Abstract:The 2018 China South Breast Cancer Symposium was held in Guangzhou from 21 to 22 December 2018. In this symposium, numerous issues regarding the neoadjuvant chemotherapy of breast cancer were extensively communicated and discussed, and some preliminary agreements were reached. It is believed that this symposium will provide help for the relevant clinical works in the future.

Abstract:For promoting and standardizing the development of ambulatory anorectal surgery, the National Clinical Research Center for Geriatric Disorders (Xiangya) and China Ambulatory Surgery Alliance, by organizing the experts in relevant fields, developed the Clinical Practice Guideline for Ambulatory Anorectal Surgery (2019), based on accordance with the literature and domestic actual situation and then after a full discussion. It is hoped that this guideline will take a leading role in promoting the development of ambulatory anorectal surgery in China.

Abstract:After improvement, innovation and development by the team of Ge Minghua and Zheng Chuanming, the endoscopic thyroidectomy by a gasless unilateral axillary approach is a safe and feasible endoscopic procedure with an excellent cosmetic result. Here, the authors provide a concrete description in terms of how to easily master this operation, how to perform the standardized operative steps of the procedure and the attention points.

Abstract:Triple-negative breast cancer (TNBC) has special epidemiological and biological characteristics. Due to the lack of specific therapeutic targets, there is currently no standard chemotherapy regimen resulting in poor therapeutic response and dismal overall outcomes in the recurrence and metastasis stage. In recent years, with the continuous studies in terms of homologous recombination repair, tumor immunotherapy and new targeted drugs, certain achievements have been attained in the field of basic and clinical research concerning systemic treatment of advanced TNBC, which provide new insights for precise treatment of recurrent or metastatic TNBC.

Abstract:Objective: To assess the diagnostic value of ultrasound-guided fine needle aspiration (US-FNA) cytological examination for thyroid nodules and the influential factors.
Methods: The clinical data of patients with thyroid nodules (2 380 nodules) undergoing thyroidectomy between January 2016 and December 2018 were retrospectively analyzed. Using the postoperative pathological results as reference standard, the diagnostic efficiency of US-FNA for thyroid nodules was calculated, and the influences of ultrasound features and nodule size on the diagnosis were also analyzed.
Results: Among the 2 380 nodules, 133 were diagnosed as benign nodule (Bethesda II) and 1 468 were diagnosed as malignant nodule (Bethesda VI), in which 1 534 were consistent with the pathological results. The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of US-FNA in diagnosis of thyroid nodules were 98.0% (95% CI=97.3%–98.7%), 73.2% (95% CI=65.9%–80.5%), 97.4% (95% CI=96.6%–98.2%), 78.2% (95% CI=71.2%–85.2%) and 95.8% (95% CI=94.8%–96.8%), respectively. Both false positive and false negative rates of US-FNA diagnosis for thyroid nodules with diameter ≤10 mm were higher than for those with diameter >10 mm, and the false negative rates of US-FNA diagnosis for thyroid nodules with ultrasound appearance of absence of microcalcification or vascular flow were increased, while the false positive rate of US-FNA diagnosis for hypoechoic nodules was increased (all P<0.05).
Conclusion: US-FNA is of high value in the differential diagnosis of thyroid nodules, and it is easy to operate and less traumatic, so it deserves to be widely used. However, the false positive and negative results should be taken into account in nodules with diameter >10 mm or nodules without microcalcification or vascular flow as well as the hypoechoic nodules.

Abstract:Objective: To investigate the clinical value of dissection of the lymph nodes posterior to the right recurrent laryngeal nerve (VIb level) during surgery for papillary thyroid carcinoma (PTC).
Methods: A total of 238 patients with PTC were enrolled as study subjects. The patients were clinically staged as cN1 in 35 cases and cN0 in 203 cases. All patients underwent thyroidectomy and central lymph node dissection (CLND). The cervical lymph node metastases of the patients and the risk factors for VIb lymph node metastasis were analyzed, and the postoperative prognosis of the patients were also observed.
Results: Among the 238 PTC patients, VIa lymph node metastasis occurred in 108 cases, VIb lymph node metastasis occurred in 67 cases, and lateral cervical lymph node metastasis occurred in 24 cases. The incidence of cervical lymph node metastases in cN1 patients was significantly higher than that in cN1 patients (94.29% vs. 46.31%, P<0.05). Results of univariate and multivariate factors showed that the maximum tumor diameter, tumor infiltration, lymph node staging, number of tumors and VIa lymph node metastasis were influential factors for VIb lymph node metastasis (all P<0.05). No injury of recurrent laryngeal nerve occurred after operation. The 3-year recurrence rate of the patients was 3.4% and the median time to recurrence was 26.3 months.
Conclusion: The maximum tumor diameter, tumor infiltration, lymph node staging, number of tumors and VIa lymph node metastasis are risk factors for VIb lymph node metastasis. In CLND, the VIb subregion should be removed as completely as possible, especially for those with the above risk factors.

