Radioguided Occult Lesion Localisation Versus Wire-Guided Lumpectomy in the Treatment of Non-Palpable Breast Lesions

The purpose of this study was to compare the two methods—guidewire localisation and the radioguided occult lesion localisation—used in the localisation and surgical removal of non-palpable breast tumours. This retrospective study enrolled patients diagnosed with nonpalpable malignant breast tumours. In this study either guidewire localisation (GWL, n?=?69) or radioguided occult lesion localisation (ROLL, n?=?321) was used for the detection and removal of the tumours. The two methods were compared with regards to preoperative localisation time, operating time, removed specimen volume, the pathological tumour size, the presence of positive surgical margins and postoperative complications. Furthermore, we have also investigated other factors that could have an impact on the frequency of positive resection margins. The localisation time was significantly shorter in the ROLL group, both with ultrasound guidance (5.7?±?1.44 min vs. 21.6?±?2.37 min, p?=?0.05) and with radiographic guidance (21.8?±?3.1 min vs. 41.6?±?3.75 min, p?=?0.021) as well. No significant difference was observed between the two methods in terms of operating time, removed specimen volume and pathological tumour size, or the presence of positive resection margins, or the occurrence of postoperative wound infections. The size of the tumour (ROLL, GWL grps), the presence of a multifocal tumour (ROLL grp), the presence of an extensive in situ breast carcinoma around the invasive cancer (ROLL, GWL grps) and the volume of the removed breast specimen (GWL grp) significantly increased the frequency of positive resection margins. We recommend the use of the ROLL method for the removal of nonpalpable breast tumours as it has a much shorter localisation time, and it is a simpler surgical technique as well.     

Comparison of Radio-guided Occult Lesion Localization (ROLL) and Magnetic Occult Lesion Localization (MOLL) for Non-palpable Lesions: A Phantom Model Study

BackgroundLocalization of nonpalpable breast cancers can be achieved with several techniques. We sought to compare radio-guided localization (ROLL) and magnetic tracer localization (MOLL) techniques by using a phantom model we previously developed, which can provide an accurate simulation for excision of nonpalpable breast lesions.Materials and MethodsWe designed 20 phantom models (10 MOLL, 10 ROLL group) for localization. A handheld gamma probe for the ROLL group and a manual magnetometer (SentiMag) for the MOLL group were used to test the ability of the modality to detect olives in turkey breasts. The excision time for each procedure, specimen size, and weight of the specimens removed from the turkey breasts were recorded.ResultsBoth techniques resulted in 100% retrieval of the lesions. There was no difference between the groups in the duration of operative excision, specimen weight, or specimen volume.ConclusionThis experimental trial found similar success rates for ROLL and MOLL in localization of occult lesions using the turkey breast phantom model. MOLL can be performed in clinics without the need for a nuclear medicine team and radiation safety procedures.     

Magnetic Seeds: An Alternative to Wire Localization for Nonpalpable Breast Lesions

IntroductionMagnetic seeds have emerged as an alternative to wires for localization of nonpalpable breast lesions. The purpose of this study was to evaluate the utility of magnetic seeds compared to wires for preoperative localization.Materials and MethodsA retrospective cohort analysis of magnetic seed localization (MSL) and wire localization (WL) excisional biopsies and lumpectomies performed at a single institution was conducted. Indication, age, BMI, number of markers, procedure type, operative time, and postoperative opioid administration were reviewed. Impact of localization method on operative time, specimen volume, postoperative opioid administration, and re-excision rate were assessed.ResultsA total of 608 MSL procedures in 601 patients were compared to 628 WL procedures in 620 patients. MSL excisional biopsies were significantly longer (37.0 minutes) than WL excisional biopsies (31.9 minutes, P< .001), but in lumpectomies without axillary surgery, MSL procedures (42.3 minutes) were significantly shorter than WL procedures (46.9 minutes, P = .017). Significantly less tissue was excised during MSL lumpectomies (68.5 cm³) and excisional biopsies (32.3 cm³) than WL lumpectomies (78.1 cm³, P = .039) and excisional biopsies (38.7 cm³, P = .018). Postoperative opioid administration was similar for MSL and WL procedures (P = .076). Re-excision rates for MSL lumpectomies were significantly higher for ductal carcinoma in situ (35.3% MSL vs. 18.5% WL, P = .013), but were similar for invasive carcinoma (14.4% MSL vs. 17.7% WL, P = .290). Logistic regression analysis showed no association between localization method and re-excision (OR 1.007, 95% CI 0.681-1.488; P = .973).ConclusionMSL is a feasible alternative to WL for excision of nonpalpable breast lesions with regard to surgical outcomes.     

