Background and purpose:With the progressive development of breast cancer surgery toward more individualized and minimally invasive approaches,sentinel lymph node biopsy(SLNB)has replaced axillary lymph node dissection(ALND)as the standard method for axillary management in certain early-stage breast cancer patients.However,there is ongoing debate in clinical practice regarding whether regional lymph node irradiation(RNI)is necessary for patients with sentinel lymph node(SLN)positive status who have not undergone ALND.This study aimed to analyze the clinicopathological features and survival prognosis of patients with SLN-positive status who did not undergo ALND,evaluate the clinical application value of RNI,and provide evidence to support clinical treatment decisions for this group of patients.Methods:This single-center retrospective study screened breast cancer patients who underwent SLNB at Shandong Cancer Hospital from September 1,2014,to August 31,2023.All patients signed informed consent for treatment.Based on whether postoperative radiotherapy included regional lymph node irradiation(internal mammary and/or axillary and/or supra-/infra-clavicular fields),patients were divided into the RNI group and the no-RNI group for follow-up.Additionally,patients were further divided into multiple subgroups based on factors such as the type of breast surgery,tumor molecular subtype,and histological grade,to compare the clinical value of RNI among subgroups.The primary endpoint was locoregional recurrence-free survival(LRRFS),and the secondary endpoints included invasive disease-free survival(iDFS)and overall survival(OS).The Strengthening the Reporting of Observational Studies in Epidemiology(STROBE)checklist was followed for this study.Results:Clinical data of 8 328 breast cancer patients'were screened for this study,and after applying inclusion and exclusion criteria,356 patients were included in the analysis,with 186 in the RNI group and 170 in the no-RNI group.There were no significant differences between the two groups in terms of age,body mass index(BMI),menopausal status,tumor location,pathological type,histological grade,vascular invasion,estrogen receptor(ER)and progesterone receptor(PR)status,and human epidermal growth factor receptor 2(HER-2)expression(P＞0.05).However,the number of positive SLNs,T stage,and the proportion of patients undergoing total mastectomy(TM)were significantly higher in the RNI group than in the no-RNI group(P=0.006,P=0.043,P＜0.001).After a median follow-up of 38 months,no recurrence or metastasis was observed in the RNI group,while the recurrence and metastasis rate in the no-RNI group was 3.5%(6/170).Of these,4 cases had local regional recurrence,and 2 had distant metastasis.The RNI group showed superior iDFS compared to the no-RNI group(P=0.017),however there was no statistically significant difference in LRRFS and OS(P=0.051 and P=0.356).Exploratory subgroup analysis indicated that patients with tumor diameter＞2 cm(P=0.033)and triple-negative molecular(TNBC)(P=0.020)might benefit from RNI treatment in terms of LRRFS.Conclusion:For certain high-risk patients,such as those with larger tumor diameter,TNBC,or high non-SLN metastatic risk,RNI still plays an important role in reducing the risk of recurrence and metastasis in breast cancer.In clinical practice,an individualized RNI strategy should be developed based on the patient's residual lymph node tumor load,biological behavior of the tumor,and surgical method.

Sentinel lymph node biopsy(SLNB)has become the standard technique for axillary staging in breast cancer,promoting a more in-dividualized approach to axillary surgery.This review discusses several current emerging issues in SLNB for patients with breast cancer:inpa-tients with 1-2 positive sentinel lymph nodes(SLNs),studies such as SENOMAC have reinforced the safety of omitting axillary lymph node dissection(ALND),although careful consideration remains necessary for patients with abnormal axillary imaging findings and in the context of post-operative regional nodal radiotherapy strategies.Omission of SLNB may be appropriate in early-stage patients with clinically and ra-diologically negative axilla under strictly defined conditions to further minimize surgical trauma.In parallel,techniques for SLNB after neoad-juvant therapy continue to advance,with tumor safety outcomes becoming increasingly reliable,and the dual de-escalation of both surgery and radiotherapy may be anticipated.In addition,regional lymph nodes serve not only as the initial site of tumor metastasis but also as crit-ical hubs of the adaptive immune response,positioning SLNs a potential window into tumor immune surveillance.

