Objective To evaluate the efficacy and safety of bile duct stent in the surgical treatment of iatrogenic bile duct injury. Methods From January 2020 to June 2024 in department of general surgery of general or branch hospital of Ruijin Hospital, the clinical data of 7 cases with iatrogenic bile duct injury who underwent surgical treatment were retrospectively analyzed to evaluate the therapeutic effect and complications of bile duct injury. Results For 7 cases with iatrogenic bile duct injury, 2 of which were Strasberg D type, were performed with biliary duct repair and bile duct stenting, 5 of which were Strasberg E1 type, were performed with primary end-to-end anastomosis and bile duct stenting. All the operations were successful, and none of patients had the complications such as biliary leakage, jaundice, acute cholangitis, bile duct calculus, and bile duct stenosis. Conclusions It is safe and effective to replace T tube with bile duct stent in the surgical treatment of iatrogenic bile duct injury of Strasberg D/E1 type.
Breast cancer is the most common malignancy among women worldwide. In recent years, with the rapid development of artificial intelligence (AI) technology, foundation models in pathology have shown great potential in the diagnosis and treatment of breast cancer. This article provided a systematic overview of the current state and future directions of digital pathology and AI-assisted diagnosis for breast cancer from four dimensions: technical architecture, clinical applications, frontier explorations, and ethical challenges. We focused on the latest advances in pathology foundation models such as Virchow, UNI, and CONCH in downstream tasks including histological grading, HER2 scoring, and genotype prediction, discussed breakthroughs of multimodal generative AI systems like PathChat and SlideSeek in promoting interpretable diagnosis, and provided perspectives on emerging directions such as spatial transcriptomics integration and three-dimensional(3D) pathology reconstruction.
Early-stage breast cancer diagnosis and treatment are characterized by long disease course, high heterogeneity, multi-source and heterogeneous data, and dynamic evolving decision-making. The traditional multidisciplinary team (MDT) decision-making model faces challenges such as low efficiency and fragmented whole-cycle management. Large language models (LLMs) provide a new approach to solving these problems by virtue of their advantages in processing unstructured text, integrating multi-source data, and assisting clinical reasoning. This paper elaborated on the application value of LLMs in breast cancer MDT decision-making, focused on analyzing three core methods: personalized treatment recommendation agents, multi-agent collaboration, and clinical decision-making evidence generation and fusion. Furthermore, it proposed future development strategies across four dimensions: dynamic update of clinical knowledge bases, in-depth integration of case databases and models, human-machine collaborative case management, and OpenClaw-style intelligent physician assistant, providing references for promoting whole-cycle precise diagnosis and treatment of breast cancer and optimizing the MDT model.
Objective To assess safety and aesthetic outcomes of single-port breast endoscopy-assisted versus traditional open subpectoral implant placement in stage Ⅰ breast reconstruction for early-stage breast cancer. Methods A retrospective review was performed on clinical data from patients with early-stage breast cancer who underwent breast reconstruction at our hospital between January 1 and December 31, 2024. Patients were divided into two groups according to the surgical approach: the endoscopic surgery group (n=10) and the traditional open surgery group (n=14). Comparisons were made between groups of operation time, intraoperative blood loss, number of sentinel lymph nodes detected, length of hospital stay, wound drainage volume on postoperative day 3, drain removal time, surgeons' assessments of aesthetic outcomes (Ueda score), and patients’ satisfaction with breast reconstruction (BREAST-Q questionnaire). Statistical analyses were conducted. Results The traditional surgery group had a significantly longer postoperative drain removal time compared with the endoscopic surgery group (P<0.05). Postoperative aesthetic outcomes, evaluated by Ueda score and BREAST-Q questionnaire, were significantly superior in the endoscopic surgery group (P<0.05). No significant differences were identified between groups in operation time, intraoperative blood loss, number of sentinel lymph nodes detected, length of hospital stay, or wound drainage volume on postoperative day 3 (P>0.05). Conclusions Single-port endoscopy-assisted prepectoral implant placement in phase Ⅰ breast reconstruction appears to provide safety outcomes comparable to those of traditional open surgery, with the added benefit of improved postoperative aesthetics. Further studies are warranted to confirm its broader applicability under appropriate clinical indications.
