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36例诊治分析

目的探讨隐匿性乳腺癌的诊断和治疗方法。方法对36例隐匿性乳腺癌患者分别采用乳房X线、MRI检查,对肿块切除活检病理免疫组化检查;治疗采用乳腺癌根治术、改良根治术或保乳术后加放疗。结果乳腺钼靶的阳性率45．8％（11／24）,MRI的阳性率70％（7／10）;免疫组化检查阳性率62％（18／29）;乳腺癌根治术、改良根治术和保乳术后加放疗的5年生存率分别73．9％、77．8％（P〉0．05）。结论乳腺钼靶和MRI有重要诊断价值,切检和免疫组化检查有助于确诊;乳腺癌根治术或改良根治和保乳术后放疗的5年生存率相同。     

隐匿性乳腺癌62例临床分析

目的 分析隐匿性乳腺癌的临床特征及预后影响因素.方法 回顾性分析天津市肿瘤医院1997年10月至2011年10月收治的62例隐匿性乳腺癌的临床病理资料,对其临床特征及影响预后的因素进行分析.结果 62例隐匿性乳腺癌患者3、5、10年总生存率分别为87.4％、76.4％、73.2％;中位生存期为53个月.阳性淋巴结数目＞4个的患者3、5、10年总生存率低于阳性淋巴结数目≤4个者(77.8％、64.8％、38.9％比90.7％、86.7％、86.7％,P=0.015).乳腺癌根治术后病理切片发现原发灶组3、5、10年总生存率低于未发现原发灶组(60.0％、40.0％、40.0％比92.0％、83.6％、79.2％,P=0.023).有复发转移组总生存率低于无复发转移组(63.5％、28.6％、19.0％比97.1％、97.1％、97.1％,P=0.000).结论 隐匿性乳腺癌预后与阳性淋巴结数、乳腺病理切片能否发现原发灶以及有无复发转移有关.     

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。     

乳腺癌术后乳糜漏的诊治分析

目的探讨乳腺癌术后乳糜漏的诊断及治疗方法,为该病提供有效治疗方法。方法回顾性分析1997年6月至2013年8月收治6例乳腺癌术后并发乳糜漏的诊治经过。结果 1例保守治疗治愈。5例行手术治疗,1例治愈,4例术后仍有乳糜漏,采用碘仿纱填塞漏口加压包扎、负压引流治愈。结论术中熟悉腋窝的解剖关系、彻底结扎淋巴管可以减少乳糜漏发生。禁食营养支持治疗、局部加压包扎、碘仿纱填塞和负压引流是治愈乳腺癌术后乳糜漏的有效方法。     

乳腺癌改良根治术后上肢淋巴水肿与腋窝淋巴结阳性率的相关性分析

目的探讨分析乳腺癌改良根治术后上肢淋巴水肿与腋窝淋巴结阳性率的相关性。 方法对2014年11月至2016年11月进行改良根治术治疗的112例乳腺癌患者进行回顾性研究,依据周径测量法对患者淋巴水肿状况进行测量,将未出现水肿患者作为对照组,出现水肿患者列入水肿组,应用SPSS18.0进行分析,对两组患者上肢淋巴水肿与腋窝淋巴结阳性率进行Logistic单因素与多因素分析,两组患者术后上肢淋巴水肿症状对比采用χ²检验,P<0.05差异有统计学意义。 结果经单因素分析结果显示,患者体质指数、淋巴结转移、术后并发症、瘤体大小、放射治疗与上肢淋巴水肿、腋窝淋巴结阳性率有关(P<0.05);经多因素分析上肢淋巴水肿的独立危险因素为：体质指数、年龄、放射治疗(P<0.05);通过对比,水肿组上肢肿胀感与沉重感发生率显著高于对照组(P<0.05)。 结论导致乳腺癌患者术后出现上肢淋巴水肿的独立危险因素诸多,应当对出现的危险因素给予高度重视,采取相应措施来降低上肢淋巴水肿的发生率。     

隐匿性乳腺癌：九例报道及文献复习

从１９７７年至１９９４年，作者共收治９例隐匿性乳腺癌。９例均以腋下肿块为首发症状。在６例行根治术或改良根治术的患者中，４例生存达１０年以上，１例术后８年因心脏病死亡，１例术后己４个月仍在化疗中。另３例行腋下肿块切除者术后因脑转移、肝转移分别于８个月、１６个月、３２个月死亡。我们认为隐匿性乳腺癌宜选择乳腺癌根治术或改良根治术并辅助放疗、化疗。     

