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Objective To investigate the clinical value of axillary ultrasound (AUS)in the identification of axillary nodal metastasis (ALNM).Methods Two hundred and eighty-two consecutive patients with stage Tis-T2 breast cancer were prospectively enrolled between December 2013 and September 2015.All the patients underwent AUS performed by two specified senior ultrasound doctors.Sonographic features of their axillary lymph nodes (longitudinal and transverse diameters,cortical and hilar thickness,blood flow form)were collected.These patients were divided into metastatic, suspicious and non-metastatic groups based on the ultrasound features by ultrasound doctors.The diagnostic accuracy of AUS was compared with results of pathology.Univariate and multivariate Logistic regression analyses were used to evaluate the relationship between sonographic features and ALNM.The area under the ROC curve was used to assess the accuracy of the multivariate Logistic regression model.Results The sensitivity,specificity,positive and negative predictive value and accuracy of AUS were respectively 85.6%,87.1%,86.4%,86.3%,and 86.3% in the metastatic and non-metastatic groups.The Kappa value was 0.727(P <0.001).The ALNM burden in the non-metastatic group was significantly lower than in the metastatic group (1.2 vs 6.9,P <0.001).The false-negative results were found only in 16 cases,fourteen of whom had only 1,and two had 2 and 3 ALNM,respectively.Univariate Logistic regression analysis showed that maximum cortical thickness was the most significant predictive factor of ALNM(the area under the ROC curve was 0.872).Multivariate Logistic regression analysis suggested that cortical thickness and the ratio of hilar thickness to cortical thickness were predictive factors of ALNM(P <0.05).The area under the ROC curve of the multivariate Logistic regression model was 0.879 and its sensitivity and specificity were 77.0% and 85.1%,respectively.Conclusion AUS is a valuable tool for detecting ALNM.Patients with false-negative results of AUS have a lower axillary metastatic burden.Maximum cortical thickness is the most significant predictive factor of ALNM.AUS may be a potential alternative method for sentinel lymph node biopsy as axillary lymph node staging in early-stage breast cancer patients.
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Objective To assess the clinical application value of axillary lymph node staging of breast cancer by B ultrasound.Methods From February to December 2014, 200 female breast disease patients in Department of Breast Surgery Affiliated Hospital of Academy of Military Medical Sciences, were enrolled, with median age 50 years old, including 153 cases of breast cancer, 44 cases of fibroadenoma, 2 cases of mastitis and a case of huge fibroma.The state of axillary lymph node was assessed by doctor with more than twenty years experience in B ultrasound diagnosis.According to the characteristics of the ultrasound image of lymph node and experience of the B ultrasound doctor, the patients were divided into axillary lymph node metastasis group, suspicious group and no metastasis group.The axillary lymph nodes were staged by sentinel lymph node biopsy or axillary lymph node dissection.Based on pathological diagnosis and results of the ultrasound, the sensitivity, specificity, positive predictive value, negative predictive value, false negative rate, and metastasis burden of axillary lymph nodes in false negative patients were analyzed.The relationship between the B ultrasound characteristics and axillary lymph node metastasis was also studied by univariate analysis.Results The metastasis rate of above-mentioned 3 groups by B ultrasound was 84.51%, 45.16% and 7.14%, respectively.The sensitivity, specificity, positive predictive value and negative predictive value of screening for axillary lymph node metastasis by B ultrasound were 89.6%, 89.1%, 84.5% and 92.7%, respectively in metastasis group and no metastasis group. According to consistency analysis between pathological diagnosis and B ultrasound, the Kappa value was 0.779.The false negative rate was only 7.1%(7/98 cases) in no metastasis group judged by B ultrasound, and the patients′axillary lymph node metastasis burden was very low, with only one lymph node positive.The univariate analysis showed that patients with longitudinal diameter of lymph nodes≥1 cm had a higher risk for metastasis than 1.5(P<0.001); cortical thickness≥3 mm and lymph node appearing blood flow signal of the central or mixed type were also high metastasis risk factor, the lymph node metastasis rate was 67.5%, 75%and 79%, respectively, P<0.001).Conclusion B Ultrasound is a valuable method for detecting axillary lymph node metastasis in breast cancer.It has lower false negative rate, and the false negative patients just have smaller axillary lymph node metastasis burden.The longitudinal diameter of lymph nodes more than 1 cm, lymph node aspect ratio≤1.5, lymph node of cortical thickness≥3 mm, and blood flow signal of the central or mixed type have higher relationship with axillary lymph node metastasis.B Ultrasound may be a potential alterative method for sentinel axillary lymph node biopsy for axillary lymph node staging in early breast cancer.
