Volume 30,Issue 11,2021 Table of Contents

1 Hunan expert consensus on diagnosis and treatment of granulomatous lobular mastitis (2021 edition)

2021, 30(11):1257-1273. DOI: 10.7659/j.issn.1005-6947.2021.11.001

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Granulomatous lobular mastitis (GLM) is an unusual chronic breast inflammatory disease in clinical practice, and its incidence has been on the rise in recent years. However, the misdiagnosis rate of this disease is relatively high due to the unclear pathogenesis and limited knowledge of the clinicians. In addition, the non-standard treatment and unsatisfactory treatment effect will cause repeated bouts of this condition, with delayed and difficult healing. So, it is commonly called “the cancer of inflammation”. Therefore, the Hunan Expert consensus on diagnosis and treatment of granulomatous lobular mastitis (2021 edition) was developed by the organization of five academic institutions that included the Breast and Thyroid Health Management Society of Hunan Provincial Health Management Association, Group of Breast and Thyroid Surgery of Society of General Surgery of Hunan Medical Association, Committee for Prevention and Treatment of Breast Diseases of Hunan Preventive Medicine Association, Society of Surgery of Hunan Association of Chinese Medicine and Integrative Medicine, and Hunan Alliance of Breast and Thyroid Surgery in collaboration with the experts in relevant fields, after detailed discussions of the problems concerning the diagnosis and treatment of GLM both online and offline, striving for perfection and reaching a general agreement.

2 Construction of a prognostic nomogram model for newly diagnosed patients with breast cancer liver metastases

SONG Zhangjun , LIU Fende , WANG Huxia , WANG Xingguang , JIE Lu

2021, 30(11):1274-1284. DOI: 10.7659/j.issn.1005-6947.2021.11.002

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Background and Aims The prognosis of patients with breast cancer liver metastasis (BCLM) is poor, and the prognosis is often different due to different factors. There are few studies on the prognosis of BCLM, and still a lack of accurate prediction method for the prognosis of BCLM so far. Therefore, this study was conducted to construct a nomogram to predict the 3- and 5-year overall survival (OS) and cancer specific survival (CSS) of newly diagnosed BCLM patients, so as to provide a reference for clinical use.Methods The data of patients with initial diagnosis of BCLM between 2010 and 2016 were retrieved from the SEER database. Strictly following the inclusion and exclusion criteria, 1 994 patients were selected and randomly divided into model group (n=1 398) and validation group (n=596) at a ratio of 7∶3. The variables with statistical significance in univariate analysis were included in the multivariate Cox regression model, and the independent risk factors affecting the survival of BCLM patients were obtained. A nomogram for predicting OS and CSS was established based on the independent risk factors affecting the prognosis of BCLM patients. The reliability of the nomogram was evaluated by concordance index (C-index) and calibration curve.Results Age, race, marriage, grade, status of hormone receptors, surgery, chemotherapy, bone metastasis, brain metastasis and lung metastasis were independent prognostic factors for patients with BCLM (all P<0.05). Based on these factors, the nomogram was successfully constructed. The C-index of OS in model and validation groups were 0.709 and 0.731, and the C-index of CSS in model and validation groups were 0.709 and 0.732, respectively. Calibration curves also showed an excellent agreement between actual survival and nomogram prediction.Conclusion The established nomogram can accurately predict the prognosis in patients with initial diagnosis of BCLM. It may be helpful for clinicians to make individualized treatment plans.

3 Association of age at diagnosis with clinicopathologic features and prognosis in patients with triple-negative breast cancer

YANG Hongwei , CHEN Maoshan , LI Fangfang , YIN Heng , MOU Dewu , FAN Li , HUANG Yunhui

