乳腺钼靶检查在乳腺癌新辅助化疗疗效评估中的价值

目的对乳腺癌新辅助化疗(NAC)前后乳腺钼靶X线征象进行观察分析,以评价其在疗效评估中的应用价值。方法对比分析21例NAC后的乳癌肿块及腋窝淋巴结的大小、形态、钙化和密度等钼靶X线表现。结果 21例乳癌肿块均较NAC前缩小,4例肿块呈局限性密度减低,20例肿块形态发生改变;9例钙化的形态和数目无明显变化,但钙化的范围较前缩小;9例腋窝淋巴结缩小及密度减低。结论新辅助化疗后乳腺癌肿块的钼靶摄影X线征象均有所变化,乳腺钼靶检查可以用来评估NAC的疗效。     

乳腺钼靶检查在乳腺癌新辅助化疗疗效评估中的价值

目的对乳腺癌新辅助化疗（NAC）前后乳腺钼靶X线征象进行观察分析,以评价其在疗效评估中的应用价值。方法对比分析21例NAC后的乳癌肿块及腋窝淋巴结的大小、形态、钙化和密度等钼靶X线表现。结果21例乳癌肿块均较NAC前缩小,4例肿块呈局限性密度减低,20例肿块形态发生改变;9例钙化的形态和数目无明显变化,但钙化的范围较前缩小;9例腋窝淋巴结缩小及密度减低。结论新辅助化疗后乳腺癌肿块的钼靶摄影X线征象均有所变化,乳腺钼靶检查可以用来评估NAC的疗效。     

60例乳腺癌钼钯X线图像中钙化的临床分析

乳腺癌的诊断中钼靶发挥着重要的作用,而钙化在乳腺癌钼靶X 线检查中是一种特征性的表现。文献［1］报道约有30%~50%的乳腺癌钼靶X 线图像中有钙化的发现,也有一部分乳腺癌是以钙化为惟一征象。作者收集我院60例乳腺钼靶X 线图像中有钙化并已病理证实为乳腺癌的患者的临床资料,探讨钙化在乳腺癌诊断中的意义。     

乳腺癌X线征象分析

目的：分析乳腺癌X线表现,提高乳腺癌X线诊断水平。方法：对46例经病理证实的乳腺癌X线表现作回顾性分析。结果：46例中肿块影28例,微小钙化14例,局限浸润7例,结构紊乱5例、乳管造影乳管不规则、管腔截断、显影间断2例,皮肤局限性增厚9例,乳头下陷及漏斗征7例,血管增多增粗15例,大导管征7例、腋下淋巴结13例。结论：钼靶乳腺X线摄影是诊断乳腺癌的最主要方法。肿块和微小钙化是乳腺癌主要X线征象,局限浸润、结构紊乱为不典型征象。对乳头溢液者行导管造影,结合间接征象,综合分析,可提高诊断率。     

乳腺癌X线征象分析

目的:分析乳腺癌X线表现,提高乳腺癌X线诊断水平。方法:对46例经病理证实的乳腺癌X线表现作回顾性分析。结果:46例中肿块影28例,微小钙化14例,局限浸润7例,结构紊乱5例、乳管造影乳管不规则、管腔截断、显影间断2例,皮肤局限性增厚9例,乳头下陷及漏斗征7例,血管增多增粗15例,大导管征7例、腋下淋巴结13例。结论:钼靶乳腺X线摄影是诊断乳腺癌的最主要方法。肿块和微小钙化是乳腺癌主要X线征象,局限浸润、结构紊乱为不典型征象。对乳头溢液者行导管造影,结合间接征象,综合分析,可提高诊断率。     

钼靶X线摄影在围绝经期女性乳腺癌患者筛查中的临床价值分析

目的 探究钼靶X线摄影在围绝经期女性乳腺癌患者筛查中的临床价值.方法 将84例围绝经期女性乳腺癌患者与66例乳腺良性病变患者均实施钼靶X线摄影检查、彩色多普勒超声检查,比较两种检查方式的乳腺癌诊断效能.结果 围绝经期女性乳腺癌患者钼靶X线摄影检查的灵敏度、特异度、准确度分别为98.00％(82/84)、96.00％(63/66)、97.00％(145/150),与彩色多普勒超声的99.00％(83/84)、96.00％(63/66)、98.00％(146/150)比较,差异均无统计学意义(P﹥0.05).钼靶X线摄影、彩色多普勒超声与临床病理组织学检查结果的一致性良好,Kappa值分别为0.932、0.945.钼靶X线摄影乳腺钙化灶、乳房微小肿块、腺体结构扭曲的检出率均高于彩色多普勒超声,差异均有统计学意义(P﹤0.05).结论 钼靶X线摄影和彩色多普勒超声在围绝经期女性乳腺癌患者筛查中均有较高的诊断价值,但钼靶X线摄影对乳腺钙化灶、乳房微小肿块、腺体结构扭曲的检出率更高.     

