Clinicopathological characteristics,treatments,and prognosis of breast ductal carcinoma in situ with microinvasion:A narrative review

Background:Ductal carcinoma in situ with microinvasion(DCIS-MI)is defined as ductal carcinoma in situ(DCIS)with a microscopic invasive focus≤1 mm in the longest diameter.The current literature is controversial concerning the clinical prognostic features and management of DCIS-MI.This narrative review described recently reported literature regarding the characteristics,treatment,and prognosis of it.Methods:Searching PubMed for relevant articles covering the period of 1982 to 2021 using the following terms by MeSH and free-word:breast cancer,microinvasion,DCIS,DCIS-MI,and invasive ductal carcinoma(IDC).Results:DCIS-MI tends to express more aggressive pathological features such as necrosis,HER2+,ER-or PR-,and high nuclear grade.The overall prognosis of DCIS-MI is typically good,however,some indicators such as young age,HR-,HER2+and multimicroinvasive lesions,were associated with worse prognoses.And there are also conflicting results on the differences between the prognoses of DCIS-MI and DCIS or T1a-IDC.Postoperative chemotherapy and anti-HER2 therapy still have uncertain benefits and are more likely to be used to treat high-risk patients who are HR-orHER2+to improve the prognosis.Conclusion:DCIS-MI has more aggressive pathological features,which may suggest its biological behavior is worse than that of DCIS and similar to early IDC.Although the overall prognosis of DCIS-MI is good,when making decisions about adjuvant therapy clinicians need to give priority to the hormone receptor status,HER2 expression and axillary lymph node status of patients,because these may affect the prognosis and treatment response.

Perinodular ductular reaction/epithelial cell adhesion molecule loss in small hepatic nodules

AIM: To investigate if loss of epithelial cell adhesion molecule (EpCAM) is associated with microinvasion in hepatocellular carcinomas (HCCs) in the presence of chronic hepatitis B.

Implantation of trabecular micro-bypass stent using a novel “landing strip” technique

AIM：To describe a novel technique of creating a landing strip within the trabecular meshwork to guide trabecular micro-bypass stent（iStent） implantation in patients who underwent phacoemulsification.METHODS：Thirty-four eyes from 30 patients who underwent i Stent implantation after phacoemulsification from May 2014 to February 2015 were included in our retrospective study. All iStents were implanted via the ＂landing strip＂ technique. A 25-gauge microvitreoretinal blade was used to bisect the trabecular meshwork to less than 1 clock-hour, effectively creating a landing strip. The iStent applicator was pressed along the landing strip and then the stent was released into the trabecular meshwork. RESULTS：Of the 34 eyes with iStent implantation, 27（79.4%） eyes had primary open-angle glaucoma, 6（17.6%） eyes had pseudoexfoliation glaucoma, and 1（2.9%） eye had ocular hypertension. At 6-month follow-up（n=17）, the mean number of hypotensive medications decreased from 2.2±1.2 at baseline to 0.8±1.3（P=0.05） and mean intraocular pressure decreased from 19.7±4.1 mm Hg at baseline to 16.7±2.1 mm Hg（P=0.58）. Two eyes（5.9%） required subsequent trabeculectomy. CONCLUSION：The ＂landing strip＂ technique appears to be an effective way to assist with iS tent implantation.

Is adjuvant chemotherapy necessary for patients with microinvasive breast cancer after surgery？

Objective: Survival and treatment of patients with microinvasive breast cancer(MIBC) remain controversial. In this paper, we evaluated whether adjuvant chemotherapy is necessary for patients with MIBC to identify risk factors influencing its prognosis and decide the indication for adjuvant chemotherapy.Methods: In this retrospective study, 108 patients with MIBC were recruited according to seventh edition of the staging manual of the American Joint Committee on Cancer(AJCC). The subjects were divided into chemotherapy and non-chemotherapy groups.We compared the 5-year disease-free survival(DFS) and overall survival(OS) rates between groups. Furthermore, we analyzed the factors related to prognosis for patients with MIBC using univariate and multivariate analyses. We also evaluated the impact of adjuvant chemotherapy on the prognostic factors by subgroup analysis after median follow-up time of 33 months(13-104months).Results: The 5-year DFS and OS rates for the chemotherapy group were 93.7% and 97.5%, whereas those for the nonchemotherapy group were 89.7% and 100%. Results indicate that 5-year DFS was superior, but OS was inferior, in the former group compared with the latter group. However, no statistical significance was observed in the 5-year DFS(P=0.223) or OS(P=0.530) rate of the two groups. Most relevant poor-prognostic factors were Ki-67 overexpression and negative hormonal receptors. Cumulative survival was 98.2% vs. 86.5% between low Ki-67(≤20%) and high Ki-67(>20%). The hazard ratio of patients with high Ki-67 was 16.585 [95% confidence interval(CI), 1.969-139.724; P=0.010]. Meanwhile, ER(-)/PR(-) patients with MIBC had cumulative survival of 79.3% compared with 97.5% for ER(+) or PR(+) patients with MIBC. The hazard ratio for ER(-)/PR(-) patients with MIBC was 19.149(95% CI, 3.702-99.057; P<0.001). Subgroup analysis showed that chemotherapy could improve the outcomes of ER(-)/PR(-) patients(P=0.014), but not those who overexpress Ki-67(P=0.105).Conclusions: Patients with MIBC who overexpress Ki-67 and with negative hormonal receptors have relatively substantial risk of relapse within the first five years after surgery. However, adjuvant chemotherapy can only improve the outcomes of ER(-)/PR(-)patients, but not those who overexpress Ki-67. Further studies with prolonged follow-up of large cohorts are recommended to assess the prognostic significance and treatment of this lesion.

