乳腺癌保乳治疗近期观察

目的探讨乳腺癌保乳治疗的方法与疗效。方法19例Ⅰ～Ⅱ期原发性乳腺癌施行局部扩大切除并腋窝淋巴结清扫,手术后患侧乳房接受放射治疗。结果手术后6个月随访,患者本人对保留乳房的满意率100%,十分满意者占90%。经随访2～26个月,平均随访12个月,无局部复发,无远处转移和死亡病例。结论Ⅰ～Ⅱ期乳腺癌实施保乳治疗,近期疗效满意,远期效果有待长期随访观察。     

早期乳腺癌保乳保腋窝手术38例近期疗效观察

 目的　探讨早期乳腺癌行保乳保腋窝手术的近期疗效。方法　回顾性分析2008年2月至2010年4月在该院接受保乳保腋窝手术治疗的38例早期乳腺癌患者的临床资料。手术方式为乳腺局部肿物切除,术中将肿物及切缘送快速冷冻病理检查,同时行前哨淋巴结活组织病理检查（SLNB）,全组38例均为阴性,予保留腋窝,未做腋窝淋巴结清扫。结果　全部病例术后无皮下积液及上肢水肿,术后随访6～32个月,局部均无复发,其中2例分别于术后6个月、13个月出现腋窝淋巴结转移,经放疗后得到缓解。结论　SLNB阴性的早期乳腺癌患者行保乳保腋窝手术创伤小,术后并发症少,近期疗效满意,严格掌握适应证、规范化的手术和术后综合治疗是保证疗效的关键,保乳保腋窝手术有可能逐步取代简化根治术成为治疗早期乳腺癌的主要术式。     

前哨淋巴结活检术在早期乳腺癌保乳术中的应用

目的探讨前哨淋巴结活检术（sentinellymph node biopsy,SLNB）在早期乳腺癌保乳术中的应用效果。方法回顾性分析56例pT1.2N0M0期乳腺癌行保乳术＋前哨淋巴结活检术的临床资料。56例SLN阴性,未行腋窝淋巴结清扫术（axillary lymph node dissection,ALND）。术后辅以化疗、放疗,激素受体阳性患者行内分泌治疗。结果56例成功施行保乳手术,保乳术后双乳对称。SLNB替代ALND者各项术后并发症少。中位随访时间36个月（1～72个月）,1例发现局部复发,行乳腺癌改良根治术时发现腋窝淋巴结转移;1例发现腋窝淋巴结复发转移。结论SLNB可以缩小手术范围,减少术后并发症,保留腋窝形态,提高保乳质量。     

保留乳房的乳腺癌切除术108例

目的 研究保留乳房的乳腺癌切除术的适应证、术中技巧及预后.方法 回顾分析2001年7月至2007年7月接受保乳手术的108例乳腺癌患者的临床资料.结果Ⅰ期22例,Ⅱ期81例,Ⅲ期5例,肿瘤局部扩大切除并腋窝淋巴结清除术48例,象限切除并腋窝淋巴结清除术52例,单纯肿块局部扩大切除5例,象限切除或肿块局部扩大切除联合前哨淋巴结活检3例,术后给以放、化疗综合治疗,随访3～89个月(中位时间29个月),局部复发率为2.78%(3/108),远处转移率为1.85%(2/108).术后综合治疗结束后满半年的患者乳房外形评估,优良为60.19%(65/108),差为39.81%(43/108).结论 对单发性的乳腺癌,肿瘤直径≤3 cm的早期乳腺癌患者进行保留乳房的综合治疗,可以取得与根治术相同的临床疗效.     

保留乳房的乳腺癌切除术108例

目的 研究保留乳房的乳腺癌切除术的适应证、术中技巧及预后.方法 回顾分析2001年7月至2007年7月接受保乳手术的108例乳腺癌患者的临床资料.结果Ⅰ期22例,Ⅱ期81例,Ⅲ期5例,肿瘤局部扩大切除并腋窝淋巴结清除术48例,象限切除并腋窝淋巴结清除术52例,单纯肿块局部扩大切除5例,象限切除或肿块局部扩大切除联合前哨淋巴结活检3例,术后给以放、化疗综合治疗,随访3～89个月(中位时间29个月),局部复发率为2.78%(3/108),远处转移率为1.85%(2/108).术后综合治疗结束后满半年的患者乳房外形评估,优良为60.19%(65/108),差为39.81%(43/108).结论 对单发性的乳腺癌,肿瘤直径≤3 cm的早期乳腺癌患者进行保留乳房的综合治疗,可以取得与根治术相同的临床疗效.     

