早期乳腺癌保乳手术加综合治疗的临床研究

目的探讨早期乳腺癌保乳手术加综合治疗的适应证、治疗方法及疗效。方法对51例Ⅰ～Ⅱa期乳腺癌施行保乳手术联合术后放疗、化疗及内分泌治疗的综合治疗（保乳组）；并与同期施行改良根治术加综合治疗的56例Ⅰ～Ⅱa期乳腺癌（对照组）进行对比。结果保乳手术方式包括肿瘤局部切除＋腋窝淋巴结清扫术（ALND）15例、象限切除＋ALND术25例、单纯象限切除术11例。两组平均随访16．9个月，保乳组局部复发1例，对照组无局部复发；保乳组远隔脏器转移率为0，对照组为3．6％，两组比较差异无显著性意义（P〉0．05）；保乳组与对照组的手术并发症发生率分别为13．7％和33．9％（P〈0．05）。结论临床早期乳腺癌采用保乳手术加综合治疗可以取得满意的临床疗效，且美容效果良好，可作为早期乳腺癌的首选治疗方法。     

新辅助化疗后保乳手术治疗Ⅱ、Ⅲ期乳腺癌的临床观察

目的 探讨新辅助化疗后保乳手术治疗Ⅱ、Ⅲ期乳腺癌的可行性.方法 对解放军第309医院2003年6月-2008年12月收治的Ⅱ、Ⅲ期乳腺癌经新辅助化疗后接受保乳治疗的46例患者进行随访观察.化疗方案为第1天静脉注射表柔比星60mg/m2,第2天紫杉醇150mg/m2,持续3h静脉滴注,21d为1个疗程,共2～4个疗程.手术方式为象限切除或肿块局部广泛切除联合腋窝淋巴结清除.术后对患者局部复发、远处转移及乳房外形情况进行随访观察.结果 新辅助化疗后,术前肿瘤病灶临床完全缓解(CR)9例,部分缓解(PR)37例.术后病理学检查发现,癌细胞均有不同程度的变性、坏死,并伴有细胞间质水肿、纤维增生、炎性细胞浸润,其中病理完全缓解4例,经过58个月的中位随访(8～70个月),局部复发4例(4/46),远处转移3例(3/46),远处转移者中2例死亡.保乳综合治疗(放疗+化疗)结束后1年,对31例患者进行乳房外形评估:优6例、良18例、差7例.结论 Ⅱ、Ⅲ期乳腺癌经过新辅助化疗后保乳是可行的,术中规范化切除且术后进行放、化疗及全身综合治疗是保乳治疗成功的关键.     

早期乳腺癌前哨淋巴结活检替代腋窝清扫的临床应用

目的：探讨腋窝前哨淋巴结活检术在早期乳腺癌中替代腋窝淋巴清扫术的意义。方法：选择15例早期（T1-2N0M0）乳腺癌患者,用1%亚甲蓝溶液行腋窝前哨淋巴结活检,淋巴结阴性,不行腋窝清扫。结果：15例患者随访1～3年,术后无一例出现患侧上肢肿胀、患侧上肢感觉麻木、运动障碍等并发症。所有患者未发现有局部复发及腋窝肿大淋巴结。结论：对于早期乳腺癌患者,腋窝前哨淋巴结活检阴性可替代腋窝清扫术。     

热疗配合放、化疗治疗乳腺癌术后锁骨上淋巴结转移50例临床观察

乳腺癌是危害妇女健康的恶性肿瘤，目前主要采用手术、放疗、化疗及内分泌治疗等综合治疗。部分病人术后及放疗后锁骨上出现转移性肿大淋巴结，治疗效果较差。我们自1998年10月～2000年10月采取热疗配合放疗、化疗治疗锁骨上淋巴结转移病人50例，效果较为满意，现将结果报告如下。     

