Use of an Intraoperative Ultrasonography-Guided Localization and Tissue Fixation Device Demonstrates Less Margin Positivity During Breast-Conserving Surgery for Invasive Breast Cancer Than Standard Preoperative Needle-Wire Localization: A Retrospective Comparative Analysis in a Consecutively Treated Case Series

PurposeTo retrospectively compare 2 methods of pre-resection, image-guided tumor localization—preoperative needle-wire localization (PNWL) and intraoperative ultrasonography-guided localization and tissue fixation (IUGLTF)—for patients with invasive breast cancer at the time of breast-conserving surgery (BCS).Patients and MethodsWe identified 118 cases in which image-guided localization was required for nonpalpable and questionably palpable tumors from a series of 204 consecutive invasive breast cancers treated by BCS. We defined a positive margin as tumor at the inked surface. We defined a close margin as tumor within 1 mm or less of the inked surface.ResultsOf those 118 cases requiring pre-resection, image-guided localization, 54 patients underwent PNWL and 64 underwent IUGLTF placement. A positive margin was identified in 6 of 54 (11.1%) undergoing PNWL compared with 1 of 64 (1.6%) undergoing IUGLTF (P = .046). A positive or close margin was identified in 9 of 54 (16.7%) undergoing PNWL compared with 3 of 64 (4.7%) undergoing IUGLTF (P = .032). The mean volume and mean weight of the BCS specimens were not different in the 2 groups.ConclusionBased on the finding of less margin positivity associated with the IUGLTF technique than the PNWL technique, we believe that the use of an IUGLTF device by surgeons during BCS could be highly advantageous in the surgical management of nonpalpable and questionably palpable invasive breast cancers.     

Ultrasonography Mapping Combined With Mammography Before Breast-Conserving Surgery for Primary Breast Cancer With Microcalcifications: A Novel Approach

IntroductionEvaluation for the spread of breast cancer with microcalcifications is challenging, because the microcalcifications sometimes spread beyond the lesions detectable by ultrasonography (US). An original method for preoperative mapping was performed for such lesions, using US in combination with mammography (MG) (US + MG mapping) before breast-conserving surgery (BCS).Materials and MethodsA total of 885 consecutive patients underwent BCS for primary breast cancer. Of the 885 patients, 154 (17.4%) with ductal carcinoma in situ or invasive carcinoma having microcalcifications underwent US + MG mapping preoperatively. Five patients who received neoadjuvant chemotherapy and 17 patients who were lost to follow-up were excluded. Accordingly, 133 lesions in 132 patients were retrospectively evaluated. The associations among this method, surgical margin (positive, close, or negative), pathologic characteristics, the area of the lesion within the specimen, and local recurrence rate during 5 years of follow-up were analyzed.ResultsThe median age and follow-up duration were 51.3 years (range, 28-80 years) and 71.4 months (range, 60-79 months), respectively. The surgical margin was negative in 96 lesions (72.2%), close in 27 lesions (20.3%), and positive in 10 lesions (7.5%). Local recurrence was noted in 1 patient (0.8%). There was no significant association between surgical margin status and the presence of invasive carcinoma. Larger lesion area was significantly associated with positive or close margin (P = .027).ConclusionUS + MG mapping is useful and results in a high complete-resection rate and an extremely low 5-year local recurrence rate.     

