早期乳腺癌保乳手术12例治疗体会

目的探讨早期乳腺癌施行保留乳房的根治术体会。方法回顾分析自2002年1月～2004年8月间共收治的12例早期乳腺癌患者。结果本组患者均行保留乳房的乳腺癌根治术，左侧6例，右侧6例，术后经化疗、放疗、内分泌治疗均获得较满意的效果。结论早期乳腺癌行保乳手术及放、化疗可达到与根治手术相同的生存率，并有良好的美容效果。     

乳腺癌保乳手术治疗体会

目的总结乳腺癌施行保留乳房的根治术的治疗效果。方法回顾性分析2003年8月～2007年12月我科开展的52例保乳手术的乳腺癌患者的临床资料。术后均行联合化疗、放疗、内分泌治疗。结果本组52例均获得随访，随访时是2个月-4年。51例均未发现有局部复发及远处转移，1例出现局部复发并肺转移。除1例因乳房过小术后外形欠美观外，其余51例保乳术后的乳房外形基本满意。结论乳腺癌行保乳手术并联合放、化疗可达到与传统根治手术相同的近期效果，并具有患者心理打击小、美容效果好的优点。     

保留乳房的乳腺癌改良根治术治疗早期乳腺癌的临床观察

目的探讨保留乳房的乳腺癌根治术治疗早期乳腺癌的疗效。方法对22例早期乳腺癌患者行保乳手术治疗，术后并行辅助放疗、化疗等综合治疗。结果全组随访6～48个月，无局部复发和远处转移，3年生存率100％（17／17）。结论对早期乳腺癌行保乳手术疗效满意，严格掌握手术指征，规范的切除和术后放疗、化疗等综合治疗是保乳手术治疗成功的关键。     

乳腺癌保乳手术临床应用体会

目的 总结乳腺癌保乳手术治疗效果。方法 2001年1月～2004年12月我科对15例乳腺癌患者施行保乳手术。结果 联合术后放、化疗，15例患者近期疗效满意。结论 保乳术与根治术疗效相似。     

早期乳腺癌保留乳房手术26例效果观察

目的探讨早期乳腺癌保留乳房(保乳)手术的方法和效果。方法选取2012-01—2014-01间接受手术治疗的52例早期乳腺癌患者,根据不同术式分为2组,各26例。对照组行改良根治术,观察组实施保乳手术,2组患者术后均给予辅助治疗。比较2组的近期手术效果。术后随访3 a,比较2组患者的存活率和对乳房外观的满意度。结果观察组手术时间、术中出血量及术后住院时间均优于对照组,差异有统计学意义(P0.05)。术后随访3 a,2组患者的无病生存率差异无统计学意义(P0.05)。但观察组患者对乳房外观满意度优于对照组,差异有统计学意义(P0.05)。结论对早期乳腺癌患者实施保乳手术,创伤小、患者术后恢复快,远期效果满意。而且能保留患者完整的乳房形态及患侧上肢功能,维护患者心身健康。但需严格掌握手术指征,规范进行手术操作和术后的辅助治疗。     

保乳手术与改良根治术治疗早期乳腺癌的临床对照研究

目的：比较保乳手术与改良根治术对早期乳腺癌预后的影响。方法：回顾性分析我院1998年7月—2008年7月经保乳手术治疗的63例早期乳腺癌患者临床资料,并与同期行改良根治术63例早期乳腺癌患者进行对比。结果：保乳手术治疗没有增加患者的局部复发率、转移率、病死率,生存率与同期改良根治术相当,并且保持了患者良好的乳房外形。结论：对于早期乳腺癌,保乳手术是一种切实可行的手术方式。     

