276例触不到肿块的乳腺癌(T0期)临床分析

目的:探讨触不到肿块的乳腺癌(T0期乳腺癌)的诊断、治疗和预后.方法:1978～1997年共收治女性乳腺癌9980例,其中检出T0乳腺癌276例(278例次).主要根据乳头溢液、乳腺腺体增厚、乳头糜烂、乳头回缩等主诉,进行追踪检查而发现,其中12例曾患乳腺癌的患者行对侧乳腺常规X线摄影而发现.结果:全部病例接受手术治疗并经病理组织学检查,病变多数(73.0%)为非浸润性癌及早期浸润性癌.234例根治术中淋巴结转移率为7.7%.结论:本组5、10、15年生存率分别为98.1%、94.6%、90.3%,明显提高了生存率.     

Ⅱ期乳腺癌765例临床病理分析

目的:探讨Ⅱ期乳腺癌外科手术的远期疗效.方法:我院自1973年1月到1983年12月共手术治疗765例Ⅱ期乳腺癌,占经治可手术女性乳腺癌2 665例的28.7%.其中肿瘤≤2cm者(T1N1h)50例,2.1～3cm者362例,3.1～4cm者238例,4.1～5cm者115例.行扩大根治术仅2例,传统根治术434例,改良根治术280例和全乳切除术49例.按病理类型、淋巴结转移以及生存情况进行分析研究.结果:临床为N0者病理检查31%见淋巴结转移,TlN1h者59.2%阳性,T2N1者56.9%阳性.本组病例的3年复发率为4.2%;5年生存率、健在率分别为77.4%及70.0%;10年生存率、健在率分别为62.4%及60.2%.其中非浸润性癌,早期浸润性癌,浸润性特殊型癌及浸润性非特殊型癌3年复发率分别为0%、2.1%、2.0%及4.8%;5年生存率和5年健在率分别为93.3%、90.0%,80.9%、78.7%,86.0%、82.0%及75.6%、67.4%;10年生存率和10年健在率分别为89.7%、89.7%,75.6%、75.6%,78.0%、72.0%及58.8%、56.7%.原发癌≤2cm(T1N1h)、2.J～3cm、3.1～4cm及4.1～5cm者的3年复发率分别为10.0%、2.8%、4.3%及6.3%;5年生存率和5年健在率分别为60.0%、50.0%,82.1%、74.4%,75.4%、68.5%及74.5%、68.2%;10年生存率和10年健在率分别为46.9%、42.9%,68.3%、66.0%,57.1%、54.9%及61.7%、60.7%.结论:Ⅱ期乳腺癌治疗结果与术式无明显相关,降低3年复发率,提高5年、10年生存率、健在率的关键是辅助化疗.     

T_0乳腺癌74例(77例次)检诊经验

1978～1986年共查出本病74例(77例次)。全部病例均接受手术治疗。包括根治术70例次,全乳切除7例次。病变多数(67.5％)为非浸润、早期浸润及特殊类型癌。淋巴结转移率12.9％。77例次中46例术后随诊3～5年以上,均健在。检出T_0 癌必须重视病史和乳腺出现的任何异常现象,并采用联合诊断方法进行追踪检查。本组检出77例次T_0癌,主要是通过将本组病例中出现的乳头溢液、腺体增厚、乳头糜烂这些临床表现作为重要线索,深入追踪检查,并且对曾患乳腺癌患者的对侧乳腺进行常规腺X片摄影检查后而发现。大量检出T_0癌将有助于减少晚期癌的出现,从而提高乳腺癌的治愈率和降低死亡率。     

