According to the world's latest cancer burden data released by the World Health Organization's International Agency for Research on Cancer, the number of new cases of breast cancer reached 2.26 million in 2020, surpassing lung cancer for the first time and becoming the most common cancer in the world. With fast growth rate, late diagnosis and low milk retention rate, the incidence and treatment of breast cancer in China is still grim. Although the high cure rate of early breast cancer compared to other cancers gives many people the opportunity to regain their lives, they can be trapped by the huge physical and mental trauma caused by mastectomy, and many patients are never able to regain their confidence to return to society, and pain and inferiority will accompany them for the rest of their lives.
While ensuring the radical treatment of breast cancer, starting from the most sincere needs of patients, improving the postoperative quality of life of patients, and allowing them to return to their families and society as soon as possible in a complete and healthy physical and mental state is the greatest pursuit of Cong Yizi, deputy chief physician of the Department of Breast Surgery of Yantai Yuhuangding Hospital, and his colleagues. From life preservation to breast protection to reproduction, it is more valuable to cast benevolence with ingenuity, so that female patients have the opportunity to live as brilliantly as summer flowers in their eyes.
Striving for excellence and continuing beauty is not a dream
As the "number one killer" of female cancer, breast cancer destroys people far more than pain.
The importance of breasts for women is self-evident, it blooms with the growth of life, and will nourish new life, not only an important embodiment of female beauty but also directly related to intergenerational continuation. Therefore, whether breast protection can be successfully preserved in the treatment of breast cancer is the focus of many patients, and the inability to maintain milk is tantamount to being pronounced "death penalty" in advance for many people. In the Department of Breast Surgery of Yuhuangding Hospital, with the development of new technologies such as plastic surgery and neoadjuvant chemotherapy, breast protection is not the ultimate pursuit, helping patients better continue their beauty and giving them the opportunity to enjoy a better life is the key.
Ms. Li, 34, came to the hospital for ultrasound in the outer hospital to suggest multiple low-echo areas of the left breast, and improved the mammography, and the imaging footage showed that her left milk was silt-like calcification and regional distribution. After admission, an empty needle aspiration biopsy is performed, and pathology suggests carcinoma in situ for ductal mammary glands. Because of its wide range of calcifications, it is not possible to guarantee that the surgical margin is negative, so it is not suitable for breast-conserving surgery. Such a result is like a thunderbolt on a sunny day for Ms. Li, and in consideration of her future life, she and her family strongly demand "breast protection".
After preoperative multidisciplinary discussion, Cong Yizi suggested that Ms. Li undergo stage I breast reconstruction. Under the guidance of Qiao Guangdong, director of the Department of Breast Surgery of Yuhuangding Hospital, they finally performed a laparoscopic subcutaneous gland resection of the breast + sentinel lymph node biopsy + stage I breast implantation for the patient. Under the premise of ensuring complete resection of the tumor during the operation, the nipple areola complex and skin were successfully retained, and ms. Li's breast shape was basically symmetrical with the contralateral side after the operation.
In addition to breaking through difficulties to successfully "preserve milk" for many patients, Cong Yizi and colleagues are also committed to helping patients regain their beauty with "invisible hands". The application of tumor plastic surgery technology not only gives breast tumor patients the opportunity to avoid total breast removal, but also obtains a better breast shape, truly realizing a two-way cure of body and mind.
Ms. Chen, 32, is one of the "lucky ones". After the examination found the breast mass on the right side, Ms. Chen went to Yuhuangding Hospital for treatment accompanied by her family. Ultrasonography revealed that her right breast was about 2.0 cm from the nipple and a 2.5 cm-sized mass, irregular in shape, under-clear boundaries, and after admission, she improved the mammography target, breast MRI and other tests, and was tested with an empty core needle, and she was eventually diagnosed with breast cancer. Because she was not yet married, Ms. Chen had higher requirements for breast aesthetics, and after full preoperative discussion and preparation, Cong Yizi and her colleagues finally solved the big problem for them by improving double-ring plastic breast preservation surgery + axillary sentinel lymph node biopsy, leaving only circular scars on the hidden areola and about 3 cm scars on the armpits.
"The era of 'the more breasts cut, the safer' is over, if you can get patients with smaller physical trauma, why not enjoy it?" In Cong Yizi's view, under the premise of ensuring the root effect of breast cancer, try to maintain the integrity and beauty of women's physical appearance, which can help patients regain confidence and help them return to the family and society as soon as possible.
