Abstract:With the flourishing development of omics technologies in recent years, the widespread application of genomics, transcriptomics, metabolomics, modification-specific proteomics, single-cell transcriptomics, spatial transcriptomics, and other omics approaches has deepened the multidimensional analysis of triple-negative breast cancer (TNBC) heterogeneity. The in-depth exploration in basic research has made it possible to target some key signaling pathways for precision therapy. Recent clinical studies have discovered promising therapeutic approaches, offering therapeutic opportunities for both early and late-stage TNBC patients by targeting tumor-intrinsic mechanisms and microenvironmental characteristics. Based on the intrinsic features of TNBC and the current treatment landscape, the authors of this article discuss the progress of precision therapy from the perspectives of internal heterogeneity and treatment modalities in TNBC.

Abstract:The robotic surgery system was first applied to thyroid surgery in 2007, which integrates the advantages of endoscopic and traditional open surgery, and further promotes the development of minimally invasive thyroid surgery. In 2014, our institution pioneered robotic thyroid surgery in China, successfully performing surgeries for over 3 200 patients. As of July this year, a total of 11 931 robotic thyroid surgeries have been completed nationwide. Its cosmetic results are significantly superior to traditional open surgery, and the safety data for commonly used approaches and oncological safety data have been continually updated with the improvement in both quantity and quality of operations. This has provided valuable experiential guidance for the implementation of robotic thyroid surgery in China. The development and clinical application of new technologies have also similarly promoted the research and practice of domestic robots. In the future, more locally produced robots will be put into clinical use, leading to a further reduction in surgical costs and facilitating their widespread adoption in clinical practice, similar to the popularity of endoscopic techniques. Here, the authors provide a overview of the relevant information in respect of its development and current status in China, so as to aid a better understanding for fellow professionals.

Abstract:Breast cancer is the most common malignant tumor among Chinese women. Young breast cancer patients are not uncommon and have unique medical needs. With the progress of clinical research both domestically and internationally, and the release of international consensus and guidelines, the diagnosis and treatment of young breast cancer patients have gradually garnered widespread attention in the academic community. In 2022, to standardize and optimize the diagnosis and treatment of young breast cancer in China, the Expert Committee on Diagnosis and Treatment of Young Breast Cancer in China released the "Expert consensus on diagnosis and treatment of young breast cancer in China (2022 Edition)". Herein, the authors provide an interpretation of the key points within this consensus to better convey the information to readers.

Abstract:In the past decade, there has been a rapid development of robotic thyroid surgery in China. The safety, the oncological radical nature, and the cosmetic outcomes of transaxillary approach surgery are continuously validated, and the rate of its implementation is rapidly increasing. Here, we summarize and share insights on tansaxillary robotic-assisted endoscopic thyroid surgery performed in our center, covering aspects such as approach selection, indications and contraindications, instrument improvement, incision selection, space creation, intraoperative skills, and complications. The aim is to offer reference and assistance for the development of this surgical procedure.

Abstract:Since the first endoscopic thyroidectomy by a gasless unilateral axillary approach (GUA-ET) conducted in South Korea in 2003, it has now been 20 years. This is a cosmetic and minimally invasive surgical procedure for thyroidectomy. Due to the incision hidden in the axillary skin lines, there is no need to cut the skin, platysma muscle, and neck white line, ensuring the integrity of the neck skin, platysma muscle, sternothyroid muscle, and neck midline. This avoids complications such as neck scars and swallowing dysfunction, thus achieving cosmetic effects. Additionally, the surgical space is established in the natural fascial gap between the skin under the clavicle and the clavicular part of the pectoralis major muscle, and between the clavicular part of the sternocleidomastoid muscle and the sternum, without cutting normal tissue structures such as muscles. Although it appears to be a remote surgery, it actually achieves the goal of minimally invasive surgery. However, due to remote operation, the leverage effect of surgical instruments in the clavicular head region, the internal suction device outside the retractor, and other factors lead to a reduction in the vertical space of the surgery. This results in less-than-ideal suspension of the thyroid, causing unclear exposure of the recurrent laryngeal nerve, and incomplete clearance of lymph nodes in the central region posterior to the thymus or VIB region. At the same time, structures such as the tributaries of the external jugular vein, supraclavicular nerve, carotid vascular sheath, and middle thyroid vein are necessary pathways for establishing space, making it prone to complications such as bleeding and nerve damage. Moreover, contralateral procedures and the close fusion of certain portions of the sternocleidomastoid muscle with the sternal tendon increase the surgical complexity. Therefore, based on the above factors, the surgical quality control and safety of this procedure have been questioned by some peers. Nevertheless, since Professor Zheng Chuanming introduced this technique to China in 2017, this procedure has been widely adopted by many domestic medical institutions within just 7 years. It has received high recognition from many physicians engaged in thyroid surgery, and in 2022, the first domestic expert consensus in this field was released, making the promotion of this procedure more standardized and feasible. It is evident that as the technique matures, the advantages of this procedure gradually become apparent. It avoids the complications such as the keloid scar in the neck and neck joint movement after traditional neck incision, and numbness around the lips after oral procedures. Compared to the most mature thoracic/breast approach in our country, the unilateral VI region lymph node dissection as well as exposure and protection of the recurrent laryngeal nerve become easier. Without a doubt, strict control of surgical indications, adherence to the principles of "cure the disease first, protect function second, and consider cosmetic appearance third" in tumor treatment, and effective control of surgical quality and safety management are necessary for the scientific and standardized promotion of this procedure. It may even lead to continuous expansion of the indications for this procedure in thyroid surgery. This article, combining literature reports and the experience in equipment improvement and detail management of the authors' team, elaborates on the quality control and safety management of this procedure.

