早期乳腺癌的诊断和外科治疗进展

乳腺癌是危害妇女生命和健康的恶性肿瘤一。近年来,欧美发达国家的乳腺癌发病率持续升高,但是乳腺癌的死亡率开始出现下降趋势[1],这归功于乳腺癌的早期诊断和规范化、个体化的综合治疗。我国乳腺癌诊治的总体水平落后于欧美国家,但是随着乳腺癌二级预防的广泛开展和各种早期诊断技术的应用,早期乳腺癌所占比例越来越多,促使我们更加重视早期乳腺癌的综合治疗,实现乳腺癌     

新一代信息技术与乳腺癌诊治模式的变革

<正>乳腺癌是女性最常见的恶性肿瘤,早期诊断和辅助治疗可显著降低死亡率。但在我国,乳腺癌死亡率并未显著降低,可能与乳腺癌早期诊断率低、规范化综合治疗欠缺和地区差异大等相关。结合我国具体国情,亟需在目前乳腺癌诊治水平的基础上,利用各种先进信息技术,提高乳腺癌早期诊断率、促进综合治疗的规范化并缩小地区差异,来进一步提升乳腺癌的诊治水平,提高乳腺癌治愈率。近年来,以云计算、大数据、人工智能等为代表     

乳腺癌术后复发转移相关因素研究进展

正乳腺癌是当前女性发病率最高的恶性肿瘤。随着早期诊断、早期治疗以及乳腺癌辅助治疗的不断完善,乳腺癌术后无病生存率和总体生存率均明显提高,术后局部复发和远处转移仍然是导致乳腺癌患者死亡的重要原因。乳腺癌的复发转移是指乳腺癌经过治疗后在原发灶附近或远隔器官出现病理性质完全相同肿瘤的现象。乳腺癌术后肿瘤复发和转移的问题严重影响临床治疗的效     

早期乳腺癌的手术治疗及预后

目的　探讨早期乳腺癌的手术方式和预后。方法　对 2 3年间收治并获得随访的 14 9例15 5个早期乳腺癌的临床资料进行回顾性分析。手术方式包括传统根治、仿根治、乳腺全切加低腋淋巴结清除、乳腺单纯切除以及局部切除术。结果　乳腺原位癌 5 ,10 ,15和 2 0年的生存率分别为99 .2 % ,92 .2 % ,86.8%和 85 .7%。早期浸润性乳腺癌 5 ,10 ,15和 2 0年的生存率分别为 10 0 .0 % ,89 .5 % ,70 .0 %和 75 .0 %。各种术式对早期乳腺癌预后的影响不明显 (P >0 .0 5 )。结论　早期乳腺癌的预后可能与乳腺癌的多原发灶有关 ,而与手术方式关系不明显 ;乳腺单纯切除术是早期乳腺癌的首选术式。     

国人早期乳腺癌远处转移预报模型的研究

目的：利用乳腺癌传统临床病理因素建立早期乳腺癌远处转移的预报模型，实现早期乳腺癌患者的“低危组”和“高危组”分类以指导临床个体化治疗。方法：通过多因素Logistic回归分析对早期乳腺癌危险因素进行筛选，在此基础上建立早期乳腺癌远处转移的预报模型，并观察其效果。结果：多因素Logistic回归分析从12个危险因素中筛选出3个建模因子: 腋淋巴结转移、肿块大小和C-erb-B2表达，由此建立Logistic回归模型，该模型回顾性与前瞻性预报的正确率分别为79.3％，69.2％。结论：可以通过预测模型将早期乳腺癌患者分为“低危组”和“高危组”两个亚型，以预测早期乳腺癌远处转移的危险性，该预测模型为乳腺癌患者术后个体化治疗提供了一定依据。     