乳腺乳头状癌

 1978～1994年间天津肿瘤医院共收治乳腺癌7630例，其中乳腺乳头状癌81例，占同期乳腺癌的1．1％，本病无论临床或病理组织学表现，均具有不同于一般乳腺癌的特点，好发于老年女性，病程长，肿块较大，59例呈囊性，常合并乳头溢液，病理组织学检查，36例为非浸润性癌，20例为早期浸润癌，25例为浸润性癌，腋下淋巴结转移率21．7％。冰冻切片检查尤其囊内型癌易被误诊为良性，应注意鉴别。经手术与化疗综合治疗，5年无瘤生存率89．3％（50／56），10年无瘤生存率为80％（32／40）。     

115例临床未触及肿块的乳腺癌诊断分析

背景与目的：早期诊断是提高乳腺癌治疗疗效的关键,乳腺癌病理分期越早,临床症状越不典型,本研究回顾性分析了临床体检未触及肿块（包括乳房及腋淋巴结均未触及肿块）乳腺癌诊断的方法与特点,以期提高乳腺癌的早期诊断率。方法：收集2006年9月—2009年3月期间收治的共115例体检未触及肿块的乳腺癌患者的临床检查资料,包括乳头溢液、钼靶X线片、超声检查的情况,并分析其病理特征及肿瘤分期情况。结果：115例患者（117侧乳房）中,原位癌（包括导管原位癌、导管上皮内肿瘤、小叶原位癌、神经内分泌性导管内癌、大汗腺性导管内癌）占33.3%,微小浸润性导管癌占22.2%,浸润性癌占44.5%。20例（22侧）单纯乳头溢液患者原位癌11侧,占50%;微小浸润导管癌3侧,占13.6%;浸润性癌8例（包括浸润性导管癌7例,粘液腺癌1例）,占36.4%。34例单纯钼靶表现异常者中原位癌（15例）和微小浸润导管癌（11例）共占76.5%。浸润性癌占23.5%;19例单纯表现为B超结节者中原位癌占31.6%,浸润性导管癌比例高达68.4%。乳头溢液伴钙化灶者,原位癌占50.0%;乳头溢液伴B超结节者,原位癌占33.3%;B超结节伴钙化灶,以及乳头溢液伴B超结节与钙化灶者,原位癌均占50.0%。术后病理分期情况,0～Ⅰ期96例（98侧）占83.8%,Ⅱ期15例,Ⅲ期4例;腋淋巴结转移1～3枚的11例,4～9枚的3例,〉10枚的1例。结论：乳房体检乳腺未触及肿块时,要重视B超、钼靶等影像学检查及乳头溢液的临床检查,其中一项异常,应积极进一步诊治。     

Ⅰ期乳腺癌253例临床病理分析

我院自1973年到1983年底共手术治疗253例Ⅰ期乳腺癌,占经治可手术女性乳腺癌2665例的9.5%.其中肿瘤≤0.5cm者15例,0.6cm~1cm者43例,1.1cm~2cm者195例.行传统根治术90例,改良根治术148例,全乳切除术11例和局部切除术4例.临床为N_0者病理检查18.6%见淋巴结转移,N1a者30.1%阳性.本组病例的10年健在率为79.4%.其中非浸润性癌、早期浸润性癌、浸润性特殊型癌及浸润性非特殊型癌10年健在率分别为92.7%、78.6%、96.8%及72.8%;原发癌≤0.5cm、0.6cm~1cm及1.1cm~2cm者的10年健在率分别为93.3%、81.4%及77.9%.治疗结果与术式无明显相关.     

