内容紹介
Summary
Since breast reconstruction has been covered by health insurance, we can choose a procedure that combines the cosmetic satisfaction of patients with curability. We report about a patient with breast cancer that who underwent nipple-sparing mastectomy after evaluating the intraductal spread by automated breast ultrasound system(ABUS), while hand held ultrasound(HHUS)showed only limited information on the intraductal spread of the lesion. A 52-year old woman with an abnormal screening finding was referred to our hospital. HHUS showed an irregular and poorly defined hypoechoic mass lesion with a lactiferous duct extending to directly under the nipple. A core needle biopsy revealed invasive ductal carcinoma. We performed ABUS to assess the intraductal spread in the lesion because the patient requested breast reconstruction. The coronal section of the breast in the ABUS did not show intraductal spread. We, therefore, decided to perform a nipple-sparing mastectomy and sentinel lymph node biopsy. Intraoperative evaluation by frozen and permanent sections showed negative margins. The ABUS findings helped in the evaluation of the intraductal spread of the lesion and in the choice of the optimal procedure for the patient.
要旨
乳房再建手術の保険適応以来,根治性と整容性を両立させた乳癌手術術式の選択肢が増えている。今回,全自動乳房超音波診断装置(automated breast ultrasonography system: ABUS,GE社製)による画像評価により,乳頭乳輪温存手術が施行できた症例を経験したので報告する。症例は52歳,女性。乳癌検診で異常を指摘され当科を受診した。hand held型の超音波検査(hand held ultrasound: HHUS)では左乳房に不整形低エコー腫瘤と乳頭直下まで連続する拡張乳管を認めた。針生検では浸潤性乳管癌の診断であった。乳頭乳輪温存手術希望が強いため,ABUSを施行し乳頭直下までの拡張乳管を認めなかったため,内視鏡補助下乳頭乳輪温存胸筋温存乳房切除術およびセンチネルリンパ節生検術を施行した。病理診断ではすべての切除断端は陰性であった。本症例では,乳管内進展を判断し術式を決定する上でABUSは有用であった。
目次
Since breast reconstruction has been covered by health insurance, we can choose a procedure that combines the cosmetic satisfaction of patients with curability. We report about a patient with breast cancer that who underwent nipple-sparing mastectomy after evaluating the intraductal spread by automated breast ultrasound system(ABUS), while hand held ultrasound(HHUS)showed only limited information on the intraductal spread of the lesion. A 52-year old woman with an abnormal screening finding was referred to our hospital. HHUS showed an irregular and poorly defined hypoechoic mass lesion with a lactiferous duct extending to directly under the nipple. A core needle biopsy revealed invasive ductal carcinoma. We performed ABUS to assess the intraductal spread in the lesion because the patient requested breast reconstruction. The coronal section of the breast in the ABUS did not show intraductal spread. We, therefore, decided to perform a nipple-sparing mastectomy and sentinel lymph node biopsy. Intraoperative evaluation by frozen and permanent sections showed negative margins. The ABUS findings helped in the evaluation of the intraductal spread of the lesion and in the choice of the optimal procedure for the patient.
要旨
乳房再建手術の保険適応以来,根治性と整容性を両立させた乳癌手術術式の選択肢が増えている。今回,全自動乳房超音波診断装置(automated breast ultrasonography system: ABUS,GE社製)による画像評価により,乳頭乳輪温存手術が施行できた症例を経験したので報告する。症例は52歳,女性。乳癌検診で異常を指摘され当科を受診した。hand held型の超音波検査(hand held ultrasound: HHUS)では左乳房に不整形低エコー腫瘤と乳頭直下まで連続する拡張乳管を認めた。針生検では浸潤性乳管癌の診断であった。乳頭乳輪温存手術希望が強いため,ABUSを施行し乳頭直下までの拡張乳管を認めなかったため,内視鏡補助下乳頭乳輪温存胸筋温存乳房切除術およびセンチネルリンパ節生検術を施行した。病理診断ではすべての切除断端は陰性であった。本症例では,乳管内進展を判断し術式を決定する上でABUSは有用であった。