Endoscopic tattooing (ET) technology plays a crucial role in the diagnosis and treatment of gastrointestinal diseases. This article provided a systematic review of the development and current status of ET technology. It focused on the characteristics, advantages, and limitations of commonly used dyes such as India ink, Spot®, nanocarbon, indocyanine green, and methylene blue, as well as new types of marking materials. In terms of clinical applications, the article discussed in detail the practical value of this technique in various scenarios, including pre-surgical localization, lymph node tracking, post-endoscopic follow-up examinations, small bowel endoscopy rendezvous, navigation during endoscopic retrograde cholangiopancreatography (ERCP), and marking before neoadjuvant therapy. ET enables precise tracking of lesions and lymphatic drainage, providing essential visual guidance for diagnostic and therapeutic procedures. This thereby significantly enhances the accuracy and safety of treatments.
Infectious and inflammatory breast diseases are a group of clinically common conditions whose management is highly controversial, and for which standardized evidence-based guidelines have long been lacking. In 2025, the American Society of Breast Surgeons (ASBrS), Society of Breast Imaging (SBI), and College of American Pathology (CAP) jointly issued the 2025 Guidelines for the Management of infectious and inflammatory lesions of the breast, which focus on the three most common conditions—lactational mastitis (LM), granulomatous mastitis (GM), and periductal mastitis with squamous metaplasia of lactiferous ducts (PDM-SMOLD)—and propose a standardized diagnostic and management pathway centered on minimizing invasive interventions. This article interpreted the key points of the guidelines and compared them with the domestic Clinical Practice Guidelines for the Diagnosis and Treatment of Inflammatory Breast Diseases (2025 Edition), to provide insights for clinical practice in China.
Objective To analyze the clinicopathological characteristics and prognosis of primary synchronous bilateral breast cancer (SBBC) based on Shanghai Jiao Tong University Breast Cancer Database, and to explore risk factors of prognosis. Methods This retrospective study enrolled operable SBBC patients from Shanghai Jiao Tong University Breast Cancer Database (January 2009 to June 2022) to assess clinicopathological characteristics, treatments, and survival outcomes. COX proportional hazards regression analysis was used to evaluate the factors influencing prognosis of disease-free survival (DFS) and breast cancer free interval (BCFI). Results A total of 322 cases with SBBC were included. In the first tumor, there were more cases who had tumors with a diameter greater than 2.0 cm, lymph node metastasis, and high Ki-67 index, compared with the second tumor (All P<0.05). And the proportion of progesterone receptor (PR) positivity in the first tumor was lower (P<0.05). The surgical approaches for both breasts showed moderate consistency, with Kappa value of 0.548. There were no significant differences in DFS and BCFI between the cases with bilateral invasive carcinoma and unilateral invasive carcinoma(both P>0.05). Multivariate analysis showed that bilateral lesions with PR negativity was an independent prognostic risk factor associated with DFS (P<0.05) while family history of breast cancer, bilateral lesions with LN 1-3, and bilateral lesions with PR negativity are prognostic risk factors associated with BCFI (P<0.05). Conclusions SBBC patients with PR negativity of bilateral lesions have a poor prognosis, and required close follow-up.
Objective To compare the surgical safety and cosmetic outcomes of single axillary incision non-lipolysis reverse-sequence endoscopic nipple-sparing mastectomy and traditional open surgery in the treatment of gynecomastia (GYN). Methods A retrospective cohort study was performed on 51 GYN patients who underwent mastectomy at West China Hospital and the Fourth People's Hospital of Sichuan Province from March 2021 to August 2024. The cohort was divided into the endoscopic group (39 cases) and the open group (12 cases). Baseline characteristics, surgical-related data, postoperative complications and cosmetic outcomes of two groups were collected and analyzed. Results There were no significant differences in age, body mass index (BMI), breast size, and the mean operation time between the two groups. The overall complication rate was 7.7% in the endoscopic group and 8.3% in the open group, with no significant difference (P=1.000. The unilateral resected gland in the endoscopic group was heavier than that in the open group (P=0.011). In the cosmetic outcomes reported by doctors, the endoscopic group showed advantages in improving chest flatness and reducing scars. In the body-Q scale reported by patients, the endoscopic group reported higher scar scores than that of the open group (91.1 ± 12.2 vs. 61.4 ± 4.0; P<0.001). In terms of satisfaction with chest module and nipple, there was no significant difference between the two groups. Due to the inability of the endoscopic group to remove excess skin, the endoscopic group had a lower score in evaluation of appraisal of excess skin than that of open group, but with no significant difference. Conclusions Compared with the traditional open surgery, the single axillary incision non-lipolysis reverse-sequence endoscopic nipple-sparing mastectomy has better postoperative cosmetic outcomes, and with no increased operation time, and postoperative complications. It is a safe and effective surgical option for treating GYN and is worthy of further promotion.
