目的:探索早期乳腺癌的临床特点和诊断方法。方法:回顾性分析46例早期乳腺癌的临床资料。结果:46例患者中表现为乳腺痛及肿块者30例,以乳房肿块就诊者16例。钼靶照片14例,诊断为乳腺癌5例(35.7%)。42例作彩色超声检查,发现不规则低回声结节37例(89.0％),部分肿块内可见点状强回声,周围有蟹足状,血流增加。细针穿刺细胞学检查40例,23例发现癌细胞,直接住院,术中冰冻切片决定手术方式;23例门诊先行切除活检后住院治疗。结论:高危妇女表现为乳腺增生,用药不好转、症状加重者,应怀疑乳腺癌,首选彩色超声检查,诊断价值优于钼靶照片。有肿块者结合穿刺细胞学检查,可提高早期乳腺癌的诊断率。
【Abstract】ObjectiveTo evaluate the localized biopsy of nonpalpable breast lesions (NPBLs) and its role in the early diagnosis and treatment of breast cancer. MethodsOne hundred and fifty-eight NPBLs from a series of 141 women detected by mammography were resected with wire localization technique. ResultsForty-two lesions (26.6%, 42/158) in 42 patients were diagnosed with malignant result, including 12(28.6%) patients with stage 0 breast cancer, 24(57.1%) with stageⅠ, 2(4.8%) with stage Ⅱ and 4(9.5%) with stage Ⅲ disease according to American Joint Committee on Cancer (AJCC) staging system（the 6th edition）. The contralateral axillary lymph nodes metastasis were found in only one (2.4%) patient with stage Ⅲ disease and the other fortyone patients remained free of recurrent disease at a median follow-up of 31 months.ConclusionThe results showed that the most nonpalpable breast cancers detected by mammography were earlystage breast cancers and had good prognosis. The NPBLs should get a localized biopsy in order to facilitate the early diagnosis and treatment of nonpalpable breast cancers.
ObjectiveTo evaluate the effects of sentinel lymph node biopsy following total mastectomy on immunologic function and prognosis for patients with early breast cancer. MethodsTwo hundred and eleven patients with early breast cancer were entered in this study. In all these cases, the results of sentinel lymph node biopsy were negative. These patients were randomly divided into control group and research group. In 86 cases of control group, the sentinel lymph node biopsy and axillary lymph node dissection following total mastectomy was performed. In 125 cases of research group, the sentinel lymph node biopsy following total mastectomy was performed. The injury of shoulder joint function was analyzed in one year after surgery. The changes of T cell subsets and IL-2 level were detected in the patients respectively on the first day before operation, the second week after operation, and the fourth week after operation. Postoperative fatality rate and postoperative recurrence rate were also observed in two groups. Results①The points of shoulder joint function in the control group and the research group were 72.7±6.5 and 93.5±8.2 respectively, there was an obvious difference (P < 0.05).②The injury degree of shoulder joint function in the research group was significantly lower than that in the control group (P < 0.01).③Compared with the control group, the changes of T cell subsets and the IL-2 level had no significant differences in the research group on day 1 before operation and on week 2 after operation (P > 0.05). On the fourth week after surgery, the CD4+, CD4+/CD8+, and IL-2 level in the research group were obviously higher than those in the control group (P < 0.05). However, the percentage of CD8+ T cell in the research group was significantly lower than that in the control group (P < 0.05).④There were no significant differences for postoperative fatality rate and postoperative recurrence rate between two groups (P > 0.05). ConclusionsSentinel lymph node biopsy for patients with early breast cancer is safe and reliable. With respect to conventional axillary lymph node dissection, it could improve immune function and quality of life after surgery in patients with early breast cancer.
ObjectiveTo systematically evaluate the efficacy, cosmetic outcome and adverse reaction of hypofractionation radiotherapy (HRT) versus conventional radiotherapy (CRT) for early stage breast cancer after breast conserving surgery. MethodsThe databases including CNKI, CBM, VIP, PubMed, EMbase and The Cochrane Library (Issue 1, 2015) were searched from the inception to May 2015 to collect the randomized controlled trials (RCTs) related to HRT versus CRT for early stage breast cancer after breast conserving surgery. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsSix RCTs involving 8 240 patients were included. Meta-analyses results showed, there were no statistical differences between the HRT group and the CRT group in local-regional recurrence rate (5 year: RR=1.01, 95%CI 0.73 to 1.40, P=0.94; 10 year: RR=1.04, 95%CI 0.86 to 1.26, P=0.67), mortality (5 year: RR=0.95, 95%CI 0.85 to 1.08, P=0.45; 10 year: RR=0.97, 95%CI 0.86 o 1.09, P=0.61), photographic breast appearance (RR=0.98, 95%CI 0.91 to 1.05, P=0.56), the incidence of lung fibrosis (5 year: RR=1.07, 95%CI 0.66 to 1.72, P=0.78; 10 year: RR=1.05, 95%CI 0.62 to 1.77, P=0.86), the incidence of rib fracture (5 year: RR=1.00, 95%CI 0.60 to 1.68, P=0.99; 10 year: RR=1.19, 95%CI 0.70 to 2.00, P=0.52), and the incidence of ischemic of heart (5 year: RR=0.88, 95%CI 0.54 to 1.45, P=0.62; 10 year: RR=0.86, 95%CI 0.54 to 1.37, P=0.53). ConclusionHRT could provide similar tumor control as CRT without serious toxicity. Meanwhile HRT is superior to CRT in terms of patient convenience and costs, it should be promoted as adjuvant treatment for early stage breast cancer after breast conserving surgery.
