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.     

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。     

乳腺叶状肿瘤的诊断与治疗:附9例报告

回顾分析10年间收治的乳腺叶状肿瘤9例的临床资料。全组术前仅1例确诊，其余均误诊。9例均手术治疗，行肿块局部切除2例，局部扩大切除2例，单纯乳房切除4例，乳腺癌改良根治术1例。9例均获2~10年随访，其中行局部切除1例，术后1年复发，再行乳房单纯切除术，今已6年，未再复发，1例4年死于脑出血;其余7例无复发，无转移。提示：乳腺肿块是该病的首发常见症状，术前诊断困难，明确诊断主要依靠术中冷冻切片检查;手术治疗，多采用局部扩大切除或单纯乳房切除术，预后良好。     

早期乳腺癌30例分析

目的 探讨早期乳腺癌的临床特点及诊断方法，为提高早期乳腺癌的诊断率提供参考依据。方法 回顾性分析30例早期乳腺癌的临床资料。结果 30例病人中乳腺局限性增厚18例（60％），可触及结节者仅11例（37％）；有乳腺增生病史伴增生症状加重者22例（73．3％）。钼靶X线单纯钙化12例（40％），肿块结节影5例（17％）。24例（80％）超声检出边界不规则低回声结节，79％的结节内或周围可测到血流信号。11例通过空芯针穿刺获得诊断，19例由超声或钼靶定位后手术活检确诊。结论 高危年龄妇女乳腺增生伴症状加重、乳腺局限性增厚是早期乳腺癌的重要表现；彩色多普勒超声对早期乳腺癌的诊断价值优于钼靶X线检查；及时对乳腺结节、局限性增厚、钼靶X线致密影等可疑病灶行组织学穿刺活检或超声以及钼靶定位后手术活检，可提高早期乳腺癌的诊断率。     

隐性乳腺癌临床诊治分析（附8例报告）

目的 探讨隐性乳腺癌发病率、诊断、治疗与预后。方法 对我院1985年4月～2004年12月8例隐性乳腺癌进行回顾性调查分析。结果 隐性乳腺癌少见，本文报告8例，占1985年4月～2004年12月912例乳腺癌的0．9％。本病首发症状是转移性腋下肿块，乳腺触不到肿块，乳腺外检查亦无可疑征象，确诊时多为中晚期癌。结论 强调腋淋巴结转移癌在没有明显乳外癌灶的情况下，应视为乳腺癌而尽早予以治疗。可手术的隐性乳腺癌宜行根治术，乳腺内、外检查未发现原发病变的腋转移癌应按乳腺癌治疗并密切随诊。     

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。     

乳腺微小钙化灶的外科微创治疗

目的探讨乳腺微小钙化灶的外科微创治疗。方法采用意大利IMS生产的GITTOHI—TECH高频钼靶X线机及其配套的数字化立体定位活检系统,对30例钼靶X片上乳腺有微小钙化病灶、无任何临床体征的患者,在X线定位下穿刺活检,进行病理组织学检查。明确诊断后采取相应的手术方式治疗。结果全部病灶定位准确,病变完全切除并明确诊断。浸润性导管癌3例(10%),导管内癌6例(20%),重度不典型增生2例(6.7%),纤维腺瘤6例(20%),导管内乳头状瘤3例(10%),乳腺增生病10例(33.3%)。无金属导丝折断现象,无感染、切口延迟愈合及气胸等并发症。结论对X线片显示有恶性可能的钙化病灶、而临床未触及肿块者,行乳腺钼靶引导下导丝定位活检,切除乳腺组织少,能确定乳腺微小病变的性质,对早期乳腺癌的诊断有重要价值。     

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目的分析选择性乳腺导管造影对有乳头溢液而临床扪不到包块的乳腺癌的诊断价值。方法回顾性分析1980年1月至2003年12月收治74例扪不到包块的乳腺癌经选择性乳腺导管造影诊断结果。结果选择性乳腺导管造影明确诊断68例,占91%。造影主要发现为大导管及分支导管管壁不规则浸润、僵硬、狭窄及截断征象和导管束状结构因癌侵犯、收缩或压迫等引起的改变。误诊病例与造影失败和诊断经验不足有关。结论选择性乳腺导管造影对有乳头溢液的早期乳腺癌诊断具有重要价值。     