保留乳房的乳腺癌切除术108例

目的 研究保留乳房的乳腺癌切除术的适应证、术中技巧及预后.方法 回顾分析2001年7月至2007年7月接受保乳手术的108例乳腺癌患者的临床资料.结果Ⅰ期22例,Ⅱ期81例,Ⅲ期5例,肿瘤局部扩大切除并腋窝淋巴结清除术48例,象限切除并腋窝淋巴结清除术52例,单纯肿块局部扩大切除5例,象限切除或肿块局部扩大切除联合前哨淋巴结活检3例,术后给以放、化疗综合治疗,随访3～89个月(中位时间29个月),局部复发率为2.78%(3/108),远处转移率为1.85%(2/108).术后综合治疗结束后满半年的患者乳房外形评估,优良为60.19%(65/108),差为39.81%(43/108).结论 对单发性的乳腺癌,肿瘤直径≤3 cm的早期乳腺癌患者进行保留乳房的综合治疗,可以取得与根治术相同的临床疗效.     

保留乳房的乳腺癌切除术108例

目的 研究保留乳房的乳腺癌切除术的适应证、术中技巧及预后.方法 回顾分析2001年7月至2007年7月接受保乳手术的108例乳腺癌患者的临床资料.结果Ⅰ期22例,Ⅱ期81例,Ⅲ期5例,肿瘤局部扩大切除并腋窝淋巴结清除术48例,象限切除并腋窝淋巴结清除术52例,单纯肿块局部扩大切除5例,象限切除或肿块局部扩大切除联合前哨淋巴结活检3例,术后给以放、化疗综合治疗,随访3～89个月(中位时间29个月),局部复发率为2.78%(3/108),远处转移率为1.85%(2/108).术后综合治疗结束后满半年的患者乳房外形评估,优良为60.19%(65/108),差为39.81%(43/108).结论 对单发性的乳腺癌,肿瘤直径≤3 cm的早期乳腺癌患者进行保留乳房的综合治疗,可以取得与根治术相同的临床疗效.     

保留乳房的乳腺癌切除术108例

目的 研究保留乳房的乳腺癌切除术的适应证、术中技巧及预后.方法 回顾分析2001年7月至2007年7月接受保乳手术的108例乳腺癌患者的临床资料.结果Ⅰ期22例,Ⅱ期81例,Ⅲ期5例,肿瘤局部扩大切除并腋窝淋巴结清除术48例,象限切除并腋窝淋巴结清除术52例,单纯肿块局部扩大切除5例,象限切除或肿块局部扩大切除联合前哨淋巴结活检3例,术后给以放、化疗综合治疗,随访3～89个月(中位时间29个月),局部复发率为2.78%(3/108),远处转移率为1.85%(2/108).术后综合治疗结束后满半年的患者乳房外形评估,优良为60.19%(65/108),差为39.81%(43/108).结论 对单发性的乳腺癌,肿瘤直径≤3 cm的早期乳腺癌患者进行保留乳房的综合治疗,可以取得与根治术相同的临床疗效.     

保留乳房的乳腺癌切除术108例

目的 研究保留乳房的乳腺癌切除术的适应证、术中技巧及预后.方法 回顾分析2001年7月至2007年7月接受保乳手术的108例乳腺癌患者的临床资料.结果Ⅰ期22例,Ⅱ期81例,Ⅲ期5例,肿瘤局部扩大切除并腋窝淋巴结清除术48例,象限切除并腋窝淋巴结清除术52例,单纯肿块局部扩大切除5例,象限切除或肿块局部扩大切除联合前哨淋巴结活检3例,术后给以放、化疗综合治疗,随访3～89个月(中位时间29个月),局部复发率为2.78%(3/108),远处转移率为1.85%(2/108).术后综合治疗结束后满半年的患者乳房外形评估,优良为60.19%(65/108),差为39.81%(43/108).结论 对单发性的乳腺癌,肿瘤直径≤3 cm的早期乳腺癌患者进行保留乳房的综合治疗,可以取得与根治术相同的临床疗效.     