Axillary management in breast cancer is shifting from traditional extensive dissection toward a precision de-escalation approach that emphasizes risk stratification and reduced intervention. With advances in systemic therapy and imaging assessment, minimizing or even omitting certain axillary surgeries and radiotherapy procedures has become a feasible strategy, effectively lowering upper-limb complications without compromising oncologic safety. Future efforts should integrate multi-modal evaluation and individualized predictive models to refine patient selection and clinical decision-making, and further guide the development of more precise and less invasive axillary management pathways.
Circulating tumor DNA (ctDNA) represents the liquid biopsy technology with the most advanced clinical translation and the deepest research foundation to date. Leveraging its non-invasive, dynamic, and highly specific advantages, ctDNA has emerged as an important breakthrough direction in the precision diagnosis and treatment of breast cancer. In this article, we systematically reviewed the detection methodologies of ctDNA, with a dedicated focus on its clinical utility and current research status across different stages of breast cancer management. Furthermore, we provided a forward-looking perspective on the future development of ctDNA in guiding the full-course precision management of breast cancer.
Hormone receptor positive/human epidermal growth factor receptor 2 negative (HR+/HER2-) breast cancer is the predominant molecular subtype. However, even after completion of standard adjuvant endocrine therapy, patients of this subtype continue to face a persistent risk of late recurrence. Cyclin-dependent kinase 4/6 (CDK4/6) inhibitors precisely target dysregulated cell-cycle progression. They have been proved to significantly reduce the risk of recurrence in high-risk early-stage patients in the adjuvant setting, thereby reshaping the treatment landscape of HR+/HER2- early breast cancer. This review systematically summarized the key evidence supporting adjuvant CDK4/6 inhibitor therapy, critically analyzed current controversies in clinical practice, outlined major recommendations from international and national guidelines, discussed strategies for individualized treatment optimization, and provided perspectives on future research directions. These insights may help inform the standardized and precise use of CDK4/6 inhibitors for patients of early breast cancer.
Breast surgery diagnosis and treatment is gradually transitioning from multi-disciplinary management to digital, intelligent, and precision-based care. Multidimensional data generated during the diagnosis and treatment process—including imaging, pathology, genomics, clinical treatment, follow-up, and rehabilitation provides the foundation for a full-process digital diagnosis and treatment system. Supported by artificial intelligence (AI), cloud platforms, multimodal imaging fusion, and multi-omics integration, this system can cover screening, diagnosis, treatment decision-making, surgical planning, postoperative treatment, and long-term follow-up, thereby paving the way for the digital, intelligent, and precision-based transformation of breast surgery.
The progression of breast cancer is intimately governed by the tumor microenvironment, with emerging evidence underscoring the critical modulatory roles of intratumoral microbiota. This review comprehensively delineated the compositional profiles, pathogenic mechanisms, therapeutic modulatory effects, and targeted intervention strategies pertaining to the intratumoral microbiota in breast cancer. At the compositional level, neoplastic tissues display pronounced dysbiosis, with microbial signatures stratified by molecular subtypes and specific genera demonstrating prognostic relevance. Mechanistically, intratumoral microbiota synergistically orchestrates tumorigenesis, local invasion, and metastatic dissemination via the induction of DNA breaks, inflammatory cascade amplification and immune landscape remodeling, metabolic rewiring, epigenetic perturbation, and activation of canonical oncogenic signaling axes. With regard to therapeutic outcomes, intratumoral microbiota contributes to chemoresistance, endocrine therapy failure, and anti-HER2 refractoriness, while concurrently potentiating immunotherapeutic responses. On the interventional front, engineered bacterial vectors and nanoplatform-based drug delivery systems exhibited favorable synergistic antitumor efficacy in preclinical settings. Finally, this review addressed prevailing challenges, including assay standardization, integrative multi-omics interrogation, and the translational gap toward clinical implementation.
