乳腺-甲状腺多原发癌的临床分析

目的探讨乳腺-甲状腺多原发癌的临床特点。方法收集2010-05—2016-05间在郑州大学第二附属医院诊断为乳腺-甲状腺多原发癌患者24例,对其临床资料进行回顾性分析。结果 (1)24例乳腺-甲状腺多原发癌均为女性。(2)同时癌9例,异时癌15例。乳腺癌首发12例,甲状腺癌首发3例。(3)两原发癌发生间隔时间在3a内的18例,占75%。(4)乳腺多原发癌与乳腺单癌发病诊断年龄无统计学差异,甲状腺多原发癌发病诊断年龄与甲状腺单癌发病诊断年龄比较,差异无统计学意义(P0.05)。(5)多原发癌中乳腺首发癌浸润性癌占80.95%;再发癌以导管内癌为主,占66.66%。多原发癌中甲状腺癌均为乳头状癌,其首发癌与再发癌中乳头状微小癌分别为83.33%、91.66%。(6)乳腺多原发癌ER阳性率为62.5%,乳腺单发癌ER阳性率52.63%,差异无统计学意义(P0.05)。(7)24例多原发癌中,乳腺癌与甲状腺癌,均获得根治性手术机会,预后良好。结论乳腺-甲状腺多原发癌的第二原发癌好发于3a内,其再发癌肿瘤分化好,临床分期较早。早发现、早诊断,治疗效果好。     

乳腺癌外科"三保"治疗的进展

继乳腺癌保乳治疗取得初步效果之后，以保护腋窝为主要目的的前哨淋巴结活检技术亦得以积极开展，药物去势又有代替卵巢切除之势。保乳、保腋窝、保卵巢的“二保”治疗，正在驱动着乳腺癌外科向前发展，其技术和方法正在进一步完善，远期效果亦正在研究观察中。     

上消化道多原发癌的诊治分析

目的：探讨上消化道多原发癌的诊断及手术治疗，方法：对48例诊断为上消化道多原发癌患者，42例按肿瘤不同的生长部位采取3种不同的手术方式，同时清扫颈，胸，腹三区域或胸，腹二区域淋巴结。结果：颈部淋巴结鳞癌转移13例，胸部淋巴结鳞癌转称21例，腺癌转移9例，腹部淋巴结鳞癌转移8例，腺癌转移25例，本组无手术死亡，均获得随访，存活5年8例，存活3年12例，存活1－2年10例，现有10仍仍在随访中，结论：上消化道多原发癌以淋巴结转移为主，彻底的手术是患者获得长期生存的关键，颈，胸，腹三区域或胸，腹二区域淋巴结清扫极其重要。     

乳腺

不同前哨淋巴结的定义标准对核素法行乳腺癌前哨淋巴结定位活检的影响；区域血流灌注与乳腺癌生物学行为的关系；新辅助化疗对乳腺癌耐药基因表达的影响；乳腺癌新辅助化疗后腋窝淋巴结的变化；乳腔镜治疗乳腺良性肿瘤68例；乳腺癌新辅助化疗后前哨淋巴结活检术的研究；1679例乳腺癌内乳淋巴结转移的高危因素分析；     

乳腺导管原位癌综合治疗进展

乳腺导管原位癌(ductal carcinomain situ,DCIS)在组织学上定义为癌细胞累及上皮全层,尚未突破基底膜而仅局限在导管内的恶性肿瘤[1]。自20世纪80年代以来,随着乳腺X射线检查技术不断进步,使临床不可触及的乳腺癌,尤其是DCIS检出率明显增加,     

乳腺外科的发展趋势

乳腺癌已成为欧美国家女性最常见的恶性肿瘤之一。在发展中国家，近年来其发病率也居高不下。中国乳腺癌发病率每年约增长3％；在京、津、沪等大中城市，乳腺癌已跃居女性恶性肿瘤之首。外科治疗在乳腺癌局部治疗中地位显著。自1894年Halsted创立乳腺癌根治术以后的100多年间，乳腺癌外科治疗经历了扩大根治术和改良根治术的尝试和修正，最大的变革无疑是20世纪后30年间迅速发展的保乳治疗，     

