CAJ | 학술논문

目的探讨仅影像学表现为恶性钙化而乳房未扪及肿块乳腺癌的病灶定位方法、手术方法及其治疗效果.方法对61例乳房体检不能触及肿块、影像学检查也未发现肿块,仅X线钼靶片或超声检查显示恶性钙化病灶或局部血流丰富的乳腺癌(T1～2NOM0)患者,术前应用全数字化平板乳腺机(FFDM),对钙化病灶进行坐标法立体定位、术中精确切除病灶、术后应用FFDM法复检标本,同时行广基带血管腺体组织瓣Ⅰ期乳房内成形保乳手术(单发病灶者)或乳腺癌改良根治术(多中心病灶者).结果 50例行保乳手术的患者,坐标法定位病灶的准确率为100%(50/50).对病灶切缘阴性、FFDM复检无病灶残留者,其广基带血管腺体组织瓣乳腺Ⅰ期成形结果按JCRT标准,达优率为86.0%(43/50);Compliance差值为1.5 cm.11例行乳腺癌改良根治术,均为外弥漫性恶性钙化多中心病灶者.61例患者的随访时间为6～58个月(中位随访时间为39个月).全组仅1例远处转移,无局部复发患者.结论对不能扪及肿块的乳腺癌病灶,应用FFDM坐标法定位,准确可行.对单发病灶者,在定位下行保乳手术,同时行广基带血管腺体组织瓣Ⅰ期乳房内成形术,疗效满意.
목적 탐토부영상학표현위악성개화이유방미문급종괴유선암적병조정위방법、수술방법급기치료효과.방법 대61례유방체검불능촉급종괴、영상학검사야미발현종괴,부X선목파편혹초성검사현시악성개화병조혹국부혈류봉부적유선암(T1～2NOM0)환자,술전응용전수자화평판유선궤(FFDM),대개화병조진행좌표법입체정위、술중정학절제병조、술후응용FFDM법복검표본,동시행엄기대혈관선체조직판Ⅰ기유방내성형보유수술(단발병조자)혹유선암개량근치술(다중심병조자).결과 50례행보유수술적환자,좌표법정위병조적준학솔위100%(50/50).대병조절연음성、FFDM복검무병조잔류자,기엄기대혈관선체조직판유선Ⅰ기성형결과안JCRT표준,체우솔위86.0%(43/50);Compliance차치위1.5 cm.11례행유선암개량근치술,균위외미만성악성개화다중심병조자.61례환자적수방시간위6～58개월(중위수방시간위39개월).전조부1례원처전이,무국부복발환자.결론 대불능문급종괴적유선암병조,응용FFDM좌표법정위,준학가행.대단발병조자,재정위하행보유수술,동시행엄기대혈관선체조직판Ⅰ기유방내성형술,료효만의.
Objective To investigate the methods of lesion localization and surgical treatment for non-palpable breast cancer, presented with only small calcification lesion on the images. Methods From November 2003 to August 2007, 61 patients with non-palpable lesion were finally pathologically diagnosed as early breast cancer (T1-2NOM0), based on the small calcification lesions shown by full field digital mammography (FFDM) through molybdenum target, and the rich blood supply shown by type-B ultrasonic examination. Accurate lesion-localization prior to surgical resection was conducted, and sample re-examination by FFDM was done after resection. Patients with single lesion underwent breast-conserving surgery, precise excision with the aid of image-guided wire localization, and stage Ⅰ breast reconstruction was performed simultaneously using wide-based gland-tissue flap. Patients with multiple lesions received modified radical mastectomy. Results Among the 50 patients treated with breast-conserving surgery, the accuracy of localization for lesions was 100% (50/50), and all lesions were excised completely with a negative margin proven by FFDM re-examination and pathological examination. The superior rate of mammaplasty was 86.0% (43/50) according to JCRT criteria, with a compliance difference of 1.5 cm. Modified radical mastectomy was performed in 11 patients. The follow-up period in this series was from 6 to 58 months with a mean follow-up time of 39 months. Distant metastases were detected in only one patient and local recurrence was not observed yet. Conclusion Lesion localization by FFDM in patients with non-palpable breast cancer is accurate and practical. In patients with single lesion, breast-conserving resection followed by synchronous stage Ⅰ breast reconstruction with wide-based gland-tissue flap is appropriate.