Verification of a molecular pathology detection method of sentinel lymph node in breast cancer patients:a comparison between RT-LAMP and GeneSearch / 军事医学

Objective To verify the reliability of our previously established reverse-transcription loop-mediated isother-mal amplification ( RT-LAMP) method for the detection of sentinel lymph nodes metastasis in breast cancer patients .Meth-ods Sentinel lymph nodes of breast cancer patients were analyzed by RT-LAMP and FDA-approved GeneSearch methods respectively, and the consistency of the two methods was assessed with a kappa concordance test.Results One hundred and thirty-four cases of sentinel lymph node samples were collected from seven hospitals in Beijing .Using the GeneSearch assay as the gold standard, the sensitivity, specificity and consistentcy of RT-LAMP were 96.2%(25/26),96.3%(104/108) and 96.3%(129/134), respectively.Statistical analysis showed that the two methods were consistent (Kappa=0.8857, P<0.001).Conclusion RT-LAMP is highly consistent with GeneSearch ,efficient,simple and inexpensive, promising a good prospect of application to intra-operative detection of sentinel lymph nodes metastasis for breast cancer patients.

Multicenter prospective study of magnetic resonance imaging prior to breast-conserving surgery for breast cancer / 中华医学杂志(英文版)

<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>

Comparative validation of MSKCC and SOC models for predicting non-sentinel lymph node metastasis in Chinese breast cancer patients / 中国肿瘤临床

Objective:The study aimed to validate the Memorial Sloan-Kettering Cancer Center (MSKCC) nomogram and Stan-ford Online Calculator (SOC) prediction of non-sentinel lymph node (NSLN) metastasis in Chinese patients with sentinel lymph node (SLN)-positive breast cancers. Methods:The MSKCC nomogram and SOC were used to calculate the probability of NSLN metastasis in 120 breast cancer patients who were positive for SLNs. The area under the receiver operating characteristic curves (AUC) for each model was evaluated. Patients with 10%and 90%probabilities of NSLN metastasis were separately examined. Results:The MSKCC and SOC predicted the likelihood of NSLN metastasis in a consecutive group of 120 patients with AUCs of 0.688 and 0.734, respective-ly. At the lowest probability cutoff value of 10%, the false-negative rates of MSKCC and SOC were both 4.4%, and the negative predic-tive values were 75.0%and 90.0%, respectively. When the highest probability cutoff value of 90%was used, the false-positive rates were 0.0%and 6.7%, and the positive predictive values were 100.0%and 68.8%, respectively. Conclusion:Results of the MSKCC no-mogram and SOC were inferior to those of previous studies on predicting NSLN metastasis in Chinese patients with breast cancers. The prediction ability of SOC was slightly superior to that of the MSKCC nomogram.

Ultrasound-guided fine-needle aspiration for the evaluation of axillary lymph node metastasis in breast cancer / 中华普通外科杂志

Objective To study the utilization of preoperative ultrasound-guided fine-needle aspiration(USFNA) for axillary lymphnode(ALN) metastasis in breast cancer and to evaluate the feasibility and accuracy of the technique. Methods Forty ALNs in 40 armpit negative palpation highly suspective breast cancer patients underwent USFNA. The cytopathological results were compared with the histopathological results of sentinel lymphnode(SLN) biopsy or axillary lymphnode dissection(ALND). The sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV) and diagnostic accuracy of USFNA for the ALN metastasis were analysed. Results All the 40 patients were confirmed with breast cancer by pathology. Sensitivity of USFNA was 52. 2%, specificity was 100%, PPV was 100%,NPV was 60. 7% and diagnostic accuracy was 72. 5%. 12(30% ) patients with positive cytology proceeded to ALND, avoiding SLN biopsy. Conclusions USFNA is a minimally invasive, highly specified technique for prediction of breast cancer ALN metastasis before operation.

