSM 12.92), and the average pain score was 3.53 (RANSM 3.50 vs. CNSM 3.54). None needed adjuvant therapy in the robot group. In the conventional surgical group, four patients underwent adjuvant radiotherapy and sixteen patients underwent chemotherapy including six neoadjuvant cases. Conclusion: Our results showed that RANSM had advantages of shorter hospitalization and lower pain scores although it had slightly longer operation time and could not applicable in relatively large breasts. In the near future, RANSM may be considered as the surgery of choice over CNSM in breast cancer patients. Citation Format: Ji Young You, Haemin Lee, Eun-Shin Lee, Seung Pil Jung. Comparison of robot-assisted nipple sparing mastectomy with conventional nipple sparing mastectomy: a single-center experience. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-14-20.

PurposeBRCA1 and BRCA2 are among the most important genes involved in DNA repair via homologous recombination (HR). Germline BRCA1/2 (gBRCA1/2)-related cancers have specific characteristics and treatment options but conducting gBRCA1/2 testing and interpreting the genetic imprint are sometimes complicated. Here, we describe the concordance of gBRCA1/2 derived from a panel of clinical tumor tissues using next-generation sequencing (NGS) and genetic aspects of tumors harboring gBRCA1/2 pathogenic variants.Materials and MethodsTargeted sequencing was performed using available tumor tissue from patients who underwent gBRCA1/2 testing. Comparative genomic analysis was performed according to gBRCA1/2 pathogenicity.ResultsA total of 321 patients who underwent gBRCA1/2 testing were screened, and 26 patients with gBRCA1/2 pathogenic (gBRCA1/2p) variants, eight patients with gBRCA1/2 variants of uncertain significance (VUS; gBRCA1/2v), and 43 patients with gBRCA1/2 wild-type (gBRCA1/2w) were included in analysis. Mutations in TP53 (49.4%) and PIK3CA (23.4%) were frequently detected in all samples. The number of single-nucleotide variants (SNVs) per tumor tissue was higher in the gBRCA1/2w group than that in the gBRCA1/2p group (14.81 vs. 18.86, p=0.278). Tumor mutation burden (TMB) was significantly higher in the gBRCA1/2w group than in the gBRCA1/2p group (10.21 vs. 13.47, p=0.017). Except for BRCA1/2, other HR-related genes were frequently mutated in patients with gBRCA1/2w.ConclusionWe demonstrated high sensitivity of gBRCA1/2 in tumors analyzed by NGS using a panel of tumor tissues. TMB value and aberration of non-BRCA1/2 HR-related genes differed significantly according to gBRCA1/2 pathogenicity in patients with breast cancer.

Background Although the initial projection after primary nipple reconstruction is excellent, nipple projection gradually flattens in most cases due to multiple causes. Although various methods have been reported to rebuild the nipple after nipple flattening, the most effective method of secondary nipple reconstruction remains unknown. The aim of this study was to review our institution’s experiences with secondary nipple reconstruction. Methods We conducted a retrospective review from March 2012 to January 2019. We performed secondary nipple reconstruction if the primary reconstructed nipple height differed by more than 6 mm from the normal nipple height. We chose the method of nipple revision according to the degree of tissue scarring and the remaining nipple projection. Results We performed secondary nipple reconstruction on a total of 27 nipples, using pursestring sutures for 19 nipples and star flaps in eight nipples. The median follow-up period was 8 months (range, 6–19 months) after the final nipple reconstruction. Among the 19 nipples reconstructed using purse-string sutures, 10 (53%) demonstrated acceptable projection of more than 5 mm. Among the eight nipples reconstructed using star flaps, six (75%) showed acceptable projection of more than 5 mm. Most of the patients (73%) were satisfied (scores of 4 or 5) with the nipple reconstruction overall. Conclusions Few studies have presented favorable outcomes of secondary nipple reconstruction. When the star flap and purse-string suture methods were used depending on the remaining nipple height and scarring, appropriate projection could be achieved.