早期可手术乳腺癌的诊治现状与展望

<正>乳腺癌是一种“全身性疾病”理论的提出与实践,使其从单一的局部治疗,发展到以手术为基础,包含放疗、内分泌治疗、化疗、靶向治疗和免疫治疗等的综合治疗模式^[1]。进入本世纪后,在综合治疗基础上,笔者进一步探索早期乳腺癌最优诊治流程和方案。早期乳腺癌目前无明确的定义,本文提及的早期乳腺癌主要指可手术的非局部晚期乳腺癌。     

早期乳腺癌的诊断

近年来,乳腺癌的发病率有上升的趋势,据报道在一些国家和地区乳腺癌在女性恶性肿瘤的发病率已上升到首位。因些,乳腺癌是危害妇女健康的主要肿瘤,而乳腺癌的早期诊断是决定乳腺癌预后的关键。本文重点讨论早期乳腺癌的诊断。 诊断早期乳腺癌的重要意义 乳腺癌具有好发血行转移的生物学特性,其发生率之高和造成后果的严重性,已经引起人们普遍重视。临床实践表明,初诊乳腺癌患者中约半数以上已经发生血行转移,而这些微小的转移癌灶,虽然潜在于体内,但用目前的检查方法尚难查出。李树玲报道Ⅰ期乳腺癌虽经根治性手术切除,     

乳腺癌的早期诊断

为探讨乳腺癌的早期诊断,总结我院自1994～1997年间70例乳腺癌的诊断经验。结果 Ⅰ期乳腺40例,占57.4％,其中小乳腺癌13例占18.6％,0期原位癌3例,占4.3％,50岁以下乳腺癌占70％。认为重视乳腺癌的高危因素、定期检查和乳腺X线摄片是早期诊断乳腺癌的重要措施。     

乳腺癌的现状和远景

乳腺癌是女性最常见的恶性肿瘤 ,外科治疗历史久远。在各种恶性肿瘤中 ,乳腺癌是疗效比较好的一种 ,然而总的生存率仍然不能令人满意 ,以早期发现 ,早期治疗为好。为了探讨乳腺癌的病因和发生发展规律 ,提高早期诊断率和远期生存率 ,近年来临床和基础研究不断有所发现。本文作者多年来致力于乳腺癌的基础和临床工作 ,深入浅出地阐述了当代乳腺癌研究的各方面进展 ,临床外科医生读后可以对乳腺癌的现状和发展前景有一概括的认识 ,将会有所收获。     

早期乳腺癌辅助化疗方案的选择

早期乳腺癌辅助化疗适应证的选择较进展期乳腺癌更为困难,避免过度治疗及治疗不足是难点。《早期乳腺癌初始治疗国际专家共识》从-92007年共识不同的角度出发,以各种治疗方法的适应证为着眼点,为临床医师提供早期乳腺癌的全身治疗决策。新的计算方法将早期乳腺癌的辅助化疗对象界定为HER2阳性、三阴性（ER、PgR、HER2均为阴性）、ER阳性而HER2阴性三组人群。     

早期乳腺癌影像学检查现状与展望

乳腺癌是一种严重威胁女性身心健康的恶性肿瘤,在我国,其发病率位居大城市女性恶性肿瘤的第一位,而且发病率呈逐年增长趋势。目前很多影像学检查方法被应用于乳腺的早期筛查,如乳腺检查（CBE）、乳腺X线摄影、超声成像（US）、计算机断层摄影（CT）、磁共振成像（MRI）、正电子发射断层显像术（PET）和乳腺热层析成像等,尤其是乳腺组织活检的应用,旨在提高早期乳腺癌的检出率。     

早期乳腺癌影像学检查现状与展望

乳腺癌是一种严重威胁女性身心健康的恶性肿瘤，在我国，其发病率位居大城市女性恶性肿瘤的第一位，而且发病率呈逐年增长趋势。目前很多影像学检查方法被应用于乳腺的早期筛查，如乳腺检查（CBE）、乳腺X线摄影、超声成像（US）、计算机断层摄影（CT）、磁共振成像（MRI）、正电子发射断层显像术（PET）和乳腺热层析成像等，尤其是乳腺组织活检的应用，旨在提高早期乳腺癌的检出率。     

