1、Breast Cancer: Diagnosis 乳腺癌：診斷,1,.,Objectives 目標(biāo)：, List the symptoms of a breast cancer patient 列出乳腺癌患者的癥狀 Describe screening and diagnostic procedures 描述篩查和診斷程序 Explain how mammography is used to diagnose breast cancer 釋如何用于診斷乳腺癌的乳房x光檢查,2,.,DIAGNOSTIC PROCEDURES 診斷程序 Physical Examination 體格檢查 In m

2、ost cases, breast cancer presents as a lump.7 To determine whether the lump (or laboratory investigation in the breast) indicates malignancy, fine needle aspiration, biopsy, and laboratory investigation are used. 在大多數(shù)情況下,乳腺癌表現(xiàn)為腫塊。是否確定腫塊為惡性腫瘤, 要通過(guò)細(xì)針吸取細(xì)胞學(xué)檢查(FNAC),和實(shí)驗(yàn)室研究（國(guó)際學(xué)術(shù)期刊）。,3,.,Signs that indicat

3、e a lump may be malignant include: 跡象表明一個(gè)腫塊可能是惡性腫瘤包括： 1) Findings of a radiological opacity (microcalcification) with radiating fibrous strands 發(fā)現(xiàn)輻射不透明度(鈣化)輻射纖維鏈 2) Other changes within the breast that are noticed by the patient 引起患者注意的乳房?jī)?nèi)的其他變化 3) Signs of locally advanced or metastatic disease, inc

4、luding a large mass, tethering to the skin and/or chest wall, lymph node enlargement, peau dorange, nipple inversion, and skin infiltration。局部晚期或轉(zhuǎn)移性疾病的跡象，包括一個(gè)大腫塊，貼附于皮膚或胸壁，淋巴結(jié)腫大,呈現(xiàn)紅斑,乳頭內(nèi)陷和皮膚侵潤(rùn)。,4,.,5,.,Data from a large randomized trial of breast self-examination (BSE) screening has shown that instru

5、ction in BSE has no effect on reducing breast cancer mortality.21 Nevertheless, women should be encouraged to be aware of their breasts since this may facilitate detection of interval cancers between routine screenings by a physician. 現(xiàn)階段的實(shí)驗(yàn)隨訪中沒(méi)有發(fā)現(xiàn)乳腺自檢對(duì)降低乳腺癌死亡率有何益處。所以女性的乳腺自我檢查仍可作為一項(xiàng)常規(guī)的乳腺癌篩查手段。,6,.,N

6、ot all women having breast cancer present with a lump. Other possible presenting signs and symptoms include: 不是所有女性有腫塊的就稱之為乳腺癌，其他可能呈現(xiàn)的癥狀和體征體現(xiàn)為： Breast pain or tenderness 乳房疼痛或壓痛 Change in breast shape or size 乳房形狀或大小的改變 Dimpling, flaking, or thickening of the skin on the breast 凹陷、脫落或乳 房皮膚增厚 Redness

7、 or warmth of the breast 乳腺乘紅色或發(fā)熱 Peau dorange 呈現(xiàn)紅斑 Nipple inversion, rash, or discharge; and 乳頭內(nèi)陷，紅腫或有無(wú)分泌物 Swelling of the upper arm or in the armpit. 上臂或腋窩有無(wú)腫脹,7,.,乳腺自我檢查 （BSE） 乳腺自我檢查是一項(xiàng)以檢查者為中心 ,簡(jiǎn)便易行、無(wú)需花費(fèi)、安全無(wú)創(chuàng)的檢查方法 。檢查者可以自己實(shí)施 ，無(wú)需任何設(shè)備支持。美國(guó)癌癥協(xié)會(huì)（ACS）在2003 年發(fā)布的新的乳腺癌普查指南中建議：從20歲開(kāi)始，應(yīng)告知女性乳房自我檢查(BSE)的益處和局

