乳腺增生病182例分析

本文报告了经病理证实的乳腺增生病182例,其中乳痛症型9例,小叶增生型25例,纤维腺病型56例,纤维化型28例,囊肿病型64例.病程15天至10年,平均1年5个月.年龄18～60岁,平均32.5岁,其中21～40岁者占68.7%.本组单纯肿物切除17例,乳腺区段切除165例.随访142例,随访率为78%,复发2例.本文对乳腺增生病的命名、分型、临床、病理和治疗作了讨论.     

手术治疗乳腺增生病

目的:探讨手术治疗乳腺增生病的意义及其方法。方法:对有手术指征的病人,酌情选用区段切除,乳房单纯切除等术式。结果:55例病人均经病理检查证实为乳腺增生病,所有病人术后效果良好。结论:乳腺增生病经保守治疗无效者,可考虑手术治疗,但需严格掌握手术适应症。     

近红外乳腺扫描影像与乳腺增生病辨证分型关系探讨

目的 探讨影像诊断技术与中医辨证分型的关系，使用药更有针对性、合理性。方法 采用近红外乳腺扫描影像技术对820例乳腺增生病患者进行扫描检查，同时进行护理指导。结果 820例患者检查顺利，不同证型的乳腺增生病其近红外乳腺影像各有差异。结论 近红外乳腺扫描检查敏感性高、直观、无创、操作方便，检查中良好的护理有利于检查顺利进行。     

乳腺肿块的诊断

乳腺肿块是乳腺疾病患者最常见的主诉,对其诊断在临床上有重要意义.鉴别良恶性肿块对病人来说是最关心的问题,对诊断、治疗和预后有极其重要价值.下述几点可作为乳腺肿块临床诊疗的参考.     

改良式乳腺肿块切除术治疗乳腺良性肿块的临床效果分析

目的 探讨改良式乳腺肿块切除术治疗乳腺良性肿块的临床应用价值.方法 对176例乳腺良性肿块患者根据手术方式不同分为研究组86例和对照组90例,研究组病例行改良式乳腺肿块切除术治疗,对照组病例行传统式乳腺肿块切除术治疗,术后比较两组手术时间、术中出血量、疼痛时间、切口愈合、术后并发症、乳腺美容效果等情况.结果 与照组相比,研究组的术后乳腺美容效果得到明显提高（P＜0.01）;手术时间有所缩短（15～40 min,P＜0.05）;疼痛持续时间短（0.5 ～3 d,P＜0.05）;术区硬块感时间缩短（25 ～80 d,P＜0.05）;术后积液、术后感染及切口Ⅰ期愈合与对照组比较,差异无统计学意义（P＞0.05）.结论 改良式乳腺肿块切除术是治疗乳腺良性肿块的一种安全、有效、美观的临床术式,值得在临床中应用与推广.     

近红外乳腺扫描影像与乳腺增生病辨证分型关系探讨

目的探讨影像诊断技术与中医辨证分型的关系,使用药更有针对性、合理性.方法采用近红外乳腺扫描影像技术对820例乳腺增生病患者进行扫描检查,同时进行护理指导.结果 820例患者检查顺利,不同证型的乳腺增生病其近红外乳腺影像各有差异.结论近红外乳腺扫描检查敏感性高、直观、无创、操作方便,检查中良好的护理有利于检查顺利进行.     

