单侧乳腺癌放疗中健侧乳腺受照剂量及其诱发癌症风险预测

目的 分析单侧乳腺癌放疗所致健侧乳腺的剂量,并估算放疗诱发健侧乳腺癌的风险。方法 在同一医院调查49例接受单侧乳腺放疗患者的基本情况,从治疗计划系统上获取其健侧乳腺的辐射剂量并进行统计分析;利用美国电离辐射生物效应委员会报告Ⅶ第2部分（BEIR Ⅶ phase 2）推荐的风险模型,结合我国人口寿命表,预测不同年龄段单侧乳腺癌患者接受放疗诱发健侧乳腺癌的风险。结果 患者的处方剂量均为50 Gy,健侧乳腺的平均剂量为（1.21±0.89）Gy （0.14~3.59 Gy）,最大点剂量平均为（17.42±13.20）Gy （0.98~45.27 Gy）;健侧乳腺的最大点剂量和平均剂量变化幅度大,且有显著相关性（R=0.527,P=0.000）,不同年龄段患者的健侧乳腺平均剂量差异无统计学意义（P>0.05）。基于健侧乳腺的平均剂量,估算出受照年龄为35、40、50、60、70和80岁患者的健侧乳腺癌终生归因风险分别为2 449/10万人、1 857/10万人、994/10万人、446/10万人、173/10万人和55/10万人。结论 患者接受单侧乳腺癌放疗过程中,其健侧乳腺剂量可达1 Gy水平,可能增加健侧乳腺癌发生风险对年轻患者不容忽视,在制定放射治疗计划时应尽可能控制对患者健侧乳腺的照射。     

三阴性乳腺癌中溶酶体相关膜蛋白-2表达水平的临床意义及预后价值

目的 探讨溶酶体关联膜蛋白2(lysosome-associated membrane protein 2,LAMP2)表达水平与三阴性乳腺癌(triple negative breast cancer, TNBC)患者临床病理特征及其预后的关系。方法 收集2015年1月至2017年1月在新疆医科大学附属肿瘤医院院确诊并行乳腺癌根治术的104例TNBC患者的临床病理资料,调取患者冻存癌组织及癌旁组织标本,使用蛋白质印迹法(Western Blot,WB)检测TNBC癌组织及癌旁组织中LAMP2表达,验证LAMP2表达水平与TNBC患者的临床病理特征及总生存(overall survival,OS)的关系。使用单因素及Cox多因素回归分析TNBC患者的预后因素。结果 WB实验结果显示,LAMP2在TNBC癌组织中表达水平显著高于癌旁组织(P<0.05)。LAMP2表达与TNBC患者TNM分期、淋巴结转移及组织学分级相关,结果有统计学差异(P均＜0.05)。生存分析结果显示,截至2022年1月25日,LAMP2高表达组5年生存率显著低于低表达组(P< 0.05)。单因素及Cox多因素回归分析：TNM分期及LAMP2表达水平是TNBC患者独立预后因素,结果有统计学差异(P＜0.05)。结论 LAMP2在TNBC癌组织及癌旁组织中差异表达,LAMP2高表达可能与患者TNM分期、淋巴结转移及组织学分级相关,更高的LAMP2的表达可能预示着患者更差的预后。     

