隐匿性乳腺癌的诊断与治疗

目的探讨隐匿性乳腺癌的诊断和治疗选择。方法对5例隐匿性乳腺癌的术前影像学检查及手术方式结合文献进行回顾性分析。结果乳腺B超及钼靶X线检查无异常发现,2例加行乳腺MRI检查提示左乳外上象限乳腺癌,5例均行乳腺癌改良根治术并同时辅以化疗,随访至今未见复发,未见远处转移征象。结论腋窝淋巴结活检、免疫组化分析及MRI检查对隐匿性乳腺癌的诊断具有重要意义,治疗主要以手术为主,而在具体的术式上则存在着不同的意见,国内绝大多数学者主张对隐匿性乳腺癌行根治术或改良根治术同时辅以化疗、放疗。     

隐匿性乳腺癌14例临床分析

目的探讨隐匿性乳腺癌的临床特点及诊治方法。方法对14例经影像学检查及腋窝淋巴结活检确诊的隐匿性乳腺癌患者实施保留胸大、小肌的乳腺癌改良根治术,术后联合内分泌治疗和化疗。回顾性分析患者的临床资料。结果经术后病理学检查,14例患者中12例在送检标本内均找到原发灶,直径2~6 mm,其中浸润性导管癌10例,导管内癌2例,2例未见原发灶。病理切片提示肿瘤腋窝淋巴结转移数目6~30个,平均7.68个。术后随访2~5 a,3例患者分别于术后第2年、3年、第4年死于骨、脑、肺转移,其余11例随访结束后均存活,无肿瘤转移和复发病例。结论对于隐匿性乳腺癌患者应联合进行乳腺钼靶摄片、MRI、彩超和腋窝淋巴结活检等综合诊断方法以明确诊断,以改良根治术为主的内分泌治疗和化疗、放疗等综合治疗方案,可提高患者的5 a生存率。     

隐匿性乳腺癌的诊治体会(附12例报道)

目的探讨隐匿性乳腺癌的临床特点,提高隐匿性乳腺癌的诊治水平。方法经腋窝淋巴结活检,患侧乳腺钼靶摄片、彩超及MRI检查,12患者例均拟诊为隐匿性乳腺癌并接受保留胸大、小肌的改良根治术。术后均给予辅助化疗和内分泌等综合治疗。对患者的临床资料进行回顾性分析。结果术后病理切片检查,腋窝淋巴结转移数目5~28个,平均7.90个,均为淋巴结转移性腺癌。10例在患侧乳腺内找到直径约2~6 mm肿瘤,浸润性导管癌9例,导管内癌2例,1例未见原发灶。全部患者均获1~5 a随访。1例术后第2年死于骨、肝、脑多发转移。另有2例术后第4年死于为骨、肺转移。余9例均存活,未见转移与复发。结论腋窝淋巴结活检,患侧乳腺钼靶摄片、彩超检查及MRI检查,对隐匿性乳腺癌的诊断具有重要意义。以改良根治术为主并辅以化疗、放疗及内分泌治疗等综合治疗,效果满意。     

隐匿性乳腺癌的临床病理特征及免疫表型分析

目的 研究隐匿性乳腺癌的临床病理学特征、免疫表型、诊断及鉴别诊断.方法 采用常规病理学技术观察5例OBC的病理形态学特征,用免疫组化法检测其免疫表型.4例行乳腺癌根治术加腋窝淋巴结清扫术,1例手术方式不详.1例根治术前实施了化疗,4例根治术后实施了化疗.结果 5例OBC的平均年龄55.8(34～78),发病至入院时间为1周至1年.病变在左腋窝4例,右腋窝1例.免疫组化显示瘤细胞表达C-erbB-2,C,CDFP-15,CK7,CK19和E-cadherin100%阳性,ER60%阳性,PR40%阳性,CK5/6和CK20均为阴性.除1例在乳腺内发现2.0 cm×1.0 cm×0.5 cm结节2枚外,其余4例在乳腺内未发现原发灶.2例在腋窝处查到6～12枚淋巴结,均未见癌组织浸润,1例查到6枚淋巴结均见癌组织浸润,1例未查到肿大的淋巴结.5例均有完整的随访结果,随访3例5～10个月存活,1例全身化疗后12个月死亡,1例经短期化疗后,随访30个月后死亡.结论 OBC的发病特点与常规乳腺癌类似;联合应用免疫组化指标有助于OBC的诊断和鉴别诊断,部分患者行乳腺癌根治术加腋窝淋巴结清扫术后仍无法查见原发灶.     