保留乳房的乳腺癌切除术108例

目的 研究保留乳房的乳腺癌切除术的适应证、术中技巧及预后.方法 回顾分析2001年7月至2007年7月接受保乳手术的108例乳腺癌患者的临床资料.结果Ⅰ期22例,Ⅱ期81例,Ⅲ期5例,肿瘤局部扩大切除并腋窝淋巴结清除术48例,象限切除并腋窝淋巴结清除术52例,单纯肿块局部扩大切除5例,象限切除或肿块局部扩大切除联合前哨淋巴结活检3例,术后给以放、化疗综合治疗,随访3～89个月(中位时间29个月),局部复发率为2.78%(3/108),远处转移率为1.85%(2/108).术后综合治疗结束后满半年的患者乳房外形评估,优良为60.19%(65/108),差为39.81%(43/108).结论 对单发性的乳腺癌,肿瘤直径≤3 cm的早期乳腺癌患者进行保留乳房的综合治疗,可以取得与根治术相同的临床疗效.     

核素淋巴显像识别前哨淋巴结在乳腺癌治疗中的应用

目的评价核素淋巴显像和γ探针定位在乳腺癌中确定前哨淋巴结(SLN)的应用价值,验证前哨淋巴结活检替代腋窝淋巴结清除术用于乳腺癌治疗的安全性与价值。方法选择1999年6月至2009年11月本院住院的女性乳腺癌患者206例(体检时腋窝均未扪及肿块),应用99Tcm-DX37～74 MBq或99Tcm-SC74 MBq经皮下注射,行核素淋巴显像后,术中注射专利兰1 ml和(或)术中用γ探针定位并行前哨淋巴结活检,与术中冰冻病理检查结果对照。若术中冰冻发现有前哨淋巴结转移,则行腋窝淋巴结清除术,若前哨淋巴结阴性,则不做腋窝淋巴结清除,术后定期随访。结果 206例乳腺癌术中成功活检SLN204例,成功率为99.0%(204/206)。本组有64例仅行SLN切除,术后病理检查证实64例SLN均阴性,故未行腋窝淋巴结清除,其中仅1例于术后1年时出现腋窝淋巴结转移,其余63例患者在随访期间均未发现腋窝淋巴结转移,也未出现同侧上肢水肿、感觉及活动异常;另140例行腋窝淋巴结清除,其中6例经病理证实SLN阳性但腋窝淋巴结为阴性,134例经病理证实SLN阳性35例,阴性99例,腋窝淋巴结阳性37例,阴性97例。核素淋巴显像和γ探针定位法的灵敏度为94.6%(35/37例),准确率为98.5%(138/140),假阴性为5.4%(2/37)。结论核素淋巴显像和γ探针定位应用于乳腺癌是切实可行和可能的,对预测腋窝淋巴结转移有很大的临床实用价值。如技术方法规范,早期乳腺癌前哨淋巴结活检则能取代常规的腋窝淋巴结清除术,乳腺癌手术上肢并发症的发生率可大大降低。     

乳腔镜前哨淋巴结活检及腋窝淋巴结清扫的临床研究

目的:探讨乳腺癌在乳腔镜下行前哨淋巴结活检及腋窝淋巴结清扫的可行性。方法:通过亚甲蓝示踪对40例Ⅰ、Ⅱ期乳腺癌行乳腔镜前哨淋巴结活检(ESLNB),然后行乳腔镜腋窝淋巴结清扫(EALND),对获得的全部淋巴结行病理检查HE染色,确定前哨淋巴结(SLN)检出率、假阴性率等。结果:40例乳腺癌患者SLN检出率为97.44%(39/40),准确率为94.87%(37/39),灵敏度为94.74%(18/19),假阴性率5.26%(1/19);每例平均前哨淋巴结活检(SLNB)检出数目1-6枚,腋窝淋巴结清扫(ALND)检出数目10-29枚。结论:应用乳腔镜下前哨淋巴结活检和腋窝淋巴结清扫准确可行,美容效果好,并发症低,可对早期乳腺癌进行准确腋窝淋巴结分期。     