乳痛灵治疗乳腺增生病60例

乳腺增生病是一种常见的乳腺疾病 ,占全部乳腺疾病的 75 %以上。本病因乳腺组织发生腺叶及导管上皮细胞增生 ,小叶与小叶周围间质纤维组织增生而得名。属于中医“乳癖”范畴。笔者 2 0 0 0年 6月— 2 0 0 2年 9月采用我院研制的乳痛灵Ⅰ号、乳痛灵Ⅱ号治疗乳腺增生病人 6 0例 ,取得满意的疗效 ,报告如下。1　临床资料本组 6 0例均为女性 ,其中已婚 4 3例 ,未婚 17例 ;年龄 19～ 5 3岁 ,平均 33岁。病程最短 3个月 ,最长 5年余 ,平均为 1 5年。单侧病变 2 4例 ,双侧病变 36例。其中肝郁气滞型 4 2例 ,冲任不调型 18例。根据临床症状、体格检…     

Infrared Imaging Does Not Predict the Presence of Malignancy in Patients with Suspicious Radiologic Breast Abnormalities

The NoTouch BreastScan (NTBS) is a non‐invasive infrared imaging device which measures thermal gradients in breasts using dual infrared cameras and computer analysis. We evaluated NTBS as a predictor of breast cancer in patients undergoing minimally invasive biopsy. In this IRB‐approved prospective trial, 121 female patients underwent NTBS prior to scheduled tissue biopsy. Twenty‐two patients were excluded due to uninterpretable scans (n = 18), diagnosis of a nonprimary breast malignancy (n = 1), or no biopsy performed (n = 3) for a total of 99 patients. Five patients had bilateral breast biopsies and one patient had two ipsilateral biopsies, resulting in 105 biopsies. Patients were prospectively scanned using a high specificity mode, termed NTBS1. All 99 patients were retrospectively re‐evaluated in a high sensitivity mode, NTBS2. Of 105 biopsies performed in 99 women, 33 (31.4%) were malignant and 72 (68.6%) were benign. NTBS1 demonstrated a sensitivity of 45.5% and a specificity of 88.9%. Of 94 normal contralateral breasts, 9.6% had a positive NTBS1. In the retrospective evaluation, NTBS2 demonstrated a sensitivity of 78.8% and a specificity of 48.6%. Half (50%) of the normal contralateral breasts had a positive NTBS2. NTBS does not accurately predict malignancy in women with suspicious imaging abnormalities. The higher sensitivity mode results in an unacceptable number of false positives, precluding its use. Infrared imaging did not improve the sensitivity or specificity of mammography in this clinical setting.     

Imaging and Management of Breast Masses During Pregnancy and Lactation

▪ Abstract: Detection and management of breast abnormalities that develop during pregnancy and lactation is difficult for both the clinician and the radiologist. This article reviews the hormonal and physiologic effects on the breast during pregnancy and lactation. Breast masses that occur in pregnant or lactating patients, including pregnancy-associated breast cancer, are discussed and the corresponding ultrasound and mammographic findings are presented. Finally, a rationale for the imaging evaluation and management of the pregnant or lactating patient with a breast mass are presented. ▪     

Percutaneous Excisional Biopsy of Palpable Breast Masses under Ultrasound Visualization

Abstract:   A palpable breast mass is a common reason for surgical consultation. Our goal was to determine whether ultrasound-guided vacuum-assisted core biopsy (US-VACB) is safe and effective in completely removing presumed benign palpable breast masses. We conducted a cohort study of 201 consecutive patients with presumed benign palpable masses who underwent removal with US-VACB. The main outcome measured was the successful removal of palpable masses. Palpable masses were successfully removed with US-VACB in 99% of cases; 2% were cancer and 7.5% were atypical ductal hyperplasia or phyllodes tumor. Two clinical recurrences representing a seroma were seen on follow-up. US-VACB is safe and effective in the initial diagnosis and management of presumed benign palpable breast masses. It provides the benefits of percutaneous biopsy and the palpable abnormality no longer remains.      

