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The Korean Surgical Society

th

67 Annual Congress of the Korean Surgical Society

Breast
()
Poster Exhibition

Annual Congress of KSS 2015 [67th Congress of the Korean Surgical Society]

PE-226

PE-227

Oncologic outcomes of volume


displacement procedures after
partial mastectomy for breast
cancer : A single-center analysis

Promoter methylation of activated


leukocyte cell adhesion molecule
(ALCAM) gene is associated with
the expression of ALCAM in breast
cancer

Department of Surgery, 1Radiology, 2Pathology,


3
Hemato-oncology, 4Plastic and Reconstructive
5
Surgery, Radiation Oncology, Kyungpook National
University, School of Medicine, Korea

Jeeyeon Lee, Jin Hyang Jung,


Wan Wook Kim, Seung Ook Hwang,
1
Taek Ju Kwon, Jin Ho Chung, Hye Jung Kim ,
1
2
2
Hyejin Cheon , Ji Young Park , Ji Yun Jeong ,
3
3
Yee Soo Chae , Soo Jung Lee ,
4
4
Jung Dug Yang , Jeong Woo Lee ,
5
In-Kyu Park , Ho Yong Park*
(Purpose) Volume displacement techniques that
use remnant breast tissue are useful in reconstructive procedures after partial mastectomy.
The authors analyzed the oncologic results of volume displacement surgery after partial mastectomy
and their associations with various clinicopathologic
factors. (Methods) One hundred and fifty-eight eligible patients with breast cancer who underwent
volume displacement procedures after partial mastectomy were included in this prospective study, in
which associations between clinicopathologic factors
and locoregional recurrence, distant metastasis, and
death were analyzed. (Results) During a mean follow-up of 56.8 months, locoregional recurrence occurred in three cases (1.9%) and distant metastasis
in four (2.5%). According to multivariate analysis,
bilaterality of breast cancer (p=0.035) and adjuvant
chemotherapy (0.042) were associated with distant
metastasis. (Conclusion) Volume displacement procedures after partial mastectomy have good oncologic results and are reasonable procedures for patients with breast cancer. In our cohort, bilaterality
of breast cancer and adjuvant chemotherapy were
associated with distant metastasis.

F284

Department of Surgery, Pathology, Catholic


University of Daegu School of Medicine,
2
Department of Surgery, Raphael Hospital, Korea

Young Ju Jeong*, Hoon Kyu Oh1,


2
Sung Hwan Park, Jin Gu Bong
(Purpose) Activated leukocyte cell adhesion molecule (ALCAM) is a cell surface immunoglobulin superfamily member and has been implicated in
tumorigenesis. In breast cancer, decreased level of
ALCAM expression is known to correlate with poor
prognosis. Despite this significance, mechanisms
that regulate the ALCAM gene expression have not
been well defined. The purpose of this study was
to investigate epigenetic alterations of the ALCAM
using pyrosequencing analysis, and to analyze the
association between methylation of the ALCAM
gene and its expression in breast cancer. Prognostic
significance of the ALCAM gene methylation and
its expression was also examined in this study.
(Methods) By using pyrosequencing of bisulfite
treated DNA, we analyzed DNA methylation status
of the ALCAM gene in fresh frozen primary breast
cancer tissues (n=47) and non-neoplastic mammary
tissues (n=10). The expression of ALCAM was assessed using immunohistochemical staining, and the
levels of ALCAM transcripts in frozen tissue were
determined using RT-PCR. The levels of T lymphocyte and macrophage infiltration and adhesion molecules including N-cadherin, E-cadherin, -catenin
and integrin were also assessed. Association between the methylation status of the ALCAM gene
and its expression was analyzed, and the relationship between ALCAM expression and the clinicopathological characteristics of the patients was
evaluated. (Results) Fifty-five of 57 cases had aberrant methylation of the ALCAM gene. The mean
methylation level of the ALCAM gene was 3.41%.

Breast () : Poster Exhibition


The methylation status of the ALCAM gene was
not significantly different between tumor and normal tissues. The level of the ALCAM gene methylation was associated with the levels of ALCAM
transcripts in tumor tissues. The expression of
ALCAM was associated with the expression of TNF
and NF-B p50 subunit in tumor tissues. The
mean methylation level of the ALCAM gene was
significantly lower in early stage of breast cancer
compared to stage III. Clinicopathologic characteristics of the patients were not associated with level
of the ALCAM gene methylation or the expression
of ALCAM. (Conclusion) We have found that the
frequency of the ALCAM gene methylation was inversely related to the expression of ALCAM, and
the expression of ALCAM was associated with the
expression of TNF and NF-B p50 subunit which
is related to inflammation in breast cancer. Our results suggest that the methylation of the ALCAM
gene contributes to the decreased expression of
ALCAM. Further studies are needed to clarify the
relevance of the epigenetic mechanism in regulation
of ALCAM expression and prognostic value of
ALCAM in breast cancer.

PE-228
Expression of CD73 is associated
associated with the molecular
subtypes of breast cancer
Department of Surgery, 1Pathology, Catholic
University of Daegu School of Medicine,
2
Department of Surgery, Raphael Hospital, Korea

Young Ju Jeong*, Hoon Kyu Oh1,


2
Sung Hwan Park, Jin Gu Bong

evaluate prognostic significance of CD73 expression.


(Methods) Specimens from 114 patients with primary breast cancer were enrolled, and representative paraffin tumor blocks were selected for constructing
tissue
microarrarys
(TMA).
Immunohistochemical staining for CD73 was performed using TMA. We compared the expression
of CD73 across the molecular subtypes of breast
cancer and correlated it with clinicopathological
characteristics. (Results) The average age was
50.8510.91 with a range of 26-78. 112 cases accounted for invasive ductal carcinoma, and 2 cases
were invasive medullary carcinoma and metaplastic
carcinoma. Positive expression rate of CD73 was
30.6%. Our analysis revealed positive expression of
CD73 was significantly associated with molecular
subtypes of breast cancer (p=0.035), specifically
CD73 expression was significantly lower in the
HER2 subtype. When all cases were stratified by
molecular subtypes, CD73 expression was significantly associated with tumor size and histologic
grade (p=0.025 and 0.043, respectively) in luminal
type breast cancer. Survival analysis across the molecular subtypes showed no significant association
between CD73 expression and survival. We also
found that CD73 expression was correlated with tumor size and positive expression of progesterone
receptor (p=0.030 and 0.008, respectively) for all
cases. Correlation between CD73 and other immunohistochemical markers showed that CD73 expression was associated with leptin and leptin receptor expression (<p=0.001 and 0.016, respectively).
The disease-free survival (DFS) and overall survival
(OS) rate at 5 years were 86.4% and 95.1%,
respectively. There was no difference in DFS and
OS based on CD73 expression. (Conclusion) Our
study showed that CD73 expression was associated
with molecular subtypes of breast cancer. Further
studies are needed to clarify the role of CD73 in
breast cancer.

(Purpose) CD73 is a glycosyl phosphatidylinositol-anchored membrane protein defined as the lymphocyte differentiation antigen, and a negative regulator of inflammation. CD73 was highly expressed
in many human solid tumors including breast cancer and is known to promote cancer progression.
The aims of this study were to analyze whether
the expression of CD73 is associated with a particular molecular subtype of breast cancer and to

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Annual Congress of KSS 2015 [67th Congress of the Korean Surgical Society]

PE-229

PE-230

Is immediate reconstruction after


mastectomy in breast cancer
patients beneficial to shoulder
function?

