乳腺选择性导管造影在溢液性乳腺癌诊断中的应用

目的探讨溢液性乳腺癌在选择性乳腺导管造影及普通数字乳腺X线摄影中的影像表现,评价选择性乳腺导管造影在溢液性乳腺癌诊断中的应用价值。方法经手术病理证实,溢液性乳腺癌均在术前行乳腺X线检查及选择性乳腺导管造影检查,计算影像诊断与手术病例结果的符合率。结果 105例入选患者中,单独行乳腺X线检查,影像诊断与手术结果相符合的为71例,占67.6%;选择性乳腺导管造影检查结诊断结果与手术相符合为98例,占93.3%。结论选择性乳腺导管造影对于溢液性乳腺癌具有重要的诊断价值。

彩色多普勒超声诊断乳腺癌50例超声声像图分析

目的:探讨乳腺癌的超声图像特征,诊断及鉴别诊断要点。方法:采用二维超声、超声血流图(CDFI)、频谱多普勒对50例乳腺癌患者进行超声检查,分析病变的形态、边缘、内部回声、包膜、纵/横比、有无钙化灶、血流信号分布等情况,并与术后病理结果对比。结果:经病理证实乳腺癌50例,周边及内部均见丰富彩色血流信号显示,穿通血管和分支血管居多。内部均见大量散在钙化或簇样钙化。30例有同侧腋窝淋巴结群肿大。结论:二维超声结合CDFI及频谱多普勒在乳腺癌诊断及鉴别诊断中有很好的临床应用价值,并可作为乳腺癌普查的一种常用手段。

数字X线摄影对早期乳腺癌的诊断价值

乳腺癌是最常见于女性的恶性肿瘤之一，乳腺癌发病率占全身恶性肿瘤的10％左右，在许多西方国家中，其乳腺癌的发病率在女性肿瘤中始终居首位。我国近年的统计资料表明，发病率在很多大城市已跃居女性恶性肿瘤的首位，且发病年龄趋于年轻化。早期发现、早期诊断、早期治疗是降低乳腺癌病死率的关键。

超声技术在乳腺癌诊断中的应用

乳腺癌为中年女性最常见的恶性肿瘤之一，发病率为10％-15％。近年来其发病率明显上升，其城市化、低龄化倾向已逐渐引起人们的注意，已升至女性恶性肿瘤中的第1位。男性乳腺癌患病率虽较妇女低，但近期也屡见报道。

乳腺癌患者血清CA153、CEA联合检测的临床意义

目的:应用ELISA法测定80例乳腺癌、50例乳腺良性疾病及30例健康体检者血清肿瘤相关抗原153(CA153)、癌胚抗原(CEA)水平。方法:抽取静脉血,采用ELISA法检测CA153、CEA的含量。结果:初治、治疗无效及复发转移的乳腺癌患者血清CA153、CEA水平均明显高于乳腺良性疾病、健康体检者和治疗显效组的水平。CA153、CEA指标联合检测的敏感性及准确性高于任意单项检测,而特异性以CA153为最高。结论:CA153、CEA指标联合检测对判断乳腺癌预后及监控其复发和转移有较高的应用价值。

AE1/AE3在乳腺癌患者腋窝淋巴结微转移检测中的意义

目的探讨广谱细胞角蛋白免疫组织化学染色法检测乳腺癌患者腋窝淋巴结微转移的可行性以及乳腺癌患者腋窝淋巴结微转移与临床病理因素的关系及其意义。方法利用AE1/AE3免疫组织化学染色法对常规病理检查腋窝淋巴结转移阴性的50例乳腺癌患者的617枚腋窝淋巴结进行微转移检测并进行统计分析。结果 50例患者中有11例有微转移,微转移与肿瘤大小、CerbB-2表达水平、病理分期正相关(P<0.05)。结论应用AE1/AE3免疫组织化学法检测腋窝淋巴结微转移是可行的,对指导治疗、判断预后具有积极的临床意义。

副乳腺癌6例

目的探讨副乳腺癌的临床特点以及诊治方法。方法对所收治的6例副乳腺癌患者的临床资料进行回顾性研究。结果 6例均行经典乳腺癌改良根治术,术后辅以放疗、化疗或内分泌治疗。随访4例出现远处转移并死于该病,2例健在。结论副乳腺癌临床少见,易误诊,诊断主要依靠影像学和术后病理,综合治疗有助于提高生存率。

