乳腺癌病史患者的乳房缩小成形术：隐匿性癌和高危病变的发生率。
Reduction mammaplasty in patients with history of breast cancer: The incidence of occult cancer and high-risk lesions.
机构信息
Department of Plastic and Reconstructive Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 266, 00029, HUS, Finland.
Department of Plastic and Reconstructive Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 266, 00029, HUS, Finland.
出版信息
Breast. 2017 Oct;35:157-161. doi: 10.1016/j.breast.2017.07.009. Epub 2017 Jul 25.
INTRODUCTION
Contralateral reduction mammaplasty is regularly included in the treatment of breast cancer patients. We analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammaplasty specimens of women with previous breast cancer. We also analyzed if timing of reduction mammaplasty in relation to oncological treatment influenced the incidence of abnormal findings, and compared if patients with abnormal contralateral histopathology differed from the study population in terms of demographics.
MATERIALS AND METHODS
The study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammaplasty between 1/2007 and 12/2011. The data was retrospectively analyzed for demographics, operative and histopathology reports, oncological treatment, and postoperative follow-up.
RESULTS
Reduction mammaplasty specimens revealed abnormal findings in 68 (21.5%) patients. High-risk lesions (ADH, ALH, and LCIS) were revealed in 37 (11.7%), and cancer in six (1.9%) patients. Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). Abnormal histopathological findings were more frequent in patients with reduction mammaplasty performed prior to oncological treatment (p < 0.001), and in patients with immediate reconstruction (p = 0.0064).
CONCLUSION
The incidences of malignant and high-risk lesions are doubled compared to patients without prior breast cancer. Patients with abnormal histopathology cannot be preoperatively identified based on demographics. If reduction mammaplasty is performed before oncological treatment, the incidence of abnormal findings is higher. In the light of our results, contralateral reduction mammaplasty with histopathological evaluation in breast cancer patients offers a sophisticated tool to catch those patients whose contralateral breast needs increased attention.
引言
对乳腺癌患者，通常会将对侧乳房缩小成形术纳入治疗方案。我们分析了既往患有乳腺癌的女性乳房缩小成形术标本中隐匿性乳腺癌和高危病变的发生率。我们还分析了对侧乳房缩小成形术与肿瘤治疗的时间关系是否会影响异常发现的发生率，并比较了对侧组织病理学异常的患者与研究人群在人口统计学方面的差异。
材料与方法
该研究纳入了 329 例于 2007 年 1 月至 2011 年 12 月期间行对称乳房缩小成形术的乳腺癌患者。回顾性分析患者的人口统计学资料、手术和组织病理学报告、肿瘤治疗和术后随访资料。
结果
乳房缩小成形术标本中 68 例（21.5%）发现异常。37 例（11.7%）存在高危病变（非典型导管增生、非典型小叶增生和不典型小叶原位癌），6 例（1.9%）存在癌症。异常组织病理学与年龄较大（p=0.0053）、标本较重（p=0.0491）和无既往乳房手术史（p<0.001）相关。在肿瘤治疗前进行乳房缩小成形术（p<0.001）和即刻重建（p=0.0064）的患者中，异常组织病理学发现更为常见。
结论
与无既往乳腺癌的患者相比，恶性和高危病变的发生率增加了一倍。无法根据人口统计学特征术前识别组织病理学异常的患者。如果在肿瘤治疗前进行乳房缩小成形术，异常发现的发生率更高。根据我们的研究结果，对乳腺癌患者行对侧乳房缩小成形术并进行组织病理学评估提供了一种复杂的工具，可以发现那些对侧乳房需要更多关注的患者。
Zotero 插件