ABSTRACT
Treatment sequencing in early-stage breast cancer has significantly changed in recent years. Instead of surgery-adjuvant chemotherapy mode, several clinical trials showed benefits using administering systemic chemotherapy (and human epidermal growth factor receptor 2 targeted therapies) prior to surgery. Neoadjuvant therapy (NAT) could frequently downstage the primary tumor and lymph nodes, allowing conversion of the planned surgery form inoperable to operable one, from a mastectomy to a lumpectomy, and potentially allowing omission of axillary lymph node dissection. These benefits also include providing the opportunity to monitor the individual drug response and more accurate prognostic estimates based on the extent of residual cancer that can guide additional adjuvant treatment. This allows escalation or de-escalation of NAT: patients who achieved pathologic complete response could be spared further chemotherapy or de-escalation of locoregional therapies, while those with residual cancer could receive additional systemic therapy postoperatively. NAT is not an option anymore but a platform for personalized breast cancer therapy.
ABSTRACT
Objective:To investigate the characteristics of lymphocyte subsets and the correlation between the immune imbalance of T helper 17 cell/regulatory T cell (Th17/Treg) and cytokines in peripheral blood of patients with Beh?et's disease(BD).Methods:From January 2018 to November 2019, 82 outpatient and inpatient with BD of the Department of Rheumatology and Immunology of the Second Hospital of Shanxi Medical University with complete data were enrolled. The disease activity was evaluated according to BD Current Activity Form(BDCAF), and 66 age and matched healthy people were selected as the control group. The absolute numbers of lymphocyte subsets and T cell subsets dominated by Th17 and CD4 +CD25 +Foxp3 + Treg in patients with BD and healthy controls were detected by Flow cytometry. The levels of interleukin (IL-2), IL-4, IL-6, IL-10, IL-17, Interferon (IFN)-γ and Tumor necrosis factor-α (TNF)-α in patients with BD were measured by Cytometric Beads Array (CBA). The correlations between the ratio of Th17/Treg with inflammatory index, the number of organ involved and the levels of cytokines were analyzed. Data were analyzed by Mann-Whitney U test, Kruskal Wallis H test, Spearman correlation analysis and multiple linear regression. Results:①The absolute numbers of Th17 cells in peripheral blood of patients with active BD [13.9(7.7, 21.1) cells/μl] and patients with stable BD [8.7(6.1, 14.0) cells/μl] were higher than those of healthy controls [6.8(4.4, 8.5) cells/μl] ( P<0.01); The ratio of Th17/Treg was significantly increased ( P<0.01). The absolute co unts of Treg cells in BD group [24.79(15.64, 37.91) cells/μl] were sign-ificantly lower than those in healthy controls [30.59(23.04, 42.08) cells/μl], the difference was statistically significant ( P=0.016). ② The ratio of Th17/Treg was positively correlated with BDCAF ( r=0.298, P=0.007) and the number of organ involved ( r=0.304, P=0.006) was negatively correlated with age ( r=-0.254, P<0.05), and not correlated with the duration of disease and ESR ( P>0.05) in patients with BD. In addition, multiple linear stepwise regression showed that the ratio of Th17/Treg was positively correlated with BDCAF ( β=0.228, P=0.036) and negatively correlated with age ( β=-0.219, P=0.043), R2=0.101. ③ The levels of IL-2, IL-6, IL-10, IFN-γ in patients with BD were stati-stically higher than those of healthy controls ( P<0.01). The ratio of Th17/Treg was positively correlated with the levels of IL-2 ( r=0.307, P<0.01) and IL-4 ( r=0.301, P<0.01) in patients with BD. Conclusion:There is immune imbalance of Th17/Treg in patients with BD, which is closely related to disease activity, the number of organ involved, and the levels of cytokines such as IL-2 and IL-4. IL-2 and IL-4 may play an important role in the immune imbal-ance of Th17/Treg in patients with BD.
ABSTRACT
PURPOSE: The combination of indocyanine green and methylene blue (ICG + MB) was reported to be an efficient tracer method in sentinel lymph node biopsy (SLNB). However, whether this method is superior to MB only or carbon nanoparticles (CN) is controversial. This study was to evaluate the efficacy of the three methods in SLNB for breast cancer, and to analyze its influencing factors. METHODS: One hundred eighty patients with early breast cancer were recruited and randomly divided into 3 groups. Each group comprising of 60 patients with SLNB using ICG + MB, MB, and CN, respectively. Then the 3 groups were compared in detection rate, mean number of SLNs, and the detection rates and number of metastatic sentinel lymph nodes (SLNs). RESULTS: The detection rate of SLNs was 100% (60 of 60) in ICG + MB group, 96.7% (58 of 60), and 98.3% (59 of 60) in MB and CN group, respectively, with no significant difference (P = 0.362). Totally, 204 SLNs (mean ± standard deviation [SD] [range], 3.4 ± 1.4 [2–8]) were detected in ICG + MB group, 102 (1.7 ± 0.7 [0–3]) and 145 (2.4 ± 0.7 [0–6]) in MB and CN group, indicating significant difference (P < 0.001). The detection rate of metastatic SLN was 23.3% (14 of 60) in ICG + MB group, which was higher than 18.3% (11 of 60) and 20% (11 of 60) in MB and CN group, respectively, but showed no statistical significance (P = 0.788). CONCLUSION: ICG + MB method was superior to MB only and CN only methods in the mean number of SLNs, thus predicting axillary lymph node metastasis more accurately. Therefore, in areas where the standard method is not available, ICG + MB may be more suitable as an alternative tracer for SLNB.
Subject(s)
Humans , Breast Neoplasms , Breast , Carbon , Indocyanine Green , Lymph Nodes , Methods , Methylene Blue , Nanoparticles , Neoplasm Metastasis , Sentinel Lymph Node BiopsyABSTRACT
Objective To discuss the advantages and disadvantages of the mammography and ultrasound examination for breast cancer diagnosis.Methods Totally 84 breast cancer patients enrolled in our study.All of the patients underwent mammography before surgery,and 69 of them received both mammography and ultrasound examination.The data were studied retrospectively.Results 84 foci were found totally on mammography and were all diagnosed above ACR BIRAD grade 4 by X-ray.Two of the 13 cases smaller than 2 cm in diameter were diagnosed as grade 3 by ultrasound.Eleven cases with microcalcification were diagnosed as grade 2（1case）and 3（1case）by ultrasound.Only 1 of the 6 cases shown as distortion was diagnosed as 5 by ultrasound.Conclusion X-ray has the superiority to ultrasound for distortion and microcalcification.For the mass smaller than 2 cm in diameter,both of X-ray and ultrasound may underestimate.