早期三阴乳腺癌改良根治术后放疗及预后相关因素分析

目的 分析研究早期（T_1~2N₁M₀）三阴乳腺癌患者改良根治术后放疗及预后危险因素,为该分期三阴乳腺癌患者临床治疗方案的选择提供依据。方法 回顾性分析2006年1月至2011年10月大连医科大学附属二院收治的术后病理分期为T_1~2N₁M₀三阴乳腺癌患者共87例。根据术后是否放疗将患者分为放疗组（53例）,未疗组（34例）。Kaplan-Meier单因素分析术后放疗、年龄、月经、组织学分级、脉管癌栓、T分期、淋巴结阳性数及转移率、手术方式、Ki-67指数等对患者5年局部区域复发率（LRR）、远处转移（DM）率、无复发生存（RFS）率、总生存（OS）率预后的影响。结果 术后放疗组与未疗组5年LRR（9.4%和15.2%）和RFS（81.3%和66.7%）比较,差异有统计学意义（χ²=8.073、12.789,P<0.05）,而DM及OS两组比较差异无统计学意义（P>0.05）。单因素分析结果显示,放疗、淋巴结转移率、年龄、Ki-67指数是影响5年LRR的危险因素（P<0.05）;脉管癌栓、淋巴结转移率是影响 5 年 DM 的危险因素（P<0.05）;放疗、脉管癌栓、淋巴结转移率和Ki-67指数是影响5年 RFS 的危险因素（P<0.05）。多因素分析结果显示,放疗和淋巴结转移率是影响5年LRR的独立危险因素（HR=0.279、5.277 P<0.05）;脉管癌栓是影响5年DM的独立危险因素（HR=2.313, P<0.05）;放疗、脉管癌栓和淋巴结转移率是影响5年RFS 独立危险因素（HR=0.378、2.35、5.084, P<0.05）。结论 术后放疗可以改善T_1~2N₁M₀期三阴乳腺癌患者的局部控制率,但对5年的DM和OS影响不大。术后放疗、淋巴结转移率、脉管癌栓、Ki-67指数、年龄与早期三阴乳腺癌预后相关。     

三阴性乳腺癌临床病理特征及其与预后的关系

目的对三阴性乳腺癌(triple-negative breast cancer,TNBC)临床病理特征及其预后分析。方法收集2001年2月—2010年2月在我院术后经病理学确诊的493例乳腺癌患者资料,回顾性分析其临床病例特征及预后。结果 TNBC多见于<35岁未绝经的女性,且组织学分级较高(P<0.05)。TNBC 5年无病生存率(DFS)低于非三阴性乳腺癌(non-TNBC)(58.5%,76.5%)(P<0.05);5年总生存率(OS)低于non-TNBC(70.5%,86.5%)(P<0.05)。结论 TNBC临床病理特征特殊且复发转移率高,预后差,针对其辅助治疗方案需进一步探究。     

Triple negative breast cancer: MRI features in comparison to other breast cancer subtypes with correlation to prognostic pathologic factors

Objective

This study aimed at determination of the MRI predictors of triple negative breast cancer (TNBC) in comparison to other breast cancer subtypes.

Materials and methods

The study retrospectively enrolled 185 female patients with 206 pathologically confirmed invasive breast cancers with different subtypes by immunohistochemistry. Histopathological analysis as well as MRI features of TNBC was compared to those of other breast cancer subtypes. MRI features included the tumor size, shape, margin, internal enhancement, intratumoral signal intensity on T2-WI, detectability by DW-MRI and ADC values.

Results

TNBCs showed higher histological grades (p < 0.0001) and younger patient age group (p = 0.006) compared to other tumor subtypes. At MRI, TNBCs were of larger size (p < 0.0001), round shape (p < 0.0001), smooth margin (p < 0.0001), with rim enhancement (p < 0.0001) and higher incidence of T2-WI tumoral hyperintensity (p = 0.0002) and intratumoral necrosis (p < 0.0001). No significant difference in tumor detectability was found by DW-MRI, however, TNBCs had higher ADC values (p < 0.0001).

Conclusion

In our study, TNBC patients were of younger age with higher grade malignancy. TNBC MRI predictors were unifocal rim enhancing mass with round shape, smooth margin, higher signal intensity on T2-WI, in addition to relatively larger sizes of tumors associated with high incidence of intratumoral necrosis and higher ADC values.     

职业放射工作人员男性乳腺癌病因概率的初步研究

目的:探讨男性乳腺癌的病因概率的计算方法,为我国职业放射工作人员男性乳腺癌的病因判定提供理论基础。方法:利用日本原爆幸存者拟合得到的男性乳腺癌超额相对危险(ERR)模型与美国电离辐射生物效应委员会(BEIR)VII提供的女性乳腺癌超额绝对危险(EAR)模型两种方法,对既往1例被诊断为男性乳腺癌病例进行乳腺剂量及其病因概...     

