Lymphocyte subsets predictive value and possible involvement of human papilloma virus infection on breast cancer molecular subtypes

AIM To detect human papilloma virus(HPV) presence and to characterize cellular immune response in breast cancer patients. METHODS A total of 74 women were included, of which 48 samples were from patients diagnosed with breast cancer and 26 patients with benign pathology of the breast. Molecular subtype classification was performed based on the immunohistochemical reports of the tumor piece. HPV genome detection and genotyping from fresh breast biopsies was performed using the INNO-LIPA HPV Genotyping Extra test(Innogenetics, Ghent, Belgium). CD3+, CD4+, CD8+ and natural killer(NK)+ cells levels from peripheral blood samples from patients with breast cancer and benign pathology were measured by flow cytometry. RESULTS Luminal A was the most frequent breast cancer molecular subtype(33.33%). HPV was detected in 25% of the breast cancer patients, and genotype 18 was the most frequent in the studied population. The mean of CD3+, CD4+ and CD8+ subpopulations were decreased in patients with breast cancer, in relation to those with benign pathology, with a statistically significant difference in CD8+ values(P = 0.048). The mean of NK+ cells was increased in the benign pathology group. The average level of CD3+, CD4+, CD8+ and NK+ cells decreased as the disease progressed. HER2+ and Luminal B HER2+ tumors had the lowest counts of cell subsets. HPV breast cancer patients had elevated counts of cellular subsets. CONCLUSION Determining level changes in cellular subsets in breast cancer patients is a useful tool to evaluate treatment response.

Efficacy and prognosis of vacuum-assisted excision for benign intraductal papilloma of breast:A meta-analysis

Objective:To evaluate the safety and effectiveness of vacuum-assisted excision for benign intraductal papilloma of breast.Methods:The databases including PubMed,Embase,Cochrane Library,WangFang,CNIK,VIP and Web of Science were searched by computer,according the inclusion and exclusion criteria after screening of literature.The Cochrane handbook and Newcastle-Ottawa scale was used to evaluate the studies.Then the Review Manager 5.3 software was to used analyze the data.Results:A total of 1016 patients was included in 9 articles.The amount of blood loss in vacuum-assisted surgery was less than that in open surgery[MD=-6.38,95%CI(-9.90,-2.86),P<0.05].The drainage[MD=-2.56,95%CI(-4.97,-0.15,P<0.05]and drainage time[MD=-0.25,95%CI(-0.40,-0.09),P<0.05]in vacuum-assisted surgery was less than that in open surgery.There were also few postoperative complications than that in open surgery[RR=0.43,95%CI(0.29,0.64),P<0.05].Compared with open surgery,the postoperative recurrence rate was lower in vacuum-assisted surgery[RR=0.26,95%CI(0.14,0.49),P<0.05].Last,there was no statistically significant difference in the operative time between vacuum-assisted surgery and open surgery,[SD=-12.82,95%CI(-25.70,0.06),P=0.05].Conclusion:Compared with open surgery,vacuum-assisted excision has the advantages of less blood loss and lower postoperative complications,but the operative time is not statistically significant compared with open surgery.In addition,compared with open surgery in this study,vacuum-assisted excision has the advantages of lower recurrence rate,but it still needs long-term dynamic observation.

Intraductal papilloma of the breast in association with preoncogenic gene of breast cancer

We reported a case of an African American woman who went to the hospital with palpable right breast lump with bloody nipple discharge at University of Texas Medical Brand at Galvestion. The modalities of breast imagings included mammography and ultrasongraphy.The method used for viral identification was Linear Array HPV genotyping test Intraductal papilloma revealed as high density tubular or rounded lobular masses with partially circumscribed,obscured margins and clustered punctate microcalcifications on mammograms.Ultrasound showed as intraductal masses with dilated ducts.The core biopsy demonstrated duct filled with papillary lesion and post excision revealed intraductal papilloma.HPV DNA types 16,33,58 and 71 were detected after use of Linear Array HPV genotyping test.