Abstract:Background and Aims Due to the 3D visualization and flexible intra-articular elements of robotic surgical devices, the application of robotic surgical systems in thyroid surgery has expanded the scope of laparoscopic surgery. This study was designed to provide a summary and analysis of patients with thyroid cancer (TC) undergoing robot-assisted radical thyroidectomy with super-meticulous capsular dissection (SMCD) technique in the authors' hospital, to evaluate the efficacy and safety of implementing the SMCD technique with robotic assistance.Methods The clinical data of 1 045 TC patients who underwent robotic-assisted radical thyroidectomy with SMCD technique in the First Affiliated Hospital of the Army Military Medical University from June 2018 to May 2022 were retrospectively analyzed.Results All 1 045 patients successfully underwent robotic surgery. Among them, 214 cases (20.5%) underwent unilateral lobectomy with unilateral central lymph node dissection, 342 cases (32.7%) underwent total thyroidectomy with unilateral central lymph node dissection, 317 cases (30.3%) underwent total thyroidectomy with bilateral central lymph node dissection, 157 cases (15.0%) underwent unilateral lateral neck dissection and 15 cases (1.4%) underwent bilateral lateral neck dissection. Except for 172 cases (16.5%) who underwent lateral neck dissection via the bilateral axillo-breast approach (BABA), the remaining 873 cases (83.5%) were completed via the unilateral axilla-bilateral areola approach (UABA), with an average operative time of (151.74±59.62) min. Parathyroid transplantation was performed in 38 cases (3.6%), and 336 cases (32.2%) underwent postoperative ¹³¹I treatment. After operation, temporary hypoparathyroidism occurred in 245 cases (23.4%), and permanent hypoparathyroidism occurred in 7 cases (0.7%); temporary hoarseness occurred in 4 cases (0.4%); local recurrence occurred in 3 cases (0.3%). Both univariate and multivariate analyses showed that the extent of surgery was a factor for the occurrence of temporary hypoparathyroidism (HR=1.51, 95% CI=0.90-2.49, P<0.001; HR=1.20, 95% CI=1.00-1.43, P=0.049).Conclusion Robotic surgery for TC is safe and thorough, and the UABA approach is capable of performing robotic total thyroidectomy plus central compartment clearance, while the BABA approach is a more suitable choice for lateral lymph node dissection. The application of SMCD with robotic assistance helps preserve parathyroid function and reduces the occurrence of permanent hypoparathyroidism.

Abstract:Background and Aims The application of robotic systems in thyroid surgery has gradually expanded, but there is limited large-sample reports on bilateral axillo-breast approach (BABA) thyroidectomy using the 4th-generation da Vinci surgical robot both locally and abroad. Therefore, this study was performed to summarize the treatment outcomes and experiences of BABA thyroidectomy cases completed at the authors' center using the 4th-generation da Vinci surgical robot, so as to provide reference information for clinical practice.Methods The clinical data of 649 patients undergoing the 4th-generation da Vinci robot-assisted BABA thyroidectomy at the Department of Thyroid Surgery of China-Japan Union Hospital of Jilin University from April 2020 to August 2023 were retrospectively collected. Relevant clinical variables were summarized and analyzed.Results Of the 649 patients, 79 were males and 570 were females, with an age range of 13 to 64 years and an average age of (35.1±9.2) years. There were 464 cases of unilateral malignancy, 107 cases of bilateral malignancy, 64 cases of unilateral benign tumors, and 14 cases of bilateral benign tumors. All surgeries were successfully completed without conversion to open surgery, with a median operative time of 130 (110-150) min. In 571 cases of malignant lesions, the total number of central lymph nodes (CLNs) dissected was 2 628, with an average of number of 4.60±3.59; the total number of positive CLNs was 489 (18.6%), with an average of number of 0.86±1.65. On the third postoperative day, the proportions of painless and mild, moderate, and severe pain were 52.2%, 30.5%, 17.3%, and 0, respectively. The median postoperative hospital stay was 3 (3-3) d, and the median hospitalization cost was 50 500 (48 100-56 700) yuan. During operation, EMG signal degradation of the recurrent laryngeal nerve (RLN) occurred in 71 cases. After operation, temporary RLN injury occurred in 17 cases; temporary coughing during drinking occurred in 4 cases, and temporary reduction of vocal range occurred in 10 cases; temporary hypocalcemia occurred in 145 cases. During a median follow-up of 6 months, the overall satisfaction rate was 94.6%, with no permanent complications. Learning curve analysis showed a significant decrease in the curve at the 26th case, followed by stabilization, and similar learning curves were observed between different surgical procedures.Conclusion The 4th-generation da Vinci robot-assisted BABA thyroidectomy is safe, effective, and offers good minimally invasive cosmetic results. Adherence to a learning curve is necessary during the application process, and the mastery of the robotic surgical operating system is a key factor influencing the surgical process.

