Table_1_Management of Adenoid Cystic Carcinoma of the Breast: A Single-Institution Study.docx

ObjectiveThe purpose of our study was to analyze the clinicopathologic features and surgical and oncological outcomes of adenoid cystic carcinoma (ACC) of the breast and to provide the basis for a clinical therapeutic schedule.
MethodsA total of 14 patients with primary breast adenoid cystic carcinoma treated at Cancer Hospital of the Chinese Academy of Medical Sciences from January 2000 to December 2017 were included. Data on clinical presentation, treatment strategy, and outcome, as well as the pathological features of ACC, were reviewed and analyzed.
ResultsFourteen patients were diagnosed with ACC of the breast, out of 23205 total patients treated for breast cancer (0.06%). All but three patients were postmenopausal, with a median age at diagnosis of 60.5 years (range, 39–73 years). The most common clinical presentation was a palpable mass (85.7%), and the imaging characteristics of all patients on color Doppler ultrasound and mammography were nonspecific. Six patients (42.9%) were suspected of having ACC by fine-needle aspiration cytology (FNAC) and were confirmed by postoperative histology and immunohistochemistry. All 14 patients underwent surgery, and no patient had a positive lymph node status. Median tumor size was 1.75 cm (range, 1–3 cm). Eight/14 (57.1%) patients were hormone receptor negative (HR−) and HER-2/neu (−) (HER2−). The remaining patients were hormone receptor positive (HR+). There was no significant difference in clinicopathological characteristics between the HR+ group and the HR- group (P>0.05). The mean follow-up period was 57 months. Local recurrence occurred in 14.3% of patients, 1.7% of patients had distant metastasis, all patients with local recurrence or distant metastasis were in the HR (-) group, and all patients were alive at the last follow-up.
ConclusionACC of the breast cannot be simply summarized as triple-negative breast cancer because it also includes a small number of hormone receptor-positive breast cancers. Establishing a preoperative diagnosis is difficult on the basis of clinical imaging examination, FNAC may be useful tool in the diagnosis. the final diagnosis can only be assessed based on the results of the histopathological and immunohistochemical examination. Breast-conserving surgery may be an alternative treatment strategy, and axillary lymph node dissection or sentinel node biopsy may not be necessary in some cases.

研究背景与目的：本研究旨在分析乳腺腺样囊性癌（adenoid cystic carcinoma, ACC）的临床病理特征、手术及肿瘤学结局，为临床诊疗方案提供依据。

研究方法：纳入2000年1月至2017年12月于中国医学科学院肿瘤医院接受治疗的14例原发性乳腺腺样囊性癌患者，回顾性分析患者的临床表现、治疗策略、结局及腺样囊性癌的病理特征相关数据。

研究结果：共纳入23205例乳腺癌治疗患者，其中14例确诊为乳腺腺样囊性癌（占比0.06%）。除3例患者外，其余均为绝经后女性，诊断时中位年龄为60.5岁（范围39~73岁）。最常见的临床表现为可触及肿块（85.7%），所有患者的彩色多普勒超声及乳腺钼靶影像学特征均无特异性。6例患者（42.9%）经细针穿刺细胞学检查（fine-needle aspiration cytology, FNAC）疑似为腺样囊性癌，后经术后组织病理学及免疫组化检查确诊。全部14例患者均接受了手术治疗，无一例出现淋巴结阳性。肿瘤中位大小为1.75cm（范围1~3cm）。14例患者中8例（57.1%）为激素受体阴性（HR−）且HER-2/neu阴性（HER2−），其余患者为激素受体阳性（HR+）。HR+组与HR−组的临床病理特征无显著差异（P>0.05）。平均随访时长为57个月。14.3%的患者出现局部复发，1.7%的患者发生远处转移；所有出现局部复发或远处转移的患者均属于HR−组，且末次随访时所有患者均存活。

研究结论：乳腺腺样囊性癌不能简单归类为三阴性乳腺癌，因其还包含少数激素受体阳性的乳腺癌病例。仅依靠临床影像学检查难以实现术前确诊，细针穿刺细胞学检查可作为辅助诊断手段，最终确诊需基于组织病理学及免疫组化检查结果。保乳手术可作为可选治疗策略，部分病例无需行腋窝淋巴结清扫或前哨淋巴结活检。