ObjectiveTo explore the influence of sentinel lymph node (SLN) status on the prognosis of elderly breast cancer patients ≥70 years old, and to screen patients who may be exempted from sentinel lymph node biopsy (SLNB), so as to guide clinical individualized treatment for such patients. MethodsA retrospective analysis was made on 270 breast cancer patients aged ≥70 years old who underwent SLNB in the Affiliated Hospital of Southwest Medical University from 2012 to 2021. The clinicopathological characteristics of the total cases were compared according to the status of SLN. Kaplan-Meier method was used to draw the survival curve, and the influence of SLN status on the overall survival (OS) time, local recurrence (LR) and distant metastasis (DM) of patients were analyzed, and used log-rank to compare between groups. At the same time, the patients with hormone receptor (HR) positive were analyzed by subgroup. The differences between groups were compared by single factor χ2 test, and multivariate Cox regression model was used to analyze and determine the factors affecting OS, LR and DM of patients. ResultsThe age of 270 patients ranged from 70 to 95 years, with a median age of 74 years. One hundred and sixty-nine (62.6%) patients’ tumor were T2 stage. Invasive ductal carcinoma accounted for 83.0%, histological gradeⅡ accounted for 74.4%, estrogen receptor positive accounted for 78.1%, progesterone receptor positive accounted for 71.9%, and human epidermal growth factor receptor 2 negative accounted for 83.3%. The number of SLNs obtained by SLNB were 1-9, and the median was 3. SLN was negative in 202 cases (74.8%) and positive in 68 cases (25.2%). Thirty-five patients (13.0%) received axillary lymph node dissection. There was no significant difference in LR between the SLN positive group and the SLN negative group (P>0.05), but the SLN negative group had fewer occurrences of DM (P=0.001) and longer OS time (P=0.009) compared to the SLN positive group. The results of univariate and multivariate analysis suggest that the older the patient, the shorter the OS time and the greater the risk of DM. Analysis of HR positive subgroups showed that SLN status did not affect patient survival and prognosis, but age was still associated with poor OS time and DM. ConclusionsFor patients with invasive ductal carcinoma of breast in T1-T2 stage, HR positive, clinical axillary lymph nodes negative, and age ≥70 years old, SLNB may be exempted. According to the patient’s performance or tumor biological characteristics, patients who need systemic adjuvant chemotherapy may still consider SLNB.
ObjectiveTo identify the risk factors of bone metastasis in breast cancer and construct a predictive model. MethodsThe data of breast cancer patients met inclusion and exclusion criteria from 2010 to 2015 were obtained from the SEER*Stat database. Additionally, the data of breast cancer patients diagnosed with distant metastasis in the Affiliated Hospital of Southwest Medical University from 2021 to 2023 were collected. The patients from the SEER database were randomly divided into training (70%) and validation (30%) sets using R software, and the breast cancer patients from the Affiliated Hospital of Southwest Medical University were included in the validation set. The univariate and multivariate logistic regressions were used to identify risk factors of breast cancer bone metastasis. A nomogram predictive model was then constructed based on these factors. The predictive effect of the nomogram was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis. ResultsThe study included 8 637 breast cancer patients, with 5 998 in the training set and 2 639 (including 68 patients in the Affiliated Hospital of Southwest Medical University) in the validation set. The statistical differences in the race and N stage were observed between the training and validation sets (P<0.05). The multivariate logistic regression analysis revealed that being of white race, having a low histological grade (Ⅰ–Ⅱ), positive estrogen and progesterone receptors status, negative human epidermal growth factor receptor 2 status, and non-undergoing surgery for the primary breast cancer site increased the risk of breast cancer bone metastasis (P<0.05). The nomogram based on these risk factors showed that the AUC (95% CI) of the training and validation sets was 0.676 (0.533, 0.744) and 0.690 (0.549, 0.739), respectively. The internal calibration using 1 000 Bootstrap samples demonstrated that the calibration curves for both sets closely approximated the ideal 45-degree reference line. The decision curve analysis indicated a stronger clinical utility within a certain probability threshold range. ConclusionsThis study constructs a nomogram predictive model based on factors related to the risk of breast cancer bone metastasis, which demonstrates a good consistency between actual and predicted outcomes in both training and validation sets. The nomogram shows a stronger clinical utility, but further analysis is needed to understand the reasons of the lower differentiation of nomogram in both sets.
