The value of different surgical methods in the repair of huge chest wall defect after breast malignant tumor operation / 中华内分泌外科杂志

Objective To evaluate the value of different surgical methods in the repair of huge chest wall defect after breast malignant tumor operation.Methods The clinical data of 22 patients with chest wall defect after chest operation were retrospectively analyzed.All patients received one-stage repair for the chest wall defect with different surgical methods.Of the patients,9 cases got repair with latissimus dorsi myocutaneous flap,4 cases received repairment with internal mammary perforator flap of contralateral breast,and the others received dermatoplasty.Results All the 22 cases were successfully repaired.Two cases of dermatoplasty got mild edema who was healed after acitive dressing change.No one got effusion,infection or necrosis.No recurrence or distant metastasis happened except one case of liver metastasis in the follow-up of 6 to 24 months.Conclusions Application of different surgical methods in repair for the chest wall defect can improve patients' life quality.It is easy,safe and effective.We should choose the most suitable surgical method according to individual situation.

Contralateral breast as the donor for immediate breast reconstruction or chest wall defect repair in breast cancer patients undegoing mastectomy / 中华内分泌外科杂志

Objective To explore the feasibility of using contralateral breast as the donor for immediately breast reconstruction or chest wall defect repair after mastectomy in breast cancer patients. Methods From Jul. 2013 to Mar. 2016, contralateral breast fat flap was used as the donor for 8 breast cancer patients with immediate autologous non-microsurgical breast reconstruction or chest wall defect repair after mastectomy. All participants in this study received preoperative oncological screening with ultrasound, mammography, and magnetic resonance imaging which revealed the absence of pathological abnormalities in the donor breast. Results Among the 8 pa-tients, 4 patients underwent immediate breast reconstruction and 4 received chest wall defect repair. Only 1 pa-tient undergoing breast reconstruction had minor complications with little or no effect on the final outcome. No patient undergoing chest wall defect repair had postoperative complications. The functional and aesthetic out-comes were very satisfactory. Regular follow-ups were from 3 to 34 months with no recurrence found up to the present. Conclusions This article presents the first case for immediately breast reconstruction or chest wall de-fect repair using contralateral breast as the donor. The surgical method has some complications but with good aesthetic outcomes, which can be an option for breast cancer patients with hypertrophic and ptotic breast.

Extended resection, gland reconstruction and mammary gland lavage-a new attempt to treat mammary duct expansion / 中华内分泌外科杂志

Objective To study the safety and availability of extended resection,gland reconstruction and mammary gland lavage in treatment of mammary duct expansion.Methods 41 patients with duct expansion admitted from Mar.2012 to Jan.2015 were studied and they were randomly divided into two groups.15 patients in the control group received normal surgical treatment,and 26 patients in the observation group received extended resection,gland reconstruction and mammary gland lavage treatment.Results The operation time,intraoperatve blood loss,length of hospital stay and degree of satisfaction of the observation group were superior to those of the control group while the recurrence rate was lower than that of control group.The gland expanded resection reduced the recurrence rate,the shape of the breast was improved,and the continuous irrigation was the guarantee for the immediate formation of the gland.The three kinds of surgical procedures were organically combined and complement each other.Conclusion The surgical methord of extended resection,gland reconstruction and mammary gland lavage is worth of further exploring due to its advantages of easy to operate,good cosmetic effect and low recurrence rate.

Quality of life in Chinese women treated surgically for breast cancer with one of three different procedures / 中华内分泌外科杂志

