隐匿性乳腺癌的诊断和治疗方式分析  

Analysis of the Diagnosis and Treatment for Occult Breast Carcinoma

作　　者：黄雅静 胡晓鹏[1] 吴亚群[1] 罗智勇[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院甲状腺乳腺外科,湖北武汉430030

出　　处：《现代生物医学进展》2017年第31期6066-6069,共4页Progress in Modern Biomedicine

基　　金：国家自然科学基金项目(81502373)

摘　　要：目的:探讨隐匿性乳腺癌的术前诊断方法和最佳治疗方式。方法:回顾性分析我院2005年1月-2016年5月收治的26例隐匿性乳腺癌患者的临床资料,包括治疗方法和预后情况。结果:26例女性患者,在患侧腋窝淋巴结清扫的基础上,14例行患侧乳房切除术+术后放疗,5例仅行患侧乳房切除术,4例行患侧乳腺外上象限局部切除术+术后放疗,3例患者仅行患侧乳房象限切除术。23例患者行术后化疗,根据激素受体情况决定内分泌治疗及靶向治疗。乳房切除与未切除患者术后局部无复发率(P=0.005)及总生存率(P=0.006)比较差别均有明显统计学意义。术后放疗组与未放疗组局部无复发率比较差异有明显统计学意义(p=0.02),而总生存率比较差异无明显统计学意义(P=0.11)。结论:隐匿性乳腺癌患者术前需完善乳腺彩超、钼靶及MRI等检查,也可选择乳腺核素显像。在患侧腋窝淋巴结清扫的基础上,患侧全乳切除+局部放疗是更加合适的治疗方式。Objective： To investigate the preoperative diagnostic methods and optimal surgical management for occult breast carcinoma （OBC）. Methods： A total of 26 cases of patients diagnosed with OBC based on available criteria were collected including therapeutic methods and follow-up in the Tongji Hospital, Wuhan, China, from January 2005 to May 2016. A systematic retrospective study was performed. Results： On the basis ofipsilateral axillary lymph node dissection （ALND）, 14 cases of patients had ipsilateral mastectomy and postoperation radiotherapy. 5 cases of patients had ipsilateral mastectomy alone. 4 cases had local excision of the affected side breast, whereas 3 cases only had ipsilateral quadrantectomy. Postoperative chemotherapy was performed in 23 cases of patients. Endocrine therapy and targeted therapy were determined according to hormone receptors status. Comparison of breast resection and non resection group, postoperative local recurrence rate （p=0.005） and overall survival （10=0.006） were significantly different. Compared with postoperative radiotherapy and non radiotherapy group, local recurrence rate had significant difference （p=0.02）, overall survival rates were not significantly different （p=0.11）. Conclusions： Besides breast ultrasound, mammography and MRI examinations, breast scintimammography with technetium-99m tetrofosmin can also be applied for the diagnosis of OBC. Modified radical mastectomy plus radiotherapy is an optimal choice to achieve better survival compared with quadrantectomy alone based on the ipsilateral ALND.

关 键 词：腋窝淋巴结转移 隐匿性乳腺癌 乳房切除 放疗 

分 类 号：R737.9[医药卫生—肿瘤]