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乳腺癌腋窝淋巴结外科处理及其解剖学基础
解剖学是所有外科手术的基础.毫无疑问,解剖学的不断发展,促进了手术技术的进步,手术方式也出现相应的变化.随着相关疾病生物学特性认识的深入、外科治疗理念的进步以及非手术治疗手段的丰富,推动了外科手术方式的变革,使其更趋合理、更加人性化.
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乳腺癌医学影像检查应注意的几个问题
2007年10月中国疾病预防控制中心发布的<中国乳腺癌防治现况报告>指出,我国乳腺癌发病率明显上升,城市地区尤为显著,北京地区女性乳癌发病率为45/10万,10年间上升了23%,成为近年来城市病死率增长快的肿瘤.从发病年龄分布曲线发现,亚洲地区女性发病高峰年龄较西方国家提前 [1].
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浸润性乳腺癌人表皮生长因子受体2基因定量检测标准化的困境和对策
21世纪的病理学在肿瘤领域的工作,一方面仍是传统病理学的内容,即做出诊断,寻找肿瘤关键的预后因子,如分级和分期等,以及与外科医生讨论再切除标本的特征.另一方面是病理学的新内容,即快速和准确地进行免疫组织化学和分子标记评估,确定诊断和预测治疗反应.换言之,21世纪的病理医生是为新兴的分子靶向治疗处理至关重要的信息,从而正确筛选患者.现对人表皮生长因子受体2基因(HER-2)定量检测标准化的困境和对策进行简单论述.
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Digital image-guided surgery to breast reconstruction
Objective We are entering a time when more and more digital images are being introduced to the operating room to enhance surgical outcomes .At the Surgical Simulation Research Lab of the University of Alberta, we developed a technology to superimpose a 3-dimentional (3D) breast model on top of the surgical site to guide a breast reconstruction procedure .Methods The breast models were created from the patient's magnetic resonance images .Our technician modified the breast model by taking data from pre-surgical scanning or from the healthy side of the breast .In the simulated environment , motion sensors were placed on the chest of the patient to capture the movements of the patient during the procedure, which were used to adjust the orientation of the 3D model to ensure a perfect mapping of the surgical site.Results Visual guidance was successfully displayed on top of the surgical site .Motion tracking captured movements of the simulated patient and was used for adjusting the 3D model in a short period of time.Conclusions Feasibility test on this innovative technology is reported in this short paper . We expect the same technology can be applied to other reconstruction surgical procedures in the future .
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妊娠合并乳腺癌的临床研究进展
妊娠合并乳腺癌(pregnancy assisted breast cancer,PABC)是指在妊娠期或产后一年内诊断的原发性乳腺癌,其发病率为10~30/10万,其中40岁以下的患者约占15%[1],仅次于妊娠合并子宫颈癌,是常见的妊娠合并癌肿之一.近年来,随着高龄初产妇的增加,妊娠合并乳腺癌的发病率也有所增加,现就妊娠期合并乳腺癌的临床表现、诊断、治疗以及预后等方面进行综述.
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三阴性乳腺癌分类治疗的机遇与挑战
三阴性乳腺癌(triple-negative breast cancer,TNBC)由于缺乏特异性的治疗靶点及预后判断指标,已逐渐成为乳腺癌研究领域的热点和难点。同时,TNBC高度异质性的特点使其临床个体化治疗存在着极大的盲目性和局限性,这也给疾病的诊治带来更多的挑战。目前,分子生物学技术尤其是基因芯片技术的发展为TNBC的治疗提供了新的机遇。基于基因表达谱分析结果,TNBC可分为六个亚型,这为TNBC的分类治疗奠定了理论基础。化疗作为目前TNBC治疗的主要手段,患者的临床获益十分有限,而根据TNBC分子分型结果展开的相关研究显示,抗雄激素受体的内分泌治疗、以铂类为基础的化疗、多聚二磷酸腺苷核糖聚合酶(poly ADP-ribose polymerase,PARP)抑制剂靶向治疗等手段分别在特定的TNBC亚群患者中疗效明显。此外,已有大量临床试验发现血管内皮生长因子(vascular endothelial growth factor,VEGF)抑制剂、表皮生长因子受体(epidermal growth factor receptor,EGFR)抑制剂等也能使TNBC患者不同程度地获益。因此,从TNBC分子分型着手寻找新的治疗靶点及疗效预测指标,有助于指导临床内分泌、化疗及靶向药物的应用,使TNBC分类治疗成为可能。然而,目前TNBC分子分型及分类治疗的相关研究尚处于探索阶段,其成果应用于临床还有待于更多的试验加以证实。另外,如何将分子分型与易于检测的临床病理指标相结合,还需要做大量的基础-临床间的转化工作。
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首届中国进展期乳腺癌共识指南(草案)
首届中国进展期乳腺癌会议暨“复发转移乳腺癌的管理和综合治疗进展学习班”于2013年8月30日到9月1日在中国北京顺利召开.本次会议为国家继续教育项目,编号2013-04-13-025(国),由中国抗癌协会乳腺癌专业委员会和中国女医师协会临床肿瘤学专家委员会联合主办,北京大学肿瘤医院承办.进展期乳腺癌(advanced breast cancer,ABC)与早期乳腺癌相比,没有公认的治疗标准,特别是在接受一线治疗后.虽然中国抗癌协会乳腺癌专业委员会[1]和NCCN指南[2]、ESMO会议指南[3]都对进展期乳腺癌进行了描述,但目前较全面细致的是ABC1[4],即欧洲肿瘤学校(European School of Oncology,ESO)国际ABC专责小组于2011年在葡萄牙里斯本确立的进展期乳腺癌国际共识指南(1st International Consensus Guidelines for Advanced Breast Cancer,ABC1).为学习和讨论并形成适合中国的共识指南,北京大学肿瘤医院携手乳腺届的同仁,以及ABC1的专家70多人,对ABC1指南涉及的50多个问题,进行了点评和投票,并综合了其他指南起草了中国进展期乳腺癌共识指南(1st Chinese Consensus Guidelines for Advanced Breast Cancer,CABCl) (草案).
