Preliminary outcome of breast cancer located at the lower quadrant treated with a thoracomammary flap

Conservative surgical treatment with wide local excision of lower pole breast carcinoma is a major factor of poor cosmetic results. We propose reconstruction of the inferior part of the breast using a fascio-cutaneous flap during excision of lower pole cancers, particularly in cases of women with small-sized breasts. In 2005, 14 patients were selected to undergo conservative breast surgery with fasciocutaneous flap taken from the fatty area found below the thoraco-mammary fold. This area of tissue was de-epedermized and the rotated to fill the breast defect. Patient were followed to determine carcinologic and cosmetic result as one year. All patients had invasive carcinoma. Mean volume of existed tissue was 43 cm3. Margins were adequate for 12 patients and the final 2 patients in the serie had to undergo mastectomy for involved margins. At one year, cosmetic results were graded as good by both the surgeon and the patients. Mammograms were satisfactory except for one case of partial liposclerosis of the flap. Preliminary results showed feasibility and relevance of this new technique for breast cancer located at the lower pole.     

侧胸壁筋膜皮瓣在乳房外侧象限局部缺损修复中的临床应用

目的探讨应用侧胸壁筋膜皮瓣修复乳房外侧象限局部缺损的可行性及美容效果。 方法回顾性分析2016年7月至2018年7月郴州市第一人民医院乳腺甲状腺外科收治的外侧象限乳腺疾病患者46例,其中乳腺癌30例、肉芽肿性乳腺炎10例和交界性叶状肿瘤6例。观察组(26例)采用侧胸壁筋膜皮瓣修复局部缺损,对照组(20例)采用切缘周围脂肪筋膜瓣移位成形修复局部缺损。采用t检验比较2组患者年龄、肿瘤直径、残腔大小、切口长度、手术时间、出血量、引流管留置时间;采用χ²检验比较2组患者肿瘤位置、TNM分期、并发症发生率;采用Kruskal-Wallis秩和检验比较2组患者术后美容效果。 结果2组患者的手术切口长度和引流管留置时间比较,差异有统计学意义(t＝18.143、2.197,P均<0.050)。观察组和对照组术后并发症发生率为15.4%(4/26)和20.0%(4/20),2组比较,差异无统计学意义(χ²＝0.000,P＝0.986)。术后美容效果评价显示观察组优良率为96.2%(25/26),对照组优良率为70.0%(14/20),2组患者优良率比较,差异有统计学意义(χ²＝4.138,P＝0.042)。术后2组患者美容效果评价比较,差异有统计学意义(H＝6.528,P＝0.038)。术后所有患者中位随访24个月(12~36个月),均无局部复发及远处转移。 结论采用侧胸壁筋膜皮瓣修复乳房外侧象限局部缺损是可行的,手术可操作性强、创伤小,切口隐蔽及美容效果好,值得临床推广。     

Diminished survival in patients with inner versus outer quadrant breast cancers.

PURPOSE: To evaluate the role of breast tumor location on survival in patients with breast cancer. PATIENTS AND METHODS: We evaluated tumor location within the breast on breast cancer-specific survival (BCSS) and overall survival (OS) in patients with invasive breast cancer using the Surveillance, Epidemiology, and End-Results (SEER) registries in the United States. Effects on survival were evaluated according to age, stage, tumor site, tumor size, grade, axillary lymph node status, extent of surgery, and radiotherapy (RT). A multivariate model was used with complete data on 45,880 patients. The median follow-up was 59 months. RESULTS: Patients with outer tumor location demonstrated superior BCSS on Kaplan-Meier analysis for both local stage (node-negative, P <.001) and regional stage disease (node-positive, P =.0002). For BCSS, the hazard ratio (HR) for inner quadrant location compared with outer quadrant was 1.31 (95% confidence interval [CI], 1.19 to 1.37; P <.001); and for OS, the HR was 1.12 (95% CI, 1.05 to 1.17; P <.001). When ER and PR status were included in the model, the HR for inner quadrant location compared with outer quadrant was 1.27 for BCSS (95% CI, 1.16 to 1.40; P <.001) and 1.11 for OS (95% CI, 1.03 to 1.19; P =.004). Patients treated by lumpectomy that received RT had a superior OS compared with patients that did not receive RT in both local (HR, 0.52; 95% CI, 0.48 to 0.61; P <.001) and regional (HR, 0.63; 95% CI, 0.56 to 0.72; P <.001) stage disease. Mastectomy patients with local stage disease that received RT had a diminished OS (HR, 1.24; 95% CI, 1.02 to 1.50; P =.033). CONCLUSION: On multivariate analysis, incorporating data on age, stage, tumor site, tumor size, grade, ER and PR status, axillary lymph node status, extent of surgery, and RT, this SEER registry-based study demonstrates that medial tumor location adversely impacts BCSS and OS.     

