Early breast cancer

Introduction to early breast cancer Early breast cancer (EBC) is one of the issues that breast oncologists have been paying attention to for many years. The significance is that the long-term cure rate of early breast cancer can reach more than 90%; the improvement of early breast cancer diagnosis rate will greatly improve the survival rate and life span of patients, and reduce the mortality rate. basic knowledge The proportion of illness: 0.0025% Susceptible people: no specific population Mode of infection: non-infectious Complications: nipple retraction anemia

Early breast cancer

(1) Causes of the disease

In the past 30 years, domestic and foreign scholars have made a lot of progress in epidemiology and laboratory research on the cause of breast cancer, but so far, the cause has not been fully clarified, and the role of various risk factors in the pathogenesis of breast cancer. Still exploring, studying breast cancer and its related factors, the purpose is to find the cause of the disease, suggesting high-risk factors, monitoring high-risk groups, in order to achieve three early (early detection, early diagnosis, early treatment) and intervention control, for breast cancer Prevention and treatment open up new avenues.

Although the current understanding of the cause of breast cancer is still vague, but there are gradually more understanding of its risk factors, breast cancer incidence is a variety of factors, any single factor can not explain the cause of breast cancer, breast cancer may be The result of a combination of factors under certain conditions, most scholars believe that the following factors may be related to the onset of breast cancer.

1. Menstruation and marriage Menarche age is an important risk factor for breast cancer. It is believed that the age of menarche is 12 years old, and the risk of breast cancer is more than 4 times higher than that of 13 years old. It is generally considered that the age of menarche is one year later. The risk of breast cancer can be reduced by about 20%. The age of menarche is closely related to the nutrition and diet of children, the nutrition is improved, and the age of menarche will gradually advance, which may be related to the increase in the incidence of breast cancer. The length of the menstrual cycle reflects the number of changes in the hormone levels experienced in a person's life, the menstrual cycle is short, the number of changes is many, and the number of times the breast is stimulated by estrogen is higher, the higher the risk of breast cancer.

The risk of breast cancer is increased at the age of menopause. It is estimated that the risk of breast cancer is reduced by 50% compared with the 55-year-old menopausal. The risk of breast cancer is greater before menopause, and the risk of postmenopausal breast cancer is higher. Small, postmenopausal is only 1 / 6 of premenopausal breast cancer, the incidence of breast cancer after artificial menopause is reduced, women with longer menopause and menstrual irregularities, the risk of breast cancer increases.

According to the study, the age of menarche is small, the age of menopause is late, and the number of years of menstruation is independent of the risk factors for breast cancer. Unmarried is a risk factor for breast cancer. The facts show that unmarried women, women who are married late and have a short duration after marriage, have a high incidence of breast cancer.

2. Whether production and lactation are factors that directly affect breast cancer, the results are not completely consistent, and prolific times can reduce the risk of breast cancer. Lilinfed believes that the incidence of breast cancer with 4 or more births is extremely low. High-yield has a protective effect on breast cancer, which may be caused by a large amount of estriol (E3) in the placenta, which has a protective effect on women.

Some people think that the number of breastfeeding months has a protective effect on the occurrence of breast cancer. Considering the mixed production and birth times, in recent years, some people believe that breastfeeding is a protective factor for independent effects, especially for premenopausal women, but it needs more breastfeeding for prolificacy. The opportunity, not breastfeeding, cannot be considered an important protective factor for breast cancer.

3. Benign breast disease Whether cystic hyperplasia of the breast belongs to precancerous lesions is still controversial. Some people think that this disease can disappear on its own after marriage or after pregnancy, even if it relapses after menopause, it can heal itself. It is believed that the risk of breast cancer can be increased by 3 to 6 times in breast benign disease. It is most important for cystic hyperplasia of the breast and breast fibroma. Patients with cystic hyperplasia of the breast have higher breast cancer than those without cystic hyperplasia. The incidence rate is 3 to 4 times higher. Pathological examination confirms that about 20% to 30% of breast cancer patients have cystic hyperplasia of the breast. The literature reports that the cancer rate of cystic hyperplasia of the breast is 2% to 4%. In patients with cystic hyperplasia, the incidence of breast cancer can be increased by 2 to 3 times. This risk can be continued until 30 years after the diagnosis of cystic hyperplasia of the breast.