转移性乳腺癌的超声表现

目的探讨转移性乳腺癌的超声表现。方法回顾性分析经病理证实的6例转移性乳腺癌的声像图特征。结果 6例转移性乳腺癌中,5例单发、1例多发;肿瘤直径0.84~4.00cm;声像图示肿瘤呈低回声,形态不规则、边界不清,血流丰富。6例中4例诊断为BIRADS 5级,2例诊断为BIRADS 4级,BIRADS 5级肿瘤可见成角、毛刺和强回声晕。结论转移性乳腺癌超声表现与乳腺原发恶性肿瘤相似,不易鉴别。     

乳腺癌分期与术式选择

乳腺癌严重威胁女性的健康,外科治疗在乳腺癌治疗中占据了极其重要的地位。起初,乳腺癌根治术占据着主要地位,随后经历了到扩大根治术和改良根治术的转变。后来,乳腺癌的外科治疗完成了从最大的可耐受的治疗向最小的有效的治疗的转变,随着保乳手术和前哨淋巴结活检术的产生和发展,个体化保守治疗成为乳腺癌外科治疗的发展方向。     

Supraclavicular nodal failure in patients with one to three positive axillary lymph nodes treated with breast conserving surgery and breast irradiation, without supraclavicular node radiation

The purpose of this study was to evaluate the risk factors associated with supraclavicular nodal failure (SCF) in patients with one to three positive axillary nodes treated with breast conserving surgery and axillary dissection without supraclavicular node radiation (S/C RT) to aid in the selection of patients for S/C RT. Two hundred two breast conservation patients with one to three positive axillary nodes on axillary dissection treated with breast irradiation without S/C RT and 20 patients with S/C RT between August 1985 and May 2002 were identified and retrospectively evaluated. The Kaplan-Meier method was used to determine SCF-free and overall survival curves. Risk factors for SCF were examined. The median follow-up from surgery was 72 months (range: 4-195). Nine of 202 patients (4%) failed in the ipsilateral breast, 4 (2%) in the ipsilateral supraclavicular lymph nodes, 4 (2%) in the ipsilateral axillary and/or internal mammary nodes and 30 (15%) distantly. The 5- and 10-year SCF-free survival was 97.92%. The overall survival at 5, 10, and 15 years was 91.35%, 75.58%, and 67.18%, respectively. SCFs were associated with high grade or ER negative cancers, but not with number of positive nodes. Two of the four SCFs were associated with distant metastases, and two with local failures. One patient with a SCF was salvaged and is disease-free at 134 months. The overall low incidence of SCF in patients with one to three positive nodes treated with breast radiation alone after breast conserving surgery and adequate axillary dissection suggests that additional S/C RT is unnecessary in this cohort. When it occurs, supraclavicular nodal failure is often associated with distant metastases.     

Filariasis presenting as a breast lump

Lymphatic filariasis is common in Myanmar. Filariasis of breast is rare. This is a case report of filariasis presenting as breast lump.     

Occult contralateral breast carcinoma incidentally detected by breast magnetic resonance imaging

The incidence of synchronous bilateral breast cancers has been reported to be between 3.4% and 7.4%, as detected on mammography, physical examination, or both. We undertook a study to determine how often magnetic resonance (MR) imaging detects a contralateral abnormality in patients with known breast carcinoma. As part of an institutional review board (IRB) -approved research protocol, 17 patients with pathologically proven invasive carcinoma underwent preoperative MR imaging of both breasts using a T1-weighted, high-resolution gradient echo sequence (precontrast and postcontrast), an echo-planar sequence during administration of gadolinium, and a T2-weighted, fast-spin echo sequence. The morphology and dynamic enhancement of lesions in both breasts were assessed. Biopsy was recommended for any lesion meeting set criteria. MR imaging identified all 17 known invasive cancers in the breast of concern on mammography or physical examination. Five of 17 patients (29%) had 10 contralateral lesions identified on MR, for which biopsy was recommended. One of these lesions proved to represent a fibroadenoma. The other 9 lesions proved to represent a malignancy (6 invasive lobular, 2 infiltrating ductal, and 1 tubular). Four of the 17 patients (24%) with invasive cancer had contralateral synchronous cancers occult to physical examination, mammography, and ultrasonography. In this series, breast MR imaging of the breasts was more sensitive than mammography or physical examination in the detection of early breast cancer. Breast MR imaging of the contralateral breast may be of value as a routine screen in those patients with a known or suspected malignancy.     