Influence of subcutaneous and


visceral abdominal adipose tissue
measured by computed
tomography on biological receptor
status and prognosis of breast
cancer

Department of Orthopaedic Surgery, Department of


1
General Surgery, Surgery, Department of General
2
Surgery, Plastic Surgery, Department of General
Surgery, College of Medicine, Hanyang University,
Korea

Department of Surgery, 1Radiology, 2Nuclear


Medicine, Hanyang University Medical Center, Korea

Bong-Gun Lee, Joon-Kuk Kim, Jong Oh Lee1,


1
2
Sung Hyouk Choi , Hee Chang Ahn ,
1
Min Sung Chung *

Sung Hyouk Choi, Min Young Choi,


1
2
Bo-Kyeong Kang , Ji Young Kim ,
Min Sung Chung*

(Purpose) To compare SAM (Shoulder and Arm


Morbidity) between patients who received transverse rectus abdominis myocutaneous (TRAM) flaps
after mastectomy (group A) and patients who underwent mastectomy only (group B). (Methods) 30
patients a in each group was examined at minimum 2 postoperative years by a single orthopedic
surgeon. Visual analog scale (VAS) score, prevalence of limitation of motion (LOM), prevalence of
rotator cuff disease, muscle strength, shoulder function score (American Shoulder and Elbow Surgeons
[ASES] score and Shoulder Pain and Disability
Index [SPADI]), and measurement of scapula tilt on
chest radiography and standing position in each
group were compared. (Results) No significant differences in VAS, prevalence of LOM, prevalence of
rotator cuff disease, muscle strength, shoulder function score and scapula tilt on physical examination
were observed. However, the lower angles of the
scapula on chest radiography (4.0313.2 Vs
3.3812.4 mm; p=0.029) and pectoralis minor index
(0.377.66 mm Vs 0.379.09 mm; p=0.001) showed
significant differences between the two groups.
(Conclusion) We confirmed that breast reconstruction after mastectomy has an advantage in
terms of preserving the scapular resting alignment,
but did not provide benefits to shoulder morbidity.

(Purpose) Pre-existing obesity and postoperative


weight gain are related to a poor prognosis of
breast cancer. Obesity is usually considered in
terms of the body mass index (BMI). Few studies
have investigated the association between obesity
and biological receptor status, pathological predictors and clinical outcomes in breast cancer by
using abdominal adipose tissue measurement.
(Methods) Total abdominal adipose tissue (TAAT),
visceral adipose tissue (VAT), subcutaneous adipose
tissue (SAT), and visceral/subcutaneous ratio (VSR)
were measured from abdominal computed tomography performed for preoperative evaluation in 237
breast cancer patients and were compared with biological receptor status and clinical outcomes.
(Results) Estrogen receptor (ER) negative breast
cancer in pre-menopausal women showed significantly higher SAT area compared with
ER+breast cancer (p=0.04). Conversely, in post-menopausal women, SAT area was higher in ER+compared with ER- (p=0.02). PR status showed similar
propensity in pre- and post-menopausal women
(p<0.01, p<0.01). Higher SAT area was measured in
tumor larger than 2cm (p<0.01). In multivariate logistic regression models, SAT area was only positively correlated with PR+status among post-menopausal women. (2nd tertile-OR: 0.28, 95% CI:
0.10-0.78, p=0.02, 3rd tertile-OR: 0.09, 95% CI:
0.02-0.39, p<0.01). Based on the results of multivariate Cox analysis in all patients, VSR0.36 was
associated with better disease free survival and was

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significant independent prognostic factor (OR: 0.44,
95% CI: 0.21-0.96, p=0.04). In subgroup analysis,
pre-menopausal women with VSR0.36 showed favorable overall survival (OR: 0.11, 95% CI:
0.01-0.90, p=0.04). (Conclusion) According to SAT
area, conflict ER and PR status was observed between pre- and post-menopausal women. Higher
SAT have a higher proportion of PR+breast cancer
in post-menopausal women. VSR0.36 showed better survival outcomes which suggest the importance
of proportion between SAT and VAT, not just BMI,
in prognosis of obese patient with breast cancer.

PE-231
Impact of immunotherapy using
viscum album as an adjuvant
treatment in invasive breast cancer
Division of Breast and Endocrine Surgery, Hallym
University Sacred Heart Hospital, Department of
Surgery, Hallym University College of Medicine,
Korea

Han Sung Kim, So-Eun Ahn, Kang Yool Lee,


Jun Ho Kim, Lee Su Kim*
(Purpose) Viscum album, also known as European
Mistletoe, is as powerful medicinal herb which is
used for treatment of many cancers including
breast cancer. The effect of Viscum album is to enhance macrophage phagocytic and cytotoxic medicated abilities, and the prominent extracts like viscotoxins and lectins have cytotoxic and growth-inhibiting effects on cancer cells. In this study, we
evaluate
survival
benefit
of
adjuvant
immunotherapy in invasive breast cancer compared to
patients who have not undergone immunotherapy.
(Methods) Of 754 female patients who underwent
curative surgery followed by standard adjuvant
therapies in Hallym Sacred Heart Hospital from
2003 to 2011, 162 patients underwent immunotherapy with Viscum album, which is a species of mistletoe, as an adjuvant therapy. In order
to analyze survival benefit, 31 patients who were
taken immunotherapy for less than 12 months were
excluded. We compared disease free survival (DFS)

and overall survival (OS) of immunotherapy group


(n=131) with those of non-immunotherapy group
(n=592)
using
Kaplan-Meier
survival
curve.
(Results) The mean age of all patients was
50.140.41 (range, 23-85) years and the median follow-up period was 61 months (range 7-137). In the
clinical or pathological characteristics between the
two groups, patient in immunotherapy group had
more poor-prognostic factors such as histologic
grade (52.6% vs. 28.4%, p<0.001), nuclear grade
(54.1% vs. 28.1%, p<0.001), hormone receptor (HR)
negative (87.8% vs. 14.5%, p<0.001), and HER2
overexpression (36.7% vs. 20.2%, p<0.001). More patients in immunotherapy group were gotten adjuvant chemotherapy (98.5% vs. 87.7%, p<0.001)
and target therapy for HER2 overexpression (26.7%
vs. 14%, p<0.001) compared to non-immunotherapy
group. Much more patients in immunotherapy
group have not taken endocrine therapy (22.1% vs.
88.2%, p<0.001). In survival analysis for all patients,
there was no significant survival benefit in immunotherapy group, statistically. In subgroup analysis by HR status, however, immunotherapy group
had significant DFS benefit (5-year DFS: 96.7% vs.
87.3%,
p<0.001).
In
subgroup
analysis
by
Trastuzumab used, hormone receptor negative
group had no significant DFS and OS benefit. Of
201 HR negative patients, recurrence was related ti
lymph node (LN) status, TNM stage, and adjuvant
immunotherapy in both univariate and multivariate
analysis. (Conclusion) In this study, additional immunotherapy after standard treatment without endocrine therapy showed survival benefit in HR
negative group, even though immunotherapy group
had more poor-prognostic factors. Therefore, we
suggested that adjuvant immunotherapy might be a
therapeutic option for HR negative patients.

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Annual Congress of KSS 2015 [67th Congress of the Korean Surgical Society]

PE-232
Synergistic effect with the
combination of selenium with
eribulin in breast cancer cell lines

and synergic pattern were found between the combination treatment groups and the eribulin without
selenium treatment group. (Conclusion) The current study showed that combination of selenium
with eribulin could increase cytotoxicity and this
might be through apoptosis in MDA-MB-231 breast
cancer cells.

Department of Surgery, Ewha Womans University


2
School of Medicine, Department of Surgery, Ewha
Womans University Mokdong Hospital, Korea

PE-233

Joohyun Woo , Jun Woo Lee , Myung-Jin Kim ,


Dong Wook Park2, Nam Sun Paik1,2, Byung-In
1,2
1,2
Moon , Woosung Lim *

Immediate breast reconstruction


using a laparoscopically harvested
omental flap

(Purpose) Eribulin, a non-taxane microtubule dynamics inhibitor, is used to treat patients with
metastatic breast cancers. Even if it is proved to be
an effective drug in the metastatic disease, various
adverse events negatively affect quality of life of
the patients who have previously received multiple
lines of chemotherapy. The cytoprotective role of
selenium that has been reported could be helpful
in this clinical situation. However, the combination
effects of selenium on chemotherapy have not yet
been clearly defined. Considering anticancer property of selenium, authors designed this study to investigate the combined effects of selenium on chemotherapy using eribulin on breast cancer cell
lines. (Methods) Under adherent culture conditions, three breast cancer cell lines, MDA-MB-231,
MCF-7 and SK-BR-3 were treated with eribulin at
0.6 nM and selenium at 2M, 4M, or 8M.
Changes in cytotoxicity and degree of apoptosis after 24 hours or 48 hours in each treated group
were evaluated and analyzed. (Results) In the
MDA-MB-231 cells, there was a significant difference in cytotoxicity according to concentration of
selenium (P=0.022). The combination treatment
group (eribulin at 0.6nM plus selenium at 4M)
showed a significantly increased percentage of cell
death (5.9% vs. 48.2%; P=0.05) and a tendency toward increased early apoptosis (27.8% vs. 43.9%;
P=0.083), compared with the eribulin without selenium treatment group. Isobologram analysis demonstrated the synergistic effect of the combination
treatment in the MDA-MB-231 cells. However, in
the MCF-7 or SK-BR-3 cells, no significant differences in cytotoxicity, the percentage of apoptosis,