早期乳腺癌保乳手术64例临床效果观察

目的对早期乳腺癌保乳手术的方法和效果进行探讨。方法选择32例接受保乳手术的早期乳腺癌患者为观察组,选择同期行改良根治术的32例早期乳腺癌患者为对照组。比较2组患者的近期效果、术后3 a存活率和对乳房外观的满意度。结果观察组手术时间、术中出血量、术后住院时间及对乳房外观的满意度均优于对照组,差异有统计学意义(P0.05)。术后随访3 a,观察组31例患者无病生存(96.8%),1例患者在术后2 a局部复发,接受改良根治术,存活至今。对照组32例患者均无病生存(100.0%),2组差异无统计学意义(P0.05)。结论在严格掌握手术适应证的前提下,对早期乳腺癌患者实施保乳手术,创伤小、患者术后恢复快,远期效果好,且能保留患者乳房完整形态,改善患者术后生活质量。     

早期乳腺癌保乳手术与改良根治术的临床疗效及生活质量比较

目的:比较保乳手术与改良根治术治疗早期乳腺癌的临床效果及生活质量。方法:回顾性分析2004年4月—2007年4月经保乳手术治疗的95例(保乳组)早期乳腺癌患者临床资料,并与同期行改良根治术95例(改良组)早期乳腺癌患者进行对比。结果:保乳组与改良组的局部复发率、转移率、生存率间无统计学差异(P>0.05);保乳组和改良组乳房外观美学效果"优良"率分别为93.7%和0(P<0.05);保乳组术后5年存活患者生活质量评分亦明显高于改良组(83.66±3.70 vs.73.07±4.85)(P<0.05)。结论:对于早期乳腺癌,保乳手术在获得与改良根治术相同疗效的同时,能明显改善患者术后的生活质量;掌握好保乳手术适应证、规范的手术切除和术后个体化综合治疗是手术成功的关健。     

早期乳腺癌保乳综合治疗临床疗效观察

目的:探讨早期乳腺癌保乳综合治疗的临床治疗效果和对乳房美容效果的影响.方法:回顾分析32例早期乳腺癌患者的临床资料,所有病例均经病理证实,择期在全身麻醉下行保乳手术,术后辅助放疗、化疗及内分泌治疗,评价手术疗效及美容效果.结果:32例保乳术患者均成功进行了手术,术后预后良好,随访5年,无一例死亡,无一例局部复发或出现远处转移,保乳手术后患者美容效果满意率为86.57%.结论:早期乳腺癌患者行保乳综合治疗,临床效果确切可靠,并取得满意的美容效果.     

较大乳腺癌新辅助化疗后保乳手术24例报告

目的探讨较大乳腺癌新辅助化疗后保乳手术的可行性。方法2003年6月～2006年9月我院对24例肿瘤直径〉3cm的乳腺癌行空心针穿刺活检,以紫杉醇和（或）表阿霉素为主的联合新辅助化疗2～4个周期,化疗后7～10d行保乳手术。结果24例接受2～4个周期的新辅助化疗,临床完全缓解率（CR）12.5%（3/24）,部分缓解率（PR）87.5%（21/24）,病理完全缓解率（pCR）8.3%（2/24）。14例成功完成保留乳房手术,保留乳房率58.3%（14/24）,7例不符合保留乳房规范直接行改良根治术,3例术中冰冻切缘阳性改行改良根治术。24例随访5～44个月,中位时间24个月,无局部复发和远处转移。结论对于较大的乳腺癌,采用新辅助化疗缩小降期后,使相当部分患者获得保乳机会。     

Breast conserving therapy with accelerated partial breast versus external beam whole breast irradiation: comparison of imaging sequela and complications in a matched population

Our purpose was to evaluate and compare the imaging sequela and complications of accelerated partial breast irradiation (APBI) with those occurring in patients treated with standard external beam therapy. Patient selection included those who met the criteria for possible ABPI: age 45 or older; cancer stage T1N0M0 or ductal carcinoma in situ 3 cm or less, and negative surgical margins. One hundred and ninety seven had complete records and films available for review. Ninety-seven (49%) were treated with APBI (MammoSite) and 100(51%) were treated with external beam. Image findings for APBI versus external beam were: distortion 90(93%) versus 83(83%), seroma 67(69%) versus 7(7%), skin edema 52(54%) versus 47(47%), increased stroma 75(77%) versus 66(66%), calcifications 10(10%) versus 6(6%), and fat necrosis 12(12%) versus 6(6%). For APBI, skin and stromal edema was more commonly focal. At imaging, the seroma rate was statistically and significantly different between the two treatment modes (p < 0.0001). For patients treated with APBI, seroma formation was not related to balloon size and only weakly related to lumpectomy cavity size. The complication rate was significantly higher for those treated with APBI (36 versus 20%) and the types and treatment of complications differed. There were three recurrences among the APBI group and none among those treated with external beam radiation.     