乳腺内微钙化在乳腺癌诊断中的价值

目的 探讨微钙化对乳腺癌的诊断价值.方法 收集经手术病理证实并在乳腺钼靶X线摄影片中发现微钙化乳腺疾病患者80例,分析其微钙化的特征在乳腺癌诊断中的价值.结果 乳腺癌内微钙化多成簇分布,大多伴有肿块,形态大小各异,密度不一,单个区域数量大多>20个.结论 乳腺钼靶X线摄影对乳腺癌的诊断具有重要价值.     

乳腺癌钼铑双靶计算机X线摄影诊断分析

目的分析乳腺癌钼铑双靶计算机X线摄影（CR）影像表现,以提高乳腺癌的X线诊断水平。方法回顾分析经手术病理证实的65例乳腺癌患者的钼铑双靶CR影像表现,所有患者均摄取正、斜位片并经DrectviewCR900图像处理,5例隐约可见微小钙化而未见明确肿块影者,加照局部加压放大片,其中2例行术前三维立体定位,置放定位导丝,指导手术及病检。结果65例乳腺癌患者中,48例为浸润性导管癌,5例为浸润性小叶癌,2例髓样癌、4例硬癌、3例为导管内原位癌,2例管内癌伴早期浸润,1例乳头佩吉特病。CR表现：分叶状、不规则肿块20例,肿块伴恶性钙化29例,单纯恶性钙化型5例,乳腺局部结构紊乱和局限性致密浸润8例,星芒征3例;多伴有一项或多项次要征象。结论不规则肿块和恶性钙化是乳腺癌的最主要、最直接的X线征象,部分乳腺癌单纯以结构紊乱、非对称性致密或星芒征为主要表现。钼铑双靶计算机X线片摄影,可以充分显示乳腺癌的主要、次要X线征象,特别是对致密型乳腺内微小病灶的检出率有明显提高,是诊断乳腺癌的首选方法之一。     

乳腺癌钼靶X线征象与VEGF、MVD表达的相关性

[目的]探讨乳腺癌钼靶X线征象与肿瘤血管内皮生长因子(VEGF)和微血管密度(MVD)表达的关系.[方法]对32例经手术病理证实的乳腺癌采用S-P免疫组化法,检测肿瘤标本中VEGF和MVD表达,分析其与术前钼靶X线征象的关系.[结果]VEGF与MVD值呈正相关关系(r=0.691,P＜0.01),VEGF和MVD表达与肿瘤的大小、毛刺征、钙化、血管增粗、腋窝淋巴结转移等X线征象有关(P＜0.05),而与皮肤增厚、乳头内陷无关(P＞0.05).[结论]乳腺癌钼靶X线部分征象与VFGF和MVD表达密切相关,通过这些征象,可推测乳腺癌的生物学行为,为临床上早期诊断、判断预后提供依据.     

乳腺癌CT表现价值探讨

本文讨论12例乳腺癌CT表现。直接征象即肿块阴影,一般为圆形,卵圆形。肿块等于或高于腺体密度,边缘一般呈毛刺状参差不齐,有细小钙化。增强扫描CT值成倍增加为其特征性。间接征象有血管增粗增多,出现宽窄不一透亮带,皮肤增厚、收缩。乳后间隙消失,乳头内陷,腋下可见肿大淋巴结等。乳腺CT扫描适应症主要有乳腺钼靶照片的隐区部位,乳腺钼靶X线片上怀疑乳腺癌者,以及对致密型,青春期,哺乳期乳腺和乳腺癌根治术前了解肿块与周围组织关系等方面有一定意义。乳腺CT扫描也有局限性,它不适合于普查形式,对乳腺癌砂粒样钙化的特征性表现不如X线钼靶,对致密型乳腺中小于10mm的结节亦很难显示。     

Radiation therapy in management of breast cancer.

Randomized trials have demonstrated the efficacy of radiation therapy in the treatment of breast cancer. A reduction in the risk of recurrence has been shown in breast conservation for ductal carcinoma in situ and in invasive cancers after breast conservation and mastectomy. The importance of local control in breast cancer is becoming more apparent. Defining the groups of patients who most benefit from the therapy and improving treatment delivery systems to enhance the therapeutic index are ongoing challenges.     

Randomized clinical trial to assess the effectiveness of breast irradiation following lumpectomy and axillary dissection for node-negative breast cancer.