Objective To analyze the epidemiological characteristics and trends of the incidence and mortality of female breast cancer in Shanghai from 2002 to 2021. Methods Data on new cases and deaths of female breast cancer from 2002 to 2021 were obtained from the Population-based Cancer Registry and Vital Statistics System of Shanghai Municipal Center for Disease Control and Prevention. Cases or deaths, proportion, crude rate, age-specific rate, age-standardized rate (ASR) and others were calculated stratified by year of diagnosis or death and age-group. ASRs were calculated using Segi’ s 1960 world standard population. Trends of the annual percent change (APC) of ASRs, age-specific rates and proportions of new cases with selected diagnostic character of female breast cancer stratified by different groups were analyzed by Joinpoint analysis software. Results Annual new cases increased from 3 341 in 2002 to 7 086 in 2021, with ASR of incidence changing from 30.87/10⁵ to 46.62/10⁵. The trend of ASRs of incidence increased at an average annual rate of 2.25% (P<0.001) from 2002 to 2021. Annual deaths increased from 881 to 1 328, with ASR of mortality decreased from 7.71/10⁵ to 5.98/10⁵. The trend of ASRs of mortality increased at an average annual rate of 1.66% from 2002 to 2010 (P=0.029), followed by a decelerating decline at an average annual rate of 2.44% from 2010 to 2021 (P<0.001). In 2021, the crude rate of incidence of female breast cancer was 94.24/10⁵ in Shanghai, and the ASR was 46.62/10⁵. The crude rate of mortality was 17.66/10⁵, and the ASR was 5.98/10⁵. Age-specific rates of incidence and mortality generally increased with aging. The age-specific incidence rate peaked in the 60-64 years old (160.63/10⁵), followed by a marked decline after the 70-74 years old. The age-specific mortality rate peaked in the ≥85 years old (99.35/10⁵). The analysis on age-specific trends showed increases of both the median and mean ages at onset of female breast cancer. Increasing trends in age-specific incidence rates were observed across the majority of age groups, whereas age-specific mortality rates showed declining trends. The proportion of morphological verification (MV) increased; however, the proportion of cases with unspecified histological type also increased. The proportions of cases diagnosed at Stage Ⅰ and unknown stage showed increasing trends. Conclusions The ASR of female breast cancer incidence in Shanghai remains relatively high, whereas the ASR of mortality has declined. The age-specific characteristics at onset showed a pronounced trend toward aging. Improvements in early detection and clinical management of breast cancer may have influenced these epidemiological features, contributing to reduced mortality through improved survival rates in Shanghai. Nevertheless, considerable scope remains for further advancements in screening, diagnosis, and survival improvement for breast cancer. This study provided a scientific basis for further research, prevention and control for breast cancer.
In recent years, indole-3-carbinol (I3C) has been introduced into tumor therapy research, playing a key role in inhibiting and interfering with the occurrence and development of various tumors. This article explored the mechanisms by which I3C and its indole-derived metabolite, 3, 3’-diindolylmethane (DIM), which is converted in the acidic environment of the stomach, serve as effective natural chemopreventive agents against multiple tumors. The physicochemical properties of I3C were presented alongside epidemiological studies, emphasizing its safety and efficacy. Furthermore, it provided a detail discussion of the molecular mechanisms of I3C's anti-tumor effects, including various signaling pathways such as the phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin [PI3K/PKB(AKT)/mTOR] and aryl hydrocarbon receptor (AHR) pathways. This article served as a valuable reference for further research on I3C.
Objective To investigate the impact of blocking androgen receptor (AR) signaling pathway in the pathogenesis of male thoracic aortic dissection (TAD) and to uncover its molecular mechanisms. Methods In TAD clinical samples, animal models and primary cells, real-time quantitative polymerase chain reaction (RT-qPCR) and immunoblotting were used to detect the expression levels of AR and its pathway target gene FKBP5. Immunofluorescence was used to detect AR expression in primary cells isolated from TAD animal models. Immunohistochemistry was used to detect GPX4 expression in TAD animal models. In vascular smooth muscle cells (VSMCs), the AR signaling pathway was blocked to detect changes in oxidative stress and ferroptosis-related markers using biochemical assays. Luciferase reporter gene, chromatin immunoprecipitation, and nuclear run-on real-time transcription analysis were used to verify the transcriptional regulation of the key ferroptosis inhibitor gene long-chain acyl-CoA synthetase 3 (ACSL3) by the AR signaling pathway. In animal models, imaging and histological methods were employed to elucidate how the inhibition of the AR signaling pathway promotes the occurrence of TAD. Results Compared with normal aortic tissues, the expression of AR and its pathway target gene FKBP5, was reduced in tissues from male TAD patients and in the aortic VSMCs of male mouse TAD model tissues. Blocking the AR signaling pathway significantly reduced the expression levels of the ferroptosis inhibitor glutathione peroxidase 4(GPX4) in mouse aortic VSMCs, inducing the formation and rupture of TAD. Blocking the AR pathway induced the expression of oxidative stress and ferroptosis-related markers in VSMCs. Further research found that AR bound to the ACSL3 promoter region and promoted its transcription, inhibiting ferroptosis in VSMCs. Overexpression of ACSL3 reversed the ferroptosis induced by AR blockade. Animal experiments showed that blocking the AR signaling pathway promoted thoracic aortic lumen dilation, elastic fiber fragmentation, ultimately leading to TAD occurrence. Conclusions The AR signaling pathway inhibits ferroptosis in VSMCs through transcriptional activation of ACSL3. Loss of its function leads to elastic fiber fragmentation of the aortic wall, thereby promoting the occurrence and development of TAD.
