AJCC第8版乳腺癌分期系统对乳腺浸润性小叶癌分期评价及临床病理分析

目的 研究AJCC第8版乳腺癌分期系统对乳腺浸润性小叶癌分期评价的临床意义及其临床病理特征分析.方法 参照AJCC第8版乳腺癌分期标准,重新对2011-2016年北京大学深圳医院乳腺外科治疗的浸润性小叶癌患者进行解剖学分期及预后分期评价,并与其他类型浸润性癌的临床病理资料进行分析.结果 共收治乳腺浸润性小叶癌21例,占全部浸润性乳腺癌的2.7％,研究发现浸润性小叶癌与其他类型浸润性乳腺癌相比,年龄分布、月经状况、分子分型特征及解剖学分期与预后分期差异均无统计学意义(P＞0.05);而组织学分级差异有统计学意义(P＜0.05).浸润性小叶癌解剖学分期与预后分期评价存在差异.结论 AJCC第8版乳腺癌分期系统中的预后分期为乳腺癌的临床治疗方案的制订提供了新的参考依据,但需参考解剖学分期共同评价.浸润性小叶癌与其他类型浸润性癌相比,组织学分级低,预后分期佳,但要对浸润性小叶癌进行精准的个体化治疗还需要更大样本更完善的研究.     

乳腺肿瘤的诊断

乳腺肿块是临床工作中经常遇到的疾病。在鉴别和诊断前应先了解:①常见的乳腺疾病有哪些,②各种乳腺疾病的相对发病率,③各种乳腺疾病的好发年龄范围,④各种乳腺疾病的症状,⑤那些危险因素增加乳腺癌的发病率。临床工作中乳腺良性疾病远较恶性疾病为常见。良、恶性间的比例与不同性质的医院有关。综合性医院内良性疾病可能远较专科医院为多。一般良性疾病约占乳腺疾病中的60～80％。乳腺疾病在女性中常见的有小叶增生、乳腺癌、纤维腺瘤、管内乳头状瘤以及乳腺导管扩张症等,在男性中常见的有男性乳房发育症等。各种乳腺疾病的发病年龄亦有很大的差异。纤维腺瘤好发年龄自15～39岁,平均20岁。小叶增生为20～     

乳腺良性增生性病变及高危病变病理学新认识

所谓“乳腺良性增生性病变”包含乳腺一大组非常异质性的病变,对其基本认识在20世纪末已达成基本共识。乳腺高危病变是其中一组临床、病理学和生物学上的异质性疾病,这些疾病诊断之后长期持续性乳腺浸润性癌发生的危险性增加,但危险程度和水平各异,有些预示乳腺癌的发生风险,而有些则是乳腺癌的直接前驱病变,因此,临床意义与干预策略也不同。该组病变中非典型导管增生、非典型小叶增生和小叶原位癌双侧乳腺发生浸润性癌的相对危险性增加,小叶原位癌危险性更高并为非责任性前驱病变;导管原位癌被认为是真正的前驱病变,同侧最终发展为乳腺癌的风险较大。平坦上皮不典型性危险水平尚不明确。目前尚缺乏临床病理学和分子方面个体化危险性预测指标,这是未来个体化危险性处理战略的关键所在。     

长沙银行女职工乳腺超声体检情况分析

目的:本文探讨超声检查在长沙银行女职工乳腺超声健康体检者中的应用与超声检查的重要性.方法:通过检查并分析628例长沙银行女职工乳腺超声健康体检者的二维超声及彩色多普勒检查的健康资料.结果:乳腺小叶增生301例:乳腺纤维瘤107例;乳腺囊肿43例;乳腺癌2例;乳腺未见明显异常175例.结论:在女性乳腺疾病健康体检中,超声检查对乳腺疾病的早发现与早治疗均有重要意义.     

