Faculty of Medicine, Department of General Surgery, Gazi University, Besevler, Ankara, Turkey.
Mustafa Kemal Mah. 2137. Sok. 8/14, 06520, Cankaya, Ankara, Turkey.
Adv Exp Med Biol. 2024;1460:767-819. doi: 10.1007/978-3-031-63657-8_26.
Several studies show that a significantly stronger association is obvious between increased body mass index (BMI) and higher breast cancer incidence. Additionally, obese and postmenopausal women are at higher risk of all-cause and breast cancer-specific mortality compared with non-obese women with breast cancer. In this context, increased levels of estrogens, excessive aromatization activity of the adipose tissue, overexpression of pro-inflammatory cytokines, insulin resistance, adipocyte-derived adipokines, hypercholesterolemia, and excessive oxidative stress contribute to the development of breast cancer in obese women. Genetic evaluation is an integral part of diagnosis and treatment for patients with breast cancer. Despite trimodality therapy, the four-year cumulative incidence of regional recurrence is significantly higher. Axillary lymph nodes as well as primary lesions have diagnostic, prognostic, and therapeutic significance for the management of breast cancer. In clinical setting, because of the obese population primary lesions and enlarged lymph nodes could be less palpable, the diagnosis may be challenging due to misinterpretation of physical findings. Thereby, a nomogram has been created as the "Breast Imaging Reporting and Data System" (BI-RADS) to increase agreement and decision-making consistency between mammography and ultrasonography (USG) experts. Additionally, the "breast density classification system," "artificial intelligence risk scores," ligand-targeted receptor probes," "digital breast tomosynthesis," "diffusion-weighted imaging," "18F-fluoro-2-deoxy-D-glucose positron emission tomography," and "dynamic contrast-enhanced magnetic resonance imaging (MRI)" are important techniques for the earlier detection of breast cancers and to reduce false-positive results. A high concordance between estrogen receptor (ER) and progesterone receptor (PR) status evaluated in preoperative percutaneous core needle biopsy and surgical specimens is demonstrated. Breast cancer surgery has become increasingly conservative; however, mastectomy may be combined with any axillary procedures, such as sentinel lymph node biopsy (SLNB) and/or axillary lymph node dissection whenever is required. As a rule, SLNB-guided axillary dissection in breast cancer patients who have clinically axillary lymph node-positive to node-negative conversion following neoadjuvant chemotherapy is recommended, because lymphedema is the most debilitating complication after any axillary surgery. There is no clear consensus on the optimal treatment of occult breast cancer, which is much discussed today. Similarly, the current trend in metastatic breast cancer is that the main palliative treatment option is systemic therapy.
多项研究表明，体重指数（BMI）增加与乳腺癌发病率升高之间存在明显的更强关联。此外，与患有乳腺癌的非肥胖女性相比，肥胖和绝经后妇女的全因和乳腺癌特异性死亡率风险更高。在这种情况下，雌激素水平升高、脂肪组织过度芳香化活性、促炎细胞因子过表达、胰岛素抵抗、脂肪细胞衍生的脂肪因子、高胆固醇血症和过度氧化应激导致肥胖女性乳腺癌的发展。遗传评估是乳腺癌患者诊断和治疗的一个组成部分。尽管采用了三联疗法，区域复发的四年累积发生率仍然明显更高。腋窝淋巴结以及原发性病变对乳腺癌的管理具有诊断、预后和治疗意义。在临床环境中，由于肥胖人群的原发性病变和增大的淋巴结可能不太容易触及，因此由于对物理检查结果的误解，诊断可能具有挑战性。因此，创建了一个列线图作为“乳房成像报告和数据系统”（BI-RADS），以增加乳房 X 线摄影和超声（USG）专家之间的一致性和决策一致性。此外，“乳房密度分类系统”、“人工智能风险评分”、“配体靶向受体探针”、“数字乳房断层合成术”、“弥散加权成像”、“18F-氟-2-脱氧-D-葡萄糖正电子发射断层扫描”和“动态对比增强磁共振成像（MRI）”是早期检测乳腺癌和减少假阳性结果的重要技术。术前经皮核心针活检和手术标本中雌激素受体（ER）和孕激素受体（PR）状态的评估具有高度一致性。乳腺癌手术变得越来越保守；然而，乳房切除术可与任何腋窝手术相结合，例如前哨淋巴结活检（SLNB）和/或腋窝淋巴结清扫术，只要需要即可。通常，建议在新辅助化疗后临床腋窝淋巴结阳性转为淋巴结阴性的乳腺癌患者中进行 SLNB 引导的腋窝淋巴结清扫术，因为淋巴水肿是任何腋窝手术后最衰弱的并发症。目前对于隐匿性乳腺癌的最佳治疗方法没有明确的共识，这是目前讨论的热点。同样，转移性乳腺癌的当前趋势是，主要的姑息治疗选择是全身治疗。