乳腔镜前哨淋巴结活检及腋窝淋巴结清扫的临床研究

目的：探讨乳腺癌在乳腔镜下行前哨淋巴结活检及腋窝淋巴结清扫的可行性。方法：通过亚甲蓝示踪对40例Ⅰ、Ⅱ期乳腺癌行乳腔镜前哨淋巴结活检（ESLNB）,然后行乳腔镜腋窝淋巴结清扫（EALND）,对获得的全部淋巴结行病理检查HE染色,确定前哨淋巴结（SLN）检出率、假阴性率等。结果：40例乳腺癌患者SLN检出率为97.44%（39/40）,准确率为94.87%（37/39）,灵敏度为94.74%（18/19）,假阴性率5.26%（1/19）;每例平均前哨淋巴结活检（SLNB）检出数目1-6枚,腋窝淋巴结清扫（ALND）检出数目10-29枚。结论：应用乳腔镜下前哨淋巴结活检和腋窝淋巴结清扫准确可行,美容效果好,并发症低,可对早期乳腺癌进行准确腋窝淋巴结分期。     

Prognosis of breast cancer patients treated with sentinel node biopsy in Japan

BACKGROUND: Sentinel node biopsy predicts accurate pathological nodal staging. The survival of node-negative breast cancer patients should be evaluated between the patients treated with sentinel node biopsy alone and those treated with axillary lymph node dissection. METHODS: Ninety-seven patients with negative axillary nodes underwent sentinel node biopsy immediately followed by axillary lymph node dissection between January 1998 and June 1999 (the ALND group). Since then, if sentinel lymph nodes were negative on the frozen-section diagnosis, 112 patients underwent sentinel node biopsy alone without axillary lymph node dissection between July 1999 and December 2000 (the SNB group). We retrospectively observed the outcome of the two study groups. RESULTS: Median follow-up was 52 months in all patients. Relapse-free survival rates at 3 years in the ALND and SNB groups were 94% and 93%, respectively. Five of the 112 patients in the SNB group had overt axillary metastases. Three of them with axillary metastases alone were treated with delayed axillary lymph node dissection. These three patients have been free of other events for 3 years after local salvage treatment. CONCLUSIONS: Sentinel node biopsy will emerge as a standard method to diagnose axillary nodal staging for clinically node-negative breast cancer patients.     

Elderly breast cancer patients treated by conservative surgery alone plus adjuvant tamoxifen: fifteen-year results of a prospective study

BACKGROUND: In elderly patients with early breast cancer and a clinically clear axilla, axillary surgery, sentinel lymph node biopsy, and postoperative radiotherapy to the residual breast may not be necessary because of reduced life expectancy, effectiveness of hormone therapy in achieving long-term disease control, and generally favorable biologic behavior of breast cancer in elderly patients. METHODS: The authors followed 354 prospectively recruited women aged > or =70 years who had primary, operable breast cancer and no palpable axillary lymph nodes. All 354 women were treated with conservative surgery and adjuvant tamoxifen and without axillary dissection or postoperative radiotherapy. Women who had resection margins in tumor tissue were excluded. Endpoints were cumulative incidence of axillary disease, cumulative incidence of ipsilateral breast tumor recurrence (IBTR), and breast cancer mortality. RESULTS: After a median follow-up of 15 years (interquartile range, 14-17 years), the crude cumulative incidence was 4.2% (4% in pathologic T1 [pT1] tumors) for axillary disease, 8.3% (7.3% in pT1 tumors) for IBTR, and 17% for breast cancer mortality. Of the 268 patients who died during follow-up, 222 patients (83%) died from causes unrelated to breast cancer. CONCLUSIONS: Elderly patients with early breast cancer and no palpable axillary lymph nodes may be safely treated safety by conservative surgery without axillary dissection and without postoperative radiotherapy, provided that surgical margins are in tumor-free tissue and that hormone therapy is administered. Sentinel lymph node biopsy is also unnecessary because of the low cumulative incidence of axillary disease, and axillary surgery can be reserved for the small proportion of patients who later develop overt axillary disease.     

