保守性手术加放疗治疗早期乳腺癌的10年疗效

目的：回顾性分析保守性手术加放疗（ＣＳＲＴ）治疗早期乳腺癌的远期效果。方法：１９８７年１０月～１９９１年１月,４０例早期乳腺癌采用ＣＳＲＴ。Ｉ期２０例,Ⅱ期１９例（Ｔ２Ｎ０１３例,Ｔ１Ｎ１２例,Ｔ２Ｎ１４例）,导管内癌１例。肿瘤大小０．９～４．４ｃｍ,３６例肿块直径≤３ｃｍ。手术范围包括：乳房象限切除和腋窝下、中群淋巴结清除术,术后切线野照射全乳房,淋巴结阳性者加照内乳和锁骨区。对＞１ｃｍ的浸润性癌,用ＣＭＦ方案辅助化疗。结果：本组１０年总生存率和无病生存率９２．５％,保留乳房美观效果优良率８６．５％,局部复发率７．５％。结论：对早期乳腺癌,如病例选择适当,在具有良好的外科手术和放疗技术的单位,采用ＣＳＲＴ可取得长期满意的肿瘤局部控制和良好的乳房美观效果。     

国产亚甲蓝行早期乳腺癌前哨淋巴结活检的观察

目的：探讨前哨淋巴结活检术（sentinel lymph node biopsy，SLNB）反映早期乳腺癌腋淋巴结转移情况，并指导临床腋淋巴结阴性（cN0）乳腺癌腋窝淋巴结清除范围的可行性。方法：使用国产1％亚甲蓝对120例cT1.2N0M0期乳腺癌病人进行前哨淋巴结活检，于原发肿瘤边缘上、下、左、右选取4个注射点．将1％亚甲蓝4m1分别注射到乳腺实质及皮下组织内，已行术中活检则注射于残腔壁周围及其表面的皮下组织内。注射后从注射点向腋窝方向轻按摩5～10min，以利于淋巴管和淋巴结的染色，随后行乳腺癌改良根治手术或保乳手术。SLN常规HE染色病理检查．阴性者通过免疫组化方法行淋巴结微转移检查。结果：确定SLN87例，成功率为72．50％。SLNB的特异度为100％．假阳性率为0％，假阴性率为1．5％，准确率为98．85％；阴性前哨淋巴结的微转移率为4．44％。结论：前哨淋巴结转移状况基本上可反映乳腺癌腋淋巴结转移的状况；SLNB有望成为指导cN0，期乳腺癌腋淋巴结清除范围的方法。     

原发局部晚期乳腺癌的治疗

目的：分析女性原发局部晚期乳腺癌治疗结果及预后，以确定更完善的治疗。方法：对１４７例进行回顾性研究，对治疗及多种因素与预后的相关性进行分析。结果：与预后相关的因素为腋淋巴结转移（Ｐ＜０．０５），治疗失败的原因是血行转移（Ｐ＜０．０５）。单纯手术治疗５年及１０年生存率分别为２６．７％、２０．０％，综合治疗５年及１０年生存率分别为５２．６％、４７．７％（Ｐ＜０．０１）。结论：应采用综合治疗     

乳腺癌104例早期诊断分析报告

１９８７年１月至１９９５年１０月，我院收治临床早期乳腺癌１０４例，其中Ｔ０癌８２例，微小癌２２例。全部行手术治疗。病理类型６０例（５７．７％）为早期癌，包括非浸润性癌４５例，早期浸润性癌１５例。腋淋巴结转移为１０．７％，５年生存率为１００％（６５／６５），早期癌的主要临床表现为乳头溢流，乳头糜烂，局限性腺体增厚和直径≤０．５ｃｍ的乳房肿块，多数病例伴有乳腺癌的易患因素，本文强调对早期癌的新概念，必     