ObjectiveTo compare the clinicopathological characteristics of breast invasive micropapillary carcinoma (IMPC) with different composition ratios, and analyze the relationship between proportion of micropapillary carcinoma components and the prognosis of IMPC. Methods The related data of 121 patients with invasive ductal carcinoma (IDC) complicated with IMPC who were treated in the Department of Breast Surgery, Affiliated Hospital of Southwest Medical University from August 2016 to August 2020 were collected. With micropapillary carcinoma accounting for 50%, the patients were divided into IMPC <50% group and IMPC ≥50% group. The correlation between related clinicopathological features and prognosis of patients was analyzed. Results There were 85 patients in the IMPC <50% group and 36 patients in the IMPC ≥50% group. The analysis results showed that there was no significant differences between the two groups in menstrual status, histological grade, molecular typing, TNM stage, age, immunohistochemical expression, neoadjuvant therapy, nerve invasion, nipple invasion, and skin invasion (P>0.05). The rate of lymphatic vessel invasion (LVI) in the IMPC ≥50% group was 83.33% (30/36), which was significantly higher than 61.18% (52/85) in the IMPC <50% group, and the difference between the two groups was statistically significant (χ2=5.684, P=0.017). Kaplan-Meier survival curve was drawn, and the analysis results showed that the 3-year cumulative disease-free survival (DFS) of IMPC patients was correlated with the number of lymph node metastasis and LVI (P<0.05). And with the estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, Ki-67, molecular typing, proportion of micropapillary carcinoma components and histological grade were unrelated (P>0.05). The results of multivariate Cox risk regression analysis showed that the number of lymph node metastases and LVI were independent prognostic factors affecting DFS in patients. Conclusions When the proportion of IMPC component is ≥50%, the LVI rate of tumor is higher than that of IMPC component <50%. The number of lymph node metastasis and LVI are independent prognostic factors affecting DFS in IMPC patients.
目的 探讨Oddi括约肌松弛症（SOR）的原因，总结其临床特点及处理经验，观察横断胆管＋胆肠Roux-en-Y吻合术治疗SOR的效果。方法 回顾性分析我院2001年1月至2011年1月期间收治的76例SOR患者的临床资料，将患者分为3组，分别采用横断胆管＋胆肠Roux-en-Y吻合术（39例）、胆道探查T管引流术（28例）及不横断胆管仅行胆肠Roux-en-Y吻合术（9例）治疗。结果 76例病例均经手术治疗，无手术死亡。手术并发症为：横断胆管＋胆肠Roux-en-Y吻合术组胆瘘1例，胸腔积液1例，切口脂肪液化2例；胆肠Roux-en-Y吻合术组胆瘘1例，胸腔积液1例，切口脂肪液化2例；胆道探查T管引流术组胸腔积液2例，切口脂肪液化1例。均经保守治疗好转。76例均获随访，随访时间3～83个月，平均45个月。因本研究是回顾性研究，考虑到胆肠Roux-en-Y吻合术组例数较少（仅9例），因此在分析其疗效时合并到胆道探查T管引流术组与横断胆管＋胆肠Roux-en-Y吻合术组进行比较。横断胆管＋胆肠Roux-en-Y吻合术组术后治愈34例，好转3例，无效2例，有效率为94.9% （37/39）；胆道探查T管引流术组和胆肠Roux-en-Y吻合术组术后治愈5例（2组分别为4例和1例），好转11例（2组分别为4例和7例），无效21例（2组分别为1例和20例），有效率为43.2% （17/37）。横断胆管＋胆肠Roux-en-Y吻合术组术后有效率明显高于胆道探查T管引流术组和胆肠Roux-en-Y吻合术组（P＜0.05）。结论 横断胆管＋胆肠Roux-en-Y吻合术是治疗SOR较有效的手术方式。
Objective To observe the anastomotic status of the vortex veins in patients with central serous chorioretinopathy (CSC). MethodsA cross-sectional study of clinical practice. From July 2021 to July 2022, 50 cases (50 eyes) of monocular CSC patients diagnosed through ophthalmic examination at the First Affiliated Hospital of Zhengzhou University were included in the study. Among them, there were 37 males (74.0%, 37/50) and 13 females (26.0%, 13/50), with the mean age of (44.30±9.59) years old. The course of disease from the onset of symptoms to the time of treatment was less than 3 months. The affected eye and contralateral eye of CSC patients were divided into the affected eye group and contralateral eye group, respectively. Fifty healthy volunteers of the same age and gender were selected as the normal control group with 50 eyes. The macular area scanning source optical coherence tomography (OCT) vascular imaging examination was performed with Visual Microimaging (Henan) Technology Co., Ltd. VG200D. Horizontal watershed vortex veins anastomosis rate and asymmetric