The risk factors for cystic hyperplasia of the breast are consistent with the factors of breast cancer, such as non-fertility, late menopause, high social class, etc. However, the difference is that artificial menopause increases the risk of cystic hyperplasia of the breast, menarche Age, primiparous age has nothing to do with cystic hyperplasia of the breast, but it is related to the pathogenesis of breast cancer. In the future, according to the unified histological classification, grading, age and premenopausal factors, pathological and epidemiological research should be carried out to confirm .

Breast fibroma has long been thought not to increase the risk of breast cancer, but recent studies have suggested a tendency to be a risk factor for breast cancer.

4. Endogenous factors

(1) Breast cancer is an estrogen-dependent tumor, and its development is closely related to endocrine dysfunction. Estrogen is mainly derived from ovary, secreting estrone (E1), estradiol (E2) and estriol (E3). The components mainly act on the mammary duct. When the ovary secretes too much hormone and acts on sensitive breast tissue for a long time, it can cause proliferation and cancer of the breast cells. Animal experiments have found that hormone-fed mice can develop breast cancer. E1, E2 and E3 can increase the incidence of breast tumors in rats. The total plasma hormone level in breast cancer patients is 15% higher than that in normal women, and the E2 level in postmenopausal women can be 30% higher. Moore (1985) The level of free E2 in premenopausal breast cancer patients was significantly higher than that in normal subjects.

Tianjin Cancer Institute Guo Aiying reported that the age, sex, occupation, and ethnicity of breast cancer patients were compared with those of healthy women. The results were higher in E1 and E2 than in the control group.

(2) Examination of blood testosterone and DHEAS in breast cancer patients, testosterone in urine and dihydroandrostenone, the average androgen levels were higher than the control group.

(3) Breast cancer patients with hypothyroidism or thyroid disease have a poor prognosis. Thyroid surgery for patients with stable breast cancer can cause sudden spread of cancer.

5. Exogenous factors

(1) Greenberg's data indicates that women under the age of 45 take contraceptives after the first production. As the time for taking birth control pills increases, the risk of breast cancer increases. Pike and other studies have found that the use of contraceptives under 25 years of age increases. The risk of breast cancer, but some studies have found that women taking oral contraceptives did not significantly increase the incidence of breast cancer. Due to the inconsistent results of various studies, the relationship between the starting age of women taking birth control pills and the occurrence of breast cancer Still needs further study.

From 1982 to 1988, WH0 conducted a collaborative study and found that contraceptives have a certain relationship with breast cancer. When taking birth, it takes more than the infertility period, and the relative risk of breast cancer increases. The relative risk of breast cancer is lower in the lower social class than in the high social class. Sexual increase, observe the first time after taking the interval for several years without using, does not increase the risk of breast cancer, and continuous use or recent use can increase the risk of breast cancer, women before the age of 35, breast cancer The risk will increase, and WHO will also analyze the relationship between different types of contraceptives and different types of breast cancer.

(2) The use of estrogen in patients without ovarian increase the risk of breast cancer. Short-term use of estrogen in ovarians has nothing to do with breast cancer. If you take it for more than 5 years, the risk of breast cancer increases. The relationship between taking cumulative doses and breast cancer is still inconsistent.

(3) Hunter (1991) examined the content of selenium, which was lower in smokers than in non-smokers. The menarche was less than 13 years old and was lower than 13 years old. Yang Jinqiao (1996) analyzed the content of manganese and chromium in breast cancer patients. Human height, Schwarts (1974) reported that potassium in breast cancer tissues is several times higher than normal tissue. These factors are the cause of breast cancer or the result of lesions and need to be further explored.

6. Living habits High-fat diet can increase the induction rate of breast cancer. The reasons for the high-fat diet on breast cancer risk may be:

1 Long-term high-fat diet can affect the changes of intestinal bacterial status, and intestinal bacteria can convert steroid-derived steroid substances into carcinogenic estrogen through metabolism;

2 high-fat diet can increase the secretion of prolactin, which in turn increases the secretion of estrogen in the body;

3 fat can increase weight or even obesity, the greater the weight, the higher the risk of breast cancer;

4 over-nutrition can make menstrual menarche advance, menopause date is postponed, postmenopausal estrogen is derived from adipose tissue, in short, high-fat diet can make menarche premature, obesity and so on can increase the risk of breast cancer.