癌基因iASPP在乳腺浸润性小叶癌中的表达及其意义

目的探讨p5 3凋亡刺激蛋白基因(ASPP)的抑制蛋白iASPP在乳腺浸润性小叶癌中的表达及其临床意义。方法采用RT-PCR技术扩增乳腺浸润性小叶癌组织中iASPP mRNA;同时应用Quality One软件分析iASPP扩增产物的相对含量,分析iASPP-mRNA与临床病理因素之间的关系。结果 3 9例浸润性小叶癌组织中有3 4例表达iASPP(8 7.2%),5例不表达(1 2.8%);癌旁组织中均不表达iASPP。iASPP-mRNA在乳腺浸润性小叶癌中的表达明显增高,与癌旁组织相比差异具有显著性(P0.0 1)。不同的年龄组iASPP-mRNA的表达差异也有显著性;TNMⅢ、Ⅳ期乳腺癌组织中iASPP-mRNA的表达显著高于Ⅰ、Ⅱ期患者(P0.0 1);有淋巴结转移的癌组织中iASPP-mRNA的表达也高于无淋巴结转移者;iASPP-mRNA的表达与雌、孕激素受体的表达无关。结论 iASPP-mRNA在乳腺浸润性小叶癌中高表达。检测iASPP可以为乳腺癌的诊断、个体化治疗及预后提供参考。     

乳腺非典型性小叶增生及小叶原位癌52例随访报告

目的探讨乳腺非典型小叶增生和小叶原位癌的生物学行为及治疗方法。方法回顾性分析1982年7月至1996年1月间的17例非典型小叶增生、35例小叶原位癌的临床及随访资料。随访时行门诊体检、乳腺钼靶摄片、乳腺B超等检查;随访时间为3～257个月,平均146．6个月。结果非典型小叶增生和小叶原位癌多发生于绝经前妇女（69．2％）;52例患者均因各种良性病变行手术,术后病理证实为非典型小叶增生或小叶原位癌,其中25例（48．1％）有微钙化病变;有8例在随访期间癌变（5例在同侧乳房,3例在对侧乳房）,平均癌变间期为9．4年;尽管4例（50％）有乳腺癌或卵巢癌家族史,但未发现非典型小叶增生和小叶原位癌癌变与乳腺癌或卵巢癌家族史有关（P〉0．05）;同样,也未发现非典型小叶增生与小叶原位癌发生癌变的差异有统计学意义（P〉0．05）。结论非典型小叶增生和小叶原位癌局部切除是必要的。     

双侧同期乳腺癌

在 Ohio州 Cinccnnati研究所于 1984～ 1999年诊断的 2 382例乳腺癌中 ,5 1例同期有双侧病变(2 .1% ) ,同期是指在确诊第一个乳腺癌后的 3个月内发现另一侧乳腺癌 ,5 7%的同期双侧乳腺癌组织学类型是相同的。取以人口为基础的 Connecticut肿瘤登记(CTR) ,属国家癌肿研究所监测、流行病学和最终结果(SEER)程序的一部分 ,比较双侧乳腺癌与单纯乳腺癌病例的特征。收集 30 0例同期双侧乳腺癌和 13495例单侧乳腺癌病例进行比较。结果　双侧乳腺癌的年龄与单侧者差别不大 ,但肿瘤的小叶成分较多见 ,原位癌也常见 ,肿瘤分级较好 ,乳腺保留型手…     

乳腺浸润性小叶癌的诊断与治疗现状

乳腺浸润性小叶癌以癌细胞突破乳腺小叶内末梢乳管或腺泡基底膜而向小叶间质浸润性生长为主要特点。患者诊断时通常具有如下特点:年龄和肿瘤较大,腋窝淋巴结转移率较高,健侧容易发生。乳腺浸润性小叶癌通常具有较好的预后表型,低级别的组织学分级,较低的有丝分裂指数。浸润性小叶癌具有较高的侵袭性和广泛转移增殖倾向,与其它浸润性癌比较,预后较差。     

