性质未定乳房包块伴簇状钙化病灶手术治疗效果

SURGICAL TREATMENT FOR INDETERMINATE BREAST MASS WITH CLUSTER CALCIFICATION

目的探讨术前穿刺活检未确定性质、影像学表现为乳房包块伴周边簇状钙化灶的手术方法及其治疗效果。方法对23例穿刺活检未确定性质的乳房包块伴周边簇状钙化灶的病人,应用全数字化平板乳房机（FFDM）对钙化灶进行坐标定位,采用翼状切口整体切除乳房包块、钙化病灶及距包块1cm周围组织（触诊）,术中应用FFDM法复检标本,同时行广基腺体及脂肪组织瓣翻转移位Ⅰ期乳房内成形术。结果 2例病理检查示导管上皮不典型增生,7例为炎性肉芽肿,3例为导管内癌,9例为浸润性导管癌,2例为黏液癌。23例病人中22例行保乳手术（恶性病人术后进行辅助治疗）,1例病人行保留乳头乳晕皮下腺体切除术。坐标法定位病灶的准确率为100%（23/23）。对13例恶性病灶切缘阴性、FFDM复检无病灶残留及9例良性病变病人均采用广基腺体及脂肪组织瓣翻转移位Ⅰ期乳房内成形术,按JCRT标准评定疗效,优率为86.3%（19/22）。病人随访时间为6~31个月（中位随访时间为20个月）,无远处转移及局部复发者。结论对乳房包块伴周边簇状钙化病灶的病人,采取翼状切口整体切除乳房包块、钙化病灶及距包块周围1cm组织（触诊）,同时行广基腺体及脂肪组织瓣翻转移位Ⅰ期乳房内成形术,疗效满意,尤其适用于国人较小的乳房。

Objective To explore surgery and its efficacy for breast masses with cluster calcification on imaging features but the nature was not determined by preoperative puncture biopsy. Methods A surgery was done in 23 patients with breast masses with duster calcification- their nature of preoperative puncture biopsies was not determined. Applying full field digital mammograpby （FFDM）, coordinate positioning of calcified loci was done. Applying the wing incision, the total mass, including calcified foci and one cm peripheral tissue from the package block, was removed. FFDM was applied again at surgery to re-test the specimens, and, at the same time, wide basal gland and adipose tissue turnover in the one-stage breast shaping was performed. Results Postoperative pathology results were as follows： atypical duetaI hyperplasia （n = 2）, inflammatory granuloma （n = 7）, intra-ductal carcinoma （n=3）, infiltrating ductal carcinoma（n=9） and mucinous carcinoma （n=2）. In the 23 patients,22 underwent breast-conserving surgery--a postoperative adjuvant therapy was carried out for malignant patients-and one patient received the nipple sparing subcutaneous mastectomy. The accuracy of coordinate method for lesion localization was 100% （23/23）. For 13 cases of malignancy with negative resection margin and no residual lesion based on FFDM recheck, as well as nine cases of benign lesion were all underwent wide basal gland and adipose tissue turnover in one-stage breast shaping, according to JCRT criteria, the excellent rate being 86.3%（19/22）. A follow-up of six to 31 months （median time 20 months） showed no distant metastasis and local recurrence. Conclusion For patients with breast masses accompanying peripheral cluster calcification, the curative effect of one-stage breast shaping is satisfactory, which is especially applicable for the Chinese people with smaller breasts.