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1、BreastDiseasesBreastCenter,NanfangHospitalBreastCenter,NanfangHospitalBreastCenter,NanfangHospitalAnswerBreastCenter,NanfangHospital1.ShirleyTempleOscar:Winner7y8m45851.ShirleyTempleOscar:Winner7y8m45852.KylieMinogue:AustralianSinger3748-2.KylieMinogue:AustralianSinger3748-3.RonaldW.Reagan&NancyD.Re
2、aganThefirstlady&The40thpresidentofUSAThefirstlady&The40thpresidentofUSA66946694Breast Center, Nanfang HospitalBreast Center, Nanfang HospitalOutlineAnatomyDiagnosisBenignDiseasesMalignant DiseasesBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalSurfaceanatomyBreast:Breast:anteriorandal
3、sopartlythelateralaspectsofanteriorandalsopartlythelateralaspectsofthethorax;betweenthesubcutaneousfatlayerandthethorax;betweenthesubcutaneousfatlayerandthesuperficialpectoralfascia.thesuperficialpectoralfascia.superior:superior:2 2ndndrib.rib.inferior:inferior:6 6ththcostalcartilage.costalcartilage
4、.medial:medial:lateralborderofsternum.lateralborderofsternum.laterally:laterally:mid-axillaryline.mid-axillaryline.Nippleareolacomplex:Nippleareolacomplex:4 4thth55ththrib.rib.Langerlines:Langerlines:extendoutwardscircumferentiallyfromextendoutwardscircumferentiallyfromthenippleareolacomplex.thenipp
5、leareolacomplex.Breast Center, Nanfang HospitalBreast Center, Nanfang HospitalSurfaceanatomy6th ribLateral border of the sternum2nd ribmid-axillary lineLanger linesLanger linesBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalBreast Center, Nanfang Hospital
6、BreastAnatomyParenchymaParenchyma ThreetissuetypesThreetissuetypesGlandularepitheliumGlandularepitheliumFibrousstromaandsupportingstructuresFibrousstromaandsupportingstructuresFatFat CoopersligamentsCoopersligaments（dimplesignincancerdimplesignincancer）Fibrouscontinuationsofthesuperficialfascia,whic
7、hspantheFibrouscontinuationsofthesuperficialfascia,whichspantheparenchymaofthebreasttothedeepfasciallayersparenchymaofthebreasttothedeepfasciallayersProvideshapeandholdthebreastupward.Provideshapeandholdthebreastupward.Breast Center, Nanfang HospitalBreast Center, Nanfang HospitalfatCoopers ligament
8、ligamentBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalSegmental ductTerminal ductBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalBreastAnatomyVasculatureArterialsupplyArterialsupplyInternalmammaryarteryperforators(60%)Internalmammaryarteryperforators(60%)Lateralthoracic
9、artery(30%)Lateralthoracicartery(30%)IntercostalperforatorsIntercostalperforatorsVenousreturnVenousreturnIntercostalsIntercostalsAxillaryvein(primary)Axillaryvein(primary)InternalmammaryveinInternalmammaryveinBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalBreast Center, Nanfang Hospit
10、alBreast Center, Nanfang HospitalBreastAnatomyNervesLongthoracicnerve(Serratusanteriormusle)Longthoracicnerve(Serratusanteriormusle)Thoracodorsalnerve(Latissimusdorsimusle)Thoracodorsalnerve(Latissimusdorsimusle)MedialpectoralnerveMedialpectoralnerveLateralpectoralnerveLateralpectoralnerveIntercosta
11、lbrachialNerveIntercostalbrachialNerveBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalBreastAnatomyLymphatics1.Axillarylymphnodes1.Axillarylymphnodes（85%85%）. .2.Internalmammary2.Internalmammarylymphnodeslymphnodes. .3.Rotte
12、r3.Rotter snodessnodes：betweenpectorialminorandbetweenpectorialminorandmajormuscles.majormuscles.Breast Center, Nanfang HospitalBreast Center, Nanfang HospitalAxillaryLymphnodesAnteriorgroup:alongthelateralthoracicvessels.alongthelateralthoracicvessels.Posteriorgroup:alongthesubscapularvessels.along
13、thesubscapularvessels.Lateralgroup:alongtheaxillaryvein.alongtheaxillaryvein.Centralgroup:embeddedinfatinthecentreoftheembeddedinfatinthecentreoftheaxilla.axilla.Apicalgroup:abovethelevelofthepectoralisminorabovethelevelofthepectoralisminortenden.Thecontinuitywiththelateralnodesandreceivethetenden.T
14、hecontinuitywiththelateralnodesandreceivetheefferentsofalltheothergroups.efferentsofalltheothergroups.Breast Center, Nanfang HospitalBreast Center, Nanfang HospitalAnteriorAnterior group groupPosterior groupPosterior groupCentral groupCentral groupLateral groupLateral groupApical groupApical groupRo
15、tters LNRotters LNInternal Internal mammary chainmammary chainBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalLymph nodes levelLevelILevelILateralPectoralisMinorMuscleLateralPectoralisMinorMuscleLevelIILevelIIDeepPectoralisMinorMuscleDeepPectoralisMinorMuscleLevelIIILevelIIIMedialPecto
16、ralisMinorMuscleMedialPectoralisMinorMuscleBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalCommonDiseasesMass:CystandFibroadenomaCystandFibroadenoma：developwithindevelopwithinlobules.lobules. Carcinomas:developintheCarcinoma