Longnecker (1988) studied drinking alcohol to increase the risk of breast cancer by 1.5 to 2.0 times. Biological studies suggest that ethanol can affect the permeability of cell membranes, and its metabolites have a stimulating effect on the mammary gland, but it has not been determined that ethanol is caused by ethanol. How dangerous is the risk of cancer, and women who have previously used estrogen have recently increased the risk of breast cancer.

7. Virus-infected animal experiments show that breast cancer in mice can be caused by viruses. Most of the deoxyribonucleic acid (DNA) of mouse mammary gland cells contain several proviral complexes of breast tumor virus, some of which have evolved into The virion continues to cause breast cancer in some mice. The mother with breast cancer can transmit the virus through the milk. This virus-containing milk factor can induce breast cancer. Currently, it can be used in breast cancer patients and normal human milk. The virus particles were found in a morphology similar to that of mouse milk factor. The positive rate of viral particles in breast cancer was 39%, and that in normal people was 5%. Therefore, it is concluded that the virus may play an important role in the occurrence of human breast cancer.

8. Genetic factors have been statistically confirmed. The incidence of breast cancer family history is 3 to 5 times higher than that of the general population. It is often seen in the clinic that the mother and daughter or both have breast cancer at the same time or in succession. The second generation is 10 to 20 years ahead of schedule, the mother has breast cancer, and her daughter is 40 to 50 times more likely to have breast cancer than a family history. Obviously, breast cancer has a family genetic predisposition.

In mouse experiments, it has been confirmed that breast milk is transmitted and the hereditary breast cancer is hereditary. The genetic evidence of human breast cancer is gradually increasing. The gene linkage analysis shows that the long and short arm exchange sites of chromosomes may be related to the sensitive genes of breast cancer. Breast cancer genotype transmission is the same as chromosomal dominant inheritance.

However, most breast cancer patients do not have a family history, and most twins do not have the same disease, indicating that the gene is not the only cause of the disease.

9. Deward et al reported that the incidence of breast cancer does not increase with age, but the age at which obesity begins in some countries is related to breast cancer, and obesity at age 50 is not associated with breast cancer. For every 10kg increase in weight over 60 years old, the risk of breast cancer increases by 80%. Long-term physical exercise, prevention of weight gain and obesity can prevent breast cancer.

10. Radiation effects Japanese atomic bomb survivors and exposure to medical X-ray population data show that high-dose radiation can increase the risk of breast cancer, and that American watchmakers emit radiation from radium used for luminous exposure on the dial. The risk of breast cancer is increased. The risk of breast cancer depends on the age and dose of radiation. Generally, it is active in 10 to 30 years old. It is the most sensitive to radiation exposure. It is less dangerous after 30 years old. The risk of breast cancer exposure to radiation in the first pregnancy is higher than before or after this period; in women who are not born, breast cancer is more likely to develop breast cancer than radiation, and in general, women in menstruation Period and pregnancy are sensitive to radiation.

The incubation period of breast exposure to radiation is estimated to be as short as 5 years, usually 10 to 15 years. The incubation period of young people is longer than that of the elderly. Low-dose radiation is used to check the breast, and the risk of breast cancer is very small.

11. The number of years of education The longer the education period, the higher the risk of breast cancer. The Tianjin Cancer Institute surveyed college educated patients with breast cancer 3.6 times higher than those without university education. The breasts of people with long years of education developed breast. The high risk of cancer is a comprehensive factor. These people tend to have a late marriage, late birth, low birth weight, oral contraceptives, high economic level, good nutritional status, etc., which have a positive effect on the occurrence of breast cancer.

12. Spiritual function When the nerve is stimulated by anxiety, tension or depression, it acts on the central nervous system of the cerebral cortex, causing autonomic dysfunction and suppression of immune function, which can inhibit immunity against cancer, if the cerebral cortex is strongly stimulated Repeated existence, so that the body is always in a state of tension, resulting in imbalance of the body environment, and ultimately will affect the body's anti-cancer mechanism, research shows that the risk of breast cancer is associated with emotional disorders.

(two) pathogenesis

Early breast cancer has the following histological features.

