Nipple-Areola Sparing Mastectomy Followed by Immediate Breast Reconstruction in 126 Patients

This study is to explore the indications, procedures, effectiveness, and feasibility of nipple-areola sparing mastectomy followed by immediate breast reconstruction. The nipple-areola sparing mastectomy followed by immediate breast reconstruction was performed in 126 patients with breast cancer from June 2005 to October 2011. The cosmetic outcomes of the reconstructed breasts were evaluated according to objective and subjective criteria. Meanwhile, the postoperative complications were observed and the therapeutic efficacies were followed up. All the operations were successful. Six patients experienced mild complications early after surgery and were resolved after symptomatic treatment. Both the subjective and objective evaluation for the aesthetic outcomes yielded a satisfactory rate of 97.62% during the 6-80-month follow-up. No recurrence or metastasis was found in 118 cases. Nipple-areola sparing mastectomy followed by immediate breast reconstruction is a simple and effective option for significantly improving the cosmetic outcomes and quality of life of patients, without serious complications or impact on the comprehensive treatment and long-term effect against breast cancer.

Analysis of risk factors of surgical site infections in breast cancer

Background Adjuvant chemotherapy has become an important component of standard therapy for breast cancer. However, until now, there have been few reports on the surgical site infections （SSI） after breast cancer surgery, specially after adjuvent chemotherapy. To study the risk factors of SSI of breast cancer, we analyzed patients diagnosed with breast cancer and treated with surgery. Methods Fifty-five patients diagnosed with breast cancer and received breast conserving or modified radical operations in our hospital during January 2008 to March 2008 were selected. Factors （patients＇ age, body mass index （BMI）, diabetes mellitus, no or administered adjuvant chemotherapy, with or without onset of myelosuppression and the degree, surgical approaches, duration of operation, postoperative drainage duration and total drainage volume） associated with SSI were retrospectively reviewed and statistically analyzed by single factor analysis. Results Five patients suffered SSI （5/55, 9.1%）; nineteen receiving adjuvant chemotherapy experienced Grade III＋ myelosuppression, among which 4 had SSI; only 1 out of the remaining 36 patients without adjuvant chemotherapy had SSI. The difference between the two groups was significant （P=-0.043）. The incidence of SSI in patients with postoperative drainage tube indwelling longer than 10 days was 5/21, whereas no SSI occurred in that less than 10 days （P=0.009）. In our study, there was no significient difference in other associated factors. Conclusions Concurrent Grade III＋ myelosuppression after adjuvant chemotherapy is an important risk factor of SSI in breast cancer and needs further study. No SSI was detected with indwelling time of post operative drainage less than 10 days.

Polymorphisms of GSTP1 is associated with differences of chemotherapy response and toxicity in breast cancer

Background Although chemotherapy is one of the most important treatments of breast cancer,it is limited by significant inter-individuval variations in response and toxicity.The metabolism of epirubicin （EPI） and cyclophosphamide （CTX） is mainly mediated by cytochrome P450s （CYPs） and glutathione S-transferases （GSTs）.It has been well-known that the activities of these enzymes are polymorphic in population due to their genetic polymorphisms.The aim of this research was to examine the effects of genetic polymorphisms in CYP3A,GSTP1 and MDR1 genes on treatment response and side-effects of breast cancer patients receiving EPI/CTX chemotherapy.Methods One hundred and twenty patients with stage Ⅱ or Ⅲ invasive breast cancer were recruited and treated with three to four cycles of EPI 80 mg/m2 and CTX 600 mg/m2 every two weeks.The AJCC TNM staging system （sixth edition）was used to evaluate the pathological response of primary tumor and axillary lymph nodes.The genotypes of gene polymorphisms were determined by using PCR-restriction fragment length polymorphism methods.Results Patients carrying GSTP1 105 lle/Val or 105 lle/lle genotype were more likely to have good response （OR,0.40;95% CI,0.16-0.96;P=0.024） and light toxicity （OR,0.35;95% Cl,0.13-0.78;P=0.006） than those carrying 105Val/Val genotypes.The response to the treatment was not correlated with estrogen receptor,progesterone receptor and Her2/neu status of tumors.No correlation was found between toxicity effect and patient＇s age,tumor staging,menopause status,and dose intensity of the drugs.Conclusion GSTP1 polymorphism was associatiated with the chemotherapy response or adverse effects of EPI and CTX regimens.

A prospective study comparing endoscopic subcutaneous mastectomy plus immediate reconstruction with implants and breast conserving surgery for breast cancer

Background Breast conserving surgery （BCS） has been the standard surgical procedure for the treatment of early breast cancer. Endoscopic subcutaneous mastectomy （ESM） plus immediate reconstruction with implants is an emerging procedure. The objective of this prospective study was to evaluate the clinical outcomes of these two surgical procedures in our clinical setting. Methods From March 2004 to October 2007, 43 patients with breast cancer underwent ESM plus axillary lymph node dissection and immediate reconstruction with implants, while 54 patients underwent BCS. The clinical and pathological characteristics, surgical safety, and therapeutic effects were compared between the two groups. Results There were no significant differences in the age, clinical stage, histopathologic type of tumor, operative blood loss, postoperative drainage time, and postoperative complications between the two groups （P 〉0.05）. The postoperative complications were partial necrosis of the nipple and superficial skin flap in the ESM patients, and hydrops in the axilla and residual cavity in the BCS patients. There was no significant difference in the rate of satisfactory postoperative cosmetic outcomes between the ESM （88.4%, 38/43） and BCS （92.6%, 50/54） patients （P 〉0.05）. During follow-up of 6 months to 4 years, all patients treated with ESM were disease-free, but 3 patients who underwent BCS had metastasis or recurrence -- one of these patients died of multiple organ metastasis. Conclusions After considering the wide indications for use, high surgical safety, and favorable cosmetic outcomes, we conclude that ESM plus axillary lymph node dissection and immediate reconstruction with implants -- the new surgery of choice for breast cancer -- warrants serious consideration as the prospective next standard surgical procedure.

Molecular and functional imaging in cancer-targeted therapy:current applications and future directions

Targeted anticancer drugs block cancer cell growth by interfering with specific signaling pathways vital to carcinogenesis and tumor growth rather than harming all rapidly dividing cells as in cytotoxic chemotherapy.The Response Evaluation Criteria in Solid Tumor(RECIST)system has been used to assess tumor response to therapy via changes in the size of target lesions as measured by calipers,conventional anatomically based imaging modalities such as computed tomography(CT),and magnetic resonance imaging(MRI),and other imaging methods.However,RECIST is sometimes inaccurate in assessing the efficacy of targeted therapy drugs because of the poor correlation between tumor size and treatment-induced tumor necrosis or shrinkage.This approach might also result in delayed identification of response when the therapy does confer a reduction in tumor size.Innovative molecular imaging techniques have rapidly gained importance in the dawning era of targeted therapy as they can visualize,characterize,and quantify biological processes at the cellular,subcellular,or even molecular level rather than at the anatomical level.This review summarizes different targeted cell signaling pathways,various molecular imaging techniques,and developed probes.Moreover,the application of molecular imaging for evaluating treatment response and related clinical outcome is also systematically outlined.In the future,more attention should be paid to promoting the clinical translation of molecular imaging in evaluating the sensitivity to targeted therapy with biocompatible probes.In particular,multimodal imaging technologies incorporating advanced artificial intelligence should be developed to comprehensively and accurately assess cancer-targeted therapy,in addition to RECIST-based methods.