以腋窝淋巴结转移为首发症状的隐匿性乳腺癌临床分析

Clinical analysis of axillary lymph node metastasis as first symptom of occult breast cancer

目的:探讨伴腋窝转移的隐匿性乳腺癌(OBC)诊断、治疗及预后。方法:回顾性分析2000-03-2004-07收治的24例伴腋窝转移的OBC患者的临床资料。结果:24例术前触诊、钼钯和超声检查均未发现同侧乳腺确切肿物,术中病理示淋巴结转移癌(乳腺来源可能性大)。行同侧乳房切除加腋窝淋巴结清除术(术中剖开乳腺腺体9例发现原发灶),其3、5年总生存率分别为79.2%和66.7%。腋淋巴结转移数目<4者13例和≥4者11例,其3、5年生存率分别为84.6%、76.9%和72.7%、54.5%。结论:OBC应选择以同侧乳房切除加腋窝淋巴结清除术为主的综合治疗,特别是腋淋巴结转移数≥4者,治疗应更积极。

OBJECTIVE： To explore the diagnosis,treatment and prognosis in occult breast cancer patients with axillary lymph nodes metastasis.METHODS： The clinical data of 24 occult breast cancer patients with axillary lymph nodes metastasis from March 2000 to July 2004 were analyzed retrospectively.RESULTS： Twenty-four cases of preoperative palpation,molybdenum palladium and ultrasound examination were not found in the ipsilateral breast tumor exactly,but intraoperative frozen section of axillary tumor showed lymph node metastasis（breast was very likely the source）.The ipsilateral mastectomy plus axillary lymph node dissection was performed（mammary gland cut open surgery,9 cases of primary tumor was found）,and the 3-year and 5-year overall survival rates were 79.2% and 66.7% respectively.The number of axillary lymph node metastasis 4 was in 13 cases and ≥ 4 in 11 cases,and their 3-year and 5-year survival rates were 84.6%,76.9% and 72.7%,54.5% respectively.CONCLUSION： The comprehensive treatment based on ipsilateral mastectomy plus axillary lymph node dissection should be chose for OBC patients,in particular the number of ≥ 4 axillary lymph nodes,and the therapy should be more active.