Purpose: Triple-negative breast cancer (TNBC) has attracted more attention both clinically and experimentally because of its high-risk biological characteristics and lacking of effective treatment method. The purpose of this retrospective study was to find out the incidence of triple-negative breast cancer (TNBC) in all kinds of breast cancers and to compare and analyze the clinicopathological features, recurrence, metastasis and prognosis of patients with TNBC and non-triple negative breast cancer (non-TNBC). Methods: A total of 1578 female patients with primary breast cancer were diagnosed and treated at the department of General Surgery, the Chinese PLA General Hospital, China, from Jan. 2004 to Jun. 2009. The 1578 breast cancer patients were divided into two groups: the TNBC group and the non-TNBC group. The clinical features and prognosis of the two groups were compared. Results: The incidence of TNBC was 20.41%. Compared with the non-TNBC, the TNBC were characterized as younger age, higher histological grade, higher rate of positive lymph node, bigger tumor size, higher clinical stage at diagnosis, higher histological grade, quicker and easier recurrence and metastasis and lower 5-year DFS rate and 5-year OS rate. The metastasis of TNBC had obvious organic tendency. The lungs, liver and brain were the first three most common sites of metastases. The information of age, the tumor size, lymph node status, clinical stage, histological grade, pathological types and operation method, especially the age and lymph node status play the important roles in judging the prognosis of TNBC. Conclusions: According to this study we found that TNBC was a distinct subgroup of breast cancer with particular clinicopathologic behavior. Compared with the non-TNBC, TNBC was characterized by more aggressive behavior, and lower DFS and OS rate. The metastasis of TNBC had obvious organic tendency. The information of age, the maximum diameter of the tumor, lymph node status, clinical stage, histological grade, pathological types and operation method, especially the age and lymph node status played the important roles in judging the prognosis of TNBC patients.

目的 隐匿性乳腺癌(occult breast cancer,OBC)是一种少见类型的乳腺癌,OBC发病率较低,缺乏大样本的临床研究,因而在诊断和治疗上存在较多争议.本研究回顾性分析9例OBC患者的临床资料,探讨OBC的诊断、治疗及预后.方法 选取解放军总医院2013-08-27-2015-01-23收治的OBC患者9例.患者均为女性,平均年龄50.7岁,中位年龄52岁.本组均因腋下无痛性肿块而就诊,穿刺病理确诊为淋巴结转移性腺癌.6例行乳腺癌改良根治术,3例行腋窝淋巴结清除术.结果 9例患者术后病理均确诊为OBC,3例经全乳连续切片发现原发癌灶.TNM分期:T0N1M05例,T0N2M01例,T0N3M03例.全组9例均获随访,随访时间为11～28个月.除1例死亡外均无瘤生存至今,未见局部复发和远处转移.结论 OBC是乳腺癌的一种特殊类型,发病隐匿,但预后好.以腋下无痛性肿物而就诊的中老年女性应考虑OBC的可能.穿刺病理结合免疫组化可以帮助确诊.乳腺MR是术前筛查乳腺内原发灶的最敏感方法.治疗应以手术为主,术后加做全身的辅助综合治疗.

Objective To explore the prospect of clinical application of indocyanine green (ICG) in sentinel lymph node biopsy (SLNB) in patients with breast cancer. Methods Seventy-two female breast cancer patients were selected from those receiving surgery during July 2014 and December 2014, with an age range of 33-67 years and a median age of 50 years, and they were randomly divided into experimental group (n=35) and control group (n=37), ICG and methylene blue as tracers were used respectively for SLNB. The surgical specimens were submitted to frozen section for pathological examination. The patients with metastasis to SLN received axillary lymph node dissection. Results The successful detection rate of metastasis to SLN by ICG method was 94.3%, with a total of 111 SLNs, with an average of 3.17 SLNs for each patient, and the accuracy rate was 94.3%, the sensitivity and false negative rate were 100% and 0%, respectively. On the other hand, the detection rate with methylene blue method was 92.0%, including 78 SLNs, with an average of 2.1 SLNs for each patient, and the accuracy rate was 89.2%, the sensitivity and false negative rates were 92.9% and 7.7%, respectively. The differences between two methods in the average SLNs and false-negative rate were statistically significant (P 0.05). Conclusion ICG method for SLNB in breast cancer shows a higher success rate and lower false negative rate, indicating that its clinical efficacy is superior to that of methylene blue, therefore it may be hopeful to be used alone in SLNB for breast cancer. DOI: 10.11855/j.issn.0577-7402.2015.05.12

Myc induced nuclear antigen-mina53( Mina53 )is a newly discovered gene,which is the direct target gene of c-Myc. Mina53 plays a role in mammalian cell proliferation. Many studies have indicated that Mina53 gene highly expressed in many tumor tissues,which suggests that the abnormal expression of the Mina53 gene may closely associate with the development,progression and prognosis of the tumors. Studies on Mina53 gene will help revealing the essence of tumors and provide a new target for diagnosis and treatment.

