乳腺导管内癌诊疗进展

Progress in diagnosis and treatment for ductal carcinoma in situ

近年来，随着乳腺癌钼靶筛查技术的应用和普及，乳腺导管内癌的检出率不断上升。熟悉乳腺导管内癌的临床表现、提高对乳腺导管内癌辅助检查结果的辨别能力，对诊断乳腺导管内癌至关重要。乳腺导管内癌的手术方式包括全乳腺切除、肿瘤局部广泛切除加放疗，以及单纯的肿瘤局部广泛切除；乳腺导管内癌常规不行腋窝淋巴结清扫已成为共识，前哨淋巴结活检仍存在争议；辅助全乳放疗和内分泌治疗可以减少局部复发，预防第二原发乳腺肿瘤，防止区域或远端转移的发生；但是各种治疗方法对乳腺导管内癌的预后影响不大，应该引起临床医师足够的重视。

Increases in diagnostic frequency of breast ductal carcinoma in situ（DCIS） have followed the introduction of mammographic screening in past years. It is very important to distinguish the clinical syn- drome of DCIS. The management of surgery for DCIS includes mastectomy, lumpectomy plus radiotherapy and lumpectomy alone; axillary lymph node dissection（ALND） in DCIS has not been recommended and sen- tinel lymph node biopsy（SLNB） is still controversial; adjuvant radiotherapy for ipsilateral whole breast and endocrine treatment can reduce local recurrence, prevent second primary breast tumor, preclude regional and distant metastasis. But whatever we take towards the DCIS above, there is little disturbance to DCIS ＇ s inher- ent prognosis. Doctors must pay enough attention to this point.