Microinvasive analysis of textile relics from an ancient Silk Road turquoise mining site

The Xinjiang region,with its unique location and climate,exhibits well-preserved relics of great academic interest.This paper focuses on the microinvasive analysis of textile samples obtained from an ancient turquoise mining site in the Heishanling region of Xinjiang,active between 820 and 400 BC.Various analytical techniques,including optical microscopy,scanning electron microscopy,Fourier-transform infrared spectroscopy with attenuated total reflection,and liquid chromatography-mass spectrometry,were employed to investigate these textiles.The results revealed that the textiles were composed of wool and dyed using indigo and purpurin.The bluegrass and madder-derived dyes were likely sourced locally or imported from wetter regions such as the Chinese Central Plains.The infrared deconvolution spectra and the results demonstrated that red and blue dyes considerably influenced the movement of wool fiber chains,leading to a more rapid decay of dyed fibers compared to those that were undyed.In addition,the medium dyeing process and Ke techniques were employed to create unique color shades and special patterns.This scientific and technological analysis of the textiles provides essential data for elucidating the materials available to ancient laborers.Furthermore,it offers scientific evidence supporting the cultural exchange between the western regions and the Central Plains and integration along the Silk Road.

基层医院鞍区病变微侵袭外科治疗探讨

目的 探讨基层医院在蝶鞍区病变微侵袭外科治疗的可行性及最佳手术方式.方法 回顾性分析2003年7月至2009年5月收治的70例蝶鞍区病变患者的临床资料.其中垂体腺瘤56例,垂体转移癌1例,颅咽管瘤3例,鞍结节脑膜瘤2例,脊素瘤1例,空蝶鞍综合征3例,脑脊液鼻漏2例,视神经损伤2例.显微镜下经鼻一蝶入路,采取两种入路方式,手术29例,显微镜、鼻内窥镜联合应用经鼻、蝶入路手术15例,鼻内窥镜下采取两种入路方式手术26例.结果 56例垂体腺瘤全切27例,次全切24例,部分切除5例,垂体转移癌予以大部分切除,鞍结节脑膜瘤2例全切,脊索瘤1例次全切,颅咽管瘤3例部分切除,空蝶鞍综合征填塞术3例,2例术后视力改善明显,1例改善不明显,脑脊液漏2例均成功修补,视神经管减压1例效果良好,1例无效.结论 基层医院科室联合,技术、设备共享,可以在蝶鞍区病变微侵袭外科治疗方面取得突破;内镜下经鼻、蝶入路是处理鞍区病变的最佳手术方式,但不能取代显微外科手术,最大限度的利用各自的优点,在鞍区病变的治疗方面将发挥更大作用.

Microinvasive breast cancer with supraclavicular lymph node and ovarian metastasis as clinical findings: a rare case report

Breast cancer is a common malignancy among women. Due to the improvement of social awareness and advances in imaging technologies, significant achievements are obtained at its diagnosis and treatment each passing day. A 54-year-old, multiparous and postmenopausal woman, who presented with a palpable lymph node in the right supraclavicular region and a right adnexal mass but had no findings from the breast examination, is reported in this article. Following advanced assessment, metastatic carcinoma was identified in the lymph node biopsy and the adnexal mass. During the exploration for the primary origin, microinvasive breast cancer was diagnosed following mammographic imaging and an excisional biopsy from the right breast. Microinvasive breast cancer, which did present itself with clinical findings with metastases despite the lack of local findings, was discussed with the review of the literature.