NCCN乳腺癌临床实践指南2016.2版(1)

2016-12-29 修改笔名 NCCN乳腺癌临床实践指南2016.2版

NCCN乳腺癌临床实践指南2016.2版(1)

王云(浮云)非浸润性乳腺癌:l小叶原位癌(LCIS-1)l导管原位癌(DCIS)检查和主要治疗(DCIS-1)l导管原位癌术后治疗和监测/随访(DCIS-2)l导管原位癌切缘状况(DCIS-A)小叶原位癌(LCIS-1)注解:a.初次活检(穿刺或手术)或最终切除活检发现为小叶原位癌伴或不伴其他增生性改变(不典型的导管或小叶增生)。b.小叶原位癌的一些亚型(多形性小叶原位癌)与导管原位癌可能有相似的生物学行为。对于多形性小叶原位癌,临床医生可考虑完全切除,并达到切缘阴性,但是目前尚缺乏手术切除达阴性切缘疗效的结果数据。没有数据支持可以在此情况下使用放疗。c.粗针穿刺活检有4个以上累及末端导管小叶单位的多灶/广泛性LCIS,可能与手术切除时发现浸润性乳腺癌风险更高有关。导管原位癌(DCIS)检查和主要治疗(DCIS-1)注解:d.见“乳腺专用MRI检查原则”(BINV-B)。e.使用MRI未显示出增加阴性切缘或减少转为乳房切除的可能性。缺乏支持改善长期结果的数据。f.期望进行保乳手术的患者,可行再次切除以获阴性切缘。乳房肿瘤切除术不能做到切缘阴性时应行全乳切除。g.见“导管原位癌切缘状况”

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