见微知著——腋窝淋巴结与前哨淋巴结活检

腋窝淋巴结状态是判断乳腺癌患者分期的重要指标,也是影响患者预后的一项独立危险因素。腋窝淋巴结处理是乳腺癌外科治疗的重要组成部分,前哨淋巴结活检已是临床淋巴结阴性患者的腋窝标准处理。随着前哨淋巴结研究的进展,前哨淋巴结阳性的腋窝处理方式及新辅助治疗患者的前哨淋巴结活检问题已成为近期研究的热点。本文就腋窝淋巴结管理的理念变迁及前哨淋巴结活检技术的新进研究进展作一探讨。     

超声造影引导下细针穿刺细胞学在判断乳腺癌腋窝淋巴结状态中的应用

研究经皮超声造影引导下细针穿刺细胞学检查评估乳腺癌患者腋窝淋巴结状态的可行性及应用价值。取2014年7月～2016年1月笔者所在医院收治的342例乳腺癌患者,术前行经皮超声造影引导细针淋巴结穿刺活检。以术后淋巴结病理结果为金标准评估细针病理结果。结果表明经皮超声造影引导下细针穿刺细胞学检查判断腋窝淋巴结状态的敏感性、特异性、阳性预测值、阴性预测值和诊断准确率分别为97.57%(281/288)、100.00%(54/54)、100.00%(281/281)、88.52%(54/61)、97.95%(335/342)。经皮超声造影引导下细针穿刺细胞学检查可在术前准确评估乳腺癌患者腋窝淋巴结状态,细针穿刺细胞学病理阳性患者可避免前哨淋巴结活检,直接行腋窝淋巴结清扫术。     

乳腺癌前哨淋巴结活检术新型荧光靶向示踪剂的研发进展

前哨淋巴结活检术是临床腋窝淋巴结阴性的早期乳腺癌患者腋窝的标准处理模式,但由于传统示踪剂(蓝染料、核素和荧光示踪剂等)定位特异性差及药物准入等问题,限制了其在临床的推广应用。蓝染料和荧光示踪剂由于分子颗粒较小导致其易通过前哨淋巴结使次级淋巴结显像。核素示踪剂虽然可以特异性定位前哨淋巴结,但存在药品准入和放射安全性等问题。利妥昔单抗是一种针对淋巴结中B淋巴细胞膜上CD20分子的特异性人源化单克隆抗体,新型荧光靶向示踪剂将吲哚菁绿偶联于利妥昔单抗,将兼顾荧光显像与靶向定位的优点,其单抗的分子完整性和免疫活性无破坏,为无菌、无致热原、无急性毒性的示踪剂。     

吲哚菁绿与亚甲蓝在乳腺癌前哨淋巴结活检术中应用的对比研究

通过对比吲哚菁绿（ICG）与亚甲蓝两种染色剂在前哨淋巴结活检（SLNB）中的应用,来证实ICG荧光示踪法在SL‐NB中的优势。选取我院从2010年到2012年68位行SLNB的乳腺癌患者,随机分成两组,一组采用ICG荧光导航SL‐NB ,共36例,另一组采用亚甲蓝染料法SLNB ,共32例,SLNB结束后行腋窝淋巴结清...     

老年乳腺癌临床病理特征及手术方案选择分析

回顾性分析老年乳腺癌的临床病理特征及手术方案的选择。筛选出2012年1月~2014年12月河北医科大学第四医院乳腺中心经病理证实的女性原发性乳腺癌共4 609例,老年乳腺癌(≥65岁)共795例。按年龄65岁~70岁及≥70岁分组,比较两组患者临床病理特点及手术方式。结果显示65岁~70岁组及≥70岁组患者分别554例(12.01%)及241例(5.60%),初诊Ⅳ期患者及骨转移者≥70岁组均高于65岁~70岁组。两组患者肿瘤学分级差异无统计学意义,但两组患者中Ⅰ级和Ⅱ级者均较高。65岁~70岁组患者选择改良根治术高于≥70岁组患者(χ~2=4.792,P=0.029),局部切除术以及放弃手术治疗患者均低于≥70岁组。而在乳房切除+前哨淋巴结活检术、乳房单纯切除术以及乳房切除+低位淋巴结摘除术方案上两组差异无统计学意义。老年乳腺癌患者自查意识差,但其恶性程度低,由于多伴有其他系统疾病,治疗方案需个体化,手术方式可选择局部扩大切除术,提高患者生活质量。     

对宫颈癌中前哨淋巴结检测的认识

广泛子宫切除+盆腔淋巴结清扫是治疗早期宫颈癌的标准术式。但对无盆腔淋巴结转移患者,淋巴结清扫并无治疗意义,且伴随多种并发症。前哨淋巴结检测有望解决这一问题,其在宫颈癌中的应用有较大可行性,亦存在局限性。只有正确认识并应用之,才能造福患者。     

