2017整理乳腺癌.6.6.ppt

Breast Cancer 2011.6.6 Introduction Most common female cancer最常见的女性癌症 Accounts for 32% of all female cancer占所有女性癌症的32％ 211,300 new cases yearly and rising每年新增211,300个病例 40,000 deaths yearly每年40,000人死亡 Gross Anatomy大体解剖 Microscopic Anatomy显微解剖 Stromal tissue基质组织 Connective tissue, capillaries, lymphocytes, etc.结缔组织，毛细血管，淋巴细胞等 Adipose tissue脂肪组织 Ductal tissue乳腺导管组织 Squamous epithelium鳞状上皮细胞 Columnar or cuboidal epithelium柱状或立方形上皮 Lobular tissue小叶组织 Presentation Breast lump乳房肿块 Abnormal mammogram乳房X光检查异常 Axillary lympadenopathy腋窝淋巴结病变 Metastatic disease转移性疾病 Screening Mammography乳房摄影筛检 Recommendations建议 Biannually or annually in 40-49 y/o每半年或每年在40-49年 Annually in 50 y/o每年在“50 15% relative risk reduction相对危险度减少15％ Birads分级 0 - Incomplete assessment; need additional imaging evaluation 1 - Negative; routine mammogram in 1 year recommended 2 - Benign finding; routine mammogram in 1 year recommended 3 - Probably benign finding; short-term follow-up suggested (3%) 4 - Suspicious abnormality; biopsy should be considered (30%) 5 - Highly suggestive of malignancy; appropriate action should be taken (94%) Biopsy techniques活检技术 FNA Diagnostic and therapeutic in cystic lesions囊性病变的诊断和治疗 Core needle粗针 U/S guided or sterotatic 90% effective in establishing diagnosis 90％，在建立有效的诊断 Atypia – need excision异型性- 需要切除 Sterotatic Needle localization细针定位 Excision biopsy切除活检 Risk of Future Invasive Breast Carcinoma Based on Histologic Diagnosis from Breast Biopsies未来浸润性乳腺癌的风险基于活检病理诊断乳腺癌 No Increase AdenosisApocrine metaplasiaCysts, small or largeMild hyperplasia (2 but 5 cells deep)Duct ectasiaFibroadenomaFibrosisMastitis, inflammatoryPeriductal mastitisSquamous metaplasia腺病顶浆化生囊肿，小型或大型轻度增生（“2，但5细胞深）导管扩张症纤维腺瘤纤维化乳腺炎，鳞状上皮化生乳腺炎炎症Periductal Slightly Increased (relative risk, 1.5–2) Moderate or florid hyperplasia, solid or papillaryDuct papilloma with fibrovascular coreSclerosing adenosis, well-developed中度或华丽的增生，乳头状与固体或纤维血管硬化性腺病导管内乳头状瘤的核心，发达的 Moderately Increased (relative r