乳腺良性和交界性叶状肿瘤98例临床特征分析

Clinical characteristics and management principle of benign and borderline breast phyllodes tumor: An analysis of 98 cases

目的探讨乳腺良性及交界性叶状肿瘤(phyllodes tumor,PT)的临床特点、手术治疗方式和预后。方法回顾性分析2005-09-01—2015-12-31吉林大学第一医院乳腺外科行手术治疗的67例良性PT和31例交界性PT的临床及病理学资料、手术治疗方案和预后情况。结果乳腺良性和交界性PT病人的中位年龄分别为43岁和47岁,中位病程分别为4个月和8个月,中位肿瘤直径分别为3 cm和4 cm。粗针穿刺对良性及交界性PT的诊断准确率为38.5%(5/13),术中快速冰冻病理学检查准确率为47.6%。主要手术方式为乳腺区段切除术和单纯乳房切除术。中位随访时间为35个月。1例交界性PT在术后3年出现局部复发。结论良性和交界性PT多见于中年女性,非青春期的乳腺巨大肿瘤要考虑PT可能。目前的术前空芯针活检乃至术中快速病理学检查通常难以明确诊断和区分良性和交界性PT,最终的诊断取决于石蜡病理学检查。经外科治疗后,良性和交界性PT的总体预后佳。

Objective To study the clinicpathological characteristics, surgery and prognosis of benign and borderline breast phyllodes tumor （PT）. Methods The clinicpathological data, surgery method and prognosis of 67 cases of benign PT and 31 cases of borderline PT who received surgery in the First Hospital of Jilin University from September 1, 2005 to December 31, 2015 were analyzed retrospectively. Results The median age of benign PT and borderline PT cases was 43 year-old and 47 year-old, respectively. And the median course of disease was four months and eight months, respectively. The median tumor size was 3 cm and 4 cm, respectively. The diagnostic accuracy of core needle biopsy was 38.5% for benign and borderline PT, and fast frozen pathology was 47.6%, Lumpectomy and mastectomy were the common surgery procedure. The median follow-up time was 34 months. Only one case of borderline PT occurred local recurrence after three years. Conclusion Benign and borderline PT often occurs in middle-aged and old female. PT should be considered in non adolescent large breast tumor. It is difficult for core needle biopsy and fast frozen pathology to diagnosis and identify the benign and borderline PT. The final diagnosis depends on the paraffin pathology. The prognosis of benign and borderline PT is better after surgery treatment.