保留乳腺治疗临床Ⅰ、Ⅱ期乳癌体会

目的:讨论保留乳腺治疗乳癌的可行性.方法:对15例临床Ⅰ、Ⅱ期乳癌患者实施了乳癌区段切除加同侧腋窝淋巴结清扫术;术后辅以化疗,放疗,或抗雌激素(TAM)治疗.结果:13例获随访,2例失随访.4例患者随访10～14年,6例随访8～9年,3例随访5～7年.所有患者随访期内存活,其中1例于术后4年10个月患侧乳癌局部复发,行患乳单纯切除;术后6年7个月发现对侧腋淋巴结转移而行乳癌改良根治术,随访10年仍健在.全组患者无病生存率92.31%,复发率7.69%,治疗效果不低于乳癌改良根治术.结论:保留乳腺治疗临床Ⅰ、Ⅱ期乳癌可作为同期乳癌根治性手术的替代术式.     

早期乳腺癌外科保守性手术治疗的疗效观察

目的　探讨早期乳腺癌保守性外科治疗的效果。方法　对临床早期乳腺癌 1 2 5例行乳房象限切除术加腋淋巴结清扫术 ,其中 0期 3例 ,Ⅰ期 89例 ,Ⅱ期 33例 ,全组患者术后乳房放疗 1 0 2例 ,未放疗 2 3例 ,浸润性癌围手术期化疗 7周 ,腋淋巴结阳性术后常规放疗 ,此后 6～ 1 2个月内追加 1 2～ 1 6次化疗。ER阳性服用TAM 2～ 5年。此外 ,选用同期 0～Ⅱ期仿根治术或根治术常规综合治疗 95例作对照观察。结果　 ( 1 )病理检查 :1 2 5个象限切除标本中断端阳性 1 0例( 80 % ) ,均以管内癌形式出现。腋淋巴结平均检出 1 6 8枚 ,阳性率 1 5 2 % ;( 2 )生存情况 :1 2 5例随诊 ,>3年 85例 ,>5年 6 3例 ,全部存活 ,仅 1例术后 2 5年局部复发 ,1例术后 2年骨转移带瘤生存 :随诊 <3年 4 0例 ,1例术后 1年肺转移带瘤生存 ;对照组 95例 ,1例肺转移死亡。结论　早期乳腺癌保守性外科治疗与仿根治术 ,根治术效果相似且能保持乳房良好外形 ,是Ⅰ ,Ⅱ期乳癌理想的治疗方法     

乳腺癌保乳治疗304例的临床分析

目的 探讨Ⅰ～Ⅱ期乳腺癌保乳治疗的临床效果及存活率和局部复发的影响因素.方法 收集1988年6月～2005年6月在解放军总医院住院的304例临床Ⅰ～Ⅱ期乳腺癌患者,所选患者均行乳腺肿瘤局部切除,腋窝淋巴结清扫及术后放疗.所有患者接受了术后化疗,雌激素受体阳性者口服三苯氧胺.中位随访时间8.1年.结果 患者5年总存活率,疾病特异性存活率及无局部复发存活率分别为92.58%,93.46%,86.26%.10年总存活率,疾病特异性存活率及无局部复发存活率分别为85.29%,88.27%,77.75%.5年和10年的局部复发率分别为5.5%和11.7%.统计结果 显示,年龄(＜40岁),腋窝转移淋巴结数量(＞4)与疾病特异性存活率相关联;而年龄(＜40岁),雌激素受体阴性与局部复发相关联.24例局部复发者均切除了同侧乳腺,随访5～130个月,有5例死亡.并发症为30例次.结论 保乳治疗具有很高的长期存活率,局部控制率和较低的并发症发生,是治疗Ⅰ～Ⅱ期乳腺癌的可靠方法 .     