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Objective To analyze the clinical value of ultrasound and ultrasound-guided core needle biopsy ( UNB) in the evaluation of axillary lymph node metastasis for breast cancer.Methods A total of 454 cases of breast cancer treated between June 2008 and August 2014 at our hospital were retrospectively analyzed.UNB was performed on patients with abnormal ultrasonic diagnosis of axillary lymph nodes.Among them, 354 cases underwent neoadjuvant chemotherapy or endocrine therapy while 100 cases underwent surgery after UNB.The sensitivity, specificity, accuracy, positive predictive value, negative predictive value and false negative rate of ultrasound and UNB were evaluated.Results Among the 454 patients with abnormal axillary lymph nodes of ultrasound imaging, the metastasis rate with UNB was 70.9%,while the negative rate was 29.1%.Among the 100 cases who underwent surgery after UNB, the metastasis rate was 25% while the ultrasound imaging lymph node longitudinal and transversal ( L/T)≤1.5,the lymph node size>1 cm,and the metastasis rate was 92.3%(12/13).UNB showed that sensitivity was 64.1%, specificity 100%, accuracy 86%, positive predictive value 100%, negative predictive value 81.3%,and false negative rate was 18.7%.The results of UNB seemed consistent with those of postoperative pathological diagnosis, the Kappa value being 0.685.Based on 2 and 3 needles, the above mentioned 6 indices were 50% and 77.8%, 100% and 100%, 77.8% and 92.5%, 100% and 100%, 71.4% and 89.7%,and 28.6%and 10.3%, respectively.The Kappa value of UNB based on 3 needles was higher than on 2 needles (0.822 vs 0.526 ) .Conclusion Ultrasound is a valuable tool for detecting axillary lymph node metastasis in breast cancer.UNB can accurately determine the axillary lymph node metastasis status.UNB based on 3 needles shows a higher accuracy than on 2 needles.
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<p><b>BACKGROUND</b>This multicenter prospective study aimed to assess the utility of dynamic enhanced magnetic resonance imaging (MRI) prior to breast-conserving surgery for breast cancer.</p><p><b>METHODS</b>The research subjects were drawn from patients with primary early resectable breast cancer treated in the breast disease centers of six three-level hospitals in Beijing from 1 January 2010 to 31 December 2012. The participants were allocated to a breast-conserving surgery group (breast-conserving group) or a total mastectomy group (total mastectomy group). Enhanced MRI was used to measure breast volume, longest diameter of tumor and tumor volume. The correlations between these measurements and those derived from histopathologic findings were assessed. The relationships between the success rate of breast-conserving surgery and MRI- and pathology-based measurement results were statistically analyzed in the breast-conserving group.</p><p><b>RESULTS</b>The study included 461 cases in the total mastectomy group and 195 in the breast-conserving group. Allocation to these groups was based on clinical indications and patient preferences. The cut-off for concurrence between MRI- and pathology-based measurements of the longest diameter of tumor was set at 0.3 cm. In the total mastectomy group, the confidence interval for 95% concurrence of these measurements was 35.41%-44.63%. Correlation coefficients for MRI and histopathology-based measurements of breast volume, tumor volume and tumor volume/breast volume ratio were r = 0.861, 0.569, and 0.600, respectively (all P < 0.001). In the breast-conserving group, with 0.30 cm taken as the cut-off for concurrence, the 95% confidence interval for MRI and pathology-based measurements of the longest diameter of tumor was 29.98%-44.01%. The subjective and objective success rates for breast-conserving surgery were 100% and 88.54%, respectively.</p><p><b>CONCLUSIONS</b>There were significant correlations between dynamic enhanced MRI- and histopathology-based measurements of the longest diameter of breast lesions, breast and tumor volumes, and breast volume/tumor volume ratios. Preoperative MRI examination improves the success rate of breast-conserving surgery.</p>