vortex-venous dilation rate were observed by en face OCT. The device comes with software to calculate the central foveal choroidal thickness (SFCT), mean choroidal thickness (MCT), and choroidal vascular index (CVI). One-way analysis of variance and χ2 test were used to compare the three groups. When variances were unequal between groups, nonparametric tests were performed. ResultsThe SFCT values of the affected eye group, contralateral eye group, and normal control group were (567.12±129.02), (513.26±133.17), (327.64±97.40) μm, respectively; MCT were (407.38±97.54), (388.24±94.13), (275.46±60.55) μm, respectively; CVI were 0.34±0.05, 0.32±0.04, and 0.27±0.04, respectively; anastomosis rates of vortex veins were 98% (49/50), 78% (39/50), and 40% (20/50), respectively; asymmetric dilation rates of vortex veins were 96% (48/50), 88% (44/50), and 48% (24/50), respectively. The differences of SFCT (F=53.974), MCT (Z=51.415), CVI (F=28.082), vortex vein anastomosis rate (χ2=43.056), asymmetric dilation rate of vortex veins (χ2=37.728) among three groups were statistically significant (P＜0.001). Compared with the contralateral eye group, the SFCT, MCT, CVI, vortex vein anastomosis rate, and vortex vein asymmetric dilation rate in the affected eye group were significantly higher than those in the contralateral eye group. Among them, the differences of SFCT (t=2.054), CVI (t=2.211), and vortex vein anastomosis rate (χ2=9.470) were statistically significant (P＜0.05); the differences of MCT (Z=7.490), asymmetric dilation rate of vortex veins（χ2=2.714) were not statistically significant (P=1.000, 0.140). ConclusionsSFCT, MCT, and CVI in the affected and contralateral eyes of monocular CSC patients significantly increase. The anastomotic rate and asymmetric dilation rate of the vortex vein in the opposite eye were lower than those in the affected eye.
Objective To quantitatively evaluate the changes of choroidal biomarkers in patients with central serous chorioretinopathy (CSC) and preliminarily explore its pathogenesis. MethodsClinical cross-sectional study. From July 2021 to December 2022, 74 eyes of 65 patients with CSC (CSC group) confirmed by ophthalmic examination at the First Affiliated Hospital of Zhengzhou University were included in the study. Among them, 46 patients (51 eyes) were male, 19 patients (23 eyes) were female. The duration from the onset of symptoms to the time of treatment was less than or equal to 3 months. A control group consisted of 40 healthy volunteers (74 eyes) matched in age and gender. Among them, 26 patients (50 eyes) were male, and 14 patients (24 eyes) were female. Using VG200D from Microimaging (Henan) Technology Co., Ltd., macular scanning source light coherence tomography angiography was performed, with scanning range 6 mm × 6 mm. According to the division of the diabetes retinopathy treatment research group, the choroid within 6 mm of the macular fovea was divided into three concentric circles centered on the macular fovea, namely, the central area with a diameter of 1 mm, the macular area with a diameter of 1-3 mm, and the surrounding area of the fovea with a diameter of 3-6 mm. The device comes with software to record the three-dimensional choroidal vascular index (CVI), choroidal vascular volume (CVV), perfusion area of the choroidal capillary layer (CFA), choroidal thickness (CT), and three-dimensional CVI, CVV, and CT in the upper, temporal, lower, and subnasal quadrants within 6 mm of the fovea. Quantitative data between the two groups were compared using an independent sample t-test. Qualitative data comparison line χ2 inspection. The value of receiver operating curve (ROC) analysis in predicting the occurrence of CSC, including CVI, CVV, CFA, and CT. ResultsCompared with the control group, the CVI (t=3.133, 4.814), CVV (t=7.504, 9.248), and CT (t=10.557, 10.760) in the central and macular regions of the affected eyes in the CSC group significantly increased, while the