The contralateral breast in ipsilateral breast carcinoma

I examine the problem of the management of the opposite breast of a patient with ipsilateral carcinoma, reviewing the literature from the standpoint of the incidence of carcinoma in the contralateral breast, autopsy studies, blind biopsy results, and other factors such as age and multicentricity. In my series of 343 cases of carcinoma of the breast, there were 110 cases (32%) of bilateral mastectomy; 47 (43%) showed carcinoma in only one breast, 40 (36%) exhibited contralateral carcinoma, and 23 (21%) showed Consensus Added Risk Factors (CARF). The remaining 233 cases of carcinoma of the breast were treated by unilateral mastectomy. In 59 of these cases of bilateral mastectomy in which a prophylactic contralateral mastectomy had been performed, 15% showed carcinoma of the opposite breast and 22% showed CARF. In 51 cases, the contralateral mastectomy had been performed for clinical or radiographic indications. Of this group, 61% showed carcinoma and 20% showed CARF. All of my studies are based on routine pathologic studies and not on any specialized, subserial whole organ studies.     

母乳喂养中常见乳房问题的处理

对２１０例产妇在早期母乳喂养中常见的乳头平坦或凹陷、乳头皲裂、奶胀等乳房问题进行了临床调查分析,提出了相应的处理措施。乳头平坦或凹陷者用乳头伸展练习法和注射器抽吸乳头法纠正,经处理后首次吸吮成功距分娩的时间平均为１５３２±２８７ｈ（１５～６８ｈ）,出院时吸吮成功率９５２％;乳头皲裂者着重纠正含吮姿势,同时利用产妇自身乳汁治疗创口,治愈率１００％;奶胀者热敷、按摩、拍打乳房,增加喂哺次数,及时排空乳房,１～２ｄ解除率为１００％。     

Amyloid tumor of the breast mimicking breast carcinoma

Amyloid tumors of the breast are extremely rare. Few isolated cases have been reported to date. Amyloid involvement of the breast has no specific diagnostic features on mammography; on occasion, this causes diagnostic challenges. In this paper, the case of a 58-year-old woman with an amyloid tumor of the breast, which developed secondary to long-standing rheumatoid arthritis, is presented. She presented with a palpable mass in her right breast, which led to an erroneous clinical diagnosis of breast cancer. The unusual mammography findings are demonstrated and the differential diagnosis, in light of the radiological images and the clinical and pathologic features, is discussed.     

数字乳腺断层摄影诊断乳腺结构扭曲病变

目的 对比观察数字乳腺断层摄影（DBT）与全数字化乳腺X线摄影（FFDM）评价乳腺结构扭曲（AD）病变的优势，探讨DBT与超声鉴别乳腺良恶性AD的价值。方法 回顾性分析58例经DBT检出AD病变患者的DBT、FFDM及超声资料，以病理结果为标准，比较DBT与FFDM评价乳腺AD的敏感度、特异度、准确率，分析DBT与超声鉴别乳腺良恶性AD与病理结果的一致性；绘制DBT与超声鉴别乳腺良恶性AD的ROC曲线，比较其诊断效能。结果 所有病例均接受FFDM，41例接受超声检查。对于DBT检出的58例乳腺AD，FFDM仅发现23例，差异有统计学意义（χ²=33.03，P<0.05）。DBT评估致密型乳腺内AD的敏感度[80.65%（25/31）]及准确率[78.00%（39/50）]高于FFDM[35.48%（11/31）、48.00%（24/50），χ²=12.98、9.65，P均<0.05），而特异度[73.68%（14/19）]与FFDM[68.42%（13/19）]差异无统计学意义（χ²=0.13，P>0.05）。DBT及超声鉴别乳腺AD良恶性的结果与病理结果的一致性中等（Kappa=0.65、0.71，P均<0.05）。DBT及超声鉴别良恶性AD的敏感度、特异度分别为91.30%（21/23）、72.22%（13/18）及82.61%（19/23）、88.89%（16/18），AUC差异无统计学意义（Z=1.45，P>0.05）。结论 DBT评估乳腺AD的敏感度及准确率均高于FFDM；DBT鉴别乳腺AD良恶性的效能与超声相当。DBT检出AD的恶性程度较高，建议及时行活检确诊。     

Importance of breast awareness in identification of breast cancer

In a move to reduce the number of deaths from breast cancer there was a shift in emphasis in 1991 away from breast self-examination to breast awareness. This article takes a close look at the background to this shift, the conflicting messages with regards to breast awareness, and the need to re-educate and empower nurses and other health professionals with the knowledge and confidence to teach the public about these issues. Breast Cancer Care plays a vital role in networking with nurses, other health professionals and the public to clarify the breast awareness message.     

