隐匿性乳腺癌1907年由Halsted第一次描述，是指以腋窝淋巴结转移性腺癌为主要症状，而无论是在查体或者传统影像学检查（主要是钼靶）中乳腺原发病灶均无法找到的病例。是一种罕见病，发病率占同期可切除乳腺癌原发病率的0.3%-0.8%。尽管大多数文献均提示隐匿性乳腺癌的预后类似或者优于原发病灶明确的同期（Ⅱ期）乳腺癌，但其诊断以及治疗仍存在争议。安徽医科大学第一附属医院乳腺外科裴静

诊断：１.组织病理检查：细针穿刺能提供一些有用信息，但阴性结果并不能除外恶性病变，因此腋窝淋巴结活检往往是必需的。一旦确立为转移性腺癌，在女性患者中有约90%可能是隐匿性乳腺癌。女性隐匿性乳腺癌的ER/PR阳性的比例高达 50%。因此，免疫组化受体的阳性有助于进一步提示隐匿性乳腺癌的可能性。由于相当比例的原发病灶无法找到或者即使找到也因为太小而不能进行免疫组化分析，因此，对腋窝切除标本进行受体检查有助于判断预后和指导内分泌治疗。２.影像学检查：钼靶和B超是乳腺癌筛查的传统方式。但是绝大多数隐匿性乳腺癌在钼靶上见不到明确的结节。MRI及PET可提高诊断率。

目前治疗：治疗争论的焦点在于无法确认原发病灶的情况下是否有必要行改良根治术切除乳腺。尽管改良根治术与单纯腋窝淋巴结清扫比较在总生存率上差异无显著性，但单纯腋窝清扫术后复发率明显高于改良改良根治订，二者的无病生存率差异有显著性。鉴于复发以及后续治疗对患者生活质量的影响，目前影像学诊断对隐匿性乳腺癌原发病灶识别率较低的现状下还是应该首选改良根治术，降低复发率，提高患者的无病生存率。

诊断和治疗的发展方向：尽管单纯腋窝清扫手术的高复发率明显降低了患者的生存质量，但是，改良根治术后乳腺的缺失同样给患者带来了痛苦，并且两种方法所导致的总生存率并没有显著差异。因此，采用更为敏感的方法对可疑的乳腺隐匿性病灶进行定位，并行保留乳腺的根治性切除可能是今后隐匿性乳腺癌诊断和治疗的发展方向。

Eur J Surg Oncol. 2011 May;37(5):388-97. Epub 2011 Feb 17.
Systematic review of radioguided surgery for non-palpable breast cancer.
Lovrics PJ, Cornacchi SD, Vora R, Goldsmith CH, Kahnamoui K.
SourceDepartment of Surgery, McMaster University, Hamilton Health Sciences and St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada. lovricsp@mcmaster.ca

Abstract
BACKGROUND: This systematic review examines whether radioguided localization surgery (RGL) (radioguided occult lesion localization - ROLL and radioguided seed localization - RSL) for non-palpable breast cancer lesions produces lower positive margin rates than standard wire-guided localization surgery.

METHODS: We performed a comprehensive literature review to identify clinical studies using either ROLL or RSL. Included studies examined invasive or in situ BC and reported pathologically assessed margin status or specimen volume/weight. Two reviewers independently assessed study eligibility and quality and abstracted relevant data on patient and surgical outcomes. Quantitative data analyses were performed.

RESULTS: Fifty-two clinical studies on ROLL (n = 46) and RSL (n = 6) were identified. Twenty-seven met our inclusion criteria: 12 studies compared RGL to WGL and 15 studies were single cohorts using RGL. Ten studies were included in the quantitative analyses. Data for margin status and re-operation rates from 4 randomized controlled trials (RCT; n = 238) and 6 cohort studies were combined giving a combined odds ratio (OR) of 0.367 and 95% confidence interval (CI): 0.277 to 0.487 (p < 0.001) for margins status and OR 0.347, 95% CI: 0.250 to 0.481 (p < 0.001) for re-operation rates.

CONCLUSIONS: The results of this systematic review of RGL versus WGL demonstrate that RGL technique produces lower positive margins rates and fewer re-operations. While this review is limited by the small size and quality of RCTs, the odds ratios suggest that RGL may be a superior technique to guide surgical resection of non-palpable breast cancers. These results should be confirmed by larger, multi-centered RCTs.

Copyright © 2011 Elsevier Ltd. All rights reserved.