前哨淋巴结活检在乳腺癌治疗中的意义

自１８９４年Ｈａｌｓｔｅｄ报道Ｈａｌｓｔｅｄ乳腺癌根治术以来,腋淋巴结清扫一直是乳腺癌手术治疗中不可缺少的重要部分。腋淋巴结有无转移是影响乳腺癌病人预后最重要的因素,也是术后选择辅助治疗方案的重要依据。乳腺癌前哨淋巴结活检是乳腺外科领域在２０世纪９０年代中的一个里程碑式进展,其目的是藉此预测腋窝淋巴结有否肿瘤转移,使腋窝淋巴结阻性的乳腺癌病人免行腋淋巴结清扫。 前哨淋巴结的定义及其临床意义 前哨淋巴结是原发肿瘤引流区域淋巴结发生转移必经的第一个淋巴结,并以此进一步转移至远端淋巴结。前哨淋巴结作为有…     

男性乳腺癌13例临床分析

目的：探讨男性乳腺癌的生物学特性与预后的关系。达到早期诊断、治疗和改善预后。方法：回顾１９７０年至１９９８年１３例男性乳腺癌病例,从肿块大小、组织分型、淋巴转移及激素受体加以研究分析。结果：ＴＮＭ分期１期２列,２期７例血透３期３例,４期１例。７例病人行乳癌根治术,５例病人行改良根治术。１例病人行肿块切除术及睾丸切除术。术后病理提示１０例患者（７６．９％）腋淋巴结阳性,３例病人行改良根治术。１例病人     

早期乳腺癌的保守性手术治疗

本研究旨在讨论早期乳腺癌保守性手术的治疗和整形效果，作者于１９８４年～１９９５年对６８例早期乳腺癌患者分为局部切除加术后根治性放疗组（局切组，ｎ＝３３）和局部切除加腋淋巴清扫加术后根治性放疗组（局加腋组，ｎ＝３５）行保守性手术治疗。治疗效果：局切组与局加腋组３年、５年、１０年的生存率分别为９７．０％、７８．８％、７２．７％和９４．３％、８０．０％、７７．１％，远处转移率分别为６．１％、１２．１％、３．０％和８．６％、１７．１％、８．６％，局部复发率分别为６．１％、６．１％、３．０％和５．７％、５．７％、２．９％，两组无显著差异（Ｐ＞０．０５）。整形效果：效果满意者，两组分别为６０．６％和６５．７％；效果一般者，两组分别为３３．３％和１１．４％（Ｐ＞０．０５）。影响整形效果的因素有：乳房类型、手术切口、患者年龄及术后放疗。作者认为，对早期乳腺癌行保守性手术治疗是安全的，在乳腺切口距肿瘤缘２ｃｍ～３ｃｍ完整切除肿瘤，并行患乳整形术以及对侧乳房酌情行缩小成形术，可取得较满意的整形效果。     

早期乳腺癌前哨淋巴结活检术212例临床应用

选取212例早期乳腺癌患者,其中130例行前哨淋巴结活检术后继续行腋窝淋巴结清除术,82例患者仅行前哨淋巴结活检术.130例患者中,前哨淋巴结预测腋窝淋巴结转移正确率为90.77％,灵敏度95.0％,特异度88.9％,假阴性率5.0％,阳性预测价值79.2％,阴性预测价值97.6％.术后6、12个月,腋下仅行前哨淋巴结活检术乳腺癌患者的掖区疼痛、手术侧麻木或感觉异常、上肢水肿、手术侧上肢活动腋区皮肤明显牵拉感症状均低于腋下行淋巴结清除术患者（P＜0.05）.全部患者中位随访38个月,2组患者无瘤生存率差异无统计学意义（P＞0.05）.早期乳腺癌患者运用前哨淋巴结活检技术可以正确预测腋窝淋巴结情况,同时降低了腋窝淋巴结清除的并发症,提高了患者的生活质量.     