根治性切除术、化疗、放疗、光动力学疗法联合治疗三期乳癌

目的探讨术中光动力学疗法对拓展三期乳癌根治范围的作用。方法三期乳癌患者（T4任何NM0）12例，其中皮肤浸润伴橘皮样外观9例，炎性乳癌3例；N1 9例，N23例。术前给予CEF方案辅助化疗2～3个周期。化疗后手术前48h静点HpD5mg／kg。行根治性切除术。缝合皮肤前进行激光照射，激光波长630nm，光纤末端能量密度270J／cm^2。术后辅助CEF／TAC方案化疗、放疗及内分泌治疗。结果随访3～12个月，胸壁和腋窝局部未见肿瘤残留及复发，肝、肺、胸椎以及对侧乳腺均未见转移。结论化疗、手术、放疗、化疗联合术中光动力学疗法治疗三期乳癌，能够有效地清除残留肿瘤、防止复发和转移。     

成人前列腺横纹肌肉瘤的诊治体会

目的 探讨成人前列腺横纹肌肉瘤的早期诊断、治疗及预后.方法 回顾性分析本科2005年1月~2011年12月收治的3例前列腺横纹肌肉瘤患者的临床资料.结果 2例行前列腺穿刺活检术确诊,1例行经尿道前列腺电切术后确诊,病理类型均为胚胎性横纹肌肉瘤.确诊后行回肠膀胱尿流改道术,术后给予辅助化疗及放疗.3例中,1例术后11个月因肿瘤多发性转移导致死亡;1例已存活1年,无复发及转移;1例术后转肿瘤科治疗,51 d后行CT复查时发现肺部转移,现已存活3个月,后两例目前正在随访中.结论 前列腺横纹肌肉瘤是一种高度恶性的肿瘤,早期诊断困难,进展迅速,预后差,确诊需依靠病理检查,提高诊治效果的关键在于早期诊断及尽早手术治疗.     

CT检查在直肠癌术后复发早期诊断中的作用

作者对177例直肠和直肠乙状结肠癌术后患者作了临床及CT的随访研究。术前接受放疗108例,术后放疗47例,其余未经放射治疗。术后临床随访5年。CT检查在术后6～9个月开始,间隔6～9个月。作两次CT检查者98例,三次者48例。CT扫描范围从会阴或直肠至第4腰椎平面,均用增强检查。并口服造影剂显示小肠。CT发现肿块或临床上有局部复发症状者经CT定位穿刺活检或手术活检。作者见到,第1次CT检查发现盆腔内有肿     

乳腺癌前哨淋巴结的临床研究

目的　评价乳腺癌前哨淋巴结活检(sentinellymphnodebiopsy ,SLNB)的必要性、可行性、准确性及临床应用价值。方法　利用脂质体 亚甲蓝混合物对本院 2 0 0 1年 6月～ 2 0 0 2年 12月收治的 32例T1～ 2 N0 M0 乳腺癌患者进行SLNB。随后常规行腋窝淋巴结清扫(axillarylymphnodedisescetion,ALND)。将切除的前哨淋巴结 (SLN)和腋窝淋巴结 (ALN)同时送病理检查 ,了解其符合率 ,并评价SLNB在早期乳腺癌中的可行性及临床应用价值。结果　成功确定患者SLN 31例 ,共 5 7枚 ,成功率为 96 .9% (31/ 32 ) ;SLN阳性 9例(2 9.0 % ) ,SLN阴性 2 2例 (70 % ) ;ALN阳性 10例 (31.3% ) ,ALN阴性 2 2例(6 8.8% ) ;SLNB的灵敏度为 90 .0 % ,准确性为 93.8% ,假阴性率为 10 .0 % ,假阳性率为 0。结论　SLNB可以准确地预测乳腺癌患者ALN的组织学特征 ;利用脂质体 亚甲蓝混合物作为显示剂可以提高SLNB的成功率     

乳腔镜下应用核素联合染料示踪法对新辅助化疗后乳腺癌患者行前哨淋巴结活检的研究(附41例报告)