Tc-99m Sestamibi Scintimammography for the Evaluation of Breast Masses in Patients with Radiographically Dense Breasts

Abstract: The objective of this study was to evaluate the usefulness of technetium-99m sestamibi (MIBI) scintimammography for the diagnosis of breast cancer in patients with palpable breast masses that cannot be adequately evaluated by mammography due to the presence of radiographically dense breasts. At 5 minutes after intravenous injection of MIBI, scintimammograms were obtained in 80 patients who had grade 3 or 4 glandular density on mammograms and a palpable breast mass. Excisional biopsy or FNA biopsy was obtained in 68 lesions in 67 patients. Scintimammography (22 true positive, 4 false positive, 41 true negative, 1 false negative) resulted in a sensitivity of 95.6%, specificity 91.1%, positive predictive value 84.6%, and negative predictive value 97.6%. Mammography (19 true positive, 21 false positive, 24 true negative, 4 false negative) resulted in a sensitivity of 73.9%, specificity 53.3%, positive predictive value 44.7%, and negative predictive value 80%. MIBI scintimammography has a higher sensitivity and specificity than mammography in patients with radiographically dense breasts. It is useful as an adjunct to mammography in those patients with radiographically dense breasts for the characterization of palpable masses. Although sensitivity of mammography in this cohort was high, its specificity was significantly lower than scintimammography. If validated in prospective studies it could provide a safe way of avoiding a breast biopsy in patients with benign findings on clinical exam, mammography, and needle aspiration cytology.     

Morphologic Risk Factors for Local Recurrence in Patients with Invasive Breast Cancer Treated with Conservative Surgery and Radiation Therapy

Abstract: The combination of conservative surgery and radiation therapy (CS and RT) is now the local treatment of choice for many women with invasive breast cancer. A number of patient factors, treatment factors, and pathologic factors must be taken into consideration in determining the suitability of this approach for an individual patient. The purpose of this article is to review the morphologic features of the tumor that are important to consider in selecting patients for CS and RT and in assessing their risk of local recurrence.     

Reducing the Human Burden of Breast Cancer: Advanced Radiation Therapy Yields Improved Treatment Outcomes

Radiation therapy is an important modality in the treatment of patients with breast cancer. While its efficacy in the treatment of breast cancer was known shortly after the discovery of x‐rays, significant advances in radiation delivery over the past 20 years have resulted in improved patient outcomes. With the development of improved systemic therapy, optimizing local control has become increasingly important and has been shown to improve survival. Better understanding of the magnitude of treatment benefit, as well as patient and biological factors that confer an increased recurrence risk, have allowed radiation oncologists to better tailor treatment decisions to individual patients. Furthermore, significant technological advances have occurred that have reduced the acute and long‐term toxicity of radiation treatment. These advances continue to reduce the human burden of breast cancer. It is important for radiation oncologists and nonradiation oncologists to understand these advances, so that patients are appropriately educated about the risks and benefits of this important treatment modality.     

Shortened Radiation Therapy Schedules for Early‐Stage Breast Cancer: A Review of Hypofractionated Whole‐Breast Irradiation and Accelerated Partial Breast Irradiation

Breast‐conserving therapy consisting of segmental mastectomy followed by whole‐breast irradiation (WBI) has become widely accepted as an alternative to mastectomy as a treatment for women with early‐stage breast cancer. WBI is typically delivered over the course of 5–6 weeks to the whole breast. Hypofractionated whole‐breast irradiation and accelerated partial breast irradiation have developed as alternative radiation techniques for select patients with favorable early‐stage breast cancer. These radiation regimens allow for greater patient convenience and the potential for decreased health care costs. We review here the scientific rationale behind delivering a shorter course of radiation therapy using these distinct treatment regimens in this setting as well as an overview of the published data and pending trials comparing these alternative treatment regimens to WBI.     