8、限性。應(yīng)該強(qiáng)調(diào)及時(shí)向健康專家報(bào)告任何新的乳房癥狀的重要性。選擇乳房自我檢查的女性應(yīng)接受指導(dǎo)和在定期體檢時(shí)讓醫(yī)生檢查她們的手法是否正確。女性也可選擇不做或不定期做乳房自我檢查2. 乳腺自我檢查的優(yōu)缺點(diǎn)：乳腺自我檢查給婦女提供了一個(gè)認(rèn)識(shí)乳房的機(jī)會(huì) ，使婦女們?cè)鰪?qiáng)了乳房保健意識(shí) ，并促使她們一旦發(fā)現(xiàn)乳房腫塊就去醫(yī)院檢查。但過(guò)去 20 多年來(lái) ,美國(guó)、 加拿大、 俄羅斯、 英國(guó)、 日本和中國(guó)都先后開(kāi)展了關(guān)于乳腺自我檢查的研究 ，加拿大預(yù)防衛(wèi)生保健組織在比較了來(lái)自這些國(guó)家的7個(gè)國(guó)際性研究報(bào)告后發(fā)現(xiàn) ，實(shí)施乳腺自檢與不實(shí)施乳腺自檢的婦女在乳腺癌的病死率上沒(méi)有差別 ，腫瘤在診斷時(shí)的分期和大小也無(wú)統(tǒng)計(jì)學(xué)意義。

9、相反 ，干預(yù)組的良性病變的活檢率明顯高于對(duì)照組 ，就醫(yī)率也大大提高。從而得出結(jié)論 ,乳腺自我檢查有害無(wú)益3 。,8,.,DIAGNOSTIC PROCEDURES診斷程序 Mammography乳房x光檢查 Introduction 介紹 A mammogram is an X-ray image of the breast. The procedure used to generate a mammogram is termed a mammography.30 Mammography can detect tumors at an early stage, when they are st

10、ill small and cant be detected by palpation.31 Based on fair evidence, screening mammography in women aged 40 to 70 years decreases breast cancer mortality.32,33 The benefit is higher for older women, in part because their breast cancer risk is higher.34 乳房x光片是乳腺癌的x射線圖像。程序用于生成一個(gè)乳房x光檢查稱為一個(gè)乳房x光檢查。在早期階

11、段乳房x光檢查可以檢測(cè)腫瘤,當(dāng)他們還小,不能被觸診?；诠降淖C據(jù),年齡在40-70歲的女性通過(guò)篩查性乳房x光檢查降低乳腺癌死亡率。尤其針對(duì)年長(zhǎng)者,部分原因是他們患乳腺癌的風(fēng)險(xiǎn)高。,9,.,Transcript 記錄 Screening by mammography can detect small tumors before there is any nodal involvement. This technique is therefore an effective tool for early detection of breast cancer. On a mammogram, bre

12、ast carcinomas typically display fine calcification and areas of irregularity. Occasionally, fixation of deep lesions, either to the chest wall or skin, can also be seen.35 There are several advantages to using mammography as a screening technique: 小的腫瘤篩查通過(guò)乳房x光檢查可以發(fā)現(xiàn)之前有任何節(jié)點(diǎn)參與。這種技術(shù)是早期發(fā)現(xiàn)乳腺癌的一種有效工具。乳房x

13、光檢查,乳房癌通常顯示鈣化和不規(guī)則的地方。偶爾,深層病灶,固定胸壁或皮膚,也可以看到。使用乳房x光檢查作為篩查技術(shù)有如下幾個(gè)優(yōu)勢(shì):,10,., The ability of mammography to detect cases much earlier than physical examination is well established.36 Technical advances have enhanced the utility of mammography in recent years by providing increased visualization of the bre

14、ast parenchyma while using lower doses of X- ray radiation.37 Combined with clinical examination, mammography can be at least 90% accurate in its diagnosis. It should be noted, however, that the success of low-radiation mammography depends largely on the quality of interpretation.38 乳房x光檢查檢測(cè)比體格檢查更早。