目的 在乳腔镜下采用核素联合染料示踪法对新辅助化疗后的乳腺癌患者行前哨淋巴结活检(SLNB),探讨通过前哨淋巴结(SLN)对腋窝淋巴结内癌细胞转移情况进行预测的可行性.方法 选择行新辅助化疗2～4个疗程后的乳腺癌患者41例,术前15～18h在肿块或活检腔周围分4点注射~(99)Tc~m标记的硫胶体0.5～1.0mCi(1Ci=3.7×10~(10)Bq),术中在同样部化皮下注射美蓝4～6ml.使用γ探测仪在存在高放射活性的部位进行体表定位,腋窝注射溶脂剂,吸脂后,乳腔镜下行SLNB,然后行腋窝淋巴结清扫.将检出的淋巴结制成石蜡切片行常规病理检查,将结果显示有癌细胞转移的淋巴结确定为转移阳性;对病理检查显示为转移阴性的SLN进一步采用免疫组化法检测CK19的表达.计算采用SLN进行预测的准确率、敏感性、特异性、假阴性率和假阳性率.结果 41例患者中,39例患者(95.12%)检出SLN,共126枚,每例平均3.07(1～5)枚.病理检查显示,18例患者的SLN转移阳性(均为真阳性),21例SLN转移阴性(其中20例为真阴性,1例为假阴性).SLN对腋窝淋巴结内癌细胞转移情况的预测准确性为97.43%,敏感性为94.74%,特异性100%,假阴性率为5.26%,假阳性率0%.免疫组化法检测显示,1例病理检查显示转移阴性的SLN内CK19表达阳性.所有患者均对SLNB术后的美容效果较为满意.结论 乳腔镜下应用核素联合染料示踪法能提高SLN的检出率,且具有微创、美容的优点.通过SLN内癌细胞转移情况能够较为准确地预测新辅助化疗后乳腺癌患者腋窝淋巴结内癌细胞的转移情况.     

Lymphatic mapping and retrieval of the sentinel lymph node in treatment of early breast cancer

Lymphatic mapping and sentinel lymph node biopsy is an important step to surgical individualization of breast cancer therapy. With lymphatic mapping and minimally invasive biopsy of one or two detected lymph nodes the method provides an exact evaluation of the nodal status. Using sentinel lymph node biopsy (SLNB), costs and morbidity of an axillary lymph node dissection (ALND) can be avoided in nodal negative patients, whereas nodal positive patients are chosen for ALND very selectively according to the detection of an increased percentage of micrometastases. While experienced centers are introducing this method into clinical practice for the benefit of patients with early-stage breast cancer in Europe, further research should focus on quality control, definition of standards considering the individual needs of the individual patient, and the evaluation of the impact of micrometastases. This article gives an overview of the current knowledge of SLNB and discusses critically current indications and methods as well as application techniques.     

Sentinel node detection by lymphoscintigraphy and sentinel lymph node biopsy in vulvar melanoma

Purpose

Vulvar melanoma is a rare malignant tumour. Its surgical excision is the mainstay of treatment whilst the surgical management of regional lymph nodes remains controversial; on the contrary elective inguinofemoral lymphadenectomy causes considerable morbidity. Lymphoscintigraphy (LS) and sentinel lymph node biopsy (SLNB) are accurate staging procedures of lymph node status in breast cancer and cutaneous melanoma patients. In this retrospective paper we report our experience of LS and SLNB in vulvar melanoma patients.

Methods

Twenty-two consecutive patients with a diagnosis of vulvar melanoma were treated at our institute: patients with clinically positive groin nodes or with previous surgery on the primary tumour were excluded. Twelve were selected for our analysis. All patients underwent sentinel lymph node localization with LS the day before surgery and the surgical procedure of SLNB associated with radical surgery.

Results

Six patients had metastatic SLNB and in five of six (83.3%) it was the only positive node. In the other six patients SLNB was negative for metastatic disease. No skip metastases were observed. In SLNB negative patients the mean Breslow thickness was 2.06 mm (range: 0.60–7.10) and only one patient showed a high Breslow thickness (patient 8). In SLNB positive patients the mean Breslow thickness was 4.33 mm (1.8–6.0).

Conclusion

Our data indicate that, even in vulvar melanoma, the sentinel lymph node pathological status predicts the pathological status of the remaining groin nodes and suggests that elective groin dissection can be spared in cases of a negative SLNB. Breslow thickness (<1 mm) was not predictive of negative nodes.     