Background: Since 2015, Smoking cessation program have been provided by the local smoking cessation support center in Korea. This program consisted of a 5-days of residential smoking cessation program and an inpatient program. This article is to assist smokers to quit smoking by analyzing and comparing the success factor in smoking cessation from the two different programs.Methods: This study was conducted with a total of 996 participants from the residential smoking cessation program and the inpatient program, from January 2018 to December 2020 at the University Hospitals. Based on the registration card information, we did a retrospective research. Success defines that the smoking cessation continued after 6 months of program participation when it is confirmed by urine cotinine test or phone consultation. The outcome of this study was performed by cross-tabulation analysis and regression analysis.Results: The findings show that the expected value of success in smoking cessation is higher as the subject is older in their age (P

We provide evidence for the reclassification of theThis study included breast or ovarian cancer patients tested forWe present 10 breast cancer patients and 7 ovarian cancer patients from 15 families identified as havingWe presented clinical evidence for the reclassification of

Although adjuvant chemotherapy (CTx) is still recommended for high-risk patients with hormone receptor-positive and human epidermal receptor (HER)-2-negative breast cancer, recent studies found that selected patients with low disease burden may be spared from CTx and receive hormonal treatment (HT) alone. This study aims to evaluate the trends of treatment (CTx + HTThe Korean Breast Cancer Society Registry was queried (2000 to 2018) for women with pT1-2N0-1 hormone receptor-positive and HER2-negative disease who underwent surgery and adjuvant systemic treatment (CTx and HT). Clinicopathologic factors, change in pattern of treatment over time, and OS for each treatment option were analyzed.A total of 40,938 women were included in the study; 20,880 (51.0%) received CTx + HT, while 20,058 (49.0%) received HT only. In recent years, there has been a steady increase in the use of HT alone, from 21.0% (2000) to 64.6% (2018). In Cox regression analysis, age, type of breast and axillary operations, T and N stages, body mass index, histologic grade, and presence of lymphovascular invasion were prognostic indicators for OS. There was no significant difference between CTx + HT and HT alone in terms of OS (P = 0.126).Over the years, there has been a shift from CTx + HT to HT alone without a significant difference in OS. Therefore, HT alone could be a safe treatment option in selected patients, even those with T2N1 disease.

Purpose Women with large and/or ptotic breasts are generally not considered candidates for nipple-sparing mastectomy because of concerns regarding the high incidence of postoperative complications including ischemic complications. Therefore, we adopted a vertical skin resection technique for nipple-sparing mastectomy, and obtained satisfactory results following immediate autologous breast reconstruction. In this study, we aimed to describe our operative technique and review its outcomes. Methods Between January 2010 and March 2017, immediate autologous breast reconstructions were performed in 28 patients with moderate or large ptotic breasts after nipple-sparing mastectomy using the vertical reduction pattern. Grade II ptosis was observed in 12 patients, and 16 patients were classified as having grade III ptosis. Results Of the 28 patients, 21 received abdominal free flap reconstruction. In the remaining 7 patients, extended latissimus dorsi flaps were used in conjunction with anatomic implants. The mean weight of the excised breast tissue in the 2 groups was 575 g and 482 g, respectively. Satisfactory esthetic outcomes without major complications were achieved in all patients. Similar vertical reductions or mastopexies in the contralateral breast allowed better postoperative adjustment for symmetry. There was only 1 case of complete nipple necrosis; however, the problem was solved with "skin banking." No local recurrences or distant metastases were detected at follow-up (mean 18 months, range 4 months to 6 years). Conclusion To enhance cosmetic outcomes in patients with large and/or ptotic breasts, the vertical skin resection pattern for nipple-sparing mastectomy can be used to achieve better breast shape while preserving the nipple-areola complex. Moreover, it can improve the esthetic outcome without compromising oncologic safety.

Anti-tumoral T cell immunity is counterbalanced by several types of immunosuppressive cells such as Myeloid-Derived Suppressor Cells (MDSC). Circulating MDSC levels correlate with poor prognosis and metastatic progression of breast cancer patients. However, the value of MDSC in predicting chemotherapeutic treatment responses in the metastatic lesions is not clearly understood. We performed a prospective cohort clinical study to measure MDSC before and after chemotherapy in metastatic breast cancer patients (N=64). Multicolor flow cytometry was used to quantitate two major subtypes, i.e. monocytic (M-) and polymorphonuclear (PMN-) MDSC, and one additional subtype, C-C chemokine receptor 2 (CCR2)-positive M-MDSC in the fresh peripheral blood mononuclear cells. M-MDSC were defined as HLA-DRlow/−CD45+CD11b+CD15−CD14+ PBMC, and PMN-MDSC were defined as CD45+CD11b+CD33+CD15+ CD14− PBMC. PMN-MDSC and CCR2+ M-MDSC, but not M-MDSC, were significantly increased after chemotherapy. Subsequently, we divided the patients by two groups (therapy-sensitive vs. -resistant groups) by treatment responses. Treatment-resistant patients had significantly increased CCR2+ M-MDSC. Unsupervised clustering of patients based on MDSCs populations dichotomized patients PMN-MDSC high or M-MDSC high groups. M-MDSC high patients had increased bone and lymph node metastasis. In addition, CCR2+ M-MDSC levels correlated with the progression-free survival (P Citation Format: Ju Won Kim, Jason K. Sa, Seung Pil Jung, Kyong Hwa Park, Serk In Park. C-C chemokine receptor 2-positive monocytic myeloid-derived suppressor cells predicts chemotherapeutic responses of the metastatic lesions in breast cancer patients. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4349.