河南省肿瘤诊疗质量控制中心乳腺癌规范化病理诊断专家共识

乳腺癌的发病率位居女性恶性肿瘤的首位。随着医疗水平的提高,乳腺癌已经成为疗效最佳的实体肿瘤之一。而规范化的乳腺癌病理报告,对于临床选择适合而有效的手术方式及治疗方案尤为重要。但在病理诊断工作中仍然存在不规范的情况,特别是新辅助治疗后的标本取材及病理诊断等方面。为推动河南省乳腺癌规范化诊治,由河南省肿瘤诊疗质量控制中心乳腺癌专家委员会参照国内外的乳腺癌相关诊疗指南制定了本共识。

河南省肿瘤诊疗质量控制中心乳腺癌规范化病理诊断专家共识

乳腺癌的发病率位居女性恶性肿瘤的首位。随着医疗水平的提高,乳腺癌已经成为疗效最佳的实体肿瘤之一。规范化的乳腺癌病理报告,对于临床选择合适而有效的手术方式及治疗方案尤为重要。但在实际病理诊断工作中,很多方面仍然存在不规范的情况,特别是新辅助治疗后的标本取材及病理诊断等方面。为推动河南省乳腺癌的规范化诊治,由河南省肿瘤诊疗质量控制中心乳腺癌专家委员会参照国内外的乳腺癌相关诊疗指南制定了本共识。

Measurement of Serum Total and Free Prostate-Specific Antigen for Breast Cancer Diagnosis in Women

Objective: To investigate the diagnostic value and the relationship between the clinicopathological features and the levels of total and free prostate-specific antigen (PSA) in women with breast cancer.Methods: Using the microparticle enzyme immunoassay system, we measured the concentrations of these markers in the sera of 85 women with breast cancer and in 30 healthy women.Rseults: The lowest detection level for both markers was 0.01 ng/ml. Free PSA levels were significantly higher in women with breast cancer than that in healthy women (P<0.05). The percentage of free PSA predominant subjects was 37.6% in breast cancer patients and 3.3% in healthy women. Cut-off values were 0.36 ng/ml for total PSA and 0.02 ng/ml for free PSA. In women with breast cancer, total PSA positivity was 23.5% and free PSA positivity was 27.1%. Compared to negatives, total PSA positive patients had a higher percentage of lymph node involvement tumours (P>0.05). However, patients with predominant free PSA had a higher percentage of early stage than patients with predominant PSA-ACT.Conclusion: Although the sensitivity of free PSA predominance is low (37.6%) in distinguishing women with breast cancer from healthy women, its specificity is high (97.0%).Free PSA predominance tends to be present in early stage tumours. These findings may indicate clinical significance of preoperative measurement of serum total and free PSA in women with breast cancer.

Utility of an upright-type 11-gauge stereotactic vacuum-assisted biopsy device (Mammotome) for the diagnosis of breast microcalcifications

Objective: The aim of this study was to evaluate the utility of an upright-type 11-gauge stereotactic vacuumassisted biopsy device (Mammotome) for the diagnosis of breast microcalcifications Methods: Between May 2001 and October 2005, 154 biopsies in 152 patients with microcalcifications were performed using the upright-type 11-gauge stereotactic vacuum-assisted biopsy device. Patients in whom this biopsy was diagnosed as carcinoma or a borderline lesion, had a subsequent surgical excision of the lesion. Histopathological and radiological features of the two specimens were then compared with each other. Results: Microcalcification was identified on specimen mammograms and microscopic slides in 97.4% of cases. Of 154 Mammotome biopsies 98 (63.6%) were benign, 51 (33.1%) were malignant, 3 (1.9%) showed atypical hyperplasia, and 2 (1.3%) were indeterminate, respectively. Of the 48 cases that received surgical excision, 6 of 36 ductal carcinomas in situ (16.7%) upstaged to invasive ductal carcinoma and 1 of 2 atypical ductal hyperplasias was upstaged to ductal carcinoma in situ. The positive predictive value of the 11-gauge Mammotome for the diagnosis of invasion in breast cancer was 100%. Linear calcification and pleomorphic calcification linear/segmental distribution was reliable indications of malignancy. The mean follow-up time of the benign lesions was 22 months, and without evidence of lesion growth. Complications included vasovagal reactions (6.3%), bleeding (0.6%) and hematoma (2.6%). Conclusion: The upright stereotactic 11-gauge Mammotome procedure is an effective and reliable method for the diagnosis of breast microcalcifications. It has minimal side effects. For lesions diagnosed as ADH or DCIS with the 11-gauge Mammotome, subsequent surgical excision should be performed.

