1679例乳腺癌内乳淋巴结转移的高危因素分析

目的 探讨乳腺癌内乳淋巴结转移的高危因素。方法回顾性分析复旦大学附属肿瘤医院乳腺外科1956-2003年开展的l679例乳腺癌扩大根治术临床资料,选取病人年龄、肿瘤大小、肿瘤位置、腋窝淋巴结转移状况共4个乳腺癌内乳淋巴结转移可能相关的因素,分析不同情况下内乳淋巴结转移的高危因素。结果在选取的4个因素中,肿瘤大小不是影响内乳淋巴结转移的独立因素。腋窝淋巴结状况为内乳淋巴结转移的重要影响因素。不同情况下,肿瘤位置和年龄对内乳淋巴结转移的影响也不同。腋窝淋巴结阴性病人的内乳淋巴结转移率为4．4％,腋窝淋巴结1-3个阳性为18．8％,腋窝淋巴结4-6个阳性为28．1％,腋窝淋巴结≥7个为41．5％。结论有4个或以上腋窝淋巴结转移、内侧肿瘤合并腋窝淋巴结转移、肿瘤直径〉5．0cm的年轻病人是内乳淋巴结转移率的高危病人。     

乳腺癌癌周淋巴管密度对腋淋巴结转移状态的影响

目的探讨乳腺癌患者癌周组织中淋巴管密度（1ymphaticvesseldensity,LVD）与同侧腋淋巴结转移数量及转移水平的关系。方法对接受乳腺癌改良根治术的浸润性乳腺癌95例,采用D2—40单克隆抗体免疫组织化学法检测乳腺癌癌灶周边组织微淋巴管,计数LVD,分析其与同侧乳腺癌腋淋巴结转移的关系。结果95例乳腺癌癌周组织LVD与腋淋巴结转移数量呈正相关（r=0．856）,与腋淋巴结转移水平亦有显著相关性（r=0．664）。结论乳腺癌组织中癌周淋巴管密度与乳腺癌的淋巴结转移数目及淋巴结转移水平密切相关。     

保留乳头乳晕复合体的乳腺癌改良根治术预后的相关因素分析

目的探究影响保留乳头乳晕复合体(NAC)的乳腺癌改良根治术(NSM)预后的相关因素。 方法回顾性分析2011年1月至2014年12月84例早期原发性乳腺癌并接受NAC的NSM患者临床病理资料。使用统计软件SPSS 20.0进行数据分析,采用K-M生存曲线评估术后无病生存(DFS)及总生存(OS),采用单因素分析和Cox多因素分析影响NSM术后患者DFS和OPS的影响因素。P<0.05差异有统计学意义。 结果术后局部复发8例,远处转移6例,术后5年DFS为83.3%,OS为91.7%。多因素分析显示,肿瘤最大径、肿瘤距乳头乳晕距离(TND)、腋窝淋巴结状态、组织学类型及Her-2阳性是影响DFS的独立危险因素(P<0.05);而腋窝淋巴结状态是影响术后OS的独立危险因素(P<0.05)。 结论肿瘤最大径、TND、腋窝淋巴结状态、组织学类型及Her-2阳性是DFS的独立危险因素,腋窝淋巴结状态是OS的独立危险因素;腋窝淋巴结情况同时影响患者术后DFS和OS,术前系统、精准地评估并妥善处理特殊腋窝淋巴结可提高乳腺癌患者预后。     

Incidence of intramammary nodes in completion mastectomy specimens after axillary node sampling: implications for breast conserving surgery

BACKGROUND: Axillary node sampling (ANS) is widely used in conjunction with breast conserving surgery in the treatment of primary breast cancers in the UK. Some evidence suggests that axillary staging techniques can miss intramammary nodes contained within the axillary tail of the breast. This study aims to assess the incidence of such nodes in completion mastectomy specimens in women who have had previous breast conserving surgery and ANS. METHODS: One hundred and fifty-seven completion mastectomy specimens were obtained from women who had previous breast conserving surgery and ANS, at the Nottingham Breast Institute over a 3-year period. The pathology samples underwent detailed histological examination to identify lymph nodes, and determine their disease status. RESULTS: Seventy-six (48%) of completion mastectomy specimens contained intramammary lymph nodes. Fifteen patients were upstaged (lymph node stage) because of the histological findings at completion mastectomy. One patient from the study population received additional systemic treatment, as a result of the upstaging. CONCLUSION: The incidence of intramammary nodes in this series correlates with previous data. This study shows that in breast cancer patients who undergo ANS, intramammary nodes, if present and more so positive, are unlikely to change systemic treatment decisions, but may increase the number of patients needing radiotherapy and or further axillary dissection.     

