1、Breast Cancer: Diagnosis 乳腺癌：诊断,Objectives 目标：, List the symptoms of a breast cancer patient 列出乳腺癌患者的症状 Describe screening and diagnostic procedures 描述筛查和诊断程序 Explain how mammography is used to diagnose breast cancer 释如何用于诊断乳腺癌的乳房x光检查,DIAGNOSTIC PROCEDURES 诊断程序Physical Examination 体格检查In most cases,
2、 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.在大多数情况下,乳腺癌表现为肿块。是否确定肿块为恶性肿瘤, 要通过细针吸取细胞学检查(FNAC),和实验室研究（国际学术期刊）。,Signs that indicate a lump may be
3、 malignant include:迹象表明一个肿块可能是恶性肿瘤包括：1) Findings of a radiological opacity (microcalcification) with radiating fibrous strands 发现辐射不透明度(钙化)辐射纤维链2) Other changes within the breast that are noticed by the patient 引起患者注意的乳房内的其他变化3) Signs of locally advanced or metastatic disease, including a large mass
4、, tethering to the skin and/or chest wall, lymph node enlargement, peau dorange, nipple inversion, and skin infiltration。局部晚期或转移性疾病的迹象，包括一个大肿块，贴附于皮肤或胸壁，淋巴结肿大,呈现红斑,乳头内陷和皮肤侵润。,Data from a large randomized trial of breast self-examination (BSE) screening has shown that instruction in BSE has no effect
5、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. 现阶段的实验随访中没有发现乳腺自检对降低乳腺癌死亡率有何益处。所以女性的乳腺自我检查仍可作为一项常规的乳腺癌筛查手段。,Not all women having breast canc
6、er present with a lump. Other possible presenting signs and symptoms include: 不是所有女性有肿块的就称之为乳腺癌，其他可能呈现的症状和体征体现为： Breast pain or tenderness 乳房疼痛或压痛 Change in breast shape or size 乳房形状或大小的改变 Dimpling, flaking, or thickening of the skin on the breast 凹陷、脱落或乳 房皮肤增厚 Redness or warmth of the breast 乳腺乘红色或
7、发热 Peau dorange 呈现红斑 Nipple inversion, rash, or discharge; and 乳头内陷，红肿或有无分泌物 Swelling of the upper arm or in the armpit. 上臂或腋窝有无肿胀,乳腺自我检查 （BSE）乳腺自我检查是一项以检查者为中心 ,简便易行、无需花费、安全无创的检查方法 。检查者可以自己实施 ，无需任何设备支持。美国癌症协会（ACS）在2003 年发布的新的乳腺癌普查指南中建议：从20岁开始，应告知女性乳房自我检查(BSE)的益处和局限性。应该强调及时向健康专家报告任何新的乳房症状的重要性。选择乳房自我检
8、查的女性应接受指导和在定期体检时让医生检查她们的手法是否正确。女性也可选择不做或不定期做乳房自我检查2.乳腺自我检查的优缺点：乳腺自我检查给妇女提供了一个认识乳房的机会 ，使妇女们增强了乳房保健意识 ，并促使她们一旦发现乳房肿块就去医院检查。但过去 20 多年来 ,美国、 加拿大、 俄罗斯、 英国、 日本和中国都先后开展了关于乳腺自我检查的研究 ，加拿大预防卫生保健组织在比较了来自这些国家的7个国际性研究报告后发现 ，实施乳腺自检与不实施乳腺自检的妇女在乳腺癌的病死率上没有差别 ，肿瘤在诊断时的分期和大小也无统计学意义。相反 ，干预组的良性病变的活检率明显高于对照组 ，就医率也大大提高。从而得
9、出结论 ,乳腺自我检查有害无益3 。,DIAGNOSTIC PROCEDURES诊断程序 Mammography乳房x光检查Introduction 介绍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 still small and cant be detected by palpation
10、.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射线图像。程序用于生成一个乳房x光检查称为一个乳房x光检查。在早期阶段乳房x光检查可以检测肿瘤,当他们还小,不能被触诊。基于公平的证据,年龄在40-70岁
11、的女性通过筛查性乳房x光检查降低乳腺癌死亡率。尤其针对年长者,部分原因是他们患乳腺癌的风险高。,Transcript 记录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, breast carcinomas typically display fine calcificat
12、ion 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: 小的肿瘤筛查通过乳房x光检查可以发现之前有任何节点参与。这种技术是早期发现乳腺癌的一种有效工具。乳房x光检查,乳房癌通常显示钙化和不规则的地方。偶尔,深层病灶,固定胸壁或皮肤,也可以看到。使用乳房x
13、光检查作为筛查技术有如下几个优势:, 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 breast parenchyma while using lower doses of X- ray radi
14、ation.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光检查检测比体格检查更早。技术进步近年来加强了乳房X光检查的应用提供可视化的乳腺实质而增加使用低剂量的X -射线辐射。结合临床检查,
15、乳房x光检查至少达到90%准确的诊断。然而,值得注意的是,低辐射乳房x光检查的成功很大程度上取决于interpretation的质量, The finding that screening reduces breast cancer mortality has important implications regarding the onset and progression of the disease. Evidence suggests that metastases occur very early in the course of the disease and that breas
16、t 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 cancer can avert the onset of metastasis. 筛查可降低乳腺癌的死亡率对疾病的发
17、病和进展有重要意义。证据表明,转移病灶发生在发病早期，乳腺癌应该从一开始就被认为是一种全身性疾病。因此,通过筛查能够降低乳腺癌的死亡率达10%到30%,提供了令人信服的证据表明,乳腺癌的早期诊断和治疗可以避免转移,DIAGNOSTIC PROCEDURES 诊断程序Confirmation 确认Introduction 介绍It is important to use methods other than mammography and physical examination to confirm a diagnosis of breast cancer. These methods can