2021, 30(11):1285-1293. DOI: 10.7659/j.issn.1005-6947.2021.11.003

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Background and Aims Age is closely related to the incidence, biological behavior and prognosis of breast cancer, and is an important reference factor for clinical decision-making. Different ages reflect different physiological states of the patients. Since the absence of hormone receptors in triple-negative breast cancer (TNBC) is sex hormone-independent, whether age affects the treatment decisions and prognosis of these patients remains to be studied. This study was conducted to investigate the relationship between age at diagnosis and clinicopathologic features, treatment strategies, and prognosis of TNBC patients.Methods The data of TNBC patients diagnosed as stage I to III during 2010 to 2016 were extracted from the SEER database. Patients were divided into five groups defined as 18-39 years, 40-49 years, 50-59 years, 60-69 years, and ≥70 years group, according to the age at diagnosis. Comparisons of clinicopathologic features and treatments were performed among different age-groups. Multivariate Cox proportional risk model was used to analyze the relationship between age at diagnosis and breast cancer specific survival (BCSS), and the hazard ratio (HR) with corresponding 95% confidence interval (CI) was calculated.Results A total of 30 576 TNBC patients with a median age of 57 years (IQR: 48-67 years) met the criteria were enrolled in the final analysis. Among them, 3 007 cases (9.83%) aged from 18 to 39 years old, 6 071 cases (19.86%) aged from 40 to 49 years old, 8 097 cases (26.48%) aged from 50 to 59 years old, 7 176 cases (23.47%) aged from 60 to 69 years old and 6 225 cases (20.36%) aged ≥70 years old. The distributions of diagnosis year, race, marital status, TNM stage, pathological type, histological grade, surgical treatment and radiotherapy or chemotherapy had significant difference among groups (all P<0.05). With the increase of age at diagnosis, the T stage and N stage were declined, histological grade was improved, and the rates of mastectomy and chemotherapy were reduced. The median follow-up was 32 months (IQR: 15-54 months), and breast cancer-related death occurred in 3 482 cases (11.39%). The BCSS rate was statistically different among different age groups (P<0.001). The univariate Cox proportional analysis showed that the age at diagnosis, race, marital status, T stage, lymph node stage, TNM stage, pathological type, histological grade, surgical treatment and radiotherapy were significantly associated with BCSS (all P<0.05), but no significant connection was observed between the chemotherapy and BCSS (P=0.284). The multivariate Cox analysis showed that patients with the age of 18-39 years (HR=1.00, 95% CI=0.88-1.13, P=0.990), 40-49 years (HR=0.95, 95% CI=0.85-1.06, P=0.330), and 50-59 years (HR=1.03, 95% CI=0.93-1.14, P=0.597) had a similar BCSS with patients aged 60-69 years, while patients aged ≥70 years had a worse BCSS than those aged 60-69 years (HR=1.56, 95% CI=1.41-1.74, P<0.001). The relationship between age at diagnosis and BCSS was similar in subgroup patients with different years of diagnosis, TNM stages, surgical treatment, radiation status, and chemotherapy status.Conclusion Age at diagnosis is significantly associated with the prognosis of TNBC, elder age (≥70 years old) is an independent poor prognostic factor, and the survival is similar among patients aged from 18 to 69 years old.

4 Application value of radioisotope combined with methylene blue dye in sentinel lymph node biopsy of breast cancer in China: a Meta-analysis