FDG PET positive lymph nodes are highly predictive of metastasis in breast cancer

AIM: To determine whether or not fluorodeoxyglucose positron emission tomography (FDG PET) imaging when positive could obviate the necessity for sentinel lymph node biopsy and for complete axillary node dissection in patients with breast cancer. METHODS: A total of 80 female patients with a histological diagnosis of breast cancer and clinically negative axillary nodes underwent an FDG PET and sentinel lymph node biopsy (SLNB) or total axillary dissection for staging of axilla. Both SLNB and axillary dissection were performed in 72 patients, while eight patients had total axillary dissection without SLN biopsy. RESULTS: Of the 80 patients, 36 had lymph node metastasis on histopathology. SLNB was positive for metastasis in 35 (97%) of 36 patients (29 macrometastasis and seven micrometastasis). In the patient with false negative SLNB, the lymph node was completely replaced by the tumour. The FDG PET was true positive in 16 of 36 patients (sensitivity, 44%). There were two false positive studies with FDG PET, resulting in a specificity of 95%. The positive predictive value and accuracy of FDG PET for the detection of axillary lymph node metastasis were 89% and 72%, respectively. Univariate analysis revealed that higher grade of tumour, increased size and number of axillary lymph nodes were significantly associated with positive FDG PET results for axillary staging. CONCLUSION: FDG PET cannot replace histological staging using SLNB in patients with breast cancer. However, FDG PET has a high specificity and positive predictive value for staging of the axilla in these patients. The patients with higher grade of tumour, larger size and higher number of axillary lymph nodes may be considered for FDG PET scan for axillary staging.     

乳癌哨兵淋巴结检测临床应用

目的：探讨乳癌哨兵淋巴结活检预测腋窝淋巴结转移状态的可靠性.方法：本组为2000年11月至2004年2月我院收治的140例乳癌患者.术中应用国产亚甲蓝注射液4～6 ml肿瘤上、外、下半圆形皮下连续注射,134例行乳癌改良根治术或患侧乳腺区段切除加腋窝淋巴结清扫术.术后解剖蓝染淋巴管,沿着色淋巴管找到蓝染的哨兵淋巴结.哨兵淋巴结及腋窝淋巴结常规行石蜡病理切片检查.5例行乳腺区段切除加哨兵淋巴结活检,1例行全乳切除加哨兵淋巴结活检（冰冻、石蜡病理检查SLN转移阴性）,未行全腋窝淋巴结清扫.结果：140例患者中136例检出哨兵淋巴结,检出率97.14%,灵敏度 88.71%,准确率94.31%,阴性预测值89.71%,假阴性率11.29%,仅哨兵淋巴结阳性7例.结论：应用亚甲蓝注射液淋巴结着色方法行乳癌哨兵淋巴结活检可以准确地预测腋窝淋巴结转移状态.     

临床颈淋巴转移阴性口腔鳞癌的前哨淋巴结研究

目的探讨前哨淋巴结活检术(SLNB)在口腔鳞癌治疗中的的预测价值。方法口腔鳞癌患者20例,使用亚甲蓝染色法对前哨淋巴结进行染色识别。结果SLNB成功率为70％。SLNB对颈淋巴结微转移的检测准确率为100G。前哨淋巴结(SLN)每例平均2．4枚。14例患者中有6例存在颈部淋巴转移,其中5例仅转移至SLN,1例SLN和非SLN均有转移。结论SLNB能准确预测口腔鳞癌颈淋巴结转移情况,为SLNB阴性的口腔鳞癌患者避免颈淋巴清扫术提供了诊断依据。     

