乳腺癌根治和乳房重建术体位摆放及护理

目的：探讨乳腺癌根治和乳房重建术体位摆放及术中护理问题。方法：2008-01~2009-12间,本院收治的45例乳腺癌根治和乳房重建的患者,术中均先平卧位做乳房根治术,然后侧卧位消毒铺巾,取背阔肌代皮瓣做乳房重建。结果：经根治术和重建术,结合术后保持引流导管畅通和供、受瓣区护理,再造乳房全部成活,供受区切口均Ⅰ期愈合。随访至今,再造乳房外观自然,重建的腋前皱襞与健侧基本对称,腋顶及腋前皱襞凹陷畸形基本纠正。结论：乳腺癌根治乳房重建术是修复根治术后较严重缺损的较好方法,正确摆放手术体位,能有效地预防并发症的发生。术中合理、妥善的护理能有效提高手术的成功率与再造乳房的成活率。     

保留乳头乳癌改良根治术评价

目的评价保留乳头乳癌改良根治术应用于乳腺癌的术后美容效果和近期疗效。方法对符合入选条件的早期乳癌患者按乳房大小分为两组,组一施行保留乳头乳癌根治术或一期行扩大背阔肌带蒂肌瓣再造乳房,组二施行保留乳房手术 放疗,比较术后美容效果的优良率,随访复发转移情况。结果两组间患者年龄、病理性质、临床分期相似,术后优良率无统计学差异,无复发生存差别有统计学意义。结论体积小的乳房适合做保留乳头改良根治术,术后Ⅰ期行扩大背阔肌带蒂肌瓣再造乳房效果满意;体积较大的乳房适合于保留乳房手术。保留乳头改良根治术可作为ⅠⅡ期乳癌手术的可供选择的术式。     

背阔肌肌皮瓣岛状转移修复乳腺癌术后放射性溃疡7例

目的：探讨背阔肌肌皮瓣岛状转移修复乳腺癌术后放射性溃疡的治疗效果。方法：2011—10—2012—10收治乳腺癌术后放射性溃疡7例,女性6例,男性1例,年龄53～67岁,溃疡均位于腋下及侧胸,面积最大的10cm×15cm,最小的7cm×8cm。7例均采用胸背动脉为蒂,背阔肌肌皮瓣岛状转移修复,供皮区中厚皮覆盖。结果：本组7例患者皮瓣全部成活,创面一期修复。结论：背阔肌肌皮瓣岛状转移修复乳腺癌术后放射性溃疡可以获得良好治疗效果。     

乳癌根治术后一次性完成乳房再造一例报告

乳癌标准根治术背阔肌肌皮瓣一次性胸壁修复和乳房再造,国内报道甚少。我院最近成功一例报道如下: 病例介绍 女性,36岁。2年前因右侧乳房包块在某医院行单纯乳腺切除术,术后病理诊断为乳腺导管癌。入院前一月右腋窝出现2×2cm活动、质硬包块,     

自体颗粒脂肪移植丰乳术后乳腺X线征象

目的探讨自体脂肪移植丰乳术后乳腺的X线征象。方法对15例自体脂肪移植丰乳术后患者行全数字化乳腺摄影,观察其X线征象。结果 15例患者30例次乳房X线摄片中,3例次乳房无明显异常征象(非同一患者),27例次乳房后间隙及腺体后部散在类圆形低密度区,其内密度同脂肪密度,27例次中,4例次腺体后缘与脂肪交界处移行不自然。23例次腺体后缘受压前移,显示"占位"效应,其中16例次乳房后间隙内见1～3个大小不等油脂性囊肿形成,并有2例次(同一患者)乳房后间隙内散在颗粒状钙化,11例次乳房内多发等密度结节影,边界清晰。结论自体颗粒脂肪移植术后,乳腺X线表现有其特征性,尤其是液化坏死后形成油脂性囊肿并伴有钙化是其特征性表现,可完全与乳腺癌钙化征象鉴别,乳腺X线摄影表现也可评价丰乳效果。     

CT血管造影在背阔肌肌皮瓣移植中的应用

目的：探讨CT血管造影术（CTA）用于背阔肌肌皮瓣移植的可行性及其临床意义。方法：3例上肢皮肤肌肉缺损需要行背阔肌肌皮瓣移植的患者行3D-CTA检查,连续螺旋CT扫描,观测胸背动脉分布及彼此间的吻合情况,对背阔肌肌皮瓣结构进行计算机三维重建并立体显示,以此结果指导治疗方案的制定和实施。结果：背阔肌肌皮瓣的解剖学结构特点可通过三维重建技术准确反映。结论：重建的图像可以提供正常背阔肌肌皮瓣三维动态解剖,为背阔肌肌皮瓣的临床应用提供了直观的数字化解剖依据。     