A myocutaneous flap for closure of upper arm amputations for uncontrolled axillary tumors

Tumor spread or recurrence in the axilla is usually treated with nodal dissections. At times disease recurrence is uncontrolled, causing significant morbidity including pain, bleeding, lymphedema, and neurologic symptoms. Previously, forequarter amputation has been the treatment for this problem, resulting in a significant cosmetic and functional deficit. This report describes a novel myocutaneous flap that can be used to cover soft tissue defects after major disarticulations of the upper extremity. The deltoid myocutaneous flap has been used to successfully treat three patients with uncontrolled tumors in the axilla and preserve the shoulder structures to lessen the functional deficit.     

Poor prognosis of lowr quadrant breast carcinoma

Althoguh some lymphatic plexuses exist in lower audrants of the breast, there have been no investigations of whether or not carcinoma located in this region is a prognostic factor for breast cancer. Of 914 patients with carcinoma of the breast who underwent curative resection following chemo-endocrine therapy between 1982 and 1985, 149 patients had disease of the lower quadrants. The recurrence-free survival rate was lower in patients with the lower quadrants carcinoma than in those with carcinoma of other breast regions. MUltivariate analysis showed that a lower quadrant tumor location was a significant prognostic factor for recurrence, especially soft tissue and visceral recurrence. The worse prognosis of patients with lower quadrant carcinoma of the breast suggests the possible existence of residual or occult tumor cells after surgical resection. © 1996 Wiley-Liss, Inc.     

Computational feasibility of deformable mirror microwave hyperthermia technique for localized breast tumors

Purpose: Computational feasibility of a new non-invasive microwave hyperthermia technique that employs dual deformable mirror is investigated using simplified computational tools and anatomically realistic breast models.

Materials and methods: The proposed technique employs two pairs of electromagnetic sources and continuously deformable mirrors to focus the electromagnetic radiation at the target site for hyperthermia. The mirror functions like a continuum of radiating elements that offer effective scan coverage inside the breast with efficient field focusing at the target location. The electric field focusing and temperature mapping in the two-dimensional numerical simulations are investigated using wave propagation and bio-heat transfer models respectively. The method of moments, a popular numerical simulation tool, is used to model the electric field maintained by the deformable mirrors for continuous wave excitation. The electromagnetic (EM) energy deposited by the mirrors is used in the steady state bio-heat transfer equation to quantify the temperature distribution inside two-dimensional anatomically realistic breast models.

Results: Feasibility of the proposed technique is evaluated using numerical breast models derived from magnetic resonance images of patients with variation in breast density, age and pathology.

Conclusions: The computational study indicates preferential EM energy deposition and temperature elevation inside tumor tissue with minimum collateral damage to the neighboring normal tissues. Simulation results obtained for the magnetic resonance (MR) breast data appear promising and indicate the merit in pursuing the investigation using 3D computational models.     

Computational feasibility of deformable mirror microwave hyperthermia technique for localized breast tumors.

