Zhi-Jie Hong

Papillary breast lesions diagnosed by core biopsy require complete excision

BACKGROUNDnSurgical excision of papillary breast lesions with atypia diagnosed using core needle biopsy (CNB) has been accepted; however, the management of benign papillary lesions (without atypia) has been controversial. The purpose of this study was to evaluate the surgical outcome of nonmalignant papillary lesions diagnosed by ultrasound-guided 14-gauge CNB, and to establish clear guidelines on management of these lesions.nnnMETHODSnWe retrospectively identified 268 nonmalignant papillary breast lesions, including 203 benign lesions and 65 atypical lesions, diagnosed by CNB and subsequently surgically excised in 250 women at our institution between July 2004 and October 2010. For each lesion, medical records and radiologic and pathologic reports were reviewed and coded. We compared the histological upgrade among the collected variables.nnnRESULTSnOn histological examination after surgical excision, 15.4% atypical papillary lesions and 5.9% benign lesions were upgraded to malignant, and 20.2% benign lesions were upgraded to atypical. Atypia (Pxa0=xa00.015) was significantly associated with malignant upgrade at excision. No clinical or radiologic variable was helpful in predicting the possibility of histological upgrade of CNB-diagnosed nonmalignant papillary lesions.nnnCONCLUSIONSnNonmalignant papillary lesions diagnosed with CNB showed an unacceptable pathological upgrade rate after excision. Therefore, surgical excision should be performed for all papillary lesions of the breast for definitive diagnosis.

Factors predictive of breast cancer in open biopsy in cases with atypical ductal hyperplasia diagnosed by ultrasound-guided core needle biopsy.

AIMSnThe purpose of the study was to explore factors predictive of breast cancer as diagnosed by excision biopsy in cases with a diagnosis of atypical ductal hyperplasia (ADH) on ultrasound-guided core needle biopsy (CNB).nnnPATIENTS AND METHODSnWe carried out diagnosis of breast lesions by ultrasound-guided CNB in a single hospital in Taiwan from November 2003 to October 2009. Patients who were diagnosed with ADH and subsequently underwent excision biopsy were included in this study (nxa0=xa0124).nnnRESULTSnFifty-six of the 124 patients who were included (45.2%) had cancer, and the remaining 68 had benign lesions. By multivariate analysis of all clinical characteristics and on the basis of the imaging features in these cases, older patient age (≥50xa0y/o, OR: 3.910, pxa0=xa00.005), larger tumour size (≥15xa0mm, OR: 3.398, pxa0=xa00.013), and the presence of architectural distortion by mammography (OR: 10.7, pxa0=xa00.036) were found likely to be associated with breast cancer.nnnCONCLUSIONSnOpen biopsy is necessary in patients who were diagnosed with ADH on CNB. Older patients (≥50xa0y/o), with a larger tumour size (≥15xa0mm) and an abnormal mammography are especially likely to have breast cancer.

Prognostic value of the lymph node ratio in breast cancer subtypes.

BACKGROUNDnSeveral studies indicate that lymph node (LN) ratio (LNR) is more predictive than the traditional LN-positive stratification (pNs). We assessed whether LNR can provide additional prognostic information on node-positive breast cancer patients, particularly with breast cancer subtypes (BCS).nnnMETHODSnWe retrospectively reviewed the medical records of 2,049 patients with primary breast cancer treated between January 2006 and December 2011 and identified 511 subjects with positive axillary LN. Clinicopathological findings, types of treatment, and the 5-year overall survival (OS) were included.nnnRESULTSnThe results of multivariate analysis of the cohort showed that the correlations of pNs and LNR in regard to OS were P < .001 and P < .001, respectively, with adjustment for tumor characteristics and treatment factors. Moreover, our data revealed that LNR was more predictive in luminal A, luminal B, and luminal human epidermal growth factor receptor 2 in a comparison of pNs and LNR with regard to OS among BCS.nnnCONCLUSIONnLNR and pNs are important prognostic factors with regard to OS for patients with node-positive breast cancer, but LNR has a more correlated value in BCS.

A paraduodenal hernia (Treitz's hernia) causing acute bowel obstruction

Paraduodenal hernias, also called Treitz’s hernia, are unusual causes of intestinal obstruction and account for 0.9% of all intestinal obstructions (1). Paraduodenal hernias constitute half of all internal abdominal hernias and occur when the small bowel herniates into the paraduodenal fossa with manifestation of intestinal obstruction (2). Specific clinical signs are often absent, leading to the frequent delay of correct diagnosis, with bowel necrosis resulting in up to 20% of patients (3). Herein, we present our case to increase the awareness of Treitz’s hernia and suggest the early CT scan intervention may be helpful to make the preoperative diagnosis of paraduodenal hernia.

The evolution of computed tomography from organ-selective to whole-body scanning in managing unconscious patients with multiple trauma: A retrospective cohort study.

