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 review the properties of bio-derived hydrogels and their application and research progress in tissue engineering. MethodsThe literature concerning the biol-derived hydrogels was extensively reviewed and analyzed. ResultsBio-derived hydrogels can be divided into single-component hydrogels (collagen,hyaluronic acid,chitosan,alginate,silk fibroin,etc.) and multi-component hydrogels[Matrigel,the extract of extracellular matrix (ECM),and decellularized ECM].They have favorable biocompatibility and bioactivity because they are mostly extracted from the ECM of biological tissue.Among them,hydrogels derived from decellularized ECM,whose composition and structure are more in line with the requirements of bionics,have incomparable advantages and prospects.This kind of scaffold is the closest to the natural environment of the cell growth. ConclusionBio-derived hydrogels have been widely used in tissue engineering research.Although there still exist many problems,such as the poor mechanical properties,rapid degradation,the immunogenicity or safety,vascularization,sterilization methods,and so on,with the deep-going study of optimization mechanism,desirable bio-derived hydrogels could be obtained,and thus be applied to clinical application.
Breast cancer, the most common malignancy in the world, also causes the most death cases of women among malignancies. Breast cancer risk reduction guidelines (version 2023) was updated by National Comprehensive Cancer Network (NCCN). Based on high-level evidences from evidence-based medicine and the latest research progress, the guidelines provided standardized guidance for breast cancer risk assessment and risk reduction strategies for individuals without a history of invasive breast cancer or ductal carcinoma in situ, which has attracted widespread attention from clinicians worldwide. Breast cancer is also the most common malignancy in Chinese women, and the number of newly diagnosed breast cancer cases each year in China ranks first in the world due to the large population, so the breast cancer prevention has become a major public health challenge in China. Aimed to provide reference for breast cancer prevention in China, this article interpreted the guidelines (the new version) based on the characteristics of breast structure in Asian women and the epidemiological characteristics of breast cancer in China.
ObjectiveTo understand the application of acellular dermal matrix (ADM) in implant-based breast reconstruction. MethodLiteratures on application of ADM in the implant-based breast reconstruction were reviewed. ResultsADM was widely used in the implant-based breast reconstruction and revisionary breast surgery. ADM could help to achieve a better reconstruction outcome by precisely locating the inferior mammary fold and strengthening the local control of the implant. However, whether ADM might increase the postoperative complications was controversial. ConclusionADM assisted implant-based breast reconstruction could achieve a better cosmetic outcome, but the large sample randomized controlled trial is needed to evaluate the application effect and risk of ADM.
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.