隐匿性乳腺癌的诊断和治疗方式分析

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。

Analysis of the Diagnosis and Treatment for Occult Breast Carcinoma

ABSTRACT Objective: To investigate the preoperative diagnostic methods and optimal surgical management for occult breast car- cinoma(OBC). Methods: A total of 26 cases of patients diagnosed with OBC based on available criteria were collected including thera- peutic 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 of ipsilateral axillary lymph node dissection (ALND), 14 cases of patients had ipsilateral mastecto- my 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. En- docrine therapy and targeted therapy were determined according to hormone receptors status. Comparison of breast resection and non re- section group, postoperative local recurrence rate (p=0.005) and overall survival (p=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). Conclusion: Besides breast ultrasound, mammography and MRI examinations, breast scinti- mammography with technetium-99m tetrofosmin can also be applied for the diagnosis of OBC. Modified radical mastectomy plus radio- therapy is an optimal choice to achieve better survival compared with quadrantectomy alone based on the ipsilateral ALND.