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Adult , Female , Humans , Middle Aged , Breast Neoplasms , General Surgery , Magnetic Resonance Imaging , Methods , Prospective StudiesABSTRACT
Objective To investigate the clinical features , diagnosis and treatment of ectopic thyroid in order to avoid misdiagnosis and mismanagement .Methods Six cases of ectopic thyroid admitted to Fuzhou Gen-eral Hospital from Jan .2000 to Oct.2011 were retrospectively analyzed and the literatures were reviewed .Re-sults Three cases of ectopic thyroid were located in the anterior cervical area , 2 cases were at the base of the tongue and 1 case in the gall bladder .Two cases of aberrant thyroid were confirmed preoperatively in patients whose gland wasn't discovered by imaging examinations at the normal position of the thyroid gland .A symptomless individual of aberrant thyroid did not need other treatment but follow-up.One case with foreign body sensation in pharynx had a good response to thyroxine therapy .Four cases with accessory thyroid were operated because of misdiagnosis .Three cases were ectopic thyroid tissue and one was nodular goiter confirmed by pathology .None of these patients developed hypothyroidism after surgery .Conclusions Ectopic thyroid gland is a rare disease fre-quently misdiagnosed and mistreated .Goiters in the commonly location of ectopic thyroid gland such as the anteri-or cervical area and the base of the tongue should be paid special attention .Hormonal therapy or surgical inter-vention should be chosen according to clinical features , type of the goiter , thyroid function and whether it is be-nign or malignant .Long term follow-up and thyroid function tests are absolutely necessary .
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Objective To examine the anticancer effect of a novel histone deacetylase inhibitor (HDACi), JZ004, on colon cancer cells HCT-8 and HT-29, and to investigate the molecular mechanisms of proliferation inhibition and apoptosis induction of cancer cells treated by JZ 004.Methods Colon cancer cells were treated with a series of concentrations of JZ004 .MTT assay was used to detect the proliferation of cancer cells .The cell cycle distribution and apoptosis were deter-mined by flow cytometry .Rhodamine 123 and DCFH-DA were applied to detect the mitochondrial membrane potential (ΔΨm) and reactive oxygen species ( ROS) production.The protein expressions of acetyl-histone H3, p21, cyclin-dependent kinase(CDK)4, Bcl-2, Mcl-1 and Bax were assayed by Western blotting .Results JZ004 was found to inhibit proliferation and induce apoptosis of colon cancer cells in a time-and dose-dependent manner , accompanied by a dose-dependent hyperacetylation of histone H3.JZ004 induced the cancer cell arrest in G 0/G1 phase by increasing the expres-sion level of p21 while CDK4 was downregulated .JZ004 also increased cellular ROS production and reduced ΔΨm by regu-lating the expressions of Bcl-2 family proteins .Conclusion As a novel HDACi , JZ004 effectively inhibits proliferation and increases ROS production to induce apoptosis of colon cancer cells .The results indicate that JZ004 is a potential compound to be developed as an anti-colon cancer agent for clinic application .