乳腺癌根治术后皮下积液16例诊治体会

目前乳腺癌多以根治术为主,辅以化学药物、放射治疗和激素治疗.根治术要求分离皮瓣上至锁骨,内侧至胸骨,外侧至背阔肌前缘,下至腹直肌前鞘.创面较大,皮肤缝合后皮下为一潜在腔隙,皮下积液是乳腺癌根治术后最常见的并发症,国内报道112例其发生率为11.11%[1],国外文献报道乳腺癌根治术后皮下积液率高达35%[2].从2004年3月-2007年11月本院乳腺癌病人行乳腺癌根治术后皮下积液16例,现报告如下.     

应用背阔肌肌皮瓣重建上肢功能及修复复合组织缺损

目的探讨背阔肌肌皮瓣重建上肢肌肉功能、修复上肢软组织缺损创面的临床效果。方法2008年7月～2014年12月新疆医科大学第一附属医院骨科中心采用背阔肌肌皮瓣移植修复34例上肢肌肉功能、软组织缺损创面,男性25例,女性9例;年龄17～65岁,平均40.5岁。其中屈肘功能障碍者10例,屈肘并屈指功能障碍者7例,伸肘伸指功能障碍者5例,肘部皮肤缺损或骨外露12例。背阔肌肌皮瓣大小范围11cm×4cm～35cm×10cm;供区大部分采取一期缝合,2例供区部分缝合、部分采用中厚皮片植皮。结果34例患者术后获随访8个月～7年,平均21个月。其中术后出现血管危象2例,对症处理后好转;肌皮瓣的皮瓣部分坏死2例;背阔肌肌皮瓣完全坏死2例,发生局部感染1例,经清创换药完全愈合;其余18例未见明显术后并发症。结论背阔肌皮瓣血运丰富,抗感染能力强,肌瓣可填塞死腔,背阔肌肌皮瓣是修复上肢肌肉功能、上肢软组织缺损创面和骨外露感染创面的一种理想皮瓣。     

游离背阔肌肌皮瓣治疗头皮巨大瘢痕癌

目的探讨背阔肌肌皮瓣游离移植在修复头皮巨大瘢痕癌中的临床应用。方法 2009-10至2012-09我科共收治5例头皮巨大瘢痕癌患者,病变面积6 cm×8 cm～11 cm×10 cm,均侵犯颅骨,其中1例侵入颅内。均采用背阔肌肌皮瓣游离移植修复,皮瓣面积14 cm×13 cm～17 cm×16 cm。结果 5例背阔肌肌皮瓣移植术后均顺利成活,无并发症,皮瓣质地柔软,略高出周围皮肤。结论游离背阔肌肌皮瓣组织量大,血供丰富,设计灵活,是目前修复大面积头皮瘢痕癌切除后缺损较为理想的方法。     

保留皮肤的乳腺癌改良根治术Ⅰ期假体植入重建乳房的探讨

目的探讨保留皮肤的乳腺癌改良根治术Ⅰ期假体植入乳房重建的可行性。方法对15例Ⅰ、Ⅱ期乳腺癌患者行保留皮肤的乳腺癌改良根治术后,同期于胸大、小肌间植入硅胶假体重建乳房。结果保留乳头乳晕复合体5例,不保留乳头乳晕复合体10例,术后随访5~27个月,术后外观良好,双侧乳房对称,优良率达97%。所有病例均无局部复发或远处转移。结论保留皮肤的乳腺癌改良根治术后用硅胶假体行即刻乳房重建,具有操作方便、效果明显,是安全可行的手术方法。     

Magnetic resonance imaging of breast vascularity in medial versus lateral breast cancer

Objective

Breasts with malignant tumors can demonstrate a general increased vascularity compared to the contralateral breast and a prominent blood vessel adjacent to the tumor on magnetic resonance imaging (MRI). The aim of the study was to further characterize these alterations in blood supply by location of the tumor within the breast using MRI.

Materials and methods

The study group included 105 patients who underwent breast MRI for suspicion of a malignancy over a 2-year period. Fifty-one had pathologically verified malignant tumors (study group), 11 had pathologically verified benign lesions (control), and 43 had negative scans (control). The malignant lesions were distinguished by location, medial or lateral, within the breast. Origin of the vascular supply and vessel diameter was recorded in a blinded manner. When available, MRI scans performed 2 years after treatment were reviewed as well.

