背景:由于乳房X线摄影筛查和乳腺癌诊断的改进,预癌的检测也在增加。它们被定义为更可能导致癌症的乳腺形态变化。评估的癌前病变为不典型导管增生(ADH),小叶原位癌(LCIS)和放射状瘢痕。
方法:在1期。1.2018-31。12.2022年,我们在比尔森教学医院外科诊所进行了1,302例计划中的乳腺疾病手术,其中30例(2%)是癌前手术。ADH被证实为11倍,LCIS8×,和根性疤痕11×。三组患者的平均年龄为56岁(27-85岁)。前癌仅通过超声检查诊断为8倍,3×乳房X线照相术和19×两种方法的组合。随后,穿刺活检总是完成。我们进行了28例肿瘤切除术,术中活检和2例乳腺切除术。
结果:在来自穿刺活检的ADH的情况下,术中证实ADH8×,DCIS诊断2次,和黏液性癌1倍。在LCIS,术中活检4次未发现肿瘤,LCIS被确认1次,诊断为小叶浸润性癌1次,2次进行乳房切除术,没有术中活检。在放射状疤痕中,ADH诊断为3倍,硬化性腺病6×,DCIS1×,浸润性癌1次。在对样本进行最后的组织学处理后,诊断出的癌症有所增加。在ADH中,DCIS被确认3倍,DIC2×,和黏液性癌1倍。在LCIS,诊断为LIC3倍。在放射状疤痕中,DCIS被确认为1倍,浸润性癌保持1倍。因此,由于手术解决方案,11例患者(37%)被诊断出癌症。无患者接受腋窝淋巴结手术。所有11名患者随后接受了肿瘤治疗,总是放疗和激素治疗的结合。所有病人都活着,10名患者病情完全缓解,1例DCIS患者4年后出现局部复发.
结论:乳房癌前病变的手术治疗是有意义的,除了癌前病变外,DCIS甚至浸润性癌症通常是隐藏的。多亏了手术解决方案,癌症被及时发现。
BACKGROUND: Thanks to mammographic screening and the improvement of breast cancer diagnostics, the detection of precancers is also increasing. They are defined as morphological changes of the mammary gland which are more likely to cause cancer. The evaluated precancers are atypical ductal hyperplasia (ADH), lobular carcinoma in situ (LCIS) and radial scar.
METHODS: In the period 1. 1. 2018-31. 12. 2022, we performed 1,302 planned operations for breast disease at the Surgical Clinic of Teaching Hospital Plzeň, of which 30 (2%) were precancer operations. ADH was confirmed 11×, LCIS 8×, and a radical scar 11×. The average age of the patients in all three groups was 56 years (27-85). Precancer was diagnosed 8× only by sonography, 3× by mammography and 19× by a combination of both methods. Subsequently, a puncture biopsy was always completed. We performed 28 tumor excisions with intraoperative biopsy and 2 mastectomies.
RESULTS: In the case of ADH from puncture biopsy, ADH was confirmed intraoperatively 8×, DCIS was diagnosed 2×, and mucinous carcinoma 1×. In LCIS, no tumor was found by intraoperative biopsy 4×, LCIS was confirmed 1×, lobular invasive carcinoma was diagnosed 1×, mastectomy was performed 2× without intraoperative biopsy. In the radial scar, ADH was diagnosed 3×, sclerosing adenosis 6×, DCIS 1×, invasive carcinoma 1×. After the final histological processing of the samples, there was an increase in diagnosed carcinomas. In ADH, DCIS was confirmed 3×, DIC 2×, and mucinous carcinoma 1×. In LCIS, LIC was diagnosed 3×. In the radial scar, DCIS was confirmed 1×, and invasive carcinoma remain 1×. Thus, carcinoma was diagnosed in 11 patients (37%) thanks to the surgical solution. No patient underwent axillary node surgery. All 11 patients subsequently underwent oncological treatment, always a combination of radiotherapy and hormone therapy. All patients are alive, 10 patients are in complete remission of the disease, one with DCIS experienced a local recurrence after 4 years.
CONCLUSIONS: Surgical treatment of precancers of the breast makes sense, DCIS or even invasive cancer is often hidden in addition to precancer. Thanks to the surgical solution, the cancer was detected in time.