Inflammatory breast carcinoma in magnetic resonance imaging: a comparison with locally advanced breast cancer

RATIONALE AND OBJECTIVES: Although inflammatory breast carcinoma (IBC) accounts for 1%-4% of all breast cancer cases, the appearance of this highly malignant tumor in magnetic resonance imaging (MRI) is still not well characterized. The aim of this study was to identify typical imaging features of IBC in comparison with noninflammatory locally advanced breast carcinoma (LABC). MATERIALS AND METHODS: MRIs of 48 patients with IBC were compared with an equivalent cohort of 52 subjects with LABC. Age and histopathologic subtype were equivalent between the two groups. To delineate characteristic features, a multitude of dynamic and morphologic parameters were evaluated using T1- and T2-weighted sequences. RESULTS: No significant differences of prevalences could be found for the following criteria: dynamic tumor signal characteristics, prominent vessels, perifocal edema, axillary lymph node involvement, morphology of focal masses, and morphologic pattern of non-mass like enhancement. Otherwise, the quantity of focal masses and the spatial distribution of the tumoral infiltration significantly differed between the two cancer groups. The following parameters occurred more frequently in the IBC cases: edema (cutaneous/subcutaneous 81.3%, perimamillar 70.8%, diffuse 89.6%, prepectoral 72.9%, intramuscular pectoral 41.7%), thickening (75.0%) and pathologic enhancement (60.4%) of Cooper's ligaments, skin thickening (83.3%), punched-out sign (initially strong, focal increase of some dermal or subcutaneous parts followed by slow-continuous enhancement of the surrounding skin; 56.3%). CONCLUSIONS: Inflammatory breast carcinoma seems to represent a specific biological entity resulting in typical MRI characteristics. Some of the parameters are supposed to visualize the characteristic extensive lymphovascular infiltration and therefore may improve the diagnosis of IBC.     

乳腺癌59例临床病理特征与预后分析

目的分析59例乳腺癌患者临床病理因素的预后价值。方法收集自2000年1月~2008年1月本科收治的、经病理证实的59例乳腺癌患者的病史资料,分析年龄、肿瘤大小、腋窝淋巴结转移情况对乳腺癌预后的影响。结果患者的死亡率与肿瘤大小、腋窝淋巴结转移、年龄显著相关。结论肿瘤大小、腋窝淋巴结转移情况对乳腺癌是有价值的预后因素。     

Magnetic resonance imaging for axillary staging in patients with breast cancer

Purpose

To determine the utility of MRI for assessing axillary lymph node status in patients with breast cancer.

Materials and Methods

A consecutive series of patients who underwent breast MR before surgical management of breast cancer with axillary sampling between 2005 and 2007 were identified. MRs were evaluated for the number of nodes, contrast kinetics, nodal area, and number of nodes with no fatty hilum. Data were analyzed in the context of final breast pathology, sentinel lymph node status, and axillary nodal status. Correlations were analyzed using Kendall's τ‐b test. Reported P values are one‐sided.

Results

Fifty‐six females (median = 58 years) were studied. Sentinel lymph nodes (SLN) were positive in 15/56 patients (27%). All SLN + patients (n = 15) had completion axillary dissection. Extent of nodal disease was 1 (n = 3), 2 (n = 4), >2 (n = 8). Presence of any axillary lymph node with no fatty hilum and the number of nodes with no fatty hilum on MR significantly correlated with pathologic node positivity (P = 0.04); while kinetics, node number, and node size did not correlate.

Conclusion

Breast MR may be useful in the assessment of axillary nodes in patients with breast cancer. J. Magn. Reson. Imaging 2009. © 2009 Wiley‐Liss, Inc.     

Sentinel lymphoscintigraphy in patients with breast cancer undergoing excisional biopsy