Abstract:Background and Aims Currently, there is limited literature on the use of indocyanine green (ICG) fluorescence imaging technique for identification and protection of the parathyroid glands in robotic thyroid surgery, and further research is needed to explore its clinical utility. This study was performed to explore the safety and effectiveness of employing ICG fluorescence imaging technique during transoral robotic thyroidectomy vestibular approach (TORTVA) by comparing cases with and without its use.Methods Data of patients who underwent TORTVA between December 2018 and November 2021 were retrospectively collected. After screening, 80 patients were included. Among them, 45 patients underwent surgery with the use of ICG fluorescence imaging technique (ICG group), while 35 patients did not use this technique (control group). Propensity score matching (PSM) was performed using a 1∶1 nearest-neighbor matching method to eliminate confounding bias between the two groups. Then, the intraoperative and postoperative parameters were compared between the two groups of patients.Results After PSM, 24 patients were included in each group, with balanced baseline characteristics. There was no statistically significant difference in intraoperative blood loss between the ICG group and the control group (P=0.910). However, the ICG group demonstrated a significantly shorter average operative time compared to the control group (223 min vs. 251 min, P=0.032). There were no statistically significant differences in the number of lymph nodes dissected, positive lymph nodes, and lymph node positivity rate between the two groups (all P>0.05). Total hospital stay and postoperative hospital stay showed no statistically significant differences between the two groups (both P>0.05). There were no significant differences in postoperative parathyroid hormone and serum calcium levels between the two groups (all P>0.05). The incidence of complications was 12.5% in the ICG group and 25.0% in the control group, with no statistically significant difference (P=0.461). Both groups had no patients undergoing intraoperative autotransplantation of the parathyroid glands, and there were no occurrences of permanent recurrent laryngeal nerve injury or hypoparathyroidism in the either group.Conclusion The use of ICG fluorescence imaging technology during TORTVA does not increase the risk of postoperative complications, demonstrating reliable safety. Additionally, it provides clearer visualization of the parathyroid glands, significantly reducing operative time and exhibiting certain effectiveness.

Abstract:Background and Aims After clinical exploration, our team has introduced improvements and innovations to the traditional trans-subclavian approach endoscopic thyroidectomy, focusing on surgical incision localization, surgical pathway, and surgical instruments. This article was written to serve as a reference for colleagues.Methods Utilizing surgical video footage, data of one case of gasless endoscopic right thyroid lobectomy with right central lymph node dissection by trans-subclavian approach performed by our team was presented, along with review of relevant literature and discussion.Results The operation was successfully completed under endoscopy, with a total operative time of 65 min and an estimated blood loss of about 5 mL. Postoperative recovery was satisfactory, and the patient was discharged with tube removal on the 2nd postoperative day. The total drainage volume was 100 mL, and the postoperative hospital stay was 2 d.Conclusion The modified gasless trans-subclavian approach endoscopic thyroidectomy for treating papillary thyroid carcinoma is safe and feasible, with thorough central neck dissection, excellent incision concealment, and low operative difficulty. So, it has clinical application value.