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BACKGROUND: Major psychological problems in patients with carcinoma of large intestine(CLI) were depression and anxiety. Are these bad moods correlated with the pathological stages, the pathological classification and the clinical manifestation of CLI?OBJECTIVE: This study was designed to investigate the relationship between the depression and anxiety state and the clinical manifestations in CLI patients.DESIGN: A comparative observation on patients was conducted in this study.SETTING: This study was conducted at the Department of General Surgery, General Hospital of Shenyang Military Area Command(MAC) of Chinese PLA and the Department of General Surgery, the 307 Hospital of the Chinese PLA. PARTICIPANTS: This study was conducted in the General Surgery Department of the General Hospital of Shenyang Military Area Command of Chinese PLA from February 2002 to February 2003. Totally 79 inpatients and outpatients were diagno sed as CLI by pathological examination. Their informed consents were obtained. Among them, 68 were accordant with the inclusion criteria, 51 males and 17 females; 21 with an age ≥55 years and 47 with an age ＜ 55 years; 39 with an average course of disease≥10 weeks and 29 with an average course of disease ＜10 weeks; 49 in Dukes A-C stages of CLI and 19 in Dukes D stage; 13 with a cancer of anal canal, 55 with a nonanal-canal cancer; 42 with a squamous cell carcinoma and 26 with a nonsquamous carcinoma; 40 with a serum level of carcinoembryonic antigen(CEA) ≥30 μg/L and 28 with it ＜30μg/L; 44 with a serum level of interleukin-8 (IL-8)≥90ng/L and 24 with it＜90 ng/L.METHODS: Sixty-eight patients with CLI received self-rating depression scale(SDS) and self-rating anxiety scale(SAS) testing made by Zung in one week before treatment. Statistical analysis of the scores was performed according to the classifications of age, sex, course of disease, pathological stages, types of carcinoma, and serum level of CEA and IL-8 respectively.MAIN OUTCOME MEASURES: ① The occurrence of depression and anxiety in CLI patients(standard scores of SDS and SAS were ≥50 ). ②The relationship between the standard scores of SDS and SAS and the various variables as age, sex, course of disease, pathological stages, types of carcinoma and serum level of CEA and IL-8.RESULTS: Totally 68 patients with CLI entered the statistical analysis procedure. ① The incidence of depression and anxiety(standard score ≥50) were 48% (33/68) and 43% (29/68) in patients with CLI. ② In patients with an age ＜55, male patients, and patients with a course of disease ≥10weeks, the standard scores of SDS(46.51 ±9.82, 47.74 ± 14.25, 48.38 ± 11.73) and SAS(44.28 ±11.24, 45.06±13.27, 45.78±12.59) were significantly higher than those in patients with an age ≥55,female, and with a course of disease ＜10 weeks(SDS: 43.27 ±10.06, 42.63±10.06, 42.19±14.34;SAS: 41.65±12.77, 41.22±10.89, 42.30±10.21) (t=2.192-2. 329, P ＜0.05). In patients in Dukes D stage of carcinoma, those with a cancer of anal canal and those with a nonsquamous carcinoma, the standard SDS scores(48.04±12.71, 47.23±9.85, 48.06±14.32) and SAS scores (44.96±10.13, 45.17±12.34, 45.28±14.38) were significantly higher than those in patients with Dukes A-C stages of carcinoma, with nonanal canal cancer, and with a squamous cell carcinoma(SDS: 43.42±11.97,44.05±12.14, 44.36±10.57; SAS: 42.23±13.04, 42.39±11.09,43.14±10.60) (t=2.136-2.298, P ＜0.05).In patients with serum level of CEA ≥30 μg/L and with IL-8 level ≥90 g/L,the standard scores of SDS(48.27±11.69, 49.04±12.24) and SAS(44.94±13.34,45.26±12.70) were significantly higher than those in patients with CEA ＜30μg/L and IL-8 ＜90 ng/L( SDS: 43.48±12.76, 44. 15±13.61;SAS: 41.47±10.58, 41.71±14.53) (t =2. 248-2. 314, P＜0.05).CONCLUSION: It is showed that those patients with these variables as a longer course of disease, an older age, male, a more advanced Dukes staging,and higher levels of CEA and IL-8 are prone to depression and anxiety.
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Objective To explore the enhancement effect of caffeine in cisplatin-induced apoptosis of osteosarcoma cell line OS-U2. Methods The osteosarcoma cells were incubated with different concentrations of cisplatin (0.2, 2, 5, 10 and 20?g/L), caffeine (0.2, 2.0mmol/L) and caffeine + cisplatin for 24, 48 and 72 hours. The proliferation of OS-U2 cells was determined by MTT assay, the apoptotic levels were determined by flow cytometry (FCM), and the morphologic changes of apoptotic cells and the positive rates of apoptosis were determined by fluorescence microscopy. Results The proliferation of OS-U2 cells was inhibited, and the apoptotic level was increased when incubated with caffeine and/or cisplatin. There were dose- and time-effect relationships between the lethal effect of cisplatin on osteosarcoma cells and caffeine. Conclusion There is a remarkable enhancement effect of caffeine on cisplatin-induced apoptosis of osteosarcoma cell line OS-U2. It seems that the apoptosis-inducing activity of caffeine may enhance the lethal effect of cisplatin on osteosarcoma cells.