Some small tumors of the breast cannot be diagnosed by needle biopsy, and an excisional biopsy is occasionally needed for the diagnosis. Sentinel node navigation surgery is frequently suitable for patients with such small breast cancers. The purpose of this study was to compare sentinel lymphoscintigrams in breast cancer patients who had previously undergone excisional biopsy with sentinel lymphoscintigrams in patients undergoing no excisional biopsy. We also investigated the possibility of clinical application of the sentinel node navigation procedure in the former group of patients. METHODS: Sentinel lymphoscintigrams of 43 patients with breast cancer undergoing excisional biopsy were compared to those of 116 patients without excisional biopsy. Lymphoscintigrams were obtained by using intradermal and/or subdermal injections of technetium-99m labeled phytate at 2 points on each side of the dermal incision in patients after excisional biopsy. Injections were performed at 2 points of the skin over the tumor in the patients who had not undergone excisional biopsy. RESULTS: Axillary lymph nodes were visualized in 42 of 43 patients undergoing excisional biopsy (98%) and in 115 of 116 patients without excisional biopsy (99%). The number of visualized axillary nodes was 1 to 5 (mean +/- SD = 2.1 +/- 1.0) and 1 to 5 (mean +/- SD = 1.9 +/- 1.0) in the two groups, respectively. No significant difference was determined between the two groups. Parasternal lymph nodes were depicted in 3 patients after excisional biopsy who had the tumor in the outer half of the breast, in contrast to 4 without excisional biopsy who had the tumor in the inner half. Intramammary hot spots were observed in 5 patients after excisional biopsy and in 2 without excisional biopsy. Lymphatic vessels were observed in 23 patients (53%) who had the excisional biopsy, and in 37 (32%) who did not have the biopsy. The former figure was significantly higher than the latter (p < 0.02). CONCLUSION: Sentinel node navigation surgery for axillary nodes was shown to be possible in patients undergoing excisional biopsy. However, the visualization of parasternal nodes, intramammary hot spots and lymphatic vessels tended to increase in number, and care must be exercised in the management of these patients.     

21基因检测对激素受体阳性类乳腺癌的预后及治疗指导作用

乳腺癌是一类具有异质性的肿瘤,不同患者的治疗方式和疗效均不同。以往的治疗经验大多是根据临床病理因素（年龄、绝经状况、淋巴结状况、肿瘤大小、分期、分级、免疫组化、肿瘤类型等）或利用Adjuvant! Online等工具来综合判断,但这些经验或工具均不能对化疗进行疗效预测,不能筛选出可能从化疗中获益较多或较少的人群。多项回顾性/前瞻性研究先后证实,在雌激素受体阳性、人表皮生长因子受体2阴性、淋巴结阴性/阳性（1~3枚）肿瘤中,21基因检测能评估预后情况,并预测化疗疗效,判断患者能否从化疗中获益,使患者获得更适合的个体化治疗,避免过度治疗,显著提高医生及患者的治疗信心。     

早期乳腺癌保乳手术治疗的临床研究

目的探讨早期乳腺癌保乳手术治疗的适应证及方法。方法分析我院近5年来20例保乳手术治疗的乳腺癌患者临床资料。结果保乳术后患者乳房外形均较好,两侧乳房基本对称,患者3年生存率为95％,复发率为5％。结论早期乳腺癌保乳手术治疗安全、疗效确切,全身综合治疗是保乳手术治疗成功的关键。     

环氧化酶-2在乳腺癌演变过程中的作用研究进展

环氧化酶-2（cyclooxygenase-2，COX-2）在乳腺癌组织中表达水平比其在正常乳腺组织和乳腺良性疾病组织中表达水平高，且和乳腺癌预后有一定关系。COX-2可通过多种途径影响乳腺上皮细胞的代谢和演变。本文综述了COX-2在乳腺癌演变过程中的变化规律和作用机制。     

乳腺癌前哨淋巴结探查的研究进展

乳腺癌前哨淋巴结(sentinel lymph node, SLN)是乳腺癌淋巴转移通道中最先经历的第一级淋巴结。通过乳腺癌SLN预测乳腺癌区域淋巴结转移状况,为乳腺癌的准确分期和外科手术提供了重要的依据。根据示踪剂的不同,有两种方法可以探查乳腺癌SLN,其中使用放射性核素标记物作为示踪剂探查乳腺癌SLN是目前较具优势的方法,且不同于传统的淋巴显像;乳腺癌SLN探查的成功率受到诸多因素的影响,其探查技术亦需进一步的研究来提高。     

First experiences with technetium-99m furifosmin as tumour-seeking agent in breast cancer and recurrent ovarian cancer

Recent in vitro studies suggest that technetium-99m furifosmin may have tumour-seeking properties. We analysed the diagnostic value of^99mTc-furifosmin scintigraphy in nine patients with documented carcinoma of the breast and in eight patients with continued recurrent ovarian cancer. In the breast,^99mTc-furifosmin failed to visualize the primary malignant tumour and the associated malignant lymph nodes in all patients. In contrast, multiple sites of increased tracer uptake were demonstrated in one patient with acute benign inflammatory breast disease. In four of eight patients with recurrent ovarian cancer,^99mTc-furifosmin scintigraphy demonstrated early (5 min p.i.) localized increased uptake corresponding to adhesions to the bowel as diagnosed by computed tomography, but failed to reveal further abnormalities in all patients. The present study demonstrates that furifosmin is of no value in the imaging of breast cancer and recurrent ovarian cancer. These results do not continue the pattern observed in cell culture studies and are quite in contrast to the findings of mammoscintigraphy using^99mTc-methoxyisobutylisonitrile and^99mTc-tetrofosmin.     