Abstract:Background and Aims Currently, the gasless unilateral axillary approach endoscopic thyroidectomy (GUA-ET) is gradually gaining widespread adoption. However, the creation of the working space has consistently been a challenge in this operation due to the potential risk of damaging crucial blood vessels and nerves during subcutaneous dissection. Our center recently discovered a fat pad located in the supraclavicular fossa (referred to as freedom fat by the authors, abbreviated as F fat) that can be used for tracing the external jugular vein and its tributaries, supraclavicular nerves, and subcutaneous nerve branches during GUA-ET surgery. This study was conducted to determine the clinical application value of using F fat as a guide marker in GUA-ET surgery.Methods The clinical data of 177 patients with papillary thyroid carcinoma who underwent GUA-ET surgery in the Second Ward of the Department of Breast and Thyroid Surgery of Hunan Provincial People's Hospital from May 2022 to December 2022 were retrospectively analyzed. Among them, the F fat was used as a guide marker during surgery in 93 cases (observation group), and was not used during surgery in 84 cases (control group). A comparison was made between the two groups in terms of time for creation of the initial working space, number of cases of bleeding during space creation, rates of conversion to open surgery, and the incidence of complications such as skin burns.Results There were no statistically significant differences in sex and age between the two groups (both P>0.05). The time for the creation of the initial working space in the observation group was significantly shorter than that in the control group [(12.84±2.218) min vs. (30.49±5.871) min, P<0.05]. During the creation of the working space, there were 4 cases of bleeding in the observation group (4.3%) and 6 cases in the control group (7.1%), with no statistically significant difference (P>0.05). No conversion to open surgery required due to intraoperative bleeding and no complications such as skin burns occurred in the observation group, while there were 1 case each of open conversion due to intraoperative bleeding and skin burns in the control group, but the differences were not statistically significant (both P>0.05).Conclusion Using F fat as a landmark to guide GUA-ET surgery can avoid the need of dissection and exposure for protecting structures such as the external jugular vein and its tributaries. This effectively shortens the time for the creation of the initial working space and may also reduce the occurrence of complications. So, it is recommended to be commonly used in clinical practice.

Abstract:Background and Aims Carbon nanoparticles suspension injection (hereinafter referred to as carbon nanoparticles), as a lymph node tracer, has been widely used in thyroid surgery to quickly identify parathyroid glands and avoid inadvertent surgical damage. However, the specific usage methods and standardized technical procedures for carbon nanoparticles in surgery for thyroid papillary carcinoma (PTC) are not yet unified. Therefore, this study was conducted to gather the skills, knowledge, and experiences of domestic surgeons regarding the use of carbon nanoparticles in surgery for PTC through a questionnaire survey, so as to provide a basis for the standardized clinical use of carbon nanoparticles.Methods On the basis of literature review, a questionnaire survey titled Methods of utilizing carbon nanoparticles in thyroid papillary carcinoma was designed and distributed to senior and high-volume surgeons engaged in thyroid surgery. After the questionnaires were collected, a synthetic analysis was conducted.Results A total of 107 questionnaires were distributed in this survey, and 105 valid responses were received from 78 tertiary grade A hospitals in 26 provinces. Among the experts surveyed, 91 (86.7%) reported using carbon nanoparticles at a quantity ranging from 100 to 1 000 vials annually. There was a high degree of consensus among the experts, with 53 (50.5%) considering the thyroid gland showing a map-like, mottled, and evenly stained appearance as the best result after injection of carbon nanoparticles. In lobectomy and total thyroidectomy, over 90% of experts believed that intraoperative injection of carbon nanoparticles was the optimal timing. More than 50% of experts suggested an optimal injection dose of 0.05 to 0.1 mL per injection point, with a waiting time of 1 to 5 min after injection, believed that only one injection point was needed for lobectomy, while two injection points were deemed sufficient for total thyroidectomy, and found that the time for negative imaging of the parathyroid glands and central lymph node staining was 1 to 5 min after injection. Over 70% of experts recommended the intraoperative direct visualization injection of carbon nanoparticles in lateral neck lymph node dissection, endoscopic, and robotic thyroid surgeries. The summary of techniques to avoid intraoperative leakage of the tracer included appropriate dilution, fine needle insertion, intact capsule, minimal injection volume, depth control, negative pressure needle extraction, routine compression, sealing the needle track, and maintaining a clean surgical field.Conclusion This study, for the first time, provides an initial understanding of the usage of carbon nanoparticles among surgeons through a questionnaire survey. It offers an experiential summary and generalization of the technical methods employed with carbon nanoparticles. The survey results demonstrate good representativeness, serving as a guiding foundation for future research on the rational and correct use of nano-carbon in in clinical settings.

