临床触诊阴性的乳腺多发病灶麦默通微创旋切的应用价值

目的：探讨超声引导下麦默通系统在临床触诊阴性的乳腺病灶中的应用价值。方法：对超声检查发现的163例患者的575个乳腺肿块在超声引导下行麦默通微创旋切术,切除标本送常规病理检查。结果：575个病灶均被准确定位切除,引导成功切除率达100%,术后2例出现局部血肿,5例出现皮下淤血,术后病理显示所有肿块中：乳腺纤维瘤316个,乳腺囊肿174个,导管乳头状瘤35个,腺病41个,乳腺癌9个。结论：超声引导下麦默通装置具有定位准确、微创切除或活检乳腺肿块的功能,尤其适合于临床触诊阴性的乳腺病灶。     

超声引导美蓝双重标记与经皮缝线牵引联合切除触诊阴性乳腺肿物

目的 探讨应用超声引导美蓝双重标记与经皮缝线牵引联合微创切除触诊阴性乳腺肿物的价值.方法 对46例直径0.5～1.0 cm的触诊阴性乳腺肿物,术前1 h超声引导下应用美蓝对肿物及肿物四周行双重标记,术中经皮缝线牵引外提肿物,行手术准确切除肿物.术后1个月超声复查有无残留或误切.结果 46例58个肿物均准确切除,无残留和误切.切除部分手术时间为10～20 min.结论 超声引导美蓝双重标记与经皮缝线牵引联合微创切除触诊阴性乳腺肿物,定位准确,手术时间短,创伤减轻,操作简单,便于普及和推广.     

超声在麦默通旋切系统切除乳腺良性肿块的应用价值

目的:探讨超声在麦默通微创治疗乳腺良性肿块中的应用价值.方法:20例患者58枚乳房肿决,术前经临床及超声检查拟诊为良性肿块,在超声引导下行麦默通微创旋切术.结果:超声能清晰显示肿块微创旋切的全过程,58枚肿块完整切除,引导成功率100％.术后病理报告均为良性,超声诊断准确率100％(58/58).术后未出现皮肤损伤及感染等并发症.术后后3月超声随访显示病灶未见明显残留.结论:超声在麦默通微创治疗乳腺良性肿块中有重要作用.超声引导下麦默通旋切系统切除乳腺良性肿块安全可行,值得推广.     

超声引导定位切除临床触诊不清乳腺肿块的疗效

目的探讨超声引导定位切除临床触诊不清乳腺肿块患者的疗效。方法选取70临床触诊不清乳腺肿块患者作为研究对象,其中35例术前经X线定位切除为对照组,另35例采用超声引导定位切除为观察组。记录两组手术情况。结果对照组35例(35病灶)均为良性,观察组共35个病灶,其中直径≤10mm为20个,10mm为15个;良性病灶为33个,恶性为2个;纤维腺瘤为10个、乳腺腺病为18个、囊性增生4个、浸润性导管癌3个。观察组平均手术时间为(30.44±5.71)分钟明显短于对照组(46.88±4.72)分钟,P0.05。观察组定位费用平均为(159.35±21.64)元,明显少于对照组(517.98±28.87)元,P0.05。结论超声引导定位切除临床触诊不清乳腺肿块可更精准,缩短手术时间,减少治疗费用。     

超声引导对乳腺隐匿性病灶亚甲蓝多点定位的临床研究

目的 探讨应用超声引导亚甲蓝多点标记,切除触诊阴性乳腺肿物的价值.方法 对66例乳腺隐匿性病灶患者,术前1h在超声引导下,用亚甲蓝对肿物及肿物四周行多点定位注射,然后通过手术准确地切除肿物.术后1个月时,超声复查有无残留或误切.结果 66例患者的78个肿物,均准确切除,无残留和误切.结论 超声引导亚甲蓝多点定位切除乳腺隐匿性病灶,定位准确,操作简单,便于普及和推广.     

