18例乳腺纤维腺瘤癌变患者临床特点与预后分析
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摘要
目的:探讨乳腺纤维腺瘤癌变(carcinomatous change of the fibroadenoma,CCFA)的临床病理表现、诊疗及预后。方法:对18例CCFA的患者进行一般情况、彩色多普勒超声、乳腺X线钼钯摄影、术后病理及预后分析。选取纤维腺瘤(fibroadenoma,FA)患者超声检查资料24例、乳腺X线钼钯摄影资料20例,分别与CCFA患者超声检查12例、乳腺X线钼钯摄影10例进行对比分析。结果:超声检查显示乳腺纤维腺瘤癌变组与FA组在内部回声、形态、边界及包膜方面存在显著性差异(P<0.05),乳腺X线钼钯摄影显示CCFA组与FA组在边缘情况及是否存在细小密集钙化方面存在显著性差异(P<0.05),而在肿块的形态、是否存在粗颗粒钙化方面无显著性差异(P>0.05)。CCFA发病多为早期,腋窝淋巴结转移率低。CCFA患者5年DFS和OS均为91.67%(11/12)。单因素生存分析中仅腋窝淋巴结转移具有统计学意义,有转移者预后差(P=0.000 3)。结论:超声检查及乳腺X线钼钯摄影在鉴别CCFA及FA方面有一定价值。CCFA患者5年生存率较高,预后较好。
Objective: To determine clinicopathologic features, diagnosis, treatment, and prognosis of patients with carcinomatous change of fibroadenoma(CCFA). Methods: Clinical and mammographic features, ultrasound, and prognostic and pathological results of 18 patients with CCFA were analyzed. The ultrasound data of 24 cases and mammographic data of 20 cases,which were confirmed by pathological diagnosis, were selected. Imaging data of CCFA(12 cases with ultrasound and 10 with molybdenum data) were also compared. Results: Ultrasound data showed a significant difference in the internal echo, shape, border,and peplos between the groups with CCFA and FA(P<0.05). The mammographic results showed a significant difference(P<0.05) in the border and the existence of small dense calcification between the two groups. However, no significant differences were observed in the shape and coarse calcification between the two groups(P>0.05). CCFA was detected in the early stage, and the rate of axillary lymph node metastasis was low. The five-year DFS and OS was 91.67% in CCFA cases(11/12). The univariate analysis showed that the axillary lymph node metastasis of CCFA cases was statistically significant(P=0.000 3). An unfavorable prognosis in the cases with lymph node metastasis was further detected. Conclusion: Two-dimensional ultrasound and mammography are important in differentiating CCFA and FA. CCFA has a high five-year survival rate with favorable prognosis.
Objective: To determine clinicopathologic features, diagnosis, treatment, and prognosis of patients with carcinomatous change of fibroadenoma(CCFA). Methods: Clinical and mammographic features, ultrasound, and prognostic and pathological results of 18 patients with CCFA were analyzed. The ultrasound data of 24 cases and mammographic data of 20 cases,which were confirmed by pathological diagnosis, were selected. Imaging data of CCFA(12 cases with ultrasound and 10 with molybdenum data) were also compared. Results: Ultrasound data showed a significant difference in the internal echo, shape, border,and peplos between the groups with CCFA and FA(P<0.05). The mammographic results showed a significant difference(P<0.05) in the border and the existence of small dense calcification between the two groups. However, no significant differences were observed in the shape and coarse calcification between the two groups(P>0.05). CCFA was detected in the early stage, and the rate of axillary lymph node metastasis was low. The five-year DFS and OS was 91.67% in CCFA cases(11/12). The univariate analysis showed that the axillary lymph node metastasis of CCFA cases was statistically significant(P=0.000 3). An unfavorable prognosis in the cases with lymph node metastasis was further detected. Conclusion: Two-dimensional ultrasound and mammography are important in differentiating CCFA and FA. CCFA has a high five-year survival rate with favorable prognosis.