Predictors of nonsentinel node metastasis in patients with breast cancer after sentinel node metastasis

HYPOTHESIS: The presence of nonsentinel lymph node (NSLN) metastasis after having a positive sentinel lymph node dissection finding is associated with tumor size and stage, the presence of lymphovascular invasion, micrometastasis, and extranodal extension. DESIGN: Retrospective case series. SETTING: University hospital. PATIENTS: Four hundred seven consecutive patients at a single institution who underwent sentinel lymph node dissection as part of breast conservation or mastectomy with biopsy-proved cancer. INTERVENTION: Completion axillary lymph node dissection and definitive therapy. MAIN OUTCOME MEASURES: Sentinel node metastasis, NSLN metastasis, tumor size and stage, lymphovacular invasion, micrometastasis, extronodal extension, histological tumor characteristics, and number of sentinel nodes removed. RESULTS: In a univariate analysis, size of the primary tumor and extranodal extension were associated with having positive NSLN findings. The presence of micrometastasis was associated with negative NSLN findings. When all factors were included in a logistic regression analysis, the significant predictor of NSLN metastasis was extranodal extension (P =.002). Lymphovascular invasion was not associated with positive NSLN findings (P =.11). The number of sentinel nodes removed also had no bearing on the status of the NSLNs (P =.37). CONCLUSIONS: Although primary tumor size and micrometastases correlate with the status of the NSLNs, extranodal extension is the most important independent predictor of NSLN metastasis. These findings may ultimately spare patients a full axillary lymph node dissection. However, pending results of larger clinical trials, full axillary lymph node dissection is still recommended for patients with sentinel lymph node metastases.     

Cancer cell emboli in the pectoral lymphatics of patients with breast cancer

In order to investigate the possibility of local recurrence in the pectoral muscles of patients who undergo modified radical mastectomies, the cancer cell involvement of the lymphatics associated with the pectoralis major muscle was studied in 39 patients who underwent a standard radical mastectomy for Stage I-III breast cancer. Cancer cell emboli were found in the transpectoral lymphatics of 2 patients (2/39 = 5.1 per cent) and in the pectoral fascial lymphatics of 6 patients (6/39 = 15.4 per cent). Two patients with fascial lymphatic cancer cell emboli were from a group of 14 patients with intramammary lymphatic tumor emboli of a low degree (ly 1). The other 6 patients with cancer cell emboli in either the pectoral fascia or the transpectoral lymphatics were from a group of 11 patients with intramammary lymphatic tumor emboli of a moderate degree (ly 2). There was a significant relationship between the intramammary and the pectoral lymphatic cancer cell emboli (Chi square test: (p less than 0.05). The results of this study therefore indicate that lymphatic cancer cell emboli in the pectoral fascia and muscle are an important risk factor for patients who undergo a modified radical mastectomy.     

男性乳腺癌的治疗及预后因素分析:附37例报告

目的　探讨男性乳腺癌 (MBC )的治疗和预后因素。方法　回顾性分析 3 7例男性乳腺癌的临床资料。手术方式包括经典根治术 (10例 ) ,改良根治术 (19例 ) ,单纯乳房切除术 同侧腋窝淋巴结摘除术 (4例 ) ,单纯乳房切除术 (4例 )等。结果　上述手术方式的患者 5年生存率依次为 80 .0 %,78.9%,2 5 .0 %,2 5 .0 %;腋窝淋巴结有转移和无转移的患者 5年生存率分别为 5 0 .0 %和 93 .3 %;雌激素受体 (ER)阳性和阴性的患者 5年生存率分别是 80 .0 %和 42 .8%(P <0 .0 5 ) ;结论　改良根治术是MBC的首选术式 ,术后可根据情况辅以其他治疗 ;腋窝淋巴结转移、病理类型及肿瘤分期等因素影响预后 ,其中手术方式和腋窝淋巴结状况为影响预后的主要因素。     