Abstract:Background and Aims Secondary hyperparathyroidism (SHPT) is a common complication of chronic kidney disease (CKD), characterized by imbalances in calcium and phosphorus homeostasis leading to compensatory overproduction of parathyroid hormone (PTH). Patients with poor response to medical treatment progress to refractory SHPT, and surgical removal of hypertrophic parathyroid glands is currently an effective method. However, surgical treatment has limitations, including high risks associated with surgery and anesthesia, as well as potential postoperative complications such as infection, permanent parathyroid dysfunction, and scar formation. With advancements in medical technology, thermal ablation has become a research focus for SHPT treatment, but standardized diagnostic and therapeutic protocols are lacking, necessitating more evidence from evidence-based medicine to facilitate the development of standardized guidelines. Therefore, this study was conducted to compare the clinical effectiveness and safety of ultrasound-guided thermal ablation with traditional parathyroidectomy (PTX) in the treatment of refractory SHPT and explore the clinical prospects of thermal ablation in the management of refractory SHPT.Methods Multiple domestic and international databases were searched to collect clinical controlled studies comparing ultrasound-guided thermal ablation with traditional open PTX in the treatment of refractory SHPT of CKD. The search period extended from the inception of each database to November 31, 2022. After applying inclusion and exclusion criteria, literature screening was conducted, and Meta-analysis was performed using RevMan 5.3 software. Evaluation indicators included serum PTH and calcium levels at 3 and 6 months postoperatively, hospitalization duration, and the incidence of hypocalcemia and hoarseness.Results A total of 12 studies involving 1 060 patients were included, with 510 in the thermal ablation group and 550 in the PTX group. Compared to the PTX group, the thermal ablation group showed no statistically significant differences in postoperative 3- and 6-month PTH levels (MD=18.18, 95% CI=-21.19-57.55, P=0.37; MD=-5.35, 95% CI=-32.59-21.90, P=0.70) and calcium levels (MD=-0.09, 95% CI=-0.28-0.10, P=0.35; MD=-0.10, 95% CI=-0.29-0.10, P=0.34). The incidence of hypocalcemia in the thermal ablation group was lower than that in the PTX group (18.5% vs. 27.3%), with a statistical difference (OR=0.57, 95% CI=0.38-0.84, P=0.005), while the incidence of hoarseness showed no significant difference between the two groups (OR=0.89, 95% CI=0.55-1.45, P=0.64). The thermal ablation group had a significantly shorter hospitalization duration than the PTX group (MD=-3.97, 95% CI=-5.68--2.27, P<0.000 1).Conclusion Ultrasound-guided percutaneous thermal ablation for SHPT may be a potential alternative to PTX, demonstrating safety, effectiveness, high repeatability, and fewer complications. However, its ultimate superiority requires confirmation through large-sample, multicenter, prospective, randomized controlled studies.

Abstract:Background and Aims Breast cancer has a high incidence rate, and surgery remains the primary treatment. Breast-conserving surgery (BCS) is a common approach for early-stage breast cancer, but the breast conservation rate is low in China, and noticeable scars often result from traditional open BCS. Currently, endoscopic minimally invasive techniques, known for their postoperative cosmetic effects and high patient satisfaction, have been applied in breast surgery for BCS. However, due to the challenges in surgical procedures and intraoperative localization, their adoption is limited in China, and research data are scarce. This study was performed to compare the short-term efficacy of endoscopic BCS with open BCS in the treatment of early breast cancer and explore the clinical application value of endoscopic BCS.Methods The clinical data of patients with unilateral breast cancer (stage 0-Ⅱ) who underwent BCS in the Department of Breast and Thyroid Surgery of the First Affiliated Hospital of the Army Medical University from January 2019 to December 2022 were retrospectively collected. Among them, 79 patients underwent endoscopic BCS (endoscopic group), and 602 patients underwent traditional open BCS (open group). After 1∶1 propensity score matching (PSM) of baseline data, the relevant clinical variables were compared between the two groups.Results Before PSM, there were significant differences in baseline data between the two groups (some P<0.05). After PSM, with balanced baseline data, there were 79 patients in each group, and the baseline data were comparable between the groups (all P>0.05). Compared with the open group, the endoscopic group had a longer operative time (Z=-5.415, P<0.001) and increased hospitalization costs (Z=-6.042, P<0.001). There were no statistically significant differences between the groups in intraoperative blood loss, number of lymph nodes removed, drainage volume, and hospitalization time (all P>0.05). Regarding postoperative complications within 30 d, there were no significant differences in incidence rates of intraoperative associated injuries, bleeding, infection, flap necrosis, or subcutaneous fluid accumulation between the two groups (all P>0.05). However, the overall incidence rate of complications was lower in the endoscopic group than that in the open group (P=0.043). Breast-Q scale scores showed that patients in the endoscopic group were more satisfied with postoperative breast shape and had better physical health and sexual health compared to those in the open group (all P<0.05).Conclusion The application of endoscopic technology in early breast cancer BCS is associated with fewer postoperative complications, higher patients' satisfaction, and improvement in postoperative patients' quality of life. It is a feasible surgical approach.