Occult contralateral breast carcinoma incidentally detected by breast magnetic resonance imaging

The incidence of synchronous bilateral breast cancers has been reported to be between 3.4% and 7.4%, as detected on mammography, physical examination, or both. We undertook a study to determine how often magnetic resonance (MR) imaging detects a contralateral abnormality in patients with known breast carcinoma. As part of an institutional review board (IRB) -approved research protocol, 17 patients with pathologically proven invasive carcinoma underwent preoperative MR imaging of both breasts using a T1-weighted, high-resolution gradient echo sequence (precontrast and postcontrast), an echo-planar sequence during administration of gadolinium, and a T2-weighted, fast-spin echo sequence. The morphology and dynamic enhancement of lesions in both breasts were assessed. Biopsy was recommended for any lesion meeting set criteria. MR imaging identified all 17 known invasive cancers in the breast of concern on mammography or physical examination. Five of 17 patients (29%) had 10 contralateral lesions identified on MR, for which biopsy was recommended. One of these lesions proved to represent a fibroadenoma. The other 9 lesions proved to represent a malignancy (6 invasive lobular, 2 infiltrating ductal, and 1 tubular). Four of the 17 patients (24%) with invasive cancer had contralateral synchronous cancers occult to physical examination, mammography, and ultrasonography. In this series, breast MR imaging of the breasts was more sensitive than mammography or physical examination in the detection of early breast cancer. Breast MR imaging of the contralateral breast may be of value as a routine screen in those patients with a known or suspected malignancy.     

Elevating your breast program to the next level

This paper describes a series of steps taken to elevate the Hoag Breast Program to the next level. The hope is that some of our ideas will be useful to you and your breast program.     

PATHOLOGICAL ASPECTS OF THE UK BREAST SCREENING PROJECT WITH SPECIAL REFERENCE TO MINIMAL AND ‘BORDERLINE’ LESIONS

Because of the logistical and financial implications of large scale screening for the early detection of breast cancer, the Department of Health and Social Security in the UK has established a study to compare two methods, mammography and breast self-examination. Screening is under evaluation in women aged 45–64 years, over a seven year period. Mammography is carried out in health districts based on Edinburgh and Guildford and self-examination related to a programme of education in Huddersfield and Nottingham. Four other health districts, Bristol, Dundee, Oxford and Stoke, act as control areas. A Pathology Review Panel composed of pathologists from each participating centre has been established to verify the accuracy of the histopathological data. In particular, all lesions in the borderline between benign and malignant disease are reviewed together with all minimal carcinomas. The Pathology Panel has carried out four consistency surveys to improve diagnostic criteria and accuracy, and 83% agreement is now achieved with no errors across the benign/malignant border. Review of ‘borderline’ cases from the study is now in progress.     

Developmental breast asymmetry

Developmental breast asymmetry (DBA) can affect psychosocial well-being in the young female. Correction of breast asymmetry may present a reconstructive challenge, especially in tuberous breasts. Fifty-two cases of DBA treated between January 2002 and January 2006 were reviewed. Preoperative clinical assessment of the specific anatomical deformity, subsequent surgical treatment modalities, esthetic outcome, and patient's satisfaction were evaluated. Surgical modalities used in our series include augmentation mammaplasty with or without tissue expansion, parenchymal scoring, nipple areola complex reduction, glanduloplasty techniques, mastopexy and reduction mammaplasty. The mean age of DBA presentation was 21 years; 69% (36/52) patients had tuberous breasts, of which 67% (24/36) were unilateral and 33% (12/36) were bilateral deformities. Patients with tuberous breast deformity presented consistently under the age of 25 years. Esthetic outcome was rated "good" in 75% (39/52), and symmetry rated as "good" in 58% (30/52) by professional evaluation. Surgical treatment is tailored to the affected esthetic units of the individual breast. In our experience, symmetry is the hardest parameter to achieve, particularly in tuberous breasts. Operative treatment is of great value to the psychosocial well-being of the patient. A conceptual approach in the assessment and treatment of DBA is emphasized by this series.     

