Exarchos Georgios, Metaxa Linda, Constantinidou Anastasia, Kontos Michalis
2nd Department of Surgery, National and Kapodistrian University of Athens, Athens, Greece.
Radiology Department, St Bartholomew's Hospital, London, UK.
Breast Care (Basel). 2019 Mar;14(1):48-52. doi: 10.1159/000494691. Epub 2018 Dec 1.
Delayed breast cellulitis (DBC) is a relatively rare complication following breast-conserving surgery. It is often challenging to distinguish DBC from other clinical conditions such as postoperative infection, inflammatory reaction following radiation, and recurrent inflammatory carcinoma. The definition of DBC, diagnostic approach, and treatment are not well established in the literature.
We performed a literature search with the keywords 'Delayed breast cellulitis' and 'Breast conservation therapy cellulitis', without limitations to the dates or the article types, in the PubMed database. Information about the number of cases with DBC, the age of the patients, the interval between the onset of symptoms and the time of surgery or radiotherapy, and the type and outcome of DBC treatment were reviewed and tabulated.
We identified only 5 papers that were absolutely related to our subject, reflecting the fact that 'delayed breast cellulitis' is a fairly unknown term and the condition is rather underreported. Although most agree that DBC is primarily an aseptic inflammatory process, bacterial growth may contribute to its development or recurrence. Obesity, breast size, location of the breast tumor, removal of the axillary lymph nodes, and connective tissue disorders are considered as risk factors. There is no clear evidence on how DBC should be best managed. Antibiotic treatment is controversial, and many authors suggest anti-inflammatory agents or sole observation. Prevention of lymph stasis and its consequences with massage and skin care may be helpful. Despite the fact that malignancy is rare, in cases where the condition persists for more than 4 months, a core biopsy should be performed to rule out recurrent or second primary carcinoma.
The correct diagnostic approach is essential as it provides patients with reassurance, minimizes anxiety, and prevents unnecessary medical investigations, treatments, and costs.
延迟性乳腺蜂窝织炎（DBC）是保乳手术后一种相对罕见的并发症。将DBC与其他临床情况（如术后感染、放疗后的炎症反应以及复发性炎性癌）区分开来往往具有挑战性。DBC的定义、诊断方法和治疗在文献中尚未明确确立。
我们在PubMed数据库中以“延迟性乳腺蜂窝织炎”和“保乳治疗蜂窝织炎”为关键词进行文献检索，检索日期和文章类型不限。回顾并列表了有关DBC病例数、患者年龄、症状出现至手术或放疗时间间隔以及DBC治疗类型和结果的信息。
我们仅找到5篇与我们主题绝对相关的论文，这反映出“延迟性乳腺蜂窝织炎”是一个相当不为人知的术语，且该病症报告不足。尽管大多数人认为DBC主要是无菌性炎症过程，但细菌生长可能促使其发展或复发。肥胖、乳房大小、乳腺肿瘤位置、腋窝淋巴结清扫以及结缔组织疾病被视为危险因素。关于如何最佳管理DBC尚无明确证据。抗生素治疗存在争议，许多作者建议使用抗炎药或仅进行观察。通过按摩和皮肤护理预防淋巴淤滞及其后果可能会有所帮助。尽管恶性肿瘤罕见，但在病情持续超过4个月的情况下，应进行核心活检以排除复发性或第二原发性癌。
正确的诊断方法至关重要，因为它能让患者安心，将焦虑降至最低，并避免不必要的医学检查、治疗和费用。
