PurposeRecently, transoral endoscopic thyroidectomy (TOET) is receiving attention because it is regarded as a true minimally invasive surgery in that it does not leave scars on any part of the body and the area of flap dissection is similar to that of open surgery. In this study, we present the surgical procedures and initial outcomes of TOET in the treatment of papillary thyroid microcarcinoma (PTMC) patients.MethodsThe medical records of patients who underwent TOET for PTMC between July 2016 and February 2017 were retrospectively reviewed. Indication of TOET was PTMC without capsular invasion or lymph node metastasis on preoperative imaging studies.ResultsTen female patients were enrolled. Seven patients underwent thyroid lobectomy and three patients underwent isthmusectomy. The mean age and tumor size was 43.3 ± 11.5 years and 0.6 ± 0.2 cm, respectively. Operation time for lobectomy and isthmusectomy was 121.1 ± 30.7 (range, 65–148) and 90.0 ± 9.2 minutes (range, 82–100 minutes), respectively. The mean number of retrieved lymph nodes was 2.7 ± 1.7. Two patients had transient vocal cord palsy, which recovered in three months. There was no case with subcutaneous emphysema, surgical site infection, postoperative bleeding, or mental nerve injury.ConclusionTOET was feasible and could be performed safely for PTMC. TOET might become a new treatment option for the patients who do not want to leave visible scars on the body.

Background. We sought to determine the significance of Ki-67, one of the tumor cell proliferation markers, as a useful prognostic factor in early breast cancer. Results. Univariate analysis determined that tumor size, lymph node involvement, histologic grade, estrogen receptor, progesterone receptor, bcl-2, and Ki-67 (C10%) were statistically significant for both overall survival (OS) and distant metastasis-free survival (DFS). Of these factors, lymph node involvement and high Ki-67 expression were identified as independent prognostic factors for OS and DFS on the basis of multivariate analysis. The survivals of intermediate-and high-risk groups according to 2007 St. Gallen consensus were further separated by Ki-67 expression level (5-year DFS rate = 91.9% vs. 86.3% for Ki-67 \ 10% and C10%, respectively in intermediate-risk group (P = .01); 5-year DFS rate = 82.5% vs. 61.4% for Ki-67 \ 10% and C10%, respectively in high-risk group (P = .01)). The survivals of low-and high-risk groups according to Adjuvant! Online were further separated by Ki-67 expression level (5-year DFS rate = 97.8% vs. 89.5% for Ki-67 \ 10% and C10%, respectively in low-risk group (P = .02); 5-year DFS rate = 9.4% vs. 82.6% for Ki-67 \ 10% and C10% in highrisk group (P = .005)). Conclusions. Ki-67 is an independent prognostic factor for DFS and OS in early breast cancer and can provide additional prognostic information on the risk stratification with the use of the 2007 St. Gallen consensus and Adjuvant! Online.

Purpose: To determine the prognostic roles of breast cancer subtypes in females with operable invasive breast cancer. Experimental Design: Data of 321,958 patients from Surveillance, Epidemiology, and End Results (SEER) database were analyzed. Breast cancer subtypes were classified into four categories according to the status of hormone receptor (HRc) and HER2: HRc(þ)/HER2(À), HRc(þ)/HER2(þ), HRc(À)/ HER2(þ), and HRc(À)/HER2(À). Results: Proportions of HRc(þ)/HER2(À), HRc(þ)/HER2(þ), HRc(À)/HER2(þ), HRc(À)/HER2(À), and unknown subtype were 70.3%, 9.4%, 3.9%, 10.4%, and 6.0%, respectively. HRc (þ)/HER2(À) showed the highest 5-year breast cancer-specific survival (BCSS) rate (95.5%), followed by HRc(þ)/HER2(þ) (94.1%), HRc(À)/HER2(þ) (89.3%), and HRc(À)/HER2(À) (83.1%). HRc(þ)/HER2(À) and HRc(þ)/HER2(þ) showed higher 5-year overall survival (OS) rates (88.4% and 88.2%, respectively) than HRc(À)/HER2(þ) and HRc(À)/HER2(À) (83.9% and 76.5%, respectively). HRc(À)/HER2(À) showed the worst BCSS irrespective of race, age, or stage. Although proportions of HRc(À)/HER2(À) in the subgroup with negative event regarding BCSS and OS were 10.4% and 10.2%, respectively, they were 34.2% and 22.7%, respectively, in the subgroup with positive event. Subtype was a significant factor in both univariable and multivariable analyses regarding both BCSS and OS (all P < 0.001). Conclusions: Breast cancer subtype was a significant independent prognostic factor regarding both BCSS and OS in multivariable analyses. HRc(þ) subtypes showed better prognosis compared with HRc(À) subtypes regarding both BCSS and OS. HRc(À)/HER2(þ) showed better prognosis than HRc(À)/HER2(À) but worse prognosis than HRc(þ) subtypes regarding both BCSS and OS. The triple-negative subtype showed the worst BCSS compared with the other subtypes irrespective of race, age, or stage.

