McClenathan James H, de la Roza Gustavo
Department of Surgery, Kaiser Permanente Medical Center, 900 Kiely Blvd., Santa Clara, CA 95051, USA.
Am J Surg. 2002 Jun;183(6):646-9. doi: 10.1016/s0002-9610(02)00858-9.
Adenoid cystic carcinoma is a rare type of breast cancer that is generally reported in individual case reports or as series from major referral centers. To characterize early diagnostic criteria for adenoid cystic carcinoma and to determine whether breast-preserving surgery with radiotherapy is as effective as mastectomy for eradicating the disease, we reviewed clinical records of a large series of patients treated for adenoid cystic carcinoma of the breast at a large health maintenance organization (HMO) that includes primary care facilities and referral centers.
Using the data bank of the Northern California Cancer Registry of the Kaiser Permanente Northern California Region (KPNCR), we retrospectively reviewed medical records of patients treated for adenoid cystic carcinoma of the breast. Follow-up also was done for these patients.
Adenoid cystic carcinoma of the breast was diagnosed in 22 of 27,970 patients treated for breast cancer at KPNCR from 1960 through 2000. All 22 patients were female and were available for follow-up. Mean age of patients at diagnosis was 61 years (range, 37 to 94 years). In 17 (77%) of the women, a lump in the breast led to initial suspicion of a tumor; in 4 (23%) of the 22 patients, mammography led to suspicion of a tumor. Median tumor size was 20 mm. Pain was a prominent symptom. Surgical management evolved from radical and modified radical mastectomy to simple mastectomy or lumpectomy during the study period, during which time 1 patient died of previous ordinary ductal carcinoma of the contralateral breast, and 7 died of unrelated disease. At follow-up, 12 of the 13 remaining patients were free of disease; 1 patient died of the disease; and 1 patient remained alive despite late occurrence of lymph node and pulmonary metastases.
Whether breast-preserving surgery with radiotherapy is as effective as mastectomy for treating adenoid cystic carcinoma of the breast has not been determined.
腺样囊性癌是一种罕见的乳腺癌类型，通常在个别病例报告中或作为主要转诊中心的系列病例报道。为了明确腺样囊性癌的早期诊断标准，并确定保乳手术联合放疗在根除该疾病方面是否与乳房切除术同样有效，我们回顾了在一个大型健康维护组织（HMO）中接受治疗的大量腺样囊性癌患者的临床记录，该组织包括初级保健机构和转诊中心。
利用北加利福尼亚凯撒永久医疗集团（KPNCR）的北加利福尼亚癌症登记数据库，我们回顾性地查阅了接受乳腺腺样囊性癌治疗患者的病历。同时对这些患者进行了随访。
1960年至2000年期间，在KPNCR接受乳腺癌治疗的27970名患者中，有22例被诊断为乳腺腺样囊性癌。所有22例患者均为女性且可供随访。患者诊断时的平均年龄为61岁（范围37至94岁）。17名（77%）女性因乳房肿块最初怀疑患有肿瘤；22例患者中有4例（23%）因乳腺X线摄影怀疑患有肿瘤。肿瘤大小的中位数为20毫米。疼痛是突出症状。在研究期间，手术治疗方式从根治性和改良根治性乳房切除术演变为单纯乳房切除术或肿块切除术，在此期间，1例患者死于对侧乳房先前的普通导管癌，7例死于无关疾病。随访时，其余13例患者中有12例无疾病；1例患者死于该疾病；1例患者尽管出现了晚期淋巴结和肺转移但仍存活。
保乳手术联合放疗在治疗乳腺腺样囊性癌方面是否与乳房切除术同样有效尚未确定。
