Endoscopic technique is one of the important development directions of modern surgical techniques. Compared with the laparoscopic and thoracoscopic surgery, the development of endoscopic technology in breast surgery is generally slow due to the limitation of the physiological structure of this organ. The characteristics of endoscopic technology such as micro-incision trauma and remote operation are especially suitable for breast (cancer) surgery, which desires flawless skin surface and perfect remodeling. In the meantime, however, the obstacles of breast (cancer) endoscopic surgery include the establishment and maintenance of a satisfactory surgical field, the endoscopic exposure of large and heavy glands, the obstruction by the slope of the skeletal thorax, the remote operation that is difficult to accomplish with conventional endoscopic instruments, and the complete removal of large and tough glands and so on. By studying and pondering the experience of the pioneers of endoscopy, the endoscopic team of West China Hospital took five years to develop this novel one axillary-incision, single-port and liposuction-free endoscopic surgical approach which is low costing and only requires one-port operation platform. The original “inverse sequence method”, “Huaxi hole no. 1, 2, 3” and other endoscopy-assisted approach overcome the aforesaid obstacles. It has significantly reduced the technical threshold and operational difficulty of breast (cancer) endoscopic surgery and contributed our own wisdom to the vigorous development of breast endoscopic technology in China. The author shared her observations and thoughts on the technical details of breast endoscopic surgery based on her nearly 20 years of experience in endoscopic operation.
ObjectiveTo study the application of artificial intelligence based on neural network in breast cancer screening and diagnosis, and to summarize its current situation and clinical application value.MethodThe combined studies of neural network and artificial intelligence in the directions of breast mammography, breast ultrasound, breast magnetic resonance, and breast pathology diagnosis in CNKI and PubMed database were reviewed.ResultsPublic databases of mammography, such as Digital Database for Screening Mammography (DDSM), provided raw materials for the research of neural network in the field of mammography. Mammography was the most widely used data for screening and diagnosis of breast diseases by neural network. In the field of mammography and color doppler ultrasound, neural network could segment, measure, and analyze the characteristics, judge the benign or malignant, and issue a structured report. The application of neural network in the field of breast ultrasound focused on the diagnosis and treatment of benign and malignant breast diseases. Samsung Madison Group taken the lead in grafting research results into ultrasound instruments. Breast MRI had a lot of high-throughput information, which had became the breakthrough point for the joint study of artificial neural network and imaging omics. Pathological images had more data information to be measured, and quantitative analysis of data was the advantage of neural network. The combination of the two kinds of methods could significantly improve the diagnosis time of pathologists.ConclusionsTo study the application of artificial intelligence in breast cancer screening and diagnosis is to analyze the application of neural network in breast imaging and pathology. At present, artificial intelligence screening can be used as a physician assistant and an objective diagnostic reference assistant, to improve the diagnosis of breast disease. With the development of medical image histology and neural network, the application of artificial intelligence in medical field can be extended to surgical method design, efficacy evaluation, prognosis analysis, and so on.
Malignant melanoma is a kind of highly malignant tumor, which mainly occurs in the skin, mucous membrane, and rarely in the breast. Here we reported a case of malignant melanoma in the chest wall skin with mammary metastasis. A sizable pigment spot on the skin of the thoracic region was found at the patient’s birth, existing for 50 years with quite atypical clinical manifestation. A nodule at 12 o’clock of the left breast was found by ultrasound four months ago, who was mistaken for a fibroadenoma. As a result, the patient received a minimally invasive excision of the breast lesion, after which the pathological report suggested malignant melanoma. By sharing this case, we aimed to discuss the diagnosis and treatment of this kind of atypical malignant melanoma in detail and provide some clinical experience.
ObjectiveTo summarize the burden and epidemiological trends of global breast cancer and China’s breast cancer according to the 2018, 2020 and 2022 versions of the global cancer statistics report jointly prepared by the International Cancer Research Institute of the World Health Organization and the American Cancer Society. MethodThe data of global and Chinese breast cancer in the 2018, 2020, 2022 edition of the Global Cancer Statistical Report were analyzed. ResultsIn 2022, the global new breast cancer was estimated to be about 2.309 million, ranking the second. The crude incidence rate of breast cancer was 54.1 per 100 000, and the age standardized incidence rate (ASIR) was 46.8 per 100 000. In 2022, the global breast cancer death would be about 666 000, ranking the fourth, with the crude mortality rate of 11.3 per 100 000, age standardized mortality rate (ASMR) was 12.6 per 100 000. The incidence rate and mortality rate of breast cancer vary greatly between regions/countries, and were related to the human development index; the crude incidence rate was high in economically developed regions, and the crude mortality rate was relatively increasing, but the ASMR was low. In economically underdeveloped areas, the crude incidence rate was relatively low, and the crude mortality rate was relatively decreasing, but ASMR was high. In 2022, the number of breast cancer patients in China would be 357 000, ranking the fourth, with a crude incidence rate of 51.7 per 100 000 and an ASIR of 33.0 per 100 000. In 2022, there would be about 75 000 deaths from breast cancer in China, ranking the seventh, with a crude mortality rate of 10.9 per 100 000 and an ASMR of 6.1 per 100 000. From 2018 to 2022, the incidence rate and mortality rate of breast cancer in China show a downward trend. ConclusionsBoth the world and China are facing a severe burden of breast cancer, and breast cancer prevention and treatment has a long way to go.