Evaluation of two different regimens as neoadjuvant chemotherapy for breast cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To compare the efficacy and toxicity of two different regimens as neoadjuvant chemotherapy for breast cancer.</p><p><b>METHODS</b>Forty-eight patients with stage II, III breast cancer as proved by cytology biopsy, were treated with either 5-Fu, epirubicin, cyclophosphamide (FEC) or epirubicin, paclitaxel (ET) regimens for 2 cycles every 3 - 4 weeks. Clinical responses in the breast and lymph nodes were assessed after 2 cycles of neoadjuvant chemotherapy. Patients in FEC arm received combination of 5-fluorouracil (5-Fu) 500 mg/m(2) by 4-hour continuous infusion on D1 and D8, epirubicin (EPI) 50 mg/m(2) by intravenous injection on D1, and cyclophosphamide (CTX) 500 mg/m(2) by intravenous injection on D1 and D8. Patients assigned to the ET arm received EPI 60 mg/m(2) by intravenous injection on D1, paclitaxel (TAX) 150 mg/m(2) by 3-hour continuous infusion on D2. All patients were treated by operation 2 weeks later and radiotherapy was added to some.</p><p><b>RESULTS</b>For primary tumor in the breast, the overall response rate (RR) was 50.0% (12/24) in FEC arm and 79.2% (19/24) in ET arm. One patient showed clinical complete response (cCR), 11 partial response (PR), 12 no change (NC) after the FEC therapy, while 1 patient showed CR, 18 PR, 5 NC after ET therapy. There was no pathologic complete response or progressive disease, though a higher proportion of RR was observed in stage II than stage III patients in these two groups. Clinically palpable axillary lymph nodes which had been found in all 48 patients before 2 cycles of treatment, 50.0% (12/24) in the FEC patients and 66.7% (16/24) in the ET patients became in-palpable. The major toxicity, including leukopenia, gastroenteric reactions, were similar in both groups, but alopecia was more severe and arthralgia, myalgia, neurotoxicity and flushing of face were the unique features of the ET regimen.</p><p><b>CONCLUSION</b>Neoadjuvant chemotherapy with two different regimens were effective to the primary tumor and axillary metastatic lymph nodes of breast cancer, and the side effects were tolerable. Higher efficacy and more side effects are observed in ET than in FEC regimen.</p>

Conservative surgery for the treatment of breast cancer:Analysis of 148 cases / 中国微创外科杂志

Objective To investigate the therapeutic procedures,indications and efficacy of breast-conserving therapy (BCT). Methods BCT was carried out in 148 patients with breast carcinoma in this hospital from January 1996 to October 2003.There were 5 patients in stage 0,85 patients in stage Ⅰ,55 patients in stage Ⅱ,and 3 patients in stage Ⅲ.The surgical treatment was quadrantectomy or local wide excision of tumor,combined with axillary lymph node dissection.Routine adjuvant irradiation,chemotherapy and hormone therapy were given postoperatively. Results Pathological examinations of breast specimens found no positive margins.Follow-up observations for a median of 54 months (range,2 ～ 84 months) revealed a local recurrence rate of 2 7% ( 4/148 ;3 patients in breast and 1 patient in axillary fossa).Distant metastasis occurred in 5 patients (3 4%) and 3 of them died.Sites of metastasis included lung,liver,meninges and bone.The duration from surgery to distant metastasis was 6 ～ 43 months.Evaluation of cosmetic results in 108 patients who had received BCT for at least 12 months showed that good outcomes were achieved in 32 4% of the patients (35/108),fair outcomes,in 49 1% of the patients (53/108),and poor,in 18 5% (20/108). Conclusions For patients with early stage breast carcinoma,and part of those with local advanced breast cancer who have received neoadjuvant chemotherapy and gotten downstaging effects,the effects of BCT is satisfactory.Standard excision,postoperative irradiation and systemic combination treatment are crucial to BCT.Most patients receiving BCT have good cosmetic results.

Relationship between expression of Kiss-1 and nm23 and lymph node metastasis in breast cancer / 中国癌症杂志

Background and purpose:Kiss-1 and nm23 have been identifi ed as tumor metastasis suppressor genes,and they have been associated with the metastatic potential of breast cancer.The purpose of this study was to evaluate the relationship of Kiss-1 and nm23 expression with lymph node metastasis in breast cancer.Methods:The expression of Kiss-1 and nm23 protein was detected by immunohistochemistry in 70 patients with breast cancer.Results:The positive rate of Kiss-1 and nm23 were 62.86% and 68.57%,38.46% and 50.00% in breast cancer patients with lymph node metastasis,markedly lower than the 77.27%,and 79.55% in patients without lymph node metastasis(P

Response and prognosis of taxanes and anthracyclines neoadjuvant chemotherapy in patients with triple negative breast cancer / 中国癌症杂志

