Altered physiologic and benign F-18 FDG uptake in the lower cervical muscle and chest wall following ipsilateral breast surgery or radiotherapy were common, and also normal physiologic uptake in ovary and uterus, brown fat, thyroid were considered as predominant findings in women patients with breast cancer. Knowledge of these findings might aid in the interpretation of FDG PET/CT in patients with breast cancer.

PurposeNeoadjuvant chemotherapy (NC) is yet to be established as the definitive treatment regimen for locally advanced breast cancer (LABC). The aim of this study was to determine the efficacy and toxicity of NC with epirubicin and paclitaxel.MethodsBetween March 2007 and January 2009, 50 patients with LABC were enrolled in an open-label, phase II, multicenter study carried out at five distinct institutions. All patients were scheduled to receive four cycles of 60 mg/m2 epirubicin and 175 mg/m2 paclitaxel every 3 weeks, preoperatively, unless they developed profound side effects or disease progression. After curative surgery, two additional cycles of chemotherapy were administered to patients who had shown a positive response to NC.ResultsIn all, 196 cycles of chemotherapy were administered preoperatively; 47 of the 50 patients (94%) underwent all four cycles of designated treatment. Complete disappearance of invasive foci of the primary tumor, and negative axillary lymph nodes were confirmed in eight patients (16.0%), post operation. The cumulative 5-year disease-free survival rate was 70.0% for patients with complete remission (CR) and partial remission (PR), and 33.3% for patients with stable disease (SD) and progressive disease (PD) (p=0.018). The cumulative 5-year overall survival was 90.0% for patients who achieved CR and PR and 55.6% for patients who had SD and PD (p=0.001). Neutropenia (42.0%) was the most common grade 3/4 toxicity. However, none of the toxicities resulted in cessation of the treatment.ConclusionThe encouraging pathologic response observed in the patients treated with epirubicin plus paclitaxel NC in this study suggests that epirubicin could be a substitute for doxorubicin, which is the most cardiotoxic agent.

Purpose: Neoadjuvant chemotherapy (NAC) has become the standard treatment for locally advanced breast cancer. The postoperatively adjuvant systemic treatment is based on the status of the histological and biological markers of either the pre-NAC or the post-NAC. There have been several reports that have demonstrated the changes of the histological and biological markers after NAC. The aim of this study is to investigate the effects of NAC on the expression of the histological and biological markers of breast cancer. Methods: We analyzed the paired pre-and post-NAC tumor specimens from 37 patients with stage IIIA, IIIB or IIIC breast cancer. All the patients received 2 to 6 cycles of anthracycline-containing NAC. Over 6 pieces of pre-NAC tumor specimens were taken by 14 G core needle from multiple sites of a tumor, and the post-NAC specimens were taken at the time of the operation. The histologic grade and immunohistochemical expression of estrogen receptor (ER), progesterone receptor (PR), c-erbB2, p53, Ki67, CD31 and pglycoprotein were analyzed in the paired pre-and post-NAC tumor specimens from 37 patients. Results: Twenty five patients (67.6%) revealed significant changes of more than one marker. The markers that showed changes of more than two grades were as follows; histologic grade in 1, ER in 4, PR in 9, c-erbB2 in 4, p53 in 1, Ki67 in 4, CD31 in 9 and pglycoprotein in 5 patients. In 12 patients (32.4%), significant changes were found in the markers that can influence the decision-making for adjuvant treatment (i.e. ER, PR and cerbB2). The ER/PR status changed from positive to negative in 4 patients and c-erbB2 was changed from positive to negative in 3 patients. Among those patients, the strategy of adjuvant treatment was adjusted according to the changes. Conclusion: The specimens for the histologic and biologic markers of a tumor should be taken before NAC because NAC can have an influence on the expression of the prognostic markers of locally advanced breast cancers, and this may subsequently influence predicting the prognosis and making the decision for adjuvant systemic treatment.

Purpose: Misdiagnosis is frequent in femoral hernia as inguinal hernia. The aims of this study were to examine the diagnostic concordance and to define the factors having influence on the correct diagnosis of femoral hernia. Methods: Thirty-two patients who underwent femoral hernia operations were analyzed retrospectively. Results:The mean age of the study subjects was 65.8±15.5 (36∼97) and the female to male ratio was 5.4：1. The mean body mass index (BMI) was 19.8 kg/m 2 (14.6∼26.9 kg/m 2 ). Twelve patients (37.5%) showed preand post-operative diagnostic concordance and 20 patients (62.5%) did not. Among the 20 misdiagnosed cases, 16 cases were misdiagnosed as inguinal hernia, 2 cases as lipoma, and 1 case as lymphadenopathy. The factors related to the correct diagnosis of femoral hernias were associated with groin mass (96.9%, 31/32: 23 painless and 8 painful), size fluctuation of mass (cyclic wax and wane pattern) (84.4%, 27/32), long duration of mass (over 1 month) (75.0%, 24/32), femoral venous compression CT findings (63.6%, 14/22), and positive ultrasonographic findings (42.1%, 8/19). Emergency operation was done in 12 cases (37.5%). Incarceration was found in 23 cases (71.9%) and most of the incarcerated organs were omental fat (11 cases) and small bowel (10 cases). Bowel resection was done in 4 cases and 2 patients combined inguinal hernia. Conclusion: Through the careful taking of medical history and physical examination, physicians can achieve the correct diagnosis and can also decrease the frequency of emergency operations and their related complications.

Purpose: Several approaches in endoscopic thyroid surgery have been developed to avoid large scars on the anterior neck. We assessed the feasibility and cosmetic benefit of performing gasless endoscopic thyroid surgery through a single infraclavicular approach. Methods: Thirty-one patients with a benign thyroid mass on sonography received gasless endoscopic thyroidectomy through a single infraclavicular approach. A 5-cm infraclavicular incision was created laterally, depending on the distance from the clavicle to the thyroid mass, but which would be completely hidden by a V-shaped shirt collar. In some cases, hand-assisted vessel ligation was performed through this incision. Results: The study included 26 female patients (out of 31), and the mean age was 38.2 years old (range, 14 to 70). All patients received a unilateral thyroid lobectomy, with or without isthmectomy, and tumors were benign (follicular adenoma in 12 and adenomatous hyperplasia in 19). A recurrent laryngeal nerve was identified in all cases. The mean operation time was 162.5 min (range, 100 to 300 min). No patients required conversion to conventional open surgery or showed postoperative bleeding, even without drainage. Hoarseness occurred in 1 patient with injury of the recurrent laryngeal nerve, which was repaired through the same incision and recovered within 6 months. Temporary hoarseness occurred in another 3 patients, but recovered within 3 months. Conclusion: Gasless endoscopic thyroidectomy through a single infraclavicular approach improved cosmetic outcomes and allowed for bleeding control through hand-assisted ligation of vessels. Therefore, the technique is suitable for surgeons inexperienced in endoscopic thyroidectomy.