Results

Of the 24 medial malignant tumors, 21 (87%) had a predominantly medial vascular supply and 3 (13%), a predominantly lateral supply; of the 23 lateral tumors, 11 (48%) had a predominantly medial vascular supply and 8 (35%), a predominantly lateral supply (p = 0.03). In 4 cases, no dominant vessel was noted. Maximum vessel diameter was 3.6 ± 1.1 mm in the patients with malignancy and 2.6 ± 0.8 mm in the controls (p < 0.0005). General increased vascularity was demonstrated in 91% of the medial tumor subgroup and 83% of the lateral tumor subgroup, as opposed to 36-37% in the control groups (p < 0.0005). Follow-up MRI, performed in 8 patients in the malignant-tumor group after treatment, revealed a considerable decrease in the prominent vessels, to a size close to that of the controls.

Conclusion

Breasts with malignant tumors are characterized by an altered general vascular supply, a prominent feeding vessel, and increased regional vascularity. Both the presence and location of the tumor affect the vascular supply. The vascular change apparently diminishes after treatment, although this finding requires further investigation in a larger sample.     

Clip placement facilitating the approach to breast lesions

We describe a novel technique for marking non-palpable breast lesions with the aim of selecting the best approach prior to performing a biopsy. The technique employs a new coil, specifically designed for breast localization, guided by stereotaxy. This technique is reserved for selected cases in which the lesion is seen peripherally in only one mammographic view with negative or non-conclusive ultrasonographic results, and deeply seated after a stereotactic study. Once the coil is released beside the lesion, the shortest approach from the skin may be employed to perform the biopsy. To our knowledge, this is the first report of this technique.     

Gadolinium-enhanced MRI of breast hamartoma

Hamartoma of the breast is a relatively rare, well-circumscribed benign breast tumour that lacks a true capsule, and is composed primarily of dense, fibrous tissue with associated ducts and a variable amount of fat. A typical mammographic finding is a well-delineated, non-homogeneous mass containing mottled densities corresponding to fat, epithelium and connective tissue. Ultrasonographically, hamartoma has a well-circumscribed heterogeneous internal echo pattern corresponding to areas of fat and soft tissue components. This is the first original paper to describe the MRI findings of hamartomas. Mammography and ultrasonography usually enable a diagnosis of hamartoma; however, gadolinium-DTPA enhanced dynamic MRI is the only method in the preoperative management of atypical hamartomas that allows the exclusion of malignancy elsewhere in the breast and hamartoma. Correspondence to: K. K. Oh     

Preoperative breast MRI in patients with invasive lobular breast cancer

To investigate the use of MRI in preoperative characterization of invasive lobular breast cancer (ILC) and in detection of multifocal/multicentric disease. We retrospectively reviewed T1-weighted FLASH 3D precontrast and postcontrast MR images together with subtraction images of 26 women with histopathologically proven invasive lobular cancer. Two experienced radiologists described tumor patterns of ILC independently. MR findings of unifocal, multifocal, single quadrant and multiquadrant disease were correlated with results of other imaging techniques and compared with histopathological findings as gold standard. Most ILC presented on MRI as a single spiculated/irregular, inhomogeneous mass (pattern 1, n=12) or as a dominant lesion surrounded by multiple small enhancing foci (pattern 2, n=8). Multiple small enhancing foci with interconnecting enhancing strands (pattern 3) and an architectural distortion (pattern 4) were both described in three cases. There was one case of a focal area of inhomogeneous enhancement (pattern 5) and one normal MR examination (pattern 6). Unifocal and multifocal lesions were identified on MRI in four patients with normal conventional imaging. In nine women, multiple additional lesions or more extensive multiquadrant disease were correctly identified only on MRI. MRI may play an important role in the evaluation of patients with ILC, which is often difficult to diagnose on clinical examination and conventional imaging and more likely occur in multiple sites and in both breasts. However, false-negative MR findings do occur in a small percentage of ILC.     

Avoiding preoperative breast MRI when conventional imaging is sufficient to stage patients eligible for breast conserving therapy

Aim

To determine when preoperative breast MRI will not be more informative than available breast imaging and can be omitted in patients eligible for breast conserving therapy (BCT).

Methods

We performed an MRI in 685 consecutive patients with 692 invasive breast tumors and eligible for BCT based on conventional imaging and clinical examination. We explored associations between patient, tumor, and conventional imaging characteristics and similarity with MRI findings. Receiver operating characteristic (ROC) analysis was employed to compute the area under the curve (AUC).

Results

MRI and conventional breast imaging were similar in 585 of the 692 tumors (85%). At univariate analysis, age (p < 0.001), negative preoperative lymph node status (p = 0.011), comparable tumor diameter at mammography and at ultrasound (p = 0.001), negative HER2 status (p = 0.044), and absence of invasive lobular cancer (p = 0.005) were significantly associated with this similarity. At multivariate analysis, these factors, except HER2 status, retained significant associations. The AUC was 0.68.