临床多发混合性乳腺肿块在B超定位下手术的应用体会

目的探讨通过B超发现临床触诊阴性多发混合型乳房肿块在B超定位下手术切除的临床应用价值,提高乳腺癌的早期诊断率。方法 153例女性临床触诊阴性而B超发现乳房多发混合性肿块病人术前在B超引导下定位标记,在全麻下行乳房肿块切除术。结果全组153例多发混合型乳房肿块一次全部切除。术中冰冻切片病理诊断乳腺癌3例,随即行乳腺癌改良根治术,余150例为乳腺良性病变。结论在B超定位引导下对临床触诊阴性多发混合型乳房肿块切除准确、可靠、易操作,效果确切,是发现早期乳腺癌的一条途径,值得推广。     

超声引导下导丝定位活检技术的临床应用

目的：探讨超声引导下导丝定位活检术在临床触诊阴性乳腺病变中的临床应用价值。 方法：回顾性分析在临床触诊阴性乳腺病变切除的84例(88例次)患者的临床资料,分析切除准确率及术后病理检查结果。 结果：88例次患者中,术前放置定位导丝均1次成功,定位成功率100.0%;所有病灶均一次完整切除,成功率100.0%。术后病理学检查结果：恶性病变10例（11.9%）,非典型增生7例（8.3%）,其他良性病变67例（79.8%）。 结论：乳腺超声引导下导丝定位活检技术提高了无肿块乳腺癌的早诊率,安全,准确、简便,经济,值得推广。     

CD105表达与乳腺癌临床病理参数的关系

为探讨CD10 5标记的微血管密度 (MVD )与乳腺肿瘤临床病理和预后的关系 ,作者应用免疫组织化学SP法及CD10 5单克隆抗体测定了 5 3例乳腺癌 ,3 0例乳腺良性肿块 ,2 0例正常乳腺组织中CD10 5标记的MVD ,并对其与临床病理因素和术后生存率进行分析。结果示正常乳腺组织、乳腺良性肿块 ,乳腺癌CD10 5的表达值依次为 3 .12± 1.18,10 .5 0± 3 .41和 5 0 .0 3± 15 .41,乳腺癌组织明显高于前两组 (P <0 .0 1)。用MVD表示的CD10 5值与TNM分期、淋巴结转移等病理因素无关。单、多因素分析结果表明 ,CD 10 5标记的MVD是乳腺癌的独立预后因素。提示CD10 5是乳腺癌血管生成的重要因素 ,它在乳腺癌中的表达较良性肿块及正常乳腺明显增高 ;CD10 5标记的MVD与临床病理因素无关 ,它可作为乳腺癌的一种重要预后指标。     

麦默通旋切系统在临床触诊阴性乳腺病灶的应用

【摘要】〓目的〓探讨超声引导下麦默通旋切系统在临床触诊阴性乳腺病灶中的诊疗作用。 方法〓对62例共85个临床触诊阴性乳腺病灶进行超声引导下麦默通旋切术。结果〓85个病灶皆被准确、完整切除。术中冰冻切片病理示良性病变77例,乳腺癌8例。85例术中冰冻切片和术后石蜡切片诊断均相符。术后3个月复查B超均未见局部复发。结论〓超声引导下麦默通旋切术是确诊临床触诊阴性乳腺病灶的有效方法,在诊断的同时可完整切除良性病灶,达到治疗效果。     

超声引导下导丝定位联合皮肤体表标记在切除乳腺微小病灶中的应用

探讨超声引导下导丝定位联合皮肤体表标记在经乳晕旁切口切除乳腺不可触及的微小病灶中的价值。对81例单发乳腺微小肿物进行手术治疗,术前所有患者均于乳腺彩超下置入定位导丝并于体表标记肿物位置。所有患者均选用乳晕旁弧形切口,顺定位导丝结合术前做好的体表标记顺利找到并切除肿物。81例手术均获得成功,术中2例导丝出现滑脱,1例导丝被电刀烫断,通过寻找残余的导丝仍成功切除病灶。应用超声引导下导丝定位联合皮肤体表定位方法,使一些临床上不可触及的肿物也能够选择乳晕旁隐蔽切口作为手术路入,具有定位准确、操作方便、术后美观等优点,值得推广。     