Clonal Analysis of Peripheral Papilloma and Cancerous Cells of the Breast

OBJECTIVE Because almost al malignancies represent monoclonal proliferations,we have studied the clonal status of peripheral papil omas (peri-PM),ductal carcinomas in situ(DCIS),and normal breast tissues to explore a reliable way to distinguish benign and malignant(or pre-malignant) cases previously diagnosed morphologically. METHODS Twenty-six cases of peri-PM,25 cases of peri-PM with atypical ductal hyperplasia(ADH),27 cases of DCIS,16 cases of developed canceration and 20 specimens of normal tissue were examined in the study.The clonal status of these tissues was studied using an assay based on inactivation mosaicism of the lenth-polymorphic X-chromosomes at the androgen receptor(AR)locus. RESULTS Loss of polymorphism at the AR locus was found in all DCIS cases and 10 cases(10/25,40.0%)of peri-PM with ADH,indicating the monoclonality of the tumors.Twenty-four out of 26(92.3%)cases with peri-PM and 19 specimens of normal tissue were shown to be polyclonal.In 16 cases of developed canceration,identical X chromosome inactivation(monoclonal alterations)was observed from both the peri-PM with ADH part,and the DCIS part in each case. CONCLUSION These results contribute to the understanding of the genetic changes of peri-PM,and confirm the peri-PM withADH as a precancerous lesion of the breast.Clonal analysis might be a useful modality to screen high-risk cases from precancerous lesions or to distinguish between benign hyperplasia and early carcinoma.

超声特征列线图模型在乳腺导管原位癌和导管内乳头状瘤鉴别诊断中的应用

目的:分析乳腺导管原位癌(DCIS)和导管内乳头状瘤(IDP)的临床及超声特征,构建DCIS与IDP的列线图预测模型。方法:选取经病理证实的156例(212个)DCIS和158例(238个)IDP的患者资料,经单因素和多因素分析评估超声诊断DCIS的影响因素,建立诊断模型,明确各超声征象在诊断中的价值。结果:单因素分析结果显示,两组在年龄、病史、结节长径、体积、边缘、后方回声、钙化、彩色多普勒血流成像(CDFI)及阻力指数(RI)等方面差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,结节周围导管无异常、后方回声衰减、出现微钙化及RI≥0.70时,倾向于DCIS;结节周围导管为单纯性扩张或乏血供时,倾向于IDP。将这些指标纳入列线图模型,在训练集和验证集中均显示出较高的预测性能、校准和临床价值。结论:超声特征列线图模型可以便捷鉴别DCIS和IDP,当结节周围导管无异常、后方回声衰减、出现微钙化、RI≥0.70时应警惕DCIS的发生。

超声造影联合乳腺钼靶X线对乳腺导管内乳头状瘤的诊断价值

目的:研究分析超声造影联合乳腺钼靶X线对乳腺导管内乳头状瘤(DIP)的诊断价值。方法:选取我院在2022年1月-2024年1月期间收治的60例疑似DIP患者采取超声造影、乳腺钼靶X线检查,对比分析检查结果。结果:60例疑似DIP患者经病理检查显示,将病理检查结果作为金标准,阳性检出56例,超声造影阳性检出46例,乳腺钼靶X线检出43例,阳性检出率分别为76.67%、71.67%,联合检查阳性检出55例,阳性检出率91.67%。敏感度、特异度和准确度对比,超声造影与乳腺钼靶X线比较无差异(P>0.05),联合检查敏感度和准确度则要高于超声造影、乳腺钼靶X线检查(P<0.05)。结论:在DIP的临床诊断中,采用超声造影、乳腺钼靶X线均有着良好优势,但是两者联合检测能够进一步提高诊断准确性。

乳腺导管内乳头状瘤的超声造影特征及定量参数分析

目的 通过对比乳腺导管内乳头状瘤与纤维腺瘤、浸润性导管癌超声造影的不同特征,探讨超声造影对乳腺导管内乳头状瘤的诊断价值。方法 选取自2020年1月至2021年11月新疆医科大学第一附属医院经病理证实为乳腺导管内乳头状瘤患者22例,及同期病理证实为纤维腺瘤患者32例、浸润性导管癌患者31例,回顾分析3组病例超声造影的定性及定量指标特征。结果 (1)超声造影定性分析结果:导管内乳头状瘤组超声造影后快速向心性高增强,增强后范围扩大比率高于纤维腺瘤组(P<0.05);导管内乳头状瘤组超声造影后内部充盈缺损,增强后范围扩大,周边汇聚征,向心性增强比率(9.1%、27.3%、4.5%、54.5%)均低于浸润性导管癌组(48.4%、90.3%、48.4%、87.1%),造影剂分布较浸润性导管癌组更均匀,差异具有统计学意义(P<0.05)。(2)超声造影定量参数分析结果:导管内乳头状瘤组的上升支斜率(K)及梯度(Grad)均小于浸润性导管癌组,峰值强度(A)高于纤维腺瘤组,差异具有统计学意义(P<0.05)。结论 乳腺导管内乳头状瘤具有较好的超声造影特征,超声造影对提高导管内乳头状瘤的诊断提供了更多有价值证据。