B超引导下乳腺隐匿性病灶定位切除分析

[目的]探讨B超发现乳腺隐匿性病灶定位切除的方法.[方法]选取2000年9月至2004年9月的377例B超发现有乳腺隐匿性病灶的患者进行研究.其中103例分别选择在B超引导下乳腺定位针穿刺金属丝定位切除(A组33例)或体表定位切除(B组70例),比较两组只行区段切除病例的术后美容效果.[结果]103例中乳腺癌11例,发现率为10.68%.10例乳腺癌行全乳切除,1例行保乳术.另1例重度不典型增生和1例导管内乳头状瘤病也行全乳切除术.只行区段切除者91例其中A组30例(包括1例保乳术),B组61例,术后3个月的美容效果评价结果美容效果良好者A组29例(96.67%),B组42例(70.49%).两组差异有显著性(P＜0.001).[结论]B超引导下乳腺定位针穿刺金属丝定位切除,操作简便,定位准确可靠,有利于保证病变的切除和减少不必要的乳腺损害,为乳腺隐匿性病灶的准确诊断创造了条件.     

超声成像联合光散射成像系统对乳腺肿瘤良恶性鉴别的应用价值

目的: 探讨超声成像联合光散射成像系统(简称\     

超声引导定位切除乳腺隐匿病灶28例分析

28例40处女性乳腺隐匿性病灶,经超声引导下行体表标记定位和美蓝染色定位手术切除,并对两种定位方法所需手术时间进行比较.全部病灶均被准确切除,平均手术时间35min.两种定位方法手术时间无显著性差异(P＞0.05).     

乳腺良恶性疾病患者血栓弹力图检测价值

[目的]用血栓弹力图(TEG)和传统的凝血功能检测对乳腺良恶性疾病患者的凝血功能进行测定,评估TEG的检测价值.[方法]对268例乳腺癌(实验组)和45例乳腺良性病变患者(对照组)进行TEG检测和凝血四项检测[血浆凝血酶原时间(PT)、部分凝血活酶时间(APTT)、凝血酶时间(TT)和纤维蛋白原(Fib)],同时计数血小板(PLT)及测定D-二聚体(D-dimer),根据各项参数了解其凝血状态.[结果]传统凝血功能检测结果:实验组的PT明显缩短,PLT、Fib与D-二聚体水平较对照组有明显增高(P＜0.05),而APTT、TT与对照组相比无统计学差异(P＞0.05).TEG检测结果中,实验组各个参数测量值水平和对照组相比:R值没有明显差异(P＞0.05),Angle值接近显著性差异(P=0.055),K值明显减小,MA值和CI值明显增大(P＜0.05),支持实验组血液的高凝状态;从测量数值超出正常范围的高凝例数来看,K值和CI值在两组比较中有显著性差异(P＜0.05);R值、Angle值、MA值两组中没有显著性差异(P＞0.05).[结论]乳腺癌患者相比良性病变患者血液高凝的表现较为明显,TEG可用来监测患者围术期凝血功能,预防血栓栓塞并发症的发生.     

隐匿型乳腺癌的临床诊治要点

隐匿型乳腺癌（Occult breast cancer ,OBC ）是以腋窝淋巴结转移癌为主要表现的一种少见的乳腺癌表现。对于这类患者应当进行完善的术前检查,不仅需要包括标准的双侧乳腺摄影片,还要通过超声和核磁共振评估双侧乳腺和腋窝淋巴结,以寻找原发病灶。由于此类患者具有较高的局部复发风险,因此不推荐单纯对乳腺进行观察,乳房局部治疗应包括全乳切除,也可以考虑保留乳房联合全乳放疗。同时也应进行腋窝淋巴结清扫以提高局部控制并且完善分期。此外,患者还可以接受新辅助或辅助全身治疗。虽然隐匿性乳腺癌伴腋窝转移患者的疾病分期为T0N1-2M0 期,但比同期别原发性乳腺癌预后更好,腋窝淋巴结转移数目,尤其是小于4 枚转移与4 枚或以上转移相比仍然是最为可靠的预测结局的因素。     

乳腺良恶性病变组织中ER、c-myc和hTERT的表达

[目的]探讨ER、c—myc和hTERT在乳腺良恶性病变组织中的表达及意义。[方法]用免疫组化SP法检测25例乳腺腺病和79例乳腺癌组织中ER、c—myc和hTERT的表达。[结果]ER、c—myc和hTERT在乳腺腺病组织中的阳性表达率分别为28．0％、12．0％和20．0％；在乳腺癌中的阳性率分别为72．2％、70．1％和92．4％．均明显高于乳腺腺病组，差异有显著性（P〈0．01）。乳腺癌组中，c—myc和hTERT、ER和hTERT、ER和c—myc均呈显著正相关（r值分别为0．382、0．388和0．632，P〈0．01），而hTERT和患者年龄、肿瘤大小（最大径）、淋巴结转移情况均无相关性（P〉0．05）。[结论]在乳腺癌中ER、c—myc、hTERT均高表达，可能参与了乳腺癌的发生、发展，其中ER和c-myc的过表达可能和hTERT转录激活进而激活端粒酶有关。     

