乳腺癌合并肺癌的诊断与治疗

目的探讨乳腺癌合并原发性肺癌的诊断途径和治疗原则。方法回顾性分析26例乳腺癌合并原发性肺癌的临床表现、诊断途径、治疗方法及预后。病理检查包括：经CT引导肺占位穿刺活检或支气管镜病理检查、锁骨上淋巴结或腋窝淋巴结病理检查、乳腺和肺部肿瘤切除手术后病理检查。治疗方法包括：根治性切除、姑息性切除、化疗、靶向治疗、内分泌治疗等。结果26例最终诊断为乳腺癌合并原发性肺癌，占同期乳腺癌住院手术患者的2％；18例经过常规病理与第一原发癌病理对照即明确诊断；8例需要加做免疫组织化学及肿瘤标志物检查确诊。21例为乳腺癌检查时，胸部X线片和或CT检查发现肺部占位，其中15例无明显肺癌临床症状；9例肺脏单发结节，仅5例手术，均行根治性肺叶切除术，临床及病理证实均为I-Ⅱ期肺癌，均得到及时的准确诊断和恰当治疗，临床治疗效果满意。结论乳腺癌合并肺癌可能并不少见，及时取得病理诊断结果，是恰当治疗、改善预后的前提和关键。

Diagnosis and Treatment of Breast Cancer Combined With Primary Lung Cancer

Objective To investigate the diagnostic approach and the treatment principle of breast cancer combined with primary lung cancer. Methods Twenty-six patients diagnosed as breast cancer combined with primary lung cancer were retrospectively analyzed. Detailed analysis was carried out for the clinical and pathological characteristics, the diagnostic approaches, the therapeutic methods and prognostic factors. All of the 26 patients were final diagnosed by pathological examination. Biopsy specimens were obtained using invasive methods, CT-guided needle aspiration biopsy or trans-bronchoscope biopsy or surgical resection （mastectomy/ lung lobectomy）or the supraclavicular/axillary lymph nodes biopsy was performed. Besides conventional morphopathological examination, differential diagnosis was performed by immunohistochemical examination and evaluation using a molecular marker. Treatment methods include ： radical resection, palliative resection, chemotherapy, targeted therapy, and endocrine therapy. Results Among the 26 patients, diagnosis was obtained by morphopathological methods alone in 18 cases ,and by immunohistochemical and molecular marker exami- nation in the remaining 8 cases. 21 patients had their lung cancer discovered from X-ray and/or CT examina- tion of the breast cancer. 15 patients were asymptomatic of the lung cancer at the time of diagnosis ,9 patients had presented with a solitary pulmonary nodule after mastectomy, only 5 patients were successfully treated with surgery,Clinical and pathological examination confirmed that they were I -Ⅱ lung cancer,and timely and accurate diagnosis and appropriate treatment were given, and the clinical results were satisfactory. Conclusion Breast cancer associated with primary lung cancer may not he uncommon. Timely obtaining of the pathological results is the premise and key for appropriate treatment and the prognosis improvement.