1. Intraductal carcinoma (intraduta carcinoma) The gross specimens are of different sizes, round and irregular, without capsules. The cut surface shows a wide range of cancerous tissues, with scattered nodular, strip-like, granules. The state is unclear, the surface of the tumor is yellow, and the microscopic features are that the cancer cells are located in the dilated duct, and the basement membrane is intact. According to the structure of the cancer in the duct, it is divided into solid type, acne type, papillary type, sieve type and Tubular (Figure 1).

2. Lobular carcinoma in situ (LCIS) gross specimens are scattered in the mammary gland in the lesions. Generally, there are few masses, which often coexist with the lobular hyperplasia of the breast or cystic changes of the breast. Or several leaflets, lobular intact, enlarged, glandular tube thickened, clustered into clusters; glandular tube loses the characteristics of double-layer structure and columnar epithelium, but no basement membrane is damaged, myoepithelial tends to disappear, and its cells can be compared with normal cells. Large, nuclear, fine chromatin in the nucleus, irregular nuclear membrane, light coloration, mitotic figures are rare; or deep nuclear staining, abnormal shape, mitotic figures are more common (Figure 2).

3. Benign tumor cancer On the basis of primary benign disease, the glandular duct and acinar epithelium are stratified, and the cell morphology is obviously heteromorphic; nuclear fission is common, and the cell arrangement is extremely disordered, forming focal carcinoma in situ.

4. Minimal mammary cancer (MBC) The gross specimen has no obvious mass or only hard tissue, no capsule, and the nodular nodule is less than 1 cm in diameter. On the basis of carcinoma in situ, cancer The cells punctate or partially break through the basement membrane or infiltrate into the stroma.

Early breast cancer prevention

1. Avoid mental stimulation, maintain emotional stability, and cultivate good psychological quality, which can enhance the body's ability to fight cancer. Moderate exercise can reduce the chance of breast cancer.

2. Get enough sunlight to get the vitamin D you need. Because vitamin D has the effect of preventing breast cancer. Guaranteed 10-15 minutes of sunshine per day to prevent breast cancer.

3. Avoid receiving too much radiation. Especially during menstruation and pregnancy, it is very sensitive to radiation and should be avoided as much as possible.

4. Proper physical protection of the breast. Breastfeeding is promoted and weaning is slow. Use a suitable bra to improve breast blood and lymph circulation.

5. Timely treatment of precancerous lesions of the breast. Such as cystic lobular hyperplasia, papilloma of the breast, mammary gland hyperplasia with epithelial hyperplasia and atypical hyperplasia.

6. Appropriate section of brake fat intake, less alcohol. Excessive consumption of meat, omelettes, butter, and animal fats increases the risk of breast cancer; green vegetables, fruits, fresh fish, and dairy products reduce the risk of breast cancer.

7. Menopausal women try to avoid using estrogen.

8. Regular regular physical examination. Experts recommend that women over the age of 35 should have breast ultrasound, lactation or mammography every 2-3 years. For those who are prone to breast cancer, those over the age of 40 should be checked once a year.

9. The following vulnerable people should strengthen their self-protection. When there is abnormality such as swelling or discharge in the breast, they should go to the hospital for examination in time, and do not delay the illness. People with a family history of breast cancer, especially mothers or sisters with breast cancer, are more likely to have their own disease; those with early menstrual early (before 12 years old) or late menstruation (after 50 years old) are more likely to have breast cancer than others. People are high; after the age of 30, the first child, the unborn or the unmarried person has more chances of breast cancer than others; repeated radiation exposure can also increase the chance of breast cancer; eating high-fat food and obesity Easy to get breast cancer.

Early breast cancer complications Complications, nipple anemia

1, a small number of breast cancer patients in the early stages may have varying degrees of tenderness or nipple discharge.

2, breast cancer growth rate is relatively rapid. The breast may have an "orange peel" change, the surface of the tumor is sunken, the nipple is biased toward the direction of the tumor, and the nipple is invaginated. By lymphatic metastasis and distant metastasis in the late stage of breast cancer, a series of other symptoms can be complicated.

3, breast cancer patients in the middle and late stage may appear "tumor loss of appetite - cachexia syndrome". Loss of appetite is both a cause of cachexia and a clinical manifestation of cachexia. There may be symptoms such as loss of appetite, anorexia, weight loss, fatigue, anemia and fever. In severe cases, life may be dangerous.