Department of Surgery, Ulsan University Hospital,


Korea

F288

Su Bien Park, Byung Kyun Ko*


(Purpose) Breast cancer patients tend to demand
oncoplastic surgery that meets their cosmetic
satisfaction. In autologous reconstruction, the latissimus dorsi flap and transverse rectus abdominis
myocutaneous flap play the main role. The disadvantage of these autologous tissues is the presence of donor-site morbidity and deformity.
Laparoscopically harvested ometal flap (LHOF)
compensates for these disadvantages associated
with the donor site. Some reports have described
LHOF, but most are case reports or small series.
The data of complication rates and long-term results for this new procedure are not fully surveyed.
We report our experience of immediate breast reconstruction by LHOF at our institution. (Methods)
From December 2014 to May 2015, 7 patients underwent LHOF for immediate breast reconstruction
after mastectomy. Patients with a history of either
intra-abdominal malignancyor upper abdominal laparotomy were excluded from the study. All patients
were evaluated for outcome of the operation,
length of hospital stay, and postoperative
complications. (Results) 7 patients underwent immediate breast reconstruction using a LHOF after
skin-sparing mastectomy (n=4) or nipple-areolar
preservation mastectomy (n=3). In 3 patients, the
omental flap size was found to be inadequate during the procedure and a silicone implant was in-

Breast () : Poster Exhibition


serted under the omental flap. The postoperative
course of all patients was uneventful and the mean
length of hospital stay was 17.4 days. The mean
operative time for harvesting of the omental flap
was 130 minutes without conversion to an open
procedure. There was no total graft loss, but 2 cases of partial skin necrosis and 2 cases of epigastric
hernia. Cosmetic results were mostly satisfactory,
with a soft and symmetric breast that was natural
in appearance. Donor site scar were minimal (three
laparoscopy scars on the abdomen). No size reduction of the reconstructed breast was noted during
the follow-up period. Although the follow-up period was short, neither local nor systemic recurrence
has occurred so far in any patient. (Conclusion)
Immediate breast reconstruction with LHOF provides a soft and natural-looking reconstructed
breast with less donor-site deformity. However
LHOF has a limitation in preoperative estimation of
omental volume and use of a silicone implant in
sequence. We need more studies that estimate
whether silicone implant is inserted based on
omental volume and reconstructed breast size. In
the matter of incision hernia, more specific technique should be considered, for instance anchoring
the abdominal fascia or use meshes for overlapping
the pedicle.

PE-234
Vacuum-assisted breast biopsy
using a single circumareolar
incision
Department of Surgery, Damsoyu Hospital, Korea

Byung Seo Choi, Geon Young Byun,


Seong Bae Hwang, Sung Ryul Lee*
(Purpose) Breast mass excision with Vacuum-as
sisted breast biopsy (VABB, Mammotome ) has
been widely performed. The aim of this study is to
investigate feasibility, safety and cosmetic benefit of
VABB through a single circumareolar incision.
(Methods) From September 2012 to July 2015, the
results of 178 VABB were retrospectively reviewed.
Lesions with BI-RADS category 3 and 4a were

included. Operation time, complication and patient


satisfaction for cosmetic result were evaluated.
VABB for multiple tumors or large tumor were also performed through a single circumareolar incision, without additional incision. (Results) The
mean size of the mass was 2.231.72 cm (range
1-12) and the mean operation time was 9.031.61
min (range 5-80). Most common histopathologic result was fibroadenoma (67.8%) and 1 case of ductal
carcinoma in situ (0.31%) was also found. Only 4
cases (1.24%) of complications were found and all
of them were hematoma. 79 patients (44.5%) had
multiple tumors and 13 patients (7.3%) had giant
fibroadenomas
larger
than
5cm
in
size.
Complication associated with the removal of multiple tumors or giant tumor was not found.
Postoperative scar was barely visible and all the
patients were satisfied with the cosmetic result.
(Conclusion) From our experience, the VABB
through a single circumareolar incision is feasible,
safe and cosmetically excellent procedure even if
having multiple or giant tumors.

PE-235
Effect of marine brown alga on
two human breast cancer cell lines
: Apoptosis and cell-cycle arrest
Department of Surgery, College of Medicine,
Uijeongbu St. Marys Hospital, The Catholic
University of Korea, Korea

Yong-Seok Kim, Hyewon Bang,


Jeong-Soo Kim*
(Purpose) Diekol and Seanol, a phlorotannin compounds isolated from Ecklonia cava have been reported to several biologic properties, including anti-oxidant, anti-viral, anti-inflammatory, anti-cancer
activities. The purpose of this study was to investigate the anti-cancer effects induced by these
agents on human breast cancer cell lines.
(Methods) In this study, cell viability assay in
duced by Dieckol and Seanol was investigated using WST-1 assay on human breast cancer SK-BR-3,
MCF-7 cell lines. Apoptosis and Cell-cycle analysis

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Annual Congress of KSS 2015 [67th Congress of the Korean Surgical Society]
was assayed via Annexin V-flourescein isothiocyanate and propidium iodide staining followed
by flow cytometric analysis. Immunoblotting analysis was also performed using BAX/Bcl-2, CDK2,
CDK4, and cyclin D3. (Results) Dieckol and Seanol

reduced the number of viable cells and increased


apoptotic cells in a dose-dependent manner. We analyzed the effect of Dieckol and Seanol on the
cell-cycle distribution using flow cytometry. In dieckol treated group, the percentage of cells at the
G2/M phase significantly increased on MCF-7,
SK-BR-3 cell lines. Immunoblotting analysis re
vealed that Dieckol and Seanol increased the expression level of BAX/Bcl-2 and downregulated the
expression of cyclin D3. (Conclusion) Dieckol and

Seanol were cytotoxic to SK-BR-3, and MCF-7 human breast cancer cells via induction of apoptosis
and cell-cycle arrest. Therefore, we suggest that

Dieckol and Seanol may be a potential therapeutic


agent for breast cancer treatment.

PE-236

amous cell carcinoma. (Results) She underwent a


modified radical mastectomy in the right breast
and wide excision and local flap coverage. The
pathology demonstrated squamous cell carcinoma
in right breast and ipsilateral hand. There is a
lymph node metastasis. (Conclusion) Here we
present a case of a unusual metastatic site of squamous cell carcinoma of hand, the breast.

PE-237
Cumulative sum analysis for
learning curve for breast mass
excision using an
ultrasound-guided vacuum-assisted
biopsy system
Department of Surgery, Yonsei University College of
1
Medicine, Department of Surgery, Dongnam
Institution of Radiological & Medical Sciences, Korea

Metastatic squamous cell carcinoma


mimicking primary breast cancer

Sung Mook Lim, Hyung Seok Park*,


1
Chang Wan Jeon

Department of Surgery, College of Medicine,


Uijeongbu St. Marys Hospital, The Catholic
University of Korea, Korea

(Purpose) The aim of the study is to evaluate the


existence of a learning curve for procedures using
an ultrasound-guided vacuum-assisted breast biopsy
system (VAB) using the cumulative sum (CUSUM)
analysis (Methods) Data from a series of 54 consecutive patients who underwent ultrasound-guided
VAB procedures were reviewed in the study.
Patients' characteristics, operative times, and complication rates were analyzed. Total operation times
were analyzed using the CUSUM method. (Results)
The CUSUM analysis revealed three phases of the
learning curve: phase 1 (the initial 15 cases), phase
2 (the middle 23 cases), and phase 3 (the subsequent cases). Operative times including preparation time, procedure time, and total operation time
in phase 1 were significantly longer than those in
phase 2 and 3. Surgical complications were most
frequently found in the initial phase (26.7%), however, complication rates were not significantly different among the three groups. (Conclusion) The
current study demonstrated the three different
phases of the learning curve for ultrasound-guided

Yong-Seok Kim, Jeong-Soo Kim*


(Purpose) Metastases to the breast from extramammary sites are extremely rare. Most studies
have reported the common sites are leukemia, lymphoma, malignant melanoma. Only one case of
metastatic squamous cell carcinoma in the breast
from hand has not been reported in the literature.
(Methods) A 77-year-old female presented with a
lump in the right breast in May 2015. She had no
history of pain or nipple discharge. Breast ultrasound revealed an lobulated, 3.7cm hypoechoic
nodule in the upper outer quadrant of the right
breast. A core needle biopsy indentified an invasive
carcinoma with squamous differentiation. And she
complained of 5cm sized protruding lesion in the
2nd web space of right hand. Incisional biopsy was
performed, and this lesion was diagnosed as squ-

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VAB procedures using the CUSUM analysis. The
CUSUM analysis can be used to determine appropriate procedural competency of various procedures
in patients with breast disease.