Objective:This study evaluated the accuracy of internal mammary sentinel lymph node biopsy(IM-SLNB)in patients with early-st-age breast cancer after receiving neoadjuvant therapy(NAT).It explored the benefits of IM-SLNB in guiding cancer staging,evaluating progn-osis,and optimizing adjuvant treatment strategies.Methods:A retrospective study was conducted to collect clinical data of patients who re-ceived IM-SLNB following NAT in Shandong Cancer Hospital and Institute from October 2013 to November 2023.We analyzed the influence of clinicopathological characteristics on internal mammary lymph node(IMLN)metastasis and assessed the prognostic significance of IMLN me-tastasis following NAT.Results:The study included 132 breast cancer patients who underwent IM-SLNB following NAT.The metastasis rates of axillary lymph nodes(ALN)and internal mammary lymph nodes(IMLN)were 90.9%(120/132)and 9.1%(12/132),respectively.The perce-ntages of patients in the following groups were as follows:ALN-positive/IMLN-positive(8.3%,11/132),ALN-positive/IMLN-negative(43.1%,57/132),ALN-negative/IMLN-positive(0.7%,1/132),and ALN-negative/IMLN-negative(47.7%,63/132).The detection rate of internal mam-mary sentinel lymph nodes(IM-SLN)after NAT was 98.5%(132/134);two patients could not undergo IM-SLNB owing to surgical difficulties.Among the 12 cases of IMLN metastasis,6 patients experienced a change in postoperative pathological staging:2 shifted from stage ⅢA toⅢC,2 from stage ⅡB to ⅢC,1 from stage ⅡA to ⅢA,and 1 from stage ⅡA to ⅢC.IMLN metastasis was determined to be an independ-ent risk factor for disease-free survival(DFS)and overall survival(OS)(P<0.05).Patients with IMLN metastasis demonstrated significantly lower DFS and OS than those without IMLN metastasis(P<0.05).Conclusions:The pathological status of both ALN and IMLN should be con-sidered in the axillary pathological response after NAT.Patients with detectable IMLN during surgery after NAT should undergo IM-SLNB to ensure comprehensive lymph node staging.The status of IMLN metastasis following NAT serves as an independent prognostic factor.

Objective To investigate the diagnostic efficacy of targeted biopsy(TB)combined with ipsilateral hemiglandular systematic biopsy(SB)of the dominant lesion,so as to explore a novel reduced-core biopsy strategy.Methods A retrospective analysis was conducted on the clinical data of 299 patients treated in our hospital during Sep.1,2022,and Feb.28,2023,who had a Prostate Imaging Reporting and Data System(PI-RADS)score ≥3 and underwent combined TB and SB.The dominant lesion was defined as the lesion with the highest PI-RADS score on multi-parametric magnetic resonance imaging(mpMRI);in cases of identical scores,the largest was designated as the dominant.SB was categorized as ipsilateral(ipsi-SB)or contralateral(contra-SB)to the dominant lesion.The consistency in detecting clinically significant prostate cancer(csPCa)was compared between TB with ipsi-SB(TB+ipsi-SB),TB with contra-SB(TB+contra-SB),and TB with SB(TB+SB).Subgroup analyses were performed based on PI-RADS score,prostate-specific antigen(PSA)level,prostate volume(PV),and mpMRI lesion distribution to evaluate csPCa detection rates across different variables.Results TB+ipsi-SB demonstrated comparable detection rate to TB+SB(46.2％vs.46.8％).The K values for TB+ipsi-SB and TB+contra-SB relative to TB+SB were 0.987(95％CI:0.969-1.000,P＜0.01)and 0.933(95％CI:0.892-0.974,P＜0.01),respectively.Across all subgroups,TB+ipsi-SB showed the highest agreement with TB+SB.Notably,in subgroups with PI-RADS 3 and 5,PSA＞0-20 ng/mL,PV＜25 mL,bilateral or multiple mpMRI lesions,TB+ipsi-SB achieved complete concordance with TB+SB in csPCa detection[K=1.000(95％CI:1.000-1.000),P＜0.01].Conclusion For patients with PI-RADS score ≥3,TB+ipsi-SB exhibits near-perfect consistency with TB+SB in csPCa detection while requiring fewer biopsy cores.TB+ipsi-SB represents a promising refinement of the TB+SB approach.

