Clinical Diagnosis And Treatment Of 20 Cases Of Breast Neuroendocrine Carcinoma

Objective Neuroendocrine carcinoma of the breast is a rare type of breast cancer.Currently,studies on its general situation,clinical characteristics,diagnostic information,and treatment strategies are all small-sample studies,and standard guideline about neuroendocrine carcinoma of the breast has not been formed,so more relevant studies are still needed.To investigate the clinical characteristics,diagnosis and treatment strategies of the breast neuroendocrine carcinoma and to improve clinicians' clinical knowledge level of the breast neuroendocrine carcinoma by retrospectively summarizing the characteristics of 20 cases of the breast neuroendocrine carcinoma in the Second Affiliated Hospital of Dalian Medical University.Methods Clinical data of 20 cases with the breast neuroendocrine carcinoma,who were admitted in Department of Breast Surgery,the Second Affiliated Hospital of Dalian Medical University from March 2005 to December 2017,were collected by consulting medical records,and follow-up of these patients was finished by telephone or on-site inquiries.Subsequently,these data were analyzed retrospectively.Results In this group of 20 patients,1 case(5.0%)was male,and 19 cases(95.0%)were female.The age of the 20 patients was from 28 to 77 years,and the average age was 54.35±13.35 years.Regarding the locations of the lesions,11 cases(55.0%)were located in the left breast.(including 7 cases(63.6%)in the upper outer quadrant,2 cases(18.2%)in the upper inner quadrant,1 case(9.1%)in the lower outer quadrant,and 1case(9.1%)in the lower inner quadrant),and 9 cases(45.0%)were located in the right breast(including 6 cases(66.7%)in the upper outer quadrant,1 case(11.1%)in theupper inner quadrant,1 case(11.1%)in the lower outer quadrant,and 1 case(11.1 %)in the lower inner quadrant).the lesions were from 0.8 to 7.1 cm in size,and the average value of the 20 cases was(2.90 ± 1.67)cm.In aspect of surgery,18 patients(90.0%)received modified radical mastectomy,1 patient(5.0%)received total glandectomy and sentinel lymph node biopsy and stage I silicone implant breast reconstruction,and 1patient(5.0%)received radical mastectomy.Regarding TNM stage,there were 7 cases(35.0%)in stage IA,5 cases(25.0%)in stage IIA,6 cases(30.0%)in stage IIB,1 case(5.0%)in stage IIIA,and 1 case(5.0%)in stage IIIB.In terms of pathological types,there were 5 cases(25.0%)of highly differentiated neuroendocrine carcinoma,4 cases(20.0%)of poorly differentiated neuroendocrine carcinoma(small cell carcinoma),and11 cases(55.0%)of invasive breast cancer with neuroendocrine differentiation.In molecular typing,there were 7 cases(35.0%)of Luminal A,7 cases(35.0%)of Luminal B(HER2 negative),4 cases(20.0%)of HER2 positive(HR positive),and 1 case(5.0%)of HER2 positive(HR negative)and 1 case(5.0%)of Triple-negative type.The positive rates of ER,PR and HER2 in this group were 90.0%,60.0% and 25.0%,and the positive rates of NSE,Cg A and Syn in this group were 90.0%?95.0%?75.0%.20 patients were followed up for 5-119 months,with an average follow-up of 59.85±24.51 months.One patient developed bone metastases in the 6th year after surgery and survived for 119 months.One patient developed pulmonary metastasis at the 20 th month after surgery and died at the 28 th month after surgery.So far,the remaining postoperative patients still survived and no signs of recurrence or metastasis was found.Conclusions The breast neuroendocrine carcinoma has no specific clinical and imaging manifestations.The diagnosis relies on histopathological and immunohistochemical detection by the thick needle(hollow needle)biopsy or the surgical resection biopsy.In terms of treatment,clinical strategy formulation to the breast neuroendocrine carcinoma still refers to the standard guidelines of general breast cancer.In addition,ER/PR positive rate of the breast neuroendocrine carcinoma is high,its molecular typing is mostly Luminal type that needs to undergo endocrine therapy,and neoadjuvant treatment(including neoadjuvant chemotherapy and neoadjuvant endocrine therapy)can be performed when necessary.For specific patients whose ER or PR are positive(who is elderly,cannot tolerate neoadjuvant chemotherapy,refuses neoadjuvant chemotherapy,or cannot tolerate surgery),neoadjuvant endocrine therapy is also a well-established therapy,even achieving optimal results.However,more cases are still needed for research.