【作者】 李云英； 于泳； 只向成； 苗秀启；

【Author】 Li Yun-Ying YongYu Zhi Xiang-Cheng MiaoXiu-Qi Department of Breast Cancer, Tianjin Medical University Affiliated Cancer Hospital Tianjin 300060,Cbina

【机构】 天津医科大学附属肿瘤医院乳腺科；

【摘要】 目的:探讨乳腺导管内癌(DCIS)的临床特点和诊断治疗方式。方法:2000年——2005年间共手术治疗的女性乳腺癌9030例,其中乳腺导管内癌291例(占同期乳腺癌的3．2％),回顾分析本组乳腺导管内癌的发病年龄,分期、临床表现、诊断、治疗方式及预后。结果:291例采用不同术式手术,经治疗后1例死于它病,2例死于肿瘤,其余均健在。本组57例保乳手术患者(包括33例行1／4乳腺切除+腋下淋巴结清除术、13例行乳腺肿瘤区段切除+低位腋下淋巴结清除术、11例肿瘤局部广泛切除术)均健在,无复发及转移。本组乳腺导管内癌腋下淋巴结转移率为2．2％ (由于隐匿浸润所致)．结论:乳腺导管内癌的治疗应根据具体情况个体化治疗,由于乳腺导管内癌属于非浸润性癌,腋淋巴结转移率低,因此除非临床高度怀疑有淋巴结转移的应采取全乳+腋淋巴结清除术之外,外科治疗应以保守方式为宜,对部分乳腺导管内癌,如肿瘤体积／乳腺体积比值大、钼靶摄影为弥漫性钙化、多中心起源性病变、肿瘤核为Ⅲ级的预后不佳者,仍以乳腺切除为最好选择。更多还原

【Abstract】 Objective: To classify the characteristics and management of breast ductal carcinoma in situ (DCIS). Methods: From 2000 to 2005, 9030 cases of new diag- nosed female breast cancer were treated in Tianjin Medical University Affiliated Cancer Hospital, which included 291 cases DCIS. Age, clinical staging, clinical manifestation, diagnoses, treatment and prognosis were discussed in this study. Rasults: All 291 cases DCIS were treated by different surgical approach. Among them 1 case died from non-cancer related disease, 2 died from breast cancer. Breast conserving surgery were performed in 57 cases, which included 33 cases quandrantectomy with axillary lymph node dissection (ALND), 13 cases lumpectomy with ALND and 11 cases wide excision only. All patients in this group were disease free during the follow-up period. Axillary lymph node metastases were found in 2.2% in all DCIS. Conclusion: DCIS needs personalized treatment. Because of its nature of non-invasive and low incidence of axillary lymph node metastases, breast conserving surgery is the better choice unless there is definite evidence of axillary lymph node involvement which mastectomy with ALND could be performed. In addition, mastectomy is still suitable for cases with larger tumor/breast ratio, extensive calcification in mammogram, multi centralized lesion and grade III tumor.更多还原