4, lymphatic metastasis may occur in the late stage of breast cancer, the ipsilateral axillary lymph nodes are enlarged, and the number of enlarged lymph nodes is increasing, sticking to each other, and a small number of patients may have lymphatic metastasis of the contralateral axilla. Long-term metastasis can also occur in the late stage of breast cancer.

Early breast cancer symptoms Common symptoms Nipple discharge Breast tissue hypertrophy Breast mass Lymph node enlargement

1. Intraductal cancer: occurs mostly under the nipple, around the areola and the upper quadrant of the breast. Nearly half of the cases are locally sputum and the lumps of different sizes or unclear breast tissue are thick, the mass and the skin are non-adhesive, individual patients can Stinging or discomfort, some cases can not get a lump, 25% to 40% of nipple discharge, especially in papillary tube cancer, often with nipple discharge as a precursor symptom, the nature of the discharge is mostly bloody, also Can be serous, more than 40% of cytology can detect cancer cells, 5% to 25% of cases with nipple eczema-like cancer.

2. lobular carcinoma in situ: 1/4 to 3/4 is bilateral, bilateral mammary glands can occur simultaneously, or in both sides of the breast, another feature is the small size of the tumor, involving the extent of the breast It is also narrow, which can involve several breast lobules at the same time, and can involve several distal ducts or acinar cells in one or one lobule, so the tumor is small and scattered, and the surrounding boundary is unclear. Less than the intratumoral mass, the patient's self-conscious symptoms and signs are not obvious, so breast lobular carcinoma is often difficult to find or misdiagnosed as lobular hyperplasia of the breast. Most cases of clinical diagnosis are preoperative diagnosis of benign breast lesions, histological examination after surgical resection. Occasionally discovered.

3. Small breast cancer: Most patients have no obvious clinical symptoms, mostly accidental findings, or suspected benign tumors in the anti-cancer screening. They have been diagnosed by biopsy. X-ray photographs have important diagnostic value for breast microcarcinoma. The application of the breast ultrasound diagnostic apparatus can find solid tumors as small as 5 mm. The lesions are mostly in the outer upper quadrant or the areola. The mass rarely adheres to the skin, the texture is hard or tough, and the boundary is clear or slightly ambiguous. Limited mobility, a small number of people can occur simultaneously on both sides, accompanied by axillary lymphadenopathy.

4. Signs: The incidence of intraductal cancer is mostly under the nipple, and the tissue around the areola is thickened, and some cases have no mass; 25% to 40% are nipple discharge, especially in bloody discharge, 40 More than 5% of cytology can be found in cancer cells, and mammography and mammography can assist in the discovery and diagnosis.

Early breast cancer screening

Cytological examination: Cytological examination is divided into nipple smear smear cytology and breast mass needle aspiration cytology.

Early intraductal carcinoma may have hemorrhage and discharge; breast Paget's disease may also have nipple erosion, ulceration and no mass, therefore, the diagnostic positive rate of wound smear or smear cytology can reach 70% to 80%. And the method is simple, no pain, no damage.

For patients with breast lumps, fine needle aspiration cytology can be used to assist diagnosis. This method has been used for nearly 80 years since the establishment of Gathric in 1921.

1 Advantages: high positive rate and most cases can be diagnosed; the method is simple and can be used for census.

2 Disadvantages: 10% to 20% of cases have a false positive rate; can not replace intraoperative frozen sections.

In addition to the above, the detection of biological and biochemical markers of breast cancer can also provide a reference for the diagnosis of breast cancer. For example, CEA detection of nipple discharge in patients with ductal carcinoma has a greater significance for diagnosis.

Early breast cancer has no positive findings in clinical examination due to small mass or inability to touch breast masses, thus delaying diagnosis and losing the opportunity for early treatment. The development of multi-field breast examination methods has made breast screening and early detection of breast cancer possible.

1. Mammography: Mammography is the longest and most mature method of diagnosis, and has a high diagnostic rate for early breast cancer, including mammography and dry mammography, US Health Insurance. Among the breast cancers found in the HIP survey, the tumors were not detected in the clinic and the tumors were found to be 1/3, but the shortcomings were that they were not satisfied with some compact breast development and easily missed small cancer lesions.

2. B-ultrasound examination: Ultrasound diagnosis has strong diagnostic resolution for distinguishing capsule, solid tumor and dense breast mass, and the diagnostic coincidence rate is high.