Expression of E2F-1, Rb and ER in Peripheral Papil-loma and Ductal Carcinoma in Situ of the Breast and its Significance

OBJECTIVE To investigate the correlation of E2F-1, Rb and ER expression with peripheral papilloma (Peri-PM) and ductal carcinoma in situ of the breast (DCIS), and further explore some molecular mechanisms of the canceration of Peri-PM. METHODS Imunohistochemistry was used to examine the expression of E2F-1, Rb and ER in 60 Peri-PM, 60 Peri-PM with atypical ductal hyperplasia (Peri-PM with ADH) and 60 DCIS. Normal breast tissues were selected as a control group. RESULTS Based on immunohistochemical staining, the positive rate of E2F-1 expression in Peri-PM, Peri-PM with ADH and DCIS was 21.7%, 46.7% and 78.3% respectively. The positive rate of Rb expression was 83.3 %, 53.9% and 21.7% and the ER expression was 86.7%,61.7% and 55.0%. Significant differences were found among the 3 groups (Peri-PM, Peri-PM with ADH and DCIS) (P<0.05). Significant differences existed between any 2 groups (P<0.05) except for the rate of ER positive expression comparing Peri-PM with ADH verus DCIS (P>0.05). The expression of E2F-1 was nega- tively correlated with ER and Rb, and at the same time the expression of ER was positively correlated with Rb. Following the degree of breast epithelial hyperplasia involved and its development into carcinoma, the positive rate of E2F-1 expression displayed an elevating tendency, but that of Rb and ER expression showed a tendency to decline. CONCLUSION The interaction of the 3 indexes studied may play an im- portant role in the conversion of precancerous lesions to early in situ breast carcinoma, and the evaluation of these indexes might provide a valuable basis for screening high-risk cases of Peri-PM.

人乳头瘤病毒感染对乳腺癌患者p53、bcl-2和c-erbB-2表达及预后的影响

目的探讨人乳头瘤病毒(HPV)感染对乳腺癌患者p53、B淋巴细胞瘤2基因(bcl-2)和人类表皮生长因子受体2(c-erbB-2)的表达及预后的影响。方法选取2017年2月至2020年1月在首都医科大学附属北京友谊医院行乳腺癌根治术的乳腺癌患150例,原位杂交法检测乳腺癌患者HPV感染情况,按照是否有HPV感染将150例患者分成HPV感染组86例和未感染组64例。采用免疫组化法检测乳腺癌组织中p53、bcl-2和c-erbB-2蛋白表达情况。收集患者的临床特征并分析HPV感染及p53、bcl-2、c-erbB-2蛋白阳性表达与临床特征的关系;随访患者术后2年的生存情况。结果150例乳腺癌患者中HPV感染86例,感染率57.33%。HPV感染组p53、c-erbB-2阳性表达率高于未感染组,bcl-2阳性表达率低于未感染组(P<0.05);HPV感染与国际妇产科协会(FIGO)肿瘤分期有关,p53阳性表达淋巴转移有关,bcl-2阳性表达与FIGO分期有关,c-erbB-2阳性表达与组织学分级、淋巴转移有关(P<0.05)。HPV感染组2年生存率低于未感染组[82.55%(71/86)vs.93.75%(60/64),χ2=4.155,P=0.042]。结论乳腺癌患者HPV感染率较高,HPV感染可能通过促进c-erbB-2和p53表达以及抑制bcl-2表达,促进乳腺癌进展并导致患者预后不良。