WANG Min , YANG Yong , WANG Yuan , SHI Jian , ZHENG Aiqiu

2021, 30(11):1294-1303. DOI: 10.7659/j.issn.1005-6947.2021.11.004

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Background and Aims Sentinel lymph node biopsy (SLNB) has become a standard treatment method for early breast cancer patients with negative axillary lymph nodes. The success or not of SLNB is closely related to the choice of tracer. Radioisotope and methylene blue are the two most widely used tracers in clinical practice. However, because the application of SLNB in China is lagged behind as compared to other countries, the current investigation showed that only 14.55% hospitals use the double-tracer technique of radioisotope plus methylene blue dye, with 62.73% hospitals still mainly use the single tracer method of methylene blue dye. There are few summary studies on the combined use of tracers. This study was conducted to evaluate the application value of radioisotope plus methylene blue dye method in SLNB of breast cancer in China by Meta-analysis.Methods The publicly published studies comparing using radioisotope plus methylene blue dye and single methylene blue dye method in SLNB performed by Chinese medical institutes were searched in Wangfang Data, CNKI, VIP database, Pubmed and Cochrane Library from the inception to December 2020. The literature was screened strictly according to the inclusion and exclusion criteria, and the data of the included studies were extracted. Meta-analysis was carried out by Revman 5.4 software, and the differences in the detection rate and detection number of sentinel lymph nodes (SLNs), as well as the false negative rate, sensitivity and accuracy rate between the two methods were compared. The publication bias was evaluated by funnel plot.Results A total of 18 studies were finally included, and all of them were domestic studies. Meta-analysis results showed that the identification rate of SLNs (OR=5.81, 95% CI=4.04-8.37, P<0.000 01), sensitivity (OR=3.35, 95% CI=2.17-5.17, P<0.000 01) and accuracy rate (OR=3.45, 95% CI=2.20-5.41, P<0.000 01) were significantly increased and the false negative rate (OR=0.26，95% CI=0.17-0.39, P<0.000 01) was significantly decreased by using method of radioisotope plus methylene blue dye compared with the single methylene blue tracer method. The detection rates of SLNs reported in the 18 articles were used to assess publication bias, and the funnel plot showed that a low possibility of publication bias.Conclusion Radioisotope combined with methylene blue dye method has good application value in SLNB of breast cancer in China. It is expected to be widely used in majority of hospitals in China.

5 Efficacy and safety of pyrotinib combined with TCbH regimen in treatment of young patients with locally advanced HER-2 positive breast cancer at first diagnosis

ZHENG Xiangxin , ZHANG Xuxu , WU Ji , GU Shucheng , JIANG Xiaoling , SHI Xiaohong , YUAN Mu , LU Bolin , QIU Xing , BAI Jianyin , YANG Peng , GUAN Xiaoqing

2021, 30(11):1304-1310. DOI: 10.7659/j.issn.1005-6947.2021.11.005

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Background and Aims Trastuzumab mainly acts on the HER-2-HER-2 homodimer, but exerts little effect on the signaling pathway of ligand-induced HER-2 heterodimers. Pyrotinib can completely block the downstream pathway of the homo- and heterodimers of the HER family. Therefore, based on the different action mechanisms of the two drugs, this study was conducted to investigate the short-term efficacy and safety of the neoadjuvant chemotherapy regimen of pyrotinib combined with TCbH regimen (docetaxel, carboplatin and trastuzumab) in the treatment of young patients with locally advanced HER-2 positive breast cancer at first diagnosis.Methods From October 2018 to January 2020, 32 young patients with first diagnosis of locally advanced HER-2 positive breast cancer admitted in the Affiliated Suqian Hospital of Xuzhou Medical University were selected as study subjects. The patients were randomly divided into two groups, of whom, 16 patients received pyrotinib plus TCbH regimen (observation group), and the other 16 patients received TCbH regimen alone (control group). The treatment efficacy and adverse reactions of the two groups were compared.Results In observation group, 2 patients achieved clinical complete response (cCR) after 4 cycles of treatment and asked for surgical treatment, and the postoperative pathology demonstrated pathologic complete response (pCR); 5 patients achieved cCR after 6 cycles of treatment, then underwent surgical treatment, and the postoperative pathology revealed pCR; the remaining 9 patients showed obvious tumor regression after 6 cycles of treatment, but did not reach cCR, and the pathology showed non-pCR after surgical treatment. The total pCR rate was 43.8% (7/16). In control group, 4 patients achieved cCR after 6 cycles of treatment and received surgical treatment, postoperative pathology showed pCR, the pathological findings of the remaining 12 patients were non-pCR after 6 cycles of treatment, the total pCR rate was 25.0% (4/16). There was a statistical difference in total pCR rates between the two groups (χ²=4.800, P=0.028). The incidence rates of diarrhea and hand foot syndrome in observation group were higher than those in control group (both P<0.05), which were tolerable in all patients after symptomatic treatment; there were no significant differences in incidence rates of other adverse reactions caused by chemotherapy between the two groups (all P>0.05); no cardiotoxicity events occurred in both groups.Conclusions The neoadjuvant therapy of pyrotinib combined with TCbH regimen can significantly improve the pCR rate of locally advanced HER-2 positive breast cancer, with satisfactory curative effect and tolerable adverse reactions. It may be used as another preferred regimen besides TcbHP (docetaxel, carboplatin, trastuzumab and pertuzumab) regimen.