延迟放疗对乳腺癌保乳术后患者生存状况影响的研究

目的 探讨延迟放疗对乳腺癌保乳手术后患者生存状况的影响.方法 选取乳腺癌保乳手术患者150例,按随机数表法将患者分为对照组和观察组,每组75例.两组患者行乳房保留术后,对照组行常规放疗后辅助化疗;观察组根据患者具体情况,先行辅助化疗,再行放疗,延迟＞8周.观察并统计两组患者的术后局部复发(LR)、总生存(OS)、不良反应情况.结果 术后3年,观察组及对照组LR率分别为20.00％ (15/75)和36.00％ (27/75),差异有统计学意义(x2 =4.631,P=0.031);观察组及对照组OS率分别为94.67％和86.67％,差异无统计学差异(x2=2.953,P=0.134).观察组并发症1例,为皮下积液,转移2例;对照组并发症6例,其中皮下积液6例.转移8例,两组比较具显著差异(P＜0.05);治疗后观察组和对照组角色功能、情绪功能、社会功能和躯体功能等各项生活质量评分分别为(81.3±3.4)、(69.1±4.8)、(80.5±5.1)、(79.5±6.1)和(70.3±2.6)、(55.9±3.3)、(60.2±4.1)、(65.1±5.8)分,两组各项比较差异显著,具统计学意义(P＜0.05);观察组美容效果优良率为97.33％,高于对照组86.67％,差异具有统计学意义(x2 =8.631,P=0.003).结论 延迟放疗能对乳腺癌保乳手术患者患者生存状况产生积极影响,预后效果较好,患者生活质量明显提高,值得临床推广.     

早期乳腺癌保乳术后全乳调强放射治疗与常规切线野放疗的剂量学比较

目的探讨早期乳腺癌保乳术后全乳调强放射治疗(intensity-modulated radiotherapy,IMRT)的剂量学优势。方法选择6例接受保乳手术的T1N0M0早期乳腺癌病例,其中左侧乳腺癌4例,右侧乳腺癌2例,应用三维调强治疗计划系统为每例患者设计常规切线野与IMRT2种全乳放射治疗计划,处方剂量均为50Gy/25次。用剂量体积直方图(dose volume histograms,DVH)来比较2种计划中计划靶体积(planning target volume,PTV)、危及器官(organs at risks,OARs)的剂量学差异。结果在2种计划中,95%PTV均接受50Gy,99%PTV均接受95%的处方剂量;但在IMRT计划组V110%(接受大于110%处方剂量体积占PTV的百分比)下降了9.1%(46.3%比37.2%,P<0.05);同侧肺的V20(至少接受20Gy照射的肺体积占同侧肺体积的百分比)下降了7.2%(26.8%比18.0%,P<0.05);同侧肺的V30下降了12.0%(23.2%比11.2%,P<0.05);4例左侧乳腺癌患者的心脏V30下降了3.8%(7.0%比3.2%,P<0.05)。结论全乳IMRT在保证靶区覆盖率的前提下,改善了靶区内剂量的均匀性,降低了危及器官的受照剂量及缩小了危及器官的照射体积,尤其是同侧肺、心脏的照射体积,降低放射性肺炎及心血管事件发生的可能。     

Patterns of Recurrence after Breast-Conserving Treatment for Early Stage Breast Cancer by Molecular Subtype

Purpose

To study clinical features and patterns of recurrence after breast-conserving treatment (BCT) for three molecular subtypes of early stage breast cancer.

Methods

The sample studied included 596 patients with T1-2N0-1 breast cancer who received BCT. Three groups were defined by receptor status. Luminal: estrogen receptor (ER) or progesterone receptor (PR) positive; triple negative (TN): ER, PR, and epidermal growth factor receptor-2 (HER2) receptor negative; and HER2 overexpressing: ER and PR negative but HER2 receptor positive.

Results

The number of patients in each group was 408 (68.5%), 105 (17.6%), and 83 (13.9%), respectively. The median follow-up period was 79 months. The TN and HER2 subtypes occurred in younger patients (p=0.0007) and had higher nuclear grade and poorer histologic grade (p<0.0001 and 0.0071, respectively). During the follow-up period, locoregional recurrence was detected as the first site of recurrence in 26 (6.4%), 11 (10.5%), and 9 (10.8%) patients in the luminal, TN, and HER2 subtypes, respectively (p=0.1924). Thirty-one (7.6%), 7 (6.7%), and 7 (8.4%) patients in each group had distant metastases as the first sign of recurrence (p=0.8996). Median time to locoregional and distant recurrence was shorter in the HER2 subtype (p=0.0889 and 0.0780, respectively), and the HER2 subtype was significantly associated with poor overall survival (p=0.0009).

