乳腺癌201166 (2).ppt
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1、Breast Cancer 2011.6.6 Introduction nMost common female cancer最常见的女 性癌症 nAccounts for 32% of all female cancer占 所有女性癌症的32 n211,300 new cases yearly and rising每年 新增211,300个病例 n40,000 deaths yearly每年40,000人死亡 Gross Anatomy大体解剖 Sappys plexus lymphatics under areolar complex 75% of lymphatics flow to ax
2、illa Microscopic Anatomy显微解剖 nStromal tissue基质组织 nConnective tissue, capillaries, lymphocytes, etc.结缔组织, 毛细血管,淋巴细胞等 nAdipose tissue脂肪组织 nDuctal tissue乳腺导管组织 nSquamous epithelium鳞状上皮细胞 nColumnar or cuboidal epithelium柱状或立方形 上皮 nLobular tissue小叶组织 Presentation nBreast lump乳房肿块 nAbnormal mammogram乳房X光检
3、查异常 nAxillary lympadenopathy腋窝淋巴结病变 nMetastatic disease转移性疾病 Screening Mammography乳房摄影 筛检 nRecommendations建议 nBiannually or annually in 40-49 y/o每半年或每年在40-49年 nAnnually in 50 y/o每年在“50 n15% relative risk reduction相对危险度减少15 nBirads分级 n0 - Incomplete assessment; need additional imaging evaluation n1 -
4、 Negative; routine mammogram in 1 year recommended n2 - Benign finding; routine mammogram in 1 year recommended n3 - Probably benign finding; short-term follow-up suggested (3%) n4 - Suspicious abnormality; biopsy should be considered (30%) n5 - Highly suggestive of malignancy; appropriate action sh
5、ould be taken (94%) Biopsy techniques活检技术 nFNA nDiagnostic and therapeutic in cystic lesions囊性病变的诊断和治 疗 nCore needle粗针 nU/S guided or sterotatic n90% effective in establishing diagnosis 90,在建立有效的诊断 nAtypia need excision异型性- 需要切除 nSterotatic nNeedle localization细针定位 nExcision biopsy切除活检 Risk of Futur
6、e Invasive Breast Carcinoma Based on Histologic Diagnosis from Breast Biopsies未来浸润性乳腺癌的风险基于活检病理诊断乳腺 癌 nNo Increase nAdenosis Apocrine metaplasia Cysts, small or large Mild hyperplasia (2 but 5cm nT4: invasion of skin or chest wall nNode nN1: 1-3 axillary nodes or int mam node nN2: 4-9 axillary nodes
7、 or palpalbe int mam node nN3: 10 nodes or combo of axillary and int mam nodes nmic micoroscopic posivitiy, mol molecular posiivity nMetastasis Modified Radical Mastectomy改良 根治术 nEntire breast tissue and Level I & II nodes整个乳房组织和I级和II节点 nSurvival at 10 yrs nNegative nodes 82% (5% local recurrence) n
8、Positive nodes 48% (5% local recurrence) Simple mastectomyModified radical Breast Treatment Trials乳腺癌治疗试验 nNSABP (1971 with B-04 update in 2002) nCompared radical, vs modified radical +/- radiation nNo survival diff for node neg or pos between three arms n75% of recurrences occur in 5 years 复发75发生在5
9、年 nTumor location not important Breast Treatment Trials乳腺癌治疗 试验 nOntario study nAll pts got lumpectomy, randomized to radiation or no radiation n25% failure rate without radiation, 5% with nNSABP B-06 nMastecomy vs lumpectomy vs lumpectomy with radiation nNo difference in survival n39% recur with lu
10、mpectomy, reduced to 14% with radiation, 3-4% with mastectomy n0.5-1% per year recurrence rate for life with BCT and radiation n2-5% complication rate with radiation (rib fx, pericarditis, cosmesis) Radiation after mastectomy?乳房切 除术后辐射? nDanish studies and one Britsh study丹麦 研究和一Britsh研究 nRecommend
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