Objective This study aims to analyze the characteristics of inpatients in the cardiovascular department of a tertiary hospital following the chest-pain-center accreditation,and provide guidance for the prevention and treatment of cardiovas-cular diseases.Methods A retrospective descriptive epidemiological approach was adopted to analyze the data of 2115 inpatients at the department of cardiovascular medicine in a tertiary hospital from 2022 to 2024 following chest pain center accreditation.Re-sults The number of the inpatients in 2022,2023,and 2024 was 582 cases(27.52％),684 cases(32.34％),and 849 cases(40.14％),respectively,with the total rising year by year.The proportion of males was higher than that of females,with a male-to-female sex ratio of 1.45∶1.The group aged 40 to 79 years accounted for the highest percentage(80.90％).The top three diseases categorized by percentage were coronary heart disease(754 cases,35.64％),hypertension(479 cases,22.64％),and arrhythmia(167 cases,7.89％).Epidemiological characterization exhibited a statistically significant difference in the disease composition of hospitalized cardiovascular patients in years,genders,ages,and seasons(x2=155.40,36.591,900.597,856.659,P＜0.05).Specific classification showed significant differences in hypertension and other conditions by age(P＜0.05);coronary heart disease and valvular heart disease by gender(P＜0.05);and significant differences across ages in coronary heart disease,hypertension,heart failure,pericardial disease,peripheral vascular disease,congenital heart disease,and others(all P＜0.05).Seasonal differences in coronary heart disease,hypertension,arrhythmia,cardiomyopathy,valvular heart disease,heart failure,pericardial disease,and others were also statistically significant(P＜0.05).Conclusion Against the backdrop of chest pain center accreditation in our hospital,inpatients in our department now demonstrate extinct demographic profiles and seasonal patterns among hospitalized cardiovascular patients.We should strengthen the prevention and treatment of coronary heart disease and hypertension,and establish a comprehensive prevention and control system based on these epidemio-logical characteristics.

Background and purpose:Internal mammary sentinel lymph node biopsy(IMSLNB)is a minimally invasive diagnostic technique for regional lymph nodes in breast cancer,which can provide accurate lymph staging and guide adjuvant treatment decision,but its clinical application has been controversial.The purpose of this study was to investigate the prognosis of IMSLNB in early breast cancer.Methods:In this study,a retrospective cohort of 7 949 patients with breast cancer from January 1,2016 to December 31,2021 was analyzed.After applying propensity score matching,the patients were divided into IMSLNB group and no-IMSLNB group,and the regional recurrence-free survival(RRFS),local recurrence-free survival(LRFS),distant metastasis-free survival(DMFS),disease-free survival(DFS)and overall survival(OS)of the two groups were compared.This study was approved by the Clinical Research Ethics Committee of the Affiliated Tumor Hospital of Shandong First Medical University(approval number:SDTHEC20130324).Results:A total of 990 patients were included in the final analysis(330 in the IMSLNB group and 660 in the no-IMSLNB group).IMSLN metastasis was found in 54 patients in the IMSLNB group,including 47 patients with axillary lymph node(ALN)metastasis and 7 patients with IMSLN metastasis only.The IMSLN transfer rate was 16.4%.The median follow-up of 41 months showed that the IMSLNB group demonstrated better 3-year DFS[98.4%vs 94.2%,hazard ratio(HR)=0.509;95%CI:0.312-0.828,P=0.007]and 5-year DFS(92.5%vs 87.3%,HR=0.214,95%CI:0.206-0.222,P=0.011)compared with no-IMSLNB group.However,no significant differences were observed in 3-year OS(99.1%vs 99.4%,HR=0.618,95%CI:0.231-1.655,P=0.338)or 5-year OS(98.5%vs 99.1%,HR=0.52,95%CI:0.51-0.53,P=0.392)between the two groups.The 3-year RRFS in the IMSLNB group was better compared with the no-IMSLNB group(99.09%vs 97.73%,HR=0.066;95%CI:0.061-0.071,P=0.048),while no significant differences were observed in 3-year LRFS(99.70%vs 98.19%,HR=0.209;95%CI:0.201-0.217,P=0.130)or DMFS(95.76%vs 