PE-238
Dermatofibrosarcoma protuberans
in breast
Department of Breast-Endocrine Surgery, Korea
University Medical Center, Korea

Hwan Soo Kim, Young Woo Chang,


Seung Pil Jung, Sang Uk Woo, Jae Bok Lee,
Jeoung Won Bae, Gil Soo Son*
(Purpose) Dermatofibrosarcoma protuberans (DFSP)
is a rare neoplasm of soft tissues. In 1924, Darier
and Ferrand first described progressive recurrent
dermatofibroma, and DFSP was described by
Hoffmann in 1925. DFSP represents about 1% of
soft tissue sarcomas with an estimated incidence of
0.8 to 5.0 cases per million per year. DFSP typically
presents during early or middle adult life. DFSP
was recurred in situ, not spread to distant site.
However metastatic cases have been associated
with local recurrence and poor prognosis.
Chemotherapy and radiation therapy have no effect
on DFPS. Therefore, the complete surgical excision
with wide, pathologically negative margins of 3
cms is the optimal treatment for primary or recurrent tumor. DFSP involves any part of body, although usually trunk and extremities. The involvement of DFSP in breast is very rare and very few
cases have been reported in the literature. It is difficult to distinguish DFSP from other primary
breast lesions. (Methods). (Results) A 46-year-old
woman presented with palpable lump in the in the
right breast. The patient had no family history of
any cancer. The physical examination revealed a
firm, 20 mm x 25 mm mass in the upper central
part of the right breast, without enlarged lymph
node in right axilla. There was no skin lesion in
the right breast. The contralateral breast and axilla
were within the normal limits. On ultrasonography,
a lesion appeared as hypoechoic, circumscribed

mass of approximately 37 mm x 30 mm in diameter in the upper central part of the right breast.
The mass of right breast was demonstrated DFPS
by pathologic examination. Computerized tomography
(CT)
scan
of
the
chest
and
2-[18F]-fluoro-2-deoxy-D-glucose (18F-FDG) positron-emission tomography (PET) showed only primary lesion in subcutaneous layer and no enlarged
lymph node. The patient underwent excision of the
tumor widely. (Conclusion) DFSP in breast is extremely uncommon and can mimic a primary
breast tumor. Surgical excision with adequate resection margins is recommended to ensure local
control of the disease.

PE-239
Signet ring cell carcinoma in breast
Department of Breast-Endocrine Surgery, Korea
University Medical Center, Korea

Hwan Soo Kim, Young Woo Chang,


Seung Pil Jung, Sang Uk Woo, Jae Bok Lee,
Jeoung Won Bae, Gil Soo Son*
(Purpose) Signet ring cell carcinoma (SRCC) can
arise from virtually all organs. Most cases of breast
SRCC are infiltrating lobular carcinoma, and a minority of cases are infiltrating ductal carcinoma.
Howerver, breast SRCC belongs to mucin-producing carcinomas. In the 2003 classification of breast
carcinomas by the World Health Organization
(WHO), breast SRCC was placed under the 'mucin-producing carcinomas' and separate from both
infiltrating ductal and ductal carcinoma. Breast
SRCC is a very rare variant accounting for 2-4.5%
of all primary breast cancers. Saphir first descrided
this tumor as a variety of mucinous carcinoma in
1941. Hull et al. reported 24 cases of breast SRCC,
which represented 4.5% of 535 cases in their
databases. To date, only a few cases have been reported in the English literature. (Methods).
(Results) A 55-year-old woman presented with
lump in the in the right breast discovered by annual examination on months ago. The patient had no
family history of any cancer. The physical examination revealed a firm, 15 mm x 10 mm mass in the

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Annual Congress of KSS 2015 [67th Congress of the Korean Surgical Society]
upper outer quadrant of the right breast, with enlarged lymph node in right axilla. On ultrasonography, a lesion appeared as hypoechoic, irregular mass of approximately 13 mm x 10 mm in diameter in the upper outer quadrant of the right
breast. Another hypoechoic, irregular mass of approximately 12 mm x 6 mm in diameter was noticed just beside previous mentioned mass. The
mass of right breast was demonstrated SRCC by
pathologic examination, and the mass of right
breast was demonstrated invasive carcinoma. On
esophagogastroduodenoscopy, atrophic mucosa of
stomach suggestive of chronic atrophic gastritis was
shown. On colposcopy, a polyp was detected in
rectum and demonstrated tubular adenoma with
high grade dysplasia. CT scan of the chest and abdomen showed several enlarged lymph nodes in
the right axilla. 18F-FDG PET showed also only
primary lesion and right axillary lymph nodes. The
patient underwent both conserving surgery and axillary lymph node dissection. After surgery, the patient received four cycles of docetaxel followed by
four cycles of anthracycline and cyclophosphamide.
Chest wall irradiation were performed. Since May
2015, she was given 2.5 mg of letrozole once daily.
Following 11 months follow-up, the patient showed
neither the evidence of progressive disease, nor
metastasis in other parts of the body. (Conclusion)
Primary SRCC of the breast is a very rare malignant tumor and must be distinguished from metastases of SRCCs to the breast. The prognosis of this
tumor is usually poor but early detection may provide a good result. It is important to differentiate
this type of tumor according to the pathological
and clinical characteristics.

F292

PE-240
Maximum standardized uptake
value of tumor on 18-FDG PET CT
after neoadjuvant chemotherapy
can predict the pathologic
response in locally advanced breast
cancer
Department of Surgery, 1Nuclear Medicine, 2Internal
3
Medicine, Pathology, Keimyung University School of
Medicine, Korea

Hyosun Kim, Youngmin Kim, Changho Yeom,


Jihyoung Cho, Kyoung Sook Won1, Keon Uk
2
3
Park , Sunyoung Kwon , Sun Hee Kang*
(Purpose) The aim of this study is to evaluate the
correlation of metabolic response in F-18 fluorodeoxyglucose
positron
emission
tomography/computed tomography (FDG-PET/CT) after
neoadjuvant chemotherapy (NAC) and with pathologic response. (Methods) This study included 26
patients with locally advanced breast cancer who
had NAC and radical surgery from September 2007
to January 2015 in our institute. Clinicopathologic
factors as age, pre-NAC clinical stage, chemotherapy regimen, clinical, metabolic and pathologic
response to NAC, operation method were analyzed
retrospectively. Pathologic response such as pathologic complete response (pCR), partial response
(pPR), non-response (pNR) were compared with
clinical and metabolic response. Metabolic response
was described as metabolic complete response
(mCR) and metabolic partial response (mPR); mCR
was defined as complete resolution of hot uptake
of primary tumor and mPR was defined as reduced uptake but not suitable for mCR. To assess
the predictive value of 18-FDG PET, we analyzed
the mean value or reduction rate (RR) of maximum
standardized uptake value (maxSUV) according to
chemotherapy response. RR was defined as ratio of
reduced maxSUV to maxSUV of pre-NAC. (Results)
In clinical stage before NAC, II was 12 patients
(46.2%), III was 14 (53.8%). Adriamycin based regimen was used in 10 patients (38.5%), and adriamycin plus taxane regimen was used in 16 patients

Breast () : Poster Exhibition


(61.5%). In metabolic response, all patients showed
reduced maxSUV after NAC. Six patients (23.1%)
showed mCR. Mean value of maxSUV before and
after NAC was 12.5 (2.6-26.5) and 5.2 (1.0-16.4).
Mean reduction rate was 60.4%. After operation,
pCR was achieved in 4 patients (15.4%), pPR in 14
patients (53.8%), pNR in 8 patients (30.7%). And
among 6 mCR patients, 4 patients showed pCR
and the other 2 patients showed pPR. Among mPR
patients, nobody showed pCR (<0.001). pCR group
showed lower value of post-NAC maxSUV (1.0,
p=0.009) and higher RR of maxSUV (82.1%,
p=0.004) than pPR and pNR group. In terms of
pre-NAC maxSUV, there was no statistical difference according to pathologic response. We found
the optimal cutoff value of post-NAC maxSUV and
RR predicting pCR and pPR, which were 5.4 and
56%. In analysis for correlation with pathologic response, both cut off value were statistically significant in univariate analysis, however post-NAC
maxSUV 5.4 or less was the only independent significant factor in multivariate analysis (Odd ratio
21.4, p=0.018). (Conclusion) MaxSUV of 18-FDG
PET after NAC has possible predictive role in assessment of NAC response before surgery in locally
advanced breast cancer. However, we should do
further evaluation and validation with larger patients for more reliable results.

