Lee J S, Grant C S, Donohue J H, Crotty T B, Harmsen W S, Ilstrup D M
Department of General Surgery, Mayo Clinic, Rochester, Minn. 55905, USA.
Surgery. 1995 Oct;118(4):640-7; discussion 647-8. doi: 10.1016/s0039-6060(05)80030-3.
Management of the contralateral normal-appearing breast in a patient with ipsilateral invasive lobular carcinoma (ILC) is controversial.
The case histories of patients with histologically proven ILC who underwent definitive surgery at our institution from 1978 to 1991 were retrospectively reviewed.
Of the 419 women with ILC, 36 (8.6%) had bilateral cancer, with a cumulative risk of 10% at 10 years. Twenty-five (69%) of these cancers were suspected before operation. From 105 contralateral prophylactic surgical procedures, seven (64%) in-situ and four (36%) invasive cancers were detected. The age at presentation and multifocality of the index cancer were significantly different between patients with unilateral and those with bilateral cancers. No survival difference was noted between patients whose contralateral cancers were suspected clinically and those whose cancers were detected prophylactically. Survival rates between patients with unilateral versus bilateral cancers were also not different. However, patients with contralateral prophylactic surgery had a better prognosis than those with unilateral tumors and no prophylaxis.
Ten percent of patients with ILC experienced bilateral cancers during a period of 10 years. Survival was not influenced by the development of a second cancer, but it improved with surgical prophylaxis.
同侧浸润性小叶癌（ILC）患者对侧外观正常乳房的处理存在争议。
回顾性分析1978年至1991年在本机构接受根治性手术且组织学确诊为ILC患者的病历。
419例ILC女性患者中，36例（8.6%）患有双侧癌症，10年累积风险为10%。其中25例（69%）癌症在术前被怀疑。在105例对侧预防性手术中，检测到7例（64%）原位癌和4例（36%）浸润性癌。单侧癌和双侧癌患者的初发年龄及原发癌多灶性有显著差异。临床怀疑对侧癌症的患者与预防性检测到癌症的患者之间未观察到生存差异。单侧癌与双侧癌患者的生存率也无差异。然而，接受对侧预防性手术的患者比单侧肿瘤且未进行预防的患者预后更好。
10%的ILC患者在10年内发生双侧癌症。生存不受第二癌发生的影响，但手术预防可改善预后。
