Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Ont., Canada.
Can J Surg. 2010 Aug;53(4):268-77.
Increasing numbers of women are seeking evaluation of screen-detected breast abnormalities, and more women with breast cancer are living with the consequences of treatment. Improved technologies have helped to individualize diagnostic evaluation and treatment, improve efficacy and minimize morbidity. This article highlights some of these technologies. Superior imaging techniques have improved breast cancer screening and show promise for intraoperative surgical guidance and postoperative specimen evaluation. Digital mammography improves the sensitivity of mammography for women younger than 50 years with dense breasts, and tomosynthesis may improve specificity. Magnetic resonance imaging provides sensitive delineation of the extent of the disease and superior screening for women with a greater than 25% lifetime risk of breast cancer Minimally invasive techniques have been developed for the assessment of intraductal lesions, biopsy of imaging abnormalities, staging of the axilla and breast radiotherapy. Ductoscopy facilitates intraductal biopsy and localization of lesions for excision, sentinel lymph node biopsy is becoming standard for axillary staging, and intraoperative radiotherapy has the potential to reduce treatment time and morbidity. Three-dimensional imaging allows correlation of final histology with preoperative imaging for superior margin assessment. Related techniques show promise for translation to the intraoperative setting for surgical guidance. New classifications of breast cancers based on gene expression, rather than morphology, describe subtypes with different prognoses and treatment implications, and new targeted therapies are emerging. Genetic fingerprints that predict treatment response and outcomes are being developed to assign targeted treatments to individual patients likely to benefit. Surgeons play a vital role in the successful integration of new technologies into practice.
越来越多的女性寻求对筛查出的乳腺异常进行评估，越来越多的乳腺癌患者正在承受治疗带来的后果。改进的技术有助于实现诊断评估和治疗的个体化，提高疗效并最大限度地减少发病率。本文重点介绍了其中一些技术。先进的成像技术提高了乳腺癌筛查的灵敏度，并有望在术中手术指导和术后标本评估中发挥作用。数字乳腺摄影提高了致密乳腺年轻女性的乳腺摄影灵敏度，断层合成术可能提高了特异性。磁共振成像能够敏感地描绘疾病的范围，并对终生乳腺癌风险大于 25%的女性进行更好的筛查。微创技术已被开发用于评估导管内病变、对影像学异常进行活检、腋窝和乳腺放疗分期。乳管镜有助于对导管内病变进行活检和定位切除，前哨淋巴结活检已成为腋窝分期的标准，术中放疗有可能减少治疗时间和发病率。三维成像可使最终组织学与术前成像相关联，从而更好地评估切缘。相关技术有望转化为术中手术指导，以提高手术效果。基于基因表达而非形态学的新乳腺癌分类描述了具有不同预后和治疗意义的亚型，新的靶向治疗方法正在出现。正在开发预测治疗反应和结果的基因指纹，以便将靶向治疗分配给可能受益的个体患者。外科医生在成功地将新技术融入实践中起着至关重要的作用。