基于超声特征构建的列线图模型对肿块型乳腺导管原位癌与导管内乳头状瘤的鉴别诊断价值

目的:探讨依据临床资料及彩色多普勒超声检查特征构建列线图模型对肿块型乳腺导管原位癌(DCIS)与导管内乳头状瘤的鉴别诊断价值。方法:回顾性分析经手术病理证实为肿块型乳腺DCIS患者185例(185个病灶)、乳腺导管内乳头状瘤193例(193个病灶)的病例资料,比较患者临床资料及超声检查指标的差异,将有统计学意义的变量纳入Logistic回归分析,筛选鉴别肿块型乳腺DCIS的影响因素,基于以上结果应用R语言构建列线图模型,绘制ROC曲线评价模型的诊断效能,应用10折交叉检验评估该模型的稳定性和泛化能力,Hosmer-Lemeshow检验和校准曲线评价该模型的拟合优度和校准度,绘制临床决策曲线评价临床受益。结果:鉴别肿块型乳腺DCIS与导管内乳头状瘤的影响因素有年龄、结节长径、距乳头距离、钙化、内部血流(P<0.05),依据以上影响因素构建列线图模型的ROC曲线AUC为0.778(95%CI:0.732~0.824),敏感度80.3%,特异度61.1%,模型具有良好的预测性能。10折交叉检验显示该模型的平均AUC为0.659,Hosmer-Lemeshow检验显示模型拟合效果良好(P=0.231)。校准曲线显示模型鉴别预测概率与实际病理结果一致性良好(C-index:0.759)。临床决策曲线显示模型具有良好的临床实用价值。结论:基于超声特征构建的列线图模型对肿块型乳腺DCIS与导管内乳头状瘤具有良好的鉴别价值。

HPV16/18E6、TLR3蛋白和血清CRP水平在乳腺浸润性导管癌中的表达

目的探讨乳腺浸润性导管癌组织中人乳头瘤病毒16/18E6(HPV16/18E6)、Toll样受体3(TLR3)蛋白及血清C反应蛋白(CRP)水平表达之间的关系及其临床意义。方法采用免疫组化染色和电化学发光分析技术检测柳州女性50例乳腺浸润性导管癌、30例乳腺导管原位癌(DCIS)、30例乳腺导管上皮非典型增生(ADH)和30例正常乳腺对照组组织中HPV16/18E6、TLR3蛋白表达和血清CRP水平,比较分析癌组、DCIS组、ADH组及对照组中HPV16/18E6、TLR3蛋白及血清CRP表达之间的相互关系,评价癌组中HPV16/18E6、TLR3蛋白及血清CRP阳性表达与临床病理特征之间的关系及其与ER、PR、HER2、Ki-67表达的相关性。结果癌组、DCIS组、ADH组及对照组中HPV16/18E6、TLR3蛋白及血清CRP阳性表达率差异均有统计学意义(P<0.01)。癌组及DCIS组HPV16/18E6蛋白和TLR3蛋白的阳性表达率均显著高于对照组(均P<0.01),且癌组、DCIS组和ADH组中血清CRP阳性率均显著高于对照组(均P<0.01)。HPV16/18E6阳性癌组中TLR3蛋白及血清CRP的阳性率均显著高于HPV16/18E6阴性组(均P<0.05);癌组、DCIS组及ADH组中HPV16/18E6与TLR3蛋白和血清CRP表达之间均呈正相关(P<0.01),TLR3蛋白与血清CRP表达亦呈正相关(P<0.01);癌组中HPV16/18E6、TLR3蛋白和血清CRP水平均与HER2和Ki-67的表达呈正相关(P<0.001);HPV16/18E6、TLR3蛋白及血清CRP阳性表达与组织学分级、淋巴结转移和pTNM分期相关(P<0.05)。此外,HPV16/18E6和TLR3蛋白的阳性表达均与肿瘤直径大小有关(P<0.05)。结论HPV16/18感染介导的TLR3蛋白阳性表达和血清CRP高水平可能涉及了HPV16/18感染后乳腺癌的发生、发展过程,TLR3蛋白和血清CRP水平可作为临床监测、评估HPV16/18相关乳腺癌患者疾病进展和预后影响因素的指标。

乳管镜在乳腺导管内乳头状瘤手术治疗中的应用价值分析

目的:分析乳管镜在乳腺导管内乳头状瘤手术治疗中的应用价值。方法:回顾性分析2020年6月-2021年6月于扬州市妇幼保健院行手术治疗的80例乳腺导管内乳头状瘤患者的临床资料,依据手术方式的不同,将其中43例实施传统乳头状瘤病变区段切除术治疗的患者纳入对照组,将37例实施乳管镜定位下乳腺导管内乳头状瘤切除术治疗的患者纳入观察组。比较两组围手术期指标(手术时间、切口长度、切除标本质量、切除标本直径);比较两组治疗总费用及术前、术后12、24 h疼痛程度[采用视觉模拟评分法(VAS)评估];比较随访6个月期间,两组并发症发生情况。结果:与对照组比较,观察组切口长度、切除标本直径均更短,切除标本质量更小(P<0.05);与对照组比较,观察组术后12、24 h VAS评分均更低(P<0.05);两组手术时间、治疗总费用比较,差异均无统计学意义(P>0.05);与对照组比较,观察组并发症发生率更低(P<0.05)。结论:将乳管镜应用于乳腺导管内乳头状瘤切除术中,可明显缩小手术范围,缓解术后疼痛,降低术后并发症发生率。