乳腺

乳腺癌保乳根治术后同时进行辅助放疗和化疗的副反应的临床观察；乳腺癌前哨淋巴结定位切除、微转移检测及其临床意义；胸腔镜内乳前哨淋巴结活检和内乳淋巴链切除的实验研究；局部进展期乳腺癌新辅助化疗后保乳手术31例报告；瘦素及瘦素受体在乳腺癌中的表达及临床意义……[编者按]     

保乳联合前哨淋巴结活检术治疗老年乳腺癌42例临床分析

目的探讨保乳联合前哨淋巴结活检术治疗老年乳腺癌的临床价值。 方法回顾性分析本院2013年1月至2015年4月行保乳联合前哨淋巴结活检术的42例老年乳腺癌患者的临床资料,并对术后局部复发、远处转移进行随访。 结果42例患者术后均无皮瓣坏死及皮下积液,患侧上肢无淋巴水肿。术后美容效果良好的有40例,2例患者美容效果一般。1例患者在术后18个月出现局部胸壁复发,1例在术后20个月出现肺转移。 结论保乳联合前哨淋巴结活检手术具有创伤小、并发症少、美容效果好、术后恢复快等优点,提高了老年患者的生活质量,值得推广。     

乳腺癌内乳区前哨淋巴结活检术研究进展

内乳区淋巴结的转移状况是乳腺癌的独立预后指标,也：是乳腺癌淋巴分期的重要依据之一。内乳区淋巴结转移的患者预后较差。随着前哨淋巴结活检技术的不断发展和新型注射技术的出现,内乳区前哨淋巴结活检的显像率显著提高,经肋间行内乳区前哨淋巴结活检术可以最小的风险评估内乳区淋巴结状况,并进一步完善乳腺癌的淋巴结分期．有助于为患者制定更为准确的个体化治疗方案。     

乳腺多原发癌1例

患者　女 ,45岁。 2年前发现右乳头庠 ,搔庠后乳头部糜烂、灼痛然后结痂 ,脱痂后乳头仍糜烂。曾外涂药物无效。查体 :双乳对称 ,右侧乳头、乳晕皮肤发红 ,糜烂 ,水肿、有渗出 ,皮肤弹性差 ,病变部位边界清楚 ,未触及包块 ;左乳及双腋窝未见异常。诊断 :右乳湿疹样癌。1999年 12月 1日在持续硬膜外麻醉下行右乳癌根治术 ,术后痊愈出院。病检 :乳头湿疹样癌与浸润性小叶癌。讨论　湿诊样癌又称派杰病。占所有女性乳癌的 2 5 %～ 3 % ,以40～ 6 0岁居多 ,平均 5 5岁。该病常以乳头刺痛 ,瘙庠 ,烧灼感等症状开始 ,继而乳头红肿 ,皮肤变厚 ,粗糙…     

乳腺癌综合治疗 乳腺癌外科治疗理念的发展及启示

乳腺癌的规范外科治疗已有100多年的历史,其间外科治疗理念和方法经历多次重大改变,并直接影响到乳腺癌临床治疗效果。这些外科治疗方式变化的本质是对乳腺癌生物学行为研究的深入、诊断和治疗技术的进步和社会人文医学的发展。在新的理论和技术的支持下,乳腺外科将在规范化治疗的基础上向个体化、微创化、精准化、保护功能、注重形体和心理康复的方向发展。     

乳腺癌前哨淋巴结活检的临床应用研究

目的探讨乳腺癌前哨淋巴结活检术（SLNB）在临床应用中的价值。方法应用亚甲蓝染色法对58例乳腺癌患者先行SLNB,随后行乳腺癌常规外科手术。结果58例患者中前哨淋巴结（SLN）检出率为93．1％,准确率为96．3％。假阴性率为5．71％,假阳性率为0;操作者的学习曲线、患者的年龄、原发肿瘤的部位影响SLN的检出率（P〈0．05）;肿瘤的大小、病理类型不影响SLN的检出率（P〉0．05）。结论乳腺癌SLNB能够准确地预测乳腺癌患者腋窝淋巴结（ALN）的转移情况。     