Conclusion

After BCT in Korean women with early stage breast cancer, the patterns of recurrence were not different among the molecular subtypes, although the TN and HER2 subtypes were associated with younger age, higher nuclear grade, and poorer histologic grade.     

早期乳腺癌保乳手术后10年局部复发与部分乳腺放疗

目的:总结早期乳腺癌保乳手术后局部复发的表现,分析全乳放疗的作用。方法:1990年4月至1995年12月保乳治疗原发性早期乳腺癌49例。行象限切除加腋窝淋巴结清扫术40例,单纯肿块局部广泛切除术9例。术后全乳切线加瘤床放疗39例,全乳切线照射整个乳房,6-MVX线,中平面剂量45GY,瘤床补加电子束剂量15GY。结果:本组10年复发3例,占6.12%(3/49),均为非浸润性癌。术后不加全乳放疗组局部复发率高(2.56%与20.00%)。行象限切除加腋窝淋巴结清扫手术组局部复发率低于单纯肿块局部广泛切除术组(2.5%与22.22%)。局部复发病例100%为原位复发。结论:保乳术后放疗是必要的,只限于肿瘤邻近区域足够剂量的放疗方式应该是可行的。     

保乳术治疗早期乳腺癌患者的临床疗效及对生活质量的改善作用

目的探讨保乳术治疗早期乳腺癌临床疗效,并观察其对患者生活质量的影响。方法 70例乳腺癌患者,其中35例采用改良根治术治疗者为对照组;另35例采用保乳术治疗,为观察组。两组术后均采用CMF化疗方案治疗,雌激素受体或孕激素受体(ER/EP)阳性者行内分泌治疗,观察组术后行全乳放疗及瘤床加量放疗。于术后2个月统计两组术后并发症及乳房美容情况,随访3年,统计两组局部复发、生存率、远处转移情况,并采用乳腺癌生命质量测定量表调查两组生活质量。结果观察组术后2个月并发症发生率2.86%,明显低于对照组(17.14%),χ~2=3.96,P=0.04;观察组术后2个月乳房美容优良率91.43%,明显高于对照组(0),χ~2=58.94,P=0.00。观察组与对照组患者3年生存率[94.29%vs97.14%]、局部复发率[2.86%vs5.71%]及远处转移率[8.57%vs11.43%]比较,差异均无统计学意义,P>0.05。观察组生理功能、躯体疼痛、生理职能、活力、总体健康、社会功能、情感职能及精神健康得分明显高于对照组相比,P<0.05。结论采用保乳术与改良根治术治疗早期乳腺癌均可取得较好疗效,但前者术后并发症少且具有较好的乳房外形,从而有利于改善患者生活质量。     

乳腺癌保留乳房手术切除范围的探讨

目的；探讨合适的乳腺癌保留乳房手术切除范围。方法：对104例乳腺癌根治手术患者的切除标本进行观察研究，每一患者标本分为“癌肿区”，“近癌区”和“远癌区”。以肿瘤切除活检标本或肉眼可见肿瘤及其周围0.5cm区域为“癌肿区”；“癌肿区”边缘向外1cm-3cm区域为“近癌区”；3cm-5cm区域为“远癌区”。对三个区域乳腺组织非典型增生和c-erbB-2,p53基因蛋白异常表达发生情况分别进行研究。结果：104例乳腺癌手术标本中，“近癌区”和“远癌区”发生非典型增生率分别为56．7％，32．7％，其中Ⅱ，Ⅲ级非典型增生率“近癌区”明显高于“远癌区”。49例c-erbB-2阳性乳腺癌中，“近癌区”亦发现有c-erbB-2阳性表达者26例（53．6％），“远癌区”阳性表达者8例（16．35）。两组比较均P＜0．01。25例p53阳性者中，“近癌区”及“远癌区”检测均阴性，结论：提示在行保留乳房手术时，一并切除近癌组织是必要的。     

