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中华乳腺病杂志(电子版)

中华乳腺病杂志(电子版) ›› 2020, Vol. 14 ›› Issue (06) : 366 -370. doi: 10.3877/cma.j.issn.1674-0807.2020.06.008

所属专题： 文献；

综述

乳腺癌中乳头乳晕复合体受侵犯的相关预测因素
黄伟玲1, 李玺1,†()   
  1. 1. 510630　广州，中山大学附属第三医院甲状腺乳腺外科
  • 收稿日期:2020-05-25 出版日期:2020-12-01
  • 通信作者: 李玺

Predictive factors of nipple-areola complex involvement in breast cancer

Weiling Huang1, Xi Li1()   

  • Received:2020-05-25 Published:2020-12-01
  • Corresponding author: Xi Li
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黄伟玲, 李玺. 乳腺癌中乳头乳晕复合体受侵犯的相关预测因素[J]. 中华乳腺病杂志(电子版), 2020, 14(06): 366-370.

Weiling Huang, Xi Li. Predictive factors of nipple-areola complex involvement in breast cancer[J]. Chinese Journal of Breast Disease(Electronic Edition), 2020, 14(06): 366-370.

保留乳头乳晕的乳房切除术(NSM)，是指完整切除乳腺腺体、活组织检查瘢痕及肿瘤表面的皮肤，保留乳头乳晕复合体(NAC)的一种手术方式。其中，NAC的侵犯与否是进行NSM的决定性条件。目前许多研究对于NAC侵犯的相关因素进行了分析报道，但缺乏一致性和全面性。笔者综合阐述了NAC侵犯率、与NAC侵犯相关的肿瘤临床病理因素，如肿瘤位置、肿瘤大小、肿瘤-乳头距离、肿瘤类型、多中心性、淋巴结受累和HER-2高表达等，以及乳头下方活组织检查的重要性。选择NSM患者时，应对预测NAC侵犯的因素进行全面考虑，并结合术前NAC下方组织微创旋切活组织检查或术中冰冻病理结果，以决定是否保留NAC，这对NSM安全完成将会有很大的帮助。

关键词: 乳腺肿瘤, 乳房切除术, 淋巴细胞, 肿瘤浸润, 乳头乳晕复合体
表1 各文献报道中NAC侵犯率及相关因素
研究者 总标本数 总浸润率(%) 年龄 TND 肿瘤大小 肿瘤位置 病理类型 肿瘤分级 多中心/多灶性 淋巴结状态 LVI 激素受体 Ki67 HER-2 新辅助
影像学 病理 影像学 病理
化疗                                  
Brachtel等[2] 232 21.0 N   Y   Y   Y Y N Y   N   Y N
Schecter等[13] 31 42.0 N Y     Y N Y N   N   N     N
Banerjee等[14] 219 20.0         Y Y       N          
Vyas等[15] 140 16.0     Y   Y         Y Y        
Steen等[16] 77 23.4 N Y   Y Y   Y N N Y N N N N Y
Menon等[17] 33 58.0         N N N   N N          
Eisenberg等[18] 208 14.0 N       N Y N N   Y   N   N  
D’Alonzo等[19] 100 14.0 N Y Y Y N Y N N N N   N N N  
Billar等[20] 392 16.0 N Y   Y Y     N   Y   N   N  
Pirozzi等[21] 50 24.0 Y Y N   N     N       N      
Weidong等[22] 2 330 10.7 Y   Y   Y Y Y Y Y Y Y Y N Y  
Simmons等[23] 217 10.6         N Y   N   N          
Laronga等[24] 286 5.6         N Y N     Y   N      
Wang等[25] 787 9.5 N       Y Y N Y N Y   N   Y  
Gulben等[26] 397 14.6 N       Y Y   N   Y Y N      
Hwang等[27] 104 19.2 Y Y     N   N N       N N N  
Vlajcic等[28] 108 23.2   Y   Y       N   Y Y        
Tang等[29] 642 6.7 N       Y     N   N   N   N  
Lambert等[30] 803 12.0         Y Y   Y   Y   N      
表2 各文献报道中TND临界值的设定及统计学差异
研究者 TND临界值(cm) P值
影像学测量值 病理标本测量值
Brachtel等[2]   ≤4 0.000 8
Vyas等[15]   ≤2.5 0.002
Steen等[16] <2   0.001
D’Alonzo等[19] ≤1   0.009
Pirozzi等[21] ≤3   0.007
Weidong等[22]   ≤3 <0.000 1
Hwang等[27] ≤1   0.013
Vlajcic等[28] ≤4   0.007
表3 各文献报道中肿瘤大小临界值的设定及统计学差异
研究者 肿瘤大小临界值(cm) P值
影像学测量值 病理标本测量值
Brachtel等[2]   >2 0.002 2
Steen等[16] >2   0.007
Weidong等[22]   >2.5 <0.000 1
Wang等[25]   >5 0.001 4
Vlajcic等[28] >2.5   0.034
Lambert等[30]   ≥4 <0.001
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