Abstract:Background and Aims In clinical practice, both HER-2 low expression and HER-2 zero expression breast cancers are categorized as HER-2 negative breast cancer, and are considered ineligible for HER-2 targeted therapy. However, recent clinical trial results of new anti-HER-2 antibody have indicated that breast cancer patients with HER-2 low expression can still benefit from HER-2 targeted treatment. This has led to increased interest in the differences between breast cancer patients with HER-2 low expression and HER-2 zero expression in terms of the biological characteristics, treatment responses, and prognosis. Therefore, this study was performed to investigate the clinicopathologic characteristics and prognosis differences between early-stage breast cancer patients with HER-2 low expression and HER-2 zero expression, so as to provide additional data for clinical practice.Methods The clinical data of 1 002 HER-2 negative breast cancer patients with early-stage disease (M0) admitted to the Department of Breast Surgery, the Second Xiangya Hospital, Central South University, between January 2010 and December 2020 were retrospectively analyzed. Patients were categorized into the HER-2 low expression group (409 cases) and the HER-2 zero expression group (593 cases) based on their HER-2 expression status. The differences in relevant clinicopathologic variables and outcomes between the two groups were compared.Results Compared to the HER-2 zero expression group, the HER-2 low expression group had a higher proportion of invasive ductal carcinoma (93.4%), with a majority exhibiting grade Ⅱ pathology (78.7%); the HER-2 low expression group had a lower proportion in the T1 stage and a higher proportion in the T2 stage according to TNM staging compared to the HER-2 zero expression group, and these differences were statistically significant (all P<0.05). In the HER-2 low expression group, the positivity rate of hormone receptors (HR) was 87.5%, and among the 199 cases tested for androgen receptor (AR), the AR positivity rate was 80.9%, both of which were higher than those in the HER-2 zero expression group (both P<0.05). Ki-67 expression was significantly lower in the HER-2 low expression group compared to the HER-2 zero expression group (P<0.05). These differences between the two groups were mainly observed in HR-positive patients (all P<0.05), while HR-negative patients showed no significant differences in all variables (all P>0.05). Regardless of HR expression status, there were no significant differences in overall survival (OS) and disease-free survival (DFS) between the HER-2 low expression group and the HER-2 zero expression group (all P>0.05). Additionally, in HER-2 low expression patients, the AR expression status had no significant impact on OS or DFS (all P>0.05).Conclusion There are certain clinicopathologic differences between HER-2 low expression and zero expression early-stage breast cancer patients. Despite the lack of significant differences in prognosis between the two groups of patients, the higher HR and AR positivity rates, along with lower Ki-67 expression level in the HER-2 low expression group, suggest a potential association with sensitivity to endocrine therapy.

Abstract:Background and Aims Young breast cancer patients carrying germline BRCA (gBRCA) mutations face a dual risk associated with both a young age and genetic mutations. Currently, there is no consensus on the feasibility of breast-conserving therapy for early-stage breast cancer patients with gBRCA mutations. This study was conducted to explore the impact of different surgical methods on the prognosis of young breast cancer patients with gBRCA mutations as well as to investigate whether this impact varies among different ethnic groups through a Meta-analysis.Methods Multiple international databases were searched to collect clinical studies comparing the prognosis of early-stage breast cancer patients with gBRCA mutations undergoing breast-conserving surgery versus total mastectomy. Meta-analysis was performed on variables that included recurrence-free survival (RFS), metastasis-free survival (MFS), breast cancer-specific survival (BCSS), and overall survival (OS).Results Six studies (2 from China, 4 from Europe and the United States) were finally included, comprising a total of 2 140 patients with gBRCA mutations, with a median age ranging from 38 to 47 years. The Meta-analysis results indicated that, in the overall population, breast cancer patients with gBRCA mutations undergoing breast-conserving surgery had an increased risk of recurrence compared to those undergoing total mastectomy (RFS: HR=1.91, 95% CI=1.03-3.54, P<0.05). However, there were no statistically significant differences in MFS, BCSS, and OS between the two surgical procedures (all P>0.05). In the Chinese population, patients with gBRCA mutations undergoing breast-conserving surgery had a higher risk of recurrence compared to those undergoing total mastectomy (RFS: HR=1.63, 95% CI=1.10-2.41, P<0.05), with no statistically significant differences in other variables (all P>0.05). In the European and American populations, there were no statistically significant differences in all above variables between the two surgical methods (all P>0.05).Conclusion For the European and American populations, breast-conserving surgery is not a risk factor for the postoperative prognosis of young breast cancer patients with gBRCA mutations. However, in the Chinese population, opting for breast-conserving surgery may entail a higher risk of recurrence for young breast cancer patients with gBRCA mutations; therefore, a full information should be provided during medical decision of surgical choice.