术前磁共振成像对乳腺癌保乳手术的临床意义

目的探讨磁共振成像（magneticresonanceimaging,MRI）对评估保乳手术可行性的价值。方法87例经临床体检和超声检查后计划进行保乳术的乳腺癌患者,均行术前乳房MRI、其中65例行钼钯X线检查,手术标本均行组织病理学检查。将MRI和钼靶X线检查结果与组织病理学结果进行对照,分析是否适宜行保乳术（breast—conservingsurgery,BCS）。结果MRI检查能够准确检测出乳腺癌灶的数目、大小和淋巴结状况,测量切除肿块／乳房体积比。通过MRI检查结果综合判断71例可行BCS、16例不可行BCS,与病理检查结果的符合率达91．6％,高于钼钯X线检查。结论术前MRI检查能为乳腺癌BCS患者的筛选提供较全面而准确的信息,是传统的影像学方法的有益补充。     

早期乳腺癌保留乳房的综合治疗

目的：探讨早期乳腺癌最佳治疗方法。方法：自１９９０年４月至１９９５年４月,本院共４８例早期乳腺癌患者接受了保守外科加术后放疗。其中０期１例,Ⅰ期３３例,Ⅱ期１４例。４５例行乳房１／４切除加腋窝淋巴结清扫,３例患者只作肿瘤切除未行腋淋巴结清扫。全部患者均接受围手术期化疗４￣７周（ＣＭＦ或ＣＡＦ方案）。放疗采用４￣６ＭＶ Ｘ线,全乳切线照射,中平面剂量４５Ｇｙ,瘤床用电子束补加１５Ｇｙ,９例腋淋巴结阳     

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。     

乳腺癌病灶的超声特点与保乳根治术预后的相关性

目的 分析乳腺癌病灶的超声特点与保乳根治术术后预后的相关性.方法 随机选择乳腺癌患者113例,根据保乳术后是否复发将其分成预后良好组(n=83)和不良组(n=30).保乳术前使用超声检查.探究2组患者超声特征,并分析乳腺癌病灶的超声特点与保乳根治术术后预后的相关性.结果 预后良好组和不良组患者超声图像特征中钙化、血流分...     

The Results of Surveillance Imaging After Breast Conservation Surgery and Partial Breast Reconstruction With Chest Wall Perforator Flaps; A Qualitative Analysis Compared With Standard Breast-Conserving Surgery for Breast Cancer

IntroductionPartial breast reconstruction (PBR) using chest wall perforator flaps (CWPF) allows for excision of tumors in the outer quadrant of the breast in women with small to moderate non-ptotic breasts resulting in a good aesthetic outcome. There are limited data available in the literature regarding long-term follow-up and the effect of CWPF on subsequent surveillance mammographic interpretation and recall rates. A retrospective audit with qualitative analysis of initial mammograms was performed to assess this.Patients and MethodsThis retrospective analysis of a prospectively maintained database included all consecutive patients who underwent either PBR with CWPF or wide local excision (WLE) between January 2013 and December 2014 by a single surgeon in a tertiary referral center. Qualitative analysis of the postoperative mammograms was performed after review by 2 blinded radiologists.ResultsThirty-six patients were included in the study, 18 in each arm. The CWPF group was younger and had larger tumor size anticipated on preoperative imaging, which correlated with larger specimens excised. Both groups were comparable with respect to tumor pathological characteristics. Comparing the first postoperative mammograms, both groups were similar in features reported such as calcifications, fat necrosis, volume loss, and radiotherapy changes. During the follow-up period (median 4 years), 138 surveillance mammograms were performed. One patient was recalled for further imaging in the CWPF group. There was no significant difference in the need for diagnostic imaging and biopsy between the groups.ConclusionPatients who underwent PBR using CWPF had similar features on postoperative surveillance mammograms compared with that post WLE.