Abstract We aimed to evaluate the benefit of whole-body computed tomography (WBCT) scanning for unconscious adult patients suffering from high-energy multiple trauma compared with the conventional stepwise approach of organ-selective CT. Totally, 144 unconscious patients with high-energy multiple trauma from single level I trauma center in North Taiwan were enrolled from January 2009 to December 2013. All patients were managed by a well-trained trauma team and were suitable for CT examination. The enrolled patients are all transferred directly from the scene of an accident, not from other medical institutions with a definitive diagnosis. The scanning regions of WBCT include head, neck, chest, abdomen, and pelvis. We analyzed differences between non-WBCT and WBCT groups, including gender, age, hospital stay, Injury Severity Score, Glasgow Coma Scale, Revised Trauma Score, time in emergency department (ED), medical cost, and survival outcome. Fifty-five patients received the conventional approach for treating trauma, and 89 patients received immediate WBCT scanning after an initial examination. Patients’ time in ED was significantly shorter in the WBCT group in comparison with the non-WBCT group (158.62u200a±u200a80.13 vs 216.56u200a±u200a168.32u200amin, Pu200a=u200a0.02). After adjusting for all possible confounding factors, we also found that survival outcome of the WBCT group was better than that of the non-WBCT group (odds ratio: 0.21, 95% confidence interval: 0.06–0.75, Pu200a=u200a0.016). Early performing WBCT during initial trauma management is a better approach for treating unconscious patients with high-energy multiple trauma.

Preliminary Report of One-port Laparoscopy-assisted Extracorporeal Appendectomy in Adult Appendicitis

In our pediatric surgery department, one-port laparoscopy-assisted appendectomy (one-port LAA) is currently a routine procedure for the treatment of acute appendicitis. The benefits of one-port LAA in pediatric surgery have been reported in the literature: it is safe, effective, fast, has a low complication rate, and provides excellent cosmetic results. The feasibility of this surgery in adolescents has already been proved in clinical practice. Only two reports(superscript 1, 2) of this surgery in adults have been published previously. The present study attempts to apply this technique in adult patients. This surgery was successfully performed on 12 patients with no postoperative complications. Only in one patient, the surgery was converted to a three-port laparoscopic appendectomy because of difficulty experienced in removing the appendix through one port. The benefits of the one-port LAA in adults are less postoperative pain, lower cost, and excellent cosmetic results. One-port LAA has proved to be an appropriate alternative procedure to other laparoscopic appendectomy techniques for the management of uncomplicated appendicitis in selected adult patients in our clinical practice.

Experienced trauma team leaders save the lives of multiple-trauma patients with severe head injuries

The trauma team leader is a professional who receives and treats trauma patients. We aimed to evaluate whether or not the seniority of a qualified trauma team leader was a prognostic factor for multiple-trauma patients managed by a trauma team. This was a retrospective cohort study conducted at a Level I Trauma Center in North Taiwan. From January 2009 to December 2013, 284 patients were randomly assigned to one of two trauma team leaders (junior and senior leaders) on duty, irrespective of the seniority of the qualified trauma team leader. All parameters were collected and compared between these two groups. In the subgroup of multiple-trauma patients with Glasgow Coma Scale (GCS)u2009≤u20098, there were significant differences in the injury severity score, revised trauma score, and seniority of the leader between the alive and dead groups. A multivariate logistic regression analysis showed that the seniority of the trauma team leader was an important mortality risk factor [odds ratio (OR): 14.529, 95% confidence interval (CI) 1.683–125.429, pu2009=u20090.015] in patients with GCSu2009≤u20098. However, in patients with GCSu2009>u20098, age was the only independent risk factor [OR: 1.055, 95% CI 1.023–1.087, pu2009=u20090.001]. The seniority of the qualified trauma leader is important for teamwork, organization, and efficiency, all of which play an important role in improving the survival outcome of patients with GCSu2009≤u20098.

Survival outcome of weak estrogen/progesterone receptor expression in HER2 negative breast cancer is similar to triple negative breast cancer

BACKGROUNDnRecent publications have suggested that human epidermal growth factor receptor 2 (HER2)-negative breast cancers with weak estrogen receptor (ER)/progesterone receptor (PR) expression levels by immunohistochemical (IHC) analysis were considered as the triple-negative (TN) subtype. This study aimed to evaluate the overall survival (OS), disease-free survival rates (DFS), and disease-specific survival (DSS) based on ER and PR expression levels into one of three groups, ER and PR <1%, ER and PR 1%-20%, and ER or PR >20% by hormone therapy.nnnMETHODSnMedical records of 3353 breast cancer patients treated from 2006 to 2013 were retrospectively reviewed. Tumor characteristics, type of treatment, OS, DFS and DSS were evaluated among the three patient groups.nnnRESULTSnRegarding OS, there were significant differences according to the received hormone therapy in the different groups: ER and PR <1% (Pxa0=xa00.972), ER and PR 1%-20% (Pxa0=xa00.264), and ER or PR >20% (Pxa0=xa00.014). Regarding DFS and DSS, there were also significant differences in the different groups: ER and PR <1% (Pxa0=xa00.611, 0.766), ER and PR 1%-20% (Pxa0=xa00.847, 0.629), and ER or PR >20% (Pxa0=xa00.031, 0.002).nnnCONCLUSIONSnIn HER2 negative breast cancer patient with hormone therapy, ER and PR expression level of 1%-20% has similar survival outcome to the ER and PR expression level of <1% by IHC analysis.