隐匿性乳腺癌的诊断和治疗

目的 :探讨隐匿性乳腺癌诊断和治疗方法 ,提高诊断准确率和生存率。方法 :回顾性分析 1 7例隐匿性乳腺癌的诊断和治疗经过及随访结果。结果 :1 7例隐匿性乳腺癌首次诊断正确率为 35 .2 9% ( 6/1 7) ,钼靶 X线摄片、增强 CT、MR影像学检查的准确率分别为5 3.85 % ( 7/1 3)、62 .5 0 % ( 5 /8)、60 .0 0 % ( 3/5 ) ,腋下肿块穿刺活检准确率为 1 0 0 % ( 8/8)。 8例患者行乳腺癌改良根治术前行 2～ 4周期化疗 ,8例患者直接行乳腺癌改良根治术 ;1例保守治疗。术后辅助放、化疗和内分泌治疗。生存率 68.75 % ( 1 1 /1 6) ,2例死于其他疾病 ,3例分别于术后 4年、4年、2年死于脑、肺、纵膈转移。 1例保守治疗患者发现后 2年死于脑转移。术前化疗患者生存率 75 .0 0 % ( 6/8)高于直接手术者 62 .5 0 % ( 5 /8)。结论 :提高认识和适宜的影像学检查能提高诊断准确率 ;连续切片和影像学检查有助于原发灶的检出 ,术前化疗加乳癌改良根治术加术后辅助治疗是适宜的治疗方式

Diagnosis and treatment of occult breast cancer

Objective: To discuss proper diagnose and treatment method of occult breast cancer in order to improve correct diagnosis rate and survival rate. Methods: The experience of 17 cases of occult breast cancer admitted to our hospital was retrospectively analysed. Results: the correct diagnosis rate of primary diagnosis was 35.29%(6/17), correct diagnosis rate of mammography, reinforced CT and MR was 53.85%(7/13), 62.50%(5/8), 60.00%(3/5) respectively.correct diagnosis rate of needle aspiration was 100%. 16 cases were practiced by modified radical mastectomy and necessary radiotherapy, chemotherapy and hormonal therapy. 1 case only accepted radiotherapy and chemotherapy and died of brain metastasis. 5 year survival rate of 16 cases was 68.75%(11/16),2 cases died of other disease, 3 cases died of metastasis at 4, 4, 2 years after operation. 5 year survival rate of 8 cases acceptcd preoperative chemotherapy for 2 to 4 rounds(75.00%, 6/8) wasn't better than that of who hadn't accept neoadjuvent chemotherapy(62.50%, 5/8). Conclusion: To improve correct diagnosis rate of occult breast cancer, doctors should reinforce his alertness and suitable image analysis is helpful. Semi serial section and image analysis are helpful for detection of primary cancer in breast. Modified radical mastectomy and necessary radiotherapy, chemotherapy and hormonal therapy are suitable treatment methods.