3. Near-infrared inspection: Near-infrared imaging diagnosis is developed in the past 20 years. It is a safe, harmless, rapid, sensitive and other means of examination. The image of early breast cancer is dark, irregular edges and rough. The vascular changes are lighter; the diagnostic coincidence rate is about 90%, but the disadvantage is that it is not sensitive to inflammation, trauma, cysts and intracapsular hemorrhage, etc., which is not sensitive to breast cancer.

Early diagnosis and identification of breast cancer

diagnosis

Lobular carcinoma in situ can not reach the mass in the clinic, only thickened breast tissue, can be diagnosed after biopsy.

Intraductal cancer with nipple discharge over 50 years old can be regarded as the main target of suspects. About 70% of nipple discharges over 70 years old are caused by cancer. Because some patients often have nipple discharge, there is a lump, or even a touch. No lumps, so for older people with nipple discharge should first do smear cytology examination, if necessary, should be performed by mammography, mammography, if small spots of calcification are found Helps in the diagnosis of intraductal cancer.

Differential diagnosis

1. Breast hyperplasia: Mammary gland hyperplasia, also known as mammary gland malocclusion, is the most common non-inflammatory, non-neoplastic breast disease in women, mostly due to endocrine dysfunction in women, mainly due to excessive secretion of estrogen, causing hyperplasia of breast and incomplete The clinical manifestations are a variety of pathological changes:

1 breast pain;

2 breast hyperplasia;

3 sclerosing breast disease;

4 cystic hyperplasia of the breast, the age of onset is mostly 20 to 40 years old, the incidence rate in developed countries is up to 1/3, and domestic accounts for about 50%. Half of the people have symptoms, mainly characterized by thickening of the breast tissue, but later can be touched. Nodules of varying sizes, no adhesion to the skin and the back of the breast, sometimes can reach a sac-like mass, and 5% of patients have nipple discharge, which occurs in the upper quadrant of the breast, mostly bilateral The patient is often accompanied by varying degrees of pain and can be radiated to the shoulders, back, and obvious before menstruation. After menstruation, the breast can be relieved or relieved. Breast cancer is generally painless. Even if it is painful, it is often painful and stinging. There is no obvious relationship with the menstrual cycle.

Cystic hyperplasia with nipple discharge is mostly bilateral porous serous discharge, while breast cancer is mostly single-hole discharge, breast cystic hyperplasia is often scattered in nodules or thickening, cystic disease And limited hard blocks, sometimes the border is unclear, and breast cancer is mostly unclear, hard texture, poor activity of the mass, and sometimes accompanied by changes in the skin and nipple, X-slice of cystic hyperplasia of the breast appears scattered in the patch or density Increased shadow, uneven density, blurred edges, shaped like clouds or cotton-like, B-ultrasound examination has no substantial space, may have poor structural performance, increased heterogeneous spot echo, cyst disease can be seen in elliptical or round Shaped dense shadow, uniform density, clear boundary, B-ultrasound can be seen elliptical or round lesions, the boundary is clear and complete, the posterior wall has echo enhancement effect, and the X-ray and B-ultrasound of breast cancer have different special signs, Needle aspiration biopsy or excisional biopsy is still required for high-risk groups and clinical suspicious individuals and localized adenopathy.

2. Breast duct dilatation: This disease is also called plasma cell mastitis. In fact, a large number of plasma cell infiltration, secondary pathological changes in the development of lesions of breast ductal dilatation, breast duct retention, is the real The pathological changes occur mostly in middle-aged women aged 37-50 years. The main manifestations are breast pain, nipple discharge, nipple retraction, breast cancer, and easy misdiagnosis. The preoperative misdiagnosis rate is over 90%.

The following points can be identified with breast cancer:

1 The patient is younger, mostly around 40 years old.

2 nipple discharge is mostly serous or purulent, and a few can also be bloody.

3 thickened milk ducts are sometimes touched under the nipple or areola,

4 breast lumps are mostly located around the areola, accompanied by pain, and are closely related to large catheters.

5 The breast has inflammatory manifestations or a history of inflammatory disease and history of breast-feeding disorders, and the breast lumps may be reduced or enlarged.