15、 技術(shù)進(jìn)步近年來(lái)加強(qiáng)了乳房X光檢查的應(yīng)用提供可視化的乳腺實(shí)質(zhì)而增加使用低劑量的X -射線輻射。 結(jié)合臨床檢查,乳房x光檢查至少達(dá)到90%準(zhǔn)確的診斷。然而,值得注意的是,低輻射乳房x光檢查的成功很大程度上取決于interpretation的質(zhì)量,11,., The finding that screening reduces breast cancer mortality has important implications regarding the onset and progression of the disease. Evidence suggests that metastases

16、occur very early in the course of the disease and that breast cancer should be considered a systemic disease from its outset. Therefore, the reduction in breast cancer mortality by screening, an estimated 10% to 30% reduction, provides compelling evidence that early diagnosis and treatment of breast

17、 cancer can avert the onset of metastasis. 篩查可降低乳腺癌的死亡率對(duì)疾病的發(fā)病和進(jìn)展有重要意義。證據(jù)表明,轉(zhuǎn)移病灶發(fā)生在發(fā)病早期，乳腺癌應(yīng)該從一開(kāi)始就被認(rèn)為是一種全身性疾病。因此,通過(guò)篩查能夠降低乳腺癌的死亡率達(dá)10%到30%,提供了令人信服的證據(jù)表明,乳腺癌的早期診斷和治療可以避免轉(zhuǎn)移,12,.,DIAGNOSTIC PROCEDURES 診斷程序 Confirmation 確認(rèn) Introduction 介紹 It is important to use methods other than mammography and physical ex

18、amination to confirm a diagnosis of breast cancer. These methods can be either non-invasive or invasive.除了乳房x光檢查和體格檢查還有其他方法來(lái)證實(shí)診斷為乳腺癌。這些方法可以是非侵入性或侵入性。,13,.,Transcript 記錄 Ultrasound is a non-invasive way to differentiate whether a possible tumor detected with mammography is, instead, a fluid-filled cy

19、st. Ultrasound can also aid in the evaluation of lumps that are difficult to visualize with mammography, and is often used in conjunction with invasive methods such as core biopsy, excision biopsy, aspiration cytology, and fine needle aspiration (FNA). 超聲波是一種非侵入性的方式來(lái)區(qū)分是否可能與乳房x光檢查發(fā)現(xiàn)腫瘤,相反,一個(gè)充滿液體的囊腫。超聲

20、波還可以幫助評(píng)估腫塊與乳房x光檢查,很難想象,常用于結(jié)合核心活檢等侵入性方法,切除活檢,細(xì)胞學(xué)檢查和細(xì)針穿刺。,14,.,STAGING AND GRADING分期和分級(jí) 10. TNM System TNM系統(tǒng) Introduction介紹 At the time of breast cancer diagnosis, the stage of disease is routinely determined as part of the management plan. The Tumor, Node, Metastases (TNM) system is now the standard

21、method for classification of breast tumors. The following operative findings are used in the clinical staging of breast cancer: the size of the primary tumor, the presence of chest wall invasion, and the presence or absence of regional or distant metastases. 在乳腺癌診斷、疾病的階段經(jīng)常決定作為管理計(jì)劃的一部分。腫瘤、節(jié)點(diǎn)轉(zhuǎn)移(TNM)系統(tǒng)

22、現(xiàn)在是乳腺腫瘤分類的標(biāo)準(zhǔn)方法。以下手術(shù)結(jié)果用于乳腺癌的臨床分期:原發(fā)腫瘤的大小,胸壁入侵的存在,地區(qū)或遠(yuǎn)處轉(zhuǎn)移的存在與否,15,.,The first factor in categorizing tumors, T, describes the extent of the primary tumor. Grades for the factor T are: 第一個(gè)因子在腫瘤的分類上,T,描述了原發(fā)腫瘤的程度。 T 分級(jí)如下: TX: Primary tumor cannot be assessed 原發(fā)腫瘤無(wú)法評(píng)估 T0: No evidence of primary tumor 沒(méi)有原發(fā)