乳腺癌行腋窝淋巴结清扫规范、争议与共识

乳腺癌的有效治疗方法很多,但外科手术是公认的乳腺癌治疗的基础。手术成功与否的最根本标志是肿瘤手术区域的局部控制。腋窝淋巴结受累的程度是预测乳腺癌术后复发和生存,指导进一步个体化治疗的最为重要指标。规范的腋窝淋巴结清扫和病理检查对乳腺癌的治疗至关重要。术前判断存在腋窝淋巴结转移的乳腺癌病人,腋窝淋巴结清扫是乳腺癌手术的规范和要求。术前临床诊断无腋窝淋巴结转移（cN0）的早期乳腺癌病人,如果前哨淋巴结活检阴性可不做进一步的腋窝淋巴结清扫也已成为共识。对于前哨淋巴结1或2枚阳性的乳腺癌病人可以不行腋窝淋巴结的清扫的观点仍然存在争论。     

美国临床肿瘤学会《早期乳腺癌病人前哨淋巴结活检指南》更新介绍与解读

2014年4月,临床肿瘤学杂志（Journal of Clinical Oncology,JCO）上发表了美国临床肿瘤学会（American Society of Clinical Oncology,ASCO）关于早期乳腺癌病人应用前哨淋巴结活检（sentinel node biopsy,SNB）的若干新推荐。这是继2005年该学会首次推荐《早期乳腺癌病人前哨淋巴结活检指南》后的第一次更新。基于随机临床试验（RCT）证据,该项指南提出3条推荐：（1）无前哨淋巴结（sentinel lymph node,SLN）转移的女性病人不必接受腋窝淋巴结清扫术（axillary lymph node dissection, ALND）;（2）大多数伴有1~2个SLN转移,且计划接受保乳术及术后全乳放疗者无需行ALND;（3）有SLN转移并行全乳切除术者应接受ALND。基于队列研究和（或）非正式共识,更新两组推荐：（1）可手术的多中心肿瘤的乳腺癌病人、将行乳房切除术的导管原位癌（ductal carcinoma in situ,DCIS）病人、之前接受过乳腺和（或）腋窝手术的以及接受术前或新辅助系统治疗的病人,可以行SNB;（2）对瘤体较大或局部晚期浸润性乳腺癌（肿瘤大小T3/T4）、炎性乳腺癌、拟接受保乳治疗的DCIS以及孕期妇女,不适于行SNB。     

Failure of sentinel lymph node mapping in breast cancer patients qualified for treatment sparing axillary lymph nodes—Clinical importance and management strategy—One‐center analysis

Sentinel lymph node biopsy (SLNB) is a standard in diagnostic and therapeutic management of patients with nonadvanced invasive breast cancer. The aim of this paper was to evaluate the clinical importance of the failure of sentinel lymph node (SLN) identification during SLNB performed to spare axillary lymph nodes. A total of 5396 patients with invasive breast cancer qualified for SLNB, treated in a period from Jan 2004 to June 2018. All cases of the failure of SLN identification and reasons underlying this situation were analyzed retrospectively. In 196 (3.6%) patients, SLN was not identified (group I), and this resulted in a simultaneous axillary lymph node dissection. 48.5% patients from this group were diagnosed with cancer metastases to lymph nodes (vs 23.6% patients with SLN removed—group II, P < .00001)—stage pN1 in 44.2% of the cases, stage pN2 in 22.1% of the cases, and pN3 in 33.7% (in group II—73.4%, 19.5% and 7.1%, respectively), with a presence of extracapsular infiltration in 68.4% patients (vs 41.7% in group II) and with a significantly higher percentage of micrometastatic nature in group II (17.0%, vs 3.2% in group I). The failure of intraoperative sentinel lymph node mapping indicates a significantly increased risk of breast cancer metastases to the axillary lymph system. At the same time, it can also indicate higher cancer stage and its increased aggressiveness. For this reason, in such situation performance of axillary lymph node dissection still appears to be the approach most advantageous for patients.     

