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目的加深对导管内癌(DCIS)的认识,以提高其诊断率和治疗效果。方法回顾性分析中国医科大学附属第一医院普通外科收治的123例DCIS患者的临床资料。包括发病年龄、临床表现、体检特征、超声和钼靶检查、病理特点、免疫组织化学检查和手术方式。结果(1)该组发病的平均年龄为(47.7±9.3)岁。(2)体检特点以乳腺肿块79例,乳头溢液19例,乳房疼痛伴腺体增厚30例等为主要表现。(3)超声、钼靶45例,可能为恶性者分别为27例(60%),30例(66.7%),方法准确率差异无统计学意义。综合2种方法后,诊断可能恶性者37例(82.2%)。(4)65例超声表现为实质性肿见块43例(66%);血流信号41例(63%);可见导管扩张52例(80%)和导管内点状强光团33例(50.7%)。(5)52例钼靶摄影主要表现有泥沙样钙化,肿物伴簇状钙化,腺体局限性致密和乳腺肿物。(6)免疫组织化学检查包括雌激素受体(ER),孕激素受体(PR),p53和c-erbB-2。DCIS与DCIS-MI的阳性表达率差异均无统计学意义。(7)行乳腺癌标准根治术6例(其中3例为DCIS-MI)。共行乳腺癌改良根治术86例,包括59例DCIS,27例DCIS-MI。DCIS伴有淋巴结转移者2例,DCIS-MI有淋巴结转移者5例。结论乳腺超声检查和钼靶摄像联合诊断可提高DCIS的诊断率。
Objective To deepen the understanding of intraductal carcinoma (DCIS) in order to improve its diagnostic rate and therapeutic effect. Methods The clinical data of 123 patients with DCIS who underwent general surgery in the First Affiliated Hospital of China Medical University were retrospectively analyzed. Including the age of onset, clinical manifestations, physical examination characteristics, ultrasound and mammography examination, pathological features, immunohistochemistry and surgical methods. Results (1) The average age of onset in this group was (47.7 ± 9.3) years. (2) The physical examination features 79 cases of breast mass, nipple discharge in 19 cases, breast pain with glandular thickening of 30 cases as the main performance. (3) Ultrasound, 45 cases of molybdenum target, which may be malignant were 27 cases (60%), 30 cases (66.7%), the accuracy of the method was no significant difference. After the two methods were combined, 37 cases (82.2%) were diagnosed as malignant. There were 43 cases (66%) of the 65 cases showed substantial cystic masses, 41 cases (63%) of the blood flow signals, 52 cases (80%) of the ductal dilatation and 33 cases 50.7%). (5) The main manifestations of 52 cases of mammography were sediment-like calcification, tumor with cluster calcification, tight gland confusion and breast tumor. (6) Immunohistochemical examination included estrogen receptor (ER), progesterone receptor (PR), p53 and c-erbB-2. There was no significant difference in the positive expression rate between DCIS and DCIS-MI. (7) 6 cases of standard radical mastectomy (3 of which were DCIS-MI). Totally 86 patients underwent modified radical mastectomy, including 59 cases of DCIS and 27 cases of DCIS-MI. DCIS with lymph node metastasis in 2 cases, DCIS-MI lymph node metastasis in 5 cases. Conclusion The combined diagnosis of breast ultrasound and mammography can improve the diagnostic rate of DCIS.