乳腺癌前哨淋巴结活检临床应用现状的思考

乳腺癌淋巴结清除术及其范围是影响术后患侧上肢功能的主要因素.准确了解腋淋巴结转移状况是合理制定乳腺癌综合治疗计划的重要依据之一,也是预测患者预后的最重要临床病理指标.另一方面,由于清除没有转移的区域淋巴结没有任何预后优势,对临床腋淋巴结转移阴性(cNo)的患者均施行腋淋巴结清除术,约70%患者不能从腋淋巴结清除术中获益.毋庸置疑的,从低位(Level I)至中低位(Level I+LevelⅡ)乃至全腋(Level I+LevelⅡ+LevelⅢ)淋巴结清除术,随着手术范围的扩大,在对腋淋巴结转移状况评价准确性得到保障的同时,术后发生相关并发症的概率随之增加,对生活质量的负面效应也随之增大.为了最大程度地降低手术相关并发症,又能最大程度地降低因为手术范围缩小对腋淋巴结转移状况评价的误差,乳腺癌前哨淋巴结活检(sentinel lymph node biopsy,SLNB)指导下的腋淋巴结处理模式由此诞生.     

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目的　探讨乳腺癌前哨淋巴结 (SLN )的分布及其在活检中的意义。方法　用 1%美蓝染色的方法 ,对2 72例可手术乳腺癌病人术中行前哨淋巴结活检 (SLNB) ,分析SLN的分布与病人的年龄、肥胖指数、乳房大小以及肿瘤的大小、部位和腋窝淋巴结有无转移的关系。结果　 (1)SLN检出率 90 1%,假阴性率 9 8%,准确率90 2 %。 (2 )SLN位于腋下群为 91 2 %,腋中群为 8 0 %,腋上群为 0 8%。 (3)肿瘤位于外侧象限者 ,SLN位于腋下群为 97%,位于腋中群为 3%;肿瘤位于内侧象限者 ,SLN位于腋下群为 74%,位于腋中上群为 2 6 %,(P <0 0 5 )。 (4)肿瘤位于乳房外侧象限的SLN检出率为 96 3%,肿瘤位于内侧者检出率 76 5 %(P <0 0 1)。 (5 )肿瘤位于乳房内侧象限的SLN假阴性率为 3%,肿瘤位于外侧象限者为 12 2 %(P <0 0 5 )。结论　 90 %以上的乳腺癌SLN位于腋下群 ,尤其是肿瘤位于乳房外侧象限者。乳房内侧乳腺癌 ,有 1/3的SLN位于腋中、上群。SLN假阴性多见于肿瘤位于乳房外侧象限者。     

Randomized clinical trial comparing level II and level III axillary node dissection in addition to mastectomy for breast cancer

BACKGROUND: In addition to mastectomy, level II and level III axillary node dissection procedures are performed widely in Japan. A randomized clinical trial was performed to determine which procedure was more effective. METHODS: One group of women had resection of the pectoralis minor muscle and dissection of level I, II and III axillary lymph nodes (level III dissection). In a second group, the pectoralis minor muscle was left intact and level III axillary lymph node dissection was not performed (level II dissection). A total of 1209 women with stage II breast cancer were enrolled in the study and randomly assigned to one of the two groups. RESULTS: The 10-year cumulative survival rate was 86.6 per cent after level II and 85.7 per cent after level III axillary dissection (hazard ratio (HR) 1.02; P = 0.931, log rank test). The 10-year disease-free survival rate was 73.3 and 77.8 per cent respectively (HR 0.94, P = 0.666). Overall survival and disease-free survival rates in the two groups were similar after both procedures. The duration of surgery was significantly shorter (P < 0.001) and blood loss was significantly less (P = 0.001) after level II dissection. In a survey of patients' symptoms on follow-up, no significant differences were found between the two procedures. CONCLUSION: The addition of pectoralis minor muscle resection and level III axillary lymph node dissection to mastectomy for stage II breast cancer did not improve overall or disease-free survival rates.     