PE-241
Prognositc effect of sentinel lymph
node biopsy after neoadjuvant
chemotherapy
Division of Breast and Endocrine Surgery,
Department of Surgery, Samsung Medical Center,
Sungkyunkwan University School of Medicine, Korea

Sungmin Park, Soo Youn Bae, Se Kyung Lee,


Seok Won Kim, Seok Jin Nam,
Jeong Eon Lee*
(Purpose) The purpose of this study was to identify the feasibility and accuracy of sentinel lymph
node biopsy (SLNB) after neoadjuvant chemotherapy (NAC) in patients with axillary lymph

node (ALN) metastasis at diagnosis. (Methods)


This is a retrospective study of 330 patients who
were diagnosed with invasive breast cancer and
ALN metastasis and treated with NAC followed by
curative surgery at Samsung Medical Center between January 2007 and December 2013. Patients
were classified into five groups according to surgical procedure for the ALNs and pathologic results;
group 1, patients with negative SLN status and no
further dissection was performed; group 2, patients
with negative SLN status undergoing further axillary lymph node dissection (ALND); group 3, patients with positive or undetected SLNs undergoing
further ALND; group 4, patients without residual
axillary metastasis undergoing complete ALND;
and group 5, patients with pathologic nodal positive disease undergoing ALND. (Results) Sentinel
lymph nodes identification rate after NAC was
99.1% and false negative rate was 7.8%. The median number of retrieved SLNs was 4 (range, 1-10).
There was no difference in the overall survival
among the groups (p=0.06). There was no significant difference in the disease-free survival rate
between the SLNB only and complete ALN dissection groups who revealed a pathologic complete
node response (79.6% versus 80.5%) and the rate of
axillary recurrence demonstrated no significant differences among the groups. (p=0.225) There was a
statistical difference of recurrence between group 1
versus 2, and group 1 versus 4 in hormone receptor-negative patients. (p=0.027) (Conclusion)
SLNB after NAC in breast cancer patients with initial ALN metastasis may help identify downstaging
to negative nodal status and thereby reduce the
surgical morbidity by avoiding standard ALN
dissection.

PE-242
Juvenile gynecomastia
Department of Surgery, Damsoyu Hospital, Korea

Seong Bae Hwang, Byung Seo Choi,


Geon Young Byun, Sung Ryul Lee*
(Purpose) Juvenile gynecomastia is thought to be
the result of an imbalance of estradiol and

F293

Annual Congress of KSS 2015 [67th Congress of the Korean Surgical Society]
testosterone. In most cases, it regressed naturally
after puberty, but juvenile gynecomastia without regression gives psychological damage to patients
having it. (Methods) A thousand and eighty six
patients who have been treated with gynecomastia
from January 2013 to August 2015 at the Damsoyu
Hospital
were
analyzed
retrospectively.
Subcutaneous mastectomy and liposuction were
performed on all cases by two surgeons (Dr.
Hwang and Dr. Lee). (Results) Juvenile gynecomastia was found in 40 patients (3.7%). The chief reason for their surgery was psychosocial problem and
all patients underwent surgery with the consent of
their parents. The mean age was 17.1 years old.
According to type of gynecomastia, fibro-glandular
type was in 35 patients (87.5%), pseudo-type in 4
patients (10%), and mixed type in one patient
(2.5%). Symmetric type of gynecomastia was in 37
patients (92.5%) and asymmetric type in three patients (7.5%). In our study, all patients enjoyed cosmetically
satisfying
outcomes.
(Conclusion)
Juvenile gynecomastia sometimes makes patients
having it embarrassed psychologically in their social life. The surgical intervention can be an useful
option for them.

in 45 patients (4.3%). According to type of gynecomastia, fibro-glandular type was most in both symmetric and asymmetric group (56% VS 62%). The
mean age was 28.0 years in symmetric group and
26.3 years in asymmetric group. The most frequent
age group in asymmetric gynecomastia was twenties (57.7%). The body mass index (BMI) was 27.4
kg/m2 in symmetric group and 24.8 kg/m2 in
asymmetric group. The both superficial mastectomies with liposuction was performed on patients
having symmetric gynecomastia. In operation method of asymmetric gynecomastia, both superficial
mastectomies with liposuction was performed in 39
patients (87%) and unilateral mastectomy with liposuction in 6 patients (13%). In our study, 96.4% of
patients enjoyed cosmetically satisfying outcomes.
(Conclusion) Asymmetric gynecomastia is more
observed in patients who are older or have lower
body mass index than in patients with symmetric
gynecomastia.

PE-244

PE-243

Breast and thyroid lesions found


simultaneously in an accessory
breast diagnosis

The asymmetry in gynecomastia

Department of Surgery, Damsoyu Hospital, Korea

Department of Surgery, Damsoyu Hospital, Korea

Seong Bae Hwang, Byung Seo Choi,


Geon Young Byun, Sung Ryul Lee*

Seong Bae Hwang, Byung Seo Choi,


Geon Young Byun, Sung Ryul Lee*
(Purpose) Gynecomastia is occurring in 5~10%
men and commonly symmetric. But in some cases,
asymmetric gynecomastia could be observed. The
aim of study is to find differences between asymmetry and symmetry in gynecomastia. (Methods)
A thousand and fifty patients who have been treated with gynecomastia from January 2013 to July
2015 at the Damsoyu Hospital were analyzed for
clinical factors retrospectively. Subcutaneous mastectomy and liposuction were performed on all cases
by two surgeons (Dr. Hwang and Dr. Lee).
(Results) Symmetric gynecomastia was found in
1005 patients (95.7%) and asymmetric gynecomastia

F294

(Purpose) Accessory breast is common occurring in


2~6% women and the surgical correction is performed for its undesirable appearance and cyclic
pain that make women embarrassed. We often encounter breast and thyroid lesions in an accessory
breast diagnosis. (Methods) 1100 patients who
have been treated with an excision of accessory
breast tissue from September 2012 to July 2015 at
the
Damsoyu
Hospital
were
analyzed
retrospectively. All patients had a breast-thyroid ultrasound exam. We performed FNA or core needle
biopsy for a suspicious lesion. (Results) All patients
were female. The age of the patients range from 21
to 60 years, median age, 33.7 years. Patients having
suspicious lesions including thyroid solid nodules

Breast () : Poster Exhibition


or breast mass more than BIRADs IV lesion on ultrasound exam were 174 (15.8%). Suspicious thyroid
nodules were 106 lesions and FNA confirmed that
benign nodules were in 94 lesions and malignant
nodules in 12 lesions. All malignant thyroid nodules were papillary thyroid carcinoma. Suspicious
breast masses were 80 lesions and core needle biopsy revealed that benign breast tumor in 77 lesions and breast cancer in 3 lesions. One of three
breast cancer patients was ductal carcinoma in situ
(DCIS) and invasive ductal carcinoma was another
two patients. We could found 15 cancer patients
(12 thyroid cancer patients and 3 breast cancer patients) of 1100 patients in preoperative accessory
breast diagnosis. (Conclusion) From our data, we
can find more cancer patients in accessory breast
diagnosis than expected cancer patients in common
population. Even though patients visit hospital for
accessory breast treatment, surgeons should not
miss any suspicious lesions found in accessory
breast diagnosis for an early detection and treatment of cancer.