Zoledronic acid (ZA) has been tested in clinical trials as an additive therapy for early-stage breast cancer. However, the mechanism by which ZA exerts its antitumor activity is still unclear. The aim of this study is to investigate whether the prevention of tumor growth by ZA is through regulating the mesenchymal stem cells (MSC)-monocyte chemotactic protein 1 (MCP-1)-macrophages axis in the tumor microenvironment. To address this issue, MDA-MB-231-FLUC human breast cancer cells were cultured and injected either alone, or coupled with MSC into the mammary fat pads of nude mice. MSC were treated with either ZA or untreated. Tumor growth was determined by using an in vivo bioluminescence imaging (BLI) and the tumor-associated macrophages (TAMs) in tumor tissues were immunohistochemically analyzed by using CD206 antibody. The effects of ZA on the cytokine related gene expression of MSC were assessed by using real-time PCR. In this study, we found that ZA-treated mice showed a significant delay in tumor growth. In addition, our data revealed that ZA weakened the ability of MSC to promote tumor growth by impairing TAMs recruitment and tumor vascularization. Furthermore, it was found that ZA decreased MCP-1 expression of MSC, and therefore reduced the recruitment of TAMs to the tumor sites and hence inhibited the tumor growth. Altogether, our study demonstrated ZA can prevent the tumor-promoting effects of MSC. The antitumor effects of ZA were caused by decreasing the MCP-1 expression of MSC, which further decreased the infiltration of TAMs into tumor sites, and therefore inhibited the tumor growth.

Zoledronic acid (ZOL) is the third generation of bisphosphonates (BPs) that has been used as the standard treatment of osseous metastasis in breast cancer and it plays a role in treating breast cancer by inhibiting bone destruction mediated by osteoclast. Recently, many researchfindings indicate that ZOL can inhibit tumor cells directly or indirectly, furthermore, we alsofind that the antitumor effect of ZOL is enhanced when combined with chemotherapy. Many clinical trials data indicate that ZOL also plays a role in both preventing relapse and reducing the probability of skeletal and visceral metastases after surgery. The present review assesses the available preclinical and clinical evidence of the antitumor effect of ZOL in treating breast cancer.

Advanced medical imaging technology has allowed the use of fluorescence molecular imaging-guided breast cancer surgery (FMI-guided BCS) to specifically label tumour cells and to precisely distinguish tumour margins from normal tissues intra-operatively, a major challenge in the medical field. Here, we developed a surgical navigation system for real-time FMI-guided BCS. Tumours derived from highly metastatic 4T1-luc breast cancer cells, which exhibit high expression of matrix metalloproteinase (MMP) and human epidermal growth factor receptor 2 (HER2), were established in nude mice; these mice were injected with smart MMP-targeting and "always-on" HER2-targeting near-infrared (NIR) fluorescent probes. The fluorescence signal was imaged to assess in vivo binding of the probes to the tumour and metastatic sites. Then, orthotopic and metastatic breast tumours were precisely removed under the guidance of our system. The post-operative survival rate of mice was improved by 50% with the new method. Hematoxylin and eosin staining and immunohistochemical staining for MMP2 and CD11b further confirmed the precision of tumour dissection. Our method facilitated the accurate detection and complete removal of breast cancer tumours and provided a method for defining the molecular classification of breast cancer during surgery, thereby improving prognoses and survival rates.

