摘要
目的探讨仅影像学表现为恶性钙化而乳房未扪及肿块乳腺癌的病灶定位方法、手术方法及其治疗效果。方法对61例乳房体检不能触及肿块、影像学检查也未发现肿块，仅X线钼靶片或超声检查显示恶性钙化病灶或局部血流丰富的乳腺癌（T1—2NOM0）患者，术前应用全数字化平板乳腺机（FFDM），对钙化病灶进行坐标法立体定位、术中精确切除病灶、术后应用FFDM法复检标本，同时行广基带血管腺体组织瓣I期乳房内成形保乳手术（单发病灶者）或乳腺癌改良根治术（多中心病灶者）。结果50例行保乳手术的患者，坐标法定位病灶的准确率为100％（50／50）。对病灶切缘阴性、FFDM复检无病灶残留者，其广基带血管腺体组织瓣乳腺I期成形结果按JCRT标准，达优率为86．0％（43／50）；Compliance差值为1．5cm。11例行乳腺癌改良根治术，均为外弥漫性恶性钙化多中心病灶者。61例患者的随访时间为6—58个月（中位随访时间为39个月）。全组仅1例远处转移，无局部复发患者。结论对不能扪及肿块的乳腺癌病灶，应用FFDM坐标法定位，准确可行。对单发病灶者，在定位下行保乳手术，同时行广基带血管腺体组织瓣Ⅰ期乳房内成形术，疗效满意。
Objective To investigate the methods of lesion localization and surgical treatment for non-palpable breast cancer, presented with only small calcification lesion on the images. Methods From November 2003 to August 2007, 61 patients with non-palpable lesion were finally pathologically diagnosed as early breast cancer （T1-2NOMO）, based on the small calcification lesions shown by full field digital mammography （FFDM） through molybdenum target, and the rich blood supply shown by type-B ultrasonic examination. Accurate lesion-localization prior to surgical resection was conducted, and sample re- examination by FFDM was done after resection. Patients with single lesion underwent breast-conserving surgery, precise excision with the aid of image-guided wire localization, and stage Ⅰ breast reconstruction was performed simultaneously using wide-based gland-tissue flap. Patients with multiple lesions received modified radical mastectomy, Results Among the 50 patients treated with breast-conserving surgery, the accuracy of localization for lesions was 100% （ 50/50 ） , and all lesions were excised completely with a negative margin proven by FFDM re-examination and pathological examination. The superior rate of mammaplasty was 86.0% （43/50） according to JCRT criteria, with a compliance difference of 1.5 cm. Modified radical mastcctomy was performed in 11 patients. The follow-up period in this series was from 6 to 58 months with a mean follow-up time of 39 months. Distant metastases were detected in only one patient and local recurrence was not observed yet. Conclusion Lesion localization by FFDM in patients with non- palpable breast cancer is accurate and practical. In patients with single lesion, breast-conserving resection followed by synchronous stage Ⅰ breast reconstruction with wide-based gland-tissue flap is appropriate.
出处
《中华肿瘤杂志》
CAS
CSCD
北大核心
2009年第4期305-307,共3页
Chinese Journal of Oncology
基金
江苏省科技厅社会发展基金（BS2006006）