浆细胞性乳腺炎术前误诊为乳腺癌、导管内乳头状瘤临床分析

目的 探讨浆细胞性乳腺炎术前误诊为乳腺癌、导管内乳头状瘤的原因及防范措施。方法 回顾性分析2019年1月—2021年6月收治的术前误诊为乳腺癌、导管内乳头状瘤的浆细胞性乳腺炎14例的临床资料。结果 14例均为非哺乳期女性,均以单侧乳腺内肿块、乳腺局部疼痛为主要症状就诊,伴乳头溢液9例,皮肤局部红肿、皮温升高7例,乳头凹陷5例,乳腺局部压痛5例,可触及同侧腋下淋巴结增大8例。初步诊断为乳腺癌8例、导管内乳头状瘤6例,择期行乳腺病灶切除术治疗,术中快速冷冻病理检查示浆细胞性乳腺炎。误诊时间5~7 d。遂10例改行乳腺区段切除术,4例改行乳管切除术,术后均一期愈合出院,术后随访2年,无复发。结论 浆细胞性乳腺炎临床发病率低,早期表现常不典型,未行病理学检查前极易误诊。加强临床医生对本病的认识,提高警惕性,必要时及早行细针穿刺活检,以提高本病术前确诊率。

乳腺导管内乳头状瘤外科治疗现状及乳腺癌预防的新策略与新思路

乳腺导管内乳头状瘤(IDP)是一种良性肿瘤,可合并非典型增生,并具有复发、癌变风险,进一步发展为乳腺癌后会给患者家庭和社会带来沉重的经济负担。本文就IDP外科治疗及乳腺癌预防性内分泌治疗策略作一综述,为今后IDP诊治及乳腺癌预防提供思路,对存在风险的IDP及时干预,降低乳腺癌的发病率。

乳腺导管内乳头状瘤超声误诊分析

目的探讨乳腺导管内乳头状瘤(IDP)超声特点及超声误诊的原因。方法回顾性分析2020年3月—2023年3月收治的行手术治疗的IDP 19例的临床资料,其中11例超声误诊,8例确诊。结果19例中以单纯乳头溢液就诊3例,以乳房肿块就诊13例,以乳头溢液合并乳房肿块就诊3例。导管扩张伴导管内实性乳头状突起型5例未误诊;导管扩张伴远端中断处实性结节型9例中3例未误诊,误诊6例,误诊为乳腺癌3例、单纯导管扩张2例、纤维腺瘤1例;囊实性结节型1例,误诊为乳腺癌;实质性结节型4例,误诊为纤维腺瘤3例、乳腺癌1例。19例均经手术病理检查确诊IDP。术后随访1年,均未见复发,预后良好。结论IDP早期超声声像图和临床表现不典型,易误诊;临床医生熟知IDP超声表现,仔细观察肿物边缘及其包膜情况,必要时可局部扩大观察并行彩色多普勒血流显像检查,仔细鉴别诊断,结合临床,可一定程度避免早期超声误诊的发生。

微创旋切术后导管内乳头状瘤扩大切除的临床必要性分析

目的:分析微创旋切术后乳腺导管内乳头状瘤(IDP)扩大切除的临床必要性。方法:回顾性分析2019年5月至2021年6月在深圳市龙岗区妇幼保健院行微创旋切术的86例IDP患者的资料,依据患者意愿确定手术方法,并分成对照组(43例,实施微创旋切术)和观察组(43例,在微创旋切术基础上扩大切除)。比较两组患者术后并发症情况、乳房美观度、生活质量、2年内复发及恶变情况。结果:观察组患者术后并发症发生率、乳房美观度分别为9.30%、93.02%,和对照组患者的4.65%、95.35%比较,差异均无统计学意义(P> 0.05);术后1年,两组患者生活质量综合评定问卷–74(GQOLI–74)中4项评分均高于术前,且观察组患者除心理功能以外的其他3项评分均高于对照组,差异均具有统计学意义(P <0.05);观察组患者术后2年内复发率为6.98%,低于对照组的23.26%,差异具有统计学意义(P <0.05);观察组患者术后2年内恶变率为2.33%,低于对照组的11.63%,但差异无统计学意义(P> 0.05)。结论:对微创旋切术后IDP患者行扩大切除术,相较于未行扩大切除术的远期复发率更低,远期生活质量更高。且并发症发生风险并未增加,乳房美观度并未下降。

