Clinical analysis of 382 immediately breast reconstruction after mastectomy in Beijing City, Tianjin City and Hebei Province from 2012 to 2016 / 中华外科杂志

Objective@#To summarize the status of immediate breast reconstruction (IBR) after mastectomy in Beijing City, Tianjin City and Hebei Province.@*Methods@#A retrospective analysis was made on the data of 382 cases with breast cancer who were treated and followed up successfully with immediate breast reconstruction after mastectomy from January 2012 to December 2016 in Beijing City, Tianjin City and Hebei Province. Clinic data of the followed-up 382 cases (all female, age (38.5±4.2) years (range: 24 to 70 years)), including general information, tumor information, sugery methods, and treatments after surgery were collected. The survival status, metastasis,complications and prognosis were followed up. Cosmetic effcet was evalated by Harris method, and life quality by Functional Assessment of Cancer Therapy-Breast scale (FACT-B). χ2 test was used to compare the difference between year 2012 and year 2013 to 2016. Bonferroni method was used to correct the inspection level, which was 0.05/10=0.005. The trend of IBR rate (ratio of IBR to modified radical mastectomy) from 2013 to 2016 was analyzed by trend χ2 test.@*Results@#There was 46 cases in stage 0, 152 cases in stage Ⅰ, 165 cases in stage Ⅱ, 19 cases in stage Ⅲ. Twenty-five cases was treated by neoadjuvant chemotherapy, 231 by chemotherapy and 35 by radiotherapy. The proportion of implant reconstruction was 48.7% (186/382), more than expanded of 21.5% (82/382), with latissimus dorsi of 12.0% (46/382), TRAM of 8.9% (34/382), DIEP of 2.1% (8/382), and latissimus plus implant of 6.8% (26/382). According to the Harris standard, the excellent and good rate of the cosmetic effect of the reconstructed breast was 93.7%. The score of FACT-B was 108.20±16.9 (range: 67 to 144) 1 year postoperatively. Compared with 2012, the IBR rate was significant increased, till 2015, the IBR rate was 153/10 000 cases (χ2=47.028, P=0.000).@*Conclusions@#There is a significant increase on IBR rate in Beijing City, Tianjin City and Hebei province by year. Most of cases received IBR is stage Ⅰ to Ⅱ. Implant reconstruction is the main reconstructive method. Postoperative cosmetic effects and quality of life are both meet patients′ demon.

Clinical analysis of 382 immediately breast reconstruction after mastectomy in Beijing City, Tianjin City and Hebei Province from 2012 to 2016 / 中华外科杂志

Objective@#To summarize the status of immediate breast reconstruction (IBR) after mastectomy in Beijing City, Tianjin City and Hebei Province.@*Methods@#A retrospective analysis was made on the data of 382 cases with breast cancer who were treated and followed up successfully with immediate breast reconstruction after mastectomy from January 2012 to December 2016 in Beijing City, Tianjin City and Hebei Province. Clinic data of the followed-up 382 cases (all female, age (38.5±4.2) years (range: 24 to 70 years)), including general information, tumor information, sugery methods, and treatments after surgery were collected. The survival status, metastasis,complications and prognosis were followed up. Cosmetic effcet was evalated by Harris method, and life quality by Functional Assessment of Cancer Therapy-Breast scale (FACT-B). χ2 test was used to compare the difference between year 2012 and year 2013 to 2016. Bonferroni method was used to correct the inspection level, which was 0.05/10=0.005. The trend of IBR rate (ratio of IBR to modified radical mastectomy) from 2013 to 2016 was analyzed by trend χ2 test.@*Results@#There was 46 cases in stage 0, 152 cases in stage Ⅰ, 165 cases in stage Ⅱ, 19 cases in stage Ⅲ. Twenty-five cases was treated by neoadjuvant chemotherapy, 231 by chemotherapy and 35 by radiotherapy. The proportion of implant reconstruction was 48.7% (186/382), more than expanded of 21.5% (82/382), with latissimus dorsi of 12.0% (46/382), TRAM of 8.9% (34/382), DIEP of 2.1% (8/382), and latissimus plus implant of 6.8% (26/382). According to the Harris standard, the excellent and good rate of the cosmetic effect of the reconstructed breast was 93.7%. The score of FACT-B was 108.20±16.9 (range: 67 to 144) 1 year postoperatively. Compared with 2012, the IBR rate was significant increased, till 2015, the IBR rate was 153/10 000 cases (χ2=47.028, P=0.000).@*Conclusions@#There is a significant increase on IBR rate in Beijing City, Tianjin City and Hebei province by year. Most of cases received IBR is stage Ⅰ to Ⅱ. Implant reconstruction is the main reconstructive method. Postoperative cosmetic effects and quality of life are both meet patients′ demon.

