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Single puncture and irrigation with Mammotome system in treatment of lactational breast abscess with-out drainage

Haizhi LI ; Biqing SONG ; Tao LI ; Qintian XU

Chinese Journal of Endocrine Surgery.2016;10(2):156-158. doi:10.3760/cma.j.issn.1674-6090.2016.02.012

Objective To evaluate clinical efficacy and safety of single puncture and irrigation with Mammotome system in treatment of lactational breast abscess without drainage. Methods 32 patients with lacta-tional breast abscess were treated with ultrasound-guided puncture and irrigation by Mammotome system. Pus was cleared and necrotic material was removed. The residual cavity was irrigated with 3% hydrogen peroxide solution and Kangfuxin solution and no drainage was placed. Breast-feeding on time was encouraged. Results All pa-tients were successfully treated with single puncture and irrigation. The average length of hospital stay was 4 days. Except for 3 cases actively requesting to stop lactating, the other 29 patients continued to breast-feed. There was one case with postoperative hematoma, one with wound granuloma, and no other complications occurred. There was no relapse during the follow-up of 3 to 36 months. All patients were satisfied with the appearance of the breasts. Conclusions Single puncture and irrigation with Mammotome system without drain placement is a safe procedure in treatment of lactational breast abscess with the advantage of minimal invasion, low complication and does not affect breastfeeding.

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The application of implantable venous access ports in management of postoperative breast cancer patients

Zhimin LIU ; Yuan ZHONG ; Xueqing JIANG ; Pengfei SHI ; Yang LI

Chinese Journal of Endocrine Surgery.2016;10(2):148-151. doi:10.3760/cma.j.issn.1674-6090.2016.02.010

Objective To investigate and analyze the experience of planting and maintaining implantable venous access ports(IVAP) in management of post-operative breast cancer patients. Methods Breast cancer pa-tients receiving IVAP after surgery from Mar. 2011 to Jun. 2014 were retrospectively analyzed. The relative com-plications were documented and summarized during implanting operation. Results 468 patients received IVAP, among whom 451 patients underwent piercing implantation via right internal jugular vein, 15 patients underwent piercing implantation via right subclavian vein, and 2 patients underwent piercing implantation via left internal jugular vein. The mean cathe tering leng th was 12.8 cm for patients receiving IVAP via right internal jugular vein, ranging from 12 to 15 cm. Thereinto, 30(6.4%) patients experienced shot-term complications including 16 cases of puncture difficulty, 5 cases of accidental arterial puncture, 2 cases of extravasation, 2 cases of blood aspiration dif-ficulty and 5 cases of arrhythmia. Three cases had long-term complications as the following:one case of catheter-re-lated infection, one case of catheter lost, and one case of incision rupture. Conclusions IVAP is a safe and effec-tive intravenous infusion device. It is crucial to choose individualized implanting access and length by professional surgical team.

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ERCC1 expression in advanced breast cancer and its relationship with cisplatin resistance

Kai LU ; Yanwen LIU ; Hui LI ; Dong LIU ; Hongling YE ; Liang XU ; Su LIU

Chinese Journal of Endocrine Surgery.2016;10(2):139-143. doi:10.3760/cma.j.issn.1674-6090.2016.02.008

Objective To investigate ERCC1 expression in advanced breast cancer and its relationship with cisplatin resistance. Methods ERCC1 expression in 50 cases of advanced breast cancer was measured by RT-QPCR. The chemotherapy (CAF) was given. Gemcitabine and cisplatin were given because of metastasis. Results The expression of ERCC1 has no relationship with age, lymph node metastasis, clinicl stage, histologi-cal grade or human epidermal growth factor receptor-2 (HER2) expression. The effective rate was 18.8% (3/16) for ERCC1 high-expressed patients and 79.4%(27/34)for ERCC1 low-expressed patients in terms of cisplatin chemotherapy. The sensitity for cisplatin chemotherapy was high for patients with low ERCC1 expression and it was low for patients with high ERCC1 expression. The effective rate (complete remission+partial remission), and ineffective rate (stable disease+progressive disease) between the two had statastical significance (P<0.001). Con-clusions ERCC1 low-expressed patients can benefit from cisplatin. ERCC1 can be used as a moleculer marker for predicting chemotherapy efficacy in breast cancer.

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Progress of metabonomics in papillary thyroid cancer

Wenjie ZHENG ; Yanan XU ; Jiadong WANG

Chinese Journal of Endocrine Surgery.2016;10(2):178-180. doi:10.3760/cma.j.issn.1674-6090.2016.02.018

Metabolomics, the newest “omics”science after genomics, thranscriptomics and proteomics, is the study of simultaneous identification and quantification of products of the biochemical reaction within an or-ganism. It has been used in the study of papillary thyroid cancer. This review presents an introduction to the con-cept and research techniques of metabolomics and the progress of application in papillary thyroid cancer.