96.06%,HR=0.865,95%CI:0.858-0.872,P=0.820)between the two groups.The exploratory subgroup analysis of DFS revealed that patients in the following subgroups could significantly benefit from IM-SLNB(P＜0.05):diagnosis age(≤50 years),premenopausal status,BMI(≤24),lymphovascular invasion(LVI,present),tumor location(lateral),molecular subtype[hormone receptor positive(HR+)/human epidermal growth factor receptor 2 negative(HER2-)],histological type(invasive ductal carcinoma),and axillary lymph node status(positive).Conclusion:IMSLNB can provide more accurate regional lymph node staging for early breast cancer,help optimize adjuvant radiotherapy strategies,and improve patients'DFS and RRFS.It can be promoted as a minimally invasive staging technique for regional lymph nodes.

Background and purpose:With the progressive development of breast cancer surgery toward more individualized and minimally invasive approaches,sentinel lymph node biopsy(SLNB)has replaced axillary lymph node dissection(ALND)as the standard method for axillary management in certain early-stage breast cancer patients.However,there is ongoing debate in clinical practice regarding whether regional lymph node irradiation(RNI)is necessary for patients with sentinel lymph node(SLN)positive status who have not undergone ALND.This study aimed to analyze the clinicopathological features and survival prognosis of patients with SLN-positive status who did not undergo ALND,evaluate the clinical application value of RNI,and provide evidence to support clinical treatment decisions for this group of patients.Methods:This single-center retrospective study screened breast cancer patients who underwent SLNB at Shandong Cancer Hospital from September 1,2014,to August 31,2023.All patients signed informed consent for treatment.Based on whether postoperative radiotherapy included regional lymph node irradiation(internal mammary and/or axillary and/or supra-/infra-clavicular fields),patients were divided into the RNI group and the no-RNI group for follow-up.Additionally,patients were further divided into multiple subgroups based on factors such as the type of breast surgery,tumor molecular subtype,and histological grade,to compare the clinical value of RNI among subgroups.The primary endpoint was locoregional recurrence-free survival(LRRFS),and the secondary endpoints included invasive disease-free survival(iDFS)and overall survival(OS).The Strengthening the Reporting of Observational Studies in Epidemiology(STROBE)checklist was followed for this study.Results:Clinical data of 8 328 breast cancer patients'were screened for this study,and after applying inclusion and exclusion criteria,356 patients were included in the analysis,with 186 in the RNI group and 170 in the no-RNI group.There were no significant differences between the two groups in terms of age,body mass index(BMI),menopausal status,tumor location,pathological type,histological grade,vascular invasion,estrogen receptor(ER)and progesterone receptor(PR)status,and human epidermal growth factor receptor 2(HER-2)expression(P＞0.05).However,the number of positive SLNs,T stage,and the proportion of patients undergoing total mastectomy(TM)were significantly higher in the RNI group than in the no-RNI group(P=0.006,P=0.043,P＜0.001).After a median follow-up of 38 months,no recurrence or metastasis was observed in the RNI group,while the recurrence and metastasis rate in the no-RNI group was 3.5%(6/170).Of these,4 cases had local regional recurrence,and 2 had distant metastasis.The RNI group showed superior iDFS compared to the no-RNI group(P=0.017),however there was no statistically significant difference in LRRFS and OS(P=0.051 and P=0.356).Exploratory subgroup analysis indicated that patients with tumor diameter＞2 cm(P=0.033)and triple-negative molecular(TNBC)(P=0.020)might benefit from RNI treatment in terms of LRRFS.Conclusion:For certain high-risk patients,such as those with larger tumor diameter,TNBC,or high non-SLN metastatic risk,RNI still plays an important role in reducing the risk of recurrence and metastasis in breast cancer.In clinical practice,an individualized RNI strategy should be developed based on the patient's residual lymph node tumor load,biological behavior of the tumor,and surgical method.