BACKGROUND: Although the conservation management of breast cancer has become a routine method of treatment in most centers, there is still considerable controversy surrounding the ultimate minimum treatment required for node-negative breast cancer to achieve adequate local control. PURPOSE: Our purpose was to assess the value of breast irradiation in reducing breast relapse following conservation surgery for node-negative breast cancer. We attempted to define low-risk groups of women for breast and distant site relapse (i.e., recurrence outside the breast) who might be spared breast irradiation or adjuvant systemic therapy. METHODS: Eight hundred thirty-seven patients were randomly assigned to receive radiation therapy or no radiation therapy following lumpectomy and axillary dissection for node-negative breast cancer. RESULTS: Breast irradiation reduced relapse in the breast from 25.7% in the controls to 5.5% in the irradiated patients. There was no difference in survival between the two groups (median follow-up, 43 months). A low-risk group (less than 5% chance of relapse in the breast without irradiation) could not be defined. Tumor size (greater than 2 cm), age (less than 40 years), and poor nuclear grade were important predictors for breast relapse. Age (less than 50 years) and poor nuclear grade were important predictors for mortality. The presence of ductal carcinoma in situ did not predict breast relapse. CONCLUSIONS: Breast irradiation significantly reduces breast relapse, but it does not influence survival. Important predictors of breast relapse are age, tumor size, and nuclear grade, but not the presence of ductal carcinoma in situ. Age and, in particular, nuclear grade predict survival. IMPLICATIONS: Further follow-up may define an acceptable low-risk group for breast relapse. Until then, we recommend that all patients receive breast irradiation. Systemic adjuvant therapy should be considered for patients with poor nuclear grade tumors.     

Breast conservation therapy in the United States following the 1990 National Institutes of Health Consensus Development Conference on the treatment of patients with early stage invasive breast carcinoma.

BACKGROUND: A National Institutes of Health (NIH) Consensus Development Conference on the treatment of patients with early stage invasive breast carcinoma, held in June 1990, recommended breast conservation therapy for the majority of women with Stage I or II breast carcinoma. The authors evaluated the national use of breast conservation therapy before and after the conference to determine whether the conference had had an impact on utilization. METHODS: Women with Stage I or II breast carcinoma (n = 109,880), diagnosed during the years 1983-1995, were identified via 9 population-based cancer registries of the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute. The likelihood of breast conservation surgery versus mastectomy and, among women who underwent breast conservation surgery, the likelihood of postoperative radiation therapy versus none, were assessed for 3 time periods (January 1983 to April 1985, May 1985 to June 1990, and July 1990 to December 1995). Associations between the use of breast conservation surgery or postoperative radiotherapy according to patient stage, age, race, and region were compared among women diagnosed before and after the NIH Consensus Development Conference. RESULTS: From 1985 (the year that the U.S. randomized controlled trial demonstrating equivalent efficacy between breast conservation therapy and mastectomy was published) through 1989, approximately 35% of women with Stage I and 19% of women with Stage II breast carcinoma underwent breast conservation surgery; these percentages remained constant throughout this period. Beginning in 1990, the year of the NIH Consensus Development Conference, the use of breast conservation surgery increased in each subsequent year; by 1995, 60% of women with Stage I and 39% of women with Stage II breast carcinoma received such treatment. However, regional variation in use was observed (Stage I, range 41.4-71.4% for 1995) and no registry reported breast conservation therapy for the majority of women with Stage II disease (range, 23.8-48.0%). The use of postoperative radiotherapy for women who underwent breast conservation surgery was similar in the periods before and after the conference. CONCLUSIONS: Although breast conservation therapy was performed more frequently following the NIH Consensus Development Conference, variation in use by region of the U.S. suggests the continued presence of barriers to widespread adoption of the recommendations formulated at the conference.     

Controversies in breast conservation treatment for breast cancer

Breast conservation treatment has become the standard treatment for early breast cancer patients, after the equivalence of mastectomy and breast conservation treatment was demonstrated in prospective, randomized trials and large retrospective studies. New questions, such as the feasibility of neoadjuvant chemotherapy in improving breast conserving rate, the appropriateness of breast conservation treatment in ductal carcinoma in situ, the effectiveness of radiation therapy in patients treated by breast conservation, and patient selection for breast conservation without radiation, are now being raised. Future work that needs to be done to answer these questions is discussed in this review.     

The management of Paget’s disease of the breast

Opinion statement Paget’s disease of the breast is a relatively rare condition, accounting for 1% to 3% of primary breast cancers. It is associated with an underlying carcinoma, invasive or noninvasive (ductal carcinoma in situ), in most of the cases. Primary treatment is surgical with adjuvant therapy being dictated by the stage and nature of the underlying tumor. Modified radical mastectomy is the standard of care with breast conservation appropriate in a select group of patients with Paget’s disease. This select group includes patients that are diagnosed with nipple-areola changes alone without evidence of a palpable mass or mammographic abnormality. In this group of patients, breast conservation offers local recurrence rates comparable to rates in patients with invasive or noninvasive cancers. In patients diagnosed with associated palpable masses or mammographic abnormalities suggestive of cancer, the recurrence rates are higher and mastectomy is warranted.     

