乳腺导管内癌的腋窝淋巴结转移率与术式选择

The incidence of axillary metastases and appropriate surgery for ductal carcinoma in situ of the breast

目的 :从腋窝淋巴结转移率的角度 ,探讨对乳腺导管内癌 (DCIS)的合理治疗方法。方法 :我院 1994年1月～ 2 0 0 3年 12月间收治的 16例女性DCIS患者 ,中位年龄 4 3岁 (30～ 84岁 ) ,中位随访时间 6 2 (6～ 114 )个月 ,2例作Halsted根治术 ,11例作改良根治术 ,2例作全乳切除术 ,1例作象限切除 +腋窝淋巴结清扫 ,术后 8例作辅助化疗 ,3例作放疗 ,10例作内分泌治疗。结果 :16例DCIS中 ,2例腋窝淋巴结有微转移。术后随访无复发 ,无死亡 ,只有 1例术后 4年骨扫描发现有髋转移。结论 :治疗DCIS宜行肿块扩大切除 (保乳手术 )

Purpose:To study the appropriate surgical treatment for ductal carcinoma in situ of the breast ( DCIS ).Methods:16 patients with DCIS treated between Jan 1994 and Dec 2003 were evaluated. All patients underwent lumpectomy and intraoperative frozen section evaluation. The median age was 43 years ( range 30 to 84 ) and the median pathologic size of DCIS was 2.0cm ( range 0.3 to 4cm ). 2 of these 16 patients had Halsted radical mastectomy, 11 had modified radical mastectomy, 2 had simple mastectomy and 1 had breast-conserving surgery ( quadrant excision plus axillary lymph node dissection ). As postoperative treatment, 3 patients received radiotherapy, 8 received chemotherapy and 10 had endocrine therapy.Results:2 patients were found to have axillary micrometastases. The median follow-up time was 62(6～114)months. All patients survived without recurrence. Only one patient was found to have metastasis in hipbone 4 years after operation.Conclusions:Lumpectomy or wider excision plus postoperative radiotherapy is feasible for most patients with DCIS.[