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The progress of internal mammary lymphatic drainage and internal mammary lymph node biopsy in breast cancer

Xiaoshan CAO ; Yongsheng WANG

Chinese Journal of Endocrine Surgery.2016;10(2):174-177. doi:10.3760/cma.j.issn.1674-6090.2016.02.017

There are two main lymphatic drainage routes of the breast: a superficial system and a deep system, and only the deep one can drain into the internal mammary lymph node (IMLN) which receive about 25%of the lymph of the breast. As one of the important nodal sites of lymphatic spread of breast, IMLN is important for neoplasm staging and it will guide adjuvant radiotherapy. However, there still lack an effective and feasible minimally invasive diagnosis technology of IMLN, leading to inaccurate staging and over/under-treatment. The“modified injection technique” broke through the bottle-neck of the low internal mammary visualization rate with traditional injection technique, and made the internal mammary sentinel lymph node biopsy possible to be a min-imally invasive assessment for IMLN status, and further guided internal mammary radiotherapy (IM-RT). Patients with IMLN positive should accept IM-RT, with IMLN negative can avoid IM-RT. With the unceasing progress in studies on internal mammary lymph drainage area, patients may obtain the individualized diagnosis and treat-ment. The review summarizes current knowledge on the anatomy and physiology of the lymphatic system of the breast to translate this into implications for clinical practice of IM-SLNB.

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Parathyroid in situ exposure and protection in differentiated thyroid carcinoma surgery

Yu ZHANG ; Xueying CEN ; Guoqing ZHENG ; Qiang HUO

Chinese Journal of Endocrine Surgery.2016;10(2):166-169. doi:10.3760/cma.j.issn.1674-6090.2016.02.015

Objective To study the application value of parathyrod in situ exposure and protection in differentiated thyroid cancer thyroid carcinoma (DTC) surgery. Methods 500 cases of DTC admitted from Jan. 2012 to Dec. 2014 were selected for the research. According to whether the parathyroid was anatomically exposed during the surgery, the patients were divided into experimental group (exposed group) and the control group (un-exposed group). Then, depending on tumor extent and risk factors, the experimental group were divided into group E1 (lateral affected glandular lobe, isthmus lobe resection and unilateral VI lymph node dissection )and E2 (total or subtotal thyroidectomy and bilateral VI lymph node dissection), while the control group were divided in-to group C1 (surgical treatment same as E1)and group C2 (surgical treatment same as E2). Patients’ postopera-tive nerve and muscle symptoms were observed, such as clinical manifestations of face, lips, hand and foot numb-ness or convulsions. Both preoperatively and postoperatively, patients’ parathyroid hormone (PTH) and serum calcium level indicators were detected before surgery and at the 1st, 3rd, 5th, 7th, 14th and 28th day after surgery. Results The lymph node metastasis rate and number between experimental group and the control group had statistical insignificance (χ2=1.02, 0.79, P=0.14, 0.96). The recurrence rate of the 2 groups had no significant difference during the follow-up (χ2=0.23, P=0.65). Group E1 was significantly lower than Group C1 in postopera-tive parathyroid function decline rate, incidence of hypocalcemia and parathyroid mistakenly cut rate. Group E2 was also obviously lower than Group C2 in all these aspects. The difference had statistical significance (P<0.05). Conclusion Parathyrod in situ exposure and protection assisted by direct vision of the magnifying glass can re-duce the mistakenly cut rate of parathyroid and the temporary hypoparathyroidism, which can effectively avoid the adverse effects caused by total thyroidectomy.

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The expression and significance of serum ghrelin, leptin, IGF-1, and IGFBP3 in children with idiopathic short stature

Ping WANG ; Jianbo JIANG ; Shan DU ; Chenyu WANG ; Ningchuan SHI

Chinese Journal of Endocrine Surgery.2016;10(2):163-165. doi:10.3760/cma.j.issn.1674-6090.2016.02.014

Objective To examine the expressions of serum growth hormone (ghrelin), leptin (LP), in sulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP3) in children with id-iopathic short stature (ISS), and their significance. Methods A total of 40 patients with ISS were selected from May. 2012 to Oct. 2014 in Fuyang Maternal and Child Health Hospital, while a total of 40 children in good health were selected as the control group. Serum ghrelin and LP levels were measured by ELISA. Serum IGF-1 and IGF-BP3 levels were detected by chemiluminescence immune assay. Results were analyzed statistically. Results The height, weight, BMI, GH, serum LP, IGF-1, and IGFBP3 levels in the observation group were significantly lower than those in the control group, while serum ghrelin expression level was significantly higher than that in the control group(P<0.05). The correlation analysis showed that ghrelin and LP were negatively correlated(r=-0.611, P<0.01), ghrelin and IGF-1 levels were negatively correlated(r=-0.520, P<0.05), Ghrelin and IGFBP3 were pos-itively correlated (r=0.586, P<0.01), IGF-1 and IGFBP3 was negatively correlated (r=-0.576, P<0.01), and LP and IGFBP3 were negatively correlated (r=-0.609, P<0.01). Conclusions It shows that ghrelin, LP, IGF-1, and IGFBP3 levels in children with ISS are related to growth hormone secretion status. The interactions between ghre-lin and insulin-like growth factor axis regulate growth and development of children.