Scientific research pilot, providing new ideas for solving clinical problems
In 2020, there were more than 416,000 new cases of breast cancer in women in China. Behind the cold numbers are one after another vivid and concrete life. In clinical diagnosis and treatment, Cong Yizi will come into contact with new patients every day, and their pain and expectations are real and urgent, which always motivates him to explore faster.
Scientific research has provided an outlet for Cong Yizi and also provided new ideas for solving clinical problems. Good at finding problems from clinical work, diligent in thinking, and cleverly borrowing scientific research tools, so that he can start from more subtleties to solve more practical problems for patients.
Sentinel lymph nodes are the first stop for primary tumors to undergo lymph node metastasis, and if there is no sentinel lymph node metastasis, it is generally considered that the subsequent lymph nodes have not metastasized. Patients with a negative sentinel lymph node biopsy usually do not need to have axillary lymph node dissection, and if there are many pathopoly positive lymph nodes, axillary lymph node dissection is usually required. With the development of medicine, patients with only 1-2 pathopolypositive lymph nodes in sentinel lymph node biopsy can also be subjected to radiotherapy treatment instead of axillary lymph node dissection under the premise of strictly grasping the indications and fully informing the patient, which can undoubtedly avoid a wide range of blind removal of healthy lymphoid tissue and greatly reduce complications such as postoperative lymphedema.
The status of the non-sentinel lymph nodes cannot be known in patients with 1-2 sentinel lymph node metastases without axillary dissection, thus influencing subsequent adjuvant therapy decisions. For such patients, in order to better assess the axillary state, Cong Yizi and colleagues established a predictive model of non-sentinel lymph node metastasis, which effectively predicted whether non-sentinel lymph nodes metastasized and metastatic load in patients with 1-2 sentinel lymph nodes metastasis, this study is of great significance for guiding the postoperative adjuvant treatment plan of breast cancer.
Cong Yizi, who is buried in scientific research, is still focusing on solving more problems. "Fascial Suture Technology" simply and effectively reduced the problem of subcutaneous effusion after breast cancer surgery, and the paper won the "Third Prize of Excellent Paper in the 16th National Breast Cancer Conference and the 15th Shanghai International Breast Cancer Forum Conference". Nano-charcoal primary tumor markers under the ultrasound guidance before neoadjuvant chemotherapy can effectively guide the scope of breast-preserving surgery and the collection of tumor specimens by the Department of Pathology, and has achieved good application results in the Department of Breast Surgery of Yuhuangding Hospital, and the department is also leading prospective, multi-center randomized controlled clinical trials, looking forward to providing new strategies and strong evidence for the localization of primary tumors before neoadjuvant chemotherapy for breast cancer. In addition, Cong Yizi and his colleagues have also conducted basic clinical translational research related to breast cancer, such as biomarker screening for neoadjuvant chemotherapy resistance in breast cancer, Tim-3-mediated malignant transformation and immune escape of breast cancer, and have received funding from the Shandong Provincial Key Research and Development Program and the Shandong Provincial Natural Science Foundation.
In addition, as the director of the breast specialist laboratory, Cong Yizi also led the scientific research team to continuously strive to promote the development of the discipline and improve the competitiveness of scientific research. Together, they have continuously improved the breast cancer tissue specimen database and the breast cancer clinical database that meets the EUSOMA certification standards, and have full-time researchers and part-time researchers to carry out basic research in the laboratory, and make unremitting efforts to explore the mechanism of breast cancer recurrence and metastasis and drug resistance, and find new therapeutic targets. Regularly organize scientific research skills training and project progress reports, and establish a good cooperative relationship with many scientific research institutions such as Cardiff University in the United Kingdom to jointly carry out basic and clinical translational research on breast cancer, laying a solid foundation for the sustainable and high-quality development of scientific research work in the department.
In recent years, Yantai Yuhuangding Hospital breast surgery scientific research achievements are remarkable, 2 projects of the National Natural Science Foundation, Shandong Provincial Key Research and Development Program and Shandong Provincial Natural Fund and other provincial and ministerial projects, Yantai City Scientific Research Program and hospital projects 9, of which 2020-2021 approved scientific research funds of nearly 2 million yuan, published 14 SCI papers, the cumulative impact factor of 57.62, significantly improved the academic influence and academic reputation.
Full management, personalized diagnosis and treatment is more heart-warming
From surgical treatment, chemotherapy, radiotherapy, endocrine therapy to today's targeted therapy and immunotherapy, the clinical treatment of breast cancer has been constantly changing in the past decade. While the survival time of patients has been greatly extended, the demand for more detailed and accurate personalized diagnosis and treatment services has become more obvious. Many times Cong Yizi and colleagues just think about one more step, but it is precisely because of this intention that they have given patients more confidence and courage in addition to treatment, and have become the most special "flower protection messengers".