Objective To determine the quality of life of patients treated with one of three different types of surgery for breast cancer.Methods This was a cross-sectional study using a questionnaire survey completed by Chinese patients without active disease after at least 2 years of follow-up after breast cancer surgery.Results This study totally included 139 breast cancer patients:44 ( 31.6%) had undergone modified radical mastectomy with reconstruction, 41(29.5%)had a quadrantectomy with axillary lymph node dissection, and 54(38.9%)had a modified radical mastectomy without reconstruction.The EORTC QLQ-C30 and EORTC QLQ-BR23 question-naires were used;their reliability was>0.82.Global health status(94.30 ±12.04, P=0.028)and role functio-ning(85.16 ±17.23, P=0.138)were highest in the quadrantectomy group.Pain score was highest in the modi-fied radical mastectomy with reconstruction group(26.13 ±30.15, P =0.042).The breast symptom score (22.56 ±22.30, P=0.009)and body image perception(85.56 ±19.72, P=0.025)were highest in the conser-vative treatment group.The overall health of patients given modified radical mastectomy without reconstruction was lower(72.61 ±20.89, P=0.014) in women older than 50 years compared with younger women.Conclu-sions The quadrantectomy with axillary lymph node dissection procedure had better acceptance, but the overall health status did not differ between groups.Overall health status is lower in women older than 50 years receiving a modified radical mastectomy without reconstruction.

Combination of indocyanine green and carbon nanoparticles for mapping sentinel lymph nodes in breast cancer patients / 中华内分泌外科杂志

Objective To evaluate intraoperative tracing of sentinel lymph nodes ( SLNs) by fluorescence imaging combined with carbon nanoparticles .Methods 112 breast cancer patients eligible for sentinel lymph node biopsy were randomly assigned to the combination group (56 cases)receiving indocyanine green (ICG)and carbon nanoparticles as the lymphatic mapping tracers and ICG alone group (56 cases).Intraoperative frozen sec-tion was performed , followed by conventional histopathology .Results In the combination group , subcutaneous lymphatic vessels were successfully visualized in 53 patients and the detection rate was 94.6%(53/56).The flu-orescence SLNs were successfully detected in 54 patients and the detection rate was 96.4%(54/56)in ICG alone group.In the combination group , SLNs were successfully identified in 54 patients by fluorescence and 52 patients by black dyed, and the SLNs detection rate was 100%(56/56).While in the ICG alone group, the SLNs were found in 52 patients and the detection rate was 92.9%(52/56)(χ2 =2.3, P>0.050).The average number of detected SLNs was 3.7 ±1.5 ( 205/56 ) in combination group vs 2.5 ±1.4 ( 130/52 ) in ICG alone group ( t =-3.5, P=0.001).17 metastatic SLNs were found in 10 patients in the combination group vs 12 metastatic SLNs in 9 patients in ICG alone group .Conclusion Combination of ICG and carbon nanoparticles for mapping sentinel lymph nodes in breast cancer patients can increase the number of SLNs detected and the detection rate , reducing the rate of misdiagnosis and false negative rate .

Effect and mechanism of miRNA-4465 overexpression in the migration and invasion of breast cancer MDA-MB-231 cells / 安徽医科大学学报

Objective To investigate the effect of overexpression of miRNA-4465 on invasion and metastasis of breast cancer MDA-MB-231 cells and its mechanism.Methods MiRNA-4465 minics was transfected into the MDA-MB-231 cells,and real-time PCR was used to detect the expression of miRNA-4465.Transwell assay was used to investigate the migration and invasion capability of cells after being transfected.Bioinformatics analysis were performed to predict the potential targets of miRNA-4465,and finally,luciferase reporter plasmids assay and west-ern blot was used to confirm the potential target of miRNA-4465.Results Comparing with negative control group, the expression of miRNA-4465 in miRNA-4465 minics group was increased significantly.Transwell migration assay showed that migration capability of cells in miRNA-4465 minics group was decreased(P =0.001);transwell inva-sion assay showed that invasion capability of cells in miRNA-4465 minics group was decreased(P =0.010).Lucif-erase reporter plasmids assay showed that comparing with the negative control +psiCHECK2-EZH2 3’UTR(wild type),the fluorescence activity of miRNA-4465 minics +psiCHECK2-EZH2 3’UTR(wild type)was decreased by 66%(P =0.001).Moreover,comparing with the negative control group,the expression of EZH2 protein was de-creased after transfecting miRNA-4465 minics into MDA-MB-231 cells.Conclusion MiRNA-4465 can suppress the invasion and metastasis of breast cancer MDA-MB-231 cells,which may be related to the regulation of EZH2.

