乳腺癌放疗相关性乳腺血管肉瘤的早期诊断策略研究

Study on early diagnosis strategy for radiation-associated breast angiosarcoma after breast cancer radiotherapy

目的 建立乳腺癌放疗相关性乳腺血管肉瘤（RABASBCR）早期诊断策略,减少误诊发生.方法 系统筛选文献,以公开发表的RABASBCR典型病例报道作为研究对象,分析发病早期的临床表现、影像学特征、活检方式等资料,筛选对早期诊断有价值的指标,建立早期诊断策略.结果 共筛选出55篇文献,包含80例RABASBCR患者.30％（24例）患者曾被误诊;中位误诊时间3个月（1～24个月）.95％ RABASBCR最早出现的症状是皮肤改变（76例）.超声、钼靶、CT、MRI误诊率分别为9/9、31/32、2/2和1/5.细针活检、粗针活检和切取活检的误诊率分别为7/14、12/25和10/26.结论 通过分析已发表的个案报道并参照Cahan标准,建立了RABASBCR早期诊断策略.

Objective To develop an early diagnosis strategy for radiation-associated breast angiosarcoma after breast cancer radiotherapy （RABASBCR） and to avoid the misdiagnosis of this disease.Methods A systematic search of PubMed for published reports of RABASBCR cases was performed.The clinical manifestations and radiological features in the early stage of disease,as well as biopsies,were analyzed to screen out valuable markers for early diagnosis and develop the early diagnosis strategy for RABASBCR.Results Fifty-five original articles involving 80 RABASBCR patients were selected for this analysis.Twenty-four （30％） of the 80 patients were misdiagnosed;the median time of misdiagnosis was 3 months （1-24 months）.The earliest symptom was skin changes in 76 （95％） of the 80 patients.The misdiagnosis rates of ultrasound,mammography,computed tomography,and magnetic resonance imaging for RABASBCR were 9/9,31/32,2/2,and 1/5,respectively.The misdiagnosis rates of fine needle biopsy,core needle biopsy,and incisional biopsy were 7/14,12/25,and 10/26,respectively.Conclusions By analyzing published case reports,we have set up the early diagnosis strategy for RABASBCR with reference to the Cahan criteria.