407例可手术乳腺癌乳头乳晕复合体癌浸润的临床病理研究

目的探求可手术乳腺癌乳头乳晕复合体（NAC）癌浸润与临床、病理的关系，及保留NAC改良乳腺癌根治术的禁忌证和适应证。方法对407例术前记录肿瘤位置、大小、肿瘤缘距乳晕边缘的距离（D）等资料；术中采集NAC的离体标本行常规病理检查；运用统计学方法分析临床、病理相关因素与NAC癌浸润的关系。结果本组NAC癌浸润率为13．27％（54／407）；与年龄、病理类型无相关性；与肿瘤的位置、D值、肿瘤最大径、肿瘤的TNM分期和NAC的临床表现及腋窝淋巴结状态差异均有统计学意义（P〈0．05）。结论肿瘤的位置、D值、肿瘤最大径、肿瘤的TNM分期和NAC的临床表现及腋窝淋巴结状态是影响NAC癌浸润的主要因素。保留NAC的改良根治术的适应证：①I、Ⅱa期乳腺癌患者；②患者有保留NAC和／或乳房外形的愿望，但不能或不愿行保乳术；③非中央区乳腺癌，D≥2cm；④肿瘤最大径≤3cm；⑤乳头无溢液、无湿疹样改变、无内陷及歪斜等异常表现，乳晕无桔皮样改变，未受侵犯；⑥保留的乳头乳晕区皮下组织深面5处取样冰冻切片病理无癌细胞浸润。严格把握适应证行保留NAC的改良根治术是安全可行的。

Clinicopathological study on the nipple-areolar complex involvement in operable breast carcinoma in 407 cases

Objective To investigate the clinicopathological characteristics of nipple-areolar complex （ NAC ） involvement in patients with operable breast carcinoma and to determine the indications and risk factors of NAC-sparing modified radical mastectomy. Methods 407 female patients with primary breast cancer were in- cluded in the study. Data like tumor position, tumor size, the distance from the tumor to the margin of areolar （D） were recorded. NAC sample in vitro was collected and routine pathological examination was performed. Sta- tistical methods were employed to analyze the relation between the clinieopathological factors and NAC involve- ment. Results The rate of NAC involvement was 13.27% （54/407）. NAC involvement had no statistically sig- nificant correlation with age or histological type, but had statistical correlation with tumor position, D value, tumor size, TNM stage, clinical manifestation of NAC, and status of axillary lymph nodes（P 〈 0.05 ）. Conclu- sions Tumor position, D value, tumor size, TNM stage, clinical manifestation of NAC and status of axillary lymph nodes are the major influential factors for NAC involvement. The indications of NAC-sparing modified mas- tectomy： 1. in I or IIa TNM stage; 2. patients have strong will to preserve NAC or breast appearance; 3. non- centric tumor （D≥2 cm） ; 4. the maximum diameter of tumor should be less than 3 cm; 5. no abnormal mani- festation like nipple discharge, eczematoid change or nipple inversion happened. 6. no occult involvement in sub- areolar tissues was found by frozen pathology.