纳米炭、美兰在早期乳腺癌前哨淋巴结活检中应用的临床比较研究

比较两种示踪剂(美兰、纳米炭)在早期乳腺癌前哨淋巴结活检(SLNB)中的临床应用价值。收集早期乳腺癌患者110例,随机分为纳米炭组、美兰组,术前10分钟~20分钟将两种示踪剂经乳晕周围及肿瘤周围皮下注射,美兰0.5ml~1.0ml、纳米炭0.2ml~0.5ml,首先行SLNB,然后常规行腋窝淋巴结清扫。以病理检查为标准,分别对SLNB的灵敏度、准确率、假阴性率等进行评价。结果,110例患者均找到了蓝染(美兰47例)或黑染(纳米炭63例)淋巴结,其检出率相同,均为100.00%。纳米炭组与美兰组的灵敏度分别为92.86%、100.00%,准确率为85.71%、85.10%,两组间差异无统计学意义;纳米炭组假阴性率为7.14%,美兰组假阴性率为0.00%,两组间差异无统计学意义。纳米炭及美兰在早期乳腺癌患者中行SLNB是可靠的,两种示踪剂在SLNB中的灵敏度、准确率及假阴性率无明显差异。     

对宫颈癌中前哨淋巴结检测的认识

广泛子宫切除+盆腔淋巴结清扫是治疗早期宫颈癌的标准术式.但对无盆腔淋巴结转移患者,淋巴结清扫并无治疗意义,且伴随多种并发症.前哨淋巴结检测有望解决这一问题,其在宫颈癌中的应用有较大可行性,亦存在局限性.只有正确认识并应用之,才能造福患者.     

胃癌前哨淋巴结研究路在何方

淋巴结转移程度和清除范围是影响胃癌预后的重要因素,根据胃癌前哨淋巴结研究的现状、存在的问题,探索胃癌前哨淋巴结的研究方向,对于揭示胃癌淋巴结转移规律、指导外科手术具有重要意义。     

胃癌前哨淋巴结研究路在何方

淋巴结转移程度和清除范围是影响胃癌预后的重要因素,根据胃癌前哨淋巴结研究的现状、存在的问题,探索胃癌前哨淋巴结的研究方向,对于揭示胃癌淋巴结转移规律、指导外科手术具有重要意义.     

Breast Cancer in Men: Emasculation by Association?

The occurrence of breast cancer in men is rare in comparison to women. Public knowledge that men can get breast cancer and of male breast self-examination are lacking. Research in the course and treatment of breast cancer in men is needed. Men generally present in more advanced stages of breast cancer than women, and have a poorer prognosis. In this article, the epidemiology, common symptoms, diagnostic methods, and current treatment of breast cancer in men are described. Gender differences in presentation and course of illness are discussed. Additionally, the psychological implications of breast cancer for male gender roles and masculine identity are explored. Directions for further investigation are given. Treatment providers are encouraged to educate themselves and their male patients on breast cancer in men and male breast examination techniques so that this disease may be identified earlier in its course and survival rates improved.     

乳腺病变的常规影像学筛查方法的合理性分析

乳腺癌是妇女最常见的恶性肿瘤之一,在我国,乳腺癌的发病率和死亡率已成为城市女性恶性肿瘤的首位,且每年以3％～5％速度增长。目前乳腺癌防治日益受到重视。然而,为了阻断高危险性的乳腺向乳腺癌发展,乳腺影像学筛查正在被越来越多的女性接受。本文就各种影像检查手段对乳腺疾病特别是乳腺癌诊断的优缺点进行简要的总结,旨在指导临床医师...     

Factors Influencing Perceptions of Breast Cancer Genetic Counseling among Women in an Urban Health Care System

The study assessed perceptions of breast cancer genetic counseling. Focus groups were conducted with twenty women (ages < = 50 years) in a Midwestern, urban health system identified as at above average risk of developing hereditary breast cancer and referred for breast cancer genetic counseling following mammography. All participants associated the words “breast cancer” with fear. African American women who received breast cancer genetic counseling may have channeled their fear into increased vigilance related to breast health. African American women who did not receive breast cancer genetic counseling were most knowledgeable about it. In contrast, Caucasian women who did not receive it reported uncertainty about the role of genetic counseling and testing in assessing breast cancer risk, mistrust in medical professionals, and lack of trust in the accuracy of genetic tests. The results could be used to help develop interventions to improve informed decision-making regarding breast cancer genetic counseling.     

