A prognostic index for ductal carcinoma in situ of the breast

Selection and clinical significance of individualized treatment for metastatic liver cancer

The liver is one of the most common target organs for metastasis of malignant tumors, with a metastasis rate of 11.1%. Approximately 40% of patients with malignant tumors will develop liver metastasis. Metastatic liver cancer not only exhibits individualized difference in the origin of primary tumor, tumor gene, and biological behavior, but also varies in the stage of progression, anatomic characteristics, organ function, and complications. In view of the different sources and pathways of metastatic tumors, the treatment of metastatic liver cancer involves two aspects: primary tumor and liver metastasis. How to choose surgery, local ablation, chemotherapy, molecular targeted drugs, endocrine therapy, biological and immune therapy, and radiotherapy as well as the treatment opportunity rationally is the key to the treatment of metastatic liver cancer. Advanced imaging techniques are used to determine the size, number, location, and blood supply of metastatic liver cancer, so as to provide an objective basis for making an accurate individualized treatment plan for metastatic liver cancer. At present, any single therapy for metastatic liver cancer has its own indications. If a metastatic liver tumor cannot be resected radically , the use of a single therapy is difficult to cure or control the progression of the tumor. In this case, it is necessary to combine two or more than two kinds of treatment methods to achieve the synergistic effect. According to the specific condition of patients with metastatic liver cancer, the individual characteristics of the patients should be analyzed by experienced clinicians to formulate an individualized treatment plan in accordance with the principles of evidence-based medicine, so as to make the patients benefit most from the plan, improve the quality of life, and prolong the survival time.

Main controversies in breast cancer

In this article, we have reviewed available evidence for diagnosis, treatment, and follow-up in female breast cancer (BC). Into daily clinical practice some controversies are occurred. Especially, in the diagnosis field, despite the fact that the optimal age in which screening mammography should start is a subject of intense controversy, there is a shift toward the beginning at the age of 40 although it is suggested that the net benefit is small for women aged 40 to 49 years. In addition, a promising tool in BC screening seems to be breast tomosynthesis. Other tools such as 3D ultrasound and shear wave elastography (SWE) are full of optimism in BC screening although ultrasonography is not yet a first-line screening method and there is insufficient evidence to recommend the systemic use of the SWE for BC screening. As for breast magnetic resonance imaging (MRI), even if it is useful in BC detection in women who have a strong family history of BC, it is not generally recommended as a screening tool. Moreover, based on the lack of randomized clinical trials showing a benefit of presurgical breast MRI in overall survival, it's integration into breast surgical operations remains debatable. Interestingly, in contrast to fine needle aspiration, core biopsy has gained popularity in presurgical diagnosis. Furthermore, after conservative surgery in patients with positive sentinel lymph nodes, the recent tendency is the shift from axillary dissection to axillary conserving strategies. While the accuracy of sentinel lymph node after neoadjuvant chemotherapy and second BC surgery remains controversial, more time is needed for evaluation and for determining the optimal interval between the two surgeries. Additionally, in the decision between immediate or delayed breast reconstruction, there is a tendency in the immediate use. In the prevention of BC, the controversial issue between tamoxifen and raloxifene becomes clear with raloxifene be more profitable through the toxicities of tamoxifen. However, the prevention of bone metastasis with bisphosphonates is still conflicting. Last but not least, in the follow-up of BC survivors, mammography, history and physical examination are the means of an early detection of BC recurrence. ed.

Liver blood supply after a modified Appleby procedure in classical and aberrant arterial anatomy

Reported here are two cases of a modified Appleby operation for borderline resectable ductal adenocarcinoma of the pancreatic body, in one of which a R0 distal resection was attended to by excision, not only of the celiac axis, but also of the common and left hepatic arteries in the presence of arterial anatomic variation Michels, type VIIIb. The possibility and avenues of the maintenance of the blood supply to the left hepatic lobe after surgical aggression of this kind are demonstrated employing computed tomography (CT) and 3-D CT angiography. Furthermore, both cases highlight all important worrisome aspects of pancreatic cancer resectability prediction.