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乳腺癌的主要争议点。

Main controversies in breast cancer.

作者信息

Zervoudis Stephane, Iatrakis George, Tomara Eirini, Bothou Anastasia, Papadopoulos George, Tsakiris George

机构信息

Stephane Zervoudis, George Iatrakis, George Papadopoulos, George Tsakiris, Rea Hospital, 17564 Athens, Greece.

出版信息

World J Clin Oncol. 2014 Aug 10;5(3):359-73. doi: 10.5306/wjco.v5.i3.359.

Abstract

In this article, we have reviewed available evidence for diagnosis, treatment, and follow-up in female breast cancer (BC). Into daily clinical practice some controversies are occurred. Especially, in the diagnosis field, despite the fact that the optimal age in which screening mammography should start is a subject of intense controversy, there is a shift toward the beginning at the age of 40 although it is suggested that the net benefit is small for women aged 40 to 49 years. In addition, a promising tool in BC screening seems to be breast tomosynthesis. Other tools such as 3D ultrasound and shear wave elastography (SWE) are full of optimism in BC screening although ultrasonography is not yet a first-line screening method and there is insufficient evidence to recommend the systemic use of the SWE for BC screening. As for breast magnetic resonance imaging (MRI), even if it is useful in BC detection in women who have a strong family history of BC, it is not generally recommended as a screening tool. Moreover, based on the lack of randomized clinical trials showing a benefit of presurgical breast MRI in overall survival, it's integration into breast surgical operations remains debatable. Interestingly, in contrast to fine needle aspiration, core biopsy has gained popularity in presurgical diagnosis. Furthermore, after conservative surgery in patients with positive sentinel lymph nodes, the recent tendency is the shift from axillary dissection to axillary conserving strategies. While the accuracy of sentinel lymph node after neoadjuvant chemotherapy and second BC surgery remains controversial, more time is needed for evaluation and for determining the optimal interval between the two surgeries. Additionally, in the decision between immediate or delayed breast reconstruction, there is a tendency in the immediate use. In the prevention of BC, the controversial issue between tamoxifen and raloxifene becomes clear with raloxifene be more profitable through the toxicities of tamoxifen. However, the prevention of bone metastasis with bisphosphonates is still conflicting. Last but not least, in the follow-up of BC survivors, mammography, history and physical examination are the means of an early detection of BC recurrence. ed.

摘要

在本文中,我们回顾了女性乳腺癌(BC)诊断、治疗及随访的现有证据。在日常临床实践中出现了一些争议。特别是在诊断领域,尽管乳腺钼靶筛查应开始的最佳年龄是一个激烈争论的话题,但有向40岁开始转变的趋势,尽管有人认为对于40至49岁的女性净获益很小。此外,乳腺断层合成似乎是乳腺癌筛查中一种有前景的工具。其他工具如三维超声和剪切波弹性成像(SWE)在乳腺癌筛查中充满希望,尽管超声尚未成为一线筛查方法,且没有足够证据推荐将SWE系统用于乳腺癌筛查。至于乳腺磁共振成像(MRI),即使它对有乳腺癌家族史的女性检测乳腺癌有用,但一般不推荐作为筛查工具。此外,基于缺乏显示术前乳腺MRI对总体生存有益的随机临床试验,其在乳腺外科手术中的应用仍存在争议。有趣的是,与细针穿刺相比,粗针活检在术前诊断中更受欢迎。此外,在前哨淋巴结阳性患者进行保乳手术后,最近的趋势是从腋窝清扫转向腋窝保留策略。虽然新辅助化疗后前哨淋巴结及二次乳腺癌手术的准确性仍存在争议,但需要更多时间来评估并确定两次手术之间的最佳间隔。此外,在即刻或延迟乳房重建的决策中,有即刻使用的趋势。在乳腺癌预防方面,他莫昔芬和雷洛昔芬之间的争议随着雷洛昔芬因他莫昔芬的毒性而更具优势而变得清晰。然而,双膦酸盐预防骨转移仍存在争议。最后但同样重要的是,在乳腺癌幸存者的随访中,乳腺钼靶、病史和体格检查是早期发现乳腺癌复发的手段。编辑。

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