Invasive ductal carcinoma of the breast with large central acellular zones (ring carcinoma): imaging and clinical findings in eight cases

OBJECTIVE: To review the mammographic and ultrasound appearances in patients who have invasive ductal carcinoma with a central acellular zone (ring carcinoma), as this feature has been reported to be associated with a poorer outcome. MATERIALS: Eight patients were identified with ring carcinomas. Two breast radiologists reviewed their mammograms and ultrasound images. Patient records were reviewed to assess outcome. RESULTS: All patients had lesions deep within the breast, adjacent to the chest wall, five lesions were incompletely visualised on mammography. The appearance was of a circumscribed or obscured mass, without microcalcification. Five patients had ultrasound demonstrating a solid well-circumscribed hypoechoic microlobulated lesion. CONCLUSION: In our series of patients who have a ring carcinoma of the breast, mammographic and ultrasound appearances were similar in all cases and lacked the typical features of malignancy.     

乳管内乳头状病变的临床分析：附1?211例报告

目的：探讨乳管内乳头状病变的临床病理特征及诊断方法。 方法：采用回顾性方法,对1?211例不同类型乳管内乳头状病变的年龄分布、乳头溢液与乳房肿块情况、病理及影像学检查结果进行分析。 结果：1?211例患者中,乳头状瘤874例,乳头状瘤病231例,乳头状癌106例;恶性病变患者平均年龄大于良性病变患者（P<0.01）,31~50岁为乳头状瘤及乳头状瘤病的高发年龄;16.0%患者有乳腺疾病手术史,乳头状瘤病患者中先后多次手术及同时双侧手术者明显多于乳头状瘤与乳头状癌患者（P<0.05）;67.8%患者有不同性质的乳头溢液,乳头状癌患者中溢液病例少于良性病变患者,但血性溢液明显多于良性病变患者（P<0.05）;约80%的良性病变术中可见肿块,恶性者术中均可见肿块,乳头状瘤病患者中伴有中-重不典型增生者明显多于乳头状瘤（P<0.05）,肿块>1.0 cm时常伴有中-重不典型增生,乳头状癌患者肿块平均最大径（1.93±0.78）cm;导管造影及导管镜检查对良性病变诊断的准确率高于彩色B超和钼靶（P<0.05）。 结论：不同类型乳管内乳头状病变有一些共同表现,也有各自特征,掌握这些特征有利于临床正确诊断及合理的治疗。     

端粒酶逆转录酶、环氧化酶-2在乳腺癌中的表达及其意义

目的 探讨端粒酶逆转录酶(hTERT)和环氧化酶(cox)-2在乳腺浸润性导管癌中的表达及其临床意义.方法 使用免疫组织化学法分别检测45例乳腺浸润性导管癌和22例乳腺良性病变标本的hTERT和COX-2蛋白表达情况.结果 hTERT在乳腺浸润性导管癌中阳性表达率fig71.11%,明显高于乳腺良性病变9.09%,两者比较差异有统计学意义(P<0.05).hTERT阳性表达与乳腺浸润性导管癌患者的年龄、肿瘤大小、腋窝淋巴结转移情况及雌、孕激素表达水平无相关性(P>0.05),与Her-2表达存在显著相关性(P<0.05).COX-2在乳腺浸润性导管癌中的阳性表达率为82.22%,明显高于乳腺良性病变50.00%,两者比较差异有统计学意义(P<0.05).COX-2阳性表达与乳腺浸润性导管癌患者腋窝淋巴结转移情况、Her-2、ER阳性表达有关(P<0.05).在乳腺浸润性导管癌中hTERT阳性表达与COX-2阳性表达呈正相关(r=0.557,P<0.01).结论 hTERT与COX-2在乳腺浸润性导管癌中的表达显著高于在乳腺良性病变中的表达,hTERT与COX-2在乳腺癌的发生、发展中起重要作用.hTERT表达与COX-2表达存在显著相关性,COX-2的过度表达可能是端粒酶激活和调节的机制之一.     

