30例麦默通微创旋切术后确诊乳腺恶性肿瘤患者的诊治特点分析

Analysis of diagnosis and treatment of 30 patients with breast cancer diagnosed after Mamotomo minimally invasive atherectomy

目的分析30例麦默通微创旋切术后确诊乳腺恶性肿瘤患者的诊治特点。方法回顾性分析2015年1月至2019年8月莆田学院附属医院收治的30例经麦默通微创旋切术后证实为乳腺恶性肿瘤患者的临床资料,分析病理结果和乳腺恶性肿瘤患者的病理类型、乳腺癌发生部位、年龄分布及临床特征、手术方式、病理分期;乳腺恶性肿瘤直径与切缘关系及预后。结果病理结果显示,1986例患者中,乳腺恶性肿瘤30例,占比1.51%;平均肿瘤直径(13.2±1.3)mm。病理类型:导管原位癌9例(30.00%)、小叶原位癌2例(6.67%)、浸润性导管癌19例(63.33%)。乳腺癌发生部位:肿瘤位于外上象限16例(53.33%),外下象限6例(20.00%)、内下象限3例(10.00%)和内上象限5例(16.67%)。30例乳腺恶性肿瘤患者中,<35岁仅1例,占比0.15%;35~45岁11例,占比1.49%,>45岁18例,占比2.99%。彩超分级:BI-RADS分级中,4a类恶性肿瘤最高,占比73.33%。二次手术方式:导管原位癌中,保乳手术率为33.33%,非保乳手术率为55.56%;小叶原位癌中,保乳手术率为100.00%;浸润性导管癌中,保乳手术率为31.58%,非保乳手术率为68.42%。术后病理分期:0期和I期恶性肿瘤占比最高(86.67%)。二次手术检出残腔阳性率为30.00%。中位随访15个月,仅1例(3.33%)浸润性导管癌在同侧胸壁复发。结论年龄>45岁、彩超为4a类、肿物为多发多象限分布时,行麦默通微创旋切术需谨慎。麦默通微创旋切术后恶性肿瘤病灶残腔阳性率较高,一定程度上会降低保乳手术率,不建议其作为乳腺恶性肿瘤的常规治疗手段,推荐其仍作为乳腺癌的活检手段之一。

Objective The analyzethe diagnosis and treatment characteristics of 30 patients with breast cancer diagnosed after Mammotome minimally invasive atherectomy.Methods The clinical data of 30 patients with breast cancer confirmed by Maimerton minimally invasive atherectomy admitted to the Affiliated Hospital of Putian University from January 2015 to August 2019 were analyzed retrospectively,the pathological types and distribution of breast cancer in breast cancer sites were analyzed;the age distribution of patients with breast cancer;the clinical characteristics,surgical methods and pathological stages of patients with breast malignant tumors;relationship between the diameter of breast malignant tumor and the margin,and prognosiswere analyzed.Results Pathological results showed that among the 1986 patients,30 cases of breast cancer accounted for 1.51%;the average tumor diameter was(13.2±1.3)mm.Pathological types:9 cases(30.00%)of ductal carcinoma in situ,2 cases(6.67%)of lobular carcinoma in situ,and 19 cases(63.33%)of invasive ductal carcinoma.The location of breast cancer:16 cases(53.33%)were located in the upper outer quadrant,6 cases(20.00%)in the lower outer quadrant,3 cases(10.00%)in the lower inner quadrant and 5 cases(16.67%)in the upper inner quadrant.The location of breast cancer:16 cases(53.33%)were located in the upper outer quadrant,6 cases(20.00%)in the lower outer quadrant,3 cases(10.00%)in the lower inner quadrant and 5 cases(16.67%)in the upper inner quadrant.Among the 30 breast cancer patients,only 1 case was<35 years old,accounting for 0.15%;11 cases were 35-45 years old,accounting for 1.49%,and 18 cases were>45 years old,accounting for 2.99%.Color Doppler ultrasound grading:in the BI-RADS classification,4a malignant tumors were the highest,accounting for 73.33%.Secondary surgery:in ductal carcinoma in situ,the rate of breast-conserving surgery was 33.33%,and the rate of non-breast-conserving surgery was 55.56%;in lobular carcinoma in situ,the rate of breast-conserving surgery was 100.00%;in invasive ductal carcinoma,the rate of breast-conserving surgery was 31.58%,and the rate of non-breast-conserving surgery was 68.42%.Postoperative pathological staging:stage 0 and stage I malignant tumors accounted for the highest proportion(86.67%).The positive rate of residual cavity detected by the second operation was 30.00%.During a median follow-up of 15 months,only 1 case(3.33%)of invasive ductal carcinoma recurred in the ipsilateral chest wall.Conclusions>45 years old,the color Doppler ultrasound is class 4a,and the tumors are multiple and multi quadrant distribution,which should be cautious to perform maimerton minimally invasive rotary resection.The positive rate of residual cavity of malignant tumor lesions after Mammotome minimally invasive atherectomy is relatively high,which reduces the the rate of breast-conserving surgery to some extent.It is not recommended as a surgical treatment for breast malignant tumors.It is recommended as one of the biopsy methods for breast cancer.