病叶假说、场癌化与精准乳腺手术新时代
The sick lobe hypothesis, field cancerisation and the new era of precision breast surgery.
作者信息
Tan Mona P, Tot Tibor
机构信息
Department of Breast Surgical Oncology, MammoCare, Singapore, Singapore.
Department of Pathology & Head, Pathology and Cytology Dalarna, County Hospital Falun, Falun, Sweden.
出版信息
Gland Surg. 2018 Dec;7(6):611-618. doi: 10.21037/gs.2018.09.08.
Abstract
Understanding the ductal anatomy of the breast provides insights into tumorigenesis, which in turn offers guidance on therapeutic decisions. In this regard, the sick lobe hypothesis, which states that cancer arises from genetically unstable cells through mutations acquired in utero, forms the basis of malignant transformation. These 'at risk' cells line the mammary ductal-lobular system of a single 'sick' lobe and when exposed to noxious events in the surrounding microenvironment, further genetic changes occur which completes conversion to malignancy, in certain defined patterns. This review explores how anatomy, pathology and genomics can merge, not only to guide optimum surgery, but also to provide a more comprehensive portal for precision medicine.
摘要
了解乳腺导管解剖结构有助于深入了解肿瘤发生机制，进而为治疗决策提供指导。在这方面，患病叶假说认为癌症源于子宫内获得突变的基因不稳定细胞，构成了恶性转化的基础。这些“风险”细胞排列在单个“患病”叶的乳腺导管小叶系统中，当暴露于周围微环境中的有害事件时，会发生进一步的基因变化，从而以特定的模式完全转变为恶性肿瘤。本综述探讨了解剖学、病理学和基因组学如何融合，不仅为优化手术提供指导，还为精准医学提供更全面的途径。
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