摘要目的 探讨局部晚期乳腺癌经新辅助化疗后病灶消退的病理表现及肿块缩小后保乳手术的可行性.方法 回顾分析2003年6月至2007年8月46例有效的新辅助化疗后手术的乳腺癌患者的临床资料.患者均为女性,年龄28～65岁,平均46.3岁,肿瘤最大径7～13 cm.所有病例均在新辅助化疗后行乳腺癌改良根治术或标准根治术,术后对切除标本以残余肿瘤为中心行6个不同方向的连续切片,评价肿瘤的消退情况.结果 全组41.3%(19/46)肿瘤呈向心性缩小,其中31.6%(6/19)肿瘤向心性缩小并且周围无癌灶残留,68.4%(13/19)肿瘤向心性缩小但周围仍有癌灶残留.全组58.7%(27/46)肿瘤呈筛状消退.结论 局部晚期乳腺癌经新辅助化疗有效的大部分患者病理表现仍未达到保乳要求,保乳手术应慎重.

abstractsObjective To investigate the pathological manifestation of the lesion as well as the feasibility of conservative breast surgery after neoadjuvant chemotherapy of patients with locally advanced breast cancer.Methods Clinic data of tlle 46 patients treated by neoadjuvant chemotherapy effectively and surgical procedures from June 2003 to August 2007 were analyzed.All the patients were female,aged from 28 to 65 years old with a mean of 46.3 years old.The diameter of neoplasm Was 7 to 13 cm.All the patients had been treated by neoadjuvant chemotherapy effectively and received modified radical mastectomy or Halsted radical mastectomy.The specimen slices were cut from 6 different directions taking the residual cancerous lesion as the center.Results Nineteen patients(41.3%)were concentrating contracted,with complete remission in 6 patients(31.6%)and residual focus in peripheral zone in 13 patients(68.4%).Twenty-seven patients(58.7%)responded in a sifter-like pattern.Conclusion For most patients with locally advanced breast cancer treated by neoadjuvant chemotherapy effectively.their pathologic features are not up to the conservative breast surgery criterion,conservative breast surgery should be cautiously comidered.