17、s:developintheterminalductlobularunit.terminalductlobularunit.Nippledischarge:PapillomaandDuctEctasia:developinthePapillomaandDuctEctasia:developinthesegmentalducts.segmentalducts.Nippleadenoma:developinthedevelopinthesegmentalducts,segmentalducts,neartheiropeninginthenipple.neartheiropeninginthenip
18、ple.Pagetsdisease:referstoexcoriationoftheskininthereferstoexcoriationoftheskininthenipple-aveolarcomplexnipple-aveolarcomplex. .Breast Center, Nanfang HospitalBreast Center, Nanfang HospitalDiagnosisofthebreastdiseasesHistoryClinical Breast ExaminationBreast imagingTissue samplingBreast Center, Nan
19、fang HospitalBreast Center, Nanfang HospitalHistoryAgeMenarcheMenarchePregnancy(Breastfeeding,1stpregnancyage)Pregnancy(Breastfeeding,1stpregnancyage)MenopauseMenopauseFamilyHistoryPriorbiopsiesHormonereplacementtherapy(HRT)Breast Center, Nanfang HospitalBreast Center, Nanfang HospitalClinicalbreast
20、-examinationInspection SkinSkin SymmetrySymmetry MassesMassesPalpation GlandGland Axilla,SupraclavicularAxilla,Supraclavicularspacesspaces Nipple-areolacomplexNipple-areolacomplexBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalClinicalbreast-examinationUseyourbellyofthemiddlethreefinge
21、rs.Breast Center, Nanfang HospitalBreast Center, Nanfang HospitalClinicalbreast-examinationNipple dischargeBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalYouvefoundalump!PositionColour and texture of overlying skinTemperatureTendernessShapeSizeSurfaceEdgeBreast Center, Nanfang Hospita
22、lBreast Center, Nanfang HospitalDifferentialdiagnosisDischargeDuctectasiaMastitisDuctpapillomabloodyDuctalcarcinomainsitu(DCIS)bloodyBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalDifferentialdiagnosisLumpCancer(75%ductal,25%lobular)FibroadenomaFibrocysticdiseaseCystAbscessFatnecrosis
23、GalactocoeleEectopicbreasttissueBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalBreastimagingUltrasonographyMammographyMRI: too sensitiveMammary ductoscopy: impracticalCT: entirebodyassessmentinABCPET-CT: entirebodyassessmentinABCBreast Center, Nanfang HospitalBreast Center, Nanfang Ho
24、spitalUltrasoundSpecially useful in young women with dense breast.Distinguish cyst from solid lesionLocalize impalpable lesions BUSguidedcoreneedlebiopsy.BUSguidedcoreneedlebiopsy.Not a screening tool (operator dependent)Breast Center, Nanfang HospitalBreast Center, Nanfang HospitalUltrasoundBenignP
25、ureandintenselyPureandintenselyhyperechoichyperechoicEllipticalshapeEllipticalshape(widerthantall)(widerthantall)LobulatedLobulatedCompletetineCompletetinecapsulecapsuleMalignantHypoechoic,Hypoechoic,spiculatedspiculatedTallerthanwideTallerthanwideDuctextensionDuctextensionmicrolobulationmicrolobula
26、tionBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalMammographyaveryusefultool forbreastcancerscreen
27、ingBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalMammographyPositionCC:craniocaudalML:mediolateralMLO:mediolateralobliqueAt least two pictures are take of each breast.Breast Center, Nanfang HospitalBreast Center, Nanfang H
28、ospitalMammographyBreast compressionEvensoutbreastthicknesssothatallofthetissuecanbeseenSpreadsoutthetissuesothatsmallabnormalitiesarelesslikelytobehiddenbyoverlyingbreasttissueAllowstheuseofalowerx-raydose.HoldsthebreaststilltominimizeblurringthepictureBreast Center, Nanfang HospitalBreast Center,
29、Nanfang HospitalBI-RADSTheBreastImagingReportingandDataSystem(BI-RADS)oftheAmericanCollegeofRadiology(ACR).Itspurposeistostandardize:(1)theterminologyinamammographicreport,(2)theassessmentoffindings,and(3)theresultingrecommendationBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalBreast
30、Center, Nanfang HospitalBreast Center, Nanfang HospitalTypesofbreasttissuedensityBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalMassAmassisdefinedasalesionseenintwo differentprojections.Ifalesionisseenonlyinasingleprojection,itshouldbecalledadensity.Massesarefurtherclassifiedbyshape,m
31、argin,anddensityBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalMassShape:round,oval,lobular,orirregular.Margin:circumscribed(well-definedorsharplydefined)microlobulated(undulationwithshortcycles)obscured(hiddenbysuperimposingadjacenttissue)indistinct(ill-defined)spiculatedDensity:high
32、er,equivalent(isodense),orlowerthanthesurroundingparenchymaorfatequivalent.不规则肿物，周围见毛刺类圆形肿物，边缘模糊外侧肿物局部加压，边缘模糊，其内见细点状钙化偏内侧肿物，局部加压，见典型的毛刺征女，39岁，左乳外上扪及两个肿物，界限不清，Localpointamplification:2masses，手术：LIDC（多灶）。2.52cm、1.21cm。女，68岁，右乳肿物，查体质硬，动度差。DR：不规则肿物，边缘略模糊浸润。皮肤广泛增厚，腋下淋巴结肿大。手术：浸润性导管癌，并腋下淋巴结转移。腋下淋巴结肿大、密度增高正
33、常左乳女，59岁，右乳肿物边缘模糊浸润，伴少许毛刺。病理：乳腺癌。女，67岁，左乳外上肿物，边界不清，动度差。DR：肿物周围明显毛刺。左乳头赘生物。手术病理：左乳癌。女女 ，5151岁，右乳肿物，边界不清，动度差，岁，右乳肿物，边界不清，动度差，DR:DR:右右乳内下肿物，边缘模糊浸润。手术：浸润性导管癌。乳内下肿物，边缘模糊浸润。手术：浸润性导管癌。女70岁，手术左乳癌DR：左乳内下不规则肿物，边缘模糊，见毛刺影。女，53岁，DR：右乳中央区Patchdensity，内侧见类圆形结节，乳晕区为中心皮肤增厚，craternipple。手术病理为：乳腺炎并乳腺癌（肿块为癌灶）不同病人，皆为高密度