(572 patients) of all accessory breast patients. The


mean age was 38.0 years in married group and
28.2 years in unmarried group. The main symptom
for accessory breast treatment was cyclic pain and
unwished appearance after delivery in married
group (53.4%), cyclic pain and unwished appearance after puberty in unmarried group (83.9%). The
amount of accessory breast tissue was statistically
more observed in married group (41.327.7g) than
in unmarried group (35.927.5g) (p<0.05). The
amount of liposuction during accessory breast surgery showed a significant increase in married
group, too (520.6268.7ml vs. 375.9198.8ml,
p<0.05). (Conclusion) From our data, we can observe more amounts of breast tissue and fatty tissue in married group than in unmarried group.
Breast surgeon should know that accessory breast
has the same natural changes as the normally located breast tissue after delivery, and keep it in
mind during accessory breast surgery.

PE-246
PE-245
The differences according to
marriage status in accessory
breast patients
Department of Surgery, Damsoyu Hospital, Korea

Seong Bae Hwang, Byung Seo Choi,


Geon Young Byun, Sung Ryul Lee*
(Purpose) Accessory breast is common occurring in
2~6% women and has the same natural changes as
the normally located breast tissue such as development, shrinkage and fatty change according to their
hormone level. We conducted an analysis of clinical
factors according to marriage status in accessory
breast patients. (Methods) 1048 patients who have
been treated with an excision of accessory breast
tissue from September 2012 to July 2015 at the
Damsoyu Hospital were analyzed retrospectively to
clinical factors according to marriage status.
(Results) The married group was observed in 45.4%
(476 patients) and the unmarried group in 54.6%

The SUVmax in tumor and axillary


lymph node on 18f-FDG PET/CT
can act as prognosis factor in
pathologic lymph node positive
breast cancer
1

Department of Surgery, Nuclear Medicine,


Keimyung University School of Medicine, Korea

Changho Yeom, Youngmin Kim, Hyosun Kim,


1
Jihyoung Cho, Bong-Il Song , Sun Hee Kang*
(Purpose)
The
positron
emission
tomography/computed tomography (PET/CT) was become essential study for cancer patient in recently.
We aimed to evaluate the effect of 18F-FDG
PET/CT for patient with breast cancer. Especially,
this study was to identify the prognostic value of
maximum standardized uptake value (SUVmax) of
primary tumor and metastatic node in invasive
breast cacinoma with ipsilateral axillary node
metastasis. (Methods) We retrospectively reviewed
the medical records of 80 patients who performed

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Annual Congress of KSS 2015 [67th Congress of the Korean Surgical Society]
18F-FDG PET/CT before first treatment for invasive
breast carcinoma between January 2007 and
November 2011. The patient underwent curative
treatment for breast carcinoma without systemic
metastasis, and had confirmed axillary node metastasis on pathologically. The clinicopathological features that were recorded included the patients age,
histology, tumor size, metastatic node, stage, hormonal receptor status, human epidermal growth
factor receptor 2 (HER2) status, primary tumor
SUVmax, metastatic nodal SUVmax and ratio of
nodal SUVmax to tumor SUVmax. There were assessed significant difference in predicting recurrence
by univariate and multivariate analysis. (Results)
All patients were women and mean age of patients
was 52 years (range, 30-84). Median follow up period of total patients was 58 months (range 11-95),
and 23 patients had recurrence (median follow-up,
21 months). 5 years overall survival (OS) rate was
90.9% and 5 years disease free survival (DFS) rate
was 72.8%. The mean value of tumor SUVmax, nodal SUVmax and ratio of nodal SUVmax to tumor
SUVmax were 8.15 (range, 1.0-26.5), 5.06 (range,
0.9-27.8) and 0.77 (range, 0.06-12.0). The tumor
SUVmax had more a significant difference from T
stage (p=0.021) and nodal SUVmax had more a significant difference from N stage (p<0.0001). The advanced breast stage, ER negative, triple negative
breast carcinoma (TNBC) and recurrence groups
had
higher
SUVmax.
The
receiver-operating-characteristic (ROC) curve determined a tumor
SUVmax of 8.3 (sensitivity, 65%; specificity, 68%;
area under the curve 0.659) and nodal SUVmax of
4.4 (sensitivity, 69%; specificity, 68%; area under
the curve 0.672) to identify the optimal cutoff value
about predicting recurrence. Univariate analysis
demonstrated that stage (p=0.017), cut off value of
tumor SUVmax (p=0.009) and nodal SUVmax
(p=0.003) had significant difference with recurrence.
In these 3 factors, there was no significant difference with recurrence by multivariate analysis.
(Conclusion) The tumor and nodal SUVmax on
18F-FDG PET/CT may be prognostic factors for
predicting recurrence in female breast cancer patients with nodal involvement.

F296

PE-247
Optimal concentration of
indocyanine green in near-infrared
fluorescence guided sentinel lymph
node biopsy in breast cancer
Division of Breast and Endocrine Surgery,
Department of Surgery, Samsung Medical Center,
Sungkyunkwan University School of Medicine, Korea

Hyun-June Paik, Ha Woo Yi, Sungmin Park,


Jam Min Ryu, Seok Jin Nam, Jeong Eon Lee,
Se Kyung Lee, Soo Youn Bae,
Seok Won Kim*
(Purpose) Near-infrared (NIR) fluorescence-guided
sentinel lymph node biopsy (SLNB) using indocyanine green (ICG) has been successfully applied in various kinds of cancers, especially in
breast cancer. Optimizing the concentration of ICG
without using human serum albumin in natural
lymphatic system is still required. (Methods) 25mg
of ICG was diluted with distilled water (DW) or
normal saline (NS). Dilution concentrations used for
measurement were 0.25g/mL, 0.5g/mL, 2.5
g/mL, 5.0g/mL, 25g/mL, and 250g/mL. The
brightness of fluorescence was measured by an image system called Visual Navigator (SH System,
Korea). We used graphic software (GIMP, version
2.8.14, The GIMP Team) to measure the brightness.
We assumed that drained serous lymphatics from a
breast cancer patient can reflect a natural lymphatic
condition injected with ICG in the operation field.
Drained lymphatics were mixed to reduce the concentration of ICG by half that was diluted with
DW or NS. We also measured the brightness of
fluorescence diluted with DW or NS that was
mixed with drained lymphatics. After this screening
test, we subdivided the range which brightness was
measured as 100 and adjusted the intensity of illumination for more specific results. (Results) Highest
brightness values were measured as 100 between
2.5g/mL and 25g/mL concentration of ICG with
DW dilution in screening settings, and the values
of brightness were measured as 100 between 2.5
g/mL and 5.0g/mL concentration of ICG with NS

Breast () : Poster Exhibition


dilution. When drained lymphatics were mixed together, the values of brightness were measured as
100 between 2.5g/mL and 25g/mL concentration
of ICG with DW or NS dilution. After subdividing
the ICG concentration to 2.5g/mL, 3.13g/mL, 5.0
g/mL, 6.25g/mL, 12.5g/mL and 25g/mL with
adjusting the intensity of illumination, the highest
brightness value was measured as 76 in 5.0g/mL
concentration of ICG with DW dilution. When diluting with NS, the highest brightness value was
measured as 61 in 5.0g/mL ICG concentration.
After mixing with drained lymphatics, the highest
brightness value was both 79 in 5.0g/mL concentration of ICG with DW and NS dilution.
(Conclusion) This study showed a practically optimal ICG concentration range in fluorescence guided
SLNB. The optimal range of ICG concentration is
from 3.13g/mL to 6.25g/mL with DW or NS
dilution. Although 5.0g/mL met the best result,
adjustment for individual settings may be
considered.

PE-248
Multi-modality imaging evaluation
in preoperative assessment of risk
for false-negative results of sentinel
node biopsy for patients with
breast cancer

operative assessment of risk for FN of SLNB for


patients with breast cancer. (Methods) We retrospectively identified patients who underwent SLNB
followed by axillary lymph node dissection. Patient
with breast and axillary ultrasound (US), breast
magnetic resonance imaging (MRI) and positron
emission
tomography/computed
tomography
(PET-CT) for preoperative evaluation was included.
False negative rates (FNR) of SLNB were compared
between subgroups using a two sample test for binomial proportion. (Results) A total of 487 patients
between 2004 and 2013 were included. Of the
women, 55 had FN results and 432 had true negative results (FNR, 11.3%). The FNR was 35.7% in
patients with suspicious node on three imaging
studies, whereas it was 6.4% in patients with negative node on all imaging studies (P<0.001). The
FNR was the highest in the patients with suspicious nodes by PET-CT (26.5% for PET-CT, 22.8%
for MRI, and 18.0% for US). Among the patients
with negative node by US (n=365), the FNR was
18.1% (15/83) for women with suspicious nodes by
MRI and/or PET-CT. (Conclusion) In patients with
suspicious nodes assessed by two or more preoperative imaging studies, an effort should be positively considered to pathologically test non-SN
during SLNB for accurate axillary staging.