The response evaluation and predictive value of Ki67 expression in neoadjuvant chemotherapy for breast cancer / 中华内分泌外科杂志

Objective To explore the expression of Ki 67 in 72 cases of breast cancer and to analyze the correlation of Ki67 expression with clinicopathological factors and efficacy of neo-adjuvant chemotherapy .To as-sess the prediction value of Ki 67 in selecting neo-adjuvant chemotherapy .Methods Ki67 expression in tumor tissues of 72 cases of breast cancer was detected before and after neo-adjuvant chemotherapy .Tumor tissues are a-chieved by core needle biopsy .Results Ki67 overexpression was found in those with axillary lymph node ( ALN) metastasis, in pathological stage III and tumor diameter >2 cm(P＜0.05).Ki67 expression was not significantly associated with age(P>0.05).Objective response(OR)rate of neo-adjuvant chemotherapy was 84.2%(61/72). Patients with Ki67 over-expression were more sensitive than those with lower-expression(P>0.05).Positive ex-pression rate of Ki67 was reduced significantly by neo-adjuvant chemotherapy(P＜0.05).Positive expression rate of Ki67 was reduced significantly in pathological complete response ( PCR ) group, clinical complete remission (CCR)group and partial response(PR)group.Conclusion The expression of Ki67 may be a potential predictive biomarker for neo-adjuvant therapy response in patients of breast cancer and can provide the basis for individual therapy for breast cancer .

Nipple reduction by using a modified Z-shaped incision technique / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore an ideal surgical method for nipple hypertrophy correction.</p><p><b>METHODS</b>From July 2008 to June 2011, 44 nipple reductions were performed for 22 women (44 sides) by using the modified Z-shaped incision technique. The incision consists of two circles, one quadrangle and one triangle located on the top, body and base of the nipple. The nipple's height was decreased and the nipple diameter and base area were reduced. Bilateral nipples were designed symmetrically.</p><p><b>RESULTS</b>22 cases(44 sides) were treated with primary healing. The mean diameter of the nipple was reduced to (9.8 +/- 1.6) mm from (17.6 +/- 3.4) mm, the average height from (18.8 +/- 3.6) mm to (8.2 +/- 1.4) mm, with the patient supine. All the patients were followed up for 14 months to 4 years with satisfactory results. No nipple necrosis, infection and numb happened. 20 patients completed the self-designed survey scale 1 year after operation, of which 4 cases achieved normal lactation, and the remaining patients didn't have childbirth and breastfeeding yet.</p><p><b>CONCLUSIONS</b>The modified Z-shaped incision technique could reduce the height, diameter, and most importantly, reduce the basal shape of all types of hypertrophic nipple to create a desired new cylindrical nipple without affection of nipple sensation and function.</p>

Expression of GRIM-19 and its target gene product STAT3 in human breast cancer / 中华内分泌外科杂志

Objective To evaluate gene associated with retinoid-interferon-induced mortality-19 (GRIM-19) expression levels and the correlation with its target gene product signal transducers and activator of transcription 3 (STAT3)in human breast cancer tissues and normal gland tissues,and to analyze their roles in the tumorigenesis of breast cancer.Methods The expression of GRIM-19 and STAT3 protein and mRNA in 40 cases of breast cancer tissues and 40 cases of normal gland tissues was detected by immunohistochemistry and Western blot.The correlation of the expression of GRIM-19 and STAT3 to various clinicopathologic characteristics of breast cancer were analyzed statistically.The mRNA expression and gene mutation of GRIM-19 in breast cancer cell line MCF-7 and 25 specimens of breast cancer and normal gland tissue were detected by reverse transcription-polymerase chain reaction(RT-PCR)and sequencing.Results The protein and mRNA expression of GRIM-19 was obviously lower in breast cancer than in normal gland tissues (P ＜ 0.05) while the protein and mRNA expression of STAT3 was obviously higher in breast cancer than in normal gland tissues(P ＜0.05).The expression of GRIM-19 and STAT3 was negatively correlated with each other(x2 =8.25,P ＜0.01).Breast cancer samples exhibited low level of GRIM-19 and moderate to high level of STAT3 expression.In contrast,the normal gland tissue was characterized by high level of GRIP-19 and low level of STAT3 expression.The protein expression of GRIM-19 was correlated with the histological grading and clinical stage of breast cancer(P ＜ 0.05).STAT3 was not correlated with clinicopathologic characteristics of breast cancer (P ＞ 0.05).No mutation of GRIM-19 gene was detected in breast cancer tissues,normal gland tissues or MCF-7 breastcancer cells.Conclusions The low expression of GRIM-19 and the high expression of STAT3 co-exist in breast cancer.Downregulation of GRIM-19 was closely correlated with increased histological grade,clinical stage and STAT3 in breast cancer.The potential role of GRIM-19 in breast cancer development may be through these correlations.