Background and purpose:Triple-negative breast cancer(TNBC) is a high risk breast cancer that lacks the benefit from molecular targeted therapy.The purpose of this study was to compare the response to neoadjuvant taxanes and anthracyclines chemotherapy and survival in patients with TNBC and non-TNBC.Methods:One hundred and thirty-eight patients treated with 4 cycles of neoadjuvant taxanes,and anthracyclines chemotherapy were included in this retrospective study.TNBC is defined as the lack of estrogen receptor(ER),progesterone receptor(PR),and human epidermal growth factor receptor 2(Her-2) expression by immunohistochemistry method.The clinical and pathologic response and neoadjuvant taxane and anthracycline chemotherapy,and the relationships of response and survival between TNBC and non-TNBC were analyzed.Results:Of the 138 patients,37(26.8%) were TNBC and 101(73.2%) were non-TNBC.The overall response rate(OR)was 85.5%(118/138),including 35.5% clinical complete response(cCR) and 50.0% clinical partial response(cPR).The pathologic complete response(pCR) was 21.7%.The cCR and pCR were 51.4% and 45.9% in patients with TNBC,significantly higher than patients with non-TNBC respectively(29.7% and 12.9%)(P0.05).In contrast,TNBC patients with residual disease after neoadjuvant chemotherapy had worse 5-year DFS and OS compared with non-TNBC(P

Clinical evaluation on the effect of paclitaxel in the treatment of advanced breast cancer / 中国普通外科杂志

Objective To evaluate the efficacy and toxicity of chemotherapy containing paclitaxel in patients with advanced breast cancer.Methods Chemotherapy containing paclitaxel was used in 30 patients with advanced breast cancer.Paclitaxel was administered by iv infusion at a dose of 135*!mg/m 2 in 3-hour every 3～4 weeks for an average of 4 sessions. All patients received premedication of dexamethasone, diphenhydramine and cimetidine to prevent allergic reactions. Results The overall response rate was 43%(13/30),including complete remission(CR) in 3(10%) cases and partial remission(PR) in 10(33%). The average duration of remission was 1.6 months in CR cases and 5 months in PR cases respectively.The major toxicity associated with paclitaxel administration includes neutropenia,myalgia,arthralgia, numbness of hands and feet,alopecia and flushing of face. Conclusion Paclitaxel is an effective agent for treatment of advanced breast cancer and its side effects are tolerable.

Treatment of locally advanced breast cancer with breast-conserving therapy after neoadjuvant chemotherapy: Report of 31 cases / 中国微创外科杂志

12 months postoperatively,and excellent results were obtained in 16.0% of the patients((4/25)),good in 40.0%(10/25),and poor in 44.0%(11/25). Conclusions For patients with locally advanced breast cancer previously treated with downstaging neoadjuvant chemotherapy,breast-conserving therapy offers satisfactory results.Strict adherence to technique and use of postoperative irradiation and systemic therapy are crucial to breast-conserving therapy.

Neoadjuvant chemotherapy with epirubicin plus paclitaxel in treatment of patients with breast cancer / 中国癌症杂志

Purpose: To study the short-term efficacy and toxicity of the neoajuvant chemotherapy with epirubicin (EPI) plus paclitaxel( TAX) in treatment of patients with breast cancer. Methods: 20 patients with stage Ⅱ,Ⅲ breast cancer were treated with paclitaxel plus epirubicin (TE) for 2 - 4 cycles every 3 weeks, their clinical response and the toxicity were assessed after 2-4 cycles of neoajuvant chemotherapy, and they are compared with those of the patients treated with vinorelbine plus epirubicin( VE) as neoadjuvant chemotherapy. Patients in TE arm received epirubicin 60 mg/m2 by intravenous injection on d 1, paclitaxel 150 mg/m2 by 3-hour continuous infusion on d 2, 3 weeks was 1 cycle. Patients assigned to the VE arm received epirubicin 60 mg/m2 by intravenous injection on d 1, vinorelbine 30 mg/m by intravenous injection on d 1 and d 8, 4 weeks was 1 cycle. All patients were treated by modified radical operation after neoajuvant chemotherapy. Results: The overall response rate( RR) was 80% (16/20) both in TE arm and VE arm. There were 3(15%) clinical complete response( cCR) and 2(10%) pathologic complete response ( pCR) in every arm. No patient showed progressive disease. A higher proportion of RR and pCR was observed in patients with 4 cycles of neoajuvant chemotherapy than those with 2 cycles in the two groups. The major toxicity, including leukopenia, gastroenteric reaction, flushing of face and phlebitis, were similar in both groups, but fatigue, alopecia and neurotoxicity were more severe in VE arm than in TE arm(P

Value of different biological markers in prediction of response to neoadjuvant chemotherapy in breast cancer / 中国癌症杂志