乳腺病灶超声全容积成像临床应用价值

目的 探讨常规二维超声、弹性成像、自动乳腺全容积成像(ABVS)对乳腺良恶性病灶鉴别诊断价值.方法 应用二维超声、弹性成像、ABVS对84例患者经手术病理证实的98个乳腺病灶进行超声检查,并将结果进行比较.结果 36例良性患者共46个病灶,48例恶性患者共52个病灶,二维超声诊断乳腺恶性病灶的敏感度为78.9%(41/52),特异度为76.1%(35/46),准确性为77.6%(76/98),阳性预测值78.8%,阴性预测值76.1%;弹性成像诊断乳腺恶性病灶敏感度为82.7%(43/52),特异度为95.6%(44/46),准确性为88.8%(87/98),阳性预测值95.6%,阴性预测值83.0%;ABVS 诊断乳腺恶性病灶的敏感度为84.6%(44/52),特异度为73.9%(34/46),准确性为79.6%(78/98),阳性预测值78.6%,阴性预测值81.0%.结论 ABVS在乳腺病灶定性诊断上有一定优势,与二维超声诊断敏感度、特异度、准确性、阳性预测值、阴性预测值无明显差异;ABVS较弹性成像诊断特异度、准确性、阳性预测值、阴性预测值稍低.     

乳腺腺病与乳腺导管癌的MRI鉴别诊断及病理对照研究

目的探讨乳腺腺病与乳腺导管癌的动态增强磁共振成像(dynamic contrast enhanced magnetic resonance imaging,DCE-MRI)、扩散加权成像(diffusion weight imaging,DWI)鉴别诊断特征,及其与病理表现相关性。材料与方法回顾性收集分析经病理证实的105例乳腺腺病、78例乳腺导管癌患者的MRI资料。所有患者术前均行乳腺DWI、DCE-MRI扫描。分析两组患者的MRI表现特点及其与病理表现的相关性,采用χ~2检验比较两组的临床资料、病灶位置、大小、形态、时间-信号强度曲线(time-signal intensity curve,TIC)及强化方式等特征;采用单因素方差分析比较两组患者的表观扩散系数(apparent diffusion coefficient,ADC)值。结果 105例乳腺腺病呈肿块样强化(mass-like enhancement,MLE)50例,非肿块样强化(nonmass-like enhancement,NMLE)55例;78例乳腺导管癌中MLE52例,NMLE26例。腺病组MLE病变形态大多形态规则(37/50,74%)、边缘清晰(35/50,70%),两组MLE病变的强化方式、TIC类型的差异均有统计学意义(χ~2值分别为14.169和13.955,P均0.01);两组MLE病变的ADC值分别为(131.63±21.8)×10~(-3) mm~2/s、(104.21±18.54)×10~(-3) mm~2/s,两者的差异有明显统计学意义(F=52.167,P0.01);两组NMLE病变强化方式多样,其差异有统计学意义(χ~2值分别为4.478,P均0.05)。两组NMLE病变的ADC值分别为(136.23±14.8)×10~(-3) mm~2/s、(102.51±16.44)×10~(-3) mm~2/s,两者的差异有明显统计学意义(F=49.167,P0.01)。结论乳腺腺病的MRI表现具有一定的特征性,MLE病变多呈良性病变特点,NMLE病变形态与恶性病变相似,动态增强结合DWI有助于其与乳腺导管癌的鉴别诊断;乳腺腺病的间质纤维化可能是造成恶性征象出现的原因。     

Nonpalpable breast cancer

Although mammography is the most reliable method for the early detection of breast cancer in asymptomatic women and in women with equivocal signs or symptoms, this screening tool is still underutilized in the United States. Precise biopsy of suspicious nonpalpable findings is facilitated by mammographic localization.     

Male breast cancer

Between 1974 and 1982 inclusive 18 male patients were treated for breast carcinoma. 12 patients had postoperative radiotherapy whereas 4 were referred for treatment of recurrent or metastatic disease. One patient showed signs of inflammatory breast cancer and was treated with chemo-radiotherapy and one was being followed up in our department after radiotherapy for prostatic cancer in 1970. Median overall survival was 52 months and the median disease-free interval was 21 months.     

