摘要
目的探讨乳腺叶状肿瘤的临床病理学特征及治疗效果。方法回顾分析十堰市太和医院甲乳外科2012年8月至2017年5月收治的104例乳腺叶状肿瘤患者的临床资料,比较乳腺彩超与钼靶对乳腺叶状肿瘤检出率,分析术前14G巴德针穿刺病检结果和术中肿块快速冰冻病检结果与术后最终病检结果符合率,据患者需求与年龄、肿块性质及大小、乳房体积等情况选择不同手术方式分析治疗疗效。结果乳腺叶状肿瘤在乳腺彩超和钼靶上无特征性的影像学表现。术后常规病理学检查示44例为良性肿瘤,交界性肿瘤36例,恶性肿瘤24例。61例患者行术前粗针穿刺,104例患者行术中快速冰冻病理,两种方式诊断叶状肿瘤准确率分别为44.3%(27/61)和67.3%(70/104)。3例行改良根治术,21例行单纯乳房切除术,66例行肿瘤局部扩大切除术,14例行单纯肿块切除术。随访101例,随访时间3~50个月,平均(28.0±3.6)个月,8例局部复发再行手术治疗,3例远处转移其中1例行化放疗,死亡2例。结论对乳腺叶状肿瘤采用粗针穿刺或术中快速冰冻病检有较高的漏诊率,最终确诊需待常规石蜡病理学检查结果。目前主要以手术治疗为主,其治疗效果与手术方式、病理分型密切相关。
Objective To investigate the clinicopathological features and therapeutic effect of phyllodes tumor of the breast.Methods One hundred and four patients with phyllodes tumor confirmed by pathology in the department of breast and thyroid surgery in Taihe Hospital from August 2012 to May 2017 were selected.Compare the difference of detection rate between breast ultrasound and molybdenum target in detection of breast phyllodes tumor.The results of 14G BARD core needle puncture biopsy before operation and intraoprative rapid frozen pathology were compared with the final pathology result.According to patients′demands,age,the properties and size of tumor,breast volume and so on,different surgical methods were chose and curative effects were analyzed.Results There were no characteristic imaging findings in phyllodes tumors of breast in the ultrasound and molybdenum target result.Postoperative routine pathological examination showed that 44 cases were benign tumors,36 borderline tumors and 24 malignant tumors.Sixty-one patients underwent preoperative core needle biopsy and 104 patients underwent intraoperative rapid frozen pathology,the accuracy rates of the two modalities for diagnosing phyllodes tumor were 44.3%(27/61)and 67.3%(70/104).Three cases underwent modified radiacal mastectomy,21 cases underwent simple mastectomy,66 cases underwent wide excision,14 cases underwent lumpectomy.One hundred and one patients had been followed up for 3-50 months[(mean value(28.0±3.6)months],8 patients had local recurrence and received surgical treatment,3 patients had distant metastasis,one of them underwent chemoradiotherapy and 2 cases died.Conclusions There is a high rate of missed diagnosis in the use of core needle biopsy or intraoperative rapid frozen pathology,the final diagnosis should be confirmed by conventional paraffin pathology.Surgery plays a very important role in the phyllodes tumor treatment,the prognosis is closely related to the surgical procedures and pathological classification.
作者
艾勇彪
张丹峰
李文仿
王明华
Ai Yongbiao;Zhang Danfeng;Li Wenfang;Wang Minghua(Department of Breast and Thyroid Surgery,Shiyan Taihe Hospital Affiliated to Hubei University of Medicine,Shiyan 442000,China)
出处
《中华诊断学电子杂志》
2018年第1期41-44,共4页
Chinese Journal of Diagnostics(Electronic Edition)
基金
十堰市科技局引导性科研项目(17Y17)
关键词
乳腺肿瘤
病理
手术方式
治疗效果
Breast neoplasm
Pathology
Surgical procedures
Treatment effect
作者简介
通讯作者：王明华，Email：wangmh1970@163.com
