Rectus femoris muscle of the lower abdomen was used as myocutaneous flap in the reconstruction of the breast in 4 patients, of which, in 2 cases the reconstruction was carried out immediately following the radical mastectomy for breast cancer by using trancfer of the pedicled myocutaneous flap, and in the other two cases, the vascularized free myocutaneous flap was used 2 months and 5 years after the radical mastectomy, respectively. The vascularized free myocutaneous flaps were survived, however, in the pedicled myocutaneous flap group, the fat of the flaps had liquefaction 23 weeks after operation. The latter were healed after repeated dressings. The external appearance of the 4 reconstructed breasts lookedsattisfactory. The patients wete follwed up for 10 to 18 months, 2 patients hadno ill effects, while the 2 pedicled myocutaneous flaps, in which 1 patient hadbulging of the weakened abdominal wall, and the other had lost from follow up.
ObjectiveTo investigate the anatomy and function of pectoralis fascia in breast cancer operation, and the choice of resection and preservation of pectoralis fascia in different operation methods.MethodWe searched the articles related to pectoralis fascia and breast cancer through PubMed, Web of Science, EBSCO, WanFang Medical Network, SinoMed, and other databases, and then selected the Chinese and foreign articles that met the objective of this paper, and made an review after reading the articles.ResultsIn the immediate breast reconstruction of breast prosthesis after breast cancer operation, the preservation of pectoralis fascia was beneficial to the complete coverage of breast prosthesis and improved the cosmetic effect after operation. The purpose of preserving pectoralis fascia adipose tissue in breast-conserving surgery was to reduce the loss of breast volume and to pursue the cosmetic effect after operation. At present, there had been reports on the safety of pectoralis fascia oncology, but there was no final conclusion on the safe distance between tumor and pectoralis fascia, and the current research could not provide sufficient evidence for the preservation of pectoralis fascia.ConclusionsThe question of whether the pectoralis fascia needs to be removed in breast cancer surgery is still controversial. The preservation of pectoralis fascia is more for better immediate breast reconstruction after operation. However, the current evidence of evidence-based medicine is not sufficient. Clinicians need to conduct multicenter, randomized controlled clinical trials to improve the evidence.
The report of brachial plexus injuries following radical mastectomy in patients with breast cancer was rare even though the operation was a main measure in treating with breast cancer. Nine patients treated from Oct. 1989 to Feb.1991 were summarized. The results were not ideal.
Objective To describe the role of breast palpation imaging (PI) in breast cancer screening. Method We searched the latest research and previous literatures of PI in the diagnosis of breast cancers, and made an review after reading the articles. Results PI had better diagnostic efficiency than clinical breast examination (CBE) in breast cancer screening. PI combined with mammography (MG) and/or breast ultrasound (BUS) could further improve the diagnostic efficiency. Conclusion PI has important value in breast cancer screening, and is an important supplement to existing breast cancer screening methods.
ObjectiveTo identify the risk factors of bone metastasis in breast cancer and construct a predictive model. MethodsThe data of breast cancer patients met inclusion and exclusion criteria from 2010 to 2015 were obtained from the SEER*Stat database. Additionally, the data of breast cancer patients diagnosed with distant metastasis in the Affiliated Hospital of Southwest Medical University from 2021 to 2023 were collected. The patients from the SEER database were randomly divided into training (70%) and validation (30%) sets using R software, and the breast cancer patients from the Affiliated Hospital of Southwest Medical University were included in the validation set. The univariate and multivariate logistic regressions were used to identify risk factors of breast cancer bone metastasis. A nomogram predictive model was then constructed based on these factors. The predictive effect of the nomogram was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis. ResultsThe study included 8 637 breast cancer patients, with 5 998 in the training set and 2 639 (including 68 patients in the Affiliated Hospital of Southwest Medical University) in the validation set. The statistical differences in the race and N stage were observed between the training and validation sets (P<0.05). The multivariate logistic regression analysis revealed that being of white race, having a low histological grade (Ⅰ–Ⅱ), positive estrogen and progesterone receptors status, negative human epidermal growth factor receptor 2 status, and non-undergoing surgery for the primary breast cancer site increased the risk of breast cancer bone metastasis (P<0.05). The nomogram based on these risk factors showed that the AUC (95% CI) of the training and validation sets was 0.676 (0.533, 0.744) and 0.690 (0.549, 0.739), respectively. The internal calibration using 1 000 Bootstrap samples demonstrated that the calibration curves for both sets closely approximated the ideal 45-degree reference line. The decision curve analysis indicated a stronger clinical utility within a certain probability threshold range. ConclusionsThis study constructs a nomogram predictive model based on factors related to the risk of breast cancer bone metastasis, which demonstrates a good consistency between actual and predicted outcomes in both training and validation sets. The nomogram shows a stronger clinical utility, but further analysis is needed to understand the reasons of the lower differentiation of nomogram in both sets.
