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目的 :探讨隐匿性乳腺癌诊断和治疗方法 ,提高诊断准确率和生存率。方法 :回顾性分析 1 7例隐匿性乳腺癌的诊断和治疗经过及随访结果。结果 :1 7例隐匿性乳腺癌首次诊断正确率为 35 .2 9% ( 6/1 7) ,钼靶 X线摄片、增强 CT、MR影像学检查的准确率分别为5 3.85 % ( 7/1 3)、62 .5 0 % ( 5 /8)、60 .0 0 % ( 3/5 ) ,腋下肿块穿刺活检准确率为 1 0 0 % ( 8/8)。 8例患者行乳腺癌改良根治术前行 2～ 4周期化疗 ,8例患者直接行乳腺癌改良根治术 ;1例保守治疗。术后辅助放、化疗和内分泌治疗。生存率 68.75 % ( 1 1 /1 6) ,2例死于其他疾病 ,3例分别于术后 4年、4年、2年死于脑、肺、纵膈转移。 1例保守治疗患者发现后 2年死于脑转移。术前化疗患者生存率 75 .0 0 % ( 6/8)高于直接手术者 62 .5 0 % ( 5 /8)。结论 :提高认识和适宜的影像学检查能提高诊断准确率 ;连续切片和影像学检查有助于原发灶的检出 ,术前化疗加乳癌改良根治术加术后辅助治疗是适宜的治疗方式
Objective: To explore the diagnosis and treatment of occult breast cancer and improve the diagnostic accuracy and survival rate. Methods: A retrospective analysis of 17 cases of occult breast cancer diagnosis and treatment and follow-up results. Results: The accuracy of the first diagnosis of concealed breast cancer was 35.29% (6/1 7). The accuracy of mammography, enhanced CT and MR imaging were 5 3.85% (7 / 1 3), 62.5% (5/8) and 60.0% (3/5). The accuracy of axillary mass biopsy was 100% (8/8). Eight patients underwent modified radical mastectomy for 2 ~ 4 cycles of chemotherapy, and 8 patients underwent modified radical mastectomy. One case received conservative treatment. Adjuvant radiotherapy, chemotherapy and endocrine therapy. The survival rate was 68.75% (11/1 6). Two patients died of other diseases. Three patients died of brain, lung and mediastinal metastasis at 4, 4 and 2 years respectively. One case of conservative treatment died of brain metastases 2 years after discovery. The survival rate of patients undergoing preoperative chemotherapy was 75.0% (6/8) higher than that of direct surgery (62.50%, 5/8). Conclusion: Awareness and appropriate imaging examination can improve the diagnostic accuracy; serial sections and imaging studies can help detect the primary tumor, preoperative chemotherapy plus modified radical mastectomy plus postoperative adjuvant therapy is the appropriate treatment