隐匿性乳腺癌的诊治探讨

Discussion on Diagnosis and Treatment of Occult Breast Cancer

目的探讨隐匿性乳腺癌的临床特点及诊治方法。方法对9例隐匿性乳腺癌患者的临床资料及疗效进行回顾性分析。结果术后9例患者中6例找到乳腺癌原发灶（3~8 mm）,随访1~8年,7例行乳腺癌改良根治术的患者中5例未出现局部复发或远处转移,1例术后1年发现骨转移灶,另1例术后1.5年死于脑、肺及骨转移;2例行保乳术的患者均无局部复发或远处转移。结论对有腋窝淋巴结转移腺癌而无明显原发癌灶的女性患者,应高度警惕隐匿性乳腺癌。治疗宜采用保乳术联合腋窝淋巴结清扫术,辅以全乳腺及区域淋巴结引流区放疗、化疗、内分泌治疗以及可能的靶向治疗。

Objective To investigate the clinical characteristics,diagnosis and treatment of occult breast cancer.Methods Data of 9 patients with occult breast cancer were retrospectively analyzed.Results Primary tumors（3~8 mm） were detected in 6 of 9 postoperative patients.After follow-up for 1 to 8 years,5 of the 7 patients treated by mastectomy survived without local recurrence or distant metastases,1 patient had bone metastases 1 year after operation,and 1 patient died of brain,lung and bone metastases 1.5 years after operation.2 patients were treated by breast-conserving surgery,all survived without diseases.Conclusion Occult breast cancer should be considered in female patients with metastatic adenocarcinoma of the axillary lymph nodes and without obvious primary cancer.Treatment of the occult breast cancer could be breast-conserving surgery and axillary lymph node dissection,followed by radiotherapy to the full-breast and drainage areas of regional lymph nodes,and chemotherapy,endocrine therapy and possibly targeted therapy.