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目的探讨乳腺肿块的合理诊疗方法。方法对2010年1月—12月因可触及乳腺肿块而进行手术的患者133例的临床资料进行回顾性分析。结果 133例患者中单侧乳腺肿块117例,双侧乳腺肿块16例。其中良性肿块101例,占总数的77.55%。良性肿块中又以乳腺纤维腺瘤、乳腺囊性增生症为多。乳腺恶性肿块32例,浸润性导管癌23例,黏液癌4例,其他共6例。高频彩超对乳腺良性肿块诊断的灵敏度81.90%,特异度为84.85%;恶性肿块的灵敏度84.85%、特异度96.49%。术中快速病理学检查对于恶性肿块诊断准确率为84.85%。根据术后常规病理免疫组织化学所显示的生物学特征将乳腺恶性肿块进一步分型,其中Luminal A型(ER+/PR+/C-erB-2-)最多,共13例,Basal-like基底样型(ER-/PR-/CerB2-,三阴乳腺癌)为5例。结论高频彩超对可触及乳腺肿块的术前诊断有较高的诊断率,术中快速病理确诊,有助于合理选择手术方式,但仍有一定的误差率。最终诊断以术后常规病理学结果为标准,经免疫组化获得生物学指标有助于个性化辅助治疗方案的制定。
Objective To investigate the reasonable diagnosis and treatment of breast lumps. Methods A retrospective analysis was performed on the clinical data of 133 patients with operable breast masses from January 2010 to December 2010. Results Among the 133 patients, 117 were unilateral breast masses and 16 were bilateral breast masses. Of which 101 cases of benign mass, accounting for 77.55% of the total. And benign breast fibroadenoma, breast cystic hyperplasia as much. 32 cases of breast malignant tumor, invasive ductal carcinoma in 23 cases, mucinous carcinoma in 4 cases, a total of 6 cases. The sensitivity and specificity of high-frequency color Doppler ultrasound in the diagnosis of benign breast mass were 81.90% and 84.85% respectively. The sensitivity and specificity of malignant mass were 84.85% and 96.49% respectively. Intraoperative rapid pathological examination for the diagnosis of malignant tumor was 84.85% accuracy. According to the postoperative pathological immunohistochemistry showed the biological characteristics of breast malignant tumor further classification, including Luminal A type (ER + / PR / C-erB-2-) up to a total of 13 cases, Basal-like basal-like type (ER- / PR- / CerB2-, triple-negative breast cancer) in 5 cases. Conclusions High-frequency color Doppler ultrasound has a higher diagnostic rate for preoperative diagnosis of palpable breast masses. Rapid intraoperative pathological diagnosis is helpful to choose the surgical method reasonably, but there is still a certain error rate. The final diagnosis of postoperative routine pathological results as the standard biological indicators obtained by immunohistochemistry contribute to the development of personalized adjuvant therapy.