6 Clinical features and diagnosis and treatment of male breast cancer: a report of 35 cases

HE Yushuang , GAO Xinyi , WU Jierong , PAN Chenxi , LI Xuelu , MA Zhenhai

2021, 30(11):1311-1317. DOI: 10.7659/j.issn.1005-6947.2021.11.006

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Background and Aims Male breast cancer is a considerably rare disease, and usually diagnosed at an advanced stage with a dismal prognosis. Currently, its treatment generally follows that for female breast cancer. Here, the authors discuss the clinical characteristics as well as the diagnosis and treatment of this disease through a retrospective analysis of male breast cancer cases.Methods The clinical features, pathological manifestations, treatment and follow-up of 35 male breast cancer patients admitted in the Second Affiliated Hospital of Dalian Medical University from March 2003 to June 2019 were retrospectively analyzed.Results In the entire group of patients, no distant metastasis was found at admission, the median age was 65 years, and the main clinical manifestation was painless breast mass. All patients received surgical treatment. Only two patients (5.7%) had partial mastectomy, and the remaining cases underwent total mastectomy or more extensive surgery. Eighteen patients (51.4%) received adjuvant chemotherapy, 4 patients (11.4%) received adjuvant radiotherapy, and 17 patients (48.6%) received adjuvant endocrine therapy. Thirty cases (85.7%) were pathologically diagnosed as invasive ductal carcinoma. Follow-up was obtained in all patients, and the 5-year overall survival rate was 83.4%.Conclusion Strengthening the knowledge about male breast cancer, so as to achieve early diagnosis and perform comprehensive treatment based on surgery is particularly important. The diagnosis and treatment of this disease still need further improved and standardized.

7 Biological actions of down-regulation of FAT atypical cadherin 4 in triple negative breast cancer cells and the mechanism

PU Lulan , XIE Shaoli , LI Jinsui , SU Xiaohan , TAN Qiao , GAO Yanchun , DENG Shishan , HOU Lingmi

2021, 30(11):1318-1326. DOI: 10.7659/j.issn.1005-6947.2021.11.007

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Background and Aims Triple negative breast cancer (TNBC) is more prone to invasion and metastasis, with a high degree of malignancy. Previous study of the authors’ team found the low expression of Fat atypical cadherin 4 (FAT4) in TNBC tissue and its prognostic relevance. Thus, this study was conducted to further investigate the effects of FAT4 on the biological behavior of TNBC cells and the associated mechanism.Methods The expression levels of FAT4 in normal mammary epithelial cell line (MCF-10A) and different TNBC cell lines (BT-549, MDA-MB-231, MDA-MB-468, and MDA-MB-436) were detected by qRT-PCR and Western blot, respectively. Then, the suitable TNBC cell lines were selected, and were transfected with FAT4-shRNA (FAT4 knockdown group) or scrambled sequences (negative control group), using untransfected TNBC cells as blank control group. In these cells, the changes in proliferation ability, apoptosis rate, and invasion/metastasis ability were determined by CCK-8 assay, flow cytometry and Transwell chamber assay, respectively. Meanwhile, the changes in YAP protein, a downstream target of the Hippo signaling pathway, as well as the epithelial mesenchymal transformation (EMT)-related proteins were also examined by Western blot analysis.Results Compared with normal mammary epithelial cell line, the mRNA and protein expression levels of FAT4 in all the studied TNBC cell lines were decreased with varying degrees (all P<0.05). The BT-549 and MDA-MB-436 cells were selected for functional experiments. In FAT4 knockdown group compared with blank control group of either the BT-549 or MDA-MB-436 cells, the proliferative abilities were significantly increased at 24, 48, and 72 h after transfection, the apoptosis rate was significantly decreased, and the invasion/metastasis ability was significantly enhanced (all P<0.05); the expression level of YAP protein showed no significant change (P>0.05), but the level of phosphorylated YAP (p-YAP) was significantly decreased, and the level of epithelial marker E-cadherin was significantly decreased and mesenchymal marker N-cadherin was significantly increased (all P<0.05); the differences in all above parameters showed no statistical significance between negative control group and blank control group (all P>0.05).Conclusion The expression of FAT4 is generally down-regulated in TNBC cells. The FAT4 down-regulation can enhance the proliferation and invasion/migration abilities and weaken the apoptosis of TNBC cells, and the mechanism may be probably associated the reduced phosphorylation of YAP protein in downstream Hippo signaling pathway after FAT4 down-regulation, and thereby promoting the EMT process.