p130Cas和paxillin在乳腺癌中表达的研究

目的 研究p130Cas蛋白和paxillin蛋白在乳腺癌组织中的表达,及其与乳腺癌临床特征、病理特征的关系,以评价乳腺癌的预后.方法 采用免疫组化SP法检测53例原发乳腺癌,10例乳腺纤维腺瘤,10例正常乳腺组织中p130Cas和paxillin蛋白的表达情况.结果 与正常乳腺组织和乳腺纤维腺瘤相比较,乳腺癌组织中p130Cas表达显著增高（P＜0.001）,而paxillin表达显著减少（P=0.003）.p130Cas的表达与患者的年龄、绝经状况、肿瘤细胞的ER和PR表达及组织学分级相关,而与肿瘤大小、淋巴结转移状况及病理学分期无关.paxillin的表达与患者的年龄、绝经状况、肿瘤细胞的ER和PR表达及肿瘤大小无关,而与病理学分期、组织学分级和淋巴结转移有关.结论 p130Cas和paxillin与乳腺癌细胞的恶性转化和侵袭转移有关;检测上述两种蛋白表达有助于评价乳腺癌患者的预后.     

Survivin在乳腺癌中的表达及临床意义

目的 检测乳腺癌组织中Survivin的表达,结合10年预后随访结果,探讨Survivin的表达的临床意义.方法 采用免疫组织化学SP法及图像分析技术检测和分析60例乳腺癌、20例乳腺纤维腺瘤和20例正常乳腺组织中Survivin的表达,所有乳腺癌病例均做10年预后随访,并结合肿瘤的病理学特征和临床随访资料分析.结果 (1)60例乳腺癌中Survivin表达明显高于乳腺纤维腺瘤和正常乳腺组织(P＜0.01);(2)乳腺癌中Survivin表达与临床分期、腋淋巴结转移有关(P＜0.05);与患者年龄、肿瘤大小、组织学类型、病理分级均无关;(3)乳腺癌中Survivin与预后生存年限的表达呈显著负相关(P＜0.05).结论 Survivin在乳腺癌组织中表达上调,对乳腺癌发生和发展起重要作用.Survivin与乳腺癌的预后呈负相关.     

Mammary Involution and Breast Cancer Risk: Transgenic Models and Clinical Studies

Postlactational involution is the process following weaning during which the mammary gland undergoes massive cell death and tissue remodeling as it returns to the pre-pregnant state. Lobular involution is the process by which the breast epithelial tissue is gradually lost with aging of the mammary gland. While postlactational involution and lobular involution are distinct processes, recent studies have indicated that both are related to breast cancer development. Experiments using a variety of rodent models, as well as observations in human populations, suggest that deregulation of postlactational involution may act to facilitate tumor formation. By contrast, new human studies show that completion of lobular involution protects against subsequent breast cancer incidence.     

Terminal Duct Lobular Units are Scarce in the Nipple: Implications for Prophylactic Nipple-Sparing Mastectomy

Background The use of nipple-sparing mastectomy (NSM) for both breast cancer treatment and risk reduction is increasing. There is no randomized data comparing nipple-sparing mastectomy with standard mastectomy techniques. There is evidence to suggest that ductal and lobular breast cancer arises in the terminal duct/lobular unit (TDLU). This study was undertaken to determine whether TDLUs exist in the nipple and if so, to what extent. Methods At the time of mastectomy the nipple papilla was excised and submitted for separate pathological examination. The presence or absence of TDLUs was noted. Results Thirty-two nipples were studied in 22 patients. There were no TDLUs in 29 specimens. Three of 32 nipple specimens were found to contain TDLUs. The three nipples contain one, two, and three TDLUs respectively. All TDLUs were found at the base of the nipple, with none located near the tip. Conclusions The infrequent occurrence of TDLUs in the nipple papilla supports the use of NSM for risk reduction surgery, including for those women with BRCA1/2 mutations.     