34、肿块，边缘模糊，第一个肿物周围见毛刺，不同程度皮肤增厚，手术：皆为乳腺癌女，46，不规则肿物，边缘见毛刺征，手术：左乳癌局部加压毛刺明显局部点压放大摄影女，62岁，左乳癌术后一年，右乳发现小病灶，导丝定位手术病理：右乳小癌灶。sssIrregualarmasswithpleomorphiccalcificationsIDC右乳纤维腺瘤，左乳浸润性导管癌。左乳肿物周围见毛刺，并且密度明显高于右侧肿物。肿物周围致密浸润，边缘模糊，乳腺癌。Breast Center, Nanfang HospitalBreast Center, Nanfang HospitalCalcificationsBenig
35、nIntermediate-concerncalcificationsCalcificationssignifyingahighprobabilityofmalignancy)Breast Center, Nanfang HospitalBreast Center, Nanfang HospitalTypicallybenignSkincalcifications(dermal)VascularcalcificationsCoarseorpopcorn-likecalcificationsLargerod-likecalcificationsRoundcalcificationsLucent-
36、centeredcalcifications“Eggshell”or“rim”calcificationsMilkorcalciumcalcificationsSuturecalcificationsDystrophiccalcificationsPunctatecalcificationsBreastCenter,NanfangHospitalBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalIntermediate-concerncalcificationsAmorphousIndistinctcalcificati
37、onsBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalHigherprobabilityofmalignancyPleomorphicorheterogenouscalcifications(granular)Finelinear,finelinearbranching(casting)calcificationsClusteredcalcificationstwocancercases：Finelinear,finelinearbranching,granularPleomorphicorheterogenousca
38、lcifications(granular)Large-scale:Finelinear,finelinearbranching,granular典型恶性钙化，不同病例，tinypleomorphiccalcification，clusterorlineardistribution女，50岁，右乳外上浸润性导管癌，区域分布细小多形性钙化。女，30岁，乳头溃疡、湿疹一年余，在外地按皮肤病治疗欠佳，查体乳头鲜红，溃烂、缺失大半。（接下一幻灯片）腋窝淋巴结肿大线状、小线虫状、细小多形性钙化，手术病理：浸润性导管癌。Pagetsdisease。女，46岁，右乳外上见区域性分布细小多形性钙化，手术病理：
39、浸润性导管癌。女，45岁，手术病理浸润性导管癌典型细小多形性钙化伴皮肤增厚，乳头凹陷局限致密，结构不良，伴恶性钙化，皮肤增厚，乳头凹陷craternipple女、75岁，左乳肿物伴多发细小多形性钙化，手术乳腺癌。右乳扪及肿物，质硬、界不清，DR：乳头后方，相当于临床扪及肿物部位见成簇细小钙化，最具特征的是钙化沿导管走行方向分布，手术：筛状癌。不规则肿物伴多形性钙化，浸润性导管癌大小不等不均质钙化及细小不定形钙化，病理：浸润性导管癌左乳癌，成簇细小多形性钙化，导管征阳性。女，46岁，乳腺DR查体发现三簇模糊伴定形钙化，导丝定位手术，guidewirelocalizethecalcificatio
40、n（接下一幻灯片）穿刺定位点（接上）女，46岁，查体发现多簇模糊不定型钙化，needle-localization，病理：乳腺癌。似良性钙化成簇钙化，形态较规则，边缘清晰，密度较高。手术病理：浸润性导管癌无定形钙化无定形钙化左乳细小浅淡不定型amorphous钙化，手术病理：浸润型导管癌。女，45岁，乳腺DR体检发现右乳外上8mm范围成簇模糊不定形钙化。手术病理：浸润性导管癌.位置偏上，容易漏诊局部点压片无定形或粗糙不均质钙化手术病理：小管癌。ClusteredAmorphousheterogenouscalcificationsBreast Center, Nanfang HospitalB
41、reast Center, Nanfang Hospital右乳浸润性导管癌，肿物似良性，密度浅淡，边缘较清。DR：肿物密度浅淡，边缘模糊似良性。手术病理：浸润性导管癌女，39岁，多灶癌，部分病灶不规则肿物伴毛刺，部分病灶边缘模糊浸润。肿物伴毛刺肿物边缘模糊浸润女，40岁，右乳外上结构不良伴钙化，局部加压可见毛刺改变，浸润性导管癌女，67岁，左乳外上肿物，边界不清，动度差，DR见小病灶伴多发毛刺。手术病理：乳腺癌。不规则肿物伴粗糙不均质钙化，周围见多发毛刺，手术乳腺癌。不规则肿物伴多发毛刺，手术乳腺癌。致密浸润、结构不良不规则肿物，周围伴放射样毛刺，手术病理：左乳癌。多发肿块，边缘见毛刺，周围
42、腺体结构不良，伴成簇细点状钙化，手术病理：多灶癌。不规则肿物伴多发细长毛刺，手术：左乳外上浸润性导管癌局部结构不良侧位切线位加压localamplify女，44岁，MLO位发现结构不良，局部摸到肿物，侧位及局部点压，发现毛刺样改变，手术病理：浸润性导管癌女，45岁，手术病理浸润性导管癌。皮肤增厚女，53岁，手术病理为：乳腺炎并乳腺癌（肿块为癌灶）皮肤增厚，乳头凹陷右乳炎性乳癌皮肤广泛增厚，下部明显左乳炎性乳癌皮肤广泛增厚，下部明显不同病人，同样高密度肿块，皮肤增厚，乳腺癌皮肤广泛增厚乳晕区皮肤增厚局限致密，结构不良，伴恶性钙化，皮肤增厚，脂肪层浑浊，乳头凹陷。浸润性导管癌。广泛皮肤增厚乳头凹陷
43、nippleretraction，导管征conductsign、漏斗征hoppersign。左乳炎性乳癌，thickenskin左乳侧位X线片：乳头缺损。乳晕增厚，密度增高，乳晕后见三角形索条状影与深部腺体相连。未见肿块。乳晕后上部两个钙化点。标本切片X线片：乳头消失，乳头根本向后凹陷，乳晕增厚，乳晕下脂肪层内见三角形和索条状致密影与后部腺体相连。手术病理：Paget病。Breast Center, Nanfang HospitalBreast Center, Nanfang HospitalMRIHigh risk patientsPersonalhistoryofbreastcaPerso
44、nalhistoryofbreastcaLCIS,atypiaLCIS,atypia1 1st stdegreerelativewithbreastcancerdegreerelativewithbreastcancerVerydensebreastVerydensebreastHigh sensitivity ( 95-100% )10-20%willhaveabiopsy10-20%willhaveabiopsyBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalMRIMagneticresonanceimagingH
45、igh sensitivity, low specificitySpeciallyusefultofindthelesionsofoccultbreastcancer.3-Dimaging.Breast Center, Nanfang HospitalBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalMammary ductoscopyBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalT
46、issuesamplingFNA ( fine needle aspiration )CNB ( core needle biopsy )mammotomestereotacicbiopsyNeedle-Localized biopsyOpen biopsyBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalFNABreast Center, Nanfang HospitalBreast Center, Nanfang HospitalCNBBreast Center, Nanfang HospitalBreast Cen
47、ter, Nanfang HospitalSamplesofCNBBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalStereotacticBiopsyProcedurePosition patient comfortably!Position patient comfortably!Patient needs to remain still for up to 45 minutesPatient needs to remain still for up to 45 minutesObtain imagesObtain
48、imagesLocalize mass or calcificationsLocalize mass or calcificationsPerform calculations Perform calculations Transmit X,Y,Z co-ordinatesTransmit X,Y,Z co-ordinatesFromKennethTomkovichMDFromKennethTomkovichMDBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalStereotacticBiopsyProcedure te
49、chniquePlace needle into incisionPlace needle into incisionAdvance needle to correct X,Y,Z positionAdvance needle to correct X,Y,Z positionObtain pre-fire imagesObtain pre-fire imagesConfirm position of needleConfirm position of needleObtain post-fire imagesObtain post-fire imagesPerform biopsy Perf