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。     

Necessity of Axillary Dissection in Elderly Women with Early Breast Cancer

The need for axillary dissection forstaging and treating early breast cancer has been questioned recently.Can a patient forego axillary dissection, with its associated costs,risks, and morbidity, if it does not affect survival? The studyattempted to find a subset of patients with early breast cancer in whomdisease-free survival was independent of axillary lymph node status. Ifsurvival does not depend on lymph node status, axillary dissectioncould be omitted in the care of these patients. This study included 378women over age 70 with T1 breast cancer diagnosed and treated duringJanuary 1992 to December 1999 at both of our institutions: a largetertiary teaching hospital in Columbus, Ohio and a breast cancertreatment center in West Columbia, South Carolina. We compared thedisease-free survival, using the Kaplan-Meier estimate, in 334node-negative patients and 44 node-positive patients with T1 breastcancer. The 3- and 5-year survival rates of patients with T1N0 tumorswere 86% and 77%, respectively; and the 3- and 5-year survival ratesfor T1 node-positive tumors were 81% and 69%, respectively(p = 0.0673). There was no statistical difference between thenode-negative and node-positive groups. Axillary dissection in womenover 70 years of age with early breast cancer may be unnecessary, asthe presence of lymph node metastases does not appear to affectdisease-free survival rates significantly in this patient group.     

The Safety and Accuracy of Sentinel-Node Biopsy in Early-Stage Invasive Breast Cancer—Turkish Experience

The purpose of this prospective study was to investigate the correlation of sentinel lymph node (SLN) and axillary lymph node (ALN) metastasis in early-stage invasive breast cancer in a single institution. One hundred and fifteen patients with early-stage invasive breast cancer first underwent SLND followed by an appropriate surgical procedure (modified radical mastectomy, lumpectomy + axillary dissection, simple mastectomy + mammoplasty). In this series, a radioactive agent (technetium) was used to investigate the sentinel lymph node/nodes. In 28 (24.3%) patients, metastases were found in both SLN and axillary dissections. There were no metastases in either of these procedures in 69 (60%) patients. SLN metastasis was found in 13 (11.3%) patients, but no axillary metastasis was found. No skip metastasis was detected. Five patients in whom the sentinel node was not found were also negative for axillary metastasis. As the studies progress in this direction, it might be possible to avoid axillary dissection in patients with early breast cancer in whom metastasis in SLN cannot be detected. We believe this will reduce morbidity from breast cancer surgeries.     

The safety and accuracy of sentinel-node biopsy in early-stage invasive breast cancer--Turkish experience.

The purpose of this prospective study was to investigate the correlation of sentinel lymph node (SLN) and axillary lymph node (ALN) metastasis in early-stage invasive breast cancer in a single institution. One hundred and fifteen patients with early-stage invasive breast cancer first underwent SLND followed by an appropriate surgical procedure (modified radical mastectomy, lumpectomy + axillary dissection, simple mastectomy + mammoplasty). In this series, a radioactive agent (technetium) was used to investigate the sentinel lymph node/nodes. In 28 (24.3%) patients, metastases were found in both SLN and axillary dissections. There were no metastases in either of these procedures in 69 (60%) patients. SLN metastasis was found in 13 (11.3%) patients, but no axillary metastasis was found. No skip metastasis was detected. Five patients in whom the sentinel node was not found were also negative for axillary metastasis. As the studies progress in this direction, it might be possible to avoid axillary dissection in patients with early breast cancer in whom metastasis in SLN cannot be detected. We believe this will reduce morbidity from breast cancer surgeries.     

早期乳腺癌保乳手术疗效分析

目的探讨早期乳腺癌保乳综合治疗的疗效。方法行保留乳房的肿瘤切除及腋窝淋巴结清扫术52例,术后给予放化疗和内分泌治疗。结果平均随访56个月,无局部复发病例,3年和5年生存率分别为96.2%和92.3%,远隔脏器转移率为3.8%。结论早期乳腺癌采用保乳综合疗法,可以达到与根治术相似的治疗效果,且提高了患者生存质量,可作为首选治疗方法。     

A role of interpectoral (Rotter's) lymph node dissection in modified radical mastectomy for breast cancer]