隐匿性乳腺癌13例诊治体会

目的总结隐匿性乳腺癌(OBC)的诊治体会,以改善治疗效果。方法选择2012-01—2015-06确诊为OBC并实施保留胸大、小肌改良根治术的13例患者。对其临床资料进行回顾性分析。结果术后常规病理学检查,11例在乳腺内找到原发肿瘤,直径4.2~10.2 mm。其中浸润性导管癌9例,导管内癌2例。2例乳腺内未发现原发灶。腋窝淋巴结转移数目7~26枚,平均6.82枚。术后随访1~5 a,1例术后第2年死于脑转移,2例术后第4年死于肺、骨转移。其余10例均无病存活。结论 OBC缺乏典型的临床表现,腋窝肿大淋巴结切检及免疫组化分析,结合乳房的影像学检查,对诊断OBC具有重要临床价值。以改良根治术为主并辅以化疗、放疗、内分泌及生物治疗等综合措施,可获满意的效果。     

胸大肌切开第Ⅲ水平淋巴结清扫在乳腺癌改良根治术中的意义

目的:了解乳腺癌第Ⅲ组淋巴结的受累情况,探讨Auchincloss改良根治术加胸大肌开窗淋巴结清扫在乳腺癌诊断与治疗中的意义。方法:选取乳腺癌患者130例,在Auchincloss改良根治术基础上,施行胸大肌开窗清扫第Ⅲ组淋巴结,对该组淋巴结的受累情况及相关因素进行分析。结果:乳腺癌患者第Ⅲ水平淋巴结阳性率13.08%,与原发肿瘤大于5cm、腋淋巴结阳性个数≥4枚及高复发率有关,术后无胸肌萎缩、严重的淋巴水肿等并发症。结论:联合胸大肌劈开的乳腺癌改良根治术,创伤较小,对腋窝第Ⅲ组淋巴结清扫效果明确,能为乳腺癌术后的综合治疗提供准确的临床病理依据。     

隐匿性乳腺癌的临床分析

目的探讨隐匿性乳腺癌的诊断、治疗及预后。方法回顾性分析2000年1月至2009年1月我科行手术治疗的29例隐匿性乳腺癌患者的临床资料。结果乳腺钼靶X线检查出原发灶16例,6例由MRI检查出原发灶,2例行PET检查出原发灶。行乳腺癌改良根治术治疗25例,腋窝淋巴结清扫术4例。3例患者术后出现复发,1例死亡。结论乳腺钼靶及MRI是发现原发灶的重要检查方法。乳腺癌改良根治术是主要的治疗方法,保乳手术治疗选择性施行。     

隐匿性乳腺癌的诊断与治疗

隐匿性乳腺癌多以同侧腋窝淋巴结肿大为首发症状,临床少见,诊断是其难点。诊断过程建议先行肿大淋巴结空芯针穿刺,并加做免疫组化,如支持乳腺癌转移,同时排除其他部位原发肿瘤后可确诊。治疗以全乳切除加腋窝淋巴结清扫术为标准,新辅助化疗是影响其预后的独立因素,术前推荐先行新辅助化疗,术后根据免疫组化结果,辅以化疗、放疗、内分泌治疗等。隐匿性乳腺癌的预后与同期其他类型的乳腺癌相似。     

乳腺癌改良根治术中部分腋窝淋巴结清扫的远期疗效分析

目的 探讨乳腺癌改良根治术中部分腋窝淋巴结清扫对乳腺癌患者预后及上肢功能的影响.方法 选择98例Ⅰ、Ⅱ期乳腺癌,随机分为部分淋巴结清扫(PALD)组(n＝48)和全腋窝淋巴结清扫(TALD)组(n＝50).PALD组行乳腺癌改良根治术加部分腋窝Ⅰ、Ⅱ站淋巴结清扫术,TALD组行乳腺癌改良根治术加全腋窝Ⅰ、Ⅱ、Ⅲ站淋巴结清扫术.比较术后远期复发及上肢功能状况.结果 随访5～10年,平均4.5年.PALD组胸部局部复发2例(4.2%),腋窝淋巴结复发转移1例(2.1%),锁骨上淋巴结转移1例(2.1%); TALD组胸部局部复发2例(4.0%),无腋窝淋巴结复发转移,锁骨上淋巴结转移1例(2.0%); 2组差异无统计学意义(P>0.05).PALD组发生患肢水肿及功能障碍2例(4.2%),TALD组8例(16.0%),差异有统计学意义(P＜0.01).PALD组和TALD组患者5年生存率(89.6%比88.0%)及10年生存率(79.2%比78.0%)差异均无统计学意义(P＞0.05). 结论 Ⅰ、Ⅱ期乳腺癌实施PALD可减少术后患侧上肢的功能障碍,且不增加预后风险.     