Summary Background A previous abdominal scar is generally considered as a challenge for breast reconstruction using abdominal flaps. Since it may interfere with the perfusion of abdominal tissue and weaken the abdominal fascia, many plastic surgeons are concerned about the theoretical risk of postoperative complications. This study aims to assess the effects of previous scar on complications in abdominal flap–based breast reconstruction. Methods This systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline using MEDLINE, Ovid, and Cochrane databases in March 2020. All studies comparing the complication rates between patients with previous abdominal scars and control group without a scar were included. However, articles such as case series fewer than 10 patients, letters and animal studies were excluded. Results A total of 2109 patients underwent 2792 abdominal flap tissue transfers for breast reconstruction in the 11 studies reviewed. A previous scar increased the risk of overall flap complications (RR 1.12; 95% CI, 0.95–1.32; fixed-effect model, I2 = 13%) and donor-site complications (RR 1.35; 95% CI, 1.13–1.62; fixed-effect model, I2 = 42%, p > 0.05). In particular, the risk of donor-site wound problem was significantly higher than that in the control group (RR 1.83; 95% CI, 1.35–2.46; fixed-effect model, I2 = 19%, p > 0.05). Conclusions This study result showed that the previous scar increased the risk for all types of complications compared with the control group. In patients with a vertical midline scar, it requires careful preoperative planning with CT angiography and attentive follow-up. However, with careful preoperative planning and an appropriate strategy, it is possible to overcome the detrimental effect of previous scar. Level of evidence I

Objective The aim of this study was to identify the effectiveness and selective applications of preoperative magnetic resonance imaging (MRI) by investigating clinicopathologic factors of the index tumor with or without false lesions on MRI. Summary of background data Preoperative MRI is commonly performed in patients with newly diagnosed breast cancer, but its clinical significance is unclear. Methods A total of 103 breast cancer patients who had undergone MRI or ultrasound followed by mastectomy were included in this retrospective investigation of pathologic, clinical, and imaging findings. Results MRI showed 29 false-positive lesions in 57 patients, 5 false-negative lesions in 5 patients, and 69 true-positive lesions in 103 patients. More false lesions on MRI were found in patients with more lesions on ultrasound, small-sized index tumors on ultrasound, or early-stage cancer. The sensitivity of MRI and ultrasound were 96.5% and 92.3% (P = 0.119), respectively, and the positive predictive value of them were 71.5% and 72.5% (P = 0.828), respectively. Conclusions Preoperative MRI is more useful in patients with newly diagnosed breast cancer who have large-sized or more advanced cancers or fewer lesions on ultrasound.

Background: The Korean Health Insurance Review and Assessment Service has conducted diabetes medical adequacy evaluation projects since 2010. This study aimed to evaluate the medical adequacy of type 2 diabetes mellitus patients after the assessment project and help establish the direction of future projects.Methods: Using data from the Health Insurance Review & Assessment Service (2010-2015), chi-square tests and t-tests were used to analyze the enforcement rate according to a combination of items for appropriate management methods. Logistic regression and linearity test were performed to assess the relationships among the evaluation group, appropriate test items, and prescription rate.Results: We found that 33.6-39.8% of patients did not undergo any diabetes-related tests. Only about 7% of hemoglobin A1c (HbA1c) tests were performed, and 36% of cases were tested simultaneously with serum lipid profile tests. As age increased, the number of days taken to prescribe diabetes medications also increased.The prescription rate of diabetes drugs for 292 days or more was 61% in patients who had not been tested for adequacy, and the average prescription rate increased as the number of tests increased.Conclusions: In older adults with a high prevalence of diabetes, it is necessary to establish a test rate for proper management of diabetes, including HbA1c, and related test items to increase the average prescription rate.

Beyond physical pain, patients with coronavirus disease 2019 (COVID-19) experience psychological anxiety during and after quarantine, often facing negative perceptions when returning to their communities. This study evaluated a health consultation program in Korea for post-quarantine patients with COVID-19, designed to help them return to their communities. The program was conducted from 9 March to 5 June 2020, in Daegu, Korea. In total, 20 doctors and 504 recovered patients were surveyed via questionnaire. The survey, comprising open-ended questions rated on a five-point Likert scale, was based on the Context–Input–Process–Product program evaluation model. Reliability was assessed, and descriptive statistics were obtained. A regression analysis was performed on factors affecting product (output) areas. As a main result, both doctors and recovered patients evaluated the program positively. The mean program effectiveness score was 4.00 in the doctors’ evaluations and 3.95 in the patients’ evaluations. Moreover, the input and process variables affected the product. This first-of-its-kind health consultation program proved to be an effective practical intervention for patients returning to the community after an infectious disease; it also highlights aspects that could increase satisfaction in systemized subsequent programs, with input and process areas for patients and doctors.