The impact of the pathological lymph node status on adjuvant systemic treatment recommendations in clinically node negative breast cancer patients

Several independent randomized controlled trials are initiated to investigate whether sentinel lymph node biopsy can be safely omitted in clinically node negative breast cancer patients with negative axillary ultrasound findings, who are treated with breast conserving therapy. A consequence of omitting sentinel lymph node biopsy is absence of pathological lymph node status information. We aimed to investigate the impact of omitting sentinel lymph node biopsy on adjuvant systemic treatment recommendations. Data from all consecutive patients with invasive breast cancer and negative axillary ultrasound findings treated with breast conserving therapy and sentinel lymph node biopsy between 2008 and 2012 were collected from a prospective database. Two methods, Adjuvant! Online and the Dutch breast cancer guideline 2012, were used to determine the adjuvant systemic treatment recommendations of every patient. At first, each patient was considered to be lymph node negative, and secondly the patients’ true pathological lymph node status was used. A total of 303 patients were consecutively included. Pathological lymph node status was pN0 in 72.3 %, pN0(i+) in 12.9 %, pN1mi+ in 5.6 %, pN1 in 7.3 %, and pN2 in 2.0 % of the patients. The decision to recommend adjuvant systemic treatment changed due to the pathological lymph node status in 1.0 % of the patients (3/303) when using Adjuvant! Online and in 3.6 % (11/303) when using the 2012 Dutch breast cancer guideline. The impact of the pathological lymph node status on adjuvant systemic treatment recommendations in clinically node negative breast cancer patients with negative axillary ultrasound findings treated with breast conserving therapy is limited. The safety of omitting the sentinel lymph node biopsy should be confirmed by the initiated randomized controlled trials.     

活体染料注射法识别乳腺癌患者前哨淋巴结失败及假阴性原因分析

目的 探讨活体染料注射法识别乳腺癌患者前哨淋巴结失败及假阴性的原因。方法 84例早期乳腺癌患者采用活体染料亚甲蓝作为前哨淋巴结活检示踪剂。术中切除前哨淋巴结行常规冰冻切片检查,无肿瘤转移者进一步做免疫组化检测。术后分离出全部乳腺及腋窝淋巴结送病理检查。结果 11例患者术中未检出前哨淋巴结,失败率13.1%。73例检出前哨淋巴结的患者中,32例前哨淋巴结受肿瘤累及,病理证实这些患者均有腋窝淋巴结转移;2例患者前哨淋巴结未受肿瘤累及,但病理证实腋窝淋巴结转移,前哨淋巴结预测腋窝淋巴结状态的敏感性为90.4%,特异性1005,假阴性率2.7%。结论 活体染料注射法识别前哨淋巴结失败主要与外科医师的技术熟练程度及方法欠妥有关,而假阴性的出现多为原发肿瘤过大及前哨淋巴结位置变异所致。     

Axillary recurrence after negative sentinel lymph node biopsy without axillary dissection: a study on 479 breast cancer patients.

AIMS: To determine the axillary recurrence rate in breast cancer patients with negative sentinel lymph nodes (SLN) who did not undergo further axillary lymph node dissection (ALND), and to establish whether this conservative axillary approach leads to an increased recourse to diagnostic axillary biopsy during the follow-up period because of the clinical suspicion of nodal recurrence. METHODS: In 479 patients, operated on for early breast cancer between 1998 and 2002 in five institutions, SLN biopsy was negative and no further axillary surgery was performed. SLN was localized using subdermal injection with 30-50 MBq of 99m-Tc-colloidal albumin. Follow-up controls were performed at 6-monthly intervals. RESULTS: The mean number of SLNs removed was 1.4 per patient. Most patients (90.6%) were given adjuvant systemic therapy, based on the primary tumour characteristics. At a median follow-up of 35.8 months, no clinical axillary recurrence was found. No patient underwent surgical axillary biopsy for suspicious clinical or ultrasonographic findings. CONCLUSIONS: Our results confirm that SLN biopsy without ALND in SLN-negative patients with early breast cancer is not followed by clinically evident axillary recurrence in the short-term.