Invasive mammary carcinoma after immediate and short-term follow-up for lobular neoplasia on core biopsy

Lobular neoplasia (LN), including atypical lobular hyperplasia (ALH) and lobular carcinoma in situ, may be encountered in breast core biopsies performed for mammographic abnormalities even though LN is often not, in itself, responsible for the abnormal mammogram. The need for surgical excision following a diagnosis of LN on core biopsy is not well defined. We examined pathologic and mammographic findings in a consecutive series of cases diagnosed as LN to address this issue. Radiology/pathology records were reviewed for cases with a pathology diagnosis of pure LN during the period 1998-2001. Specifically excluded were cases with associated atypical ductal hyperplasia, ductal carcinoma in situ, invasive mammary carcinoma, or any history of breast malignancy. Thirty-five women 39-76 years of age (mean 52 years) were identified. Specimens were obtained as stereotactic core (31) or limited wire-guided biopsy (four). The diagnoses were lobular carcinoma in situ (12), lobular carcinoma in situ/ALH (10), and ALH (13). Fourteen patients did not undergo excisional biopsy and had no subsequent clinical follow-up to warrant additional biopsy (follow-up 6 months to 3 years). Five patients had no immediate excision, but eventually during clinical follow-up for LN (1 month to 3 years), two developed mammographic lesions in the ipsilateral (one patient) or contralateral breast (one patient) that led to diagnoses of invasive mammary carcinoma (lobular and composite ductal-lobular types, 10 and 8 mm, respectively); three patients had subsequent mammographic findings in the ipsilateral or contralateral breast leading to biopsies showing only LN (two patients) or no neoplastic pathology (one patient). The remaining 16 patients (all core biopsied) underwent immediate wire-guided excisions. Thirteen (81%) showed additional foci of LN, one (6.3%) with atypical ductal hyperplasia, and two (12.5%) with invasive lobular carcinoma (3 mm and <1 mm). Three (19%) had no residual disease; however, additional clinical follow-up in one of these patients revealed an invasive mammary carcinoma in the contralateral breast (false-negative mammography). Radiographic findings were calcifications and density/mass lesions in 27 and 8 cases, respectively. Of 27 cases presenting with Ca, 10 showed colocalization of LN and Ca. In the eight cases presenting with density/mass, incidental microscopic microcalcifications colocalized to LN were found in two cases. When present, histologic Ca was associated with LN in 12 of 29 cases studied (41%). Of the 21 patients with immediate or subsequent excision, five (24%) were found to have an associated invasive mammary carcinoma (two on immediate excision and three after short-term follow-up of up to 3 years). The bilaterality of cancer risk was expected; however, the number of invasive carcinomas was not. That the invasive carcinomas detected at follow-up were small implies that they might have been present (but occult) at initial presentation. We conclude that lobular carcinoma in situ detected on core biopsy is potentially a significant marker for concurrent and near-term breast pathology requiring complete intensive multidisciplinary clinical follow-up with specific individualization of patient care.     

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。     

抗人乳腺癌单抗M4G3在隐性乳腺癌诊断中的应用

目的 探讨抗人乳腺癌单克隆抗体M4G3在以腋淋巴结转移癌为首发症状的隐性乳腺癌诊断中的应用。方法 对切检为腋淋巴结转移癌而乳腺内未触及肿物的62例做M4G3免疫组织化学检测，并对其中M4G3阳性病例做全乳腺大切片检查，寻找乳腺内原发癌灶。结果 M4G3阳性58例(93．55％58／62)；乳腺内原发灶总检出率84．62％(44／52)；M4G3与雌激素受体／孕激素受体检测结果呈正相关(r1=0．394，P1=0．026；r2=0．357，P2=0．045)；随访结果表明M4G3阳性患者的原发灶在乳腺内。结论 抗人乳腺癌单克隆抗体M4G3检测在以腋淋巴结转移癌为首发症状的隐性乳腺癌的诊断中有重要临床价值，还需辅以全乳腺大切片检查配合诊断。     