Objective To investigate the diagnostic efficacy of targeted biopsy(TB)combined with ipsilateral hemiglandular systematic biopsy(SB)of the dominant lesion,so as to explore a novel reduced-core biopsy strategy.Methods A retrospective analysis was conducted on the clinical data of 299 patients treated in our hospital during Sep.1,2022,and Feb.28,2023,who had a Prostate Imaging Reporting and Data System(PI-RADS)score ≥3 and underwent combined TB and SB.The dominant lesion was defined as the lesion with the highest PI-RADS score on multi-parametric magnetic resonance imaging(mpMRI);in cases of identical scores,the largest was designated as the dominant.SB was categorized as ipsilateral(ipsi-SB)or contralateral(contra-SB)to the dominant lesion.The consistency in detecting clinically significant prostate cancer(csPCa)was compared between TB with ipsi-SB(TB+ipsi-SB),TB with contra-SB(TB+contra-SB),and TB with SB(TB+SB).Subgroup analyses were performed based on PI-RADS score,prostate-specific antigen(PSA)level,prostate volume(PV),and mpMRI lesion distribution to evaluate csPCa detection rates across different variables.Results TB+ipsi-SB demonstrated comparable detection rate to TB+SB(46.2％vs.46.8％).The K values for TB+ipsi-SB and TB+contra-SB relative to TB+SB were 0.987(95％CI:0.969-1.000,P＜0.01)and 0.933(95％CI:0.892-0.974,P＜0.01),respectively.Across all subgroups,TB+ipsi-SB showed the highest agreement with TB+SB.Notably,in subgroups with PI-RADS 3 and 5,PSA＞0-20 ng/mL,PV＜25 mL,bilateral or multiple mpMRI lesions,TB+ipsi-SB achieved complete concordance with TB+SB in csPCa detection[K=1.000(95％CI:1.000-1.000),P＜0.01].Conclusion For patients with PI-RADS score ≥3,TB+ipsi-SB exhibits near-perfect consistency with TB+SB in csPCa detection while requiring fewer biopsy cores.TB+ipsi-SB represents a promising refinement of the TB+SB approach.