Evaluation of Malignant Breast Lesions in the Diagnostic Setting with Cone Beam Breast Computed Tomography (Breast CT): Feasibility Study

To investigate the feasibility of noncontrast and contrast‐enhanced cone beam breast Computed Tomography (CT) in demonstrating malignant breast lesions in the diagnostic setting. This Institutional Review Board approved, Health Information Portability and Accountability Act compliant, prospective study enrolled BI‐RADS four and five patients from 2008 to 2010. Eighty‐seven subjects had noncontrast breast CT, 42 had contrast‐enhanced breast CT (CE‐breast CT) with 70 pathologically confirmed cancer diagnoses. All 70 comprise the study cohort for noncontrast breast CT, and 23 who had CE‐breast CT comprise the cohort for CE‐breast CT. All had diagnostic work‐up. Patient age, breast density, lesion size and characteristics, biopsy method, and core pathology were recorded. A Fisher's exact test was used to detect a difference in detectability. For agreement in size measurement between the imaging modalities, a paired t‐test was employed. Reported p‐values were based on 2‐sided tests. Two one‐sided tests were calculated to determine equivalence within ±0.3 cm at a 90% significance level. Noncontrast breast CT identified 67 of 70 malignant lesions, detected by diagnostic work‐up. CE‐breast CT identified 23 of 23 index malignant lesions and in addition, found three malignant lesions in three cases not previously detected. Noncontrast breast CT demonstrated the index lesion in 67 of 70 cases and CE‐breast CT demonstrated the index lesion in all 23 cases. An additional three new malignant lesions not seen with conventional diagnostic work‐up were detected. In this preliminary study, breast CT with or without contrast was shown to be accurate at identifying malignant breast lesions in the diagnostic setting.     

Incidence and outcomes of incidental breast lesions detected on cross‐sectional imaging examinations

The aim of this study was to determine the frequency and outcomes of incidental breast lesions detected on nonbreast specific cross‐sectional imaging examinations. A retrospective review of the medical records was performed to identify all patients without a known history of breast cancer, who had an incidentally discovered breast lesion detected on a nonbreast imaging examination performed at our institution between September 2008 and August 2012 for this IRB‐approved, HIPAA compliant study. Outcomes of the incidental lesions were determined by follow‐up with dedicated breast imaging (mammography, breast ultrasound, and/or breast MRI) or results of biopsy, if performed. Imaging modality of detection, imaging features, patient age, patient location at the time of the nonbreast imaging examination, type of follow‐up, and final outcome were recorded. Rates of malignancy were also calculated, and comparison was made across the different cross‐sectional imaging modalities. Kruskal‐Wallis and Fisher's exact tests were used to identify factors associated with an increased rate of malignancy. Logistic regression was used to model the risk of malignancy as a function of continuous predictors (such as patient age or lesion size); odds ratios and 95% confidence intervals were obtained. A total of 292 patients with incidental breast lesions were identified, 242 of whom had incidental lesions were noted on computed tomography (CT) studies, 25 on magnetic resonance imaging (MRI), and 25 on positron emission tomography (PET). Although most of the incidental breast lesions were detected on CT examinations, PET studies had the highest rate of detection of incidental breast lesions per number of studies performed (rate of incidental breast lesion detection on PET studies was 0.29%, compared to 0.10% for CT and 0.01% for MRI). Of the 121 of 292 (41%) patients who received dedicated breast imaging work‐up at our institution, 40 of 121 (33%) underwent biopsy and 25 of 121 (21%) had malignancy. There was a significantly increased rate of malignancy in older patients (odds ratio: 1.05, 95% CI: 1.02‐1.093; P = .006). Additionally, patients with PET‐detected incidental breast lesions had a significantly higher rate of malignancy (55%), compared to patients with CT‐detected (35%) and MRI‐detected (8%) incidental breast lesions (P = .038). The rate of malignancy upon follow‐up of incidental breast lesions detected on nonbreast imaging examinations in this retrospective study was 21%, supporting the importance of emphasizing further work‐up of all incidentally detected breast lesions with dedicated breast imaging. Additionally, we found that PET examinations had the highest rate of detection of incidental breast lesions and the highest rate of malignancy, which suggests that PET examinations may be more specific for predicting the likelihood of malignancy of incidental breast lesions, compared to CT and MRI.     

