[Clinical analysis of intraoperative radiotherapy in breast-conserving surgery of early breast cancer].

OBJECTIVE: To evaluate the safety and feasibility of intraoperative radiotherapy during breast-conserving surgery instead of whole breast radiotherapy in early breast cancer patients. METHODS: From July 2008 to December 2012, 36 early breast cancer patients underwent breast-conserving surgery plus interoperative radiotherapy on a Mobetron 1000 mobile electron accelerator. Postoperative recurrence and metastases, complications and cosmetic outcomes were recorded and analyzed. RESULTS: During a median follow-up period of 27.9 months, 2 patients (5.56%) underwent mastectomy after local relapses. There was no occurrence of distant metastasis or mortality. Their average wound healing time was 17 days and 2 of them (5.56%) developed infection while another 2 (5.56%) had delayed wound healing. And 1 patient (2.78%) showed wound edema and neither necrosis nor hematoma was found. The evaluation of cosmetic outcome shows 32 patients (88.89%) were graded as excellent or good while another 4 (11.11%) fair or poor. None had radiotherapy-related acute hemotological toxicity and 2 patients (5.56%) developed skin pigmentation. CONCLUSION: Intraoperative radiotherapy during breast-conserving surgery instead of whole breast radiotherapy in early breast cancer patients is both safe and reliable with better cosmetic outcomes.

[Clinical characteristics and survival in the operable breast cancer patients with different molecular subtypes].

OBJECTIVE: According to the immunohistochemical (IHC) test of ER, PR and HER-2, breast cancer can be divided into 4 different molecular subtypes: Luminal A subtype (ER or PR positive and HER-2 negative), Luminal B subtype (ER or PR positive and HER-2 positive), HER-2 subtype (ER and PR negative, HER-2 positive) and Basal-like subtype (ER, PR and HER-2 negative). This study was to analyze the clinical features of different breast cancer subtypes, and try to find the evidence of combined and individualized treatment for patients with breast cancer. METHODS: The data of 408 surgically treated breast cancer patients in the Cancer Hospital of Chinese Academy of Medical Sciences from January 1, 2002 to December 31, 2002 were collected and retrospectively analyzed. The clinicopathological features and recurrence, metastasis as well as survival of these four subtypes were compared. RESULTS: Of the 408 cases, Luminal A subtype accounted for 60.8% (248/408), Luminal B subtype 7.8% (32/408), HER-2 subtype 12.5% (51/408), and Basal-like subtype 18.9% (77/408). Basal-like subtype had less lymph node metastases than other subtypes (P<0.05). HER-2 subtypes consisted of less patients aged 45 years or younger than other subtypes (P<0.05). Luminal B subtype contained less advanced cases than other subtypes (P<0.01). By August 2008, the median time of follow-up was 64 months (range, 3-79 months). Fifty-eight cases presented local recurrence or metastasis, and 51 of them died of the disease. The 5-year overall survival rates (OS) for patients with Luminal A, Luminal B, Basal-like and HER-2 subtype were 89.83%, 86.15%, 79.85% and 86.70% , respectively. The 5-year disease-free survival (DFS) rates of the four subtypes were 83.52%, 68.88%, 71.66% and 75.83%, respectively. The rate of local recurrence or metastasis in Luminal A subtype was significantly lower than that in Luminal B and Basal-like subtypes (P<0.05). The DFS time in Luminal B subtype was shorter than that in Luminal A subtype (P=0.0481). The OS and DFS time in Basal-like subtype were all shorter than that in Luminal A subtype (P=0.0077 and P=0.0306, respectively). CONCLUSION: The distribution of each subtype in Chinese breast cancer patients is similar to that in European and American breast cancer patients. Luminal A is the most common subtype in Chinese breast cancer patients, and has a good prognosis. While Basal-like and Luminal B subtype have a poor prognosis.

[Clinical characteristics comparison between triple-negative and non-triple-negative breast cancer].