Objective To review the research progress of adipose-derived stem cells (ADSCs) in skin wound healing. Methods The recent experiments and clinical studies on the role of ADSCs in skin wound healing were extensively retrieved and analyzed. Additionally, possible mechanisms and novel application strategies were proposed. Results As confirmed by in vitro and in vivo experiments and clinical studies, ADSCs promote skin wound healing mainly by two mechanisms: differentiation to target cells that participate in skin wound healing and cytokines paracrine to promote proliferation and migration of various cell lines that are mandatory to promote skin wound healing. Moreover, scaffold materials and cell sheet technology may further add to the potency of ADSCs in promoting skin wound healing. Conclusion Remarkable progress has been made in the application of ADSCs in skin wound healing. Further studies are needed to explore the application methods of ADSCs.
Objective To summarize the description about the pure noninvasive breast carcinoman in guidelines. Methods The related guidelines and literatures about the pure noninvasive breast carcinoma were collected to make a review. Results Through reviewing the guidelines of breast carcinoma, including Chinese Anti Cancer Association (CACA), National Comprehensive Cancer Network (NCCN), St.Gallen, European Society for Medical Oncology Clinical Practice Guidelines for Diagnosis, Treatment and Follow-up, as well as Japanese Breast Cancer Society Clinical Practice Guideline, we find that, the main treatment of noninvasive breast carcinoma is operation and the surgery for axillary is not recommended by most guidelines. The sentinel lymph node biopsy (SLNB) should be performed only when the invasive ductal carcinoma (IDC) is suspected or location of lesion would decrease the success of SLNB in the future. The radiotherapy should be advised to patients following conservation surgery. The patients with estrogen receptor (ER)-positive should undergo endocrine therapy. However, the using of endocrine therapy should be discussed with patient. Conclusions Although the prognosis of pure noninvasive breast carcinoma is better than invasive cancer, the research about it is still less, and the treatments recommended by guidelines are different. The more attention should be paid to the research about the pure noninvasive carcinoma.
Objective To summarize current research status of sperm protein 17 (SP17) in breast cancer. Method Bysearching PubMed, Web of Science, CNKI, and Wanfang databases, the studies about expression and function of SP17 in the breast cancer were summarized. Results SP17 only expressed in the breast cancer tissue but not in the normal breast tissue. The result of the study showed that SP17 was only detected in the metastatic stage of tumor cells. The preclinical trails found that the breast cancer cells with SP17 positive expression could be killed by the specific T lymphocyte. Conclusions SP17 might be a potential target of immunotherapy of breast cancer, it might promote metastasis of cancer. More studies are needed to further explore its function in tumor development, thus accelerate its application in clinical practice.
Objective To summarize the research progress of pathogenetic and development mechanism of phyllodes tumor of breast (PTB). Method Summarizing the studies on pathogenetic and development mechanism of PTB by searching PubMed, Web of Science, CNKI, and Wanfang databases, and then make a review. Results Currently, there was no uniform conclusion on the pathogenetic and development mechanism of PTB, though many factors may involve in the pathogenesis of PTB. PTB may be derived from fibroadenoma, and some studies suggested that it was closely related to hormonal receptor disorders, epithelial mesenchymal transition mechanism, gene mutation, and so on. Conclusion The pathogenetic and development mechanism of PTB is not clear yet and more researches are needed to confirm it.
ObjectiveTo explore the research progress of the cell sources and related signaling pathways of the wound-induced hair follicle neogenesis (WIHN) in recent years.MethodsThe literature related to WIHN in recent years was reviewed, and the cell sources and molecular mechanism were summarized and discussed.ResultsCurrent research shows that WIHN is a rare regeneration phenomenon in the skin of adult mammals, with multiple cell origins, both hair follicle stem cells and epithelial stem cells around the wound. Its molecular mechanism is complicated, which is regulated by many signaling pathways. Besides, the process is closely related to the immune response, the immunocytes and their related cytokines provide suitable conditions for this process.ConclusionThere are still many unsolved problems on the cellular origins and molecular mechanisms of the WIHN. Further study on the mechanisms will enhance the understanding of adult mammals’ hair follicle regeneration and may provide new strategy for functional healing of the human skin.
ObjectiveTo develop mobile phone terminal application software using artificial intelligence (AI) model of breast ultrasound so as to provide an opportunity for early diagnosis of patients with breast cancer irrespective of time and space. MethodsThe ultrasonic electronic images of patients underwent operation in the Department of Breast Surgery of West China Hospital of Sichuan University from January 2018 to April 2019 were collected. The neural network deep learning algorithm was used to train and test the breast ultrasonic electronic images at a ratio of 4∶1 to establish DeepBC model, and a mobile phone terminal application software was developed according to the trained DeepBC model, which included image reconstruction module, image classification module, and missed diagnosis module to identify and diagnose the uploaded ultrasonic electronic images. Results A total of 4 128 ultrasonic electronic images were collected in this study, including 3 302 in the training set and 826 in the test set. The accuracy, sensitivity, specificity, false positive rate, and false negative rate of the DeepBC model for the identification of malignant and non-malignant lesions in the breast ultrasound images were 93.70%, 93.10%, 94.08%, 5.92%, and 6.90%, respectively. The optimal cut-off value was 92.31% by receiver operating characteristic curve of DeepBC model and the area of receiver operating characteristic curve was 0.987. The DeepBC mobile phone terminal application software was developed according to the DeepBC model, and the web page was released in the mobile wechat. So far, more than 10 000 people had uploaded ultrasonic electronic images on the wechat web page, and the diagnosis had exceeded 30 000 times. ConclusionsIn this study, an AI DeepBC model is established successfully based on ultrasonic electronic images, each module of mobile phone terminal application software runs well and independently. And web page is simple and contents are easy to be comprehended.