Abstract:Background and Aims Resveratrol has a broad spectrum of anti-tumor effects, exhibiting the ability to inhibit proliferation and migration of papillary thyroid cancer cells. However, the underlying mechanisms of its actions remain unclear. This study was conducted to investigate the inhibitory effect of resveratrol on transplanted tumors of papillary thyroid cancer cells and its action mechanism.Methods Forty nude mice were subcutaneously inoculated with thyroid cancer cells (TPC-1) to establish the xenograft models. Then, the tumor-bearing mice were randomly divided into a model control group and three resveratrol treatment groups receiving different doses of resveratrol (2.5, 5, 10 mg/kg), with each group containing 10 mice. Respective doses of resveratrol were administered by intraperitoneal injection to the mice in the treatment groups, while the model control group received an equivalent volume of physiological saline, once daily for 21 d. Tumor growth was monitored and growth curves were plotted. After 21 d, mice in each group were euthanized, tumors were weighed, and tumor inhibition rates were calculated. Histological examination with HE staining and TUNEL staining were performed to assess tumor cell morphology and apoptosis. qRT-PCR and Western blot analyses were used to evaluate the mRNA and protein expressions of apoptosis-related proteins (caspase-3, Bax, Bcl-2) and epithelial-mesenchymal transition (EMT) related molecules (E-cadherin, N-cadherin, vimentin) in tumor tissues.Results In all three resveratrol treatment groups compared to the model control group, the growth rates of transplanted tumors were significantly inhibited, and after 21 d, tumor mass was noticeably reduced, and tumor inhibition rates increased with higher resveratrol doses (all P<0.05). Results of HE staining showed that in the model control group, cancer cells in the tumor tissue presented a patchy distribution with varied morphologies and sizes, rich cytoplasm, large nuclei, visible mitotic figures, and disrupted polarity. In contrast, in the resveratrol treatment groups with three different doses, there was a varying degree of reduction in cell numbers, loosening of cell arrangement, condensed cell nuclei, fewer mitotic figures, and varying degrees of focal necrosis. Compared to the model control group, the tumor tissues in the resveratrol treatment groups exhibited an increase in apoptosis of tumor cells, and showed increased expression of E-cadherin and Bax mRNA and protein, decreased expression of N-cadherin, vimentin, and Bcl-2 mRNA and protein; caspase-3 mRNA levels decreased, while cleaved caspase-3 protein expression increased. Moreover, these changes exhibited a dose-dependent relationship in all three resveratrol treatment groups (all P<0.05).Conclusion Resveratrol promotes apoptosis of papillary thyroid carcinoma cells, thereby inhibiting their growth in mice. The mechanism of action may involve the revercal of the EMT process.

Abstract:In thyroid surgery, the effective protection of the parathyroid glands can have a significant impact on the prognosis of patients. Currently, intraoperative protection of the parathyroid glands is mostly based on visual identification. Surgeons decide whether to perform autotransplantation based on the observed morphology and blood supply of the parathyroid glands during surgery. However, the close resemblance of the parathyroid glands to surrounding fat and lymphatic tissues in morphology and color significantly affects the efficacy of visual identification. Therefore, there is an urgent need for a method to assist surgeons in rapidly and effectively identifying the parathyroid glands during thyroid surgery. In recent years, the application of fluorescence imaging technology in thyroid surgery has become a research hotspot. This technology is used to visualize the parathyroid glands and their blood supply during surgery, providing a new method for intraoperative protection of the parathyroid glands. Fluorescence imaging technology can be divided into near-infrared autofluorescence imaging (NIRAF) and exogenous fluorescence. The principles, equipment used, and real-time imaging effects vary between different fluorescence imaging methods. At present, NIRAF is mostly used for intraoperative identification of parathyroid glands, improving the surgeon's identification rate. However, its imaging effectiveness is influenced by various factors such as the patient's blood calcium concentration, the location of the parathyroid glands, and the surrounding tissue conditions. Exogenous fluorescence imaging relies on the application of fluorescence imaging agents, including indocyanine green (ICG), low-dose methylene blue (MB), and 5-aminolevulinic acid (5-ALA). The most widely used fluorescence imaging agent is ICG, which, when specifically bound to blood lipoproteins, can be visualized under near-infrared light, aiding the surgeon in identifying the parathyroid glands and assessing the surrounding blood supply. In recent years, ICG has gradually been applied in endoscopic and da Vinci robotic surgeries as more thyroid procedures are performed. However, this method has limitations as it may result in false-positive and false-negative results in identifying the parathyroid glands, and the surgeon's judgment of the blood supply around the parathyroid glands can be influenced by subjective factors. Other exogenous fluorescence imaging methods, such as the use of low-dose MB and 5-ALA, can also perform fluorescence imaging of the parathyroid glands. Still, there are reports of adverse reactions, limiting their widespread clinical application. As the research on fluorescence imaging for parathyroid protection is still in its early stages both domestically and internationally, there is ongoing debate about the clinical application methods and effectiveness of different technologies. Based on current literature from both domestic and international sources, the authors summarize relevant reports on fluorescence imaging technology and parathyroid protection.