50、orm biopsy Number of passes and location is dependent on Number of passes and location is dependent on lesion and needle gaugelesion and needle gaugeFromKennethTomkovichMDFromKennethTomkovichMDStereotacticBiopsyTableFromKennethTomkovichMDFromKennethTomkovichMDBreast Center, Nanfang HospitalBreast Ce
51、nter, Nanfang HospitalStereotacticBiopsyFromKennethTomkovichMDFromKennethTomkovichMDBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalTripleAssessmentPathologyFNAImagingTripleAssessmentAgeExamBUSMammographyClinicalCNBConfident diagnosis in 99% of casesBenighdiseasesBreastCenter,NanfangHo
52、spitalBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalMastalgiaCyclical pain Cyclical pain hormonal hormonal Dull,diffuseandbilateralDull,diffuseandbilateral LutealphaseLutealphase TreatmentTreatmentReassuranceReassuranceNSAIDSNSAIDSEveningprimroseoilEveningprimroseoilNon-cyclical pain
53、Non-cyclical pain Non-breastvsbreastNon-breastvsbreast ImagingImaging TreatmentTreatmentReassuranceReassuranceNSAIDSNSAIDSEveningprimroseoilEveningprimroseoilBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalMastalgiaCancer must be excludedthroughexamination,mammogram,andultrasoundifthep
54、ainislocalized.Breast Center, Nanfang HospitalBreast Center, Nanfang HospitalCellulitis, mastitis UsuallyassociatedwithlactationUsuallyassociatedwithlactation Treatwith10-14daycourseantibioticstocoverTreatwith10-14daycourseantibioticstocoverStaphylococcusandStreptococcusStaphylococcusandStreptococcu
55、sAbscess TreatedbysurgicaldrainageTreatedbysurgicaldrainageChronic subareolar abscess Occursatbaseoflactiferousduct,andsquamousmetaplasiaOccursatbaseoflactiferousduct,andsquamousmetaplasiaofductmayoccur.ofductmayoccur. SinustracttoareoladevelopsSinustracttoareoladevelops Treatmentrequirescompleteexc
56、isionofsinustractTreatmentrequirescompleteexcisionofsinustract RecurrenceiscommonRecurrenceiscommonInfectiousandInflammatoryBreastDiseaseBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalInfectiousandInflammatoryBreastDiseaseMondors disease PhlebitisofthePhlebitisofthethoracoepigastricve
57、inthoracoepigastricveinPalpable,visible,tenderPalpable,visible,tendercordalongupperquadrantscordalongupperquadrantsUltrasoundmaybehelpfulUltrasoundmaybehelpfulinconfirmingthisinconfirmingthisdiagnosis.diagnosis.Treatmentself-limited,canTreatmentself-limited,canuseanti-inflammatoriesifuseanti-inflamm
58、atoriesifnecessarynecessaryBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalBreastInfectionsMastitisGeneralizedcellulitisofthebreastGeneralizedcellulitisofthebreastAscendinginfectionAscendinginfectionsubareolarductssubareolarductscommonlyoccursduringlactationcommonlyoccursduringlactatio
59、nAcuteinflammationAcuteinflammationErythema,pain,tendernessErythema,pain,tendernessBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalMastitisTreatmentTreatment AntibioticsAntibiotics StopbreastfeedStopbreastfeed EmptyofmilkEmptyofmilk(breastpump)(breastpump) RelievepainRelievepainBreast
60、Center, Nanfang HospitalBreast Center, Nanfang HospitalBreastAbscessInfectiondidnotresolvewithin48hours.Infectiondidnotresolvewithin48hours.Localizedinfection(Localizedinfection(erythematous,warm,andfluctuant)BUS:aareaBUS:aarea“ “riperipe” ”fordrainage.fordrainage.TreatmentTreatmentAntibioticsAntibi
61、oticsNeedleaspirationNeedleaspiration（+antibioticsNoscar+antibioticsNoscar）IncisionanddrainageIncisionanddrainageBreast Center, Nanfang HospitalBreast Center, Nanfang Hospitalan incision is made directly over the abscesscavityBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalCystCystsFlu
62、id-filled,epithelium-linedcavitiesFluid-filled,epithelium-linedcavitiesInfluencedbyovarianhormonesInfluencedbyovarianhormonesCommonafterage35,andrarebefore25.IncidenceCommonafterage35,andrarebefore25.Incidencedeclinesaftermenopause.declinesaftermenopause.ExcisiondependsonwhetherthecystcompletelyExci
63、siondependsonwhetherthecystcompletelyresolvesafteraspirationresolvesafteraspirationCompleteresolution,followuptoensureitdoesnotrecur.Completeresolution,followuptoensureitdoesnotrecur.Incompleteresolution,Treatasbreastmassandexcise.Fluid-Incompleteresolution,Treatasbreastmassandexcise.Fluid-filled,ep
64、ithelium-linedfilled,epithelium-linedBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalCystPalpable:needleaspirationNotpalpable:ultrasound-guidedThreecolorsbyneedleaspirationSimplecyst,clearorgreenfluidandisbenign.Simplecyst,clearorgreenfluidandisbenign.Milk-filledcyst,calledgalactocelea
65、ndisbenign.Milk-filledcyst,calledgalactoceleandisbenign.Bloodycystisacauseofconcernformalignancy.Bloodycystisacauseofconcernformalignancy.Bloodyfluid:cytologyevaluationBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalBreastCystBreast Center, Nanfang HospitalBreast Center, Nanfang Hospit