6 ductography can show catheter expansion,

7 nipple discharge has a large number of inflammatory cells,

8 breast mass puncture can see a large number of inflammatory cells or pus cells,

9 Axillary lymph nodes are swollen, soft and tender.

Mammography shows a shadow in the mammary gland, which is indistinguishable from breast cancer, but the ductal angiography shows that the large duct under the areola is dilated, distorted, and the cyst is like a severe cyst. The nipple shows a narrowing of the duct, no filling defect, accompanied by acute inflammation. The angiography shows that the catheter permeability is enhanced, the contrast agent can penetrate into the interstitial space around the catheter, and a halo-like shadow can be formed around the catheter. When the chronic inflammation is accompanied, the thickness of the catheter is uneven, and there is a small cyst in the middle, and the sclerosing change in the later stage. The lumen is thinned.

3. Breast tuberculosis: Breast tuberculosis is the result of dissemination of Mycobacterium tuberculosis. The primary lesion is more common in the lung and mesenteric lymph node tuberculosis. It is directly spread by adjacent tuberculosis lesions or retrogradely transmitted through the lymphatics. This disease is rare in China. However, the actual number may be very high, most of them are seen in outpatient clinics, often manifested as chronic infection of the breast, repeated attacks, prolonged unhealed, and difficult to diagnose.

The patient is often a woman between the ages of 20 and 40. Most of them are married and have given birth. The course of the disease is slow. At the beginning, they are mostly one or several tuberculosis lesions. They are nodular and painless, and the boundaries with the surrounding tissues are unclear. It gradually adheres to the skin. After a few months, the mass softens and forms a cold abscess. After the abscess collapses, an ulcer or sinus is formed, and the thin pus is discharged from the bean dregs. The mass does not soften, and fibrosis occurs, causing partial breast sclerosis. Often the breast is severely deformed or the nipple is invaginated.

Breast tuberculosis is treated with breast lumps, often diagnosed as breast cancer, with a misdiagnosis rate of 56.7%. According to clinical observations, breast tuberculosis has the following characteristics:

1 patients are mostly young and middle-aged women,

2 Most have a history of tuberculosis, or have other areas of tuberculosis,

3 lesions have a history of inflammation, when the mass is large and small, effective against anti-tuberculosis drugs,

4 The lumps may have redness, rupture and other history, and some cysts are sac sexy.

5 swollen needles can be seen with cheese-like tissue, with thin pus,

6 has a history of nipple discharge, can be purulent,

7 a small number of patients with nipple discharge or pus aspirate, smear can be seen with Mycobacterium tuberculosis,

8 Mammograms are mostly abnormal and have a light shadow.

9 There are breast tuberculosis and breast cancer coexist, accounting for about 5%.

4. Fatty necrosis of the breast: Fatty necrosis of the breast is a pathological change after dominant or non-dominant mammary gland trauma. The initial stage of necrosis is accompanied by hemorrhage, inflammation and cyst-like changes. Fibrosis occurs in the late stage of necrosis. The mass becomes hard and the boundary is unclear. The skin has adhesions, which are often misdiagnosed as breast cancer. The rate of misdiagnosis can reach 87.5%, 70.3% of which are misdiagnosed as cancer. The main identification analysis is as follows:

1 lack of characteristic clinical manifestations, the disease is generally hard, irregular shape, similar to breast cancer, generally divided into 2 types in clinical: glandular, superficial, subcutaneous in the breast, irregular shape, inflammatory Change, easy to diagnose as breast tuberculosis; glandular type, the mass is located in the breast parenchyma, lack of characteristics, easy to be misdiagnosed as breast cancer,

2 Lack of effective auxiliary examination, especially in middle-aged and elderly women, the mass is located under the skin, and the mass does not grow or shrink, and the breast has a history of trauma. The metastatic lymph nodes should be removed for biopsy.

5. Acute mastitis: Acute mastitis is common in secretory breasts, especially after 3 to 4 weeks after primipara, most of the pathogens are Staphylococcus aureus and a few are streptococcus, and the infection route is mostly caused by retrograde infection of the nipple cleft. It can also cause infection by directly invading the milk duct by the bacteria and ascending to the glandular lobules.

At the beginning, the mammary gland locally shows redness, swelling, heat, pain, and swelling of the surrounding lymph nodes. When necrosis is formed, there may be abscesses, breast enlargement, strong activity, hardening and tenderness. When an abscess is formed, the mass is softened and waved. Dynamic, at the same time, feeling discomfort, chills, high fever, X-ray performance structure is more blurred, flaky dense shadow, skin thickening, subcutaneous fat showing disorder, more blood vessels and lymphatic shadows, and cord-like connective Tissue blurring, sometimes accompanied by sediment-like calcification lesions.