隐匿性乳腺癌的诊断与治疗

目的探讨隐匿性乳腺癌(OBC)的诊断与治疗经验。方法回顾性分析13例隐匿性乳腺癌的诊断与治疗方法。结果 10例腋窝肿块免疫组化,7例雌激素受体(ER);病理切片淋巴结转移性腺癌。乳腺癌根治或改良根治术后标本全乳房多次连续病理切片,3例未见原发灶,10例找到直径0.15 cm～0.90 cm肿瘤。5 a生存率46.15%。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,治疗首选改良根治术并辅以化疗、放疗及内分泌治疗等综合治疗。     

Combined ROLL and sentinel lymph node: a new strategy in radio-guided surgery

Radioguided surgery for the treatment of breast cancer is becoming the gold standard for both diagnosis and therapy. The main rule in using ROLL is perfect localization of non-palpable lesions and minimal invasiveness of excision. The same criteria apply to the sentinel lymph node technique. Clinically occult breast lesions, which require an exact histological diagnosis, are most frequently detected as the result of mammographic screening. The authors show that the ROLL technique for histological diagnosis may alter the subdermal lymphatic drainage so that the sentinel node cannot be found at later surgery. The aim of this study was to report the authors' experience with a combined ROLL and sentinel lymph node biopsy technique for the diagnosis and treatment of occult cancer of the breast.     

Surgical decision making and factors determining a diagnosis of breast carcinoma in women presenting with nipple discharge

BACKGROUND: There is no consensus about the use of the various diagnostic tests and surgical procedures available to confirm or rule out breast cancer in patients presenting with nipple discharge. This study was designed to identify patient and nipple-discharge characteristics associated with the diagnosis of breast cancer and to determine the utility of mammography, sonography, ductography, and cytology in surgical decision making in patients presenting with pathologic nipple discharge. STUDY DESIGN: We reviewed the medical records of all patients who presented with nipple discharge at our institution between August 1993 and September 2000. Patient and nipple-discharge characteristics and findings on imaging studies and cytologic examination were analyzed. RESULTS: A total of 146 patients presented at our institution with nipple discharge during the study period. Of these, 52 had clinically benign discharge and were managed without surgical intervention; 94 patients had pathologic discharge and underwent a biopsy procedure for histologic diagnosis, treatment, or both. Logistic regression analysis identified mammographic (relative risk [RR] = 10.47, 95% confidence interval [CI] 2.36 to 46.39, p = 0.0002) and sonographic (RR = 5.54, 95% CI 1.27 to 25.40, p = 0.028) abnormalities as independent factors associated with a malignant diagnosis. Nineteen cancers, 62 papillomas, and 13 other benign lesions were identified among the patients with pathologic discharge. In 3 patients with cancer (15.8%) and 30 patients with a papilloma (48.4%), ductography was the only means of identifying lesions to be resected. Patients who underwent ductography-guided operation (n = 42, 50%) or any surgical procedure including a localization study (n = 66, 78.6%) were significantly more likely than patients who underwent central duct excision alone to have a specific underlying lesion identified (p = 0.045 and p = 0.033, respectively). CONCLUSIONS: Abnormalities on mammography and sonography in patients with nipple discharge should alert physicians to the possibility of a breast cancer diagnosis. In patients with pathologic discharge with normal findings on physical examination and other imaging studies, ductography might be the only means of localizing and resecting breast lesions associated with nipple discharge.     

Identification of breast cancer in patients with pathologic nipple discharge: does ductoscopy predict malignancy?

OBJECTIVE: The purpose of the current study was to review characteristics of patients with nipple discharge who underwent ductoscopy-assisted excisional biopsy who had a final diagnosis of carcinoma. METHODS: A retrospective review was performed of patients presenting with pathologic nipple discharge (PND) who underwent ductoscopy-assisted excisional biopsy and had a final diagnosis of carcinoma. RESULTS: A total of 14 (7%) of 188 patients who underwent ductoscopy-assisted excision had a final pathology of ductal carcinoma-in-situ (DCIS) (12/14, 86%) or invasive breast cancer with DCIS (2/14, 14%). Duct wall irregularities or intraluminal growths were visualized during ductoscopy in 8 of the 14 (57%) breast cancer patients. There were no visual abnormalities noted during ductoscopy that accurately predicted a final diagnosis of malignancy. CONCLUSIONS: Although occult malignancies can be identified in patients undergoing ductoscopy-assisted biopsy for PND, no clear morphologic changes visualized during ductoscopy definitively indicated the presence of malignancy.