23、腫瘤證據(jù) Tis: Carcinoma in situ intraductal carcinoma, lobular carcinoma in situ, or Pagets disease of the nipple with no tumor 導(dǎo)管原位癌；小葉原位癌；乳頭pages病，不伴有腫塊 T1: Less than 20 mm in greatest dimension腫瘤最大直徑 2cm，但 5cm T4: Tumor of any size with extension to the chest wall and/or edema or inflammatory carcino

24、ma 不論腫瘤大小，直接侵犯胸壁或皮膚 N is based on the presence and location of involved lymph nodes. 區(qū)域淋巴結(jié)的位置和區(qū)域 NX: Unable to assess status 區(qū)域淋巴結(jié)無(wú)法評(píng)估 N0: No nodes positive for carcinoma 無(wú)區(qū)域淋巴結(jié)轉(zhuǎn)移 N1: Ipsilateral (same side as primary tumor) axillary nodes involved; movable 同側(cè)腋窩淋巴結(jié)轉(zhuǎn)移，可活動(dòng),16,., N2: Ipsilateral axilla

25、ry nodes involved; fixed 同側(cè)腋窩淋巴結(jié)轉(zhuǎn)移，固定和相互融洽 N3: Ipsilateral internal mammary nodes involved 同側(cè)鎖骨下淋巴結(jié)轉(zhuǎn)移 M is based on the presence of distant metastases. M是基于存在遠(yuǎn)處轉(zhuǎn)移 MX: Unable to assess 遠(yuǎn)處轉(zhuǎn)移無(wú)法評(píng)估 M0: No distant metastases, and/or areas of tumor spread are histologically smaller than 0.2 mm and found in

26、 non-nodal tissue 未見(jiàn)遠(yuǎn)傳轉(zhuǎn)移及征象，而組織學(xué)或分子技術(shù)檢測(cè)到骨髓、血液或其他器官中 0.2mm的轉(zhuǎn)移灶,17,.,T0: No evidence of primary tumor 沒(méi)有原發(fā)腫瘤證據(jù) Tis: Carcinoma in situ or Pagets disease of the nipple 原位癌或伴有腫塊的pagets病 T1: Tumor less than 20 mm in greatest dimension 腫瘤最大直徑2cm T2: Tumor greater than 20 mm but less than 50 mm in greatest

27、dimension腫瘤最大徑大2cm, 但5cm T3: Tumor greater than 50 mm in greatest dimension腫瘤最大徑5cm T4: Tumor of any size with extension to the chest wall and/or edema or inflammatory carcinoma 無(wú)論腫瘤大小，直接侵及胸壁或皮膚 /水腫或炎性乳腺炎 N0: No nodes positive for carcinoma 區(qū)域淋巴結(jié)無(wú)轉(zhuǎn)移 N1: Ipsilateral axillary nodes involved; movable 同

28、側(cè)腋窩淋巴結(jié)轉(zhuǎn)移，可活動(dòng) N2: Ipsilateral axillary nodes involved; fixed 同側(cè)腋窩淋巴結(jié)轉(zhuǎn)移，固定 N3: Ipsilateral internal mammary nodes involved M0: No distant metastases同側(cè)鎖骨下淋巴結(jié)轉(zhuǎn)移伴或不伴有腋窩淋巴結(jié)轉(zhuǎn)移 M1: Distant metastases present 有遠(yuǎn)處轉(zhuǎn)移,18,.,Tissue pathology is another factor involved in clinical staging. In contrast, pathological staging is more comprehensive and includes all data used for clinical staging and surgical resection, as well as information gathered from pathological examination of both the initial tumor and the axillary lymph nodes. Pathological staging t