To study the influence of interpectoral lymph node (IPN) dissection on the prognosis of patients who underwent modified radical mastectomy, IPN was carefully dissected and studied pathologically on 168 cases of our breast cancer patients operated with modified radical mastectomy. There were 1.2 lymph nodes on an average in the interpectoral region, and they were almost 1-2mm in diameter. IPN metastases were found in 10 cases. (Tis: 0%, Stage I: 4.9%, Stage II: 5.7%, Stage III: 13%). Tumors located in outer quadrant in almost all these cases. Positive IPN were found in 6 (16%) of n1 alpha group, 1 (10%) of n1 beta group, and in 3 (50%) of n2 group. All these 3 cases of n2 died of distant metastasis and local recurrence. Two (1.7%) of axillary node (1a, 1b) negative patients had microinvolvement of cancer only in IPN, and are currently disease-free. These data suggest that IPN metastasis may occur even in the early breast cancer patients, and that may be controllable by lymph node excision. Therefore, routine and careful dissection of IPN through wide opening of sulcus interpectoralis is necessary for modified radical mastectomy and even for breast preserving operation.     

内镜辅助治疗乳腺癌16例临床分析

目的:探讨内镜下腋窝淋巴结清扫并保留乳头、乳晕的皮下全乳腺腺体切除术治疗乳腺癌的可行性及其优势。方法:为16例Ⅰ、Ⅱ期乳腺癌患者行内镜腋窝淋巴结清扫术,同时行保留乳头、乳晕的皮下全乳腺腺体切除术。结果:16例均成功完成保留乳头、乳晕的皮下全乳腺腺体切除术;内镜下行腋窝淋巴结清扫术的每例患者取出淋巴结8～26枚,平均15.6枚,6例发现1～5枚转移淋巴结。术后患者常规综合治疗,随访1.2～4.1年,死亡1例,失访2例,出现乳腺癌远处转移3例,其他病例无局部复发、患肢水肿及严重感觉运动障碍等并发症发生。结论:借助内镜器械,通过腋窝处微小隐蔽切口即可完成腋窝淋巴结清扫术,同时可行保留乳头、乳晕的全乳腺腺体皮下切除术,以此术式代替常规乳腺癌根治术,在保证疗效的前提下,极大地减少了并发症的发生率,有良好的功能和美容效果。     

Reevaluation of parasternal lymph node dissection in the treatment of mammary cancer

One hundred and forty one patients with mammary cancer underwent the extended radical mastectomy with parasternal lymph nodes dissection between January, 1966 and December, 1974. From the basis of the present report involvement of parasternal lymph node chain was evaluated retrospectively with respect to the stage, location, size, histological type of cancer, metastasis to axillary and subclavicular lymph nodes, and the five-year survival rate. The parasternal as well as subclavicular and axillary lymph node involvements were not found in non-infiltrating cancer. The more the stage of cancer advanced, the more frequently the parasternal lymph nodes were involved regardless of the location of cancer in the breast. The parasternal lymph node chain alone was rarely involved, but frequently affected along with the axillary lymph nodes. When the parasternal lymph nodes were involved, the five-year survival rate was extremely poor, even after their surgical removal. Subsequently, addition of parasternal lymph node dissection does not seem to be beneficial.     

Breast cancer and regional lymph node dissections

Regional lymph node metastases were evaluated in 289 patients with operable breast cancer. The metastases of the axillary and internal mammary lymph node were shown to be closely related to the survival of patients, but the status of these nodes was shown to be impossible to estimate before the operation. Thus, axillary and internal mammary node dissections seem to be very important in order to attain an acceptable amount of information for staging of certain breast cancer patients. Due to the radicality of operations including internal mammary node dissection, the use of modified extended mastectomy is proposed as the staging operation. In this manner, the anterior chest deformity created by an extended radical mastectomy can be avoided and the pectoralis major muscle spared in patients without internal mammary lymph node involvement. Also found in this study, was some evidence of the beneficial use of en bloc extended radical mastectomy for the survival of a selected group of patients.