18、 be either non-invasive or invasive.除了乳房x光检查和体格检查还有其他方法来证实诊断为乳腺癌。这些方法可以是非侵入性或侵入性。,Transcript 记录Ultrasound is a non-invasive way to differentiate whether a possible tumor detected with mammography is, instead, a fluid-filled cyst. Ultrasound can also aid in the evaluation of lumps that are difficult
19、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). 超声波是一种非侵入性的方式来区分是否可能与乳房x光检查发现肿瘤,相反,一个充满液体的囊肿。超声波还可以帮助评估肿块与乳房x光检查,很难想象,常用于结合核心活检等侵入性方法,切除活检,细胞学检查和细针穿刺。,STAGING AND GRADIN
20、G分期和分级10. TNM System TNM系统Introduction介绍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 method for classification of breast tumors. The following operative findings are u
21、sed 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.在乳腺癌诊断、疾病的阶段经常决定作为管理计划的一部分。肿瘤、节点转移(TNM)系统现在是乳腺肿瘤分类的标准方法。以下手术结果用于乳腺癌的临床分期:原发肿瘤的大小,胸壁入侵的存在,地区或远处转移的存在与否,The first factor in ca
22、tegorizing tumors, T, describes the extent of the primary tumor. Grades for the factor T are:第一个因子在肿瘤的分类上,T,描述了原发肿瘤的程度。 T 分级如下: TX: Primary tumor cannot be assessed 原发肿瘤无法评估 T0: No evidence of primary tumor 没有原发肿瘤证据 Tis: Carcinoma in situ intraductal carcinoma, lobular carcinoma in situ, or Pagets d
23、isease of the nipple with no tumor 导管原位癌；小叶原位癌；乳头pages病，不伴有肿块 T1: Less than 20 mm in greatest dimension肿瘤最大直径 2cm，但 5cm T4: Tumor of any size with extension to the chest wall and/or edema or inflammatory carcinoma 不论肿瘤大小，直接侵犯胸壁或皮肤N is based on the presence and location of involved lymph nodes. 区域淋巴结
24、的位置和区域 NX: Unable to assess status 区域淋巴结无法评估 N0: No nodes positive for carcinoma 无区域淋巴结转移 N1: Ipsilateral (same side as primary tumor) axillary nodes involved; movable 同侧腋窝淋巴结转移，可活动, N2: Ipsilateral axillary nodes involved; fixed 同侧腋窝淋巴结转移，固定和相互融洽 N3: Ipsilateral internal mammary nodes involved 同侧锁骨
25、下淋巴结转移M is based on the presence of distant metastases. M是基于存在远处转移 MX: Unable to assess 远处转移无法评估 M0: No distant metastases, and/or areas of tumor spread are histologically smaller than 0.2 mm and found in non-nodal tissue 未见远传转移及征象，而组织学或分子技术检测到骨髓、血液或其他器官中 0.2mm的转移灶,T0: No evidence of primary tumor 没
26、有原发肿瘤证据Tis: Carcinoma in situ or Pagets disease of the nipple 原位癌或伴有肿块的pagets病T1: Tumor less than 20 mm in greatest dimension 肿瘤最大直径2cmT2: Tumor greater than 20 mm but less than 50 mm in greatest dimension肿瘤最大径大2cm,但5cmT3: Tumor greater than 50 mm in greatest dimension肿瘤最大径5cmT4: Tumor of any size w
27、ith extension to the chest wall and/or edema or inflammatory carcinoma无论肿瘤大小，直接侵及胸壁或皮肤 /水肿或炎性乳腺炎N0: No nodes positive for carcinoma 区域淋巴结无转移N1: Ipsilateral axillary nodes involved; movable 同侧腋窝淋巴结转移，可活动N2: Ipsilateral axillary nodes involved; fixed 同侧腋窝淋巴结转移，固定N3: Ipsilateral internal mammary nodes
28、involved M0: No distant metastases同侧锁骨下淋巴结转移伴或不伴有腋窝淋巴结转移M1: Distant metastases present 有远处转移,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 inf
29、ormation gathered from pathological examination of both the initial tumor and the axillary lymph nodes. Pathological staging thus provides the most precise data to estimate prognosis and treatment outcomes组织病理学是另一个因素参与临床分期。相比之下,病理分期是更全面,包括所有数据用于临床分期和手术切除,以及收集的信息从初始肿瘤的病理检查和腋窝淋巴结。病理分期从而提供最精确的数据来评估预后和治
30、疗结果。,STAGING AND GRADING 分期和分级11. Tumor Grade 肿瘤分级Histological grading of breast cancer is based upon the extent of cellular differentiation (how well or poorly the cells are organized) and anaplasia (variation in size, shape and staining of the cell nuclei) observed in the sample. Breast tumors are
31、 assigned numbers of 1, 2, and 3, with a commonly used grading system:乳腺癌组织学分级是基于细胞分化的程度(好或差的细胞组织)和间变(不同大小、形状和细胞核的染色)观察到的样本。乳腺肿瘤根据常用的评分系统分为1、2、3个等级： Grade 1 (well differentiated) slight anaplasia; tumors with intact glands 1级（分化） 轻微的间变;肿瘤与完整的腺体 Grade 2 (moderately differentiated) moderate anaplasia; tumors with intact glands 2级(中度分化) 温和的间变;肿瘤与完整的腺体 Grade 3 (poorly differentiated) marked anaplasia; tumors may or may not have intact glands 3级 (低分化)-标志间变;肿瘤可能有也可能没有完整的腺体,