钼靶联合超声引导双定位法在乳腺微钙化灶活检中的 临床应用研究

目的:探讨钼靶X线与超声联合定位在乳腺微钙化灶活检中的临床应用价值。方法:在钼靶下对微钙化病灶三维定位,插入双钩定位针,到达病灶后固定位置;以超声探查双钩针,找到病灶的位置后,划出皮肤标记线,再插入单钩定位针;在标记线上作3 cm切口,用特制拉钩显露并固定病灶部位的乳腺组织和单钩针,对微钙化病灶区进行旋切;切下的圆柱体标本,放在带刻度的标本台上摄片,验证钙化灶是否已被完全切除,同时确定钙化灶在标本中的三维位置供病理检查。结果:共108例乳腺微钙化病灶分类为BI-RADS 4A的患者采用以上方法。定位时病灶距双钩针距离平均为4.1 mm(小于传统方法),标本平均重量为8.5 g(小于传统方法),病灶全部被一次性精准切除。108例中阳性20例,包括不典型增生7例,导管原位癌7例,导管原位癌伴局灶浸润性癌3例,浸润性导管癌3例;阴性病例88例。微钙化灶部位及形态与乳腺癌检出无明显关系(均P0.05)。结论:钼靶X线与超声联合定位对病灶定位准确、手术方法合理、切除标本小,并能提供病灶在标本中的精确位置进行病理检查;良性者乳房外形完全没有改变。     

A new device for MRI-guided surgical excision: report of a case

A 37-year-old female was indicated to have a non-mass lesion in her left breast on ultrasonography (US) and visited our outpatient clinic. Mammography showed no findings of masses or microcalcification. Dynamic magnetic resonance imaging (MRI) showed a segmental enhanced lesion consisting of nodular and ring enhancement. A US-assisted vacuumed needle biopsy was performed, and the histological findings revealed sclerosing adenosis and apocrine metaplasia. After 1 year of follow-up, the MRI findings suggested both a benign lesion and ductal carcinoma in situ, and surgical excision was performed. We used a new device to evaluate the surgical margin on MRI. The non-mass lesion was excised according to the device-guided margin under local anesthesia. The histological findings revealed the features of mastopathy. Following excision, MRI showed no residual non-mass lesions, and the shape of the patient’s left breast was maintained.     

乳腺微小病变定性诊断的探讨

目的 探讨应用乳腺钼靶机对不可触及的乳腺微小病变(nonpalpable breast lesion，NPBL)的定性诊断价值。方法应用乳腺钼靶机及其配套的立体定位装置导人特制的钢丝定位针指导手术切检(needle localized operation biopsy，NLOB)或直接穿刺活检(sterotactic core needle biopsy，SCNB)对82例患者90个NPBL进行的SCNB和NLOB。结果82例患者中，20例为恶性病变，占24．4％，61例为良性病变，需要手术的共有35例，占42．7％。结论SCNB和NLOB的应用对乳腺微小病变的定性诊断定位准确、安全、实用。     

Mammotome乳房活检系统临床应用2794例报告

目的 探讨影像引导下Mammotome微创手术对乳腺病灶的诊断与治疗价值。方法 广东省人民医院肿瘤中心乳腺科2004年6月至2008年11月对2794例病人（乳腺影像学发现的BIRADS评级Ⅱ~V级病灶者）在影像引导下进行Mammotome微创活检术。 结果 术后病理学诊断乳腺浸润性癌263例,乳腺导管内癌240例,不典型增生53,良性病变2238例。263例乳腺浸润性癌接受外科手术及辅助治疗。240例乳腺导管内癌,53例不典型增生及99例乳头状癌接受外科开放性手术,3例被证实组织学低估。Mammotome微创活检术后活动性出血发生率为0.11%（3/2794）,血肿0.39%（11/2794）,无切口感染发生。所有病理诊断良性病变病人术后6个月始均接受B超随访。结论 应用影像引导下Mammotome旋切系统对乳腺病灶进行微创活检,获得明确病理组织学诊断,是一种有效的、安全的手术方法。     