A retrospective comparison of MRI, ultrasound and X-ray mammography in detecting breast ductal carcinoma in situ / 中华放射学杂志

Objective:To compare the efficacies of MRI, X-ray mammography (XMG) and Ultrasound (US) in detecting and diagnosing breast ductal carcinoma in situ (DCIS).Methods:Two hundred and forty one consecutive patients with pathology-confirmed DCIS were retrospectively recruited from January 2011 to December 2017 in PLA General Hospital. The imaging examination modalities included MRI and/or XMG and/or US.The breast imaging reporting and data system (BI-RADS) categorizations by MRI, XMG and US were compared and their sensitivities of detecting DCIS were calculated. The causes of underestimation on MRI were interpreted with the information of XMG and US. Chi-square test was used to compare the differences.Results:The diagnostic sensitivity of XMG, US and MRI was 65.9% (29/44), 71.6% (101/141) and 91.2% (145/159), respectively, with statistical significant differences (χ2 =24.034, P<0.001). Breast density and lesion type would influence the sensitivity of XMG. And the sensitivity of US was decreased because of non-mass lesion. Of the 14 cases under-evaluated as BI-RADS category 1 to 3 on MRI, 5 were corrected by XMG and/or US to BI-RADS category 4. The cause of underestimation on MRI was the coexistence of DCIS with adenoma or other benign lesion. Conclusion:The retrospective comparison of MRI, XMG and US in this study showed that MRI had significant higher sensitivity in detecting breast DCIS, while the false negative rates of XMG and US were un-negligible.

Efifcacy of A Multi-parametric MRI Protocol for BI-RADS Categorization of Breast Lesions / 中国医学影像学杂志

PurposeTo investigate a multi-parametric protocol for breast MRI examination and lesions assessment correlated to the American College of Radiology (ACR) breast imaging reporting and data system (BI-RADS) categorization, and to improve the management of the breast lesions.Materials and Methods 301 pathologically confirmed lesions on 278 patients were retrospectively included. The scan protocol used a dynamic contrast enhancement sequence (DCE) of 1 mm×1 mm×1 mm spatial resolution, 120 temporal resolution and a diffusion weighted imaging (DWI) of b=1000 s/mm2. The malignant morphological features on the early-enhanced images, type II or III time intensity curve and the apparent diffusion coefficient (ADC) value less than benign/malignant threshold was equally weighted. Each was given 1 point when present malignant features and treated different on mass and non-mass-like enhancement lesions. When the sum of score was ≥2 points, the lesion was categorized as BI-RADS 5. When the sum of score was 1 point, the lesion was categorized as BI-RADS 4. When the sum of score was <1 point, the lesion was categorized as BI-RADS 3. The other specific benign findings were categorized as BI-RADS 2. No abnormality on DWI, DCE, T2WI and T1WI was categorized as BI-RADS 1. The final categories were correlated to the pathological grades as benign (B), high risk (HR) and malignant (M).Results When grouped HR as malignant (M+HR), the area under curve (AUC) of the ROC was 0.860. When grouped HR as benign (B+HR), the AUC of the ROC was 0.876, and the optimized sensitivity, specificity and accuracy was 85.3%, 86.8% and 85.1%, respectively, which were better than the other grouping. If the management of HR lesions could be lumptoectomy or short-term follow-up, the positive predictive value (PPV) of BI-RADS 5 for excisable lesions (M+HR) was 93.2%, the PPV of BI-RADS 4 for excisable lesions (M+HR) was 46.9% and the biopsy was essential. The PPV of BI-RADS 3 and below for follow-up lesions (B+HR) was 90.4%.Conclusion A simple diagnosis algorithm was established, which equally weighted the DCE morphological feature, DCE-TIC and DWI-ADC. The diagnosis protocol was well consistent with BI-RADS categorization and could predict the benign, high risk and malignant lesions in pathology as well as the proper management.