66、alNippleDischargeDischarge from the surfaceDischarge from a single ductDischarge from more than one ductBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalDischarge from the surfacePagets diseaseSkin deseases (eczema,paoriasis)Rare causes (chancre,syphilis)Breast Center, Nanfang HospitalB
67、reast Center, Nanfang HospitalDischarge from a single ductBlood-stainedintraductcarcinomaintroductpapillomaductectasiaSerous ( any colour )fibrocysticdiseaseductectasiacarcinomaBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalDischarge from more than one ductBlood-stainedBlood-stainedca
68、rcinoma,carcinoma,ectasia,fibrocysticdisease.ectasia,fibrocysticdisease.GrumousGrumousductectasiaductectasiaPurulentPurulentinfectioninfectionSerousSerousfibrocysticdisease,ductectasia,carcinomafibrocysticdisease,ductectasia,carcinomaMilkMilklactation,rarecauseslactation,rarecausesBreast Center, Nan
69、fang HospitalBreast Center, Nanfang HospitalNippleDischargePhysiologicBilateralBilateralInvolvesmultipleductsInvolvesmultipleductsHeme(-)Heme(-)Non-spontaneousNon-spontaneousBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalNippleDischargePathologicUnilateralUnilateralSpontaneousSpontane
70、ousHeme(+)Heme(+)MostcommoncauseintraductalpapillomaMostcommoncauseintraductalpapillomaBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalBenignBreastDiseasePathologic nipple discharge is persistent and Pathologic nipple discharge is persistent and spontaneous spontaneous Requires further
71、 evaluationRequires further evaluationGalactorrheaGalactorrhea Bilateral,milkydischargeoccursBilateral,milkydischargeoccurs Obtainprolactinlevels,ifhighlyelevated,suspectpituitaryadenomaObtainprolactinlevels,ifhighlyelevated,suspectpituitaryadenomaasoneofcauses.asoneofcauses.Bloody nipple dischargeB
72、loody nipple discharge MostcommoncauseisintraductalpapillomaMostcommoncauseisintraductalpapilloma Cancerpresent10%oftime.Cancerpresent10%oftime. CytologicexamondischargeCytologicexamondischarge MammogramtoruleoutassociatedmassMammogramtoruleoutassociatedmass Ifdrainagefromisolatedduct,thenitshouldbe
73、excised.Ifdrainagefromisolatedduct,thenitshouldbeexcised.Breast Center, Nanfang HospitalBreast Center, Nanfang HospitalIntraductalPapillomaSingleductBenignMovableround/ellipsemassunderthenipple-areolarcomplex4%ofintraductalcarcinomalumpectomyBreast Center, Nanfang HospitalBreast Center, Nanfang Hosp
74、italFibroadenomaCommondiseasein15-30yStromalandepithelialelementsWell-defined,movablebenigntumorofbreastMostcommoninwomen15-25yearperiod.Indication:suspiciouscytologyorbecomeverylarge.patientsexpresslydesiresthelumptoberemoved.Giantfibroadenoma:over5cm,growrapidly.Breast Center, Nanfang HospitalBrea
75、st Center, Nanfang HospitalFibroadenomaBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalPhyllodesTumorProliferationofconnectivetissuewithductalelementsFirm,lobulated2to40cminsizeBenign,borderlineandmalignantsubtypes10%malignantTreatment:wideexcisionBreast Center, Nanfang HospitalBreast
76、Center, Nanfang HospitalBreastCarcinomaBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalMagnitudeoftheproblemBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalCancer Statistics Estimates for 2000 in USA New Cases-1,220,100; Deaths-552,200Male-new cases:Male-new cases: 619,70
77、0 619,700 Prostate 180,400Prostate 180,400 Lung 89,500Lung 89,500 Colon/rectal 63,600Colon/rectal 63,600Male DeathsMale Deaths: : 284,100 284,100 Lung 89,300Lung 89,300 Prostate 31,900Prostate 31,900 Colon/rectal 27,800Colon/rectal 27,800Female-new cases:Female-new cases: 600,400 600,400 Breast 182,
78、800Breast 182,800 Lung 74,600Lung 74,600 Colon/rectal 66,600Colon/rectal 66,600Female Deaths:Female Deaths: 268,100 268,100 Lung 67,600Lung 67,600 Breast 40,800Breast 40,800 Colon/rectal 28,500Colon/rectal 28,5001:8 women will develop breast cancer in lifetime (USA)1:8 women will develop breast canc
79、er in lifetime (USA)Breast Center, Nanfang HospitalBreast Center, Nanfang HospitalBREASTCANCEREPIDEMIOLOGY:StageatBREASTCANCEREPIDEMIOLOGY:Stageatdiagnosis:UnitedStatesvs.Indiadiagnosis:UnitedStatesvs.IndiaSTAGESTAGE EXTENTEXTENT5 year5 year DISTRIBUTION DISTRIBUTIONSURVIVALSURVIVAL USA USAINDIAINDI
80、A0 0NoninvasiveNoninvasive100%100%16%16%-I IEarlystagediseaseEarlystagedisease 100%100%40%40% 1%1%II IIEarlystagediseaseEarlystagedisease86%86%34%34% 23%23%IIIIIILocallyadvancedLocallyadvanced57%57%6%6%52%52%IVIVMetastaticdiseaseMetastaticdisease20%20%4%4%24%24%USA:90%DCISorearlystagedinvasivediseas
81、eatdiagnosisINDIA:76%locallyadvancedormetastaticatdiagnosisSources:SEERSurvivalMonograph(NCI),2007;Chopra,CancerInstituteChennai,India,2001From the report of Dr. G.V. NagarajBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalRiskfactorsOestrogenexposureOestrogenexposure1. 1.FemaleFemale2.