The umbilicus is a key aesthetic unit of the abdominal wall. It contributes to the natural curvature of the abdomen and is now considered as one of the most important factors in the overall results and patient satisfaction. In this study, we present an inverted-U incisional technique for umbilicoplasty. This study aims to describe the senior author’s approach to umbilicoplasty and compare the aesthetic outcomes of the inverted-U method with those of the vertical oval incisional technique. In this retrospective cohort study, we analyzed a total of 109 patients including 51 who underwent umbilicoplasty with the inverted-U incisional technique and 58 who had surgery with the vertical oval incisional method. With the description of our operative technique, the aesthetic outcomes of both techniques were compared by two independent surgeons using a 5-point Likert scale in terms of shape, size, depth, natural appearance and periumbilical scarring. Also, the total scores of the five items were calculated to give a final score for each patient (range, from 5 to 25 points). On all measured parameters, the inverted-U incisional technique produced favorable outcomes compared with the vertical oval incisional technique. Also, the inverted-U incisional technique was given significantly higher total scores than was the vertical oval incisional technique (inverted-U 14.73 ± 2.47 vs. vertical oval 11.26 ± 3.02, p = 0.002). In this study, an inverted-U incisional technique produced significantly favorable outcomes in terms of shape, size, depth, natural appearance and overall score compared to a vertical oval incision (p

Summary: Background: Sentinel lymph node (SLN) biopsy is an essential procedure for lymph node staging in patients with breast carcinoma. Technetium-99m-labelled nanocolloid (99mTc) is the most accurate and widely used lymphatic mapping agent; however, there are concerns pertaining to the associated exposure to radiation. Studies focusing on new agents are required. We aimed to evaluate the feasibility and safety of SLN detection using fluorescein and blue light-emitting diodes (LEDs) in breast carcinoma patients. Methods: In this prospective study, a total of 61 patients with breast carcinoma, requiring SLN biopsy, were enrolled. Both fluorescein and 99mTc were intradermally injected into the areola of the affected breast of each patient. SLNs stained with fluorescein were detected using blue LED light first, and then, any remaining SLNs were detected using a gamma detection probe. The detection rate was analyzed, and the presence of complications was investigated. Results: SLNs dyed with fluorescein using blue LED light were visualized in 57 of 61 patients (93.4%). None of the patients experienced complications related to the use of fluorescein or blue LED light. Conclusions: The detection of SLNs using fluorescein and blue LED light was feasible and safe in patients with breast carcinoma. This technique involves the use of visible light, allowing for SLNs to be viewed with the naked eye, and is quantifiable, easy to use, and economical. Keywords: Fluorescein, Breast carcinoma, Sentinel lymph node biopsy

PurposeMutations in PIK3CA gene occur frequently in patients with breast cancer. Activating PIK3CA mutations have been shown to confer resistance to human epidermal growth factor receptor (HER)2-targeted treatments. In this retrospective study, we investigated whether PIK3CA mutations were correlated with treatment response or duration in HER2-positive (HER2+) breast cancer patients.MethodsWe reviewed the clinical information of patients with HER2 + breast cancer who received HER2-targeted therapy for early stage or metastatic cancers. The pathologic complete response (pCR), progression-free survival (PFS), and overall survival were compared between patients with wild-type PIK3CA (PIK3CAw) and mutated PIK3CA (PIK3CAm), among those selected for the study. Next-generation sequencing was combined with examination of PFS associated with anti-HER2 monoclonal antibody (mAb) treatment.ResultsData from 90 patients with HER2 + breast cancer were analyzed. Overall, 34 patients had pathogenic PIK3CA mutations (37.8%). The pCR rate of the PIK3CAm group was lower than that of the PIK3CAw group among patients who received neoadjuvant chemotherapy for early stage cancer. In the metastatic setting, the PIK3CAm group showed a significantly shorter mean PFS (mPFS) with first-line anti-HER2 mAb. The mPFS of second-line T-DM1 was lower in the PIK3CAm group than in the PIK3CAw group. Sequencing revealed differences in the Mutational landscape between PIK3CAm and PIK3CAw tumors.Conclusion HER2+ breast cancer patients with activating PIK3CA mutations had lower pCR rates and shorter PFS with palliative HER2-targeted therapy than those with wild-type PIK3CA. Our results suggest that HER2+ breast cancer patients with PIK3CA mutations have an unmet clinical need.