Department of Surgery, Gangnam Severance Hospital,


1
Yonsei University College of Medicine, Department
of Surgery, Breast Center, MizMedi Hospital,
2
Department of Surgery, Severance Hospital, Yonsei
University College of Medicine, Korea

Ban Seok Yang, Hak Woo Lee,


1
Jong Tae Park, Hak Min Lee , Sung Gwe Ahn,
Joon Jeong*, Seung Il Kim2

FNR: false negative rate of sentinel lymph node biopsy, FN patients/Total patients
Fig. Venn diagram of patients group

(Purpose) Understaging and omitting adjuvant chemotherapy caused by a false negative (FN) in a
sentinel lymph node biopsy (SLNB) can adversely
influence survival outcome of breast cancer
patients. The aim of this study was to evaluate the
value of multi-modality imaging studies in pre-

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Annual Congress of KSS 2015 [67th Congress of the Korean Surgical Society]

PE-249

PE-250

Prognostic factor for partial


responder and validation of tumor
response ratio after neoadjuvant
chemotherapy in breast cancer
patients

High endothelial venule and its


clinicopathologic association in
nonmetastatic breast cancer

Division of Breast and Endocrine Surgery,


Department of Surgery, Korea University Hospital,
Korea University College of Medicine, Korea

Jung Min Youn, Seung Pil Jung,


Gui Sun Choi, Sang Wook Woo, Gil Soo Son,
Jae Bok Lee, Jeoung Won Bae*
(Purpose) In the treatment of breast cancer, neoadjuvant chemotherapy (NAC) is useful in reducing
the size of breast cancer before surgical
intervention. Patients who show complete response
(pCR) to NAC are known to have improved overall
survival (OS). However, the relationship between
prognosis and patients with partial response are yet
unclear. In this paper, we evaluated the prognostic
factor in neoadjuvant setting and tumor response
ratio (TRR) method. (Methods) Clinicopathologic
factor were evaluated to predict overall survival.
TRR was calculated by dividing pathologic tumor
size by clincal tumor size. TRR was then categorized into four groups and the relationship between
different TRR groups and survival was determined
using statistical evaluation. (Results) Clinical N
stage (p=0.02), overall stage (p=0.04), pathologic N
stage (p=0.03), hormone receptor status (p=0.01)
and lymphovascular invasion (p=0.02) were significantly associated with the overall survival.
Pathologic overall stage and TRR did not show
statistical significance for overall survival. Patients
with pCR showed best survival rate throughout the
current
staing
system
and
TRR
method.
(Conclusion) Clinicopathologic factors are easily
applicable and valuable to predict overall survival,
clinicians could make use of these parameter without suspicion until the introduction of an accurate,
simple, and highly discriminating method to assess
the partial responder.

F298

Department of Surgery, 1Pathology, Kyung Hee


University School of Medicine, Kyung Hee
University Hospital at Gangdong, Korea

Youn Young Park, Jae-Hoon Jang, Sang-Ah Han,


Sung-Jig Lim1, Jeong-Yoon Song*
(Purpose) Unlike tumor angiogenesis known as a
poor prognosis factor, other kind of blood vessel so
called high endothelial venule (HEV) in tumor has
been reported as a good prognostic factor.
However, their clinical implication is not well
known. Therefore, this study was aimed to investigate HEV density within tumor microenvironment
and their association with clinical outcomes in patients with breast cancer. (Methods) We investigated HEV density in non-metastatic breast cancer
patients who underwent breast cancer surgery in
Kyung Hee university hospital at Gangdong between
June
2006
and
January
2010.
Clinicopathologic
data
were
analyzed
retrospectively. Also, we assessed densities of
MECA 79+ venules for HEVs and CD 11c+ cells
for
dendritic
cells
(DCs)
using
immunohistochemical staining. The clinicopathologic
variables included pathology, T stage, N stage, estrogen receptor (ER), progesterone receptor (PR),
HER 2 status, p53, Ki 67, extensive intraductal
component (EIC), lymphovascular invasion, nuclear
grade, modified Bloom and Richardsons histologic
grade (SBR grade), operation methods, chemotherapy, disease-free survival (DFS) and overall survival (OS). (Results) Patients were divided into two
groups (HEV_ low vs HEV_high) according to
cut-off level in previous study on HEVs in breast
cancer, and the cut-off valvue was 0.19 HEV/mm2.
The number of the HEV_high group patients was
29, and that of the HEV_low was 56. Presentation
of microinvasive cancer and HER2 expression, EIC
and SBR 3 were higher in the HEV_high group
than that of the HEV_low group (0% vs 13%,
p=0.014; 25.0% vs 48.3%, p=0.030; 26.8% vs 51.7%,

Breast () : Poster Exhibition


p=0.023; 19.6% vs 37.9%, p=0.001). PR expression in
the HEV_high group was lower than that of the
HEV_low group (51.8% vs 24.1%, p=0.012).
However, operation methods, T stage, N stage, ER,
hormonal therapy, p53, Ki 76, lymphovascular invasion, nuclear grade, locoregional recurrence, distant metastasis and mortality showed no statistically significant difference. We found that density
of DCs was increased in tumors with high density
of HEV. The patients with N stage of 2 showed
significant association with a shorter DFS (HR:
3.508 (CI: 1.043~11.803), p=0.043), and the patients
with positive ER expression were associated with
longer DFS (HR 0.060 (CI: 0.008~0.461), p=0.007).
However, DFS and OS rates of HEV-low and
HEV_high groups had no statistically significant
differences (p=0.393 and p=0.515). (Conclusion) We
could find that the density of HEV was correlated
with the density of CD11c+ DCs in the tumor
microenvironment. However, the HEV-high tumors
did not show a significantly better prognosis, while
positive ER expression and low nodal stage showed
a significantly better prognosis.

PE-251
Associations of physical activity and
metabolic syndrome with
comparison between breast cancer
survivors and non-breast cancer
participants : Findings from
KNHANES (2009-2013)

women. We would like to know whether the prevalence of metabolic syndrome according to the degree of physical activity is different between the
cancer survivors and non-cancer participants.
(Methods) We investigated physical activity pattern
and biomarkers related to the metabolic syndrome
of cancer survivors using data from the Korean
National Health and Nutrition Examination Survey
(KNHANES) 2009-2013 and compared with that of
non-cancer participants. The physical activity classified as severe activity, moderate activity, light activity like walking. And the prevalence was obtained from the data after adjustment for age and
after adjustment for age, BMI, smoke, drink, income, education respectively. (Results) The cancer
survivor group showed nearly half prevalence of
metabolic syndrome compared with non- cancer
participants group with light activity [odds ratio
(OR)=0.429; 95% confidence interval (CI)=0.205,
0.897 and OR=0.9; 95% CI=0.776, 1.044] in age-adjusted model and age, BMI, smoke, drink, income,
education - adjusted model [OR=0.433; 95%
CI=0.188, 0.997 and OR=0.887; 95% CI=0.759, 1.037].
However the OR was not different between two
groups with severe activity or moderate activity.
(Conclusion) This analysis showed that the light
intensity exercise like walking may reduce the metabolic syndrome in cancer survivor group compared with non-cancer participants. But the association between moderate to severe physical activity
and metabolic syndrome was not clear. In conclusion, light activity like walking, not the moderate to severe physical activity might guarantee reducing metabolic syndrome in cancer survivor compared with non-cancer group.

Department of Surgery, College of Medicine,


Catholic University of Korea, Korea

Yo-Han Park, Jin-Beom Cho, Ho-Joong Choi,


Jun-Hyun Lee, Jong-Min Baek*,
Ki-Young Sung, Do-Sang Lee, Il-Young Park
(Purpose) Physical activity can reduce metabolic
syndrome. And some biomarkers like waist circumference, fasting plasma glucose and cholesterol level
related to the metabolic syndrome are also known
as risk factors for some cancer for postmenopausal

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Annual Congress of KSS 2015 [67th Congress of the Korean Surgical Society]

PE-252

most patients who underwent breast reconstruction


had a satisfactory outcome.