8 Bioinformatics analysis of potential hub genes in papillary thyroid carcinoma

ZHAO Zhen , XING Yan , ZHANG Fenghua , LIU Yan , JING Shanghua

2021, 30(11):1327-1333. DOI: 10.7659/j.issn.1005-6947.2021.11.008

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Background and Aims Thyroid cancer is the disease with the fastest increase in incidence in recent years. Papillary thyroid carcinoma (PTC) is the most common subtype of thyroid cancer. There is an urgent need to find relevant biomarker molecules of PTC, so as to improve the prognosis diagnosis and provide highly specific therapeutic targets.Methods The microarray data sets (GSE60542, GSE33630 and GSE3467) related to PTC in GEO database were retrieved and analyzed, and the differentially expressed genes between PTC and normal thyroid tissue were screed using the GEO2R tool of the GEO database. The genome-wide enrichment analysis of differential genes was performed, and the interactions of proteins of these differential genes were analyzed by online database tools and visualized by Cytoscape software. The prognostic values of the hub genes for PTC were evaluated by Cbioportal analysis tool and further verified by validation experiments.Results A total of 62 up-regulated and 40 down-regulated differential genes were identified, and 10 hub genes with high connectivity were selected. Among the hub genes, the decrease of KIT was associated with poor prognosis of PTC (P<0.01). The expression of KIT was detected in 52 specimens of PTC tissue and normal adjacent tissue by qRT-PCR. The results showed that the expression of KIT in PTC tissue was significantly lower than that in normal adjacent tissue (P<0.001); the expression of KIT was significantly related to the clinical stage (P=0.008) and lymph node metastasis (P=0.023).Conclusion The expression of KIT in PTC is lower than that in normal tissues. It is probably a key gene for poor prognosis of PTC patients, and is expected to serve as a therapeutic target and molecular biomarker.

9 Identification of prognostic risk genes for thyroid cancer based on public databases

ZENG Jie , YANG Qiuyi , ZHANG Zhipeng , FAN Peizhi , ZHANG Chaojie , LIAO Wen

2021, 30(11):1334-1342. DOI: 10.7659/j.issn.1005-6947.2021.11.009

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Background and Aims The incidence of thyroid cancer is increasing over years. Although its overall prognosis is favorable, some patients still die due to recurrence or metastasis. The purpose of this study was to screen the prognostic risk genes for thyroid carcinoma using bioinformatics approaches based on public databases.Methods The protein-coding gene RNA-seq data of thyroid cancer were downloaded from Cancer RNA-Seq Nexus (CRN) database and the differentially expressed protein-coding genes were screened. Then, enrichment analysis of the differentially expressed protein-coding genes was performed using the DAVID database. Protein-protein interaction networks among the differentially expressed protein-coding genes were constructed and analyzed using STRING and Cytoscape. The hub genes and their functional prediction were screened by the Cytohubba and ClueGO plugins, respectively. The expression level of hub genes was verified in thyroid cancer based on the UALCAN database, and survival analysis of hub genes was conducted in the GEPIA database to analyze whether their expression had an impact on the survival time of thyroid cancer.Results A total of 913 differentially expressed protein-coding genes were obtained after screening. These genes were mainly involved in regulation of small GTPase mediated signal transduction, Z disc, actin binding and drug metabolism-cytochrome P450. After construction of interaction networks, 10 hub genes were screened and they were TP53, ESR1, FOS, SYP, PPARG, ACTB, GRIA1, NRXN1, HDAC3 and KIT, of which TP53 had the highest score of 62. All of them were down-regulated in thyroid cancer tissue. Prediction results revealed that TP53, ESR1 and PPARG were probably involved in negative regulation of gene silencing, and TP53 and FOS were probably involved in the process of pri-miRNA transcription by RNA polymerase II. Results of verification in the UALCAN database showed that all except TP53, all other hub genes were down-regulated in thyroid cancer tissues (all P<0.05), which was consistent with the expression results in the CRN database. Results of survival analysis showed that high expression of KIT was significantly associated with disease-free survival of thyroid cancer patients (P=0.012), but had no significant effect on their overall survival (P=0.85).Conclusion The identified protein-coding gene KIT has a low expression in thyroid cancer tissue, and its high expression is closely associated with the disease-free survival of thyroid cancer, which is speculated to be a prognostic risk marker or therapeutic target for thyroid cancer.