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Single-person operated Mammotome minimally invasive system in treating benign breast lesions

Dong LIU ; Kai LU ; Liang XU ; Su LIU ; Xin ZHANG

Chinese Journal of Endocrine Surgery.2016;10(2):159-162. doi:10.3760/cma.j.issn.1674-6090.2016.02.013

Objective To explore the application of single-person operated mammotome minimally inva-sive surgery in treatment of benign breast lesions. Methods Clinical information of 403 patients were collected and retrospectively analyzed. 262 patients receiving ultrasound guided single-person operated mammotome mini-mally invasive surgery for benign breast masses were selected as the treatment group,141 patients undergoing open surgery for treatment of benign breast masses were selected as the control group.Operative time, introopera-tive blood loss,length of stay,postoperative healing time, as well as the occurrence of complications were com-pared between the two groups. Result Compared with the control group, the operative time was shorter, the in traoperative blood loss was less, the scar size and the postoperative healing time were shorter for the treatment group. The difference had statistical significance (P<0.05).The rate of postoperative pain, local ecchymosis, local infection and breast deformity for the treatment group was significantly lower than those of the control group (P<0.05). The difference had statistical significance (P<0.05). The recurrence rate between the two groups had no sta-tistical significance (P>0.05). Conclusions Single-person operated Mammotome minimally invasive surgery has the advantages of good operative time,good cosmetic effects, small surgical trauma, less blood loss, fast postoper-ative healing and few complications, which is worthy of clinical application.

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Investigation of underestimated malignancy in patients with intraductal papillary tumors by core needle biopsy

Long SUN ; Xiaosong CHEN ; Jiayi WU ; Ou HUANG ; Yue LIANG ; Yafen LI ; Weiguo CHEN ; Li ZHU ; Jianrong HE ; Kunwei SHEN

Chinese Journal of Endocrine Surgery.2016;10(2):129-134. doi:10.3760/cma.j.issn.1674-6090.2016.02.006

Objectives To calculate the rate of pathological underestimation for core needle biopsy (CNB)- diagnosed intraductal papillary tumors, to analyze the clinical and imaging data of patients and to dis-cuss factors for underestimation. Methods A retrospective analysis of patients undergoing core needle biopsy and subsequent surgical excision was performed. 1359 female patients undergoing CNB from Jan. 2010 to Feb. 2013 in Comprehensive Breast Health Center of Ruijin hospital were analyzed. Clinical, radiological and histo-logical variables were assessed using the Chi-square test, Fisher’s exact test and a binary logistic regression model in order to predict pathological underestimation for tumors. Results There were 50 patients with CNB-di-agnosed intraductal papillary tumors. The overall underestimation rate was about 44%(22/50). CNB-diagnosed atypical papillary lesions (OR=15.164, 95% CI 1.49-170.443) and BI-RADS 5 by MRI (OR=26.766, 95% CI 2.409-297.440)were significantly related to underestimation in these patients. Conclusions Considering the high underestimation rate in CNB-diagnosed intraductal papillary tumors, routine surgical excision should be per-formed to avoid potential malignancy, especially for patients with high risk factors. MRI is helpful in these pa-tients to predict underestimation.

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Contralateral breast as the donor for immediate breast reconstruction or chest wall defect repair in breast cancer patients undegoing mastectomy

Min REN ; Ying WANG ; Xiaodong WU ; Suxia GE ; Ying CHEN ; Xiaowei YANG ; Benzhong WANG

Chinese Journal of Endocrine Surgery.2016;10(2):124-128. doi:10.3760/cma.j.issn.1674-6090.2016.02.005

Objective To explore the feasibility of using contralateral breast as the donor for immediately breast reconstruction or chest wall defect repair after mastectomy in breast cancer patients. Methods From Jul. 2013 to Mar. 2016, contralateral breast fat flap was used as the donor for 8 breast cancer patients with immediate autologous non-microsurgical breast reconstruction or chest wall defect repair after mastectomy. All participants in this study received preoperative oncological screening with ultrasound, mammography, and magnetic resonance imaging which revealed the absence of pathological abnormalities in the donor breast. Results Among the 8 pa-tients, 4 patients underwent immediate breast reconstruction and 4 received chest wall defect repair. Only 1 pa-tient undergoing breast reconstruction had minor complications with little or no effect on the final outcome. No patient undergoing chest wall defect repair had postoperative complications. The functional and aesthetic out-comes were very satisfactory. Regular follow-ups were from 3 to 34 months with no recurrence found up to the present. Conclusions This article presents the first case for immediately breast reconstruction or chest wall de-fect repair using contralateral breast as the donor. The surgical method has some complications but with good aesthetic outcomes, which can be an option for breast cancer patients with hypertrophic and ptotic breast.

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