17例隐匿性乳腺癌诊疗体会

Experience in Diagnosis and Treatment of 17 Cases of Occult Breast Cancer

目的:总结隐匿性乳腺癌患者诊疗过程中遇到的各类问题及对该病的诊疗方法,改善对该病的临床治疗效果。方法:回顾性分析我科治疗的17例确诊为隐匿性乳腺癌患者的病历资料及出院后随访结果。17例隐匿性乳腺癌患者均实施乳腺癌改良根治术,并在术后根据其病理组织学及免疫组化结果施予内分泌治疗、放化疗等治疗方案。结果:17例隐匿性乳腺癌患者术后病理组织学结果中,有14例在乳房标本中发现原发肿瘤,其中乳腺导管内癌3例,乳腺浸润性导管癌11例,原发肿瘤径长范围为0.41~1.32 cm,3例在乳房标本内未发现原发肿瘤;在17例患者的乳房标本中癌细胞转移腋窝淋巴结数量范围为6~25个,平均7.35个;17例患者出院后随访1~5年,其中1例在术后第2年因骨转移死亡,2例在术后第2年因脑转移死亡,2例分别在术后第3、4年因肺转移死亡,剩余12例均无病存活。结论:隐匿性乳腺癌并无特异性的临床特征,影像学检查、免疫组化检测以及腋窝淋巴结检查对本病的确诊有重要的诊断价值;对本病的治疗应以乳腺癌改良根治术为主要治疗手段,在术后应综合考虑各类检查结果及患者现实情况,选择内分泌治疗、放化疗、生物治疗等治疗方案,可取得较好的临床治疗及预后效果。

Objective:To summarize the various problems encountered in the diagnosis and treatment of occult breast cancer and the diagnosis and treatment methods of the disease to improve the clinical therapeutic effect of the disease.Methods:The medical records and the follow-up results after discharge of 17 patients with confirmed occult breast cancer treated in our department from March 2012 to March 2016 were analyzed retrospectively.The 17 patients were treated with modified radical mastectomy,and after the operation they were treated with endocrine therapy,radiotherapy and chemotherapy according to the results of histopathology and immunohistochemistry.Results:Among the 17 cases of occult breast cancer,14 cases were found primary tumor in breast specimen,including 3 cases of intraductal breast cancer and 11 cases of invasive ductal carcinoma of breast.,The diameter of primary tumor was 0.41~1.32 cm No primary tumor was found in 3 cases of breast specimen.In 17 breast specimens,the number of breast cancer metastatic axillary lymph node ranged from 6 to 25,with an average of 7.35.17 cases were followed up for 1~5 years after discharge.One case died of bone metastasis in the second year,2 cases died of brain metastasis in the second year after operation,2 cases died of lung metastasis at the 3rd and 4th year,respectively.The remaining 12 cases survived without disease.Conclusion:Occult breast cancer has no specific clinical features.Imaging examination,immunohistochemical detection and axillary lymph node inspection have important diagnostic value for the diagnosis of this disease.The treatment of this disease should take the modified radical mastectomy as the main treatment method.All kinds of examination results and the actual situation of the patients should be considered synthetically after operation,and endocrine therapy,radiotherapy and chemotherapy,biotherapy and so on should be selected,which can obtain better effect on clinical treatment and prognosis.