多参数弥散峰度成像评估乳腺良恶性病变的价值

摘 要：［目的］ 探讨多参数弥散峰度成像精准评估乳腺良恶性病变的价值。［方法］ 收集2016年2—9月恶性乳腺病变38例,良性乳腺病变11例,术前行弥散峰度成像（DKI）扫描。测量病灶区DKI参数—平均峰度(MK)、平均弥散率(MD)、各向异性分数（FA）、轴向弥散率（DA）、径向弥散率（DR）、峰度各向异性分数（FAK）、轴向峰度（KA）、径向峰度（KR）及ADC值。［结果］ 乳腺恶性病变组的MK、KA、KR、FAK值高于良性组,MD、DA、DR、ADC值则反之。MK、MD、DA、DR、KA、KR、DKI-ALL（多参数联合）及DKI+DWI诊断乳腺病变AUC均超过0.800,其中DKI-ALL诊断AUC达0.854。MD、DA、DR、KA、DKI-ALL诊断特异性超过90%,MK、KR敏感度超过80%。［结论］ 多参数DKI定量分析乳腺良恶性病变具有较高价值,多参数DKI及DKI联合DWI评估效能最佳。     

Phase II Clinical Trial of Carboplatin, Ifosfamide, with Oral Mesna for Metastatic Breast Carcinoma

Twenty-five women with advanced breast carcinoma refractory to first-line chemotherapy entered a phase II trial to evaluate the efficacy of ifosfamide and carboplatin. Additionally the trial assessed the clinical usefulness of oral 2-mercaptoethane sulfonate (mesna) for urothelial protection. Two partial remissions were observed (8%); toxicity was significant but acceptable, with no treatment-related deaths. The combination of ifosfamide and carboplatin had little activity as the second-line treatment in our population of patients with heavily pretreated metastatic breast cancer. Oral mesna was effective for urothelial protection, permitting outpatient administration of ifosfamide.     

Comparison of Clinical Characteristics Between Benign Borderline and Malignant Phyllodes Tumors of the Breast

Background: Phyllodes tumors of the breast are rare fibroepithelial lesions, so relatively little is known aboutthis disease entity. The present study was designed to identify differences in clinical features between benignborderline and malignant phyllodes tumors. Materials and Methods: Data from 246 women with phyllodestumors of the breast treated in Cancer Hospital Chinese Academy of Medical Sciences between 2002 and 2012were collected and analyzed, including age at presentation, age at treatment, course, size of primary tumor,location, histological type, type of surgery and treatment, local recurrence, distant metastasis, fibroadenomahistory, disease-free survival and number of mitosis per 10hpf. There are 125 (55%) benign, 55 (24%) borderlineand 47 (21%) malignant tumors. Results: In univariate analysis, average age at presentation, average age attreatment, size of primary tumor, ulceration or not, type of primary surgery, distant metastasis and number ofmitosis per 10 hpf turned out to be statistically different among the three PT types (p=0.014, 0.018, <0.000, 0.003,<0.000, 0.001 and <0.000, respectively), while recurrence and disease-free survival (DFS) demonstrated trendsfor statistical significance (P =0.055 and 0.060, respectively). Multivariate analysis revealed distant metastasisand excision were significantly different in benign, borderline and malignant phyllodes tumors of the breast(p=0.041 and 0.018, OR=0.061 and 0.051). At the same time, size of primary tumor with p=0.052 tended to bedifferent between groups (OR=1.127). However, age at treatment, ulceration and DFS showed no statisticallysignificant variation (p=0.400, 0.286 and 0.413, respectively). Conclusions: Benign borderline and malignantphyllode tumors have different distant metastasis risk, different primary tumor size and different surgicalprocedures, and malignant PTs are more likely to be bigger and to metastasize.     