Medullary thyroid carcinoma (MTC) accounts up to 10% of all thyroid cancers, but is responsible for a disproportionate number of deaths. While surgery is the only curative treatment for MTC, indications for lateral neck lymph node (LLN) dissection are controversial. We performed a retrospective review to describe clinical outcomes in 93 MTC patients from July 1995 to March 2015. We analyzed their clinicopathologic factors, and cut‐off values of tumor size and calcitonin levels were calculated using a receiver operating characteristic curve. Using the instances of lymph node metastases, the tumor size cut‐off value was 0.95 cm (area under curve, AUC = 0.697) in patients with ipsilateral central lymph node (CLN) metastases, 2.25 cm (AUC = 0.793) in contralateral CLN metastases, and 1.75 cm (AUC = 0.753) in ipsilateral LLN metastases. The cut‐off values of preoperative calcitonin levels were 226.6 pg/mL (AUC = 0.746) in ipsilateral CLN, 755.0 pg/mL (AUC = 0.840) in contralateral CLN metastases, and 237.0 pg/mL (AUC = 0.775) in ipsilateral LLN metastases. This study supports the notion that ipsilateral LLN metastases occur before contralateral CLN metastases. Therefore, ipsilateral LLN dissection should be considered in patients with contralateral CLN metastases. The extent of surgery should be based on the status of LN metastases, preoperative basal calcitonin level, and tumor size to help individualize the extent of surgery.

ObjectivesAdenomyoepithelioma (AME) of the breast exhibits characteristic proliferation of the epithelial and myoepithelial cells. Most AMEs are benign, but the 2 inherent cell types can become malignant. The present study reports 2 cases of AME with myoepithelial carcinoma of the breast, one with axillary lymph node metastasis.MethodsA modified radical mastectomy was performed in a 67-year-old woman, because a sentinel lymph node biopsy revealed one metastatic lymph node composed of a myoepithelial carcinoma component. Despite receiving radiotherapy and chemotherapy, the patient died from lung and brain metastases 21 months later. In the second case, breast-conserving surgery with sentinel lymph node biopsy was performed in a 55-year-old woman. Following additional treatment with radiotherapy and chemotherapy, there were no signs of recurrence or metastasis.ResultsThe tumors of the 2 patients were diagnosed as malignant, based on their high mitotic rate and severe nuclear atypia.ConclusionsBased on previously reported cases with distant metastases, the prognosis of myoepithelial carcinoma is poor. Myoepithelial carcinoma should be followed up with careful screening and treated aggressively.

OBJECTIVE To investigate the correlation of kinetic features of breast cancers on computer-aided diagnosis (CAD) of preoperative 3T magnetic resonance imaging (MRI) data and clinical-pathologic factors in breast cancer patients. MATERIALS AND METHODS Between July 2016 and March 2017, 85 patients (mean age, 54 years; age range, 35-81 years) with invasive breast cancers (mean, 1.8 cm; range, 0.8-4.8 cm) who had undergone MRI and surgery were retrospectively enrolled. All magnetic resonance images were processed using CAD, and kinetic features of tumors were acquired. The relationships between kinetic features and clinical-pathologic factors were assessed using Spearman correlation test and binary logistic regression analysis. RESULTS Peak enhancement and angio-volume were significantly correlated with histologic grade, Ki-67 index, and tumor size: r = 0.355 (p = 0.001), r = 0.330 (p = 0.002), and r = 0.231 (p = 0.033) for peak enhancement, r = 0.410 (p = 0.005), r = 0.341 (p < 0.001), and r = 0.505 (p < 0.001) for angio-volume. Delayed-plateau component was correlated with Ki-67 (r = 0.255 [p = 0.019]). In regression analysis, higher peak enhancement was associated with higher histologic grade (odds ratio [OR] = 1.004; 95% confidence interval [CI]: 1.001-1.008; p = 0.024), and higher delayed-plateau component and angio-volume were associated with higher Ki-67 (Or = 1.051; 95% CI: 1.011-1.094; p = 0.013 for delayed-plateau component, OR = 1.178; 95% CI: 1.023-1.356; p = 0.023 for angio-volume). CONCLUSION Of the CAD-assessed kinetic features, higher peak enhancement may correlate with higher histologic grade, and higher delayed-plateau component and angio-volume correlate with higher Ki-67 index. These results support the clinical application of kinetic features in prognosis assessment.