Conclusions

It is feasible to identify a subgroup of patients prior to preoperative breast MRI, who will most likely show similar results on conventional imaging as on MRI. These findings enable formulation of a practical consensus guideline to determine in which patients a preoperative breast MRI can be omitted.     

Metastastic rhabdomyosarcoma to the breast

Rhabdomyosarcoma is a common extramammary primary malignancy in childhood that rarely metastasises to the breast. We present a patient with primary sinonasal rhabdomyosarcoma who was in remission when she developed breast metastases. We describe particular imaging findings of this disease, using ultrasound and MR imaging. To our knowledge, MR findings have only been described in one previous case report in the literature. Received: 4 May 2000 Revised: 14 July 2000 Accepted: 19 July 2000     

乳腺良性叶状肿瘤术中乳腺内整形术10例分析

目的探讨乳腺良性叶状肿瘤临床诊断和治疗方法。方法回顾分析经手术病理确诊为乳腺良性叶状肿瘤10例患者的病历资料。结果乳腺肿块为首发症状且增长快速,术前超声、钼靶、核磁共振等影像学检查准确率50%,空芯针活检术前病理与术后病理相符率90%。局部扩大切除术随访至今未见复发,术中乳腺内成型能保证乳房的外形。结论术前空芯针活检是明确诊断的标准,局部扩大切除术可以作为乳腺良性叶状肿瘤的标准术式,术中乳腺瓣成型术能维持乳房的基本外形,值得推荐。     

Stereotactic and ultrasound-guided breast biopsy

Percutaneous imaging-guided needle biopsy has increasingly become an alternative to surgical biopsy for the histologic assessment of breast lesions. Percutaneous biopsy is faster, less invasive, and less expensive than surgical biopsy. Tissue acquisition is performed with automated core needles or directional vacuum-assisted biopsy probes. Guidance for percutaneous biopsy is usually provided by stereotaxis, ultrasound, and, more recently, under the guidance of MR imaging. Imaging guidance depends on lesion type and the results of diagnostic imaging studies. This article reviews indications, advantages, limitations, and controversial issues in percutaneous imaging-guided biopsy of breast lesions under stereotactic and ultrasound guidance. The potential for new research opportunities and directions is also discussed.     

Computer-aided diagnosis in breast DCE-MRI--quantification of the heterogeneity of breast lesions

Purpose

In our study we aim at the quantification of the heterogeneity for differential diagnosis of breast lesions in MRI.

Materials and methods

We tested a software tool for quantification of heterogeneity. The software tool provides a three-dimensional analysis of the whole breast lesion. The lesions were divided in regions with similar perfusion characteristics. Voxels were merged to the same region, if the perfusion parameters (wash-in, wash-out, integral, peak enhancement and time to peak) correlated to 99%. We evaluated 68 lesions from 50 patients. 31 lesions proved to be benign (45.6%) and 37 malignant (54.4%). We included small lesions which could only be detected with MRI.

Results

The analysis of heterogeneity showed significant differences (p < 0.005; AUC 0.7). Malignant lesions were more heterogeneous than benign ones. Significant differences were also found for morphologic parameters such as shape (p < 0.001) and margin (p < 0.007). The analysis of the enhancement dynamics did not prove successful in lesion discrimination.

Conclusion

Our study indicates that the region analysis for quantification of heterogeneity may be a helpful additional method to differentiate benign lesions from malignant ones.     

Accuracy of ultrasound-guided,large-core needle breast biopsy

Ultrasound-guided, large-core needle biopsy (US-LCNB) of suspicious breast lesions is acknowledged as less invasive and less expensive and less time consuming than surgical biopsy, and provides a histologic diagnosis with a comparable high degree. US-LCNB has been proven to help reduce the number of unnecessary surgeries for benign disease. Its limitations, however, are false-negative results and underestimation of disease. Thus, the demand for breast teams is to carefully adhere to the principles of triple assessment and imaging-histologic correlation, and follow-up of lesions with a specific benign histology after biopsy. Also, the acceptance of guidelines and rigorous quality controls help to reliably minimize the delay in the diagnosis of breast cancer in patients with false-negative biopsies. This paper aims to summarize the equipment and methods as well as the benefits and limitations of US-LCNB. Also, guidelines of quality assessment are suggested. Finally, recent developments which may help to overcome the limitations of US-LCNB will be discussed, i.e., directional vacuum-assisted biopsy (VAB), three-dimensional (3D) US-guided biopsy, as well as the use of tissue harmonic imaging (THI) and compound imaging (CI) during biopsy.