The widespread application of adjuvant therapy has shown clear benefits in the treatment of operable breast cancer. It is essential for the clinicians to select appropriate adjuvant regimens for this heterogeneous group of patients. Recent data from clinical trials evaluating the utility of adjuvant therapy were reviewed.

As a result of accuracy of staging and decreased patient morbidity,sentinel lymph node biopsy for breast cancer was quickly accepted into clinical practice.Many controversies remain in the methods and indications of sentinel lymph node biopsy.In this article,we attempt to highlight the clinical studies regarding the biopsy techniques,pathologic evaluation,indication for lymphatic mapping and eliminating axillary lymph dissection by sentinel lymph node biopsy.It is demonstrated that radioisotope and blue dye techniques are complementary.Preoperative lymphoscintigraphy is most useful for detecting an internal mammary SLN,but the practicability of internal mammary SLN biopsy is still in the investigative stage.As for intraoperative diagnosis of sentinel lymph node,imprint cytology is a quick,economic and tissue-preserving method,but not very effective in the identification of micrometastasis;axillary lymph node dissection is preferable for patients with micrometastasis.Sentinel lymph node biopsy is indicated for ductal carcinoma in situ,with prophylactic mastectomy,breast cancer patients with previous reduction mammoplasty and breast implants.Currently,NSABP B32,Z0010 and Z0011,large,prospective randomized trials are in progress to evaluate unresolved issues of SLN biopsy.Although data from these trials is not available,SLN biopsy has been widely adopted in the clinic.Consistency of technique as well as case selection has attained great significance.

Studying prognostic factors of breast cancer is a traditional subject. With new advances in detection methods applied and new prognostic factors, the clinical course and the biological behavior of breast cancer have been well understood, thus the treatment can be more rational. At present, the majority of prognostic factors related to molecular biology still need to be investigated. And although some of them have broad prospects, they are not available for routine examination currently. In this article, we reviewed some prognostic factors of breast cancer, which have been confirmed or may have potential in practical application.

New theory, technology and drugs have stinulated clinical research of breast cancer. The typical method for early detection of breast cancer consisted of self examination, clinical breast examination by a health professional and mammography, both fiberoptic ductoscopy and ductal lavage cytology could be effective supplements. Sentinel lymph node biopsy is a potential means of avoiding axillary dissection in women with clinically negative axillary patients without influencing the survival. New drugs and regimes had improved complete response in neoadjuvant setting so as to further treatment. Breast conserving therapy with local excision and radiation is well established as an option in the treatment of localized breast cancer, but social and economic factors of the patients should be considered aside from pathological and clinical factors. It is evident that emphasis on early detection, systemic treatment as well as more limited surgery are the trend of breast cancer treatment today.

The National Surgical Adjuvant Breast and Bowel Project (NSABP) is a cooperative group to conduct clinical trials in breast and colorectal cancer research. In this article, we review NSABP breast cancer clinical trials.

STK11 gene is a recently found tumor suppressor gene. It maps 19p13.3. This gene can express a kind of serine threonine kinases. STK11 gene plays an important role in the regulation of cell cycle progression, and it may relate to cell apoptosis. However, until now the mechanisms of STK11 gene is not very clear and progress in the research of this new tumor suppressor gene is sitll needed.

Purpose: Comprehensively assess the role of prognostic and predictive factors and set up a mathematical model to evaluate prognosis and to help the decision of adjuvant therapy. Methods: All prognostic indicator and therapeutic modalities have been performed, mutivariate survival analyses was done by Cox regression. The split-group method was used to construct the mathematical model for prognosis. Results: In multivariate analysis, the factors including age, tumor size, overexpression of Her-2, the interaction between ER status and endocrine therapy (ER ET), and chemotherapy can independently predict prognosis. Finally, the mathematical model acquired is PS = Size + Her2 -2. 5 x age - CT -0. 55 x ( ET x ER). Conclusions: According to PI of individuals, the different risks of failure can been distinguished.