e24099 Background: Taxane-associated lower extremity edema is a distinctive adverse effect of taxane, which severely compromise patients’ quality-of-life. Aroma lymphatic tressage (ALT) has been established as a complementary technique that uses a combination of aromatherapy and hand massage to relieve distress and modulate lymphatic drainage in cancer patients. This study aimed to evaluate the symptom-relieving efficacy of a short course ALT on taxane-induced lower extremity edema. Methods: Patients treated with taxane-based chemotherapy for early or advanced stage breast cancer were screened for the study. Patients were enrolled when they presented more than CTCAE G3 of lower-extremity edema. A total of 8 sessions of ALT were applied twice a week for 4 weeks after completing taxane. The primary endpoint was to determine the leg circumference change before and after receiving ALT. Patients’ subjective degree of edema, and quality-of-life were also assessed. Results: A total of 37 patients completed all sessions of planned treatment. All of the participants were female, with the median age of 55.4-years-old. 30.8% of them were premenopausal. The median height of the patients was 157.6cm, median weight was 60.9kg, and median BMI was 1.6kg/m2. Most of the patients received docetaxel (87.2%). The baseline thigh, calf, and ankle circumferences were 56.5cm, 37.4cm, and 22.6cm, each. After 8 sessions of ALT, the median circumferences decreased to 54.7cm, 36.2cm, and 21.9cm. 23 (62.2%) participants experienced a 3% or more reduction in circumference change with a month of ALT. Patients’ subjective degree of edema decreased 56.9% for 4 weeks compared to baseline, while mean body weight decreased from 62.6kg to 61.2kg. All the differences before and after the ALT were statistically significant (p-value < 0.0001) Most of the indicators assessing patients’ quality-of-life improved during the ALT periods, especially physical subscale (from 14.8 to 19.1, p-value < 0.0001). EORTC-QLQ-C30 score also improved from 70.8 to 57.1 (p-value < 0.0001). Conclusions: To our knowledge, this is the first clinical trial to evaluate clinical efficacy of ALT on taxane-associated lower extremity edema. Patients who received ALT after taxane-based chemotherapy presented significant decline of leg circumference and improvement of QoL.

Mutations of the p53 gene are the most common genomic alterations associated with triple-negative breast cancer (TNBC) and are reported in 60–88% cases. Despite the high incidence of such mutations, there is no consensus about the clinical application of p53 detection in breast cancer management. This study investigates the prognostic value of immunohistochemically detected p53 in TNBC patients who received adjuvant chemotherapy. We reviewed the clinicopathologic features of 1088 TNBC patients who received curative surgery and adjuvant chemotherapy. Immunohistochemically, nuclear staining of >10% was defined as p53 “positive.” Of the total 1088 TNBC patients, 709 (65.2%) had no lymph node metastasis (N0). Among the N0 patients, 408 (57.5%) were p53- positive (p53+), and 301 (42.5%) were p53- negative (p53-). p53 + tumors showed a tendency for better breast cancer-specific survival (BCSS, p = 0.052) and overall survival (OS, p = 0.079) compared to p53- tumors. In multivariate analysis, p53 + tumors showed significantly better BCSS (p53 + vs. p53-; HR 2.8, 95% confidence interval: 1.1–7.3, p = 0.034); however, in TNBC patients with lymph node metastasis, there was no correlation between p53 status, clinicopathologic characteristics, and survival. Consequently, in TNBC patients who received adjuvant chemotherapy, immunohistochemical p53 expression was associated with better BCSS in N0 patients. Keywords: Triple-negative breast cancer, Chemotherapy, p53, Immunohistochemistry, Survival

BACKGROUND: Free abdominal tissue transfer is considered the gold standard for autologous breast reconstruction. However, many plastic surgeons are concerned about the theoretical risk of flap-related or donor-site complications associated with previous abdominal surgery. Also, studies have reported conflicting results in the literature due to difference in surgical strategies used in each study. This study analyzes the effect of prior incision on the complications and risk factors in our institution. METHODS: In this retrospective cohort study, we analyzed a total of 122 patients who had undergone reconstructive surgery between March 2012 and February 2019. To assess the effect of prior incision, we divided all patients into a scar group (n=59) and a control group (n=63). Based on our operative approach, patient demographics and postoperative complications were analyzed. RESULTS: No significant differences were found between patients in the scar group and the control group in flap-related (13.3% vs. 16.4%, P=0.62) and donor-site complications (31.7% vs. 31.4%, P=0.67). In binary logistic regression modeling, only diabetes mellitus was significantly related with donor-site complications (P=0.030). CONCLUSIONS: This result suggested that previous abdominal scars are no longer a reluctant factor for breast reconstruction using an abdominal flap, when an appropriate flap design was used and the surgical techniques were tailored to each scar. In patients with vertical midline or subcostal scar, it requires careful preoperative planning with CT angiography and attentive follow-up are needed.