0～Ⅱ期乳腺癌外科保守治疗的疗效观察

目的：探讨早期乳腺癌保守性外科治疗的效果。方法：我院1990年6月－2000年4月对临床早期癌125例行乳房象限切除术加淋巴结清扫术，其中0期3例，I期89例，Ⅱ期33例。全组患者术后乳房放疗102例，未放疗23例。浸润性癌围手术期化疗7周。腋淋巴结阳性术后常规放疗，此后6－12个月内追加12－16次化疗。ER阳性服用TAM 2－5年。此外，选用同期0、I、Ⅱ期仿根治术或根治术常规综合治疗95例做对照观察。结果：1）病理检查：125个象限切除标本中断端阳性10例（8．0％），均以管内癌形式出现。腋淋巴结平均检出16．8枚，阳性率15．2％；2）生存情况：125例随诊，＞3年85例，＞5年63例，全部生存。仅1例术后2．5年局部复发，1例术后2年骨转移带瘤生存；随诊＜3年40例，1例术后1年肺转移带瘤生存；对照组95例，1例肺转移死亡。结论：早期乳腺癌保守性外科治疗与仿根治术，根治术效果相似且能保持乳房良好外形，是I、Ⅱ期乳腺癌理想的治疗方法。     

乳腺Paget's病的临床病理分析

目的:探讨有关乳腺Paget's病的发生机制,临床特点,治疗原则及预后情况,使该病的诊治更趋合理.方法:回顾性分析我院1998～2008年收治的48例乳腺Paget's病患者的临床资料.结果:48例患者中位年龄56.5岁,以乳头乳晕糜烂结痂为唯一症状者24例,合并乳头溢液者11例,伴有乳头回缩或消失者5例,合并瘙瘁者3例,单纯肿物者2例,乳头糜烂伴肿物者3例.38例患者合并有乳腺癌.其中合并导管内癌34例,合并浸润性导管癌4例,单纯Paget's病10例.38例行乳腺癌根治术,7例行全乳+低腋窝淋巴结清扫术,1例行单纯乳腺切除术,2例未手术,其中ER、PR阳性7例,HER-2阳性19例.结论:大多数乳腺Paget's病伴有导管内癌或浸润性导管癌,有乳腺肿块的患者合并浸润性导管癌的可能性更大,预后更差,且浸润性癌多伴有ER、PR阴性,HER-2阳性,预示预后较差,因而治疗应更为积极.     

乳腺癌术后辅助治疗疗效分析

 目的　探索乳腺癌根治术后患者病期、淋巴结情况及治疗方法对生存率的影响。方法对比分析我科收治的乳腺癌术后Ⅱ期110例和Ⅲ期90例,采用术后放疗、术后化疗及术后放疗加化疗进行治疗。结果　Ⅱ期和Ⅲ期乳腺癌患者术后放疗、术后化疗+放疗局部复发率均低于术后化疗(P＜0.05);Ⅲ期患者远处转移率术后放疗高于术后化疗或术后放疗+化疗(P＜0.05);Ⅱ期乳腺癌腋窝淋巴结转移数≥4个,生存率下降;Ⅲ期乳腺癌患者随着N的升级,五年生存率逐渐降低。结论　乳腺癌术后放疗可以减少局部复发率;Ⅲ期乳腺癌术后化疗可降低远处转移率;淋巴结转移数影响5年生存率。     

乳腺不典型增生与乳腺癌四例

例1，女，76岁，右乳肿块16年。体检：右乳外上触及一个4cm×2cm肿块，质硬，边界尚清，右腋南可触及一约l·scm’肿大淋巴结。根治术后病理为右乳腺浸润性导管癌，癌灶旁见广泛的导管上皮增生，部分表现为不典型增生。例2，丈，60岁，左乳肿块10年，伴乳头溢液。体检：左乳腺外上可触及一6cm×3cm大肿块，质硬。诊断为左乳腺癌，并行根治术，病理为左乳腺浸润性导管瘤，癌灶旁见多处导管上皮不同程度的增生，有的呈导管原位癌的表现。例3，女，44岁，右乳肿块7年，近来增大较快。体检：右乳外上可触及一约7cm×4cm肿物，质硬，考虑为乳腺癌…     

