[The surgical treatment of nonpalpable breast carcinomas].

L Cattelani, G Rossi, P Piccolo, P Bobbio
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Abstract

The wide-spreading use of mammography in clinical approach and in screening programmes contributed to a sensible modification in the population of patients affected by breast malignancies. A special increase has been recorded in non-palpable breast tumors. The Authors have analyzed a total of 135 patients with impalpable breast lesions during the period 1990-1997. All patients underwent fine needle stereotactic aspiration for cytology and in the meantime the lesions were marked with charcoal suspension and within 15 days time a surgical open biopsy was performed. The subgroup of malignant lesions was then surgically treated either with radical quadrantectomy or mastectomy. The results of the analysis confirmed that fine needle biopsy is an imperfect test because of its low sensibility and impossibility of distinguishing between infiltrating and "in situ" carcinomas; the stereotactic tattooing of the lesions is reliable for surgical approach. The rate of in situ carcinomas is remarkably higher than in non selected group of patients affected by palpable cancers. Pathologic staging confirms that non-palpable tumors are of better prognosis and they should benefit in large majority of a conservative surgical treatment.

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不可摸性乳腺癌的手术治疗。
乳房x线照相术在临床方法和筛查方案中的广泛应用,有助于改变受乳腺恶性肿瘤影响的患者群体。在不可触及的乳腺肿瘤中有特别的增加。作者分析了1990-1997年间135例不可触及性乳腺病变患者。所有患者均接受细针立体定向穿刺细胞学检查,同时用木炭悬浮液标记病变,并在15天内进行外科开放性活检。恶性病灶亚组则行根治性四分切除或乳房切除术。分析结果证实细针活检是一种不完善的检测方法,因为其敏感性低,无法区分浸润性癌和原位癌;病变的立体定向纹身是可靠的手术入路。原位癌的发生率明显高于未选择的可触及癌患者组。病理分期证实,不可触及的肿瘤预后较好,他们应该受益于大多数保守的手术治疗。
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