乳腺超声BI-RADS评分系统结合超声造影对乳腺肿块良恶性判断的价值

[目的]评价超声乳腺影像学报告及数据系统fBI．RADS）诊断标准结合超声造影（CEUS）诊断乳腺肿块良恶性的价值。[方法]对120例患者共122个实性肿块行常规超声检查,按照BI．RADS评分标准进行分级诊断,然后行超声造影（CEUS）并做出诊断。比较BI—RADS分级、CEUS、BI—RADS分级＋CEUS三种方法诊断的差异。[结果]BI—RADS分级诊断与CEUS诊断组间比较,其灵敏度、特异性、准确率无统计学差异（P〉0．05）,BI．RADS分级＋CEUS诊断与单独CEUS诊断比较其灵敏度、特异性、准确率亦无统计学差异（P〉0．05）。BI—RADS分级＋CEUS诊断与单独BI—RADS分级诊断比较,其特异性、准确率差异有统计学意义（P均〈0．05）。[结论]BI-RADS分级诊断与CEUS结合可以提高超声对乳腺肿瘤的诊断效率。     

Clinical,Demographic, and Situational Factors Linked to Distress Associated with Benign Breast Biopsy

Benign breast biopsy (BBB) can be distressing for many women. Few studies have examined specific aspects of the BBB more or less distressing or risk factors for distress. Women (N = 51) who had a recent BBB reported the magnitude of distress associated with specific aspects of their experience. Clinical and demographic variables were also examined as risk factors for distress. All women reported some distress associated with the BBB with one third reporting their experience was “very stressful.” Generally, biopsy-specific events were more distressing than follow-up mammography. Distress risk factors included younger age, less education, nonsurgical biopsy, and no family history of breast cancer. Clinical efforts to better manage biopsy-related distress are warranted. The authors identified clinical and demographic risk factors that furnish a simple, efficient, and potentially cost-effective means of stratifying risk for distress in the breast biopsy setting.     

Comparison of Radioactive Seed Localized Excision and Wire Localized Excision of Breast Lesions: A Community Hospital’s Experience

Background

Most data comparing wire localized excision (WLE) and radioactive seed localized excision (RSLE) derive from academic institutions with limited data from community hospitals. This study aimed to compare positive margin rates between WLE and RSLE and to determine if there were any differences in specimen volume and operation time.

超声全容积成像与弹性成像检查乳腺病灶的对比研究

[目的]探讨乳腺全容积成像(ABVS)、弹性成像(UE)对乳腺病灶良恶性鉴别诊断价值。[方法]应用ABVS、UE对82例患者的90个乳腺病灶进行超声检查,所以病例均经病理证实。[结果]良性38例共44个病灶,恶性44例共46个病灶,ABVS诊断乳腺肿瘤的灵敏度为91.3%,特异性为75.0%,准确性为83.3%,阳性预测值79.2%,阴性预测值89.2%;UE诊断乳腺肿瘤灵敏度为86.9%,特异性为97.7%,准确性为92.2%,阳性预测值97.6%,阴性预测值87.8%。[结论]ABVS、UE在乳腺病灶定性诊断上各有一定优势,UE诊断乳腺肿瘤特异性、准确性、阳性预测值高于ABVS。     

乳腺良、恶性肿瘤患者血清Th1/Th2细胞因子的比较

[目的]探讨乳腺良、恶性肿瘤患者血清Th1/Th2细胞因子是否存在差异及其临床意义。[方法]用流式荧光免疫微球分析技术（flow fluorenscence immunmicrobeads assay，FFIA）检测60例乳腺癌患者及40例乳腺良性肿瘤患者血清Th1，Th2细胞因子水平。Th1型细胞因子包括：IL-2、TNF—α、TFN-γ;Th2型细胞因子包括：IL-4、IL-5、IL-10。[结果]乳腺良、恶性肿瘤患者血清Th1/Th2细胞因子水平差异无显著性（P〉0.05）。[结论]与乳腺良性肿瘤比较，乳腺癌患者血清Th1/Th2细胞因子FFIA检测未发现Th1向Th2的偏移，临床意义有限。     

微创旋切术治疗乳腺良性肿瘤患者的疗效及安全性分析

目的 探讨微创旋切术治疗乳腺良性肿瘤患者临床效果及其安全性评价.方法 选自收治的乳腺良性肿瘤患者300例,按照患者手术方式不同分为微创组150例与开放组150例.微创组采用微创旋切术治疗,开放组采用传统开放切除术治疗.比较两组患者手术指征,术后1周应激反应指标水平变化,术后美容效果和并发症,及术后随访1年复发情况.结果 微创组出血量低于开放组,术后瘢痕小于开放组,术后愈合时间优于开放组,手术时间短于开放组,均有统计学差异(P<0.05);微创组血清Cor、E、NE水平术后1周明显低于开放组(P<0.05);微创组优良率(96.67%)高于开放组(68.00%)(P<0.05);微创组术后并发症发生率(8.67%)低于开放组(31.33%)(P<0.05);两组术后随访1年术后复发率比较无统计学差异(P>0.05).结论 微创旋切术治疗乳腺良性肿瘤患者临床效果显著,且对患者应激反应影响小,美容效果好,术后并发症少,安全性良好,值得研究.