Pregnancy and Breast Cancer: when They Collide

Women of childbearing age experience an increased breast cancer risk associated with a completed pregnancy. For younger women, this increase in breast cancer risk is transient and within a decade after parturition a cross over effect results in an ultimate protective benefit. The post-partum peak of increased risk is greater in women with advanced maternal age. Further, their lifetime risk for developing breast cancer remains elevated for many years, with the cross over to protection occurring decades later or not at all. Breast cancers diagnosed during pregnancy and within a number of years post-partum are termed pregnancy-associated or PABC. Contrary to popular belief, PABC is not a rare disease and could affect up to 40,000 women in 2009. The collision between pregnancy and breast cancer puts women in a fear-invoking paradox of their own health, their pregnancy, and the outcomes for both. We propose two distinct subtypes of PABC: breast cancer diagnosed during pregnancy and breast cancer diagnosed post-partum. This distinction is important because emerging epidemiologic data highlights worsened outcomes specific to post-partum cases. We reported that post-partum breast involution may be responsible for the increased metastatic potential of post-partum PABC. Increased awareness and detection, rationally aggressive treatment, and enhanced understanding of the mechanisms are imperative steps toward improving the prognosis for PABC. If we determine the mechanisms by which involution promotes metastasis of PABC, the post-partum period can be a window of opportunity for intervention strategies.     

Predictors of breast cancer development in a high-risk population

BACKGROUND: The purpose of this study was to investigate the strongest predictors of breast cancer in a high-risk population and to increase our understanding of the possible interactions between risk factors. METHODS: The Women At Risk High-Risk Registry provided the study population. The variables of interest included age at enrollment, presence of lobular carcinoma in situ (LCIS), atypical ductal hyperplasia (ADH), atypical lobular hyperplasia, family history of breast cancer, body mass index, and Gail scores (5-year high-risk > or =1.7%). Univariate and multivariate analyses were conducted with the Cox proportional hazards regression model and years of follow-up evaluation as the time scale. RESULTS: Out of 1553 high-risk women, 79 (5%) developed breast cancer during a median follow-up period of 5 years. Results from the multivariate Cox model demonstrated that FHBC (hazard ratio [HR] = 1.76; 95% confidence interval [CI], 1.05-2.97), ADH (HR = 1.90; 95% CI, 1.16-3.13), LCIS (HR = 1.71; 95% CI, .99-2.95), and a body mass index > or =30 (HR = 2.22; 95% CI, 1.14-4.35) were statistically significant predictors of breast cancer within this high-risk population. CONCLUSIONS: These results support current literature showing the synergistic increase in risk for patients with ADH, LCIS, and a positive family history of breast cancer. Obesity was also a strong predictor of breast cancer risk, which suggests that there may be a potentiating effect of obesity on other risk factors. Obesity may represent a modifiable risk factor, providing women with an opportunity to reduce their risk with lifestyle modification. Women with a strong family history of breast cancer or a diagnosis of ADH or LCIS may benefit most from risk-reduction strategies, chemoprevention, and surveillance.     

Management of women at increased risk for breast cancer secondary to high‐risk proliferative lesions and family history of the disease

Women with breast biopsies showing high‐risk proliferative lesions such as atypical hyperplasia (AH) and lobular carcinoma in situ (LCIS) have an increased risk of developing breast cancer. Other factors including age, family history of breast cancer, and extent of AH may play a role in increasing breast cancer risk. In addition to women with AH, there is a subset of women with a positive family history of breast cancer, without a known germline mutation, which places them also at an increased risk for breast cancer. Clinical management, screening, chemoprevention, and surgical risk‐reduction are discussed in this review to inform the management of these high‐risk women. Advanced imaging technology, pharmacologic research into different targets, and innovations in breast reconstruction are changing the way in which patients are counseled of their individual risk.     

Metastatic Breast Carcinoma Presenting as Perforated Appendicitis

SUMMARY: BACKGROUND: Patients presenting with symptoms from unknown metastatic breast carcinoma are becoming increasingly uncommon. Perforated appendicitis from metastatic breast carcinoma is a rare entity with only a few published reports in the literature. CASE REPORT: The case of a 76-year-old female patient who developed perforated appendicitis from previously unknown metastatic breast cancer is presented. During physical examination in the emergency department, a large left breast mass was palpated. The patient underwent an appendectomy and had no gross evidence of disease elsewhere in the intra-peritoneal cavity. Subsequent pathologic examination of the appendix revealed a lobular carcinoma. CONCLUSIONS: The factors that influence the site of metastasis from breast cancer include estrogen receptor status and the subtype of carcinoma - ductal versus lobular.     

