【摘要】 乳腺導管內癌（ductal carcinoma in situ，DCIS）為Gillis在1960年首先描述，近年隨著對DCIS認識逐步深入和影像學篩選的廣泛應用，其檢出率明顯增加，國外報道約占全部乳腺癌的15%~20%，我國達到7.8%~18.8%。2003年世界衛生組織正式將DCIS（包括DCIS2MI）歸入癌前病變范疇，稱為導管上皮內瘤變，認為只有浸潤性癌才是真正的乳腺癌。對于導管內癌的治療，意見還不統一，現就此進行綜述，探討其診斷與治療方法。
bjective To investigate the correlation between expression of vascular endothelial growth factor(VEGF) of serum and tumor tissues and the clinical prognosis in patients with breast cancer. Methods The expressions of VEGF level of serum and tumor tissues in 44 patients with invasive duct breast cancer, 13 with benign breast diseases and 40 healthy controls. Serum VEGF level was measured by ELISA method. The protein expression of tissue VEGF, ER and C-erbB-2 were evaluated by immunohistochemistry LSAB method. Results Serum VEGF level and tissue VEGF expression in breast cancer were higher than those in benign breast diseases （P＜0.001）, and there was no significance in benign breast diseases and healthy controls （Pgt;0.05）. VEGF expression was correlated with lymph node metastasis (P＜0.01), ER and C-erbB-2 expression (P＜0.05, P＜0.01) and clinical stage （P＜0.01）. There were no statistical correlation between VEGF expression and age, tumor size (Pgt;0.05). Conclusion There is positively correlation between serum VEGF level and tissue VEGF expression, and between VEGF expression and clinic prognosis. Serum VEGF level may be one of important index of prognosis estimation in patients with breast cancer.
Objective To summarize the relation between tumor location and lymph node metastasis in early stage of breast cancer, which is aimed at providing a more individualized treatment for breast cancer patients. Method The literatures about breast cancer location and lymph node metastasis in recent years were extracted, through the literatures study we made a thematic review of the relation between them. Results There were two main classification methods for the location of breast tumors at present: tumor in the different quadrants and tumor to skin distance. In the quadrant classification method, the tumor in the upper inner quadrant (UIQ) had the lowest lymph node metastasis rate, while the lower inner quadrant (LIQ) tumor recurrence-free survival rate and overall survival rate were significantly lower than other quadrants. When measuring tumor to skin distance, the closer the tumor was to the skin, the more likely lymph node metastasis occurred. In combination with the distribution, histology, and anatomical differences of lymphatic and lymphatic networks, our study group proposed to classify tumors according to different anatomical levels of the breast, thus the anatomic location of the tumor was divided into four types: constricted in the gland, break the anterior gland, break the posterior gland, and break both anterior and posterior gland. Conclusions Regardless of the way the location is classified, the location of breast tumors is closely related to lymphatic and lymph node metastasis. The new classification according to the distribution of tumors at different anatomical levels of the breast accords with the law of lymphatic metastasis is scientific and reasonable. Therefore, during clinical practices, we recommend to use the new method to classify tumor location, and we should consider the differences in the location of the patients’ tumor to assess the status of axillary lymph node, which may provide a more individualized treatment for breast cancer patients.
ObjectiveTo explore the surgical technique and preliminary safety and aesthetics results of immediate prepectoral implant-based breast reconstruction (BR) with titanium-coated polypropylene mesh (TiLoop Bra) after skin-sparing mastectomy (SSM) or nipple-areola-complex-sparing mastectomy (NSM) for breast cancer patients. MethodsThe clinical data of consecutive patients who underwent immediate prepectoral implant-based BR with TiLoop Bra after SSM or NSM in West China Hospital from January to July 2022 were retrospectively analyzed. The operation time, intraoperative blood loss, early complication were collected. The preliminary aesthetics results were assessed with the Ueda score and Harris score. Results All the patients were female with a mean age of 39.0±6.8 years. One patient had bilateral breast malignant tumors, and the others had unilateral malignant tumors. Six patients received neoadjuvant chemotherapy before surgery. The mean diameter of the tumors was 24.4±11.9 mm under the color ultrasound before the neoadjuvant chemotherapy. The mean operation time was 153.9±49.4 min. The mean intraoperative blood loss was 29.2±18.3 mL. There were 3 patients with tumor stage 0, 10 patients with stage Ⅰ, 6 patients with stage Ⅱ, 3 patients with stage Ⅲ and 1 patient was found no residual cancer after neoadjuvant chemotherapy. All the patients were successfully followed up with a median follow-up time of 4.8 (3.0-9.2) months. There were 2 (8.3%) patients with major complications, including 1 wound dehiscence and 1 hematoma, and 4 (16.7%) minor complications, including 2 wound dehiscence and 2 infection. The patients with excellent and good Ueda score and Harris score accounted for 82.6% and 87.0%, respectively. None of the patients had animation deformity, capsular contracture, nipple-areola or skin flaps necrosis, or implant loss. During the follow-up period, no local/regional recurrence or distant metastasis was found. Conclusion For selected reliable patients, immediate prepectoral implant-based BR with TiLoop Bra after SSM or NSM for breast cancer patients is safe and has good aesthetics results in the early postoperative period. It has broad application space in patients with suitable indications, and can be promoted as a routine operation.