Abstract:Objective: To investigate the risk factors for central lymph node metastasis (CLNM), especially the large -volume metastasis (LV-LNM, number of metastatic lymph nodes >5) in patients with cN0 papillary thyroid microcarcinoma (PTMC). 
Methods: The clinical data of 512 patients with cN0 PTMC undergoing total thyroidectomy or lobectomy plus isthmusectomy plus prophylactic central neck dissection were retrospectively analyzed, and the patients were divided into LV-LNM group and non-LV-LNM group according to the number of CLNM. The risk factors for CLNM and LV-LNM in patients with cN0 PTMC were identified.
Results: Of the 512 patients, 415 cases (81.1%) were females and 97 cases (18.9%) were males; CLNM occurred in 178 cases (34.8%) and LV-LNM was found in 21 cases (4.1%). Univariate analysis showed that sex, age, tumor size, multiple lesions, extrathyroidal invasion and BRAFV600E mutation were significantly associated with CLNM (all P<0.05); sex, multiple lesions and extrathyroidal invasion were significantly associated with LV-LNM (all P<0.05). Multivariate analysis identi?ed that males (OR=1.451, 95% CI=1.030–2.044, P=0.033), age <40 years (OR=1.720, 95% CI=1.289–2.295, P=0.000), tumor size >0.5 cm (OR=1.677, 95% CI=1.218–2.309, P=0.002), multiple lesions (OR=1.872, 95% CI=1.384–2.532, P=0.000) were risk factors for CLNM; males (OR=2.852, 95% CI=1.773–4.588, P=0.000), age <40 years (OR=1.913, 95% CI=1.434–2.552, P=0.000) and multiple lesions (OR=1.579, 95% CI=1.161–2.148, P=0.004) were risk factors for LV-LNM.
Conclusion: Sex, age, tumor size and multifocality are risk factors for CLNM in PTMC patients. Prophylactic central neck dissection should be aggressively performed in males and those with age <40 years or multiple lesions, because these patients may be more prone to LV-LNM.

Abstract:Objective: To investigate the influence of endoscopic thyroidectomy on the voice and swallowing function of patients after surgery for thyroid tumor performed under effective protection of the recurrent laryngeal nerve.  
Methods: The clinical data of 205 patients undergoing thyroid surgery from January 2017 to June 2018 were retrospectively analyzed. Of the patients, 115 cases underwent endoscopic thyroid surgery via areolar approach (endoscopic group) and 90 cases underwent open thyroid surgery (open group), and all cases were subjected to subtotal or total unilateral lobectomy plus intraoperative nerve monitoring. The changes in voice and swallowing function in the two groups of patients before and after surgery were analyzed by using both subjective and objective evaluation indexes. Subjective evaluation indexes included voice disturbance index scale (VHI), voice GRBAS classification and swallowing disorder score (SIS); the objective indicators included the fundamental frequency (F0), fundamental frequency perturbation (jitter), amplitude perturbation (shimmer), and maximum vocalization time (MPT).
Results: In terms of subjective evaluation indexes, voice and swallowing disorders occurred in some of the patients in both groups at 1 month after surgery; all of the patients in open group with voice and swallowing disorders recovered to the normal states, while some patients in endoscopic group remained with swallowing disorders at 3 months after surgery; the incidence rates of swallowing disorders at 1 month and 3 months after surgery in endoscopic group were higher than those in open group (both P<0.01). As for objective evaluation indicators, the F0 values were decreased in both groups of patients at 1 month after surgery compared with the preoperative value (both P<0.05), but all recovered to the normal states at 3 months after surgery. No significant changes in jitter, shimmer and MPT occured in both groups of patients at 1 month and 3 months after surgery compared with their preoperative values (all P>0.05).
Conclusion: Voice and swallowing disorders will occur in some patients after either endoscopic or open thyroid surgery, which in most cases will recover within 3 months after surgery. The time to swallowing function recovery is relatively prolonged in patients following endoscopic surgery, which may be probably associated with neck adhesion and fixation after operation.

