Drukker B H
Department of Obstetrics and Gynecology, Michigan State University, East Lansing 48824, USA.
Int J Fertil Womens Med. 1997 Sep-Oct;42(5):278-87.
Currently, mammography is the only method of detecting nonpalpable, early breast cancer. At this stage, 90% of the cancers are curable. Clearly, this fundamental tenet accentuates the importance of compliance and knowledge of guidelines. Although risks of mammography are minimal to nil, interpretation occasionally can be challenging, with equivocal results. New technologies are being evaluated and advances in measurement of cellular electrical potential differentials in breast tissue have produced exciting results, when compared with mammography and ultrasound. These screening efforts have increased the diagnosis of both invasive and noninvasive ductal and lobular carcinoma of the breast. For DCIS in particular, conservative, contemporary treatment options exist. These include lumpectomy with breast irradiation excluding axillary dissection. Selected patients may be treated with only lumpectomy. Although breast carcinoma is a major focus due to incidence, morbidity and mortality, the varieties of benign conditions cause many women genuine concern. Treatment options for fibrocystic change run a gamut, including cost-effective basic dietary changes, vitamin use, "health"/natural type treatments, analgesic, as well as hormonal manipulations and, on occasion, surgical intervention. Fortunately, with most patients, common sense and conservatism prevail. The presence of fibroadenomas diagnosed clinically, by ultrasound or mammography, in women aged 18-25 and beyond can create perplexing diagnostic dilemmas. Should the lesion be removed or observed? Differences of opinion exist and must be tempered by recent observations that women with complex fibroadenomas, sclerosing adenosis, epithelial calcification or papillary appocrine changes have a two- to threefold increased risk of breast cancer. The key to management in all these clinical situations is individualization. Conservatism is particularly acceptable in women under the age of 25 if a fibroadenoma is not increasing in size or not psychologically disturbing. Provoked or unprovoked nipple discharge is a clinical conundrum for patients. It is unsuspected and unwanted. While some whitish discharges result from stimulation or medication, others may have a more subtle etiology. Serous, serosanguineous, or bloody discharges mandate evaluation. Duct injection mammography and frequent excision of ductal systems are necessary. The clinician cannot forget other less common conditions, such as thrombophlebitis, fat necrosis, or infection. All clinical conditions of the breast provide a constellation of diagnostic and management problems. They are of real concern for every woman and must be resolved in an appropriate, prompt, and conscientious fashion.
目前，乳房X线摄影是检测不可触及的早期乳腺癌的唯一方法。在此阶段，90%的癌症是可治愈的。显然，这一基本原则凸显了遵循和了解指南的重要性。尽管乳房X线摄影的风险微乎其微，但偶尔其解读可能具有挑战性，结果不明确。新技术正在评估中，与乳房X线摄影和超声相比，乳腺组织细胞电位差测量方面的进展产生了令人兴奋的结果。这些筛查工作增加了乳腺浸润性和非浸润性导管癌及小叶癌的诊断。特别是对于导管原位癌（DCIS），存在保守的现代治疗选择。这些包括保乳手术加乳房放疗，不包括腋窝清扫。部分患者可能仅接受保乳手术治疗。尽管乳腺癌由于发病率、发病率和死亡率而成为主要关注点，但各种良性疾病也引起了许多女性的真正关注。纤维囊性变的治疗选择范围广泛，包括经济有效的基本饮食改变、维生素使用、“健康”/自然疗法、镇痛药，以及激素治疗，有时还包括手术干预。幸运的是，对于大多数患者来说，常识和保守态度占上风。在18至25岁及以上女性中，通过临床、超声或乳房X线摄影诊断出的纤维腺瘤的存在可能会造成令人困惑的诊断难题。该病变应该切除还是观察？存在不同意见，并且必须根据最近的观察结果加以权衡，即患有复杂纤维腺瘤、硬化性腺病、上皮钙化或乳头状大汗腺改变的女性患乳腺癌的风险增加两到三倍。在所有这些临床情况下，管理的关键是个体化。如果纤维腺瘤大小没有增加或没有造成心理困扰，对于25岁以下的女性，保守治疗尤其可以接受。自发性或诱发性乳头溢液对患者来说是一个临床难题。它意想不到且令人讨厌。虽然一些白色溢液是由刺激或药物引起的，但其他溢液可能有更微妙的病因。浆液性、浆液血性或血性溢液需要进行评估。导管造影乳房X线摄影和频繁切除导管系统是必要的。临床医生不能忘记其他不太常见的情况，如血栓性静脉炎、脂肪坏死或感染。所有乳腺临床情况都带来了一系列诊断和管理问题。它们是每个女性真正关心的问题，必须以适当、及时和认真的方式解决。