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提高对乳腺癌前哨淋巴结活检意义的认识
现代乳腺癌外科治疗始于Halsted提出的乳腺癌根治切除术,腋窝淋巴结清除是乳腺癌根治性切除术的重要内容.
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乳腺癌内分泌治疗的现状与展望
内分泌治疗是乳腺癌治疗的重要手段之一,其重要性受到了越来越广泛的重视.因此,了解乳腺癌内分泌治疗的发展历程,正确把握乳腺癌的治疗策略,将有助于提高乳腺癌的内分泌治疗效果.
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Objective: To find an effective, sensitive, specific and noninvasive diagnostic method of breast cancer. Methods: 109 masses of 102 patients with breast lesions smaller than 2 cm in diameter were divided into three groups to undergo 99mTc-MIBI imaging and compared with the results of pathology examination. 20 cases without breast lesions were selected as control. Abnormal condensation of 99mTc-MIBI in the breast reaching 10% higher than that in the counterpart of the healthy breast was regarded as positive. Results: Of 32 breast cancers, positive imaging appeared in 25. Negative imaging were found in 31 of 38 benign breast lesions. Of 39 occult breast lesions, positive imaging appeared in 6 and 3 of them were breast cancer, 2 of 3 patients with slightly increased 99mTc-MIBI imaging threshold were breast cancer also. No positive imaging was found in the control group. The diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value of 99mTc-MIBI was 88.4%, 89.2%, 88.0%, 75.0% and 95.3%, respectively. Conclusion: 99mTc-MIBI imaging had higher sensitivity and accuracy in the diagnosis of breast cancer and differentiation between benign and malignant breast lesions. It could provide useful information for the diagnosis of clinically suspected breast cancer.
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Objective: To find an effective, sensitive, specific and noninvasive diagnostic method of breast cancer. Methods: 109 masses of 102 patients with breast lesions smaller than 2 cm in diameter were divided into three groups to undergo 99mTc-MIBI imaging and compared with the results of pathology examination. 20 cases without breast lesions were selected as control. Abnormal condensation of 99mTc-MIBI in the breast reaching 10% higher than that in the counterpart of the healthy breast was regarded as positive. Results: Of 32 breast cancers, positive imaging appeared in 25. Negative imaging were found in 31 of 38 benign breast lesions. Of 39 occult breast lesions, positive imaging appeared in 6 and 3 of them were breast cancer, 2 of 3 patients with slightly increased 99mTc-MIBI imaging threshold were breast cancer also. No positive imaging was found in the control group. The diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value of 99mTc-MIBI was 88.4%, 89.2%, 88.0%, 75.0% and 95.3%, respectively. Conclusion: 99mTc-MIBI imaging had higher sensitivity and accuracy in the diagnosis of breast cancer and differentiation between benign and malignant breast lesions. It could provide useful information for the diagnosis of clinically suspected breast cancer.
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MicroRNA与乳腺癌的相关研究进展
MicroRNA (miRNA)是真核生物中一类长度约为22个核苷酸的参与基因转录后水平调控的非编码小分子单链RNA,能通过与靶mRNA特异的碱基配对引起靶mRNA的降解或翻译抑制,从而对基因进行转录后的表达调控[1].目前普遍认为miRNA参与的基因调控是遗传程序中基本的一步,调控着细胞分化、生长、凋亡、代谢等功能[2].近年来的研究表明,多种miRNA参与了癌细胞重要的生物程序的调控,间接地起着促癌基因和抑癌基因的功能,在肿瘤的发生和发展中起了至关重要的作用[3].本文就miRNA在乳腺癌中的研究进展作一综述.