Abstract:Objective: To investigate the relationship between immune cell infiltration and postoperative recurrence of differentiated thyroid cancer.
Methods: The clinical data of 507 patients were downloaded from the TCGA database. The infiltrations of 22 different kinds of immune cells in the cancer tissues were estimated by deconvolution method, and the relationship between the degree of infiltration of each kind of immune cells and postoperative recurrence of the patients was analyzed by survival analysis. 
Results: The analysis of deconvolution showed that except the naive CD4 T was absent in all specimens, all the other 21 kinds of immune cells had varied degrees of infiltration in all specimens. The analysis of Kaplan-Meier survival curves and Log-rank tests showed that only the activated NK cell infiltration was significantly associated with the disease-free survival of the patients, as evidenced by the disease-free survival time in patients with high degree of activated NK cell infiltration was significantly longer than that in patients with low degree of activated NK cell infiltration (P=0.004). Multivariate Cox regression risk model showed that the degree of activated NK cell infiltration was an independent influential factor for postoperative recurrence of differentiated thyroid cancer (HR=0.17, 95% CI=0.05–0.62, P=0.007). 
Conclusion: Activated NK cells can reduce the risk of postoperative recurrence of differentiated thyroid cancer and prolong the disease-free survival of patients, which is an independent protective factor against postoperative recurrence of differentiated thyroid cancer.

Abstract:Objective: To investigate the expression of long non-coding RNA CBR3-AS1 (CBR3-AS1) in breast cancer and its function.  
Methods: The expressions of CBR3-AS1 in 70 paired specimens of breast cancer tissue and adjacent tissue as well as in different breast cancer cell lines (MCF-7, MDA-MB-453 and SKBR3) and normal mammary epithelial cell line (HS578Bst) were detected by qT-PCR. The relations of CBR3-AS1 expression with the clinicopathologic variables and prognosis of the breast cancer patients were analyzed. The breast cancer SKBR3 cells were transfected with CBR3-AS1 interfering sequences (interference group), CBR3-AS1 mimics (overexpression group) and negative control sequences (negative control group) respectively, and then, the proliferative viability and apoptosis of cells of each group after transfection were determined by MTT assay and flow cytometry, respectively.
Results: The relative expression level of CBR3-AS1 was significantly increased in breast cancer tissue or each studied breast cancer cell line compared with tumor adjacent tissue or normal mammary epithelial cell line (all P<0.01). The CBR3-AS1 expression in breast cancer tissue was significantly associated with TNM stage (P=0.003), lymph node metastasis (P=0.047) and distant metastasis (P=0.024). The 3-year disease-free survival and overall survival rates in patients with high CBR3-AS1 expression were significantly lower than those in patients with the low CBR3-AS1 expression (53.3% vs. 70.7%, P=0.003 2; 62.8% vs. 78.4%, P=0.005 7). Compared with negative control group, the proliferative viability was significantly reduced and apoptosis rate was significantly increased in cells of interference group, while the proliferative viability was significantly increased and apoptosis rate was significantly reduced in cells of overexpression group (all P<0.01). 
Conclusion: The CBR3-AS1 expression is up-regulated in breast cancer and is closely related to the unfavorable clinicopathologic features and poor prognosis of breast cancer patients. The mechanism may probably be associated with its promoting proliferation and inhibiting apoptosis of breast cancer cells.

