Tartter Paul Ian, Weiss Stephanie, Ahmed Sharmila, Kamath Shuba, Hermann George, Drossman Susan
Departments of Surgery, Mount Sinai Medical Center, New York, New York; Departments of Radiology, Mount Sinai Medical Center, New York, New York.
Breast J. 1999 Jan;5(1):22-25. doi: 10.1046/j.1524-4741.1999.005001022.x.
A small percentage of breast cancers are not visible on mammography. Since mammographically occult malignancies may be more difficult to diagnose, we hypothesized that the lack of visualization would cause a delay in detection, more aggressive surgical and adjuvant therapy, and poorer outcome. Patients with mammographically occult malignancies were compared to patients with cancers visible on mammogram. The significance of mammographic visibility for treatment and local and distant recurrence rates were evaluated. Ninety-one of the 813 (11%) cancers were mammographically occult. Patients with mammographically occult malignancies were significantly younger, of lower body weight, and had fewer pregnancies than patients with cancers visible on mammography: age, body weight, and parity were statistically significant (p < 0.001) in stepwise logistic regression. Ductal carcinoma in situ was significantly more frequently diagnosed in patients with mammographically visible malignancies (14% versus 4%, p = 0.0163) and nodal involvement was significantly more frequent in patients with mammographically occult malignancies (35% versus 24%, p = 0.0391). Diagnostic delays exceeding 3 months were experienced by 24% of patients with mammographically occult malignancies compared to 13% of patients with tumor visible on mammography (p < 0.0001). Adjuvant chemotherapy was given to 63% of patients with occult malignancies compared to 41% of patients with mammographically visible cancers (p = 0.0027). The use of breast-conserving therapy and adjuvant radiation and tamoxifen were comparable. Survival free of local recurrence and distant metastases for the 403 patients followed for 5 years or more was not related to mammographic visibility.
一小部分乳腺癌在乳房X线摄影中不可见。由于乳房X线摄影隐匿性恶性肿瘤可能更难诊断，我们推测缺乏可视化会导致检测延迟、更积极的手术和辅助治疗以及更差的预后。将乳房X线摄影隐匿性恶性肿瘤患者与乳房X线摄影可见癌症患者进行比较。评估乳房X线摄影可见性对治疗以及局部和远处复发率的意义。813例癌症中有91例（11%）在乳房X线摄影中隐匿。乳房X线摄影隐匿性恶性肿瘤患者比乳房X线摄影可见癌症患者明显更年轻、体重更低且怀孕次数更少：在逐步逻辑回归中，年龄、体重和产次具有统计学意义（p<0.001）。乳房X线摄影可见恶性肿瘤患者原位导管癌的诊断频率明显更高（14%对4%，p = 0.0163），而乳房X线摄影隐匿性恶性肿瘤患者淋巴结受累明显更频繁（35%对24%，p = 0.0391）。乳房X线摄影隐匿性恶性肿瘤患者中有24%经历了超过3个月的诊断延迟，而乳房X线摄影可见肿瘤患者中这一比例为13%（p<0.0001）。63%的隐匿性恶性肿瘤患者接受了辅助化疗，而乳房X线摄影可见癌症患者中这一比例为41%（p = 0.0027）。保乳治疗、辅助放疗和他莫昔芬的使用情况相当。对403例随访5年或更长时间的患者进行的无局部复发和远处转移生存分析与乳房X线摄影可见性无关。