CFA (t=－8.206, －5.065) significantly decreased, with statistically significant differences (P＜0.05); CVI (t=7.129), CVV (t=10.020), and CT (t=10.488) significantly increased within 6 mm of the central fovea, while CFA (t=－2.548) significantly decreased, with statistically significant differences (P＜0.05). The CVI (t=4.980, 4.201, 4.716, 8.491), CVV (t=9.014, 7.156, 7.719, 10.730), and CT (t=10.077, 8.700, 8.960, 11.704) in the upper, temporal, lower, and lower nasal quadrants within 6 mm of the central fovea were significantly increased, with statistically significant differences (P＜0.05). In the CSC group, the maximum CVI and CVV were (0.39±0.10)% and (1.09±0.42) mm3, respectively, on the nasal side of the affected eye. Upper CT was (476.02±100.89) μm. The nasal side CVI, CVV, and CT have the largest changes. The ROC curve analysis results showed that the area under the curve of CT, CVV, and CVI within 6 mm of the central region, macular region, and fovea was over than 0.5. Subcentral CT was the most specific for the diagnosis of CSC. ConclusionChoroidal biomarkers CVI, CVV, and CT in CSC patients increase, while CFA decreases. Central CT is the most specific for the diagnosis of CSC.
ObjectiveTo observe the clinical characteristics and risk factors associated with pachydrusen in eyes affected by central serous chorioretinopathy (CSC). MethodsA retrospective clinical study. From July 2021 to June 2024, 144 cases and 158 eyes of CSC patients diagnosed through ophthalmological examination at Department of Ophthalmology of The First Affiliated Hospital of Zhengzhou University were included. All affected eyes underwent a series of assessments, including refraction, intraocular pressure measurement, fundus color photography, fluorescein fundus angiography (FFA), and swept-source optical coherence tomography (OCT). Additionally, 58 eyes underwent indocyanine green angiography (ICGA). Cross-sectional (en-face) OCT was utilized to observe the colocalization of pachydrusen with areas of dilation of large choroidal vessels and attenuation of the choriocapillaris layer. The device was used for OCT included software for calculating subfoveal choroidal thickness (SFCT). FFA fluorescein leakage was categorized into “ink stain”, “cooking smoke”, and “diffuse point leakage”. Patients were classified into groups of CSC patients complicated by pachydrusen and groups of CSC patients without pachydrusen. Comparisons between the groups were performed using the χ2 test, and factors associated with the presence of pachydrusen were analyzed using logistic regression. ResultsAmong 158 eyes, 72 eyes (45.6%, 72/158) were complicated by pachydrusen. In en-face OCT images, pachydrusen were co-located with dilated large choroidal vessels in 59 eyes (81.94%, 59/72) and corresponded to choroidal capillary layer blood flow holes in 61 eyes (84.72%, 61/72). Among the 58 eyes that underwent ICGA examination, pachydrusen corresponded to punctate strong fluorescence in 46 eyes (79.31%, 46/58) and were located in areas of choroidal hyperpermeability in 43 eyes (74.14%, 43/58). Compared with the CSC group without pachydrusen, the incidence of choroidal neovascularization, flat irregular pigment epithelial detachment, diffuse punctal leakage and multiple leakage points increased in the CSC group, and the differences were statistically significant (χ2=6.217, 8.455, 5.363, 17.749; P＜0.05). Logistic regression analysis indicated that age [odds ratio (OR)=1.116, 95% confidence interval (CI) 1.060-1.176, P＜0.001], chronic CSC [OR=2.628, 95%CI 1.250-5.526, P=0.011] were independent risk factors for the occurrence of pachydrusen. ConclusionsThe incidence of pachydrusen in eyes with CSC is 45.6%, with age and chronic CSC identified as independent risk factors for their occurrence. Pachydrusen correspond to dilated choroidal vessels and areas of choroidal hyperpermeability, which may serve as potential risk factors for CSC activity or development.