不伴肿物乳头溢液124例分析

 目的　深讨不伴肿物乳头溢液对检出早期乳腺癌及癌前病变的临床价值。方法　对124例不伴肿物乳头溢液患者(其中浆液性溢液47例,血性溢液74例,脓性3例),行手术治疗,先行病变导管切除,如为恶性,则行乳腺癌改良根治术。结果　本组病例良性者115例,占92.7%,其中乳腺导管内乳头状瘤和乳腺囊性增生病占79%;乳头状瘤(病)伴瘤细胞或导管上皮增生活跃(癌前病变)14例,占11.3%;乳腺癌9例,占7.3%,9例患者均为血性乳头溢液,占血性溢液之12.2%,均为临床早期癌(T0期乳腺癌)。结论　不伴肿物乳头溢液对检出早期乳腺癌及癌前病变有重要的临床价值。     

Occult breast carcinoma presenting as axillary metastases

PURPOSE: Breast carcinoma presenting with axillary lymphadenopathy and no clinical or radiological evidence of a primary tumor is a rare presentation. We aimed to examine the management of the breast by observation, radiation therapy, or mastectomy. METHODS AND MATERIALS: Departmental records from 1979 to 1996 of unknown primary presentations and cases of T0N1-2M0 breast carcinoma were reviewed to find cases of occult breast carcinoma presenting as axillary lymphadenopathy with no clinical or imaging evidence of a primary tumor. RESULTS: There were 6047 presentations of breast carcinoma with 20 cases of occult breast carcinoma meeting the criteria. The breast was treated by observation in 6 cases, mastectomy in 2 cases, and radiotherapy to the intact breast in 12 cases. Eighty-three percent of patients (5 of 6 patients) who had observation of the breast had a local recurrence, compared to 25% who had radiotherapy to the intact breast (3 of 12 patients) and 0% who had a mastectomy (0 of 2 patients). The median recurrence-free survival was 7 months in patients who had observation of the breast, compared to 182 months in patients who had local treatment. Three of the 6 patients who underwent breast observation have died whereas 1 of the 14 who had local treatment have died, with a mean follow-up of 73 months. It was found that patients having observation of the breast had a poorer recurrence-free survival (p = 0.003) and overall survival (p = 0.05) compared to those having local treatment of the breast. CONCLUSIONS: Patients with such a presentation should have a complete physical examination, mammography, ultrasound, and MRI of the breasts. If there remains no evidence of a primary tumor, an axillary dissection should be carried out and the breast treated by radiotherapy or mastectomy. Observation of the breast is not a recommended option.     

Breast reconstruction following mastectomy for invasive breast cancer by free flaps from the abdomen is oncologically safe

Aims

To report the long-term results of oncological safety of breast reconstruction by autologous tissue following mastectomy for invasive breast cancer.

Methods

One-hundred-fifty-six consecutive patients with invasive breast cancer treated with mastectomy and reconstruction by autologous tissue were reviewed throughout (from 1987 to 2003 with median follow up time of 66 months).

Results

Median patient age was 45.9 years (range 26–68). The 157 observed tumors had mean diameter of 25 ± 19 mm, 70 of them were poorly differentiated, and 137 were invasive ductal carcinoma. Multifocal disease was present in 44 patients. Breast reconstruction was carried out only by autologous tissue (free flaps were used in 95% and free TRAM flap transfer was the most common reconstructive procedure). There was only one local recurrence as first site of recurrence, thus yielding a local recurrence rate of 0.6%.

Conclusions

Breast reconstruction by autologous tissue following mastectomy for invasive breast cancer is an oncologically safe procedure.     

Diagnosis of T0 carcinoma of the breast

From 1978 through 1986, 74 cases (77 lesions) of T₀ carcinoma of the breast were studied. All of these cases were treated with mastectomy. Pathologically, 52 cases (67.5%) were early carcinoma, including noninvasive (30), early invasive (19) and specific type (3). Axillary lymph node metastasis was present in 12.9% of the cases. Follow-up study revealed that 46 patients have been living and in good health for 3–5 years. For successful detection, the following prerequisites are indispensable: (1) physicians concerned must be aware of the new concept that most early breast carcinoma may not be palpable; (2) physicians must be well familiarized with the clinical manifestations of nonpalpable carcinoma of the breast; (3) any abnormalities of the breast must be thoroughly investigated until proven otherwise; and (4) combined diagnostic procedures must be used.     