Common breast problems

A palpable mass, mastalgia, and nipple discharge are common breast symptoms for which patients seek medical attention. Patients should be evaluated initially with a detailed clinical history and physical examination. Most women presenting with a breast mass will require imaging and further workup to exclude cancer. Diagnostic mammography is usually the imaging study of choice, but ultrasonography is more sensitive in women younger than 30 years. Any suspicious mass that is detected on physical examination, mammography, or ultrasonography should be biopsied. Biopsy options include fine-needle aspiration, core needle biopsy, and excisional biopsy. Mastalgia is usually not an indication of underlying malignancy. Oral contraceptives, hormone therapy, psychotropic drugs, and some cardiovascular agents have been associated with mastalgia. Focal breast pain should be evaluated with diagnostic imaging. Targeted ultrasonography can be used alone to evaluate focal breast pain in women younger than 30 years, and as an adjunct to mammography in women 30 years and older. Treatment options include acetaminophen and nonsteroidal anti-inflammatory drugs. The first step in the diagnostic workup for patients with nipple discharge is classification of the discharge as pathologic or physiologic. Nipple discharge is classified as pathologic if it is spontaneous, bloody, unilateral, or associated with a breast mass. Patients with pathologic discharge should be referred to a surgeon. Galactorrhea is the most common cause of physiologic discharge not associated with pregnancy or lactation. Prolactin and thyroid-stimulating hormone levels should be checked in patients with galactorrhea.     

诊断超声在乳腺癌保乳术中的应用探讨

目的探讨诊断超声在乳腺癌患者选择保乳术,术后判断疗效中的价值。方法回顾性分析59例乳腺癌患者保乳术前超声和术后病例资料。超声测量肿瘤最大直径,观察新辅助化疗前后病灶大小、体积、血流的变化。超声预测腋窝淋巴结转移情况,并与术后病理、腋窝清扫结果进行对照分析。结果超声测量病灶最大径与病理实体测量有较好的一致性,相关系数为0．91;超声预测腋窝淋巴结转移准确率为84．8％（28／33）;超声观察部分病灶在新辅助化疗前后,其长径、体积及多普勒血流发生明显变化（P〈0．01）。结论诊断超声在乳腺癌保乳术前筛查、新辅助化疗效果观察中有一定意义。     

乳腺癌患者保乳联合健侧缩乳术的护理

分析总结29例乳腺癌保乳手术联合对侧缩乳手术患者的护理体会。密切观察患者病情变化,做好手术前后的相关护理,缩乳手术的特殊护理。心理护理、康复护理出院指导及社会支持。提高患者的生活质量。     

Benign breast disease

The author presents an overview of benign breast disease. History, epidemiology, risk factors, hormonal influence, and clinical features are discussed. Appropriate treatment for mastalgia, diffuse nodularity, mastitis, and dominant lumps is presented. The importance of patient education, clinical breast examination, mammography, and patient reassurance is stressed. Benign breast disease in men is also discussed.     

Stereotaxic breast biopsy

Stereotaxically guided core needle biopsy is an important procedure used to decrease the number of surgical breast biopsies, as well as to decrease the expense, inconvenience, and deformity that can result from surgical biopsies. Use of the technique also can decrease the expense of breast cancer screening programs. Stereotaxic core biopsy (SCB) should not be used to biopsy lesions that would otherwise not undergo biopsy. The radiologist who performs this procedure must understand the implications of the resultant histological diagnosis and be certain that the pathological and radiological findings are concordant. The performance of this procedure by a radiologist is important for accurate positioning and needle placement in the breast, allowing accurate diagnosis, and in minimizing the number of exposures required for the procedure, thereby keeping the radiation dose to the patient at a minimum. In addition to understanding the guidance system used in this procedure, the radiologist also should understand the needles and guns used and be able to select the most appropriate method for each patient. Patients undergoing SCB should be told that, in some instances, surgical biopsy may still be necessary. They should know that major complications are rare but possible. Before initiating an SCB program, the radiologist performing SCB should develop a mechanism for surgical referral of woman who have a complication or an SCB diagnosis requiring surgery. This article describes the accuracy, indications, patient selection, equipment, technique, histological preparation and interpretation, shortcomings, and complications of SCB. Special emphasis is placed on SCB procedures and findings at Memorial Sloan-Kettering Cancer Center.