MRI在乳腺癌综合治疗中的应用价值及评价

随着乳腺癌个体化、规范化综合治疗理念的推广,乳腺MRI在综合治疗中的作用日益受到重视。伴随乳腺MRI临床应用开展和研究的深入,其在乳腺癌的诊断、保乳治疗、新辅助化疗(NAC)以及随访监测中的应用价值得到评估。乳腺MRI对肿瘤范围的精确显示为多种治疗方式的合理应用、评估及监测治疗效果等方面具有重要价值,对乳腺癌综合治疗起着不可替代的作用。     

MR引导下乳腺穿刺活检机器人研究进展

乳腺癌是目前发病率最高的恶性肿瘤之一。早期诊断及治疗乳腺癌对改善预后具有重要意义。随着机器人技术发展成熟,MR引导下乳腺穿刺活检机器人技术可能成为早期诊治乳腺癌的理想方式之一。本文对近年来MR引导下乳腺穿刺活检机器人研发及应用进展进行综述。     

Management of women at high risk for breast cancer: new imaging beyond mammography

The management of women with an increased lifetime risk of breast cancer is a difficult task. This is especially true for women with a documented mutation in a breast cancer susceptibility gene (BRCA), and also for those who tested negative for a mutation, but have a family history that is suggestive of familial breast cancer. Primary prevention by prophylactic mastectomy has been shown to reduce breast cancer incidence in these women, but this intervention is still not considered a "first-line" option in the majority of guidelines. Instead, secondary prevention (intensified surveillance) is recommended. However, due to the early onset of familial breast cancer, screening must start at a substantially younger age than in women at average risk. This, together with the fact that familial breast cancers may differ from sporadic cancers in many aspects, will have a significant impact on the design and on the success rates of surveillance protocols. This article describes the different management options that exist for women at increased genetic risk and provides a survey of the current evidence regarding mammographic and non-mammographic imaging techniques. The conclusion is that mammographic screening, with or without concomitant ultrasound and clinical breast examination, is probably not sufficient to ensure an early diagnosis of familial breast cancer. If MRI is integrated in surveillance programs, early diagnosis seems to be possible. Still, the efficacy of screening even with MRI is unclear in terms of morbidity and mortality, and this lack of evidence must be communicated to women at high genetic risk.     

Variability of Preoperative Breast MRI Utilization among Older Women with Newly Diagnosed Early‐stage Breast Cancer

While magnetic resonance imaging (MRI) is frequently used following breast cancer diagnosis, routine use of breast MRI for preoperative evaluation remains contentious. We identified factors associated with preoperative breast MRI utilization and investigated the variation among physicians. We used the surveillance, epidemiology, and end Results (SEER)‐Medicare linked database to analyze the preoperative breast MRI utilization among patients with stage 0, I, or II breast cancer diagnosed between 2002 and 2007. Multilevel logistic regression models were used to identify patient‐ and physician‐level predictors of preoperative MRI utilization. Of 56,743 women with early‐stage breast cancer who were treated with surgery and evaluated by a preoperative mammogram and/or ultrasound during the study period, 8.7% (n = 4,913) received preoperative breast MRI. While patient and tumor characteristics did predict preoperative breast MRI utilization, they explained only 15.4% of the variation in utilization rates. Differences in preoperative breast MRI utilization across physicians were large, after controlling patient‐level factors and physicians' volumes. Accounting for clustering of patients within individual physicians (n = 3,144), the multilevel logistic regression models explained 36.4% of variation. The median odds ratio of 3.2, corresponding with the median value of the relative odds of receiving preoperative breast MRI between two randomly chosen physicians, indicated a large individual physician effect. Our study found that preoperative breast MRI has been adopted rapidly and variably. Although patient characteristics were associated with preoperative breast MRI utilization, physician practice was a major determinant of whether women received preoperative breast MRI. Future studies should evaluate whether routine use of preoperative breast MRI in newly diagnosed early‐stage breast cancer improves clinical outcomes.     