Comparison of acute mastitis and breast cancer:

1 breast skin without orange peel-like changes, no satellite nodules,

2 breast mass rarely occupies the whole milk, more than half of them have sac sexy.

3 breast mass is less common,

4 Most body temperature and white blood cell counts increase,

5 anti-inflammatory treatment is effective,

6 needles are mostly pus or inflammatory cells, which is helpful for diagnosis.

6. Chronic mastitis and abscess: Chronic mastitis and abscess are caused by improper or inappropriate treatment of acute mastitis. A small number of abscesses are caused by cyst infection. Chronic mastitis often has abscess formation, which is a lump and the edge is unclear. The capsule is sexy, it can be mildly tender, and has a slight adhesion to the surrounding tissue. The X-ray shows a local dense lamella shadow, the boundary is unclear, the skin is slightly thickened, and the breast abscess can be expressed as a rounded edge. Or an elliptical irregular dense shadow with no structure at the center and a lighter density around the edema.

7. Mammary cysts: more common in the middle of the breast, mostly due to hyperplasia of the mammary duct epithelial cells, leading to ductal elongation, distortion, folding, ductal necrosis due to ischemia at the fold, cyst formation, tube wall atrophy, X The line flat sheet has a round shape, an elliptical dense shadow, a uniform density, and a smooth and sharp edge. The cyst is squeezed around the adipose tissue and the translucent halo appears. The single cyst is the original shape, and the multiple cysts are oval, and the capsule wall is smooth and tidy.

8. Latex cysts: less common, due to a certain milk duct obstruction during lactation, that is, the formation of cysts, cysts can be single or multiple, gray-white, containing milk or cheese-like substances, the thickness of the capsule wall is different, the size is not Etc., can occur in any part, the deepest part of the breast is the most common, X-ray shows a circular or elliptical translucent area, the volume is small, generally 1 ~ 1.5cm, occasionally see > 3cm, the edge is smooth and sharp, The density is slightly lower than fat.

9. Breast fibroma: Breast fibroma occurs mostly in young women aged 20 to 25 years. It consists of glandular and fibrous tissues. There are two types of adolescent and giant fibroadenomas, but there is no qualitative difference. It is closely related to estrogen. There are two types of single and multiple hair. Single breast fibroma occurs in the upper quadrant of the breast, mostly small oval lumps. The fibroids that grow before menarche can grow. Large, smooth surface, tough texture, clear tumor boundary, no adhesion to skin and surrounding tissues, easy to push in the breast, sliding feeling, slow growth, no change within a few years, but can increase rapidly during pregnancy, multiple Sexual breast fibromas are uniform, medium-hard, and vary in size. Larger ones can be lobulated, smooth, tough, with clear boundaries, and calcified granules in the center of the tumor.

There is a capsule outside the breast fibroadenoma, the cut surface is grayish white, bright, not smooth, and the most visible irregular cracks in the cut surface are the expanded milk duct.

X-ray plain film of giant fibroma can be seen as a large mass of uniform mass, which is lobulated, and the surrounding tissue is pressed to form a translucent area. The center of the tumor can have calcification, and more nearby blood vessels are thickened and varicose. Although breast tumors are small, the chance of malignant transformation is large, so they must be treated seriously.

10. Intraductal papilloma: Intraductal papilloma often occurs in women 40 to 50 years old, 75% occur in the large breast tube close to the nipple, or in the cyst connected to the milk duct near the nipple, can be single It can also be multiple, the tumor is small, but often with fluff and more thin-walled blood vessels, it is easy to bleed.

There is no pain in the clinic. During the non-menstrual period, the bloody liquid overflows from the nipple, and the mass is not touched. If the lumps are found, the diameter is several millimeters. In the areola area, the breast tumor is often round and hard. Does not adhere to the skin, can push, gently press this tumor, you can have a nipple bloody discharge.

About 6% to 8% of papillary tumors in the duct can be cancerous. Therefore, breast tube angiography should be performed before surgery to confirm the diagnosis. The operation should be completely removed, and the diseased breast tube and its surrounding gland tissue should be removed together to avoid future problems. Older women should be treated with simple breast resection.

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