ROC analysis of CT hemodynamic in the diagnosis of breast cancer

Objective:The aim of this study was evaluate the diagnostic value of computed tomography(CT) perfusion in breast cancer by the method of receiver operator characteristic curve(ROC) analysis.Methods:Eighty-one cases with breast masses found by health examination or mammography were scanned by multi-slice spiral CT(MSCT) perfusion and hemodynamic parameters of blood flow(BF), mean transit time(MTT) and blood volume(BV) were calculated by deconvolution arithmetic.According to the pathologic results, two groups, benign and malignant were classified and statistical analysis were performed between them.The ROC characteristics of BF, MTT, BV were compared for each and the diagnostic value of the hemodynamic parameters were confirmed.Results:In the malignant group, BF was(0.735 ± 0.440) mL/min/mL, MTT was(22.771 ± 7.647) s and BV was 0.234 ± 0.082.In the benign group, BF was(0.466 ± 0.527) mL/min/mL, MTT was(26.712 ± 12.934) s and BV was 0.179 ± 0.117.There was a significant difference for BF and BV between the benign and malignant groups.When the hemodynamic parameters were used to discriminate the breast lesions, the area under the ROC curve(AUCROC) of BF was 0.832 ± 0.086, the maximum, while AUCROC of BV was 0.695 ± 0.092.There was no significant statistical difference between BF and BV.AUCROC of MTT was 0.473 ± 0.102, which was minimal.Since the threshold of BF was 0.381 mL/min/mL, the sensitivity was 82.3%, the specificity was 73.2%, the positive likelihood ratio(LR) was 3.071 and the negative LR was 0.242.The threshold of BV was 0.190 with sensitivity 73.3%, specificity 56.5%, positive likelihood ratio 1.685 and negative LR 0.473.Conclusion:BF and BV among CT hemodynamic parameters have certain diagnostic value in breast cancer, but BF or BV can not yet be single index to confirm or deny the diagnosis.

Diagnosis and treatment of peripherally inserted central catheters(PICC)-related sepsis in breast cancer patients carrying PICC catheter for chemotherapy

Objective:The aim of our research was to study the incidence,clinical diagnosis and treatment of peripherally inserted central catheters(PICC)-related sepsis in breast cancer patients carrying PICC catheter for chemotherapy.Methods:The data of the incidence,diagnosis and treatment of PICC-related sepsis in 215 cases of breast cancer patients carrying PICC catheter for chemotherapy in our hospital from August,2009 to September,2011 were analyzed retrospectively.Results:216 PICCs had been successfully applied in 215 cases of breast cancer patients and followed for a total of 19,109 catheter days,(median catheterization duration,88.9 days,range 1-212 days).Among those,3(1.39%) PICCs were removed respectively as a result of PICC-related sepsis in 29,73 and 108 catheter-days(median 70 d),with a rate of 0.16 per 1000 catheter-days.Conclusion:Chemotherapeutic treatment via PICC for breast cancer patients is one of the most secure and effective measures but there exists small number of cases in which PICC catheter related sepsis is possible.Careful observation of relevant symptoms and signs,early diagnosis and treatment,not relying completely on blood culture tests and timely removal of PICC catheter can be very effective in treating PICC-related sepsis in these patients.

Serological Diagnosis of Liver Metastasis in Patients with Breast Cancer

Objective To diagnose and explore the serological diagnostic factors for liver metastasis in patients with breast cancer before symptoms occur. Methods A total of 430 female in-patients with breast cancer of stages 0 to IIIC who came to Tianjin Medical University Cancer Institute and Hospital from January 2003 to January 2004 were studied and followed up until May 2011. Serum levels of biochemical markers for tumor and liver were measured at the time of diagnosis. Results Liver metastasis was more likely to occur in patients with stage Ill cancer or c-erbB-2-positive expression. Alanine aminotransferase, aspartate aminotransferase, ~/-glutamyltransferase （GGT）, alkaline phosphatase, lactate dehvdrogenase （LDH）, and carbohydrate antigen 1153 （CA153） levels were significantly higher in patients with liver metastasis than those without liver metastasis. Diagnostic indices of LDH, GGT, and CA153 were 174 U/L, 32 U/L, and 26.48 Dg/L, respectively. The areas under the curves of LDH, GGT, and CEA were 0.795, 0.784, and 0.661, respectively, and sensitivities of parallel tests for LDH and CA153 and for GGT and CA153 were 88.6% and 85.7 %, respectively. The specificity of serial tests for both pairs of enzymes was 97.7%. Conclusions Tile sensitivity and specificity of combined tumor and biochemical markers could be used as indicators during screening for breast-liver metastasis.