Mammographic appearance of recurrent breast cancer after breast conservation therapy

RATIONALE AND OBJECTIVES: To compare the mammographic appearance of recurrent breast cancer to the primary tumor in patients treated with breast conservation therapy. MATERIALS AND METHODS: The charts of women with American Joint Committee on Cancer Stage I or II breast cancer who underwent breast conservation therapy between 1977 and 2001 at our institution were reviewed. A total of 132 patients were diagnosed with local recurrence. RESULTS: The mammographic appearance of the local recurrence often varied from the appearance of the original breast cancer. This was especially true for women who had mammographically occult primary breast cancer. In these women, the recurrence was detected mammographically 76.9% of the time. CONCLUSIONS: Given the variable appearance of the local recurrence after breast conservation therapy, any suspicious finding needs to be carefully evaluated regardless of the mammographic appearance of the original tumor.     

三阴性乳腺癌X线征象及临床病理分析

目的：探讨三阴性乳腺癌(TNBC)的 X 线表现,提高对其诊断水平。方法收集经病理学及免疫组化证实的 TNBC 105例,分析 X 线表现及临床病理。结果(1)TNBC 中主要病理类型为浸润性导管癌(64例,61.0%),其次为髓样癌(24例,22.9%)。(2)本组 TNBC 的 X 线征象主要表现为肿物(82例,78.1%),其中边缘清晰者占46.3%;肿物合并钙化者占24.4%。(3)本组 TNBC患者中出现钙化者少见,分布主要表现为区域性或簇状,而形态以恶性及可疑恶性钙化为主。(4)本组 TNBC 中浸润性导管癌与髓样癌的 X 线征象,在肿瘤的形态、边缘差异有统计学意义(P <0.05)。结论(1)TNBC X 线表现为边缘清晰的类圆形肿物。(2)髓样癌在 TNBC 中所占比例较大,其 X 线表现为边缘清晰肿物。(3)TNBC 较少发生钙化,钙化形态主要表现为可疑恶性及恶性。     

Radiation recall reaction with docetaxel administration after accelerated partial breast irradiation with electronic brachytherapy

PurposeAccelerated partial breast irradiation (APBI) offers several advantages over whole breast irradiation. Electronic brachytherapy may further reduce barriers to breast conserving therapy by making APBI more available. However, its toxicity profile is not well characterized.Methods and MaterialsA 60-year-old woman was treated with APBI using Axxent (Xoft, Sunnyvale, CA) electronic brachytherapy. One month after APBI, a cycle of docetaxel and cyclophosphamide was given. Within 3 weeks, the patient developed an ulcerative radiation recall reaction in the skin overlying the lumpectomy cavity. To investigate this toxicity, the skin dose from electronic brachytherapy was compared with the dose that would have been delivered by an iridium-192 (¹⁹²Ir) source. Additionally, a dose equivalent was estimated by adjusting for the increased relative biologic effectiveness (RBE) of low energy photons generated by the electronic source.ResultsUsing electronic brachytherapy, the skin dose was 537 cGy per fraction compared with 470 cGy for an ¹⁹²Ir source. Given an RBE for a 40 kV source of 1.28 compared with ¹⁹²Ir, the equivalent dose at the skin for an electronic source was 687 cGy-equivalents, a 46% increase.ConclusionsWe present a case of an ulcerative radiation recall reaction in a patient receiving APBI with electronic brachytherapy followed by chemotherapy. Our analysis shows that the use of electronic brachytherapy resulted in the deposition of significantly higher equivalent dose at the skin compared with ¹⁹²Ir. These findings suggest that standard guidelines (e.g., surface-to-skin distance) that apply to ¹⁹²Ir-based balloon brachytherapy may not be applicable to electronic brachytherapy.