术前动脉灌注化疗加乳腺区段切除治疗乳腺癌的探讨

目的　探索早期乳腺癌保留乳房治疗的新途径。方法　 1995 - 1997年采用术前动脉插管化疗加乳腺区段切除治疗Ⅰ、Ⅱ期乳腺癌共 2 6例 ,并随访 5年以上。结果　 2 6例中 1例术后 2年 4个月死于肺转移 ,另 1例术后 4年死于其他疾病。 1例术后 1年复发 ,行全乳房切除后至今无瘤生存 6年。本组 3年生存率 (OS) 96 .15 % ,3年无瘤生存率 (DFS) 92 .3% ;5年OS 88.4 6 % ,5年DFS 88.4 6 %。结论　术前动脉插管化疗能提高肿瘤区域的药物浓度 ,杀灭部分癌细胞 ,减少术后复发。该疗法对部分Ⅰ、Ⅱ期乳腺癌病例是可行的。     

Atributable risk of breast,prostate, and lung cancer in Hawaii due to saturated fat

The dietary data from case-control studies of breast, prostate, and lung cancer in Hawaii revealed that saturated fat was a risk factor for these malignancies. The dietary intakes from the three studies were used to calculate the attributable risk (AR) due to saturated fat. For all ethnic groups combined, the ARs for the highest quartiles of intake were 14.9 percent for female breast cancer, 13.0 percent for prostate cancer, and 23.1 percent for male lung cancer. Our results suggested that a reduction of saturated fat to the lowest quartiles of intake could result in a 10 to 20 percent decrease in risk for these three cancers in Hawaii. We also examined the ethnic-specific risks associated with saturated fat consumption among the Japanese and the Caucasians in the three studies. The ARs for the highest quartiles of intake were notably higher among the Caucasians than the Japanese, primarily due to the difference in their dietary patterns. Although the calculated AR due to saturated fat was higher among the Caucasians than among the Japanese, all persons in the population would derive considerable benefit by reducing their intake of this nutrient.Authors are with the Epidemiology Program, Cancer Research Center of Hawaii, University of Hawaii, 1236 Lauhala Street, Honolulu, HI 96813, USA. Address correspondence to Dr Hankin. This study was supported in part by NIH Grant PO1 CA 33619.     

乳腺癌层粘连蛋白的免疫组织化学研究

本研究应用层粘连蛋白（ＬＮ）抗体，对２７例乳腺癌、５例乳腺良性病变进行了免疫组织化学研究。结果发现乳腺良性病变时，ＬＮ以均匀完整的线型阳性反应显示在乳腺导管及小叶基膜处。乳腺癌时，ＬＮ的染色表现为癌细胞胞浆内弥漫状阳性反应。２７例乳腺癌中，癌细胞ＬＮ染色强度不同，伴有转移的乳腺癌ＬＮ染色多数较强，强度在＋＋～的为７／１２（５８．３％）；不伴有转移的病例，ＬＮ染色多数较浅或为阴性，强度在＋＋～＋＋＋的病例为３／１５（２０％）。说明癌细胞内源性ＬＮ染色强弱与肿瘤转移密切相关，内源性ＬＮ的合成可能改变肿瘤细胞的浸润活性。     

Development and evaluation of a breast cancer prevention decision aid for higher-risk women

Objective To develop and evaluate the effectiveness of a breast cancer prevention decision aid for women aged 50 and older at higher risk of breast cancer. Design Pre‐test–post‐test study using decision aid alone and in combination with counselling. Setting Breast Cancer Risk Assessment Clinic. Participants Twenty‐seven women aged 50–69 with 1.66% or higher 5‐year risk of breast cancer. Intervention Self‐administered breast cancer prevention decision aid. Main outcome measures Acceptability; decisional conflict; knowledge; realistic expectations; choice predisposition; intention to improve life‐style practices; psychological distress; and satisfaction with preparation for consultation. Results The decision aid alone, or in combination with counselling, decreased some dimensions of decisional conflict, increased knowledge (P < 0.01), and created more realistic expectations (P < 0.01). The aid in combination with counselling, significantly reduced decisional conflict (P < 0.01) and psychological distress (P < 0.02), helped the uncertain become certain (P < 0.02), and increased intentions to adopt healthier life‐style practices (P < 0.03). Women rated the aid as acceptable, and both women and practitioners were satisfied with the effect it had on the counselling session. Conclusion The decision aid shows promise as a useful decision support tool. Further research should compare the effect of the decision aid in combination with counselling to counselling alone.     

Evaluation of an Australian intervention to encourage breast feeding in primiparous women

Breast feeding has nutritional, immunologic and antiallergicadvantages for the infant. Although it has been widely recommendedthat infants be exclusively breast fed until 4–6 monthsof age, only about half of all Australian babies currently receiveextended breast feeding. The present study evaluated an intensiveprogramme designed to increase the proportion ofprimi-parousmothers who breast fed for 4 months or longer. Women who registeredwith the hospital at least 20 weeks before delivery and whointended to breastfeed were eligible for the study. Two hundredand thirty-five women were allocated to receive either usualcare or an intensive breast feeding programme when they registeredwith the hospital. The intensive programme consisted of writtenmaterials, and group and individual sessions with a lactationcounsellor. It also included a visit from a breastfeeding consultantwhile in hospital after the birth and contact on return home.Women were followed up 6 weeks and 4 months after delivery.There were no significant differences in breastfeeding ratesbetween the control and intervention groups at either follow-uppoint. Breast feeding until 4 months was more likely among womenwhose baby did not receive a bottle feed while still in hospitaland who did not smoke, use the combined oral contraceptive pillor introduce solid food before 4 months. Those mothers who enjoyedand felt satisfied with breastfeeding were more likely to continueto 4 months. It seems likely that programmes designed to increasebreastfeeding will need to address underlying factors such ashospital policy rather than simply providing more health education.     