Trends and outcomes in use of


breast reconstruction for breast
cancer patients

PE-253

Center for Breast Cancer, National Cancer Center,


Korea

Moo Hyun Lee, Soo Jin Park, Eun Jin Song,


So-Youn Jung, See Youn Lee,
Han-Sung Kang, Eun Sook Lee*
(Purpose) Recently use of breast reconstruction is
increasing and may be related to increased mastectomy rate. We observed trend of substantial growth
in the use of implant-based techniques and decreasing use of autologous reconstruction in western
countries. We evaluated recent trends and outcome
in the breast reconstruction of breast cancer patients at single institution. (Methods) Medical records of patients underwent breast reconstruction
between 2003 and 2014 were reviewed. Number of
implant-based techniques and latissimus dorsi (LD)
flap techniques, number of reoperation and cause
of reoperation were analyzed. (Results) A total of
426 patients underwent breast reconstruction from
2003 to 2014 and the use of reconstruction has increased over time. Before 2012, 137 patients underwent breast reconstruction and 289 underwent
breast reconstruction from 2012 to 2014. Before
2012, 94.1% of breast reconstruction was used LD
flap and 67.8% of patients who underwent breast
reconstruction were using implant from 2012 to
2014. Of 222 patients who underwent breast reconstruction with LD flap, 11 underwent reoperation and causes of reoperation were asymmetry
(n=4), partial flap necrosis (n=1), skin necrosis
(n=3), wound infection (n=1), delayed hematoma
formation (n=1) and recurrence (n=1). Of 204 patients who used implants, 23 underwent reoperation and cause of reoperation was capsular contracture (n=9), delayed wound healing (n=7), postop bleeding (n=4) and wound infection (n=3).
(Conclusion) Breast reconstruction has increased,
with increased use of implants and decreased use
of autologous techniques over time. Although there
were some complications requiring reoperation,

F300

Prediction of axillary metastasis in


TNBC patients with PET-CT
Department of Surgery, Kyung Hee University
Hospital at Gangdong, Korea

Yoona Chung, Sang-Ah Han, Jae-Hoon Jang,


Sun-Young Min, Yang, You-Jung,
Jeong-Yoon Song*
(Purpose) To determine the ability of axillary LN
SUV max on PET-CT to predict axillary metastasis
of breast cancer correlation with results on ultrasonography
and
clinicopathologic
findings
(Methods) The records of breast cancer patients
who had undergone PET-CT before receiving treatment (surgery and/or chemotherapy) for invasive
breast cancer at Kyung Hee University Hospital at
Gangdong between January 2006 and December
2014 were retrospectively reviewed. The axillary
lymph nodes were preoperatively evaluated by
PET/CT. In cases with suspicious metastatic lymph
node on preoperative ultrasonography, fine needle
aspiration (FNA) of the axilla was done. Lymph
nodes were dissected by sentinel lymph node biopsy (SLNB) or ALND and were histologically diagnosed by pathologists. The maximum standardized
uptake value (SUVmax) was measured in both the
axillary lymph node (SUV-LN) and primary tumor
(SUV-T). T-test and ^2 test were used to analyze
the sensitivity and specificity. Receiver operating
characteristic (ROC) and area under curve (AUC)
analyses were done (Results) A total of 358 operable
invasive
breast
cancer
patients
were
enrolled.The patients were divided into ER/PR+
low Ki-67; ER/PR+ high Ki-67; HER2+; and TNBC
(Triple negative breast cancer) according to IHC
characteristics. Among the subtypes of the 358 tumors, 102 (28.4%) were ER/PR+ low Ki-67, 113
(31.5%) were ER/PR+ high Ki-67, 70 (19.5%)
HER2+ and 73 (20.4%) were TNBC. The predictive
value of SUV max on PET-CT for metastatic axil-

Breast () : Poster Exhibition


Table 1. Characteristics of patients by IHC type

Mean age of surgery


Tumor size (cm)
Lymph node with
metastasis (N)
SUV max
Breast
Axilla
Ratio of SUV max
(Axilla/Breast)

Total
(N=358)

ER/PR+
Low Ki-67
(N=102)

ER/PR+
High Ki-67
(N=113)

HER2 +
(N=70)

ER/PR
HER2
(N=73)

P value

52.211.2
2.371.53

51.611.7
2.031.4

53.511.3
2.361.48

51.110.3
2.721.76

52.111.1
2.501.43

0.611
0.041

1.854.81

1.263.47

1.613.55

2.466.18

2.456.34

0.151

4.083.39
0.952.00

2.82.08
0.862.35

3.83.03
0.561.3

4.393.18
1.322.43

5.954.56
1.331.79

<0.0001
0.015

0.33

0.180.48

0.120.28

0.230.37

0.942.77

0.103

Table 2. Sensitivity, specificity, PPV, NPV, and Accuracy of PET-CT

Sensitivity
Specificity
PPV
NPV
Accuracy
AUC

Total
(N=358)

ER/PR+
Low Ki-67
(N=102)

ER/PR+
High Ki-67
(N=113)

HER2 +
(N=70)

ER/PR
HER2
(N=73)

0.565
0.853
0.688
0.775
0.749
0.72

0.411
0.924
0.736
0.753
0.75
0.671

0.439
0.930
0.782
0.744
0.752
0.685

0.667
0.825
0.740
0.767
0.757
0.761

0.875
0.667
0.567
0.914
0.736
0.797

lary LN was analyzed with sensitivity, specificity,


PPV, NPV, accuracy and AUC. The sensitivity in
general was 56.5% while 41.1% in ER/PR+ Low
Ki-67, 43.9% in ER/PR+ High Ki-67, 66.7% in
HER2+, and 87.5%in TNBC. The specificity in general was 85.3% while 92.4%, 93.0%, 82.5%, and
66.7% respectively. The AUC in general was 0.72.
while0.671, 0.685, 0.761 and 0.797 (Conclusion) The
mean SUV max of the main breast lesion and
metastatic axillary lymph node showed statistically
significant difference according to the IHC sub

PE-254
Oncological safety and cosmetic
satisfaction of oncoplastic breast
conservation surgery-compare with
conventional breast conserving
surgery and total mastectomy
1

Department of Surgery, Seoul National University


2
College of Medicine, Cancer Research Institute,
Seoul National University College of Medicine,
3
Bundang Jeasaeng Hospital, Korea

Yumi Kim1, Eunshin Lee3, Wonshik Han1,2*,


1
1
Han-Byoel Lee , Young Joon Kang , Jai Hong
1
1
12
Han , Tae-Kyung Yoo , Hyeong-Gon Moon , ,
Dong-Young Noh1,2
(Purpose) In recent decades, the surgical manage-

F301

Annual Congress of KSS 2015 [67th Congress of the Korean Surgical Society]
ment of breast cancer has steadily and considerably
improved. Now oncoplastic techniques applied to
breast-conserving surgery (BCS) allow large-volume
resections without compromising oncological safety.
A satisfactory cosmetic result could be difficult to
obtain due to high tumor to breast size ratio, unfavorable location, close to the nipple and contralateral ptosis. Oncoplastic techniques allows the
performance of wide excision, conserving an excellent breast shape, may be helpful in many cases.
This study was aimed to evaluate the oncological
safety of OPS. (Methods) Between January 2012
and December 2014, 1995 patients were identified,
who underwent mastectomy at Seoul National
University Hospital by one experienced breast
surgeon. Retrospectively medical chart review was
done and patients divide into three groups. Among
them 28.22% (n=563) underwent oncoplastic surgery

F302

(OPS), 32.88% (n=656) underwent conventional


breast conserving surgery and 38.90% (n=776) underwent total mastectomy. Statistical analysis of
each groups with SPSS 22.0. (Results) 1995 patients
data were analysed (OPS: n=563, conventional BCS:
n=656, TM: n=776). Tumor size (3.02cm vs 2.50cm)
and resected volume (73.0cm vs 59.8cm) was significantly bigger in OPS group than conventional
BCS group (p<0.05). Also margin safety was better
in OPS group than conventional BCS group
(P<0.05), but re-excision rate was not significalntly
difference within both group. (Conclusion) OPS
technique allows large-volume resections with
maintenance of oncological safety and good cosmetic results. Outcomes of OPS are oncologically
acceptable with low frequencies of positive margins, while cosmetic results are much improved by
OPS.