Attitudes and treatment outcome of breast conservation therapy for stage I & II breast cancer using peroperative iridium‐192 implant boost to the tumour bed

Breast conservation therapy for early breast cancer is an established but grossly under‐utilized treatment option in India for various reasons. Breast conservation therapy was offered to 200 suitable breast cancer patients between June 1993 and June 1998. Fifty‐one patients (25%) opted for breast conservation and the remaining preferred mastectomy. In patients agreeing to conservation therapy, surgery was performed first along with peroperative implantation of iridium‐192 to deliver a boost. Whole breast irradiation of 45 Gy was delivered 3–4 weeks after the boost. Cosmesis was assessed at the end of 6 months from completion of therapy. The main reason for refusal of breast conservation therapy was fear of recurrence in the remaining breast (60%). There were no locoregional failures in our study at a median follow up of 42 months; one patient experienced a systemic relapse. Cosmesis was good to excellent in 80% of patients. Breast conservation therapy using peroperative iridium‐192 implant provides excellent locoregional disease control and cosmesis. The results of our study indicate that patient preference for mastectomy is an important reason for the under‐utilization of breast conservation therapy in India.     

Size of invasive breast cancer and risk of local recurrence after breast-conservation therapy

Risk of local recurrence is one important factor that determines a woman's suitability for breast-conservation therapy. With the evolution of oncoplastic surgery, tumours of a size that traditionally require mastectomy may be treated by breast conservation and partial breast reconstruction. This article reviews the evidence relating to tumour size as a risk factor for local recurrence to assess whether this change in practice is appropriate. A literature review through Medline and Pubmed was performed. All pathological studies analysing tumour size as a predictor of multifocality and all randomised trials and large case series of breast conservation including tumours larger than 2 cm were reviewed and critically interpreted. Pathological studies report consistent evidence that tumour size is not predictive of multifocality. Randomised trials and clinical series of breast conservation report conflicting evidence relating to tumour size as a risk factor for local recurrence, although most studies report no association. Evidence relating to cancers over 3 cm is limited. There is little evidence to justify the use of tumour size alone as an exclusion criterion for breast-conservation therapy. A registration study of patients with cancers larger than 3 cm treated by breast conservation with or without partial breast reconstruction is proposed.     

Results of the Lynn Sage Second-Opinion Program for local therapy in patients with breast carcinoma. Changes in management and determinants of where care is delivered

BACKGROUND: The treatment options of breast conservation therapy (BCT) and immediate reconstruction for patients with carcinoma of the breast have not been adopted widely. The objectives of this study were to determine how often a second opinion on the local therapy of breast carcinoma changed patient management and to identify factors predictive of remaining at the second-opinion site for therapy. METHODS: Two hundred thirty-one patients with intraductal carcinoma or Stage I and II breast carcinoma were reviewed retrospectively. At the time of the second opinion, patients completed a questionnaire regarding their initial surgical opinion and the reason for seeking consultation. RESULTS: Only 46% of patients had a complete discussion of treatment options prior to the second opinion. The second opinion changed management in 54 patients (20.3%). The most common finding was eligibility for BCT in patients who were offered only mastectomy. Definitive local therapy occurred at the second-opinion site in 65.8% of patients. The only predictors of remaining at the second-opinion site were insurance type (P = 0.008) and the patient's perception that options were not discussed at the initial opinion (P < 0.001). CONCLUSIONS: Second opinions provide useful information to patients and may change the management of their disease. They result in significant patient capture for an institution.     

Controversies in the surgical management of operable breast cancer

The literature is reviewed regarding the surgical management of breast carcinoma, and controversies are discussed. Several unresolved issues remain in the surgical management of breast carcinoma. First, the optimal surgical treatment of patients who are at increased risk for having internal mammary lymph node metastases remains unknown. Second, it remains controversial whether axillary dissection is therapeutic or merely represents a staging procedure. Third, there is no consensus regarding the optimal extent of resection prior to irradiation in breast-conserving treatment. Nevertheless, breast conservation is generally accepted as a preferable therapy in patients with operable breast carcinoma, while modified radical mastectomy, with or without breast reconstruction offers an acceptable alternative for these patients.     

Breast conservation therapy versus mastectomy in the community-based setting: can this rate be used as a benchmark for cancer care?

Despite strong evidence supporting the use of breast conservation therapy (BCT) in the treatment of breast carcinoma, the actual rates of use remain low. This article is a retrospective review of a sample of patients from the cancer registry of the Carolinas Medical Center (CMC), comparing breast conservation and mastectomy rates during an 11-year period. BCT rates have increased in CMC during this time frame and have reached national levels. Further research is needed to determine whether BCT rates can be used as a benchmark for the care of patients with cancer.