乳腺导管内乳头状瘤及其癌变组织CD44v6蛋白表达的研究

背景与目的:CD44v6是乳腺上皮恶性转化中的一个重要成分,在乳腺良恶性病变中有不同的表达,但其在良恶性病变的鉴别诊断中的价值并没有得到很好的研究。本研究目的是检测CD44v6在乳腺导管内乳头状瘤及导管内乳头状瘤癌变组织中的表达,探讨CD44v6在乳腺导管内乳头状瘤诊断及鉴别诊断中的作用。方法:对49例导管内乳头状瘤、12例导管内乳头状瘤癌变、15例导管内癌、15例浸润性导管癌及20例正常乳腺组织的石蜡切片进行免疫组织化学染色。结果:在正常组织、导管内乳头状瘤、乳头状瘤癌变、导管内癌、浸润性导管癌中,肌上皮细胞(basalepithelialcell)的CD44v6蛋白表达阳性(++/+++)率分别为95.00%、85.72%、66.66%、66.66%、0%,导管内乳头状瘤与乳头状瘤癌变之间无统计学差异(P>0.05);而上皮细胞(luminalepithelialcell)的CD44v6蛋白表达阳性(++/+++)率分别为5.00%、20.41%、83.34%、93.33%、100%,导管内乳头状瘤与乳头状瘤癌变之间有统计学差异(P<0.01)。结论:通过免疫组化检测CD44v6蛋白表达对诊断导管内乳头状瘤是否癌变具有重要参考价值。

乳腺实质性导管内乳头状瘤的超声特征

目的探讨超声在乳腺实质性导管内乳头状瘤诊断中的价值。方法回顾性分析2007年4月—2009年4月经我院超声提示为实质性肿块、病理证实为导管内乳头状肿瘤的97例患者共112个病灶的超声声像图特征。结果 112个病灶中良性92个,恶性20个。超声检查良性病灶多表现为:形态不甚规则,边界较清,纵横比<0.7,内部呈低回声且分布不均匀,后方回声增强,内部血流信号较丰富。良、恶性病灶的超声特征差异无统计学意义。结论乳腺实质性导管内乳头状瘤的超声表现具有一定特征,有助于早期诊断,但超声鉴别病灶的良恶性仍有一定困难。

乳腺单发乳头状瘤钼靶X线诊断(附42例报告)

目的：提高对乳腺单发乳头状瘤放射学诊断水平。材料与方法：作者回顾分析了４２例经病理证实的乳腺导管内单发乳头状瘤临床表现，钼靶平片及造影片表现。结果：３７例（８８％）有乳头分泌物。９５％（３５／３７）发生于中央大导管。２４％（１０／４２）平片有异常改变。造影表现：５４％（２０／３７）表现导管内充盈缺损，４１％（１５／３７）表现导管完全阻塞，４３％（１６／３７）有导管轻度扩张。结论：乳头溢液为导管内乳头状瘤最常见症状。平片多无异常改变，造影表现以导管内充盈缺损及导管完全阻塞改变多见。乳腺导管造影是诊断本瘤的有效方法。

经乳晕旁切口乳房后进路乳管小叶区段切除治疗多发性导管内乳头状瘤

目的探讨经乳晕旁切口及乳房后进路乳管小叶区段切除治疗多发性导管内乳头状瘤的可行性、效果及并发症预防。方法对该院2002年6月～2007年4月收治的年龄在40岁以上的19例乳腺多发性导管内乳头状瘤患者行多区段切除的临床资料进行回顾分析。结果18例患者均经乳晕旁切口及乳房后进路行乳腺小叶多区段切除术,手术顺利,术后恢复好,乳头无明显变形,患者感到满意,乳房及乳头感觉良好。1例患者因术中冷冻切片合并导管癌,行改良乳腺癌根治术。所有患者均无切口感染,1例发生皮下积液,经穿刺抽吸治愈。经0.25～4.6年随访,有1例患者因术中遗漏而再手术治愈。结论采用乳晕旁切口及乳房后进路行乳管小叶区段切除治疗多发性导管内乳头状瘤是可行的。掌握熟练的手术技巧,可取得较好的美容及治疗效果,并能保持良好的乳头及乳晕部位的感觉,避免了乳房单纯切除。