Abstract:Objective: To investigate the clinicopathologic features and prognosis as well as the relevant influential factors of primary breast angiosarcoma.
Methods: According to the inclusion and exclusion criteria, the data of patients with primary breast angiosarcoma were downloaded from the SEER database. The clinicopathologic characteristics and survival status of the patients were analyzed. The influential factors for prognosis were determined by univariate and multivariate Cox regression analysis.
Results: Of the selected 166 patients with primary breast angiosarcoma, 55.4% (92/166) were women under 53 years old, 75.9% (126/166) had no metastasis at diagnosis, 97.0% (161/166) underwent surgery, 34.3% (57/166) received radiotherapy, and 31.3% (52/166) received chemotherapy. The 1-year overall survival rate of the entire group was 85.47%. The survival rates were significantly different among patients with different ages, stages, degrees of differentiation and tumor sizes and undergoing different surgical procedures as well as between patients with single primary tumor and multiple primary tumors (all P<0.05). Univariate analysis showed that age, differentiation, stage, multiple primary tumors, surgical procedure, and the maximum diameter of the lesion were significantly associated with the prognosis of the patients with primary breast angiosarcoma (all P<0.05). Multivariate analysis revealed that old age, poor differentiation, advanced stage, multiple primary cancers, and high tumor load were independent risk factors for prognosis of the patients with primary breast angiosarcoma (all P<0.05).
Conclusion: Primary breast angiosarcoma has an unfavorable prognosis, and early diagnosis and treatment of primary breast angiosarcoma can reduce tumor progression and improve prognosis. Adjuvant radiotherapy and chemotherapy exert no significant effect on prognosis of the patients.

Abstract:Objective: To assess the application efficacy of titanium-coated polypropylene mesh (TCPM) in immediate breast reconstruction with silicone prosthesis after surgery for breast cancer.  
Methods: The clinical data of 26 patients with breast cancer undergoing immediate breast reconstruction using TCPM combined with silicone prosthesis from 2016 to 2018 were retrospectively analyzed. Of the patients, skin sparing total mastectomy was performed in 7 cases, and nipple sparing total mastectomy was performed in 19 cases. The surgical variables, postoperative outcome, complications and long-term follow-up results were analyzed.
Results: Operations were successfully completed in all of the 26 patients. The average operative time was (78.46±5.96) min, average intraoperative blood loss was (73.85±17.68) mL, and the time to postoperative tube removal was 10–14 d. The excellent/good rate of the appearance of the reconstructed breast reached 88.46% (23/26). Dorsal hematoma occurred in 3 cases immediately after operation, which were improved after drainage. Poor incision healing occurred in one case after operation, which was improved by anti-inflammatory treatment, dressing change and re-suture. Recurrent spontaneous seroma occurred in one case on 3 and 5 months after operation, which was relieved by drainage. The prosthesis and mesh were removed in one case due to rejection. Followed-up was performed for 5 to 21 months in all patients, and no local recurrence or distant metastasis was found in any of the patients.
Conclusion: In breast reconstruction with silicone prosthesis, TCPM can provide safe and effective prosthesis coverage and simplify the operation process. It is suitable for use in patients who have favorable economic conditions.

Abstract:Objective: To investigate the value of changes in apparent diffusion coefficient (ADC) of diffusion-weighted MRI imaging for predicting the efficacy of neoadjuvant chemotherapy in breast cancer.  
Methods: The clinical data of 80 patients with locally advanced breast cancer treated from January 2017 to December 2018 were retrospectively analyzed. The breast cancer in all patients was confirmed by hollow needle aspiration. All patients underwent neoadjuvant chemotherapy, and routinely underwent MRI examination before neoadjuvant chemotherapy and before surgery. The relationship between the changes in tumor ADC values (ΔADC) and pathological response (MP grade) were analyzed. The effectiveness of ΔADC in estimating the efficacy of neoadjuvant chemotherapy was determined by the ROC curve.
Results: In the entire group of patients, the ADC value of tumors after chemotherapy was significantly higher than that before chemotherapy (1.27×10–3 mm2/s vs. 0.98 ×10–3 mm2/s, P=0.000). The cancer type-stratified analysis showed that except of no statistical difference between ADC values before and after neoadjuvant chemotherapy in triple negative breast cancer (P>0.05), the ADC values after chemotherapy was significantly higher than those before chemotherapy in all the remaining types of breast cancer (all P<0.05). The ΔADC value in patients with major histological response was significantly higher than that in those without significant histological response (0.448×10–3 mm2/s vs. 0.209×10–3 mm2/s, P=0.004). The area under ROC curve of ΔADC in estimating the efficacy of breast cancer neoadjuvant chemotherapy was 0.72, with the sensitivity of 73.1% and specificity of 66.7%. When the cutoff value ΔADC value was 0.239×10–3 mm2/s, the positive predictive value was 51.4%, negative predictive value was 83.7% and the accuracy was 68.8%.
Conclusion: In most types of breast cancer, the changes in ADC has certain value for early predicting and evaluating the treatment response of neoadjuvant chemotherapy.