Objective To observe and analyze the imaging features of pathologic myopic paravascular abnormalities (PVA) and macular retinoschisis (MRS) and their relationship with clinical features. MethodsA retrospective case series study. A total of 371 eyes of 224 patients with pathological myopia with PVA and/or MRS diagnosed by examination in Department of Ophthalmology of the First Affiliated Hospital of Zhengzhou University from September 2021 to December 2023 were included in the study. There were 74 eyes in 48 males and 297 eyes in 176 females. Age were 54 (49, 61) years; equivalent spherical lens (SE) was −13.375 (−18.00, −10.00) D. Axial length (AL) was 29.84 (28.27, 31.24) mm. According to the features of ultra-wide-angle sweep source optical coherence tomography, PVA morphology was divided into blood vessels and paravascular microfolds, paravascular retinal cysts, paravascular retinal splits and paravascular lamellar macular holes. MRS was divided into inner layer, outer layer and mixed layer according to splitting level, and grouped accordingly. The presence of dome-shaped macula (DSM), internal and external lamellar macular hole, and full lamellar macular hole (FTMH) were recorded. According to whether PVA combined with MRS or not, the affected eyes were divided into PVA group and PVA combined with MRS group. According to whether MRS involved the fovea, the affected eyes were divided into two groups: MRS not involved the fovea group and MRS involved the fovea group. Mann-Whitney U test was used to compare age, SE and AL among different groups. Qualitative data were compared by χ2 test. ResultsIn 371 eyes, there were 120 eyes in the simple PVA group; in the MRS group, there were 251 eyes, of which 208 eyes were in the PVA combined with MRS group. There were 33, 27, 3, 14, 12, 56, 28, and 7 eyes with or without retinal detachment, choroidal neovascularization, DSM, preretinal membrane, and simple superficial detachment of neuroepithelium in inner lamina, outer lamina, and FTMH, respectively. In 328 eyes with PVA, blood vessels and paravascular microfolds, paravascular retinal cysts, paravascular retinal splits and paravascular lamellar macular holes were 151, 236, 202 and 72 eyes, respectively. There were 142 eyes with single lesion (43.29%, 142/328). There were 186 eyes with 2 or more lesions (56.71%, 186/328). There were 34 eyes in the inner MRS group, 92 eyes in the outer MRS group and 125 eyes in the mixed MRS group, respectively. It involved 155 eyes in the fovea group; 96 eyes in the fovea group were not involved. There were significant differences in the number of PVA eyes between the outer MRS group, the inner MRS group and the mixed MRS group (χ2=30.614, 28.379; P＜0.001). Compared with PVA group, PVA group combined with MRS group was more likely to have two or more PVA lesions, the difference was statistically significant (χ2=30.535, P＜0.001). Compared with the inner MRS group and mixed MRS group, the age of the simple PVA group was younger, and the age of the outer MRS group was older, and the differences were statistically significant (P＜0.05). Compared with the inner MRS group and the outer MRS group, the simple PVA group had short AL, less myopia and better optimal corrected visual acuity (BCVA), while the mixed MRS group had long AL, more myopia and worse BCVA, and the differences were statistically significant (P＜0.05). Compared with the PVA group and the inner MRS group, the fovea was more involved in the outer MRS group and the mixed MRS group, and the difference was statistically significant (χ2=3.906, 10.836; P＜0.05). Those with MRS involved in fovea were older, AL was longer, myopia was more severe, and BCVA was worse (P＜0.001). DSM-associated splits were less likely to involve macula (P＜0.001). ConclusionPVA and MRS exhibit a variety of presentations, and their imaging features correlate with clinical features.