Study on relationship between molecular subtypes of locally advanced breast cancer and neoadjuvant chemotherapy / 中华内分泌外科杂志

Objective To explore the relationship between the four different molecular subtypes of locally advanced breast cancer(LABC) and the clinical effect of neoadjuvant chemotherapy containing docetaxel and anthracyclines on breast cancer. Methods The record of 68 patients with LABC who were treated with the therapeutic scheme was reviewed. Breast cancer molecules were diagnosed by core needle biopsy through IHC and were divided into four subtypes. After 3 to 5 courses of treatment, the relationship of molecular subtype and clinical effects was analyzed. Results Univariate analysis showed that absence of estrogen receptor (ER) expression and size of tumor (≤5cm) were predictive factors for clinical complete response (cCR) (P0.05) and only HER-2 (P<0.05) was the independent variable in predicting pCR for this therapeutic scheme. Conclusion Molecular subtypes can not independently predict pCR for neoadjuvant chemotherapy regimen containing docetaxel and anthracyclines.

Nipple-areola complex sparing mastectomy with immediate breast reconstruction using subpectoral prosthesis implantation / 中华内分泌外科杂志

Objective To explore the feasibility of immediate breast reconstruction with subpectoral implantation of silicon gel prosthesis after nipple-areola complex (NAC) sparing modified radical mastectomy. Methods A total of 28 patients of 0,I,II stage breast cancer were implanted with silicon gel prosthesis immediately after they underwent skin-sparing modified radical mastectomy. NAC conservation depended on frozen section result. Results NAC of all the 28 patients were conserved. During 2-18 months (median15 months) follow-up, bilateral breasts were symmetrical and in good appearance with a 96.5% excellent rate. No local recurrence, distant metastasis or obvious complications occurred. Conclusions Immediate breast reconstruction with subpectoral implantation of silicon gel prosthesis after NAC sparing modified radical mastectomy is proven to be an effective and safe method with the advantage of good appearance and shorter recovery time in early-stage breast cancer.

Clinical significance of CK19 and hMAM mRNA detection in peripheral blood of breast cancer patients by real-time fluorescent quantitative RT-PCR / 中华内分泌外科杂志

Objective To detect the expression of Cytokeratin 19 (CK19) and human mammaglobin (hMAM) mRNA in the peripheral blood of breast cancer patients dynamically and to evaluate its clinical significance.Methods The expression of CK19 and hMAM mRNA was evaluated by real-time fluorescent quantitative reverse transcriptase pelymerase chain reaction in the peripheral blood of 40 breast cancer patients and 10 healthy volunteers.Results The expression of CK19 and hMAM in the peripheral blood of 40 breast cancer patients were higher than healthy donors.The positive expression rate of CK19 and hMAM was descending tendency during treatment.The different staging expression rate had no differences between before treatment and during treatment,but after treatment the expression rate had remarkably differences (CK19:P=0.044;hMAM:P=0.005).If the expression of CK19 and hMAM was continual positive,the rate of recurrence and metastasis would be higher (P＜0.001).Coneluslons Real-time fluorescent quantitative RT-PCR may detect the expression of CK19 and hMAM in the peripheral blood of breast cancer patients,and it is a sensitive and specific technique.The resuits suggest a possible use of this approach for evaluating prognosis,monitoring recurrence.