Background and purpose:Internal mammary sentinel lymph node biopsy(IMSLNB)is a minimally invasive diagnostic technique for regional lymph nodes in breast cancer,which can provide accurate lymph staging and guide adjuvant treatment decision,but its clinical application has been controversial.The purpose of this study was to investigate the prognosis of IMSLNB in early breast cancer.Methods:In this study,a retrospective cohort of 7 949 patients with breast cancer from January 1,2016 to December 31,2021 was analyzed.After applying propensity score matching,the patients were divided into IMSLNB group and no-IMSLNB group,and the regional recurrence-free survival(RRFS),local recurrence-free survival(LRFS),distant metastasis-free survival(DMFS),disease-free survival(DFS)and overall survival(OS)of the two groups were compared.This study was approved by the Clinical Research Ethics Committee of the Affiliated Tumor Hospital of Shandong First Medical University(approval number:SDTHEC20130324).Results:A total of 990 patients were included in the final analysis(330 in the IMSLNB group and 660 in the no-IMSLNB group).IMSLN metastasis was found in 54 patients in the IMSLNB group,including 47 patients with axillary lymph node(ALN)metastasis and 7 patients with IMSLN metastasis only.The IMSLN transfer rate was 16.4%.The median follow-up of 41 months showed that the IMSLNB group demonstrated better 3-year DFS[98.4%vs 94.2%,hazard ratio(HR)=0.509;95%CI:0.312-0.828,P=0.007]and 5-year DFS(92.5%vs 87.3%,HR=0.214,95%CI:0.206-0.222,P=0.011)compared with no-IMSLNB group.However,no significant differences were observed in 3-year OS(99.1%vs 99.4%,HR=0.618,95%CI:0.231-1.655,P=0.338)or 5-year OS(98.5%vs 99.1%,HR=0.52,95%CI:0.51-0.53,P=0.392)between the two groups.The 3-year RRFS in the IMSLNB group was better compared with the no-IMSLNB group(99.09%vs 97.73%,HR=0.066;95%CI:0.061-0.071,P=0.048),while no significant differences were observed in 3-year LRFS(99.70%vs 98.19%,HR=0.209;95%CI:0.201-0.217,P=0.130)or DMFS(95.76%vs 96.06%,HR=0.865,95%CI:0.858-0.872,P=0.820)between the two groups.The exploratory subgroup analysis of DFS revealed that patients in the following subgroups could significantly benefit from IM-SLNB(P＜0.05):diagnosis age(≤50 years),premenopausal status,BMI(≤24),lymphovascular invasion(LVI,present),tumor location(lateral),molecular subtype[hormone receptor positive(HR+)/human epidermal growth factor receptor 2 negative(HER2-)],histological type(invasive ductal carcinoma),and axillary lymph node status(positive).Conclusion:IMSLNB can provide more accurate regional lymph node staging for early breast cancer,help optimize adjuvant radiotherapy strategies,and improve patients'DFS and RRFS.It can be promoted as a minimally invasive staging technique for regional lymph nodes.

Objective This study aims to analyze the characteristics of inpatients in the cardiovascular department of a tertiary hospital following the chest-pain-center accreditation,and provide guidance for the prevention and treatment of cardiovas-cular diseases.Methods A retrospective descriptive epidemiological approach was adopted to analyze the data of 2115 inpatients at the department of cardiovascular medicine in a tertiary hospital from 2022 to 2024 following chest pain center accreditation.Re-sults The number of the inpatients in 2022,2023,and 2024 was 582 cases(27.52％),684 cases(32.34％),and 849 cases(40.14％),respectively,with the total rising year by year.The proportion of males was higher than that of females,with a male-to-female sex ratio of 1.45∶1.The group aged 40 to 79 years accounted for the highest percentage(80.90％).The top three diseases categorized by percentage were coronary heart disease(754 cases,35.64％),hypertension(479 cases,22.64％),and arrhythmia(167 cases,7.89％).Epidemiological characterization exhibited a statistically significant difference in the disease composition of hospitalized cardiovascular patients in years,genders,ages,and seasons(x2=155.40,36.591,900.597,856.659,P＜0.05).Specific classification showed significant differences in hypertension and other conditions by age(P＜0.05);coronary heart disease and valvular heart disease by gender(P＜0.05);and significant differences across ages in coronary heart disease,hypertension,heart failure,pericardial disease,peripheral vascular disease,congenital heart disease,and others(all P＜0.05).Seasonal differences in coronary heart disease,hypertension,arrhythmia,cardiomyopathy,valvular heart disease,heart failure,pericardial disease,and others were also statistically significant(P＜0.05).Conclusion Against the backdrop of chest pain center accreditation in our hospital,inpatients in our department now demonstrate extinct demographic profiles and seasonal patterns among hospitalized cardiovascular patients.We should strengthen the prevention and treatment of coronary heart disease and hypertension,and establish a comprehensive prevention and control system based on these epidemio-logical characteristics.