乳腺癌放疗精品.pptVIP

前哨淋巴结检查代替 腋窝淋巴结检查！ SLN检测的评价 和腋窝淋巴结清扫比较 超过3000例病人 方法为放射性同位素或染料或两者 SLN检测的评价 平均敏感性：94%(83-100%) 平均特异性：100% 阳性预测值：100% 阴性预测值：96%(93-100%) 精确性：98%(95-100%) 腋淋巴结解剖(ALND)的并发症 感染、疼痛、麻木、浆液瘤、 上肢淋巴水肿、功能障碍等。 Anterior Thoracic Landmarks Musculature Pectoralis major Important in surgical resection of breast malignancies Associated with lymphatics of the chest wall Pectoralis minor Important in surgical resection of breast malignancies Deltoids Mainly used for reference Breast Lymphatic Pathways Axillary Upper and lower halves of the breast Drain to the axilla from the lateral aspects of the breast Located at the level of the 2nd to 3rd intercostal spaces Breast Lymphatic Pathways Transpectoral Passes through the pectoralis muscles and drains to the supra- and infraclavicular fossa nodes (1-3 cm deep near the clavicle) Important when treating tumors close to the chest wall Supraclavicular nodes are often treated prophylactically Breast Lymphatic Pathways Internal Mammary Runs along midline on either side of the sternum Involved with inner quadrant tumors Often treated with midline electron field but may be included with steep tangential fields Breast lymphatic flow is important from a surgical perspective. If pathways are compromised during surgery, altered drainage routes can promote lymphedema. ?骨转移症状：疼痛、病理性骨折、高钙血症、肢体功能障碍等 ? X光片：60%-78%溶骨性、 10%-20%成骨性、12%-20%混合性 ?最常见骨转移部位中轴骨: 椎体、肋骨、盆骨、股骨近端 ?单纯骨转移后5年生存率约20%，中位生存期24个月 乳腺癌骨转移 乳腺癌骨转移 ?骨转移是乳腺癌最常见的远处转移部位 总数: 8%, 晚期: 70% ?发生时间：首程治疗后一年内约48%，第二年约18%。最长可达11年。 ?我院131例患者中位骨转移发生的时间34月，73.8%发生在5年内， 10%发生在10年以上。最长可达25年。 乳腺癌单发骨转移形态学表现 乳腺癌骨转移形态学表现 99mTc-MDP骨显像应用(1267pts) 基线片阳性率(%) 分期 I 0% II 3% III 7% IV 47% T(肿瘤大小) T0 0% T1 0.3% T2 3% T3 8% T4 13% 99mTc-MDP骨显像应用于分期 ?对肿瘤小于2 cm者不用做基线片 ?对II、III、IV期病人应照基线片 单纯骨转移组 53 30 (56.6) 18 (34.0) 5 (9.4) 骨转移并其它 78 15 (19.2) 44