中国实用外科杂志

中国实用外科杂志

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乳腺乳头状病变507例临床病理学特点及相关治疗分析

庞    昊，梁    跃，费晓春，吴佳毅，黄    欧，朱    丽，何建蓉，陈伟国，李亚芬，陈小松，沈坤炜   

  1. 上海市交通大学医学院附属瑞金医院乳腺疾病诊治中心，上海 200025
  • 出版日期:2016-07-01 发布日期:2016-06-23

  • Online:2016-07-01 Published:2016-06-23

摘要：

目的    探讨不同种类乳腺乳头状病变的临床特点以及相应的治疗方法。 方法    回顾性分析2013年1月至2015年12月在上海交通大学医学院附属瑞金医院乳腺疾病诊治中心行手术治疗，并经病理学检查证实为乳腺乳头状病变病人的临床资料。 结果    共有507例病人诊断为乳腺乳头状病变，其中导管内乳头状瘤（IP）不伴非典型性增生、IP伴非典型性增生、IP伴原位癌、导管内乳头状癌、包膜内乳头状癌、实性乳头状癌以及浸润性乳头状癌分别为389例（76.7%）、22例（4.3%）、24例（4.7%）、27例（5.3%）、12例（2.4%）、20例（3.9%）和13例（2.6%）。对乳腺良恶性乳头状病变相关临床因素分析发现，乳腺超声、X线检查和磁共振检查的乳腺影像学报告与数据系统（BI-RADS）分类与乳腺乳头状病变性质显著相关，BI-RADS分类为≥4B类提示恶性病变可能性较大（P < 0.05）。对不同乳腺恶性乳头状病变相关临床及治疗方案分析，发现年龄、有无溢液、溢液性状、肿块大小、激素受体状态、Ki-67表达、手术方式及辅助治疗的选择，在上述乳腺恶性乳头状病变病人中差异无统计学意义（P > 0.05）。 结论    IP是乳腺乳头状病变发生率最高的肿瘤；乳腺超声、X线检查和磁共振检查可作为乳腺良恶性乳头状病变早期诊断的方法；不同乳腺恶性乳头状病变发病率较低，其具有相似的临床特征，须待大规模队列数据进一步验证。

关键词: 乳腺乳头状病变, 病理学, 影像学

Abstract:

Clinical pathological features and treatment modalities of mammary papillary lesions：An analysis of 507 cases         PANG Hao, LIANG Yue, FEI Xiao-chun, et al. Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
Corresponding author:SHEN Kun-wei,E-mail: kwshen@medmail.com.cn; CHEN Xiao-song, E-mail: chenxiaosong0156@163.com
Abstract    Objective    To explore the clinical pathological features and corresponding treatments among different breast papillary lesions. Methods    The clinical data of patients diagnosed as breast papillary lesion between January 2013 and December 2015 in Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. Clinical pathological features and corresponding multidisciplinary treatments were collected to analysis. Results    A total of 507 patients were diagnosed as breast papillary lesions. There were 389 (76.7%), 22 (4.3%), 24 (4.7%), 27 (5.3%), 12 (2.4%), 20 (3.9%) and 13 cases (2.6%) diagnosed as intraductal papilloma (IP), IP with atypical ductal hyperplasia, IP with carcinoma in situ, intraductal papillary carcinoma, encapsulated papillary carcinoma, solid papillary carcinoma in situ and invasive papillary carcinoma, respectively. Analysis of clinical-pathological features among papillary lesions showed that breast imaging test BI-RADS (Breast Imaging Reporting And Data System) classification of mammography, ultrasound and magnetic resonance imaging was associated with the pathology result of breast papillary lesions significantly. BI-RADS no less than 4B implied higher chance of malignancy breast papillary lesions (P < 0.05). Analysis of clinical pathological features and treatment regimens among different malignant breast papillary lesions showed there was no significant difference. There was no statistical difference in terms of age, nipple discharge, character of nipple discharge, tumor size, hormonal receptor, Ki-67, pattern of surgery and adjuvant therapies (P > 0.05).Conclusion    IP is the dominant pathology type among breast papillary lesions. Mammography, ultrasound and magnetic resonance imaging are sensitive to identify early breast malignant papillary lesions. Regarding low incidence of malignant breast papillary lesions, the tumors have similar clinical-pathological features, which warrants further large cohort study.

Key words: mammary papillary lesion;pathology, imaging