Abstract:Thyroid cancer is the most common malignant tumor in the endocrine system, with a steadily increasing prevalence worldwide. Total thyroidectomy is currently a commonly used treatment for this disease. The parathyroid glands, located on the posterior mid and lower regions of the bilateral thyroid lobes (or embedded within them), are crucial for maintaining calcium and phosphorus homeostasis in the human body. Reduced function of these glands can lead to symptoms such as decreased blood calcium concentration, muscle spasms, and, in severe cases, death. Due to the small size and variable distribution of the parathyroid glands, locating and preserving them during thyroid surgery is challenging. Damage to the parathyroid glands during surgery can result in reduced function and postoperative complications, such as decreased blood calcium concentration. To reduce the risk of parathyroid damage during total thyroidectomy and prevent postoperative complications, the authors provide a comprehensive analysis of several mainstream methods for parathyroid localization and identification during thyroid surgery, which mainly include techniques based on staining methodology, optical approaches, and parathyroid hormone monitoring. The technical features and advantages of each method, providing a detailed overview of their application scenarios and technical limitations are analyzed and compared. The aim is to advance the development of parathyroid identification technology in thyroid surgery, laying a technical foundation for the rapid and accurate identification and preservation of parathyroid glands during surgery.

Abstract:Differentiated thyroid carcinoma (DTC) exhibits an indolent progression and a favorable prognosis, but it is prone to early cervical lymph node metastasis (LNM), which is closely associated with postoperative recurrence and poor prognosis. High-resolution ultrasound, CT scanning, and fine-needle aspiration biopsy are commonly used methods for preoperative assessment of the presence and extent of cervical LNM. With the development of molecular biology techniques, significant progress has been made in the understanding of molecular mechanisms related to the prognosis of DTC. It holds the promise of providing new non-invasive and accurate ways to preoperatively assess cervical LNM, individualize surgical plans, and reduce unnecessary lymph node dissection. Here, the authors, based on current clinical research, summarize and discuss the relationship between molecular biomarkers and cervical LNM in DTC, as well as their potential value in diagnosis and prognosis.

Abstract:Breast cancer is the most common malignant tumor in women. Unpredictable metastatic relapse is a major reason for treatment failure, recurrence, and even death in breast cancer patients. Circulating tumor cells (CTCs) are defined as tumor cells that detach from the primary tumor and enter the circulatory or lymphatic system. Studies have confirmed that the detection of CTCs can provide important clinical information for the diagnosis, developing treatment strategies, and prognosis assessment of breast cancer. As one of the key targets for liquid biopsies, CTCs can be collected simply by extracting a patient's blood. However, most CTCs die in the circulation, with only a very small number surviving and invading distant organs. The scarcity in numbers, heterogeneity of CTCs, and interference from complex components in blood pose significant challenges to the accurate detection of CTCs. Various detection methods developed based on the biological and physical properties of CTCs often require separation and enrichment of CTCs before detection. However, preprocessing steps like adsorption, washing, and transfer inevitably result in CTC loss. Moreover, time-consuming, complex procedures, and expensive equipment further limit the clinical application of CTC detection. Therefore, there is an urgent need for the development of new detection technologies. Microfluidic technology, characterized by microfabricated structures, has received significant attention and research in recent years. Microfluidic technology allows for precise control of micrometer-scale fluids and cells, making it particularly suitable for detecting rare CTCs. Microfluidic chips offer advantages such as low cost, simplicity of operation, low consumables, high throughput, and real-time detection. Their miniaturization allows for the integration of various detection techniques into a micro-scale platform, providing an efficient platform for the isolation, identification, and characterization of CTCs, contributing to personalized analysis and treatment of cancer patients. Recently, the rise of three dimession (3D) printing technology has provided a more efficient and personalized approach to the fabrication of microfluidic chips, avoiding the complexities and time-consuming aspects of traditional microfluidic device production. Layer-by-layer printed 3D structures will promote higher efficiency and throughput of microfluidic chips, facilitating the successful application of laboratory techniques in clinical settings. This opens up new perspectives for biological and clinical research on tumors and offers unprecedented opportunities for the diagnosis and treatment of breast cancer. In this article, the authors analyze the characteristics of different CTC detection methods in recent years, elucidate the application of microfluidic technology in the detection of breast cancer CTCs, and the cutting-edge technology of 3D-printed microfluidic chips, and provide an outlook on the application prospects of 3D-printed microfluidic chips in the detection of CTCs in breast cancer.