Mammography combined with breast dynamic contrast-enhanced-magnetic resonance imaging for the diagnosis of early breast cancer

Objective The aim of this study was to investigate the application of mammography combined with breast dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI) for the diagnosis of early breast cancer. Methods Mammography and DCE-MRI were performed for 120 patients with breast cancer(malignant, 102; benign; 18). Results The sensitivity of mammography for early diagnosis of breast cancer was 66.67%, specificity was 77.78%, and accuracy was 68.33%. The sensitivity of MRI for early diagnosis of breast cancer was 94.12%, specificity was 88.89%, and accuracy was 93.33%. However, the sensitivity of mammography combined with DCE-MRI volume imaging with enhanced water signal(VIEWS) scanning for early diagnosis of breast cancer was 97.06%, specificity was 94.44%, and accuracy was 96.67%. Conclusion Mammography combined with DCE-MRI increased the sensitivity, specificity, and accuracy of diagnosing early breast cancer.

The application of breast DCE-MRI combined with time signal curve in diagnosing early breast cancer

Objective： The aim of this study was to investigate the application value of breast dynamic contrast-enhanced magnetic resonance imaging combined with time signal curve in diagnosis of early breast cancer. Methods： Conducted dynamic contrast-enhanced MRI and drew the time signal curves of breast lesions in 60 patients with breast disease （malignant 46, benign 14）. Results： Morphological features of malignant tumors mostly showed blurred or thin spiculate outlines, irregular shape or Iobular signs, signal heterogeneity or peripheral enhancement in dynamic contrast-enhanced MRI. Time signal curve showed type III or II. Morphologic features of benign tumors mostly showed clear edge, regular shape and homogeneous signal, or diffuse spot enhancement. Time signal curve showed type I or II. Conclusion： breast dynamic contrast enhanced scan in MRI can provide morphology and functional diagnosis information of the breast tissues. Dynamic contrast-enhanced MRI combined with time signal curve can further improve the accuracy of diagnosis of early breast cancer.

Is sentinel lymph node biopsy necessary for the patients diagnosed with breast ductal carcinoma in situ using core needle biopsy or vacuum-assisted biopsy as the initial diagnostic method？

Axillary lymph node status is one of the most important prognostic indicator of survival for breast cancer, especially in ductal carcinoma in situ （DCIS）. The purpose of this study was to investigate whether sentinel lymph node biopsy （SLNB） should be performed in patients with an initial diagnosis of DCIS. Methods： A retrospective study was performed of 124 patients with an initial diagnosis of DCIS between March 2000 and June 2014. The patients were treated with either SLNB or axillary node dissection during the surgery, and we compared the clinicopathologic characteristics, image features, and immunohistochemical results. Results： Eighty-two patients （66.1%） had pure DCIS and 25 （20.2%） had DCIS with microinvasion （DCISM）, 17 （13.7%） updated to invasive breast cancer （IBC）. 115 patients （92.7%） underwent SLNB, among them, 70 patients （56.5%） underwent axillary node dissection. 3 of 115 patients （2.6%） had a positive sentinel lymph node, only 1 （1.4%） of 70 patients had axillary lymph node metastasis, in 84 patients （66.7%） who were diagnosed DCIS by core needle biopsy （CNB） and vacuum-assisted biopsy （VAB）. 26 patients （31.0%） were upstaged into IBC or DCISM in the final histological diagnosis. The statistically significant factors predictive of underestimation were large tumor size, microcalcifications, comedo necrosis, positive Her-2 status, negative estrogen receptor status. Conclusion： The metastasis of sentinel lymph nodes in pure DCIS is very low, but the underestimation of invasive carcinoma in patients with an initial diagnosis of DCIS is an usual incident, especially in the cases when DCIS is diagnosed by CNB or VAB. Our findings suggest patients presenting with a preoperative diagnosis of DCIS associated with large tumor sizes, microcalcifications, comedo necrosis, positive Her-2 status, negative ER status are more likely to be DCISM and IBC in final diagnosis. SLNB should be performed in this part of patients.