82、 2.Ageatmenarche(earlierthan13yo)Ageatmenarche(earlierthan13yo)3. 3.Ageatmenopause(laterthan50yo)Ageatmenopause(laterthan50yo)4. 4.NulliparousNulliparous（neverhavebabyneverhavebaby）5. 5.Ageoffirstpregnancy(30yo)Ageoffirstpregnancy(30yo)6. 6.NobreastfeedingNobreastfeeding7. 7.TakingHRT(hormonereplace
83、menttherapy)TakingHRT(hormonereplacementtherapy)OtherOther1. 1.RadiationexposureRadiationexposure2. 2.AgeAge3. 3.BRCA1+2BRCA1+24. 4.FamilyhistoryFamilyhistoryBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalBreast Cancer Risk FactorsRRRRFirstPregnancy(30yrs)FirstPregnancy(30yrs)1.481.48
84、Bodymassindex(29.68kg/mBodymassindex(29.68kg/m2 2) )1.481.48CollegegraduateCollegegraduate1.361.36Alcoholuse(5g/d)Alcoholuse(5g/d)1.161.16DelayedmenopauseDelayedmenopause1.14(51.14(5yrs)yrs)HRT(current)HRT(current)1.12(51.12(5yrs)*yrs)*basedondatafromCollaborativeGrouponHormonalFactorsinBreastCancer
85、.Lancet.1997;350-1047.Breast Center, Nanfang HospitalBreast Center, Nanfang HospitalBreastCancerScreeningMethodsForHealthyWomen1.BreastSelfExamStatusGuidingprincipal“Knowyourbreaststheyarenotlandmines”2.ClinicalBreastExamAge20-39:every1-3yearsAgeafter40:everyyear3.MammographyAgeafter40:everyyearBrea
86、st Center, Nanfang HospitalBreast Center, Nanfang HospitalBenefitToScreeningFor50-74yearoldgroupthereisanestimated30%reductioninmortalityFor40-49yearoldgroup,thereisanestimated17%reductioninmortalityBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalBottomLine“A palpable cancer is a late
87、cancer”IfyoucanfeelthecanceryourselfitlikelywillalreadyhavespreadGetyourpatientsscreenedBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalSymptomsNewlumpsorathickeninginthebreastorunderthearmNippletenderness,discharge,orphysicalchangesSkinirritationorchanges,suchaspuckers,dimples,scaline
88、ss,ornewcreasesBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalSymptomsWarm,red,swollenbreastswitharashresemblingtheskinofanorangePaininthebreast(usuallynotasymptomofbreastcancer,butshouldbereportedtoadoctor)No visible or obvious symptoms (asymptomatic)Breast Center, Nanfang HospitalBr
89、east Center, Nanfang HospitalClinicalmanifestationsDimpling SignRetraction of the coopers ligament.Breast Center, Nanfang HospitalBreast Center, Nanfang HospitalDimplingsignBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalPeau dorange cutaneous lymphatic oedema, Breast Center, Nanfang H
90、ospitalBreast Center, Nanfang HospitalPeau dorangeBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalBloodydischargeBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalPagetsDiseaseBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalInflammatorybreastcarcinomaBreast Ce
91、nter, Nanfang HospitalBreast Center, Nanfang HospitalLocationofprimarybreastcancerBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalDiagnosisFine-needleaspirationFine-needleaspiration Sensitivityis80-98%,specificity100%Sensitivityis80-98%,specificity100% Falsenegativesare2-10%Falsenegati
92、vesare2-10%Core-needlebiopsyCore-needlebiopsy Moretissue,howeverstillpossibilityoffalseMoretissue,howeverstillpossibilityoffalse“ “negativenegative” ” andcouldrepresentsamplingerrorandcouldrepresentsamplingerrorIncisionalbiopsyIncisionalbiopsy Forlarge(4cm)lesionsforwhompre-opchemotherapyForlarge(4c
93、m)lesionsforwhompre-opchemotherapyorradiationwillbedesirable.orradiationwillbedesirable.ExcisionalbiopsyExcisionalbiopsy RemovalofentirelesionandamarginofnormalbreastRemovalofentirelesionandamarginofnormalbreastparenchymaparenchymaBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalStaging
94、PrimaryTumorPrimaryTumor T1=Tumor2cm.ingreatestdimensionT1=Tumor2cm.but2cm.but5cm.ingreatestdimensionT3=Tumor5cm.ingreatestdimension T4=TumorofanysizewithdirectextensiontochestwallorT4=TumorofanysizewithdirectextensiontochestwallorskinskinRegionalLymphNodesRegionalLymphNodes N0=Nopalpableaxillarynod
95、esN0=Nopalpableaxillarynodes N1=MetastasestomovableaxillarynodesN1=Metastasestomovableaxillarynodes N2=Metastasestofixed,mattedaxillarynodesN2=Metastasestofixed,mattedaxillarynodesDistantMetastasesDistantMetastases M0=NodistantmetastasesM0=Nodistantmetastases M1=Distantmetastasesincludingipsilateral
96、supraclavicularM1=DistantmetastasesincludingipsilateralsupraclavicularnodesnodesBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalStagingBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalHistologicGradeBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalBreast Cente
97、r, Nanfang HospitalBreast Center, Nanfang HospitalTreatmentSurgerySurgeryChemotherapChemotherapy yTarget Target TherapyTherapyRadiation Radiation TherapyTherapyEndocrine Endocrine TherapyTherapyBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalTreatmentTypesofTreatment:LocalandSystemicLo
98、calLocalSurgerySurgeryRadiationTherapyRadiationTherapySystemicSystemicChemotherapyChemotherapyEndocrineTherapyEndocrineTherapyTargetTherapyTargetTherapyBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalSurgeryBreast conservation therapyStageI,stageII,andsometimestageIIIcarcinomasStageI,s
99、tageII,andsometimestageIIIcarcinomasLumpectomy,axillarylymphadenectomy,andpostoperativeLumpectomy,axillarylymphadenectomy,andpostoperativeradiationtherapyradiationtherapyContraindications:tumors5cm,grossmultifocaldisease,andContraindications:tumors5cm,grossmultifocaldisease,anddiffusemalignantmicroc