Objective To detect the relationship between cyclin D1 expression in breast cancer tissue and axillary lymph node metastasis. Methods We labeled 1 012 breast cancer patients treated in Breast Disease Center, General Hospital of PLA in 2014 and detected the expression level of cyclin D1 in postoperative carcinoma tissues using immunohistochemical method. According to the cyclin D1 level, the patients were divided into 5 groups, namely group 1 ( cyclin D1 negative) , group 2 ( cyclin D1≥1% and<25%) , group 3 ( cyclin D1≥25% and <50%) , group 4 ( cyclin D1≥50% and <75%) and group 5 ( cyclin D1≥75%) . Ninety cases were randomized as subjects in each group and their lymph node status were analyzed. The axillary lymph node metastasis rates between groups were compared by χ2 test. Pairwise comparison was performed by partition of χ2 test. Results The rate of ymph node metastasis was 40. 0%, 43. 3%, 35. 6%, 42. 2% and 66. 7% in groups 1-5 respectively, which showed a significant difference between groups(χ2=21. 503,P<0. 001 ) . The rate of lymph node metastasis in group 5 was significantly higher than that in other 4 groups (χ2=12. 857, 9. 899, 17. 431, 10. 841;all P<0. 004). Conclusion When the level of cyclin D1 in breast cancer tissue surpasses the reference value (75%), cyclin D1 can be regarded as a predictive factor of axillary lymph node metastasis.

Introduction: Precision and personalization treatments are expected to be effective methods for early stage cancer studies. Breast cancer is a major threat to women's health and sentinel lymph node biopsy (SLNB) is an effective method to realize precision and personalized treatment for axillary lymph node (ALN) negative patients. In this study, we developed a surgical navigation system (SNS) based on optical molecular imaging technology for the precise detection of the sentinel lymph node (SLN) in breast cancer patients. This approach helps surgeons in precise positioning during surgery.Methods: The SNS was mainly based on the technology of optical molecular imaging. A novel optical path has been designed in our hardware system and a feature-matching algorithm has been devised to achieve rapid fluorescence and color image registration fusion. Ten in vivo studies of SLN detection in rabbits using indocyanine green (ICG) and blue dye were executed for system evaluation and 8 breast cancer patients accepted the combination method for therapy.Results: The detection rate of the combination method was 100% and an average of 2.6 SLNs was found in all patients. Our results showed that the method of using SNS to detect SLN has the potential to promote its application.Conclusion: The advantage of this system is the real-time tracing of lymph flow in a one-step procedure. The results demonstrated the feasibility of the system for providing accurate location and reliable treatment for surgeons. Our approach delivers valuable information and facilitates more detailed exploration for image-guided surgery research.

目的:探讨吲哚菁绿(indocyanine green,ICG)联合亚甲蓝在乳腺癌前哨淋巴结活检(sentinel lymph node biopsy,SLNB)中的临床应用价值.方法:共入组39例乳腺癌患者,在光学分子影像手术导航系统(surgical navigation system,SNS)的引导下,使用ICG联合亚甲蓝实施SLNB.快速冰冻病理证实前哨淋巴结(sentinel lymph node,SLN)转移者,即刻行腋窝淋巴结清扫(axillary lymphnode dissection,ALND);SLN阴性者免于ALND.结果:联合法实施SLNB检出率95％,成功检出SLN125个,平均检出3.2个SLN,准确率95.0％,灵敏度100％,假阴性率0％;蓝染法检出率87.2％,成功检出SLN71个,平均检出1.8个SLN,准确率89.7％,灵敏度93.7％,假阴性率为6.3％;统计结果采用x2检验,检验结果具有统计学意义.结论:ICG联合亚甲蓝实施乳腺癌SLNB成功率高,假阴性率低,临床效果不亚于亚甲蓝,是实施SLNB的新方法.

Accurate segmentation of breast on MR images is an essential and crucial step for computer-aided breast disease diagnosis and surgical planning. In this paper, an effective approach is proposed for segmenting the breast image into different regions, each corresponding to a different tissue. The segmentation work flow comprises two key steps. Firstly, we use the threshold-based method and morphological operations to determine the breast-air boundary and breast-chest wall so that the breast region can be extracted. Then a kernelled fuzzy C-means algorithm with spatial information (SKFCM) is used to separate the fibroglandular tissues from the fat. The proposed method is used to segment the clinical breast MR images. Experimental results have been shown visually and achieve reasonable consistency. The SKFCM method is appropriate for the problem of breast tissue segmentation.

