隐匿性乳腺癌72例临床病理特征和预后分析

Clinicopathological features and prognosis analysis of 72 patients with occult breast cancer

目的：分析隐匿性乳腺癌（ occult breast cancer ，OBC）的临床病理特征及预后情况，了解患者生存状态并探讨其最佳诊疗方案。方法回顾性分析72例经手术和病理证实的OBC的临床资料，并将同期320例非OBC作为对照组探讨其预后情况。结果72例均以腋窝肿物为首要症状。 MRI乳腺内可疑病灶检出率为71.4％，高于钼靶 X 线摄影的53.5％，2者差异有统计学意义（χ2＝11.876， P ＝0.001）。腋下淋巴结转移灶癌细胞多为中-低分化，表现为淋巴结弥漫浸润的成片的大Apocrine样细胞；免疫组化CK7、CK20和TTF-1的阳性率分别为96.7％、6.7％和3.3％，与对照组相比差异无统计学意义（χ2＝0.058，P＝0.810）；ER、PR的阳性率分别为46.7％和36.7％，显著低于对照组，差异有统计学意义（χ2＝4.535，P＝0.033）。临床分期、术式、淋巴结转移数目是影响其预后的独立因素。结论 OBC以腋窝肿物为首要症状，MRI联合免疫组化更有利于OBC的诊断与鉴别诊断；OBC的ER、PR阳性率低，改良根治术联合辅助治疗可能是更好的治疗选择。

Objective To analyze the clinicopathological features and prognosis of patients with occult breast cancer （ OBC） , as well as to explore the best treatment .Methods The clinical data of 72 patients with OBC confirmed by pathology were retrospectively analyzed , while 320 cases with other kind of breast cancer were the control group .Results Axillary mass was the first sign of the 72 patients with OBC.The diagnosis rate of MRI was higher than mammary graphy （ 71.4% vs 53.5%） .The difference had statistical significance （χ2 =11.876, P=0.001） .The characteristics of OBC with axillary lymph node metastasis was mainly moderately or low differenti -ated, usually with diffuse infiltrative cancer cells , flaky, like large Apocrine cells.Compared with the control group, the positive rate of CK7, CK20 and TTF-1 had no statistical differences （χ2 =0.058, P=0.810）.The posi-tive rate of ER and PR was 46.7% and 36.7%, lower than the control group （χ2 =4.535, P=0.033）.Clinical stage, operating method and the number of lymph node metastasis may be the independent factors influencing prog -nosis.Conclusions Axillary mass is the first symptom of OBC .To combine MRI with immunohistochemistry is helpful in diagnosis and differential diagnosis of the disease .The positive rate of ER and PR for OBC patients is low.Modified radical mastectomy combined with adjuvant therapy may be the better choice .