10 Clinical efficacy of pseudomonas aeruginosa injection in treatment of lymphatic leakage after cervical lymph node dissection for papillary thyroid carcinoma

FU Lijun , KONG Yujing , HE Qi , LI Hongting , LI Liwen , QIU Xinguang

2021, 30(11):1343-1349. DOI: 10.7659/j.issn.1005-6947.2021.11.010

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Background and Aims Lymphatic leakage is a common complication after cervical lymph node dissection, for which the effects of traditional treatment methods are relatively limited. Pseudomonas aeruginosa injection for the treatment of wound surface can effectively promote the local inflammatory response and thereby closure of the leakage point. Therefore, this study was performed to effect of pseudomonas aeruginosa injection on drainage volume of patients with papillary thyroid carcinoma (PTC) with lymphatic leakage after cervical lymph node dissection as well as its safety, so as to clarify the application value of pseudomonas aeruginosa injection.Methods The data of 69 PTC patients with lymphatic leakage after cervical lymph node dissection treated in the Thyroid Surgery Department at the First Affiliated Hospital of Zhengzhou University between January 2019 and January 2020 were retrospectively analyzed. According to the treatment method for lymphatic leakage, the patients were divided into control group (37 cases, undergoing conventional bilateral tube placement for negative pressure drainage during surgery) and observation group (32 cases, receiving two pseudomonas aeruginosa injections through a drainage tube on postoperative day (POD) 4 and 6, based on the treatment of control group). The postoperative drainage volume and body temperature changes were compared between the two groups, and the drainage time and the incidence of adverse reactions were also recorded.Results There were no significant differences in the drainage volume between the two groups on POD 1, 2 and 3(all P>0.05), and the drainage volumes on POD 4, 5and 6in observation groupwere significantly lower than those of control group [(310.79±32.16) mL vs. (338.64±34.55) mL, (157.82±16.43) mL vs. (325.43±33.96) mL, (87.34±8.59) mL vs. (333.68±34.59) mL, all P<0.05]. The body temperatures on POD 6and 7 in observation group were significantly higher than those in control group [(37.78±3.77) ℃ vs. (35.96±3.60) ℃, (37.65±3.72) ℃ vs. (35.79±3.68) ℃, both P<0.05], but there was no significant difference in body temperature between the two groups at other time points (all P>0.05). The drainage time in observation group was significantly shorter than that in control group [(6.17±0.63) d vs. (7.28±0.75) d, P<0.01]. Adverse reactions such as local fever and chilling occurred in some cases in observation group within 2 weeks after surgery, and the body temperature returned to normal after physical cooling. The overall incidence of adverse reactions in the observation group was higher than that in the control group (12.50% vs. 8.11%), but the difference did not reach a statistical significance (P>0.05).Conclusion Pseudomonas aeruginosa injection is effective in the treatment of PTC patients with lymphatic leakage after cervical lymph node dissection. It can reduce the drainage volume and shorten the drainage time. Some patients may have increased body temperature and fever, which can be relieved after symptomatic treatment, and will not affect the treatment.