Breast Conservation Therapy in Patients with Early-Stage Breast Cancer Who Have Undergone a Second Re-Excision of the Primary Tumor Bed: A Report of Four Cases

Abstract: For the women with early-stage breast cancer who are candidates for breast conservation therapy, re-excision of the primary tumor bed has commonly been used in patients for several indications. These indications include positive margin or uncertain margin status of the primary excision or residual microcalcifications on postbiopsy mammogram. If the pathology from the re-excision does not confirm negative margin status, mastectomy is generally recommended. This article examines patients who have undergone a second re-excision (i.e., a lumpectomy followed by two re-excisions) who have been treated with breast conservation therapy rather than a mastectomy.
From September 1977 to November 1995, 1,562 patients underwent breast conserving therapy at this institution. Seven hundred forty of these patients underwent a re-excisional biopsy because of positive or uncertain margin status or residual microcalcifications after the first excision. Four patients (0.5%) underwent a second re-excision because of positive or uncertain margin status or residual microcalcifications on mammogram after the first re-excision. The final margin status after the second re-excision of all four patients was negative. The radiation dose was 4,600–5,000 cGy to the whole breast followed by a conedown to bring the total dose to 6,400–6,800 cGy to the primary tumor bed.
Follow-up in the four patients was 13 years, 4 years, 14 months, and 8 months respectively. All four patients are clinically without disease and have not had a locoregional recurrence. Cosmesis was excellent in all four patients. One patient had an adriamycin-induced recall reaction causing a cellulitis, which resolved with antibiotics. There were no other complications.
Highly selected patients may undergo breast-conserving therapy after a second re-excision. Good outcome and cosmesis can be achieved for this small subset of patients with avoidance of a mastectomy.     

Limitations of the keyhole technique for quantitative dynamic contrast-enhanced breast MRI

The effect of keyhole data acquisition on quantitative analysis of dynamic MRI was examined. Experiments were performed retrospectively on raw data obtained from clinical dynamic contrast-enhanced breast imaging procedures. The effects of keyhole phase-encoding acquisition and type of reconstruction algorithm on the accuracy of derived quantitative parameters was assessed. Results indicate that the minimum keyhole size used should be restricted by the approximate minimum size of the expected lesions. Furthermore, reconstruction algorithms that offer improved image resolution do not circumvent this restriction.     

隐性乳癌（附6例报告）

从１９７９年至１９９４年，共收治６例隐性乳癌。其中以有腋下肿块为首发症状５例，以肱骨，椎体转移为首发症状１例，４例行根治术后生存已超过８年、４年３年以上各１例，另１例术后２５个月死于肺转移。１例行改良根治术后２３个月死于脑转移。１例单纯乳房切除术后１６个月死于全身骨和肺转移。     

电阻抗扫描成像和高频超声诊断小乳腺癌的对照研究

目的：评价电阻抗扫描成像(electrical impedance scanning，EIS)和高频超声对小乳腺癌的诊断价值．方法：乳腺肿块(直径≤2cm)54例病理证实，行EIS和高频超声检查，时间间隔不超过3d．结果：乳腺癌23例，EIS诊断小乳腺癌17例，敏感性73．9％，特异性80．6％，准确性77．8％，阳性预测值73．9％，阴性预测值80．6％；高频超声诊断小乳腺癌20例，敏感性87．0％，特异性87．1％，准确性87．0％，阳性预测值83．3％，阴性预测值90．0％．二联合诊断，敏感性95．6％，特异性90．3％，准确性92．6％，阳性预测值88．0％，阴性预测值96．6％．结论：EIS对小乳腺癌的诊断有较大实用价值，且与高频超声结合应用，可以提高小乳腺癌的诊断准确奎．     

乳腺肿瘤组织中Ⅰ型纤溶酶原激活物抑制剂的表达

探查乳腺肿瘤组织中Ⅰ型纤溶酶原激活物抑制剂（ＰＡＩ－１）的表达，并比较乳腺恶性肿瘤组织与良性纤继腺瘤及正常组织中ＰＡＩ－１的差异。用免疫组织化学和原位杂交的方法，确定了乳腺癌、乳腺纤维腺瘤及瘤旁正常组织中ＰＡＩ－１的分布；用发色底物法检测组织提取液中ＰＡＩ－１的活性；用图象分析的方法对组织切片上的ＰＡＩ－１进行灰度定量。结果：ＰＡＩ－１主要分布在乳腺正常腺上皮细胞、瘤上皮细胞和腺癌细胞的胞浆中，但恶性组织中的成纤维细胞、巨噬细胞以及癌旁纤维组织也有染色。癌组织中ＰＡＩ－１的活性（Ｐ＜０．００１）和含量（Ｐ＜０．００５）均高于良性乳腺纤维腺瘤及瘤旁正常组织。结论：ＰＡＩ－１在乳腺恶性肿瘤组织中明显升高，ＰＡＩ－１的检测可能为临床乳腺肿瘤的诊断、预后提供新的指标。