隐匿性乳腺癌17例临床诊治分析

摘要

目的探讨隐匿性乳腺癌（occult breast cancer，OBC）的诊断、治疗和预后。方法选择2006年11月～2012年6月在苏大附一院普外科收治的17例OBC的临床资料进行回顾行分析。结果所有病例均为女性，占同期乳腺癌的0.65%，临床症状以腋下肿块为首发症状，双乳触诊均未触及明显肿块。术前行腋下肿块或细针穿刺，均找到癌细胞。5例术前行乳腺X线钼靶照相检查，2例可见有细小钙化灶，不除外乳腺癌；5例行乳腺B超检查、7例行红外线扫描，均未发现乳腺内病灶。该组5例行Halsted根治术，12例行改良根治术，术后10例在乳腺大体标本找到原发病灶，7例为浸润性导管癌，2例为导管内癌，1例为髓样癌。9例予辅助化疗、5例放疗加化疗、3例予口服三苯氧胺治疗。该组全部随访，均仍生存，9例生存已超过2年半，最长1例生存已达5年。结论临床上对女性腋窝肿块应高度警惕OBC的可能，术前予细针穿刺、腋下肿块活检有助于诊断，乳腺钼靶照片、红外线扫描、乳腺B超对乳腺原发病灶的检出率较低，多需术后乳腺大体标本病理切片确诊。确诊为OBC后，仍应按乳腺癌的处理原则进行治疗，宜选择根治术或改良根治术，术后继续行化疗，ER、PR阳性者行序贯内分泌治疗。术后要密切随诊。%Objective To investigate the diagnosis and treatment of the patients with occult breast cancer(OBC).Methods Clinical data of 17 OBC cases from June 2006 to June 2012 were retrospectively analyzed. Results All cases were female and account for 0.65% of the total breast cancer treated in the same period.All cases were found because of lump in axillary fossa.No breast mass is found from physical examination.Fine needle aspiration or excisional biopsy revealed metastatic adenocarcinoma before surgery.2 cases,suspecting breast cancer,could be found fine calcification in the examination of breast X-my molybdenum target in 5 cases.B ultrasound in 5 cases and infrared ray scan in 7 cases did not detect cancer in breast.5 cases underwent radical mastectomy and 12 cases underwent modified radical mastectomy.Pathological diagnosis of 4 cases after operation found breast primary lesion,7 cases were infiltrated duct cancer,2 cases were intraductal cancer,1 case was medullary cancer.After surgery,9 cases received chemotherapy,5 cases received radiation treatment and chemotherapy,3 cases received tamoxifen therapy.All case were still alive and 9 cases survived over two and a half years and 1 case survived for 5 years.Conclusions OBC should be considered when axillary lumph node is enlarged in female.Fine needle aspiration and excisional biopsy are helpful in pathologic diagnosis preoperatively because of low sensitivity in identifying primary tumor through the radiographic examination.Radical or modified radical mastectomy with adjuvant radiotherapy and chemotherapy is a suitable choice for the patients with OBC. Post-operative follow-up visit is necessary.