11 Experience in premedication and surgical treatment of patients with thyroid mass and hyperthyroidism

WANG Chaoyu , YUAN Ping , YU Zhaoyan

2021, 30(11):1350-1358. DOI: 10.7659/j.issn.1005-6947.2021.11.011

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Background and Aims Thyroid mass complicated with hyperthyroidism (TMCWH) is a difficult situation in thyroid surgery. The traditional concept is that patients with primary hyperthyroidism undergoing surgery generally require the use of Lugol's solution for preoperative preparation. However, with the advancement of thyroid surgical techniques and the change of operation methods, this concept has also been questioned and challenged. Therefore, this study was conducted to investigate the clinical effect and safety of performing surgery in TMCWH patients without addition of Lugol's solution in preoperative preparation.Methods The clinical data of 51 consecutive patients with TMCWH admitted from January 2018 to January 2021 were retrospectively analyzed. The general clinical data of the patients, types and doses of anti-thyroid drugs, changes in thyroid function and operation methods as well as the incidence of postoperative complications were summarized.Results There were 36 females and 15 males in the whole group, aged from 30 to 77 years old, with a disease course of 6 months to 22 years and varying degrees of thyrotoxicosis. Forty-nine patients received the combination treatment of methimazole and propranolol for preoperative preparation, of whom, 13 patients were treated with prednisone at the same time; the other two patients only used propranolol and prednisone for preoperative preparation. Two patients underwent thyroid artery embolization before operation. The preoperative preparation time of the whole group was 5-10 d; the preoperative thyroid function of 32 patients did not fully return to normal, but the basal metabolic rate (BMR) of all patients decreased significantly, and maintained at 9% to 15%, and the heart rate was 71 to 85 bpm. Total thyroidectomy was performed in 40 cases, 6 cases underwent unilateral lobectomy plus subtotal or subtotal resection of contralateral lobes, and 5 cases were subjected to unilateral lobectomy. All patients recovered uneventfully after the operation, and no thyroid crisis occurred. In postoperative outpatient follow-up, no hyperthyroidism or tumor recurrence occurred.Conclusion Surgery can be performed in TMCWH patients with T3/FT3 and/or T4/FT4 controlled within 10% of the upper limit, and BMR controlled below 20% after using conventional drugs for preoperative preparation. For TMCWH patients with significantly elevated thyroid-stimulating hormone receptor antibodies, total thyroidectomy or near total resection can be helpful for completely curing the disease.

12 Diagnostic values of spectral CT and its combination with thyroglobulin detection for benign or malignant thyroid nodules

SHI Can , PENG Song , LIANG Qi

2021, 30(11):1359-1366. DOI: 10.7659/j.issn.1005-6947.2021.11.012

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Background and Aims Thyroid nodules are common clinical entities. Among them, malignant nodules have a higher risk of metastasis. Correct definition of the nature of thyroid nodules is of great significance for developing treatment plans and improving prognosis. However, all currently available inspection methods have their limitations. Therefore, this study was performed to investigate the efficiency of spectral CT and its combination with multiple other factors in differential diagnosis of thyroid nodules.Methods The data of patients with thyroid nodules admitted from August 2018 to March 2021 were reviewed, and the eligible cases were selected according to the inclusion and exclusion criteria. The demography factors, imaging findings, spectral data and thyroid function test results of between patients with benign or malignant thyroid nodules were analyzed, and the variables with significant difference were screened out. The receiver operating characteristic (ROC) curve was draw, and the diagnostic efficiency was evaluated by the value of the area under curve (AUC).Results A total of 151 patients were enrolled, of whom 46 were males and 105 were females with a total of 224 nodules that included 61 benign nodules and 163 malignant nodules. The variables showing significant difference between patients with benign or malignant thyroid nodules were age (P<0.001), thyroglobulin (Tg) (P<0.001), thyroid peroxidase antibody (P=0.003) and calcitonin (P=0.017); the variables with significant difference in terms of morphological features and spectral parameters between benign and malignant thyroid nodules included the boundary (P<0.001), calcification (P=0.03), cystic degeneration (P<0.001), and rate of change of water concentration (RC_WC) (P=0.002). The results of multivariate analysis revealed that absent of cystic degeneration, RC_WC, Tg and age were risk factors for malignant nodules (all P<0.05). The sensitivity, specificity, accuracy and AUC for spectral CT alone (spectral parameters plus imaging characteristics) were 55.7%, 94.4%, 91.0% and 0.783, for spectral CT combined with Tg detection were 81.0%, 80.9%, 80.9% and 0.850, and for spectral CT combined with Tg and age were 85.7%, 84.6%, 84.7% and 0.905, respectively.Conclusion Spectral CT has certain value in differential diagnosis of benign and malignant thyroid nodules. The RC_WCandimaging characteristics obtained from spectral CT combined with Tg detection, with consideration of age of the patients, may offers a higher accuracy for definition of the nature of thyroid nodules.