Optimal surgical treatment of invasive lobular carcinoma of the breast

Background: The roles of breast conservation and surgical evaluation of the contralateral breast in the treatment of lobular carcinoma of the breast remain unclear. The aim of this study was to compare local recurrence, 5-year survival, and incidence of contralateral breast cancer in women with lobular carcinoma to that in women with infiltrating ductal carcinoma. Methods: Women with infiltrating ductal carcinoma (IDC) and invasive lobular breast carcinoma (ILC) diagnosed during the years 1984 to 1994 were identified through a statewide tumor registry. The women were divided into groups based on their histology and treatment (breast conservation or modified radical mastectomy). The incidences of contralateral breast cancer, local recurrence, and 5-year survival were compared within each histologic group and treatment category. Results: During the period 1984 to 1994, 4886 women were diagnosed with invasive lobular or ductal breast carcinoma. Of these, 316 (6.5%) had infiltrating lobular cancer. The 5-year survival rates were 68% and 71% for ILC and IDC, respectively (p=0.5). The local recurrence rates were 2.8% and 4.3% for ILC treated with lumpectomy and axillary nodal dissection (LAND) and modified radical mastectomy (MRM), respectively, which were not significantly different from that obtained with IDC (LAND=2.5%, MRM=2.1%). The incidence of contralateral breast cancer during the period was 6.6% and 6.5% for ILC and IDC, respectively. Conclusions: Invasive lobular carcinoma can be safely treated with breast conservation with no difference in local recurrence or survival. In the absence of a suspicious finding on clinical or radiologic examination, routine contralateral breast intervention is not recommended.Presented at the 50th Annual Cancer Symposium of The Society of Surgical Oncology, Chicago, Illinois, March 20–23, 1997.     

Limitations of the Gail model in the specialized breast cancer risk assessment clinic

The Gail model is a risk assessment tool that is accurate for general breast cancer risk screening. Because of the limited way that this model incorporates family history information, however, there are concerns that it may underestimate risk for many women attending specialized breast cancer risk assessment clinics. We collected comprehensive breast cancer risk factor information for 213 women attending a specialized breast cancer risk assessment clinic using a modified version of the CancerGene software. Breast cancer risk was calculated using the models of Gail and Claus as well as BRCAPRO and the tables of Bodian (for women with lobular neoplasia). Eighty-six percent of the women had a family history of breast cancer. Although 74% of women had risk factor histories that are thought to confound the Gail model (family history of breast cancer in second-degree relatives, family history of breast cancer before the age of 50, family history of bilateral breast cancer, family history of ovarian cancer, or personal history of lobular neoplasia), the inclusion of other models increased the risk level assignment in only 13% of the cases. We conclude that the Gail model is an appropriate risk assessment tool for most women attending specialized clinics, although the inclusion of models better able to account for family history information and personal history of lobular neoplasia is required to accommodate all women.     

Breast magnetic resonance imaging for preoperative locoregional staging

BACKGROUND: Breast magnetic resonance imaging (MRI) has been recommended increasingly in the preoperative setting for patients newly diagnosed with malignancy to evaluate tumor extent, multicentricity, and contralateral disease. METHODS: Results of conventional imaging, breast MRI, and pathology were analyzed from 603 consecutive breast cancer patients who underwent MRI preoperatively. The focus of this retrospective study was imaging-histologic correlation. RESULTS: Reoperation for positive margins after lumpectomy occurred in 8.8% of patients. Multicentricity was identified by MRI alone in 7.7% of patients, whereas 3.7% were found to have contralateral cancer by MRI. The sensitivity of MRI was 93% in detecting multicentric disease and 88% for contralateral disease, whereas sensitivity for conventional imaging was 46% and 19%, respectively. Unsuspected disease was identified by MRI equally for invasive ductal and ductal carcinoma in situ histology, whereas multicentricity was found more frequently with invasive lobular carcinoma. CONCLUSIONS: Breast MRI is recommended for preoperative evaluation of the newly diagnosed breast cancer patient.