Abstract:Objective: To investigate the efficacy and safety of neoadjuvant chemotherapy with epirubicin plus paclitaxel (E+T) in patients undergoing breast conserving surgery for breast cancer. 
Methods: One-hundred and seven female patients with 107 patients with stage IIa-IIIa primary breast cancer admitted from January 2014 to January 2018 were enrolled. All patients received 3-week E+T neoadjuvant chemotherapy before breast-conserving surgery, and all patients underwent detection of the expressions of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER-2), Ki-67, p53 and Bcl-2 in the hollow needle aspiration specimens before neoadjuvant chemotherapy. The clinical and pathological outcomes were assessed, and the toxic and adverse effects were evaluated.
Results: All patients completed 4 or 6 courses of 3-week E+T neoadjuvant chemotherapy before operation, and the tumor stage was downgraded to stage IIb in 5 stage IIIa patients after chemotherapy. All patients underwent breast-conserving surgery 12-16 d after neoadjuvant chemotherapy. The clinical effective rate was 89.72%, the pathological complete response (pCR) rate was 17.76%, and the negative conversion rate of the axillary lymph nodes (ALN) was 54.76%. There were significant differences in pCR rates between patients with positive and negative expressions of ER, PR, Ki-67 and p53 (all P<0.05), but no significant differences in pCR rates between patients with positive and negative expressions of HER-2 and Bcl-2 (both P>0.05). All toxic effects were tolerable, except for degree IV leukopenia in 5 cases and degree IV neutropenia in 5 cases. Eighty-six patients were followed up for 12-60 months, recurrence and metastasis occurred in 19 cases, death occurred in 6 cases, and contralateral breast cancer occurred in 2 cases, while the remaining patients recovered well.
Conclusion: In breast cancer patients undergoing breast-conserving surgery, higher pCR rate can achieved by neoadjuvant chemotherapy of E+T regimen with tolerable toxic and adverse reactions. ER, PR, Ki-67, p53 can be used as efficacy predictors for E+T neoadjuvant chemotherapy.

Abstract:With over 22 years of continuous development and innovation, totally endoscopic thyroidectomy has proved to be safe and feasible, and its minimal invasiveness and cosmetic benefit are beyond doubt. However, due to the narrow operation space of complete endoscopic thyroidectomy, rich blood supply of the thyroid gland, and being adjacent to the recurrent laryngeal nerve, superior laryngeal nerve, parathyroid glands, trachea, esophagus, lymphatic vessels and other important tissue structures, a series of serious associated complications may easily arise from unskilled operation. Particularly, some rare complications with low incidence in clinical practice, not specifically described in textbooks and rarely reported in domestic and foreign literature, such as delayed hemorrhage, chyle leakage, esophageal and tracheal injury, pneumothorax, CO2 embolism, are often overlooked and this results in delays in treatment. Once they occur, however, the consequences are always extremely serious. Therefore, based on the review of the literature and in combination with the clinical progress of thyroid surgery at home and abroad, the authors address the causes and prevention strategies for the rare complications of totally endoscopic thyroid surgery.

Abstract:The incidence rates of thyroid carcinoma have been on a rise in children and adolescents. Thyroid carcinoma in this population presents a higher degree of malignancy, but a longer survival period compared with adult patients. The main clinical manifestations include neck mass and hoarseness. Diagnostic methods include ultrasound, fine needle cytology and molecular diagnosis. The treatment methods include surgery, endocrine therapy, 131I therapy and targeted drug therapy, among which surgery is the main treatment option. The authors address research progress in thyroid cancer in children and adolescents in combination with items proposed by the guidelines.

Abstract:Inflammatory breast cancer is a rare type of breast cancer with low incidence, very high malignancy and rapid clinical progress. Despite that the prognosis of inflammatory breast cancer has been greatly improved, its 5-year survival rate is still less than 50%. There are many difficulties and challenges in diagnosis and treatment of inflammatory breast cancer. In this paper, the authors extract the current status and research progress of inflammatory breast cancer in terms such as epidemiology, pathobiology, imaging diagnosis and multi-disciplinary comprehensive treatment, so as to provide references for clinical choice.