PARAFFINOMAS OF THE BREAST: AN ORIENTAL CURIOSITY

Background: The injection of liquid paraffin wax was a form of breast augmentation practised in Hong Kong 30–40 years ago. Patients may present many years later with complications of this treatment. Methods: The records of 43 patients diagnosed with paraffinomas of the breast at a teaching hospital in Hong Kong were reviewed. These patients had received paraffin injections 3–41 years (median 17) previously. Results: Patients presented with hard masses in the breast 4–18 cm (median 17) diameter. Ulceration or infection occurred in 10 patients. Mammography revealed a honeycomb appearance in the affected breast. Treatment included biopsy only (7), excision of masses (3) and total mastectomy (30, bilateral in 27). Histology demonstrated hyalinized and densely sclerotic fibrous tissue with cystic spaces of various sizes. Conclusions: Awareness of this condition facilitates the differentiation from tuberculosis and carcinoma of the breast which often present late in this population of patients. Adequate treatment usually requires total mastectomy.     

Benign breast papilloma: Is surgical excision necessary?

In many centers internationally, current standard of care is to excise all papillomas of the breast, despite recently reported low rates of upgrade to malignancy on final excision. The objective of this study was to determine the upgrade rate to malignancy in patients with papilloma without atypia. A retrospective review of a prospectively maintained database of all cases of benign intraductal papilloma in a tertiary referral symptomatic breast unit between July 2008 and July 2018 was performed. Patients with evidence of malignancy or atypia on core biopsy and those with a history of breast cancer or genetic mutations predisposing to breast cancer were excluded. One hundred and seventy‐three cases of benign papilloma diagnosed on core biopsy were identified. Following exclusions, the final cohort comprised of 138 patients. Mean age at presentation was 51. Mean follow‐up time was 9.6 months. The most common symptom was a lump (40%). Of the 124 patients who underwent excision, three had ductal carcinoma in situ and there were no cases of invasive disease, giving an upgrade rate to malignancy of 2.4%. Upgrade to other high‐risk lesions (atypical lobular and ductal hyperplasia and lobular carcinoma in situ) was demonstrated in 15 cases (12.1%). Benign papilloma was confirmed in 100 cases (81.5%), and 6 (4.8%) had no residual papilloma found on final excision. Twelve patients (8.7%) were managed conservatively. Of those, one later went on to develop malignancy. Patients with a diagnosis of benign papilloma without atypia on core biopsy have a low risk of upgrade to malignancy on final pathology, suggesting that observation may be a safe alternative to surgical excision. Further research is warranted to determine which patients can be safely managed conservatively.     

Contribution of diffusion‐weighted imaging to dynamic contrast‐enhanced MRI in the characterization of papillary breast lesions

Papillary lesions have a broad spectrum of appearances on magnetic resonance imaging (MRI ). The purpose of this study was to evaluate whether apparent diffusion coefficient (ADC ) values of papillary lesions can be used to characterize lesion as benign or malignant. This retrospective study included 29 papillary lesions. Diagnostic values of dynamic contrast‐enhanced MRI (DCE‐MRI), DWI ‐ADC , and DCE ‐MRI plus DWI ‐ADC were separately calculated. The malignant papillary lesions (0.744×10^?3 mm²/s) exhibited significantly lower mean ADC values than the benign lesions (1.339×10^?3 mm²/s). Addition of DWI to standard DCE ‐MRI provided 100% sensitivity. We hypothesized that this combination may prevent unnecessary excisional biopsies.