ObjectiveTo observe the imaging features of extramacular retinoschisis (EMRS) and paravascular abnormalities (PVA) in myopic patients, and preliminary analyze the differences in age, best corrected visual acuity (BCVA), spherical equivalent (SE), axial length (AL), and subfoveal choroidal thickness (SFCT). MethodsA cross-sectional clinical study. A total of 60 myopia patients with EMRS who were admitted to Department of Ophthalmology of The First Affiliated Hospital of Zhengzhou University from January 2023 to June 2024 were included in the study. There were 18 male cases with 18 eyes and 42 female cases with 42 eyes. Age was (37.57±17.14) years; SE was (−10.76±4.66) D; AL was (28.36±1.87) mm. According to the characteristics of ultra-wide-angle optical coherence tomography images, PVA was divided into perivascular cysts (PC), perivascular microfolds (PM) and perivascular lamellar holes (PLH). According to the splitting level, EMRS can be divided into inner layer, middle layer and outer layer. According to SE, the affected eyes were divided into low myopia group, moderate myopia group and high myopia group. The occurrence of EMRS near optic disc, supratemporal, suprasal and subnasal, as well as the clinical characteristics of patients with EMRS at different locations, levels and forms of PVA were observed. Age, BCVA, SE, AL and SFCT of EMRS patients at different locations and levels were compared by independent sample t test. χ2 test or Fisher exact probability test were used to compare the categorical variables between groups. ResultsIn 60 eyes, EMRS were located in supratemporal, infratemporal, supranasal, subnasal, and paratopic discs in 36, 43, 15, 13, and 14 eyes, respectively. The EMRS in the inner and outer layers were 59 (98.3%, 59/60) and 35 (58.3%, 35/60) eyes, respectively. PVA was present in 47 eyes (78.3%, 47/60). Among them, PC, PM and PLH were 45, 39 and 18 eyes, respectively. The age of those with paratopic splitting was older than those without paratopic splitting (t=2.720). Those with temporal splitting had worse BCVA and longer AL than those without splitting (t=2.139, 2.119). Those with subnasal splitting had worse BCVA, higher myopia, longer AL and thinner SFCT than those without splitting. The differences were statistically significant (t=2.926, −2.640, 2.635, −3.938; P＜0.05). Compared with other types of EMRS, patients with inner EMRS had younger age (t=−2.383), better BCVA (t=−4.825), shorter AL (t=−4.767), lower myopia (t=4.791), and thicker SFCT (t=4.791); patients with full-layer EMRS were older (t=2.419), worse BCVA (t=3.656), longer AL (t=2.677), higher degree of myopia (t=−2.755), and thinner SFCT (t=−3.283), with statistical significance (P＜0.05). There was significant difference in SFCT among patients with or without PC (t=−2.396, P＜0.05). Compared with eyes without PM and PLH, eyes with PM had worse BCVA, longer AL, higher myopia, and thinner SFCT, and the differences were statistically significant (PM: t=2.514, 3.078, −2.811, −4.205; P＜0.05; PLH: t=2.514, 2.992, −2.949, −1.773; P＜0.05). ConclusionsEMRS primarily occurs in the temporal side, with the highest frequency in the inner layer. Patients with inner-layer EMRS are younger, have better BCVA, shorter AL, lower myopia, and thicker SFCT, whereas patients with full-layer EMRS exhibit the opposite characteristics.
目的 总结术后早期炎性肠梗阻和慢性假性肠梗阻的临床特点及处理方法。 方法 回顾性分析我科2004年3月至2009年3月期间的15例术后早期炎性肠梗阻及9例慢性假性肠梗阻的临床特点及治疗结果。 结果 15例术后早期炎性肠梗阻中保守治疗13例，平均11 d症状缓解出院； 再次手术2例，分别于术后11 d和8 d治愈出院。9例慢性假性肠梗阻中保守治疗6例，平均20 d症状缓解出院； 手术治疗3例，术后继续保守治疗，平均30 d症状缓解出院。 结论 术后早期炎性肠梗阻及慢性假性肠梗阻虽然各有其临床表现特点，但治疗上有共性，多数病例采用保守疗法便可治愈。