Diagnostic accuracy of real-time tissue elastography for breast cancer:a meta-analysis

Objective The present study aimed to determine the accuracy of real-time tissue elastography （RTE） for the diagnosis of breast cancer. Methods The search was conducted in the PubMed, Web of Science, Cochrane Library, and China Biology Medicine databases from inception through December 31, 2014, without language restrictions. The meta-analysis was conducted using STATA version 12.0 and Meta-Disc version 1.4. We calculated the summary statistics for sensitivity （Sen）, specificity （Spe）, positive and negative likelihood ratio （LR＋/LR–）, diagnostic odds ratio （DOR）, and summary receiver operating characteristic （SROC） curve. Results Ten studies that met al inclusion criteria were included in the meta-analysis. A total of 608 ma-lignant breast lesions and 1292 benign breast tumors were assessed. Al breast lesions were histological y confirmed after RTE. The pooled Sen was 0.83 （95% CI = 0.79–0.86）; the pooled Spe was 0.86 （95% CI = 0.84–0.88）. The pooled LR＋ was 9.87 （95% CI = 2.66–36.71）; the pooled LR– was 0.20 （95% CI = 0.17–0.23）. The pooled DOR of RTE for the diagnosis of breast cancer was 62.21 （95% CI = 33.88–114.24）. The area under the SROC curve was 0.9334 （standard error = 0.00125）. We found no evidence of publica-tion bias （t = –0.57, P = 0.582）. Conclusion RTE may have high diagnostic accuracy for the dif erential diagnosis of benign and malig-nant breast tumors. RTE may be a good tool for breast cancer diagnosis.

The value of 18-FDG-PET for diagnosing and evaluating lymph node metastasis in primary breast cancer

Objective: To analyze the result of 18F-2-deoxy-2-fluoro-D-glucose-positron emission tomography (FDG-PET) in suspicious primary breast cancer patients and to evaluate its value for the surgery therapy. Methods: Total 36 patients suspected of breast neoplasm were enrolled into the research. The result was compared with the pathology result. The rate of missed diagnosis, the rate of mi.sdiagnosis. the sensitivity and specificity were calculated and analyzed. Results:Compared with the pathology results, the misdiagnosis rate. the rate of missed diagnosis. the sensitivity and specificity of FDG-PET for breast cancer were 0% , 36. 36%. 63. 63% and 100%, respectively. To those who had a neoplasm no more than 2 cm in diameter, the rate of missed diagnosis was as high as 41. 67%. To 33 breast cancer patients, the misdiagnosis rate, the rate of missed diagnosis, the sensitivity and specificity for lymph node metastasis were 18. 75%, 41. 18%, 58. 82% and 81. 25%, respectively. Conclusion:FDG-PET has a perfect specificity and a considerable sensitivity to the primary breast neoplasm and similar to the lymph node metastasis diagnosis. It is an ideal choice for those patients with suspected breast cancer but reluctantly to receive a vulnerarious examination.

RASSFIA Promoter Hypermethylation as a Prognosis and Diagnosis for Breast Cancer in Vietnamese Population

Aberrant tumor suppressor gene promoter methylation was associated with the several cancers, including breast cancer, which was the common female deaths in most countries involved in Vietnam. The methylation in tumor suppressor genes, including RASSFIA, were the key targets of establishing the potential biomarkers for prognosis and early diagnosis of breast cancer. In present study, with the aim towards using the hypermethylation at CpG islands of promoter of RASSFIA as the biomarker for breast cancer in Vietnamese population, MSP （methyl specific PCR） was carried out to analyze the hypermethylation status ofRASSFIA gene in 115 samples including 95 breast cancer specimens and 20 normal breast tissues from another disease （not breast cancer）. All samples were obtained from Ho Chi Minh City Medical Hospital, Vietnam. The known predictive and prognostic factors： HER2/neu overexpression was immunohistochemistry stained as input value for breast cancer specimens. For input value confirmed, the overexpression of p53 protein was also analyzed together with prior immunochemical assay. The results indicated that the hypermethylation of frequencies for methylation of given gene reached 42.1% （P 〈 0.05）. In addition, the DNA hypermethylation of RASSFIA gene increased the possibility to be breast cancer with high incidence via calculated of odd ratio （P 〈 0.05）. In conclusion, the hypermethylation of candidate genes could be used as the promising biomarkers applying in Vietnamese breast cancer patients.