28例隐性乳腺癌的诊治分析

目的：探讨隐性乳腺癌的诊断和治疗方法。方法：对28例隐性乳腺癌患者分别采用乳房X线和乳腺导管选择造影术，对肿块行针刺和切除活检病理免疫组化检查，治疗采用乳腺癌根治术或改良根治术加放化疗。结果：16例患者行乳腺X线检查，异常者7例；6例行乳腺选择性导管造影，异常者4例，13例经免疫组化检查，确诊lO例。术后随访18例，复发死亡5例(其中4例为仅行腋窝肿块切除者)。结论：乳头溢液和乳腺局限性腺体增厚对隐性乳腺癌的诊断有重要价值，活检和免疫组化检查有助于确诊；乳腺癌根治术或改良根治术后应辅以放、化疗。     

隐匿性乳腺癌的诊治(附30例报告)

目的 总结隐匿性乳腺确（occult breast cancer，OBC）的诊治经验。方法 回顾性分析30例OBC的临床资料，均以腋下肿块为首发症状，并行手术治疗。结果 本组行乳腺癌根治术16例，改良根治术9例，腋下肿块切除加单纯乳房切除3例，腋下肿块切除术2例。术后14例予辅助化疗加放疗，10例予化疗。随访27例，平均6．8（0．5～12）年，5、10年生存率分别为75．5％和56．8％。结论 对女性腋窝肿块同时排除全身其他部位癌转移者应高度考虑OBC的可能。腋下肿块病检对诊断较有帮助，治疗可采用手术辅以放疗和（／或）化疗及内分泌治疗等综合手段。     

隐匿性乳腺癌12例临床分析

目的 探讨隐匿性乳腺癌(occult breast cancer,OBC)的诊断、治疗和愈后.方法 回顾分析首都医科大学附属大兴区人民医院与首都医科大学附属北京同仁医院1995年6月～2006年6月共12例OBC临床资料.结果 本组OBC共12例女性患者,平均年龄52.7岁,均单侧发病,绝经前4例,绝经后8例;左侧病变1O例,右侧病变2例,占同期诊治各型乳腺癌患者0.5%(12/2385);12例均以腋下肿块为首发症状;10例行腋下肿块切除活检证实淋巴结转移性腺癌,2例术前行细针穿刺检查为淋巴结转移性腺癌;12例中3例行淋巴结转移性腺癌的雌激素受体(estrogen receptor,ER)测定,均为阳性;10例术前行乳腺X线钼靶照相检查,2例可见有细小钙化灶,不除外乳腺癌;11例行乳腺B超检查、10例行近红外线扫描,均未发现乳腺内病灶;10例术前胸片、腹部B超,5例胸腹部CT及全身骨扫描和2例胃镜检查未发现全身其他部位病变;10例行乳腺癌改良根治术,1例行乳腺癌根治术,1例患者行姑息手术;9例术后病理检查发现乳腺原发病灶,浸润性导管癌6例、导管内癌3例;术后均予以放射治疗和化疗;3例雌激素受体阳性患者化疗后接受口服三苯氧胺内分泌治疗;随访3～10年,11例均生存且未见复发或转移,1例死亡,其中5例已生存5年以上,5年生存率为41.66%(5/12).结论 OBC是临床较为少见的特殊类型乳腺癌之一;左侧乳腺多见,比一般原发癌浸润能力强,早期即出现腋窝淋巴结肿大或远处转移;对肿大淋巴结进行细针穿刺细胞学检查或切除行组织学检查有助于诊断;乳腺癌改良根治术为常用治疗方法.     