Alternative sites of injection for sentinel lymph node biopsy in breast cancer

Background: Sentinel node biopsy is rapidly gaining popularity as a less invasive approach to nodal staging in breast cancer. The optimal route of injection of radiocolloids and dye is controversial. The purpose of the present paper was to review and assess the literature. Methods: A MEDLINE search for reports of studies involving different injection sites of colloid and/or dye was performed. Results: Although controversial, current evidence suggests that subareolar (SA) or intradermal/subdermal (ID/SD) injection will map the same axillary sentinel nodes (SN) as peritumoral (PT) injection in the vast majority of cases, is at least as successful, and is better logistically. Peritumoral, but not alternative routes, identify extra‐axillary sentinel nodes, which are important in a minority of patients. Conclusions: It is recommended that at least some of the radiocolloid be injected peritumorally to avoid missing those SN not located in the ipsilateral axilla. Injection of the dye and a portion of radiocolloid in an ID/SA location is reasonable to take advantage of the general ease and accuracy of ID/SA injections in identifying axillary SN.     

Occult primary breast carcinoma presenting as axillary lymphadenopathy

BACKGROUND: The objective of this study was to review the need for radiotherapy or not in patients with occult primary breast cancer presenting with axillary metastases treated with breast conservation usually with no surgery to the breast. METHODS: From 1975 to 2001, 58 patients were treated with axillary lymphadenopathy from a cryptic primary breast carcinoma. After clinical and radiological assessment, 29 patients retained a diagnosis of occult primary breast carcinoma. Clinical and pathological data were collected retrospectively on the 29 patients and survival was calculated from the date of initial diagnosis using the Kaplan-Meier method. The median follow-up was 44 months. RESULTS: Median age at diagnosis was 57 years (range 28-81 years). Sixteen patients had radiotherapy to the ipsilateral breast. Eleven patients received no local therapy to the ipsilateral breast and two patients had quadrantectomies which were negative for malignancy. Locoregional relapse occurred in 12.5% of patients who had received radiotherapy and 69% of those who had not received any radiotherapy (P=0.02). Fifty-seven per cent of patients having a local relapse were salvaged with further surgery. The eventual breast conservation rate was 93%. Patients who received radiotherapy to the breast had significantly improved relapse-free survival (HR=0.31; P=0.04) and local relapse-free survival (HR=0.09; P=0.004). There were no significant differences in overall survival between those patients who had breast irradiation and those who did not (HR 0.91; 95% CI 0.18-4.5). CONCLUSION: Occult primary carcinoma with axillary metastases can be treated successfully with breast preservation but radiotherapy to the breast is necessary to minimize the risk of locoregional recurrence.     

COX-2在乳腺癌中的表达及与淋巴结转移的关系

目的探讨环氧化酶-2(cyclooxygenase 2,COX-2)在乳腺癌组织中的表达情况及其与淋巴结转移的关系。方法应用免疫组织化学检测46例乳腺癌组织中COX-2的表达,同时应用淋巴管特异性标记物D2-40标记淋巴管并计数,分析两者的关系,并结合临床资料进行相关性分析。结果 COX-2在乳腺癌组织中的表达率为56.5%,COX-2蛋白的表达与淋巴结转移有关(P<0.05),与患者年龄、肿瘤直径、雌、孕激素受体和Her-2表达及临床分期无明显相关性。肿瘤组中淋巴管密度(D2-40 positive lymph vessel density,LVD)明显高于良性病变组(P<0.05);且LVD与COX-2的表达间有显著相关性(P<0.05)。结论 COX-2在乳腺癌组织中呈较高表达,其表达与肿瘤的淋巴结转移情况相关。乳腺癌组织中COX-2的表达与LVD存在显著的相关性,提示在COX-2可能通过受体途径诱导肿瘤淋巴管的生成,促进淋巴结转移。