Chung M A, Cole B, Wanebo H J, Bland K I, Chang H R
Department of Surgery, Roger Williams Medical Center, Providence, RI 02908, USA.
Ann Surg Oncol. 1997 Oct-Nov;4(7):545-50. doi: 10.1007/BF02305534.
The roles of breast conservation and surgical evaluation of the contralateral breast in the treatment of lobular carcinoma of the breast remain unclear. The aim of this study was to compare local recurrence, 5-year survival, and incidence of contralateral breast cancer in women with lobular carcinoma to that in women with infiltrating ductal carcinoma.
Women with infiltrating ductal carcinoma (IDC) and invasive lobular breast carcinoma (ILC) diagnosed during the years 1984 to 1994 were identified through a statewide tumor registry. The women were divided into groups based on their histology and treatment (breast conservation or modified radical mastectomy). The incidences of contralateral breast cancer, local recurrence, and 5-year survival were compared within each histologic group and treatment category.
During the period 1984 to 1994, 4886 women were diagnosed with invasive lobular or ductal breast carcinoma. Of these, 316 (6.5%) had infiltrating lobular cancer. The 5-year survival rates were 68% and 71% for ILC and IDC, respectively (p = 0.5). The local recurrence rates were 2.8% and 4.3% for ILC treated with lumpectomy and axillary nodal dissection (LAND) and modified radical mastectomy (MRM), respectively, which were not significantly different from that obtained with IDC (LAND = 2.5%, MRM = 2.1%). The incidence of contralateral breast cancer during the period was 6.6% and 6.5% for ILC and IDC, respectively.
Invasive lobular carcinoma can be safely treated with breast conservation with no difference in local recurrence or survival. In the absence of a suspicious finding on clinical or radiologic examination, routine contralateral breast intervention is not recommended.
保乳手术及对侧乳房手术评估在乳腺小叶癌治疗中的作用仍不明确。本研究旨在比较小叶癌女性与浸润性导管癌女性的局部复发率、5年生存率及对侧乳腺癌发病率。
通过全州肿瘤登记处确定1984年至1994年间诊断为浸润性导管癌（IDC）和浸润性小叶乳腺癌（ILC）的女性。根据组织学和治疗方式（保乳或改良根治性乳房切除术）将这些女性分组。比较各组织学组和治疗类别中的对侧乳腺癌发病率、局部复发率及5年生存率。
1984年至1994年期间，4886名女性被诊断为浸润性小叶或导管性乳腺癌。其中，316名（6.5%）患有浸润性小叶癌。ILC和IDC的5年生存率分别为68%和71%（p = 0.5）。接受肿块切除术和腋窝淋巴结清扫术（LAND）及改良根治性乳房切除术（MRM）治疗的ILC的局部复发率分别为2.8%和4.3%，与IDC（LAND = 2.5%，MRM = 2.1%）相比无显著差异。在此期间，ILC和IDC的对侧乳腺癌发病率分别为6.6%和6.5%。
浸润性小叶癌采用保乳手术治疗安全，局部复发率或生存率无差异。在临床或影像学检查未发现可疑病变的情况下，不建议常规进行对侧乳房干预。