Anal cancer is a malignancy closely associated with human papillomavirus (HPV) infection, with a rising incidence globally. Persistent infection with high-risk HPV acted as the core driver of anal tumorigenesis. Currently, strategies for the prevention and control of HPV-related anal cancer primarily revolve around primary prevention (HPV vaccination) and secondary prevention (screening of high-risk populations). Based on existing evidence, HPV vaccination served as the core of primary prevention and demonstrated clear efficacy in reducing the incidence of anal intraepithelial neoplasia (AIN) by blocking persistent high-risk HPV infection. Regarding secondary prevention, domestic and international guidelines have reached a consensus recommending standardized screening based on anal cytology, high-risk HPV testing, and anoscopy for high-risk groups, such as people living with human immunodeficiency virus(HIV) and men who have sex with men (MSM), to facilitate early detection and intervention.
The management of low rectal cancer has evolved from a radical "life-saving" paradigm through an era of sphincter preservation into a new epoch prioritizing function preservation, representing a transformative leap rooted in systematic innovations across surgical philosophy, technological capabilities, and therapeutic procedures. This evolution is epitomized by the revolutionary refinement of safe distal resection margins from the traditional "5-cm principle" to the contemporary "1-cm principle", which has catalyzed the development of sphincter-preserving procedures while fundamentally elevating the decision-making paradigm from "anatomic sphincter preservation" to the more sophisticated concept of "functional sphincter preservation". Technically, laparoscopic and robotic surgeries have achieved minimally invasive and precise operations, and the advancement of surgical instruments has ensured the reliability of deep pelvic anastomosis. The neoadjuvant therapy model has evolved from traditional radiotherapy and chemotherapy to total neoadjuvant therapy (TNT) and immunotherapy, significantly improving the rate of pathological complete response (pCR), laying a scientific foundation for the "watch-and-wait" strategy. Radiomics contribute to the precise preoperative assessment. The ultimate aim is to comprehensively integrate the latest theoretical advancements, smoothly applies them to practice, builds a standardized diagnosis and treatment system. Ultimately, while ensuring the safety of oncology, this initiative will customize individualized treatment plans for each patient of low rectal cancer, shifting the paradigm from merely "curing the disease" to "healing the patient".
Objective To investigate the impact of different flushing strategies on procedure time and polyp detection rate(PDR) during colonoscopy. Methods A multicenter prospective controlled study was conducted, enrolling 248 patients who underwent colonoscopy at three hospitals from 2023 August to 2024 January. The patients were assigned to research group and control group randomly. The research group received a thorough flushing strategy during colonoscopy, while the control group received a limited flushing strategy. Clinical data, endoscopic procedure time, and polyp detection results were recorded and compared between the two groups. Results A total of 248 patients were enrolled, with 125 in the research group and 123 in the control group. Baseline characteristics were comparable between the two groups. The research group demonstrated a significantly higher PDR compared to the control group (P<0.01). Among patients with detected polyps, the research group detected more small polyps in the left colon than the control group (P<0.05). Conclusions The flushing strategy during colonoscopy improves PDR and increases the detection of small polyps in the left colon without prolonging the total procedure time.
As the cornerstone of systemic treatment for colorectal cancer, chemotherapy (cytotoxic drug therapy) continues to evolve in clinical practice, with its scope and application significantly expanding. In the treatment of advanced disease, the combination of chemotherapy with targeted and immunotherapeutic agents has been continuously optimized, leading to the development of precision treatment strategies tailored to different molecular subtypes, which has markedly improved therapeutic efficacy. In the field of perioperative therapy, the application of neoadjuvant chemotherapy, total neoadjuvant therapy (TNT), and the precision enhancement of adjuvant chemotherapy are reshaping the treatment landscape for patients with resectable colorectal cancer. Furthermore, novel technologies such as circulating tumor DNA offer the potential for prediction and dynamic monitoring of clinical decision and chemotherapy efficacy. From the perspective of chemotherapy, this article systematically analyzed its role in the treatment system for colorectal cancer, and discussed its clinical challenges and future directions.