表现为锁骨上肿块的隐匿性乳腺癌的诊治分析

目的　探讨表现为锁骨上肿块的隐匿性乳腺癌的发病特点、诊断和治疗方法。方法　对经我院手术治疗的 7例表现为同侧锁骨上肿块的隐匿性乳腺癌的临床及病理资料进行回顾性分析。结果　行锁骨上肿块部分切除 1例 ,行锁骨上肿块切除、腋窝肿块切除、乳房切除 1例 ,锁骨上肿块切除、乳腺癌改良根治术 2例 ,锁骨上肿块切除、乳腺癌根治术 3例。结论　对原因不明的锁骨上肿块 ,应考虑到隐匿性乳腺癌的可能 ,应予切除并送病理确诊 ,锁骨上肿块转移的组织学类型可对判断肿瘤来源提供重要线索。一经确诊 ,本病宜选根治术 ,并辅助放、化疗。     

隐匿性乳腺癌

本文报告隐匿性乳腺癌7例,均以腋下肿块为首发症状。探讨了误诊原因,强调了以腋下肿块为首发症状的女性病人,应考虑到隐匿性乳腺癌;对乳腺各种检查无阳性发现者不能排除本病。确定性诊断需行腋下肿块活检。作者认为本病应行根治术或改良根治术并辅以放疗、化疗。     

隐匿性乳腺癌的诊断和治疗

目的 探讨隐匿性乳腺癌的发病特点、诊断和治疗方法。方法 对经治的12例隐匿性乳腺癌的临床及病理资料进行回顾性分析。结果 12例均以腋下肿块为首发症状且均予手术治疗。手术方式为腋下肿块切除术1例，腋下肿块切除加单纯乳房切除1例，乳腺癌根治术6例，改良根治术4例。11例获随访1—15年。随访期间行腋下肿块切除和加行单纯乳房切除的2例分别于术后18个月和22个月死于全身多器官转移；1例行乳腺癌根治术者于术后3年出现腋淋巴结转移而再次手术，于再次术后4年死于肺转移；其余患者仍存活，其中已生存3年以上2例，5年以上2例，10年以上4例。结论 对原因不明的腋下肿块，应考虑到隐匿性乳腺癌的可能，同时应予切除并送检病理确诊。腋下淋巴结转移癌的组织学结构对肿瘤来源能提供重要线索。一经确诊，本病宜选择乳腺癌根治术或改良根治术，并予辅助性放疗、化疗。     

Influence of mastectomy technique on sex steroid receptor analysis

Accurate analysis of hormone receptors in breast carcinoma is critical from prognostic and therapeutic standpoints. Controversy exists over whether there is receptor decay when specimens are obtained upon completion of, rather than prior to, mastectomy. In addition, the effect of mastectomy technique on receptor concentration has not been addressed. Twenty patients with breast carcinoma had biopsy specimens taken prior to and upon completion of modified radical mastectomy. Ten had axillary dissection followed by mastectomy (Group A). The others had mobilization of the breast before axillary dissection (Group B). The estrogen receptor concentration was higher in 14 of 20 premastectomy specimens. All 10 patients in Group B had positive receptors before mastectomy; 5 were negative after mastectomy. All seven patients in Group A with positive premastectomy receptors remained so postmastectomy. We concluded that if a tumor specimen for receptor analysis is not obtained prior to modified radical mastectomy, axillary dissection should precede breast mobilization.     

Management of Occult Breast Cancer with Axillary Involvement

Occult breast cancer (OBC), which is defined as clinically recognizable axillary metastatic carcinoma from an undetectable primary breast tumor, accounts for less than 1% of all patients who present with breast cancer (BC). Although criticized for high false positive rate (FPR) in routine BC diagnosis, the role of magnetic resonance imaging (MRI) is crucial in the diagnosis of OBC. The standard treatment for OBC, initially, was blind modified radical mastectomy, but one third of patients who undergo blind mastectomy, will have no histopathological findings of carcinoma. Current evidence supports the use of whole breast radiotherapy (WBRT) and axillary nodes clearance (ANC) as the locoregional treatment for patients with OBC. Management of the axilla does not differ from that of patients with BC with clinically palpable axillary lymph nodes (LNs) and ANC, which remains the gold standard, should be used for staging and loco-regional control. Neo-adjuvant chemotherapy (NACT) could reduce ANC by 43%, and for patients who undergo NACT with complete radiological response, a more conservative surgical approach, with a minimum of 3 sentinel lymph node biopsies (SLNBs), together with targeted dissection of the involved LNs could be considered as an option. This offers adequate staging and loco-regional control, combined with significantly less comorbidities than ANC. Overall, the prognosis of OBC is equal to or better than that of other BCs with metastasis to the axillary LNs. Progesterone receptor (PR) expression should be taken into account when evaluating the prognosis of OBC because PR-positive patients achieve better overall survival and have a lower risk of local recurrence. Surveillance should include breast MRI and mammography.     

