Saccomandi E, Clough K B, Mosseri V, Viehl P, Legal M, Fourquet A, Renolleau C, Durand J C
Service de Chirurgie générale, Institut Curie, Paris.
Presse Med. 1995 Sep 30;24(28):1291-5.
Routine screening mammography has greatly increased the number of breast cancers detected in the form of clumped microcalcifications without a palpable tumour.
From 1964 to 1989, 315 breast cancers revealed by microcalcifications without contralateral cancer, treated at the Institut Curie. Cancers were observed in 40% of the microcalcifications excised. Treatment was conservative in 57.5% of cases and mutilating in 42.5% of cases; these rates have changed only very slightly with time. Histologically, 50% of the tumours were intraductal cancers, 25% were microinvasive, 24% were infiltrating and 1% were lobular in situ carcinomas. The therapeutic indication can be defined on the basis of the histological result of the initial tumour excision, as the initial examination underestimated the lesions in only 5.6% of cases. Lymph node invasion was observed in 1.8% of intraductal cancers, 5.3% of microinvasive cancers and 14.8% of invasive cancers.
The overall survival was 99% at 5 years and 89.9% at 10 years. The prognosis of invasive cancer was less favourable than that of intraductal and microinvasive cancers (p = 0.03). Survival was not influenced by the radical or conservative nature of treatment. The presence of lymph node invasion severely worsened the prognosis. The 5 year recurrence rate was 4.2% for intraductal, 4.6% for microinvasive and 6.1% for invasive. The incomplete nature of the resection increased the local recurrence rate: 11.9% at 5 years instead of 5%.
Conservative treatment of cancers revealed by microcalcifications without a palpable tumour therefore appears to be justified provided the lesion is radiologically localized, with a histologically satisfactory resection and in the absence of residual microcalcifications on postoperative mammography.
常规乳腺筛查钼靶检查极大地增加了以成簇微小钙化形式发现的、无可触及肿块的乳腺癌数量。
1964年至1989年期间，居里研究所治疗了315例由微小钙化显示且无对侧癌症的乳腺癌。在所切除的微小钙化中，40%发现了癌症。57.5%的病例采用了保守治疗，42.5%的病例采用了根治性治疗；这些比例随时间变化非常小。组织学上，50%的肿瘤为导管内癌，25%为微浸润癌，24%为浸润性癌，1%为小叶原位癌。治疗指征可根据初次肿瘤切除的组织学结果来确定，因为初次检查仅在5.6%的病例中低估了病变。导管内癌的淋巴结侵犯率为1.8%，微浸润癌为5.3%，浸润性癌为14.8%。
5年总生存率为99%，10年为89.9%。浸润性癌的预后不如导管内癌和微浸润癌（p = 0.03）。生存率不受治疗方式是根治性还是保守性的影响。淋巴结侵犯的存在严重恶化了预后。导管内癌的5年复发率为4.2%，微浸润癌为4.6%，浸润性癌为6.1%。切除不完全会增加局部复发率：5年时为11.9%，而非5%。
因此，对于无可触及肿块、由微小钙化显示的癌症，只要病变在放射学上定位明确，组织学切除结果满意且术后钼靶检查无残留微小钙化，采用保守治疗似乎是合理的。