Breast Cancer in Men: A Need for Psychological Intervention

Male breast cancer is a serious issue that needs to be addressed more fully by the medical and public community. However, due to a lack of awareness and limited research on the topic, there is a general absence of knowledge concerning the psychological implications of this disease in men as well as a need for greater understanding of the medical diagnosis and treatment of male breast carcinoma. Similarly, there still remains a considerable gender difference between the awareness of female breast cancer and male breast cancer Although breast cancer in men makes up only 1% of all breast cancers reported in the United States, it is increasing in incidence. There are approximately 2000 new cases and approximately 450 deaths due to male breast cancer each year. Breast cancer diagnosis and treatment in men is very similar to that described in women, however, it has been shown that men are being diagnosed at a later stage of the disease than women.     

The stage-specific role of spirituality among African American Christian women throughout the breast cancer experience

This study presents the results of semistructured interviews conducted with 18 African American Christian women regarding the role of spirituality throughout their breast cancer experiences. The spiritual themes relevant for phases of the breast cancer experience are identified. Analysis resulted in the identification of 11 codes and 5 subcodes that corresponded to the diagnosis, treatment, and posttreatment phases of the breast cancer experience. Most of the survivors indicated that their spirituality and faith assisted them throughout the breast cancer experience. Discussion focuses on the spiritual resources used by the participants at the different stages in the breast cancer experience. Attention is given to implications for how professionals can use these resources to assist African American women coping with breast cancer.     

手术治疗在晚期乳腺癌中的应用价值

乳腺癌已经成为女性最常见的恶性肿瘤。虽然乳腺癌的早期诊断和治疗水平已经得到了很大水平的提高,但是仍有相当一部分患者在诊断时就已经存在远处转移,或者在术后出现局部复发以及远处转移。对于手术治疗在这些晚期乳腺癌患者中的作用,目前还存在很大的争议。本文对相关内容进行了探讨,认为晚期乳腺癌的治疗需要多学科协作的综合治疗,不应该忽视手术这个重要的治疗手段,从而使晚期的患者也能获得长期生存甚至治愈的机会。     

Knowledge of Breast Cancer Genetics Among Breast Cancer Patients and First-Degree Relatives of Affected Individuals

The cloning of BRCA1, a susceptibility gene for inherited breast cancer, has made genetic screening possible for individuals and families whose medical histories are suggestive of an inherited predisposition to breast cancer. To date, few systematic attempts have been made to determine the level of knowledge about breast cancer genetics among women who are likely to seek BRCA1 screening when it becomes widely available. The present study attempted to assess the general knowledge about BRCA1 mutations in two groups: (1) first-degree relatives (FDRs) of breast cancer patients; and (2) women with a previous diagnosis of breast cancer. A self-administered, thirty-item questionnaire was developed through a pilot study. Ten of the items were objective, factual questions about breast cancer genetics. Responses to these questions were used to generate an overall knowledge score for each respondent. The study population was moderately knowledgeable about breast cancer genetics, with an average score of 5.35 out of 10. Counselors should not underestimate the importance of evaluating each counselee's existing knowledge about breast cancer, which can affect the provision and reception of genetic information. In particular, specific areas of knowledge that may be confusing or misunderstood were identified and these topics are discussed in detail.     

乳腺癌的复发转移病灶需要外科治疗吗？

复发转移是乳腺癌常见的生物学特性。发生复发转移后,疾病常常不可治愈,主要治疗目的是减轻症状,改善生存质量,尽可能延长生存期。复发转移性乳腺癌被认为是一种全身疾病,局部治疗常不受重视,对于复发转移病灶的手术切除是否需要争议较大。但复发转移性乳腺癌也是一种复杂的异质性疾病,对某些亚组的转移病灶进行手术切除,与单纯全身治疗相比,可能进一步改善预后。     

Rural breast cancer patients,coping and depressive symptoms: A prospective comparison study

Many studies have revealed that individual differences in coping responses to the diagnosis and treatment of breast cancer are associated with psychological adjustment. The vast majority of these studies, however, focus exclusively on urban breast cancer survivors despite that rural breast cancer survivors are likely to have distinct experiences both in general and in relation to breast cancer. The current study quantitatively examined the coping strategies employed by both rural and urban breast cancer patients while they were undergoing radiation therapy. Further, the influence of these coping behaviours on concurrent as well as subsequent depressive symptoms (3 and 6 months later) was examined. The results revealed that the rurality of breast cancer patients was unrelated to the ways in which they coped, but did influence the relationships between some coping responses and depressive symptoms. Specifically, active coping and positive reinterpretation were negatively related to depressive symptoms for more rural breast cancer patients, but not their relatively urban counterparts. Similarly, behavioural disengagement was more strongly related to depressive symptoms for more rural patients. Possible reasons for this pattern of results and implications are discussed.