Expression of ER,CyclinD1 in glandular tissue of pubertal mammary hypertrophy / 中华内分泌外科杂志

Objective To investigate the expression of the ER,CyclinD1 in breast tissue of pubertal mammary hypertrophy and explore the possible etiology of pubertal mammary hypertrophy.Methods The expression of ER,CyclinD1 was detected by Western-blot in 15 cases of pubertal mammary hypertrophy,15 normal breast tissue and 10 cases of micromastia.Results There was significant difference of the expression of ER,CyclinD1 within breast tissue between pubertal mammary hypertrophy and micromastia(P＜0.01).There was significant difference of the expression of ER,CyclinD1 within breast tissue in pubertal mammary hypertrophy and in normal breast tissue(P＜0.01).There was no difference between the expression of ER,CyclinD1 within breast tissue in micromastia and in normal breast tissue(P＞0.05).Conclusions The expression of ER,CyclinD1 in pubertal mammary hypertrophy are significantly higher than in micromastia and normal breast tissue.The pubertal mammary hypertrophy may be related to the expression status of ER,CyclinD1 within breast tissue.

Diagnostic Value of Fiberoptic Ductoscopy in Patients with Nipple Discharge:A Report of 104 Cases / 中国微创外科杂志

Objective To evaluate the applicative value of fiberoptic ductoscopy(FDS)in abnormal nipple discharge.Methods A total of 104 patients with nipple discharge were examined by fiberoptic ductoscopy(Germany Scholly Fiberoptic Gmbh 42.0500).The results were compared with postoperative pathological diagnosis.Results All the 104 cases were successfully diagnosed with FDS.The detectable rate for intraductal mass by ductoscopy is 94 %(49/52).The sensitivity and specificity of ductoscopy for mammary duct cancer is 50%(1/2)and 91%(43/47)respectively;the negative predictive value is 98%(43/44),positive predictive value is 20%(1/5),and accuracy is 90%(44/49).Five cases of papillomatosis were diagnosed by ductoscopy,in which 3 cases were consistent with postoperative pathological findings,therefore the diagnose accordance rate is 60%;the other 2 cases were proven to be multiple papilloma.Thirty-eight cases of papilloma were detected by ductoscopy and received lobectomy of bresat;55 cases of inflammatory duct disease did not receive any operation;and 3 cases(3%,3/104)were diagnosed papilloma by re-examination with ductoscopy due to persistent nipple discharge,and were confirmed after operation.Conclusions Fiberoptic ductoscopy is the first choice for examination of nipple discharge for its accuracy in finding pathogenic cause and locating lesion,and surgery can thereby be avoided for galactophoritis and mammarv duct ectasia patients.

Excision of Intraductal Lesions under the Guidance of Breast Localization Needle / 中国微创外科杂志

Objective To evaluate the value of breast duct endoscopy and breast localization needle for the diagnosis and microinvasive treatment of intraductal lesions. Methods A total of 103 patients with nipple discharge without breast lumps were examined by breast duct endoscopy in our hospital. Of them, 63 cases of intraductal lesions were localized with breast localization needle and received arc incision of the areola of the breast and excision of the localized breast duct with 1-cm adjacent tissues, which were sent for intraoperative frozen. After the frozen pathological examination, the operation was ended for the patients with intraductal papilloma; simple mastectomy was performed on those with duct papillomatosis; and simple mastectomy combined with DIEP reconstruction was carried out for the patients with intraductal carcinoma. Results Frozen and postoperative pathological examinations showed single intraductal papilloma in 59 of the patients (59/63, 93.6%), duct papillomatosis in 2 (2/63, 3.2%) , and intraductal carcinoma in 2 (2/63, 3.2%). The 59 patients with single intraductal papilloma were reexamined in 3 months after the operation, none of them had nipple discharge or other symptoms. Conclusions Resection of intraductal lesions under the guidance of breast localization needle is less traumatic with good cosmetic outcomes. By using the method, high rates of complete resection and accuracy of pathological examination can be achieved.