100、alcificationsdiffusemalignantmicrocalcificationsLocalrecurrencemorethanmastectomysofollowupimportantLocalrecurrencemorethanmastectomysofollowupimportantModified radical mastectomy( (1948,mostmostcommonmastectomyprocedureforinvasivebreastcommonmastectomyprocedureforinvasivebreastcancer)cancer)Entireb
101、reastandaxillarycontentsareremovedEntirebreastandaxillarycontentsareremovedPectoralismusclesremainsPectoralismusclesremainsBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalSurgeryHalsted radical mastectomy(1894)Removesbreast,axillarycontents,andpectoralismajorRemovesbreast,axillaryconte
102、nts,andpectoralismajormusclemuscleCosmeticallydeformingCosmeticallydeformingOnlyindicatedwhenpectoralismuscleinvolvedOnlyindicatedwhenpectoralismuscleinvolvedSimple mastectomyAllbreasttissueisremoved,axillarycontentsnotAllbreasttissueisremoved,axillarycontentsnotremovedremovedTreatmentfornon-invasiv
103、ebreastcancerTreatmentfornon-invasivebreastcancerBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalRadiationUtilizedforprimaryandmetastaticdiseaseUsefulinbreastconservationtherapytoreducerateofrecurrence.RadiateentirebreastRad
104、iateentirebreastBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalChemotherapyChemotherapy EradicatesriskofoccultdistantdiseaseinstageIandstageEradicatesriskofoccultdistantdiseaseinstageIandstageIIpatients.IIpatients. AllpatientswithaxillarynodeinvolvementarecandidatesAllpatientswithaxil
105、larynodeinvolvementarecandidatesalongwithpatientswithnegativeaxillarynodealongwithpatientswithnegativeaxillarynodeinvolvementwhoarehighriskbyotherprognosticinvolvementwhoarehighriskbyotherprognosticindicators.indicators. Exampletreatmentis6monthsofcyclophosphamide,Exampletreatmentis6monthsofcyclopho
106、sphamide,methotrexateormethotrexateoradriamycinadriamycin,andflourouracilalongwith,andflourouracilalongwithpaclitaxelpaclitaxel. .ImprovementindiseasefreeintervalandoverallImprovementindiseasefreeintervalandoverallsurvivalsurvivalBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalChemothe
107、rapyRegimensCMFCMFCAFCAFACACTACTAC612CyclesBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalChemotherapyBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalEndocrineTherapyTamoxifenTamoxifenisaselectiveestrogenreceptormodulatorisaselectiveestrogenreceptormodulatorwhichbindstoa
108、ndinhibitsestrogenreceptorwhichbindstoandinhibitsestrogenreceptorsignalinginthebreast.Itiseffectiveinbothpre-andsignalinginthebreast.Itiseffectiveinbothpre-andpost-menopausalwomen.post-menopausalwomen.5 5yearsofadjuvanttherapywithTamoxifen20mg/dyearsofadjuvanttherapywithTamoxifen20mg/d hasbeenshownt
109、oreducebreastcancerrecurrenceshasbeenshowntoreducebreastcancerrecurrencesby47%andmortalityby22%.by47%andmortalityby22%.Aseffectiveaschemotherapyinpost-menopausalAseffectiveaschemotherapyinpost-menopausalpatientswithestrogenreceptorpositivetumorspatientswithestrogenreceptorpositivetumorsBreast Center
110、, Nanfang HospitalBreast Center, Nanfang HospitalEndocrineTherapyAromataseAromatase istheenzymefoundinfat,istheenzymefoundinfat, adrenaladrenalglands,breasttissue,andtumorcells,responsibleforglands,breasttissue,andtumorcells,responsibleforconvertingothersteroidhormonesintoestrogen.Itisconvertingothe
111、rsteroidhormonesintoestrogen.Itisthesourceofestrogeninpost-menopausalwomen.thesourceofestrogeninpost-menopausalwomen.Aromataseinhibitors(AIs)Aromataseinhibitors(AIs)havenoeffectonovarianhavenoeffectonovarianestrogenproduction.estrogenproduction.AIsAIs arerecommendedforpost-menopausalwomen.arerecomme
112、ndedforpost-menopausalwomen.Myalgias,bonelossandfracturecanoccur.TheMyalgias,bonelossandfracturecanoccur.TheexactdoseanddurationofAIsisbeinginvestigated.exactdoseanddurationofAIsisbeinginvestigated.Drugs: Drugs: AnastrozoleAnastrozole, , ExemestaneExemestane, , LetrozoleLetrozole. .Breast Center, Na
113、nfang HospitalBreast Center, Nanfang HospitalEndocrineTherapyBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalTargettherapyHer-2:positiveHerceptinBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalTargetTherapyBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalThes
114、preadofbreastcancerLocalspreadLymphaticmetastasisSpreadbythebloodstreamBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalLocalization of the recurrence at autopsyLocalization of the 1st site of the metastasesBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalPrognostic Factors
115、SizeNodesStageGradePloidyS PhaseNecrosisHER-2/neuBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalPrognosticFeaturesTumorsizeimportantprognosticfactorTumorsizeimportantprognosticfactorPoorprognosticfeaturesoftumor:Poorprognosticfeaturesoftumor: Presenceofedemaorulcerationofskin,massfixe
116、dtochestwallorskin,satelliteskinPresenceofedemaorulcerationofskin,massfixedtochestwallorskin,satelliteskinnodules,peaudnodules,peaud orange(dermallymphaticinvasion),skinretractionanddimpling,andorange(dermallymphaticinvasion),skinretractionanddimpling,andinvolvementofmedialportionofinnerlowerquadran
117、tinvolved.involvementofmedialportionofinnerlowerquadrantinvolved.Axillarynodestatus:Axillarynodestatus: BestsourceofpredictingsurvivaloroutcomeBestsourceofpredictingsurvivaloroutcome N0has10yearsurvivalrateof60%N0has10yearsurvivalrateof60% N1has10yearsurvivalrateof50%N1has10yearsurvivalrateof50% N2h
118、as10yearsurvivalrateof20%N2has10yearsurvivalrateof20% If10ormorenodesarediseased(N3)10yrsurv.Rateis14%If10ormorenodesarediseased(N3)10yrsurv.Rateis14% Poorprognosticfeatureofnodes:Poorprognosticfeatureofnodes:Capsularinvasion,extranodalspread,andedemaofarmCapsularinvasion,extranodalspread,andedemaof
