乳腺Paget''s病诊治体会

目的：分析乳腺Paget‘s病的临床、病理、预后，使该病的诊治进一步合理化。方法：结合术后随访，回顾分析我院1956～1999年病理证实的Paget‘s病56例。结果：56例患者平均年龄61.5(29～76)岁；在明确诊断前，病程6月以上者20例，占35．7％；临床可触及乳房肿块者40例(71．4％)，未触及肿块者16例(28．6％)，临床可触及乳房肿块者有较高的浸润性癌发生率，且和淋巴结、病理分级等预后因素密切相关；56例患者根治术30例，改良根治术16例，单纯切除术10例，应用辅助化疗者29例，应用辅助内分泌治疗者21例，术后放疗7例。平均随访46．5(12～120)月，临床可触及乳房肿块者及未触及肿块者总生存率分别为67．5％、81.3％，log-rank检验其差别有统计学意义(P=0．03)。结论：乳腺Paget’s病较易引起患者忽视或临床误诊，应重视该病的临床表现作到早期诊断；乳腺Paget’s病有较高的浸润性癌发生率，特别对于临床可触及乳房肿块者应采取以全乳切除术为主的综合治疗，慎行保乳手术。

Experience from diagnosis and treatment of breast paget''''s disease

Objective To explore an appropriate management for Paget's disease of the breast through analyzing clinical and pathological characteristics of this disease. Methods From January 1956 to December 1999,56 patients in our hospital were pathologically diagnosed as breast Paget's disease; the clinical data were retrospectively studied. Results Symptoms lasted more than 6 months before definitive diagnosis in 20 patients(35.71%). 40 patients (71.4%) had palpable mass while other 16(28.6%) had none The palpable cases were related to a significantly higher incidence of invasive ductal cancer(IDC) and a worse prognosis. In the 56 patients, 30 patients were treated with radical mastectomy ; 16 patients were treated with modified radical mastectomy;10 patients were treated with simple mastectomy .Chemotherapy was given to 29 of these patients;endocrinetherapy was given to 21 of them. With a mean follow up of 46.5 months, patients with no palpable mass had a significantly higher disease free survival than that of the patients with papable mass. Conclusion Paget's disease of the breast is easily to be delayed; any suspected sign or symptom should be considered seriously in order to get an early diagnosis. Since Paget's disease is related to a significantly higher incidence of IDC,especially for palpable cases,conservative surgery should be cautiously selected while mastectomy followed by adjuvant therapy should be performed.