OBJECTIVE: To compare the clinical characteristics of triple-negative (TN) breast cancer and non-triple-negative (NTN) breast cancer, enrich the information of TN patients, and provide evidences for individualized combined treatment. METHODS: The data of 408 cases received operation in the year of 2002 was enrolled in this study. TN patients were confirmed according to the immunohistochemical (IHC) test of estrogen receptor (ER), progesterone receptor (PR) and HER-2/neu. The clinical characteristics, recurrence, metastasis and survival were compared between the two groups. RESULTS: Seventy-seven patients (18.9%) were confirmed TN cases. The median follow-up was 64 months (range, 3-79 months). Of all the cases, 58 occurred local recurrence or metastasis and 51 died, it was 19 and 12 in TN group. Compared with the NTN group, the TN patient tended to be younger and the tumor mass larger (P=0.015 and 0.011). However, axillary lymph nodes metastasis occurred more often in NTN patients than in TN patients (P=0.001). The rate of local recurrence and metastasis in TN group was significantly higher than in NTN group (P=0.005 and 0.025), and TN cases were more likely to develop lung metastasis than NTN patients (P<0.01). The 3-year and 5-year overall survival rate in TN group were significantly lower than in NTN group (86.4% vs. 93.4%, P=0.0205; 77.7% vs. 87.9%, P=0.0215). The 3-year and 5-year disease-free survival rate in TN group were also significantly lower than in NTN group (78.4% vs. 92.4%, P=0.0038; 72.8% vs. 85.8%, P=0.0041). Tumor size, lymph node status and triple-negative were the most important factors influencing the prognosis on multivariate Cox regression analysis. CONCLUSIONS: TN breast cancer haa some specific clinical characteristics. The prognosis of TN patients is worse than that of NTN patients. Further study is needed to find individualized treatment for TN breast cancer patients.

[The clinical detection of breast cancer by spectrum method].

Breast cancer is one of the most frequently encountered malignant tumors of women. Early detection can save lives successfully. A safe, effective detection method is needed. The detection of breast cancer based on the laser-tissue interactions is an international research focus. The prototype of the detection system in the authors' lab uses a 780 nm low frequency modulated laser to penetrate breast tissue. Two-dimensional scan is processed under the control of computer. A photomultiplier tube (PMT) is used to get the penetrated light and convert it to electrical signal. The signal of light intensity is sampled by the system and used to get the near infrared penetrating image of breast after data processing. In the present paper the signal processing method is discussed and the data processing results in the lab experiments are given. Clinical trials were carried out in the Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, using NIR (near infrared light) breast scanner developed by the authors' lab. The investigations were performed after approval by the ethic committee of Cancer Institute and Hospital, Chinese Academy of Medical Sciences. Written informed consent was obtained from each subject. None of the patients' names, initials, or hospital numbers was used in this paper. Fifty patients underwent the examination. Thirty four of them were malignant, and 13 were benign. The other 3 lacked pathology results. Analysis and comparison were executed to evaluate the result. NIR images, mammographs, and the ultrasound images were compared with both the pathology results and each other. The accuracy percentage of NIR image reaches 72.5%, which is between the accuracy percentage of ultrasound (77.50%) and that of mammography (71.88%). In this paper, the characteristics of different breast diseases were found in NIR images, which offers criterion for NIR diagnosis method in detail. The typical NIR images of different diseases, such as papillomatosis with local cancer and cancer, were shown. The clinical trial verified the validity of tumor diagnosis with the special absorption of NIR light by hemoglobin. Both the position and the benign/malignant property of tumor can be detected by NIR method. The improving aspects of the prototype were proposed. A new approach was put forward to the optical method.

[Clinicopathologic analysis of primary pure squamous cell carcinoma of the breast].

OBJECTIVE: To analyze the clinicopathologic characteristics and treatment method for primary pure squamous cell carcinoma of the breast. METHODS: Twelve patients with primary squamous cell carcinoma of the breast pathologically confirmed were retrospectively reviewed. The clinical characteristics, diagnosis, treatment and prognosis were analyzed. RESULTS: All 12 patients were women with median age of 50 years (44-76 years). The patients all presented a single mass in the breast on presentation. The diameter ranged from 2.5 cm to 10.0 cm in diameter. All of the patients had undergone surgical resection. There were 6 cases in stage IIa, 2 in IIb, 2 in IIIa and 2 in IIIb according to the TNM staging system of AJCC and UICC. Ten of the 12 cases were followed-up from 4 months to 189 months. CONCLUSION: Primary squamous cell carcinoma of the breast is often in need of diagnosis by exclusion, but can be initially confirmed by fine needle aspiration. Presently, no standard therapy can be recommended in practice. The prognosis is controversial.