ABSTRACT
OBJECTIVE: To explore the guiding significance of artificial intelligence for clinical practice of breast cancer after operation,and to evaluate the concordance of the Watson for oncology(WFO)with the breast cancer treatment guidelines of NCCN and Chinese Anti-Cancer Association.METHODS: A total of 100 patients who were diagnosed as breast cancer after accepting surgical operations from January 2016 to December 2017 in China-Japan Union Hospital of Jilin University were enrolled.The expressions of ER,PR,Her-2 and Ki-67 protein in cancer tissues after operation were detected by using immunohistochemitry,and inputed the clinical cases information of these 100 patients into the WFO system.Finally,the treatment recommendations were compared with the breast cancer treatment guidelinesof NCCN and the China Anticancer Association.The Kappa test was used to determine the concordance.RESULTS: There were 64 cases(64%)of all 100 patients with the same treatment plans,the clinical stage Ⅱ(42/44 cases,95.5%)to Ⅲ(15/16 cases,93.6%)and triple negative breast cancer(7/8 cases,87.5%)treatment showed a higher concordance(Kappa value ≥ 0.75);The age≥ 41 years old,Luminal A of the immunophenotype and pathological grade Ⅲ also had a certain concordance,and the concordance of 41-55 years old were average,but it is not ideal of the cases that older than 55 years old or the pathological grade Ⅲ;On the contrary,the treatment recommendations of clinical stage Ⅰ(7/40 cases,17.5%),especially for both the lymph node metastasis negative were very inconsistency(Kappa value <0).But there was no statistical significance in the cases of the age ≤ 41 years old,pathological gradeⅠto Ⅱ,Luminal B and HER-2 type of immunophenotype.CONCLUSION: WFO in the patients of clinical stageⅡ to Ⅲ and triple negative breast cancer(P<0.05)has a certain reference value in the afore-mentioned situations;And WFO could be considering in the cases of age ≥ 41 years of age or older,Luminal A of immunophenotype and pathological grade Ⅲ;In contrast,for clinical stage Ⅰ of early breast cancer patients,WFO is not recommended.WFO could offer some reasonable treatment recommendations in partial patients with artificial intelligent computer system,and it may provide clinical decisionsupport for clinicians,and it has some guiding significance in breast cancer postoperative clinical practice,clinical learning and research.
ABSTRACT
OBJECTIVE: To investigate the clinicopathological effects of taking tamoxifen(TAM)on endometrium after breast cancer operation.METHODS: From January 2011 to December 2017,622 cases of breast cancer were treated in Beijing Obstetrics and Gynecology Hospital,Capital Medical University.Among them,197 patients took TAM,and 59 patients who took TAM underwent hysteroscopic surgery due to abnormal vaginal bleeding or ultrasound endometrial abnormalities.The 59 patients were divided into premenopausal and postmenopausal groups to analyze the pathological condition;the medication time was defined as 3 years and 5 years,so as to observe the endometrial pathology.Set the endometrial abnormal hyperplasia includes: endometrial cancer and the endometrial atypical hyperplasia, and the rest are benign endometrial lesions and the normal endometrium, and then analyze the ultrasound criteria for abnormal endometrial thickening in premenopausal and postmenopausal according to the endometrial pathology.RESULTS: Among the 197 patients who took TAM after breast cancer,59 patients underwent hysteroscopic surgery,32.2%(19/59)of them visited the hospital because of abnormal vaginal bleeding,76.3%(45/59)were pathologically confirmed to have a lesion,in which the endometrial polyps was with the highest incidence.The incidence of endometrial cancer after menopause was 20.0%(6/30),premenopausal endometrial cancer 3.4%(1/29),and atypical hyperplasia before menopause was 20.7%(6/29).When taking TAM for more than 3 or 5 years,the incidence of endometrial cancer and atypical hyperplasia increased.Premenopausal ultrasound endometrial thickness is associated with abnormal endometrial hyperplasia(P=0.035).The endometrial thickness 15 mm can be used as the best diagnostic ultrasound cut-off for the diagnosis of premenopausal abnormal endometrial thickening. Postmenopausal ultrasound endometrial thickness was not associated with abnormal endometrial hyperplasia(P=0.631).CONCLUSION: Taking TAM after breast cancer surgery can result in endometrial polyps and endometrial hyperplasia.Premenopausal patients can also have endometrial cancer and atypical hyperplasia,so the endometrial monitoring should not be ignored.Those who take TAM for more than 3 years need to be more alert to the occurrence of endometrial lesions.The premenopausal B-ultrasound endometrial thickness 15 mm can be used as the best diagnostic ultrasound cut-off for the diagnosis of abnormal endometrial thickening. After the menopause, the endometrial thickness of 5 mm was still used as the standard for abnormal endometrial thickening.
ABSTRACT
We analyzed retrospectively the result of postoperative RT by electron beam in 314 patients with breast cancer after a radical or modified mastectomy between 1976～1992. The radiation portals covered the supraclavicular, the axillary and the internal mammary lymph node chains and chest wall. D T40～50Gy/4～5w was delivered. The local regional failure and factors affecting the survival rates, such as the clinical stage, the status of axillary lymph nodes and radiation dose were analyzed. The symptomatic radiation pneumonitis (9.4%) was discussed.