PurposeElevated serum concentration of fibrinogen and decreased serum concentration of albumin have been reported to be markers of elevated systemic inflammation. We attempted to investigate the prognostic influence of preoperative fibrinogen to albumin ratio (FAR) for breast cancer.MethodsData from 793 consecutive primary breast cancer patients were retrospectively analyzed. Serum levels of fibrinogen and albumin were tested before curative surgery. Subjects were grouped into two groups according to the cutoff value determined by performing the receiver operating characteristic curve analysis: the high FAR group (FAR>7.1) and the low FAR group (FAR≤7.1). Overall survival was assessed using the Kaplan-Meier estimator. Independent prognostic significance was analyzed using the Cox proportional hazards model.ResultsThe high FAR group had a worse prognosis compared to the low FAR group (log-rank test, p<0.001). The prognostic effect of FAR was more significant than that of single markers such as fibrinogen (log-rank test, p=0.001) or albumin (log-rank test, p=0.001). The prognostic effect of FAR was prominent in the stage II/III subgroup (log-rank test, p<0.001) and luminal A-like subtype (log-rank test, p<0.001). FAR was identified as a significant independent factor on both univariate (hazard ratio [HR], 2.722; 95% confidence interval [CI], 1.659–4.468; p<0.001) and multivariate analysis (HR, 2.622; 95% CI, 1.455–4.724; p=0.001).ConclusionPreoperative FAR was a strong independent prognostic factor in breast cancer. Its prognostic effect was more prominent in the stage II/III subgroup and in the luminal A-like subtype. Therefore, preoperative FAR can be utilized as a useful prognosticator for breast cancer patients. Further studies are needed to validate its applications in clinical settings.

We correctly identified the precise location of parathyroid adenomas or hyperplasia by (99m)Tc-sestamibi SPECT/CT which was helpful to perform MIP.

Although BCL2 has occasionally been suggested as a candidate prognostic factor for breast cancer, it is still not accepted as a prognostic factor. We attempted to validate the role of BCL2 as a prognostic factor of breast cancer. Data on 7,230 primary breast cancer patients from the Seoul National University Hospital Breast Care Center were analyzed. Three current prognostic models, including the St. Gallen model, the Nottingham prognostic index (NPI) model and the TNM model, were used for analysis of the prognostic influence of BCL2. The positive BCL2 group showed more favorable features with regard to clinicopathologic parameters than the BCL2 negative group and a strong correlation was observed between BCL2 and the hormonal receptor. The positive BCL2 group showed better prognosis in overall survival and disease free survival (log-rank test, both p < 0.001), even in all subgroups, than the BCL2 negative group. BCL2 was a significant prognostic factor in both univariate (hazard ratio [HR], 0.361; 95% confidence interval (CI), 0.306-0.426; p < 0.001) and multivariate analyses (HR, 0.417; 95% CI, 0.417-0.705; p < 0.001). BCL2 had a strong influence on the established prognostic models, including the St. Gallen model, the NPI model and the TNM model. BCL2 was a powerful independent prognostic factor for breast cancer and had a strong influence on the current prognostic models. Favorable clinicopathologic features and a strong correlation with the hormonal receptor are suggested as the causes of superior survival in patients with BCL2 positive breast cancer.BCL2 has occasionally been suggested as a candidate prognostic factor for breast cancer; however, in general, it is still not accepted as a prognostic factor.1 Although most previously reported papers have suggested the possibility of BCL2 as a prognostic factor for breast cancer, the results were not consistent, but conflicting. Some papers have reported that by multivariate analysis BCL2 was found to be a statistically significant independent factor 2-6 ; however, other papers have reported that by survival analysis BCL2 was not found to be a statistically significant prognostic factor. 7-9 Furthermore, other papers have reported that BCL2 was significant by univariate analysis but not by multivariate analysis.10 Two papers reported that by meta-analysis BCL2 was found to be a statistically significant independent factor in breast cancer prognostication. 11,12The general acceptance of BCL2 as a prognostic factor has in part been impeded by a lack of robustness of the original research findings. A small number of papers could not provide sufficient evidence, and, due to small numbers of enrolled patients, statistical powers were too weak to show independence of influences in multivariate analyses. Furthermore, many prognostic factors are correlated and small studies have limited statistical power, especially in subgroup analyses. For these reasons, large scaled clinical studies are needed to validate the possibilities of BCL2 as a prognosticator for breast can...

Background The association between nuclear factor I/B (NFIB) gene and triple negative breast cancer has been previously suggested. Methods We investigated the relationship between NFIB mRNA and protein expression and molecular subtypes of breast cancer as well as the effect of NFIB silencing on the proliferation and apoptosis of breast cancer cells. Also, the clinical importance of NFIB expression was investigated in 163 breast cancer patients. Results By using 20 frozen human breast cancer tissues and various breast cancer cell lines, we observed a significant high level of NFIB mRNA level in triple negative breast cancer. NFIB protein was upregulated in ER negative breast cancer tissues but the expression level was similar between HER2 subtype and triple negative subtype. The clinical significance of NFIB was further examined in a tissue microarray from 163 invasive breast cancer patients, and the immunohistochemistry results showed a significant association between NFIB expression and nuclear grade, ER, and HER2 expression status. NFIB positive tumors were more likely to have high nuclear grade, ER negativity and HER2 over‐expression. HCC1954 cells transfected with siRNA against NFIB showed a significant reduction in cell proliferation and increase in apoptotic signaling pathway. Conclusions Our results show a potential role of NFIB as a novel target in ER negative breast cancers.

The likelihood of metastatic non-SLN correlated with preoperative ultrasonographic findings of the axilla, increasing pathologic size of the primary tumor, presence of lymphovascular invasion, increasing number of metastatic SLN, and decreasing number of nonmetastatic SLN. Our scoring system appears to be effective and accurate for selecting patients for whom ALND can be avoided.