ObjectiveTo explore the factors associated with non-sentinel lymph node (NSLN) metastasis in early breast cancer patients with 1-2 positive sentinel lymph nodes (SLN), seeking the basis for exempting some SLN-positive patients from axillary lymph node dissection. MethodsA total of 299 early breast cancer patients who were diagnosed with positive sentinel lymph node (SLN) biopsy and underwent axillary lymph node dissection at the Affiliated Hospital of Southwest Medical University from January 2019 to April 2023 were selected. Univariate analysis was performed on the clinical and pathological data of patients, and multivariate logistic regression analysis was conducted to identify factors related to axillary non-sentinel lymph node (NSLN) metastasis of patients with SLN positive in early breast cancer. GraphPad Prim 9.0 was used to draw receiver operating characteristic (ROC) curve, and the area under curve (AUC) of ROC was calculated to quantify the predictive value of risk factors. ResultsAmong the 299 breast cancer patients with 1-2 SLN positive, 101 cases (33.78%) were NSLN positive and 198 cases (66.22%) were NSLN negative. Univariate analysis showed that the number of positive SLN, clinical T staging and lymphovascular invasion were related to the metastasis of NSLN (P<0.001). Multivariate logistic regression analysis indicated that having 2 positive SLN [OR=3.601, 95%CI (2.005, 6.470), P<0.001], clinical T2 staging [OR=4.681, 95%CI (2.633, 8.323), P<0.001], and presence lymphovascular invasion [OR=3.781, 95%CI (2.124, 6.730), P<0.001] were risk factors affecting axillary NSLN metastasis. The AUCs of the three risk factors were 0.623 3, 0.702 7 and 0.682 5, respectively, and the AUCs all were greater than 0.6, suggesting that the three risk factors had good predictive ability for NSLN metastasis. ConclusionThe number of positive SLN, clinical T staging, and lymphovascular invasion are related factors affecting NSLN metastasis in early breast cancer patients with positive SLN, and these factors have guiding significance for whether to exempt axillary lymph node dissection.
ObjectiveTo compare the clinicopathological characteristics and prognosis of young early breast cancer patients with different human epidermal growth factor receptor 2 (HER2) expression levels, and to analyze the clinicopathological characteristics and prognosis of young early breast cancer patients with low HER2 expression. MethodsA total of 1 723 breast cancer patients who were treated in the Department of Breast Surgery of the First Affiliated Hospital of Xi’an Jiaotong University between June 2016 and June 2018 were collected and divided into three groups: HER2-negative, low-expression, and high-expression. The clinicopathological characteristics of the three groups were compared, and the relationship between HER2 expression and patients’ prognosis was analyzed. ResultsThere were 512 HER2-negative patients, 748 HER2-low expression patients, and 463 HER2-high expression patients. The results of the clinical pathological characteristics analysis of the three groups of patients showed that there were no statistical differences in marital status, menopausal status, family history, single T stage (tumor size), single M stage (distant metastasis), affected side, vascular tumor thrombus, and radiotherapy in the three groups of breast cancer patients with different HER2 expression levels (P>0.05). However, there were statistical differences in age, Ki-67 expression level, N stage, TNM stage, surgical method, estrogen receptor and progesterone receptor status, histological type, histological grade, whether to receive neoadjuvant therapy and adjuvant chemotherapy in breast cancer patients with different HER2 expression levels (P<0.05). The results of survival analysis showed that the prognosis of early breast cancer patients may not be significantly correlated with the HER2 expression level, and the prognosis of young early breast cancer patients may also not be statistically correlated with the HER2 expression status. ConclusionsBreast cancer patients with different HER2 expression levels differ in multiple clinicopathological characteristics, but these differences do not significantly affect the prognosis of the patients. Especially for early-stage breast cancer, HER2 expression levels do not seem to have a significant impact on prognosis. This suggests that HER2 status may not be a decisive factor in treatment and prognosis assessment, and other pathological characteristics and treatment methods need to be considered comprehensively. The prognosis of young breast cancer patients in early stage may also not be statistically correlated with HER2 expression status.
The progress of new therapies for solid tumors usually gradually transitions from late stage to early stage. Early treatment of Luminal breast cancer has entered the era of “endocrine therapy +”, with the strengthening of treatment duration and intensity, combined with targeted therapy and multi-gene detection, which still coexist with clinical parameters. For HER2-positive early breast cancer, neoadjuvant therapy has changed the treatment process, requiring exploration of precise strengthening and de-escalation of neoadjuvant therapy. “Neoadjuvant therapy changes adjuvant therapy, and early treatment affects recurrence treatment”.Although the early treatment of triple-negative breast cancer once showed a complicated state of “a hundred schools of thought contend”, today’s treatment strategy is far from focusing on the simple respond of those three negative markers. The core lies in precise diagnosis and classification for treatment! This article summarizes the progress of early breast cancer diagnosis and treatment, in order to provide valuable reference for clinicians' practical application.