超声综合检查和99Tc^m-硫胶体检测对乳腺癌前哨淋巴结的价值比较

目的探讨超声综合检查,包括经皮超声造影(CEUS)和常规超声检查,或99Tc^m-硫胶体前哨淋巴结检测对乳腺癌前哨淋巴结(SLN)的诊断价值比较。方法选取本院进行乳腺癌检查的患者120例为研究对象。患者均行常规超声、CEUS、99Tc^m-硫胶体前哨淋巴结检测,并以手术病理结果为标准,以ROC曲线分析常规超声、CEUS、99Tc^m-硫胶体前哨淋巴结检测对乳腺癌前哨淋巴结的诊断价值。结果120例乳腺癌患者中,经病理学诊断共检出168个淋巴结,其中转移性62个,非转移性106个。且以病理检查为标准,常规超声检查对乳腺癌前哨淋巴结转移的敏感度为69.4%,特异度为95.3%;CEUS检查的敏感度为83.9%,特异度为97.2%;99Tc^m-硫胶体检查的敏感度为88.7%,特异度为98.1%;三者联合检查的敏感度为93.5%,特异度为99.1%。另ROC曲线分析显示,常规超声、CEUS及99Tc^m-硫胶体检查及三者联合诊断的乳腺癌前哨淋巴结转移的AUC为0.823、0.905、0.934、0.963,联合诊断价值更高。结论CEUS、99Tc^m-硫胶体前哨淋巴结检测对乳腺癌前哨淋巴结的诊断价值均高于常规超声,且三者联合诊断敏感度、特异性更高。     

Correlation of number and identification of sentinel nodes during radiographer led lymphoscintigraphy prior to sentinel lymph node biopsy in breast cancer patients

PurposeThe sentinel lymph node biopsy (SLNB) concept using the cutaneous (subdermal) peri-areolar approach is rapidly emerging as the technique for axillary staging in breast cancer. The procedure indicates whether axillary lymph node dissection (ALND) is necessary, therefore drastically minimising the invasiveness of surgical treatment. The SLNB concept is based on evidence suggesting that malignant disease primarily affects the sentinel node (SN) before being disseminated into the axillary lymph nodes (ALNs).ObjectiveThis study was to define the role of lymphoscintigraphy in the visualisation of SNs during SLNB and to establish the correlation between the number of SNs identified on lymphoscintigraphy to the number of surgically identified SNs.MethodThe study was a non-experimental, correlation study utilising quantitative data. Lymphoscintigraphy reports and histology results of 55 female breast cancer patients who underwent SLNB with partial or total back-up ALND, were retrospectively evaluated.ResultsA maximum of 2 and a minimum of 0 sentinel nodes were visualised on lymphoscintigraphy in 52 out of 55 patients. Successful lymphoscintigraphy was highly predictive (p ≤ 0.001) of a successful SLNB as all 52 patients (94.5%) proceeded to have successful SN/s identification. There was a significant association (p ≤ 0.05) between the number of SN/s visualised on lymphoscintigraphy and the number of SN/s identified during SLNB. Lymphoscintigraphy accurately predicted the number of surgically identified SNs in 50.91% of cases (28/55).ConclusionConsidering that successful imaging effectively assures SN identification, the routine use of lymphoscintigraphy using the subdermal peri-areolar approach is fundamental in the reliable performance of SLNB.     

Equivalent cross-relaxation rate imaging of axillary lymph nodes in breast cancer

PURPOSE: To determine whether equivalent cross-relaxation rate (ECR) imaging (ECRI) is a feasible method for optimization of axillary lymph node dissection (ALND) and thereby improve quality-of-life (QOL). MATERIALS AND METHODS: A total of 50 breast cancer patients underwent ECRI, with off-resonance saturation pulse at frequency offset of 5 ppm. ECR threshold values were determined to evaluate metastases to lymph nodes in the ALND group before examining the relationship between ECR value and cellular density. Metastases to lymph nodes of the sentinel lymph node biopsy (SLNB) group were evaluated based on the results of the ALND group. RESULTS: In the ALND group, regions without metastases showed a higher cellular density and ECR value than those with metastases. The relationship of ECR value to cellular density formed two clusters according to the presence or absence of metastasis; cellular density was related to ECR value for both clusters. In the SLNB group, supposing a threshold ECR value of 80%, sensitivity and specificity were 88.2% and 100%, respectively. CONCLUSION: ECRI is a potentially useful method for cellular density imaging of axillary lymph nodes. ECRI provides active information that enables ALND to be avoided, thus improving QOL.