Background and purpose:Neoadjuvant chemotherapy is an excellent model for evaluation of predictive parameters.The goal of predictive parameters is to select patients who would most likely benefit from neoadjuvant chemotherapy.The objective of this study was to investigate the predictive value of biological markers for the patients' response to neoadjuvant anthracycline combined with taxanes chemotherapy.Methods:We investigated 160 patients with breast cancer who underwent 4 cycles of neoadjuvant anthracycline combined with taxanes chemotherapy,retrospectively.The expression of estrogen receptors(ER),progesterone receptors(PgR),Her2,Topo-Ⅱ and Ki-67 proteins were detected by immunohistochemical assay in core-needle biopsy specimens.The associations between biological markers as well as clinical and pathologic responses were analyzed.Results:The overall clinical response was 85%,including 28.8%(46/160) with clinical complete response(cCR) and 56.3%(90/160) with clinical partial response.The pathological complete response(pCR) was 14.4%.In the univariate analysis,absence of ER,PgR expression and over-expression of Her-2 were predictive of the cCR and pCR(P

Effect of pecutaneous transhepatic biliary internal external drainage in treatment of malignant biliary obstruction / 临床外科杂志

Objective To evaluate the clinical value of percutaneous transchepatic biliary internal external drainage (PTBIED) in treatment of malignant biliary obstruction.Methods Forty-three patients with malignant biliary obstruction,including 14 cases with hilary metastasis cancer 8 with carcinoma of gallbladder,8 with hilary biliary cancer,13 with pancreatic cancer were treated with PTBIED.Results The technical success rate was 90%.The serum total bilirubin almost fell to normal level in 40 patients.Four cases (9.3%) died within 1 month, twenty (46.5%) cases died within 6 months,thirteen (30.2%) cases are still alive 12 months later.The complications cases mild hemobilia (8 cases,18.6%),bacteriemia(10 cases,23.3%),retrograde infection(6 included,14.0%).Conclusion PTBIED is an effective and safe therapeutic method for palliation of malignant biliary obstruction.

Evaluation of neo-adjuvant chemotherapy with different cycles for locally advanced breast cancer / 中国普通外科杂志

Objective To compare the efficacy and toxicity of different cycles of neo-adjuvant chemotherapy for locally advanced breast cancer. Methods Seventy-five patients with locally advanced breast cancer were treated with epirubicin (Epi) plus paclitaxel (TAX, ET regimen). Two cycles were used in 39 patients (2 cycles group) and 4 cycles were used in 36 patients (4 cycles group). Results The overall response rate (RR) was 74% (29/39) in 2 cycles group and 94% (34/36) in 4 cycles group. One patient got clinically complete response (CR), 28 cases had partial response (PR),10 with no change (NC) in 2 cycles group, while 21 patients showed CR including 11 patients with pathologically complete response, 13 with PR, and 2 with NC in 4 cycles group. There was no progression to advanced stage in either groups. Axillary lymph nodes were palpable in all 75 patients before ET regimen, lymph nodes became non-palpable in 46% (18/39) cases in 2 cycles group and in 75% (27/36) cases in 4 cycles group. Toxicities including leukopenia, gastroenteric reactions were similar in the 2 groups, though arthralgia, myalgia, and neurotoxicity were more common in 4 cycles group than 2 cycles group. Conclusion Neo-adjuvant chemotherapy with ET regimen for 4 cycles were more effective than 2 cycles to down staging locally advanced breast cancer. Toxicities including arthralgia, myalgia, and neurotoxicity were more common in 4 cycles group than 2 cycles group.

The role of oncogene Stat3 in carcinogenesis and progression of human breast cancer / 中国普通外科杂志

Objective The aim of this study is to investigate STAT3 expression and the relationship between protein levels of STAT3 and clinicopathological parameters together with preoperative chemotherapy in human breast cancer. Methods Samples were obtained from 51 patients with breast carcinoma in which 7 patients had received preoperative chemotherapy. Western blot was used to measure the protein expression in tissue and SK-BR-3 cell line. MTT method was used to evaluate the proliferation. Cell-cycle and apoptosis were quantified by flow cytometry. Results STAT3 protein levels increased in breast cancer tissues compared with adjacent normal tissues(t=5.540,P

The effect of HO-1 activated via P38? pathway in the genesis and chemotherapy resistance of breast carcinoma / 中国普通外科杂志

Objective To investigate the role of p38? pathway and HO-1 in the genesis and chemotherapy resistance of breast cancer. Methods The proliferation and apoptosis of human breast cancer cells were examined by MTT assay. The expression of p38? and HO-1 mRNA were examined by RT-PCR. Results The p38? mRNA level in 78% of samples was significantly greater than that in the normal tissue and the p38? mRNA level in patients with lymph node metastasis was higher than that without lymph node metastasis (P