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Overview of breast cancer prevention: what's the next?
Breast cancer is the leading cause of death among women at the ages of 20-59 years[1].The incidence of breast cancer in Asia is also shown to be increasing recently, especially in the more affluent cities, and the peak incidence of breast cancer is at the age of 45-50 years[2].Breast cancer prevention has started from secondary prevention strategy of early detection of the disease with different modalities in Asia[3-5] despite the absence of unified nationwide screening program.There are a lot of discussion about the benefits and harms of breast cancer screening[6-8] and still a lot of controversial issues such as stratification of breast cancer risk, choice of screening modalities, ways of information dissemination, different culturo-religious beliefs, and various levels of medical resources, especially in Asia, remain unresolved.In no doubt, a cost-effective prevention method should be more widely accepted.
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乳腺癌手术前后化疗对手术次数和范围影响的随机临床试验研究
乳腺癌术前化疗正在广泛地用于临床.研究表明行术前化疗的乳腺癌患者其存活率与行术后化疗的相同.但是手术前化疗有其优势:它可以在体内评估肿瘤对化疗的反应,提高保乳术率且不增加局部复发的危险.
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淋巴结阳性乳腺癌的亚型及其对多西紫杉醇的反应:BCIRG001试验中免疫组化分类法的应用
Hugh等于2009年2月在
上发表了题名为"Breast Cancer Subtypes and Response to Docetaxel in Node-Positive Breast Cancer: Use of an Immunohistochemical Definition in the BCIRG 001 Trial"的论著. -
乳腺癌处理新趋势——即时乳房重建时代正在发生改变
20世纪80年代以来,人们认识到乳房切除术后放疗并不会提高生存率,因此乳房切除术后进行放疗的数量也随之下降.随着越来越多的早期乳腺癌患者选择保乳手术,并且保乳手术效果得到了实践证实,使得整形外科医生开始进行即时乳房重建代替以前的延迟乳房重建.
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三阴性乳腺癌研究进展
三阴性乳腺癌(triple negative breast cancer)是指雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)和人表皮生长因子受体2(human epidermal growth factor receptor 2,HER-2)均为阴性的乳腺癌,非洲和非洲裔美国绝经前女性好发,约占乳腺癌的15%.
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放射治疗和不同手术方式对早期乳腺癌局部复发和远期生存的影响:有关乳腺癌随机试验综述的评论
1原著摘要1.1背景影响乳腺癌局部复发风险的不同局部治疗也可以影响远期病死率.1.2目的为了量化评价局部控制对远期生存的影响,对1995年开始的乳腺癌放射治疗和不同术式的随机试验进行了联合meta分析.
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有关内乳淋巴结照射的EORTC Ⅲ期临床实验质控经验介绍
Elena Musat在近的欧洲癌症杂志(European Journal of Cancer)上发表一篇题目为"Quality assurance in breast cancer:EORTC experiences in the phase Ⅲ trial on irradiation of the internal mammary nodes"的文章.本文就其主要内容作一简单介绍.
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原发性乳腺癌水平Ⅰ与水平Ⅲ腋窝淋巴结清扫随机对照研究的10年随访结果
淋巴结(LN)转移和肿瘤大小与乳腺癌患者的生存密切相关.一直以来,淋巴结受累的程度和数目是重要的预后因素,指导着临床选择更可能从辅助治疗中获益的患者.乳腺癌区域淋巴结包括腋窝(Ax)和乳房内淋巴结.以前,清扫乳房内淋巴结和腋窝淋巴结的扩大根治术是乳腺癌的标准手术方式之一,但是几项随机对照研究表明乳房内淋巴结清扫不能提高术后生存率,因此现在大多数乳腺外科医师只清扫腋窝淋巴结.虽然仍有研究报道腋窝淋巴结清扫后患者的生存率明显高于淋巴结保留手术,但是几项研究表明腋窝淋巴结清扫无助于提高患者术后生存率,而且大样本的mete-分析也表明腋窝淋巴结清扫和放射治疗不能提高乳腺癌患者术后的生存率.几项临床研究显示,当临床没有明显的腋窝淋巴结受累,不进行腋窝淋巴结清扫或放疗时,腋窝的复发率非常高(大约18%~35%),因此,乳腺癌手术应常规行腋窝淋巴结清扫,其目的是控制局部复发和进行肿瘤(pN)的分期.