PURPOSE: Computational feasibility of a new non-invasive microwave hyperthermia technique that employs dual deformable mirror is investigated using simplified computational tools and anatomically realistic breast models. MATERIALS AND METHODS: The proposed technique employs two pairs of electromagnetic sources and continuously deformable mirrors to focus the electromagnetic radiation at the target site for hyperthermia. The mirror functions like a continuum of radiating elements that offer effective scan coverage inside the breast with efficient field focusing at the target location. The electric field focusing and temperature mapping in the two-dimensional numerical simulations are investigated using wave propagation and bio-heat transfer models respectively. The method of moments, a popular numerical simulation tool, is used to model the electric field maintained by the deformable mirrors for continuous wave excitation. The electromagnetic (EM) energy deposited by the mirrors is used in the steady state bio-heat transfer equation to quantify the temperature distribution inside two-dimensional anatomically realistic breast models. RESULTS: Feasibility of the proposed technique is evaluated using numerical breast models derived from magnetic resonance images of patients with variation in breast density, age and pathology. CONCLUSIONS: The computational study indicates preferential EM energy deposition and temperature elevation inside tumor tissue with minimum collateral damage to the neighboring normal tissues. Simulation results obtained for the magnetic resonance (MR) breast data appear promising and indicate the merit in pursuing the investigation using 3D computational models.     

上消化道恶性肿瘤化疗的研究进展

本文主要是对近年来上消化道恶性肿瘤（食管癌、胃癌、胰腺癌和肝癌）化学治疗方面的研究进展进行综述。分别评价了有关新辅助化疗、辅助化疗、进展期肿瘤姑息性化疗的治疗方案、疗效及毒副反应，并初步探讨了将来可能的发展方向。     

中央区乳腺癌的保乳治疗

目的 探讨中央区乳腺癌保乳治疗的可行性。方法 对157例肿瘤位于乳房中央区的Ⅰ～Ⅱ期及新辅助化疗后的Ⅲ期原发性乳腺癌患者,行局部扩大切除并腋窝淋巴结清扫手术,其中18例切除乳头乳晕区。手术前,93例接受2～6周期的新辅助化疗。手术后,全部患者的患乳接受放射治疗。结果 接受新辅助化疗的患者,临床有效率为87．1％（81／93）,术后病理学完全缓解率15．1％（14／93）。全部患者成功施行保乳治疗后,经随访6～53个月（中位随访23个月）,仅1例局部复发。保乳治疗后对患侧乳房外观的评价：88例优秀,48例良好,21例一般,总体优良率86．6％。结论 位于中央区的Ⅰ～Ⅱ期原发性乳腺癌患者,同样适合实施保乳治疗,近期疗效满意,远期效果有待长期随访观察。     

Ultrasound-guided fine-needle aspiration biopsy for breast tumors: needle guide versus freehand technique

BACKGROUND: We retrospectively studied whether a needle guide is necessary when performing ultrasound-guided fine-needle aspiration biopsy (US-FNAB) in patients with breast tumors. METHODS: A total of 47 patients (50 lesions) with breast tumors underwent US-FNAB with a needle guide and 127 patients (143 lesions) underwent the procedure without a needle guide (freehand biopsy). The diagnoses obtained by US-FNAB were compared with the surgical findings. RESULTS: The sensitivity of freehand biopsy for tumors < 3 cm in diameter was significantly higher than that of the needle guide technique. CONCLUSIONS: We recommend performing US-FNAB without a needle guide (freehand biopsy) in order to maximize the correct preoperative diagnosis rate, especially in patients with tumors < 3 cm in diameter.     