Discontinuation of Radiation Treatment among Medicaid‐Enrolled Women with Local and Regional Stage Breast Cancer

Abstract: For women with nonmetastatic breast cancer, radiation therapy is recommended as a necessary component of the breast conserving surgery (BCS) treatment option. The degree to which Medicaid‐enrolled women complete recommended radiation therapy protocols is not known. We evaluate radiation treatment completion rates for Medicaid enrollees aged 18–64 diagnosed with breast cancer. We determine clinical and socio‐demographic factors associated with not starting treatment, and with interruptions or not completing radiation treatment. Using data from the Washington State Cancer Registry linked to Medicaid enrollment and claims records, we identified Medicaid enrollees diagnosed with breast cancer from 1997 to 2003 who received BCS. Among the 402 women who met inclusion criteria, 105 (26%) did not receive any radiation. Factors significantly associated with not receiving radiation included in situ disease and non‐English as a primary language. Among those who received at least one radiation treatment, 65 (22%) failed to complete therapy and 71 (24%) patients had at least one 5 to 30 day gap in treatment. We found no significant predictors of interruptions in treatment or early discontinuation. A substantial proportion of Medicaid‐insured women who are eligible for radiation therapy following BCS either fail to receive any treatment, experience significant interruptions during therapy, or do not complete a minimum course of treatment. More effort is needed to ensure this vulnerable population receives adequate radiation following BCS.     

Infrared Imaging of the Breast: Initial Reappraisal Using High-Resolution Digital Technology in 100 Successive Cases of Stage I and II Breast Cancer

There is a general consensus that earlier detection of breast cancer should result in improved survival. Current breast imaging relies primarily on mammography. Despite better equipement and regulation, variability in interpretation and tissue density still affect accuracy. A number of adjuvant imaging techniques are currently being used, including doppler ultrasound and gadolinium-enhanced MRI, which can detect cancer-induced neovascularity. In order to assess the potential contribution of currently available high-resolution digital infrared technology capable of recognizing minute regional vascular flow related temperature variation, we retrospecitively reviewed the relative ability of our preoperative clinical exam, mammography, and infrared imaging to detect 100 new cases of ductal carcinoma in situ, stage I and II breast cancer. While the false-negative rate of infrared imaging was 17%, at least one abnormal infrared sign was detected in the remaining 83 cases, including 10 of the 15 patients, a slightly younger cohort, who had nonspecific mammograms. The 85% sensitivity rate of mammography alone thus increased to 95% when combining both imaging modalities. Access to infrared information was also pertinent when confronted with the relatively frequent contributory but equivocal clinical exam (34%) and mammography (19%). The average size of those tumors undetected by mammography or infrared imaging was 1.66 cm and 1.28 cm, respectively, while the false-positive rate of infrared imaging in a concurrent series of 100 successive benign open breast biopsies was 19%. Our initial experience would suggest that, when done concomitantly with clinical exam and mammography, high-resolution digital infrared imaging can provide additional safe, practical, and objective information. Further evaluation, preferably in controlled prospective multicenter trials, would provide valuable data.     

Ocular Surface Disease in Breast Cancer Patients Using Aromatase Inhibitors

Aromatase inhibitors (AIs) are widely used as adjuvant hormonal therapy in postmenopausal women with hormone receptor‐positive breast cancer. The purpose of this study was to investigate the potential impact of AIs on the anterior segment of the eye and especially the ocular surface. Participants in our study were 41 hormone receptor‐positive early stage breast cancer patients (80 eyes), treated with AIs, while 80 eyes of 40 age‐ and gender‐matched healthy controls, not previously used AIs for any purpose, were also evaluated. All participants underwent a complete ophthalmological examination, including best corrected visual acuity (BCVA) assessment, slit‐lamp biomicroscopy, and dilated fundus examination. Ocular surface disease‐related symptoms and signs were also recorded. The most common symptom was found to be blurred vision, while other symptoms included foreign body sensation, tearing, redness, and photophobia. Slit‐lamp examination revealed blepharitis and meibomian gland dysfunction in 75% and 42.5% of patients, respectively. Superficial punctate keratitis and conjunctival injection were also present. Our results demonstrated a high prevalence of ocular surface disease‐related symptoms and signs in patients receiving AIs compared to healthy controls. This study may raise a flag regarding the use of AIs. However, further and larger prospective longitudinal studies are needed to examine the possible effect of AIs alone or in combination with chemotherapy in the eyes of breast cancer patients.