Currently, it has been an international focus on intraoperative precise positioning and accurate resection of tumor and metastases. The methods such as X-rays, computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) have played an important role in preoperative accurate diagnosis. However, most of them are inapplicable for intraoperative surgery. We have proposed a surgical navigation system based on optical molecular imaging technology for intraoperative detection of tumors and metastasis. This system collects images from two CCD cameras for real-time fluorescent and color imaging. For image processing, the template matching algorithm is used for multispectral image fusion. For the application of tumor detection, the mouse breast cancer cell line 4T1-luc, which shows highly metastasis, was used for tumor model establishment and a model of matrix metalloproteinase (MMP) expressing breast cancer. The tumor-bearing nude mice were given tail vein injection of MMP 750FAST (PerkinElmer, Inc. USA) probe and imaged with both bioluminescence and fluorescence to assess in vivo binding of the probe to the tumor and metastases sites. Hematoxylin and eosin (H&E) staining was performed to confirm the presence of tumor and metastasis. As a result, one tumor can be observed visually in vivo. However liver metastasis has been detected under surgical navigation system and all were confirmed by histology. This approach helps surgeons to find orthotopic tumors and metastasis during intraoperative resection and visualize tumor borders for precise positioning. Further investigation is needed for future application in clinics.

Cancer is a major threat to human health.Diagnosis and treatment using precision medicine is expected to be an effective method for preventing the initiation and progression of cancer.Although anatomical and functional imaging techniques such as radiography, computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) have played an important role for accurate preoperative diagnostics, for the most part these techniques cannot be applied intraoperatively.Optical molecular imaging is a promising technique that provides a high degree of sensitivity and specificity in tumor margin detection.Furthermore, existing clinical applications have proven that optical molecular imaging is a powerful intraoperative tool for guiding surgeons performing precision procedures, thus enabling radical resection and improved survival rates.However, detection depth limitation exists in optical molecular imaging methods and further breakthroughs from optical to multi-modality intraoperative imaging methods are needed to develop more extensive and comprehensive intraoperative applications.Here, we review the current intraoperative optical molecular imaging technologies, focusing on contrast agents and surgical navigation systems, and then discuss the future prospects of multi-modality imaging technology for intraoperative imaging-guided cancer surgery.

Objective To find out the incidence of triple-negative breast cancer(TNBC) in all kinds of breast cancers.To compare and analyze the clinicopathological features,recurrence,metastasis,and prognosis of patients with TNBC and non-triple negative breast cancer (non-TNBC).Methods The clinicopathological features and follow-up data of 387 patients with primary breast cancer histopathologically conffirmed in our hospital from Sep.2004 to Sep.2006 were retrospectively analyzed.The 387 patients were divided into 2 groups:79 cases of TNBC and 308 cases of non-TNBC.The clinical features and prognosis of the 2 groups were compared.Results Compared with non-TNBC group,patients in TNBC group had their special features:1.higher ratio of patients ＜ 35 years( P =0.012 ) ; 2.higher ratio of patients with family history of breast cancer( P =0.031 ) ; 3.higher ratio of tumors with maximum diameter ≥ 5 cm ( P =0.044 ) ; 4. higher ratio of patients with positive lymph nodes(P =0.011 ) ; 5.higher ratio of tumors in clinical stage Ⅲ(P =0.007) ; 6.higher ratio of tumors in histological stage Ⅲ(P =0.028 ).The 5-year-disease-free survival (DFS) and overall survival (OS) rate for patients with TNBC were 72.15％ and 88.61％ respectively,lower than those of non-TNBC ( P =0.003 and 0.031 respectively).Conclusions Compared with non-TNBC patients,patients with TNBC have the features of younger age,more advanced clinical stage upon diagnose,higher rate of lymph node metastasis,larger tumors,higher histological grade,faster and easier recurrence and metastasis,and lower rate of DFS and OS.The information of age,the maximum diameter of the tumor,lymph node status,clinical stage,histological grade and pathological types,especially the age and lymph node status,play an important role in predicting the prognosis of TNBC.

以腔镜为代表的微创技术以微创、美观的独特优势成为现代外科学发展的趋势,其"最小的创伤取得最佳的治疗效果"的微创理念深入人心。腔镜甲状腺外科有着广阔的发展前景,相信将来此技术会得到更加广泛、深入、完善的发展。现将其发展现状及应用进展综述如下。

<正>1临床资料患者,男性,75岁。因"左侧腹股沟区可复性肿物3月,右侧腹股沟区可复性肿物1天"于2011年5月23日入院。患者3个月前发现左腹股沟区一鸡蛋黄大小肿物,未进入阴囊,轻度坠胀感,站立及