Role of endoscopic clipping for determining the resection line for tumors located in the middle or upper corpus of the stomach: experience with 100 gastrectomies for early gastric cancer

BACKGROUND: The efficacy and limitations of preoperative endoscopic clipping for determining the resection line in patients with early gastric cancer remain unclear. MATERIALS AND METHODS: Subjects comprised 100 patients with early gastric cancer (33 females, 67 males; mean age, 60.5 years; range, 33-84 years) who underwent pre-operative endoscopic clipping for lesions located in the middle or upper corpus of the stomach. The results of endoscopic clipping for a selection of appropriate surgical procedures were investigated. RESULTS: Distal gastrectomy was performed in 94 patients, the mean length between the lesion and proximal surgical margin of the resected stomach being 28.9 +/- 18.0 mm (mean +/- SD). The surgical margin was eventually free of tumor in all patients. In 5 patients, clips were considered to be placed inadequately, and all 5 tumors were macroscopically depressed or flat and > 40 mm in size. CONCLUSION: Pre-operative endoscopic clipping represents a safe and reliable procedure to determine the resection line for tumors located in the middle or upper corpus of the stomach for treatment of early gastric cancer. During surgical resection, frozen section examination of the proximal cut end is recommended for patients with tumors that are macroscopically depressed or flat and > 40 mm in size, or that display a macroscopically unclear proximal margin.     

背阔肌皮瓣修复在乳腺癌保乳手术中的应用

目的 探讨采用背阔肌皮瓣修复乳腺癌部分乳房切除术后较大范围缺损的治疗和美容效果.方法 24例乳腺癌患者的肿瘤最大径为3.0～5.5 cr,平均3.5 cm.均行保留乳房的病灶广泛切除,所有患者均在术中冰冻切片确定切缘达阴性后,即刻采用背阔肌皮瓣修复局部缺损,术后给予全乳放射治疗±辅助化疗±内分泌治疗.结果 全组24例患者背阔肌皮瓣全部成活,背部及乳房皮肤无坏死.术后中位随访23个月,患者均无病生存.全乳放射治疗对转移的背阔肌皮瓣末见明显影响,乳房外观优良率为79.2%,患者主观评价满意度为96.0%.结论 采用转移的背阔肌皮瓣修复部分乳房切除术后的较大缺损可获得满意的治疗效果和美容效果,对存在导管内癌、新辅助化疗后、乳房中央区(乳头乳晕区)及较大肿瘤(＞3 cm)等保乳手术相对或绝对禁忌的患者可行保乳手术,扩大了保乳手术的适应证.

Abstract：

Objective Breast conserving surgery (BCS) is one of standard treatment approaches in early breast cancer.Although most defect after BCS can be repaired, the cosmetic outcomes are unsatisfactory in the patients with poor tumor/breast ratio.Oncoplastic surgery (OPS) has emerged as a new approach for providing adequate tumor resection without compromise of aesthetic outcomes in BCS.Our purpose is to explore the cosmetic outcomes of applying latissimus dorsi (LD) muscle flap to reshape severe breast conservation deformities in breast cancer.Methods Totally 24 cases of breast cancer were studied.The tumor size was 3.0-5.5 cm ( median 3.5 cm).All the cases underwent BCS and achieved negative margin by frozen sections examination.Then LD flap reshaping were performed.All the patients received whole breast radiotherapy ± chemotherapy ± endocrine therapy.Results All the LD flaps were alive without skin necrosis.After a median 23-month follow-up, all the cases were disease-free surviving.The whole breast radiotherapy had no significant effect on the LD flaps.The rate of good cosmetic results was 79.2%.The subjective satisfactory rate of the patients was 96%.Conclusions Both satisfactory aesthetic outcome and good treatment effect were obtained using LD flap to reshape severe breast conservation deformity.OPS offers tools for breast conservation in patients otherwise destined for mastectomy or poor aesthetic outcome, such as large tumor/breast ratio, nipple-areola complex tumor, ductal carcinoma in situ,neoadjuvant chemotherapy cases and so on.     