To investigate whether machine learning–based prediction models using 3-T multiparametric MRI (mpMRI) can predict Ki-67 and histologic grade in stage I–II luminal cancer. Between 2013 and 2019, consecutive women with luminal cancers who underwent preoperative MRI with diffusion-weighted imaging (DWI) and surgery were included. For prediction models, morphology, kinetic features using computer-aided diagnosis (CAD), and apparent diffusion coefficient (ADC) at DWI were evaluated by two radiologists. Logistic regression analysis was used to identify mpMRI features for predicting Ki-67 and grade. Diagnostic performance was assessed using eight machine learning algorithms incorporating mpMRI features and compared using the DeLong method. Of 300 women, 203 (67.7%) had low Ki-67 and 97 (32.3%) had high Ki-67; 242 (80.7%) had low grade and 58 (19.3%) had high grade. In multivariate analysis, independent predictors for higher Ki-67 were washout component > 13.5% (odds ratio [OR] = 4.16; p 15.5% (OR = 7.22; p < 0.001), rim enhancement (OR = 2.59; p = 0.022), and ADC value < 0.945 × 10-3 mm2/s (OR = 2.47; p = 0.015). Among eight models using these predictors, six models showed the equivalent performance for Ki-67 (area under the receiver operating characteristic curve [AUC]: 0.70) and Naive Bayes classifier showed the highest performance for grade (AUC: 0.79). A prediction model incorporating mpMRI features shows good diagnostic performance for predicting Ki-67 and histologic grade in patients with luminal breast cancers. • Among multiparametric MRI features, kinetic feature of washout component >13.5% and intratumoral high signal intensity on T2-weighted image were associated with higher Ki-67. • Washout component >15.5%, rim enhancement, and mean apparent diffusion coefficient value < 0.945 × 10 -3 mm 2 /s were associated with higher histologic grade. • Machine learning–based prediction models incorporating multiparametric MRI features showed good diagnostic performance for Ki-67 and histologic grade in luminal breast cancers.

Background Fat grafting is now a common procedure for breast reconstruction. Many clinical studies have reported its aesthetic efficacy and oncological safety, but some experimental studies raise about the recurrence risk because of its regenerating property. This study aims to investigate the possibility of cancer recurrence associated with fat grafting. Methods In this retrospective cohort study, we analyzed a total of 339 patients who had undergone immediate reconstructive surgery after nipple-sparing mastectomy (NSM) or skin-sparing mastectomy (SSM) in our institution between February 28, 2009 and March 23, 2019. Patients who had undergone breast conserving surgery, radical mastectomy, or delayed reconstruction were excluded. We used univariate and multivariate Cox proportional hazards regression models to evaluate the association between fat grafting and cancer recurrence. Results Among the 339 patients during a median follow-up of 52 months, 27 patients (8.0%) were confirmed to have recurrent cancer. Of 67 patients who had undergone fat grafting, 10 patients were confirmed to have cancer recurrence. In multivariate analyses, fat grafting [hazard ratio (HR), 2.52; 95% CI, 1.005-6.317; P=0.0488] was independently associated with cancer recurrence. Conclusions In population of breast cancer patient who underwent immediate reconstruction in our institution, fat grafting showed significant higher risk of cancer recurrence. Although these results are at odds with many existing studies, it suggests that more careful follow-up may be necessary for patients who had undergone fat grafting after reconstructive surgery.

Breast cancer is a heterogeneous disease with various histopathologic subtypes. Except for invasive carcinoma of no special type (NST), other subtypes are rare with limited data. The purpose of this study was to analyze the characteristics and prognosis of special histopathologic subtypes of breast cancer compared to NST. A total of 136,140 patients were analyzed using the Korean Breast Cancer Society Registry database between January 1996 and March 2019. The clinicopathologic features and survival outcomes of special type breast carcinoma were compared with those of NST. The prevalence of special subtypes other than NST was 13.7% (n = 18,633). Compared to NST, patients with lobular, medullary, metaplastic, and micropapillary carcinoma had larger tumors (p

We explored the association between parity and the risk of developing a specific subtype of breast cancer. We also assessed the association between parity and prognosis according to subtypes. A total of 158,189 patients were enrolled in the Korean Breast Cancer Society Registry database between 1996 and 2015 in Korea. The database provided information on sex, age, number of parity, surgical method, stage, histological findings, presence of biologic markers, adjuvant therapy, and date and cause of death. The patients with higher parity showed a higher ratio of triple-negative breast cancer (TNBC) and human epidermal growth factor receptor 2 (HER2) subtypes. In univariate analysis, women with TNBC who had more than three children had a worse prognosis compared to other groups (HR 1.83; 95% CI 1.34–2.49; P