Sentinel node biopsies in breast cancer

Axillary lymph node status is an important prognostic factor for early breast cancer. As traditional axillary lymph node dissection is associated with a relatively high rate of mobidity, a less invasive procedure, sentinel lymph node biopsy, is being developed which aims to accurately predict the axillary nodal status and, thus, act as a guide to subsequent treatment. This new technique has a low complication rate and running costs. Although initial results are encouraging, the methodology has not been standardized across all centres. Current large‐scale studies should determine whether it is a suitable replacement for traditional axillary lymph node dissection.     

Reoperative sentinel lymph node biopsy in patients with locally recurrent breast cancer

BACKGROUND: Sentinel lymph node biopsy (SLNB) is considered a standard of care in the staging of breast cancer. The objective was to examine our experience with reoperative SLNB. METHODS: We identified 19 patients in our breast cancer database who had a SLNB in the reoperative setting. All 19 patients had undergone previous breast-conserving surgery with either an axillary lymph node dissection or an SLNB. The reoperative sentinel lymph node (SLN) was identified using blue dye, radioisotope, or both. RESULTS: The SLN was identified in 84% of the reoperative cases. Of these successful cases, both blue dye and radioisotope were used in five cases, and radioisotope alone was used in 11 cases. Radioisotope identified the SLN in the 100% of successful SLNB cases (P = .0003). There were 3 unsuccessful cases in which blue dye and radioisotope failed to identify the sentinel node. CONCLUSIONS: Reoperative SLNB after previous axillary surgery is technically feasible.     

Effect of the American College of Surgeons Oncology Group Z0011 trial on axillary management in breast cancer patients in the Australian setting

The American College of Surgeons Oncology Group Z0011 Trial demonstrated that early breast cancer patients with positive axillary sentinel lymph nodes treated with breast‐conserving surgery and breast radiotherapy had no additional oncologic benefit of proceeding to an axillary lymph node dissection (ALND). The extent to which practice has changed in Australia remains unclear. The aim of this study was to investigate the effect of the Z0011 trial on the management of positive axillary sentinel nodes at an Australian institutional level. We reviewed all breast cancer cases treated at the Sydney Adventist Hospital over a 10‐year period from 1 January 2008 to 31 December 2017. Patients who fulfilled the Z0011 trial criteria were selected. These patients were divided into two groups according to the year of surgery, before and after 1 January 2011 when the Z0011 study was published. Clinicopathologic data and axillary surgical management were compared. Of the 237 patients fulfilling the Z0011 trial criteria, there were 73 patients before and 158 patients after 1 January 2011. In the earlier group the rate of proceeding to an ALND following a positive sentinel node was 78.1% compared to 43.7% in the latter group (P < 0.0001). There was a significant decline in the rate of ALND over this 10‐year period (r = ?0.79, P = 0.006). The Z0011 trial has influenced the surgical management of the axilla leading to a significant reduction in the rate of an ALND in patients fulfilling the Z0011 trial criteria at our institution.     

Sentinel lymph node biopsy for breast cancer: improvement in results over time

Many modifications in the technique of sentinel lymph node (SLN) biopsy for breast cancer have taken place since it was first introduced. This analysis was undertaken to determine, in a large multi-institutional study, whether SLN biopsy results have improved over time. Patients with clinical stage T1-2, N0 breast cancer were enrolled in this prospective study between August 1997 and February 2002. SLN biopsy was performed using blue dye and/or radioactive colloid along with completion level I/II axillary dissection in all patients. The majority of subjects included in this study represent the surgeons' initial experience with SLN biopsy for breast cancer. Statistical comparison of the SLN identification (ID) rate and false-negative (FN) rate were performed by chi-squared analysis. A total of 3370 subjects from 300 surgeons were enrolled in the study. Collectively the SLN ID rate, as well as the mean number of SLNs removed per patient has improved, while the FN rate has remained fairly constant over time. The improved ID rate may be related to improved technical details, while the FN rate has not changed significantly. This highlights the ongoing need for surgeons to perform backup axillary dissection during their initial learning phase.