124 He J et al. / Triple negative breast cancer FIGURE 1. Blood vessel network under digital subtraction angi- ography. A = subclavian artery; B = internal mammary artery; C = lateral thoracic artery; D = circumflex scapular artery; E = Catheter FIGURE 2. Breast cancer and its feeding arteries. T = tumour to detect the ER, PR and HER-2, and the diagnosis of triple-negative breast cancer was confirmed. The cancers were at stage IIA-Ⅳ and primary invasive breast cancer. The median age was 41 years (range: 26-58 years). These patients were randomly assigned into a targeted chemotherapy group and a control group. Before chemotherapy, all patients underwent ul- trasonography of bilateral breasts, bilateral arm- pits and the liver, chest radiography and systemic Radiol Oncol 2011; 45(2): 123-128. bone scanning. For the enlarged lymph nodes, the fine needle aspiration biopsy was done to detect whether there was metastasis. There were 24 pa- tients in the target chemotherapy group with a me- dian age of 42 years (range: 28-58 years). Of them, 5 and 19 were negative and positive for regional lymph node metastasis, respectively. In respect of the TMN stage, there were 6, 8, 4, 2 and 4 cases at the stage of ⅡA, ⅡB, ⅢA, ⅢC and Ⅳ, respective- ly. In the control group (n=23), the median age of patients was 41 years (range: 26-55 years). Of them, 4 and 19 were negative and positive for regional lymph node metastasis, respectively. In respect of the TMN stage, there were 6, 9, 4, 3 and 1 cases at the stage of ⅡA, ⅡB, ⅢA, ⅢC and Ⅳ, respective- ly. There were no significant differences in the age or stage of cancers between both groups (P=0.643 and 0.514, respectively). Neoadjuvant chemotherapy Targeted chemotherapy group Before surgery, superselective intra-arterial targeted neoadjuvant chemotherapy was performed.8,9 The femoral artery is punctured with a Seldinger needle and a 5-6F catheter was inserted into ipsilateral sub- clavian artery. The blood vessel network of breast, feeding arteries of the cancer and blood supply to the cancer were presented under angiography (Figures 1, 2). The superselective catheterization was performed into a main feeding artery of the cancer, followed by infusion of half amount of the drug, and then into the main feeding artery (lateral thoracic artery or internal mammary artery) of the breast followed by infusion of 25% of the drug, and finally into the distal end of the cross between subclavian artery and verte- bral artery followed by the infusion of the remaining drug (involving the whole blood vessel network of the breast and blood vessels in the armpit). Then, the blood flow of brachial artery was blocked by pneu- matic tourniquet avoiding the entry of drug to the brachial artery. The duration of the whole perfusion was 3-5 h, and all patients treated with CEF regimen (C: cyclophosphamide [600 mg/m2]; E: epirubicin [90 mg/m2]; F: 5-fluorouracil [600 mg/m2]). A cycle lasted 21 days. Control group Before surgery, routine intravenous chemotherapy was carried out. All patients received chemother- apy with CEF regimen (C: 600 mg/m2 at day 1; E: 90 mg/m2 at day 1; F: 600 mg/m2 at day 1). A cycle lasted 21 days.