Local recurrence of breast cancer in the stereotactic core needle biopsy site: case reports and review of the literature

Abstract: Early mammographic detection of nonpalpable breast lesions has led to the increasing use of stereotactic core biopsies for tissue diagnosis. Tumor seeding the needle tract is a theorectical concern; the incidence and clinical significance of this potential complication are unknown. We report three cases of subcutaneous breast cancer recurrence at the stereotactic biopsy site after definitive treatment of the primary breast tumor. Two cases were clinically evident and relevant; the third was detected in the preclinical, microscopic state. All three patients underwent multiple passes during stereotactic large-core biopsies (14 gauge needle) followed by modified radical mastectomy. Two patients developed a subcutaneous recurrence at the site of the previous biopsy 12 and 17 months later; one had excision of the skin and dermis at the time of mastectomy revealing tumor cells locally. In summary, clinically relevant recurrence from tumor cells seeding the needle tract is reported in two patients after definitive surgical therapy (without adjuvant radiation therapy). Often, the biopsy site is outside the boundaries of surgical resection. Since the core needle biopsy exit site represents a potential area of malignant seeding and subsequent tumor recurrence, we recommend excising the stereotactic core biopsy tract at the time of definitive surgical resection of the primary tumor.     

Lobular carcinoma in situ: Observation without surgery as an appropriate therapy

Background: The finding of lobular carcinoma in situ (LCIS) in the breast has generally prompted treatment with unilateral or bilateral mastectomy. Most experts now feel that LCIS simply identifies a woman who is at high risk to develop future breast cancer and requires only close clinical and mammographic follow-up. This approach has been recommended at our institution for >15 years. This study defines the natural history of a population of women with LCIS who were treated by observation alone. Methods: Women with a pathologic diagnosis of LCIS were identified by tumor registry search. Records and pathology were reviewed. Radiographic-pathologic correlation was performed on women who had undergone mammographic-localized breast biopsies. One hundred forty-nine women with LCIS were identified. Eighty four were excluded from analysis because of synchronous invasive cancer or ductal carcinoma in situ (DCIS). The remaining 65 women formed the basis of this report. Results: Sixty-five women with LCIS were treated from 1963 through 1990. Median follow-up was 83 months. No women were lost to follow-up. Median age at diagnosis was 48 years (range 37–81), and 32% had a family history of breast cancer. Clinical findings leading to biopsy were breast mass in 43, nipple discharge in three, and mammographic abnormality in 19. Mammographic-pathologic correlation showed that the focus of LCIS in these 19 women was not associated with the mammographic abnormality. Fourteen of 65 women underwent mastectomy after diagnosis of LCIS (nine ipsilateral, five bilateral). Fifty-one of 65 women elected observation alone. In the observation group, 13 of 51 women (25%) underwent a second breast biopsy for a clinical or mammographic abnormality during the follow-up period. The median interval to biopsy was 50 months. Pathology was benign in two, LCIS in seven, DCIS in one, and invasive cancer in three. All seven women with LCIS on subsequent biopsy continued with observation and none developed breast cancer. All four cancers were detected by mammography without an associated palpable mass. Three of four cancer masses were <1 cm in diameter. The woman with DCIS was 47 years of age and developed DCIS 106 months after LCIS diagnosis. She was treated by total mastectomy and is disease free 108 months later. The three women with invasive cancer developed this at 41, 53, and 69 months after diagnosis of LCIS. All were <50 years of age. All three cancers were in the same breast as the previous LCIS. Two women were treated by modified radical mastectomy, and the third had wide excision/axillary dissection followed by radiation therapy. They are alive and disease-free at 16, 82, and 116 months. Conclusions: Four of 51 women treated with observation alone after diagnosis of LCIS developed breast cancer. All were detected by screening at an early stage. LCIS appeared to be an incidental finding on biopsy of mammographic abnormalities. The policy of observation alone for the finding of LCIS spares women mastectomy. Furthermore, cancers that develop in follow-up are likely to be detected at an early stage and be amenable to curative therapy. Observation alone is appropriate treatment for women with LCIS. Presented at the 46th Annual Cancer Symposium of the Society of Surgical Oncology. Los Angeles, California, March 18–21, 1993.