X线立体定位引导真空负压旋切活检在诊断0期乳腺癌的应用价值

目的探讨X线立体定位引导真空负压旋切活检技术在临床触诊和B超检查均为阴性乳腺微小病灶中诊断0期乳腺癌方面的价值。方法本院于2007年10月～2009年5月用数字化俯卧式穿刺活检定位系统引导真空负压旋切活检系统对113例B超检查为阴性临床不可触及的X线下可疑病灶(BIRADS评级为4级)进行微创切取活检。结果手术成功率100%。113例病例中共发现18例乳腺癌,其中乳腺导管内癌12例,导管内癌并微浸润(浸润突破基底膜小于2mm)4例,浸润性导管癌1例,浸润性小叶癌1例。乳腺癌术后病理分期0期12例,Ⅰ期6例。无严重出血等并发症。结论 X线立体定位引导真空负压旋切活检临床触诊和B超检查均为阴性的X线下乳腺微小病灶,对诊断0期乳腺癌有较高的价值。     

Failure of subcutaneous mastectomy to prevent the development of breast cancer

Three patients treated with bilateral subcutaneous mastectomies and implants for fibrocystic disease or carcinoma in situ subsequently developed invasive breast carcinoma. These cases emphasize that subcutaneous mastectomy does not prevent the development of breast cancer. If the circumstances in an individual patient justify prophylactic mastectomy, then the appropriate procedure would seem to be total mastectomy, which would accomplish thorough removal of all breast tissue, the subareolar region, and the nipple. Subcutaneous mastectomy for the patient who is likely to harbor occult invasive disease seems particularly inappropriate. As a means to reduce the risk of breast cancer, the procedure is unproved and must be considered an experimental therapeutic approach.     

乳腺导管内癌20例临床分析

我院自１９７９年１月至１９９３年１２月经手术治疗乳膜癌３５７例，其中导管内癌２０例，占５．６％。首发症状为肿块者占６０％（１２／２０），乳头溢液者占２５％，乳头湿疹样改变者占１０％，肿埠伴溢液者占５％。腋窝淋巴结转移者占１０％。５年生存率９１．７％。分析认为，某些管内癌症状不典型，易漏诊、误诊，应引起重视。对术式的选择以改良根治术为首选。     

Clinical analysis of 276 cases of non-palpable TO breast cancer

Objective Discussion of diagnosis, treatment and prognosis of non-palpable TO breast cancer. Methods Between 1978 and 1997, 9,980 female patients with operable breast cancer were treated surgically, of which 276 were determined to have TO breast cancer. Most TO breast cancers could be detected promptly with careful examination of presenting symptoms, such as nipple discharge, local thickening of the breast, nipple erosion, nipple retraction and postmenopausal mastalgia, while 12 cases were detected by routine mammography of the contralateral breast. Results All patients were treated surgically and their tissue subjected to histopathological examination. Most cases (73.0%) were noninvasive or early invasive carcinoma. Axillary lymph nodes metastases were found in 7.69% of 234 mastectomy cases. Conclusion The survival rate was significantly increased if the tumor was in an early stage. The 5-, 10-, 15-years survival rates were 98.1%, 94.6% and 90.3%, respectively.     

The place for conservative treatment in the management of Paget's disease of the nipple.

Four cases of Paget's disease confined to the nipple are presented. Three of them were treated conservatively by local radiotherapy and the fourth was treated by mastectomy. Histopathological examination of the breast in the last case failed to show any evidence of in situ or invasive carcinoma. The first three patients are well and without evidence of recurrence 3 to 5.5 years after treatment. Could conservative treatment in the form of local excision or radiotherapy offer an alternative to mastectomy? A discussion on the place of conservative treatment is presented.