不同术式对T_1乳腺癌病人的疗效评估

目的：探讨不同术式对Ｔ１乳腺癌的疗效。方法：观察Ｈａｌｓｔｅｄ术、改良根治术和乳房象限切除加腋淋巴结清扫术对２７４例Ｔ１乳腺癌病人预后的影响;并分析全部病人的腋淋巴结转移情况。结果：Ｔ１乳腺癌病人１０年生存率为８４．７％;标准根治术与改良根治术后病人的１０年生存率分别为８０．５石％和８４．１％（Ｐ＞０．０５）;乳房象限切除加腋淋巴结清除术与根治术相比,Ｔ１Ｎ０Ｍ０病人的１０年生存率分别为１００％和９０．４％（Ｐ＞０．０５）;全组腋淋巴结转移率为２７．７％;９７．４％的转移淋巴结位于低位组。结论：３种术式治疗Ｔ１乳腺癌病人的效果相同,从美观及心理因素上考虑,提倡行保守性手术;２／３以上Ｔ１病人无腋淋巴结转移,一律行腋淋巴结清除对预后意义不大,前哨淋巴结活检可以解决这一问题;腋淋巴结转移绝大多数在低位组,在不能进行前哨淋巴结活检的情况下,可仅清除低、中位淋巴结。     

Five year results of radical mastectomy for breast cancer, by a sternal splitting, intrapleural en bloc resection of the internal mammary lymph nodes

A new operative method of extended radical mastectomy enables complete resection of the axillary and internal mammary lymph nodes. In this paper, we present the histological analysis of the internal mammary involvement, and the estimated 5 year survival rate, of 100 patients with breast cancer of Stage I, II or III, who underwent this operation. The incidences of axillary and internal mammary involvements were 41 per cent and 17 per cent, respectively. The metastases in the internal mammary lymph node chain were located from just below the supraclavicular vein to the third intercostal space along the internal mammary vessels. The types of lymphatic invasion observed in the internal mammary chain were lymph node metastases in 88 per cent, metastatic lesion in the lymphoid tissue in 29 per cent and cancer cell emboli in the lymphatic channel in 71 per cent. The overall estimated 5 year survival rate was 90.5 per cent. Where there was internal mammary involvement, the estimated 5 year survival rates for those with no axillary lymph node metastasis, those with fewer than 3 metastatic axillary lymph nodes, and those with more than 4 metastatic axillary lymph nodes were 100 per cent, 80 per cent and 31.2 per cent, respectively. Although the assumption that more aggressive surgical removal of the primary lesion and the regional lymphatic spread gives a higher cure rate has not been proved, this extended radical mastectomy with adjuvant chemoendocrine therapy seems to give a higher 5 year survival rate for patients with internal mammary involvement.     

Cancer cell emboli in the pectoral lymphatics of patients with breast cancer

In order to investigate the possibility of local recurrence in the pectoral muscles of patients who undergo modified radical mastectomies, the cancer cell involvement of the lymphatics associated with the pectoralis major muscle was studied in 39 patients who underwent a standard radical mastectomy for Stage I–III breast cancer. Cancer cell emboli were found in the transpectoral lymphatics of 2 patients (2/39=5.1 per cent) and in the pectoral fascial lymphatics of 6 patients (6/39=15.4 per cent). Two patients with fascial lymphatic cancer cell emboli were from a group of 14 patients with intramammary lymphatic tumor emboli of a low degree (ly 1). The other 6 patients with cancer cell emboli in either the pectoral fascia or the transpectoral lymphatics were from a group of 11 patients with intramammary lymphatic tumor emboli of a moderate degree (ly 2). There was a significant relationship between the intramammary and the pectoral lymphatic cancer cell emboli (Chi square test: p<0.05). The results of this study therefore indicate that lymphatic cancer cell emboli in the pectoral fascia and muscle are an important risk factor for patients who undergo a modified radical mastectomy.