13 Progress in intraoperative detection of sentinel lymph node metastasis in breast cancer: one-step nucleic acid amplification technique

ZHANG Lu , BAI Junwen

2021, 30(11):1367-1373. DOI: 10.7659/j.issn.1005-6947.2021.11.013

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Breast cancer has become one of the most common malignant tumors among women, and axillary lymph node (ALN) metastasis is the most important mode of breast cancer metastasis, which is the most important indicator to estimate the prognosis and guide the decision of postoperative adjuvant treatment. Axillary lymph node dissection (ALND) is the most accurate way to evaluate ALN status, and meanwhile is the main cause of complications such as upper extremity lymphedema, pain, and sensory impairment. With the increased detection of early-stage breast cancer, ALN negative breast cancer has accounted for more than half of all breast cancer patients, if ALND is performed in all breast cancer patients, only a small number of patients will benefit from it, and the majority of patients are overtreated. Sentinel lymph nodes (SLNs) are the first barrier of lymph node metastasis in patients with breast cancer. After decades of development, sentinel lymph node biopsy (SLNB) has become a standard procedure for ALN staging in breast cancer patients and is often used to determine the choice of treatment. Accurate and rapid intraoperative diagnosis of SLN enables SLN-negative breast cancer patients to avoid ALND, and SLN-positive patients to complete ALND through a single operation to avoid the cost burden and surgical risk of a second operation. Frozen section and touch imprint cytology examinations are commonly used to detect intraoperative metastatic SLN. These two routine pathological tests only detect representative sections of SLN. Both of them have shortcomings such as low sensitivity, subjectivity, non-standardization, small amount of detected tissue (far less than 5%), and no unified diagnostic criteria. Therefore, a new detection method with accurate results and simple operation is urgently needed in clinical practice. In recent years, molecular diagnostic techniques have developed rapidly. One-step nucleic acid amplification (OSNA) is a molecular diagnostic method for accurate detection of intraoperative lymph node metastasis of breast cancer through reverse transcriptional loop mediated isothermal amplification of targeted cytokeratin 19 mRNA. The operation time of OSNA detection is about 30 to 40 min. In SLN detection and analysis, the accuracy and sensitivity of OSNA are better than those of the conventional pathological detection methods. Rapid intraoperative quantification can distinguish the macrometastases from micrometastases and guide surgical protocols. In addition, OSNA is superior in detecting SLN micrometastases. Here, the authors address the progress and application prospect of OSNA detection in SLN metastasis of breast cancer.

14 Progress of prediction models for complications of breast reconstruction following breast cancer surgery

LUO Ge , LIU Huayun , WEI Di , CHEN Yongyi

2021, 30(11):1374-1381. DOI: 10.7659/j.issn.1005-6947.2021.11.014

[Abstract](1135) [HTML](1221) [PDF 639.95 K](1415)

Abstract:
Breast cancer is the most commonly diagnosed cancer among Chinese women with a continuously increasing incidence. For improving the quality of life of patients undergoing mastectomy, breast reconstruction has become an essential component of breast cancer surgery. The prevention and control of breast reconstruction complications is crucial to ensure a smooth subsequent treatment and the success of reconstruction. A complication risk prediction model can quantify the risk of complications in individual patients undergoing different breast reconstruction procedures, and assist surgeons optimizing surgical plan selection and perioperative intervention strategies, thereby improving patients' outcomes. Here, the authors review different models for predicting the risk of breast reconstruction complications after mastectomy in terms such as model development, predictive performance and model validation, so as to provide a reference for the assessment and management of the risk of breast reconstruction complications post mastectomy in breast cancer patients.

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Volume 30,Issue 11,2021 Table of Contents

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