乳头乳晕区乳腺癌术后即刻乳房重建的临床探讨

目的 探讨乳头乳晕区乳腺癌术后即刻乳房重建的方法及临床应用。方法 回顾性分析天津医科大学肿瘤医院乳腺一科2004年1月至2007年12月共15例乳头乳晕区乳腺癌患者，其中0期乳腺癌3例，Ⅰ期乳腺癌7例，Ⅱ期乳腺癌5例。15例患者中13例行乳头乳晕区圆形切ISI的保乳手术（标本切缘阴性）后即刻背阔肌皮瓣重建术，2例拟行乳头乳晕区圆形切口的保乳手术，因标本切缘阳性，改行仿根治术，术后行即刻背阔肌皮瓣加假体植入乳房重建术。15例患者中即刻乳头乳晕重建术9例，延期乳头乳晕重建术2例，拒绝乳头乳晕重建4例。结果 13例保乳加背阔肌皮瓣重建患者中12例外形满意，满意率为92．31％，1例缝合后中央区内陷，外形不满意，但大小与健侧对称。2例背阔肌皮瓣联合假体重建乳房外形满意。9例即刻重建乳头乳晕7例成活，2例发生重建乳头部分坏死；3例乳头位置略高于健侧。2例延期乳头乳晕重建均成活，且位置对称。15例中6例发生背部皮下积液，1例背部切口裂开。随访10～48个月，中位随访时间25个月，1例患者出现切口局部复发，复发率为7．69％，无远处转移发生。结论 对乳头乳晕中央区乳腺癌进行保乳手术加即刻背阔肌皮瓣重建术可以提高术后乳房外形满意率，且可行即刻乳头乳晕重建术。保乳手术后局部复发率和远处转移率与根治术无差异。     

Molecular imaging for the characterization of breast tumors

Recently, molecular imaging, using various techniques, has been assessed for breast imaging. Molecular imaging aims to quantify and visualize biological, physiological, and pathological processes at the cellular and molecular levels to further elucidate the development and progression of breast cancer and the response to treatment. Molecular imaging enables the depiction of tumor morphology, as well as the assessment of functional and metabolic processes involved in cancer development at different levels. To date, molecular imaging techniques comprise both nuclear medicine and radiological techniques. This review aims to summarize the current and emerging functional and metabolic techniques for the molecular imaging of breast tumors.     

Surgical treatment for tumors of the upper thoracic aperture]

The data on the surgical treatment of 22 patients with tumors of the upper thoracic aperture at the Center's Clinic in 1986-1998 are presented. Transsternal access was made possible due to general broad approach used. The procedure had been designed and tested on 36 cadavers, particularly, with a view to locate the lymph nodes at the junction of the mediastinum and neck.     

带蒂背阔肌皮瓣在乳房重建手术中的应用

随着乳腺癌治疗模式的发展及患者观念的转变,乳房重建逐渐成为乳腺癌治疗的一部分。背阔肌因面积较大,且蒂部解剖变异较少,同时血供丰富可被改良成不同的皮瓣,因此被认为是良好的供瓣区。在乳房重建中,背阔肌肌皮瓣的应用较广,不仅可以使用全背阔肌或联合假体进行乳房重建,且可以根据不同的缺损范围选择合适的背阔肌皮瓣进行乳房缺损的修补。相比单纯植入物重建,背阔肌皮瓣可获得更为良好的乳房形态且对术后放疗影响较小;相比下腹部皮瓣,背阔肌皮瓣瘢痕较短,术后恢复较快。目前对于术后供区缝合方式的改进及辅助药物的应用,极大地降低了血清肿的发生率;腔镜技术的应用也避免了切取背阔肌皮瓣遗留的供区瘢痕。在临床应用中,背阔肌皮瓣行乳房重建患者满意率高,术后审美效果良好,是乳房重建中一种较为优势的手术方法。该研究总结了背阔肌皮瓣行乳房重建对并发症的控制并对近年来的手术中的问题作进一步探讨。