【作者简介】〖KG2〗〖HTSS〗蒋青(1963-),女,四川遂宁人,主管护师,硕士,Email:jq0987@yahoo.cn
ObjectiveTo expolre the effect and safety of gemcitabine combined with docetaxel in the treatment of advanced breast cancer. MethodsForty-eight breast cancer patients who got treatment by gemcitabine combined with docetaxel from March 2013 to March 2014 were prospectively enrolled in this study. ResultsOf all the 48 patients, the completely responded (CR) rate was 16.7%(8/48), partial responded (PR) rate was 35.4%(17/48), stable disease (SD) rate was 33.3% (16/48), progressive disease (PD) rate was 14.6% (7/48), and the response rate was 52.1% (25/48), the clinical benefit rate was 85.4% (41/48). The response rates of hormone receptor (HR)-positive group, human epidermal growth factor receptor 2 (HER-2)-positive group, and Basal-like group were 43.5% (10/23), 54.5% (6/11), and 64.3% (9/14) respectively, the clinical benefit rates of HR-positive group, HER-2-positive group, and Basal-like group were 82.6% (19/23), 81.8% (9/11), and 92.9% (13/14) respectively. There was no significant difference among the 3 groups in the effect, response rate, and clinical benefit rate (P=0.293, P=0.462, P=0.663). All patients suffered from varying degrees of toxicities during chemotherapy, including leukopenia, neutropenia, decreased hemoglobin, thrombocytopenia, rash, nausea, vomiting, hair loss, diarrhea, fatigue, and elevated alanine aminotransferase, wherein leukopenia (27.1%, 13/48), neutropenia (22.9%, 11/48), thrombocytopenia (4.2%, 2/48), and fatigue (10.4%, 5/48) were included inⅢ-Ⅳ degree of adverse reactions. In addition, all of 48 patients were followed-up for 1-19 months, with a median follow-up time of 12 months. During follow-up period, 6 patients died, and the overall survival rate was 87.5% (42/48). There was no significant difference among the 3 groups in overall survival and progression free survival (P > 0.050). ConclusionGemcitabine combined with docetaxel may be an effective therapy in treatment of advanced breast cancer.
ObjectiveTo investigate the anatomical characteristics of breast lymphatic drainage in patients with breast cancer after injecting methylene blue and indocyanine green (ICG) into the intradermis of the areola.MethodsOne hundred and eighty-six patients with stage 0–Ⅱ breast cancer were collected. The sentinel lymph node (SLN) biopsy was performed by injecting methylene blue and ICG. At the same time, the number of sentinel lymphatic channel (SLC), origin angle, direction, and consistency were also studied.ResultsA total of 308 SLCs were successfully showed in the 186 patients and 679 SLNs were detected. The 95.8% (295/308) of SLCs and 93.1% (632/679) of SLNs were showed by combination in the methylene blue and ICG. The 46.8% (87/186) of patients had 1 SLC, the 40.9% (76/186) of patients had 2 SLCs, the 12.4% (23/186) of patients had 3 SLCs. The 82.8% (255/308) of SLCs flowed from the outer upper edge of the areola, the 3.2% (10/308) of SLCs flowed from the outer lower edge of the areola, the 14.0% (43/308) of SLCs flowed from the inner upper edge of the areola. The 89.9% (277/308) of the SLCs flowed mainly through the 0°—60° interval in the outer upper quadrant, 10.1% (31/308) of the SLCs flowed through the 61°—90° interval in the outer upper quadrant.ConclusionsThe consistency of SLC and SLN stained by the two tracers is good. The number of SLC is 1–3. The SLCs flow mainly through the 0°—60° interval in the outer upper quadrant of the breast, then flow into in the axilla and don’t flow into the internal mammary lymph nodes. The deep superficial lymphatic channels under the skin and the penetrating lymphatic channels can not be showed by ICG, but the SLN can be showed by it.
ObjectiveTo explore advantages and feasibility of a new prosthesis implantation method after breast cancer surgery by reacquaint breast anatomy. MethodsThe clinicopathologic data of patients with breast cancer were retrospectively collected. The patients underwent the breast cancer surgery and prosthesis implantation with cricoid breast ligament in the Xuzhou Cancer Hospital from January 1, 2021 to May 30, 2023. ResultsA total of 10 patients were collected, with age ranging from 31 to 59 years old. Three patients received postoperative analgesia, 2 patients occurred infection, 1 patient occurred fat liquefaction. All patients did not experience capsular contracture, flap necrosis, or removal of the prosthesis. Two patients had sentinel lymph node metastasis. All patients followed-up 3 to 24 months after surgery. The BREAST-Q questionnaire was used to assess the quality of life and satisfaction after surgery, 3 patients were very satisfied, 5 were satisfied, and 2 were basically satisfied. ConclusionFrom the results of limited cases analysis in this study, it is safe and feasible to implant the prosthesis with cricoid breast ligament in selected patients after breast cancer surgery.
ObjectiveTo evaluate the clinical value of multi-slice CT in the diagnosis of complications due to breast augmentation. MethodsWe collected the imaging data of 32 female patients who accepted multi-slice CT examination in the second People's Hospital of Chengdu after breast augmentation between February 2010 and February 2015. The position, shape, edge, internal density, leakage, rupture and hard nodules of the prosthesis were observed and analyzed carefully. ResultsIn the 32 patients with breast augmentation, 12 were normal with bilateral symmetry and without abnormal shape or density. Among the other 20 patients, 11 had capsular contracture, 5 had prosthesis leakage, rupture and hard nodules, 4 had breast infection, 1 had fibroadenoma, 1 had cystoma, and 5 had little calcified nodules in the breast tissue. ConclusionThe multi-slice CT scan can clearly and accurately show the position, shape and size of the breast prosthesis as well as the existence of leakage, rupture and hard nodules in the prosthesis. It plays a very important role in the diagnosis of the complications due to breast augmentation and can be effective guidance for clinical operation.