Breast surgery is not a "friendly" department for women, and most of the patients admitted cannot get rid of disappointment and pessimism, but the humble and patient Cong Yizi can always give people more warmth and strength. Because of this, he has always maintained a high "number of visits", and it is the norm to be blocked by patients and family members at the door of the ward to ask questions, and no matter how busy he is, he will always answer them professionally and meticulously. More often, he and his colleagues will also use this professionalism and meticulousness in every part of the diagnosis and treatment to truly share the worries of patients.
After the 27-year-old Wang Li (pseudonym) was admitted to the hospital for a right breast mass, she was biopsized by an empty core needle before surgery, and the pathology was diagnosed with breast cancer and axillary lymph node metastasis. Due to the large primary tumor load, the maximum diameter is about 4.0 cm, and her condition is no longer suitable for breast cancer breast protection surgery. However, she and her family have a strong willingness to protect breast milk, and after multidisciplinary discussions such as breast surgery, internal oncology, radiotherapy, pathology, imaging and other multidisciplinary discussions before the operation, Cong Yizi formulated a plan for neoadjuvant chemotherapy to reduce the duration of breast protection. After 6 cycles of chemotherapy combined with targeted therapy, through magnetic resonance assessment, Wang Li's tumor has shrunk to 1.0 cm and has the conditions for breast-conserving surgery. During the operation, according to the scope of the charcoal marker, Cong Yizi and his colleagues accurately removed the tumor for him, which not only successfully preserved his milk but also greatly reduced the surgical trauma. What moved Wang Li and her family even more was that, considering the future fertility needs, Cong Yizi also asked the Department of Reproductive Medicine to freeze oocytes for her before chemotherapy, and did enough "homework" for fertility protection.
"Whole-process management not only focuses on disease treatment, but also combines individual needs to provide patients with a tailor-made multidisciplinary comprehensive treatment plan." In Cong Yizi's view, compared with the pressures such as breast loss, scarring, upper limb lymphedema, upper limb function limitation and family and social role changes that may result after surgery, it is the most valuable thing that their special group of "flower protectors" can do for patients in the process of diagnosis and treatment with the least risk and cost.
"Do not seek what should be done, shame on the doctor." For Cong Yizi, it is the duty of the doctor to always take the patient as the center, the strength of the group team to work together under tolerance, and to innovate in the inheritance. Not only to have exquisite technology as the bottom, but also to be accompanied by benevolence at any time, in order to better be responsible for patients, which is the bottom line and their biggest motivation.
Instead of limiting himself to the positioning of breast surgeons, Cong Yizi prefers to be a consistent companion, able to escort more patients with his profession and accompany them through every journey of fighting the disease.
Expert Profile:
Cong Yizi, Deputy Chief Physician of Breast Surgery, Master Tutor, Qilu Health and Health Jieqing Talent, Visiting Scholar of Cardiff University, Expert of Science and Technology Expert Database of Shandong Province and Yantai City.
Professional expertise: standardized and individualized diagnosis and treatment of breast cancer based on surgical treatment, supplemented by chemotherapy, endocrine therapy and targeted therapy; good at early breast cancer (plastic) breast preservation surgery and sentinel lymph node biopsy, local advanced breast cancer neoadjuvant chemotherapy and reduced-stage breast preservation, armpit preservation surgery, breast cancer immediate postoperative prosthesis or autologous tissue breast reconstruction surgery and minimally invasive and endoscopic surgery of breast tumors.
Graduated from Tianjin Medical University Cancer Hospital, he studied at the Affiliated Cancer Hospital of Fudan University and the Llandough Breast Center of Cardiff University in the United Kingdom. He is currently a member of the Youth Committee of the Breast Tumor Branch of the Shandong Anti-Cancer Association, a member of the Science Popularization Working Group of the Multidisciplinary Joint Committee of Breast Diseases of the Shandong Medical Association, a member of the Youth Group of the Breast Surgery Branch of the Shandong Research Hospital Association, a member of the Breast Science Group of the General Branch of the Yantai Medical Association, a member of the Breast Professional Committee of the Yantai Anti-Cancer Association, a member of the Breast Health Professional Committee of the Yantai Maternal and Child Health Association, and a review expert of Frontiers in Oncology Magazine. He has presided over 6 scientific research projects such as Shandong Provincial Key R&D Program, Shandong Provincial Natural Science Foundation and Wu Jieping Medical Fund, applied for 2 patents, and published 17 papers as the first author, of which 12 were included in SCI.
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