引文
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3 Tian YT,Niu Y.Carcinomatous change and sarcomatous change of the fibroadenoma of the breast[J].J Practical Oncol,1996,11(2):93 -94.[田艳涛,牛昀.乳腺腺纤维瘤癌变及肉瘤变[J].实用肿瘤杂志,1996,11(2):93-94.]
4 Pick PW,Iossifides IA.Occurrence of breast carcinoma within a fibroadenoma.A review[J].Arch Pathol Lab Med,1984,108(7):590-594.
5 Hou WH,Yang H,Li HX.Clinicopathological observation of four cases of breast cancer within fibroadenoma[J].J Clin Exp Pathol,2013,29(11):1242-1244.[侯卫华,杨虎,李海霞.乳腺纤维腺瘤内癌4例临床病理学观察[J].临床与实验病理学杂志,2013,29(11):1242-1244.]
6 Walter P,Kuentz C.Epithelioma(lobular)developing in a fibroadenoma:study of a case report and review of the literature[J].Ann Anat Pathol(Paris),1978,23(2):153-160.
7 Dupont WD,Page DL,Parl FF,et al.Long-term risk of breast cancer in women with fibroadenoma[J].N Engl Med,1994,331(1):10-15.
8 Krieger N,Hiatt RA.Risk of breast cancer after benign breast diseases.Variation by histologic type,degree of atypia,age at biopsy,and length of follow-up[J].Am J Epidemiol,1992,135(6):619-631.
9 Ciatto S,Bonardi R,Zappa M,et al.Risk of breast cancer subsequent to histological or clinical diagnosis of fibroadenoma-retrospective longitudinal study of 3 938 cases[J].Ann Oncol,1997,8(3):297-300.
10 Mc Divitt RW,Stevens JA,Lee NC,et al.Histological types of benign breast disease and the risk for breast cancer[J].Cancer,1992,69(6):1408-1414.
2 Li ZB,Wang PL,Lang RG,et al.Clinicopathological analysis of carcinogenesis of breast adenofibroma:a report of 11 cases[J].China J Cancer Prev Treat,2003,10(6):640-641.[李祖彬,王璞良,郎荣刚,等.乳腺腺纤维瘤癌变11例临床病理分析[J].肿瘤防治杂志,2003,10(6):640-641.]
3 Tian YT,Niu Y.Carcinomatous change and sarcomatous change of the fibroadenoma of the breast[J].J Practical Oncol,1996,11(2):93 -94.[田艳涛,牛昀.乳腺腺纤维瘤癌变及肉瘤变[J].实用肿瘤杂志,1996,11(2):93-94.]
4 Pick PW,Iossifides IA.Occurrence of breast carcinoma within a fibroadenoma.A review[J].Arch Pathol Lab Med,1984,108(7):590-594.
5 Hou WH,Yang H,Li HX.Clinicopathological observation of four cases of breast cancer within fibroadenoma[J].J Clin Exp Pathol,2013,29(11):1242-1244.[侯卫华,杨虎,李海霞.乳腺纤维腺瘤内癌4例临床病理学观察[J].临床与实验病理学杂志,2013,29(11):1242-1244.]
6 Walter P,Kuentz C.Epithelioma(lobular)developing in a fibroadenoma:study of a case report and review of the literature[J].Ann Anat Pathol(Paris),1978,23(2):153-160.
7 Dupont WD,Page DL,Parl FF,et al.Long-term risk of breast cancer in women with fibroadenoma[J].N Engl Med,1994,331(1):10-15.
8 Krieger N,Hiatt RA.Risk of breast cancer after benign breast diseases.Variation by histologic type,degree of atypia,age at biopsy,and length of follow-up[J].Am J Epidemiol,1992,135(6):619-631.
9 Ciatto S,Bonardi R,Zappa M,et al.Risk of breast cancer subsequent to histological or clinical diagnosis of fibroadenoma-retrospective longitudinal study of 3 938 cases[J].Ann Oncol,1997,8(3):297-300.
10 Mc Divitt RW,Stevens JA,Lee NC,et al.Histological types of benign breast disease and the risk for breast cancer[J].Cancer,1992,69(6):1408-1414.