119、armDistantmetastasesisverypoorprognosticindicatorDistantmetastasesisverypoorprognosticindicatorPostiveestrogenandprogesteronereceptorindicateslikelyresponsetohormonalPostiveestrogenandprogesteronereceptorindicateslikelyresponsetohormonaltreatmentandisapositiveprognosticindicatortreatmentandisapositi
120、veprognosticindicatorBreast Center, Nanfang HospitalBreast Center, Nanfang HospitalBreastCancerPathologyInsitubreastcancers： 85%85%DCISDCIS(ductalcarcinomainsitu)(ductalcarcinomainsitu)15%15%LCISLCIS(lobularcarcinomainsitu).(lobularcarcinomainsitu).Invasivebreastcancers.Otherspecialtypes.Breast Cent
121、er, Nanfang HospitalBreast Center, Nanfang HospitalDuctalCarcinomainSituDCISSeenasmicrocalcificationsonmammogramSeenasmicrocalcificationsonmammogramConfinedtoductalcells.Confinedtoductalcells.Noinvasionoftheunderlyingbasementmembrane.Noinvasionoftheunderlyingbasementmembrane.Chanceofrecurrence25-50%
122、in5years,ofthese50%willbeChanceofrecurrence25-50%in5years,ofthese50%willbeinvasiveinvasiveTxTx Mastectomyanoptionifthereisasubstantialriskoflocal/regionalMastectomyanoptionifthereisasubstantialriskoflocal/regionalrecurrencerecurrence Widelocalexcisionandradiationreducelocalrecurrenceto2%Widelocalexc
123、isionandradiationreducelocalrecurrenceto2% Wideexcisionalonesuitableif25mm,favorablehistology,andtheWideexcisionalonesuitableif25mm,favorablehistology,andthemarginsareclearmarginsareclear Nodedissectionnotnecessary(nodaldisease1%)Nodedissectionnotnecessary(nodaldisease1%)Breast Center, Nanfang Hospi
124、talBreast Center, Nanfang HospitalLobularCarcinomainSituLCISNotdetectableonmammographyNotdetectableonmammography MostcommonlyfoundincidentallyMostcommonlyfoundincidentallyRiskofinvasivebreastcancerin20yearsis15-20%Riskofinvasivebreastcancerin20yearsis15-20%bilaterallybilaterallyTxTx Carefulfollow-up
125、Carefulfollow-up BilateralmasectomymaybeconsideredifotherriskfactorsBilateralmasectomymaybeconsideredifotherriskfactorsarepresentsuchasfamilyhistoryorpriorbreastcancer,arepresentsuchasfamilyhistoryorpriorbreastcancer,andalsodependentonpatientpreference.andalsodependentonpatientpreference.Breast Cent
126、er, Nanfang HospitalBreast Center, Nanfang HospitalPagetsDiseaseUncommonUncommonUsuallyinvolvesthenippleUsuallyinvolvesthenippleHistologically,vacuolatedcellsareseenintheepidermisofHistologically,vacuolatedcellsareseenintheepidermisofthenippleandresultinaneczematousdermatitisofthenipple.thenippleand
127、resultinaneczematousdermatitisofthenipple.ItisgenerallyassociatedwithanItisgenerallyassociatedwithanunderlyingintraductalorunderlyingintraductalorinvasivecarcinoma.invasivecarcinoma. MammographyshouldbeperformedMammographyshouldbeperformedAbout30%ofpatientshaveaxillarynodemetastasisatAbout30%ofpatie
128、ntshaveaxillarynodemetastasisatdiagnosis.diagnosis.MastectomyisthestandardoftreatmentMastectomyisthestandardoftreatment 80%havea10yearsurvivalrateifthereisnomasspresentandno80%havea10yearsurvivalrateifthereisnomasspresentandnoaxillarynodesareinvolved.axillarynodesareinvolved.Breast Center, Nanfang H
129、ospitalBreast Center, Nanfang HospitalInflammatorycarcinoma1.5-3%1.5-3%ofbreastcancersofbreastcancersCharacteristicclinicalfeaturesoferythema,peaudCharacteristicclinicalfeaturesoferythema,peaud orange,orange,andskinridgingwithorwithoutapalpablemass.andskinridgingwithorwithoutapalpablemass.Commonlymi
130、stakenforcellulitis.Commonlymistakenforcellulitis. WillgenerallyfailantibioticsbeforebeingdiagnosedWillgenerallyfailantibioticsbeforebeingdiagnosedDiseaseprogressesrapidly,andmorethan75%ofpatientsDiseaseprogressesrapidly,andmorethan75%ofpatientspresentwithpalpableaxillarynodes.presentwithpalpableaxi
131、llarynodes.DistantmetastaticdiseasealsoatmuchhigherfrequencythanDistantmetastaticdiseasealsoatmuchhigherfrequencythanthemorecommonbreastcancers.themorecommonbreastcancers.30%5yearsurvivalrate30%5yearsurvivalrateRequireschemotherapytreatmentimmediatelyRequireschemotherapytreatmentimmediatelyBreast Ce
132、nter, Nanfang HospitalBreast Center, Nanfang HospitalTheMaleBreastGynecomastiaGynecomastia PrepubertalgynecomastiaPrepubertalgynecomastiaRare,adrenalcarcinomaandtesticulartumorcancausethis.Rare,adrenalcarcinomaandtesticulartumorcancausethis. PubertalgynecomastiaPubertalgynecomastiaOccursin60-70%ofpu
133、bertalboys.Occursin60-70%ofpubertalboys. SenescentgynecomastiaSenescentgynecomastia40%ofagingmenhavethistosomedegree.40%ofagingmenhavethistosomedegree.Drugs,suchassteroids,digitalis,hormones,spironolactone,andantidepressantscancausethis.Drugs,suchassteroids,digitalis,hormones,spironolactone,andantid
134、epressantscancausethis.MalebreastcarcinomaMalebreastcarcinoma 0.7%ofallbreastcancers0.7%ofallbreastcancers 1%ofmalecancers1%ofmalecancers Averageageofdiagnosisis63.6yearsoldAverageageofdiagnosisis63.6yearsold Painlessunilateralmassthatisusuallysubareolarwithskinfixation,chestwallfixation,Painlessuni
135、lateralmassthatisusuallysubareolarwithskinfixation,chestwallfixation,andulceration.andulceration. MostlyductalcarcinomaMostlyductalcarcinoma MalesgenerallypresentatlaterstagethanwomanMalesgenerallypresentatlaterstagethanwomanOverallsurvivalworseinmen,howeverwhencomparedstageforstagethesurvivalratesareOverallsurvivalworseinmen,howeverwhencomparedstageforstagethesurvivalratesaresimilar.similar.THANKSBreastCenter,NanfangHospital