Purpose:To clarify the different expression patterns of the cyclins and P21 between the normal breast epithelium cells and breast cancer cells of different degrees of malignancy.Methods:Using Western Blot, we detected the protein expression of cyclin D1, E, and p21 in the normal breast epithelium cells AG11132A, ER positive MCF 7 breast cancer cells and ER negative MDA MB 231 breast cancer cells.Results:(1) P21 protein was highly expressed and cyclin E lowly expressed in the normal breast epithelium cells. Compared with the normal breast epithelium cells, Cyclin E were highly expressed in breast cancer cells of MCF 7 and MDA MB 231 cells. Abnormal low molecular weight cyclin E was co expressed with normal cyclin E in both MCF 7 and MDA MB 231 breast cancer cells, but not in normal breast epithelium cells AG11132A. (2) In breast cancer cells, compared with the ER positive MCF 7 cells the ER negative MDA MB 231 cells expressed a high level of cyclin E protein but low p21.Conclusions:(1) There are many forms of differences both quantitive and qualitative between normal cells and cancer cells, as well as between relatively low degree and high degree invasive malignant cancer cells. (2) Cyclin E and P21 may be potential indicators that reflect the malignancy of breast cancer cells, but they should be analyzed as a whole in order to get more accurate prognostic information. [

Objective To investigate the clinical significance of fiberoptic ductoscopy-guided intraductal biopsy in diagnosing nipple discharge.Methods From May 2006 to April 2007,screening fiberoptic ductoscopy was performed for intraductal papillary lesions in 53 ducts among 51 patients.Fiberoptic ductoscopy-guided intraductal biopsy was carried out followed by open microdochectomy. Results Except for a failure in 5 ducts,biopsy found papilloma in 29 cases,ductal hyperplasia in 15 cases,severe ductal hyperplasia in 2 and carcinoma in 2.Microdochectomy revealed 43 benign diseases (12 solitary intraductal papillomas,12 multiple intraductal papillomas,and 25 ductal hyperplasia)and 4 malignancies (3 ductal carcinoma in situ,1 invasive ductal carcinoma).Surgeries performed for the 5 ducts failing a biopsy attempt revealed papilloma in one and adenosis in 4.Compared with conventional microdochectomy,fiberoptic ductoscopy-guided intraductal biopsy can significantly increase the detection rate of solitary papilloma(40.7% vs. 92.6%,P＜0.05).It might also underestimate multiple intraductal papilloma and breast cancer. Conclusion Fiberoptic ductoscopy-guided intraductal biopsy is microinvasive,safe,convenient with a high success rate,and could be as a routine procedure after intraductal lesion found by screening fiberoptic ductoscopy.

Objective To discuss the design of pedicled thoracodorsal artery perforator flap (TDAP flap),and to evaluate the aesthetic results and donor-site complications for immediate partial breast reconstruction (IPBR) after breast conserving surgery (BCS) for breast cancer patients.Method Clinical data of 13 breast cancer cases treated with BCS + IPBR using TDAP flap from November 2004 to November 2010 were retrospectively analyzed.Perforators were identified with Doppler preoperatively in all patients.Results All perforators originated within a median distance of 8.0 cm ( range,7.5 to 9.5 cm) from axillary plica at the posterior line of axilla.Median area of the flaps was 6.0 × 8.0 cm ( range,5.0 × 7.0 cm to 8.0 × 10.0 cm).One flap was muscle-sparing,while a small muscle strip was left embedding the perforators in other twelve flaps to increase the reliability of the vascular pedicle.Postoperatively patients were followedup from 4 to 71 months.Median follow-up time was 41 months.Flap necrosis and seroma in the donor-site were not found in all patients.Aesthetic results were graded as excellent or good in 9 patients,fair in 3,and poor in one.Conclusions TDAP flap is a good choice for IPBR after BCS for breast cancer patients whether lesions in outer quadrants or inner quadrants,especially for those patients with excisional biopsy.Preoperative mini-Doppler is helpful for determining the precise location of the main perforators,and decreasing the risk of vessels injury.