Fine-Needle Aspiration Cytology of Metastatic Malignancies and Lymphomas Involving the Breast

Abstract: The fine-needle aspiration cytology (FNAC) findings in 13 cases of metastatic malignancies and lymphomas involving the breast are reported. The pre-FNAC clinical diagnoses in 6 of these cases were benign breast lesions, while in 3 cases the clinical differential diagnosis was either a benign or malignant primary breast lesion versus a metastatic malignancy. In 1 of the 13 cases the pre-FNAC diagnosis was uncertain and suggested a breast carcinoma versus a lymphoma, while in 3 cases the clinical impression was of a primary carcinoma of the breast. The type of neoplasms that were diagnosed by FNAC included 7 non-Hodgkins lymphomas, 3 malignant melanomas, an adenocarci-noma of the ovary, and one each of squamous cell carcinoma of the lung and cervix. In all 13 cases the unusual cytologic patterns of the tumors in the aspirates seen on the FNAC examination distinguished the lesion from that of primary breast carcinoma. A reliable FNAC diagnosis of mammary malignancies other than a primary carcinoma is important not only to avoid an unnecessary mastectomy but also to adopt a correct management utilizing an appropriate therapeutic intervention.     

Immunohistologic diagnosis of 2 cases of metastatic prostate cancer to breast

We report 2 cases of primary prostatic carcinoma with subsequent carcinomatous lesions in the breast. Prostatic origin of these carcinomas was confirmed by immunocytochemical demonstration of prostatic acid phosphatase and prostate specific antigen within paraffin sections. Previously, only 20 cases of prostatic carcinoma metastatic to the breast have been reported in the literature. In most of these cases the designation of the breast lesion as prostatic carcinoma has been made on morphologic and clinical grounds only.     

Evaluation of Malignant Breast Lesions in the Diagnostic Setting with Cone Beam Breast Computed Tomography (Breast CT): Feasibility Study

To investigate the feasibility of noncontrast and contrast‐enhanced cone beam breast Computed Tomography (CT) in demonstrating malignant breast lesions in the diagnostic setting. This Institutional Review Board approved, Health Information Portability and Accountability Act compliant, prospective study enrolled BI‐RADS four and five patients from 2008 to 2010. Eighty‐seven subjects had noncontrast breast CT, 42 had contrast‐enhanced breast CT (CE‐breast CT) with 70 pathologically confirmed cancer diagnoses. All 70 comprise the study cohort for noncontrast breast CT, and 23 who had CE‐breast CT comprise the cohort for CE‐breast CT. All had diagnostic work‐up. Patient age, breast density, lesion size and characteristics, biopsy method, and core pathology were recorded. A Fisher's exact test was used to detect a difference in detectability. For agreement in size measurement between the imaging modalities, a paired t‐test was employed. Reported p‐values were based on 2‐sided tests. Two one‐sided tests were calculated to determine equivalence within ±0.3 cm at a 90% significance level. Noncontrast breast CT identified 67 of 70 malignant lesions, detected by diagnostic work‐up. CE‐breast CT identified 23 of 23 index malignant lesions and in addition, found three malignant lesions in three cases not previously detected. Noncontrast breast CT demonstrated the index lesion in 67 of 70 cases and CE‐breast CT demonstrated the index lesion in all 23 cases. An additional three new malignant lesions not seen with conventional diagnostic work‐up were detected. In this preliminary study, breast CT with or without contrast was shown to be accurate at identifying malignant breast lesions in the diagnostic setting.