Association between the expression of IGF1R and estrogen receptor and efficacy of neoadjuvant chemotherapy in beast cancer patients / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To detect the expression of IGF1R and estrogen receptor, and to explore the relationship between their expression and the pathological complete response (pCR) rate of neoadjuvant chemotherapy (docetaxel plus epirubicin) in breast cancer patients.</p><p><b>METHODS</b>We selected 139 women with breast cancer who underwent neoadjuvant chemotherapy (docetaxel plus epirubicin), and detected the expression of IGF1R and estrogen receptor in the samples taken before chemotherapy by Immunohistochemistry. The association between their expression and pCR rate of neoadjuvant chemotherapy was analyzed.</p><p><b>RESULTS</b>Among the 139 cases, IGF1R was highly expressed in 45.3% (63/139) cases, and ER was positively expressed in 62.6% (87/139) cases. IGF1R was highly expressed in 54.0% (47/87) of the ER+ cases, significantly higher than that of ER- cases (30.8%, P<0.01). The overall pCR rate of all the 139 patients who received docetaxel plus epirubicin as neoadjuvant chemotherapy was 10.1% (14/139). The pCR rate was 19.2% (10/52) of the ER- patients and 4.6% (4/87) of the ER+ patients (P<0.05). The pCR rate was 10.5% (8/76) in the patients with low IGF1R expression and 9.5% (6/63) in the patients with high IGF1R expression (P>0.05). The patients with negative expression of ER and high expression of IGF1R showed the highest pCR rate (31.2%, P<0.01).</p><p><b>CONCLUSIONS</b>Breast cancer patients with negative expression of ER and high expression of IGF1R are more sensitive to neoadjuvant chemotherapy of docetaxel plus epirubicin, and their pCR rate is significantly higher than that of other patients.</p>

Optimization of b-value in breast diffusion-weighted 1.5 T MR imaging ZHANG Jing / 中华放射学杂志

ObjectiveTo optimize the b-value of breast diffusion-weighted MRI (DW-MRI) at 1.5T by applying a range of b values and comparing the apparent diffusion coefficient (ADC) and signal-to-noise ratio (SNR) on a phantom,disease-free breast tissues,and benign and malignant lesions.Methods A phantom and 32 women with pathologically confirmed malignant ( 18 ) and benign ( 14 ) lesions were examined using EPI-DWI with different b values on a 1.5 T MR scanner.The b-value of EPI-DWI was 0,50,100,200,400,600,800,1000,1200,1400,1600,1800,2000,2200,2400,and 2600 s/mm2,respectively.The SNR and ADC values of the phantom,disease-free breast tissues,and benign and malignant lesions were measured.The correlation between the b-value and ADC or SNR of each image was analyzed.ResultsThe SNR of DWIdecreased as the b-valueincreased,showing aninversecorrelation (r =-0.802,P ＜0.01 ).The ADC values of benign and malignant lesion decreased as the b-value increased (r =-0.923 and -0.855,P ＜0.01 ).The maximum difference in ADC between malignant and benign lesions was observed when the b-value is between 800 and 1000 s/mm2 and diminished when the b-value was greater than 1400 s/mm2.ConclusionFor good image quality and valid differentiation between malignant and benign lesions,the optimized b-value of DWI at 1.5 T is between 800 s/mm2 and 1000 s/mm2.

Preliminary study on predicting the response of breast carcinoma to neoadjuvant chemotherapy using apparent diffusion coefficient / 中华放射学杂志

Objective To investigate the value of apparent diffusion coefficient(ADC)of breast carcinoma before and one course after neoadjuvant chemotherapy,and to predict the response of breast carcinoma to neoadjuvant chemotherapy.Methods Twenty female patients with 21 breast carcinoma lesions were examined with diffusion weighted imaging(DWI)and contrast-enhanced MRI within 7 days prior to neoadjuvant chemotherapy(adriamycin + taxinol),during 18-21 days after the first couse of therapy and within 7 days prior to the surgery resection.The tumors were divided into response group and relative nonresponse group by change of the tumor.The difference of ADC between the two groups before and after 1st course of chemotherapy was compared.Results In chemotherapy response group with 15 lesions,the mean ADC was(0.98±0.15)×10-3 mm2/s before chemotherapy and increased to(1.22±0.23)×10-3 mm2/s after 1 st course of chemotherapy(P＜0.05),while in nonresponse group with 6 lesions,the mean ADC before and after chemocherapy was(1.09±0.08)×10-3 mm2/s and(1.11±0.07)×10-3 mm2/s,respectively,with no statistical difference(P>0.05).The mean ADC of response group prior to chemotherapy was significantly lower than that of nonresponse group(P＜0.05).A significant negative correlation(r=-0.51,P＜0.05)was observed between the ADC prior to treatment and change of ADC after the first couse therapy.Conclusion Preliminary results revealed the initial ADC of the tumor in patient with breast carcinoma and the changes of ADC after 1 st couse treatment may predict response to neoadjuvant chemotherapy.