Magnetic resonance imaging as a diagnostic tool for breast cancer in premenopausal women

BACKGROUND: Screening mammography has led to earlier diagnosis of breast cancer; however, the increased tissue density of young women can complicate mammographic interpretation. We hypothesized that magnetic resonance imaging (MRI) has value in detection of mammographically occult breast cancers, particularly in premenopausal women for whom the sensitivity of mammography is compromised. METHODS: Data were available for 89 women with biopsy-proven breast cancer who had undergone both mammography and breast MRI. Variables evaluated included menopausal status and radiographic findings. Data were analyzed using Fisher's Exact test; P < .05 was considered significant. RESULTS: Of the 89 women in our study, 69 were perimenopausal or postmenopausal and 20 were premenopausal at the time of diagnosis. The malignant lesion was identified on mammography and MRI for a majority of patients. One third of premenopausal women had negative mammography but positive MRI findings. CONCLUSIONS: Our findings support a role for breast MRI in supplementing conventional mammography for early detection of breast cancer in premenopausal women.     

Projected clinical benefit of surveillance imaging for early detection and treatment of breast cancer metastases

This article presents current best knowledge to assess the projected outcomes benefit of adding multi‐modality surveillance imaging to standard follow‐up care for breast cancer patients at high risk (>30%) for developing future metastases. This analysis is motivated by recent preliminary clinical studies that have suggested that augmenting systemic treatment of early‐stage metastases with targeted surgery and/or radiosurgery achieves significant overall survival and disease‐free survival benefit. Our primary aims are to: (a) describe the clinical motivation and scan parameters needed to identify the early onset of metastatic progression in breast cancer patients for effective surgical or radiosurgical treatment; (b) estimate the anticipated survival benefit for high‐risk patients under this recommended protocol; and (c) estimate the radiation risks associated with the repeated body imaging of this protocol.     

fMRI(磁共振功能成像)对乳腺癌新辅助化疗评估的研究进展

【摘要】〓能够早期评估乳腺癌新辅助化疗疗效的方法很大程度上有助于病人治疗方案的制定,所以对于找寻精准且无创的方法的需求则日益上升。目前,MRI技术能够根据肿瘤大小、形态及强化程度等形态学变化对疗效进行评估,而且已有越来越多新兴技术能够从微观分子层面早期反映新辅助化疗后肿瘤变化,这些技术包括动态对比增强(DCE-MRI)、磁共振波谱(MRS)、磁共振弥散加权成像(DWI)、体素内不相干运动(IVIM)。作者综述MRI新技术在评估乳腺癌新辅助化疗疗效中的应用。     

放射性核素骨显像支持下建立乳腺癌骨转移裸鼠莫型

目的 建立人乳腺癌骨转移裸小鼠模型。方法 采用人乳腺癌骨高转移细胞株MDA-MB-231BO,运用细胞悬液浓度0.8×107/ml、1.0×107/ml进行左心室注射,放射性核素骨显像和X线分别检测建立的人乳腺癌骨转移裸鼠模型。观察两组裸小鼠造模后的生存时间、体质量下降率,及骨转移程度与各部位转移率。结果 在两组裸小鼠体内均建成了乳腺癌骨转移模型;1.0×107/ml组裸鼠生存时间显著低于0.8×107/ml组(P＜0.01),体质量下降率显著高于0.8×107/ml组(P＜0.05);1.0×107/ml组骨转移程度高于0.8×107/ml组,1.0×107/m1组肿瘤细胞数/细胞总数显著高于0.8×107/ml组(P＜0.05);1.0 × 107/m1组转移部位数高于0.8×107/ml组;放射性核素骨显像的检出率为100％。结论 核素骨显像在裸鼠骨转移方面具有早期诊断意义;浓度为0.8×107/ml人乳腺癌骨高转移细胞株MDA-MB-231BO可以成功的建立乳腺癌骨转移裸鼠模型,完整地模拟了乳腺癌骨转移患者的自然临床病理过程。