The aim of the study was to compare the efficacy and safety between an autocrosslinked polysaccharide (ACP) gel (Hyalobarrier) and a poloxamer/sodium alginate (P/SA: Guardix-SG) in preventing adhesions after thyroidectomy and demonstrate the noninferiority of ACP gel to P/SA. To identify differences of antiadhesive efficacy and safety between the ACP gel and P/SA, we investigated various variables such as the proportion of normal esophageal motility as assessed using marshmallow esophagography, swallowing impairment, adhesion severity and so on. This prospective, randomized, double-blinded, multicenter, phase III study investigated the antiadhesive efficacy and safety of ACP gel compared with those of P/SA for 12 weeks. Subjects were randomly assigned to receive either ACP gel (n = 97) or P/SA (n = 96). The primary endpoint was the proportion of normal esophageal motility as assessed using marshmallow esophagography, while the secondary endpoints included swallowing impairment, adhesion severity, laryngoscopic assessment of the vocal cords, and voice range profile. Safety endpoints included adverse events. There was no significant difference between the ACP gel and P/SA groups in the proportion of normal esophageal motility as the primary endpoint (P = 0.7428). In addition, there were no differences in the secondary or safety endpoints between the 2 groups. It was demonstrated that ACP gel was not inferior to P/SA. ACP gel appears both effective and safe for use in preventing adhesions after thyroidectomy.

TP53 mutation is the most common mutation in breast cancer, and it is considered a target marker of triple-negative breast cancer (TNBC). We investigated whether expression of p53 detected by immunochemical staining predicts the chemotherapy response of TNBC. A total of 11,393 TNBC patients who had between stage I and stage III enrolled in the Korean Breast Cancer Society Registry database from January 1, 2000 to December 31, 2015. There were 6,331 ‘p53-positive (+) TNBC’ patients and 5062 ‘p53-negative (−) TNBC’ patients. In univariate analysis, p53(+) TNBC had a worse prognosis than p53(−) TNBC in patients not receiving chemotherapy (P = 0.003). However, there was no difference in prognosis between p53(+) TNBC and p53(−) TNBC for patients receiving chemotherapy. In multivariate analysis adjusted for age and stage, the risk of p53(+) TNBC was 1.84 times higher than that of p53(−) TNBC in the non-chemotherapy group. However, there was no difference between p53(+) TNBC and p53(−) TNBC in patients receiving chemotherapy. In p53(+) TNBC, the risk was 0.6-fold lower when chemotherapy was administered than when chemotherapy was not administered. However, in p53(−) TNBC, there was no risk reduction effect by chemotherapy. The prognosis of p53(+) TNBC has worse than p53(−) TNBC, but the risk for survival was significantly reduced with chemotherapy. It suggests that p53(+) TNBC would be more sensitive to chemotherapy than p53(−) TNBC.

Axillary nodal status is one of the most important prognostic factors in breast cancer. The lymph node ratio (LNR) has been suggested as an independent prognostic factor because the number of dissected and involved lymph nodes might differ across institutions. Neoadjuvant chemotherapy (NAC) has been the preferred treatment method for reducing tumor mass in the breast and axillary area. However, NAC can reduce total number of excised lymph nodes compared with upfront surgery. Therefore, an emerging question is whether axillary nodal status and LNR following NAC can accurately predict prognosis. We evaluated the prognostic value of axillary nodal status and LNR after NAC. A total of 236 patients were enrolled. Patients were divided into four groups according to the following cut-off values for LNR: 0 (n = 107), 0.01–0.20 (n = 68), 0.21–0.65 (n = 50) and >0.65 (n = 11). Pathologic complete responses were observed in 16.9% of the overall cohort. In univariate analysis, pathologic N stage was a significant prognostic factor of disease free survival (DFS, p = 0.013) and overall survival (OS, p = 0.004). However, in multivariate analysis, hormone receptor status (p = 0.043) and LNR (p = 0.028) were significantly associated with DFS and LNR (p = 0.017) showed statistical significance for OS; however, pathologic N stage was no longer significantly associated with DFS or OS. Traditional nodal staging has been accepted as an important prognostic factor; however, our result indicated that the nodal ratio could be an alternative to pN staging as a prognostic factor after NAC in breast cancer. Keywords: Axilla, Breast, Neoadjuvant therapy, Lymph node, Survival