Combination of the contrast-enhanced ultrasound and color Doppler's grade to diagnose breast masses / 中华超声影像学杂志

Objective Comparing the enhancement of contrast-enhanced ultrasound(CEUS) with the intensity of the blood signals of breast masses, and producing the parameter of peak intensity (PI), to determine whether they can reflect the differentiation of the benign breast masses from the malignant ones.Methods Fifty patients with the breast masses (25 benign,25 malignant) were implemented the contrastenhanced ultrasound inspection.The blood signals of the masses could be got before performing the CEUS,then the CEUS was performed.The enhancement of the masses was divided into 4 grades according to the enhancement of breast which was around the mass (no enhancement, low enhancement, equal enhancement,and high enhancement as well).The PIs of all masses and high enhanced massed were calculated by software in machine,then them were compared according to "the groups which had been classified by their maximal diameters.Results Forty-one of 50 cases showed an obvious enhancement using CEUS compared with the routine CDFI.Malignant masses were more obviously than that of benign ones ( P＜0.05).In the 50 cases,the no enhanceed ones( n = 2) and equal enhanced ones( n = 5) were benign,and 1 case of the low enhanced masses( n = 9) was malignant.The high enhanced masses ( n = 34) were malignant or benigh.About the high enhanced masses, there were statistics meanings using the parameter of PI for the masses whose maximal diameters＜2 cm( P＜0.05),and no statistics meanings when their maximal diameters≥2 cm(P＞0.05).Conclusions The CEUS of breast can improve the appreance of the tumor' s blood vessel obviously, especially for malignant masses.The PI of the breast benign masses are different from the malignant ones.Combination of them can help to discriminate benign masses from malignant ones.The parameter of PI is useless for differentially diagnosing the breast masses if their maximal diameters≥2 cm and the blood flow grade Ⅲ before CEUS.

Surgical treatment of giant recurrent breast phyllodes tumor / 华中科技大学学报（医学）（英德文版）

In this study, a recurrent massive phyllodes tumor of the breast was surgically removed and the grafting was used to repair the local skin defects. A 29-y female patient had recurring breast phyllodes tumor of extremely large size in the chest wall after the excision of a previous tumor. The massive phyllodes tumor was eliminated by completely removing the layers of the skin and tissues above the costal bones with incisal margin being 2 cm away from the tumor lesion. The latissimus dorsi myocutaneous flap, lateral thoracic skin flap, and rectus abdominis myocutaneous flap were grafted to replace the lost tissues due to the surgery. Anti-infection and anticoagulation treatments were used after the surgery. The graft flaps had sufficient blood supply and good blood circulation, and the incisions mostly healed. The outcome of the surgery was acceptable. For the surgical treatment of the massive phyllodes tumor in the chest wall, it is an alternative of choice to use latissimus dorsi myocutaneous flap, lateral thoracic skin flap and rectus abdominis myocutaneous flap in combination for skin grafting.

Ultrasound guided radiofrequency ablation for liver carcinoma / 中国普通外科杂志

Objective To evaluate the efficacy of ultrasonically guided radiofrequency (RF) thermal ablation of hepatic carcinoma (HC) with a clustered electrode. Methods Clinical records on 245 consecutively admitted HC patients who underwent RF tissue ablation therapy were analyzed. The tumor supplying blood flow, changes of tumor size, clinical manifestation, and AFP level were analyzed. Results AFP value decreased significantly in 50% of patients one week after ablation. Tumors less than 5*!cm in diameter became avascularized 1 to 6 months after the therapy, and it was noted that all tumors shrank in size after the therapy. For tumors more than 5*!cm in diameter, RF ablation was used in conjunction with intraarterial chemotherapy and embolization. Conclusion Ultrasound guided RF thermal ablation is an effective, safe, minimally invasive technique for treating malignant hepatic tumors.