{"id":24078,"date":"2023-04-19T09:08:35","date_gmt":"2023-04-19T02:08:35","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=24078"},"modified":"2023-04-19T09:53:45","modified_gmt":"2023-04-19T02:53:45","slug":"phac-do-chan-doan-ung-thu-vu-theo-bo-y-te-lam-sang-va-can-lam-sang","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/19\/phac-do-chan-doan-ung-thu-vu-theo-bo-y-te-lam-sang-va-can-lam-sang\/","title":{"rendered":"Ph\u00e1c \u0111\u1ed3 ch\u1ea9n \u0111o\u00e1n ung th\u01b0 v\u00fa theo b\u1ed9 Y t\u1ebf: L\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng"},"content":{"rendered":"<p>Ung th\u01b0 v\u00fa l\u00e0 m\u1ed9t trong nh\u1eefng lo\u1ea1i ung th\u01b0 ph\u1ed5 bi\u1ebfn nh\u1ea5t \u1edf ph\u1ee5 n\u1eef tr\u00ean to\u00e0n th\u1ebf gi\u1edbi. Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n ung th\u01b0 v\u00fa l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi v\u00e0 c\u1ea3i thi\u1ec7n c\u01a1 h\u1ed9i s\u1ed1ng s\u00f3t c\u1ee7a b\u1ec7nh nh\u00e2n. B\u00e0i vi\u1ebft n\u00e0y s\u1ebd gi\u1edbi thi\u1ec7u ph\u00e1c \u0111\u1ed3 ch\u1ea9n \u0111o\u00e1n ung th\u01b0 v\u00fa c\u1ee7a b\u1ed9 Y t\u1ebf, bao g\u1ed3m c\u00e1c ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng.<\/p>\n<h2><a name=\"_Toc93202\"><\/a>1. \u0110\u1ea1i c\u01b0\u01a1ng v\u1ec1 ung th\u01b0 v\u00fa<\/h2>\n<p><a href=\"https:\/\/www.vinmec.com\/vi\/ung-buou-xa-tri\/thong-tin-suc-khoe\/ung-thu-vu-dau-hieu-nguyen-nhan-cach-phong-tranh-va-dieu-tri\/\">Ung th\u01b0 v\u00fa (UTV)<\/a> l\u00e0 lo\u1ea1i ung th\u01b0 th\u01b0\u1eddng g\u1eb7p v\u00e0 l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y t\u1eed vong h\u00e0ng \u0111\u1ea7u do ung th\u01b0 \u1edf ph\u1ee5 n\u1eef tr\u00ean to\u00e0n th\u1ebf gi\u1edbi. M\u1ed7i n\u0103m n\u01b0\u1edbc ta c\u00f3 kho\u1ea3ng h\u01a1n 15.230 ph\u1ee5 n\u1eef m\u1edbi m\u1eafc v\u00e0 h\u01a1n 6.100 ng\u01b0\u1eddi t\u1eed vong do UTV. Ung th\u01b0 v\u00fa nam chi\u1ebfm kho\u1ea3ng 1% c\u00e1c tr\u01b0\u1eddng h\u1ee3p UTV. \u0110a s\u1ed1 UTV xu\u1ea5t ph\u00e1t t\u1eeb c\u00e1c t\u1ebf b\u00e0o bi\u1ec3u m\u00f4 c\u1ee7a v\u00fa. B\u1ec7nh Paget c\u1ee7a v\u00fa c\u00f3 th\u1ec3 k\u00e8m theo UTV. Do v\u1eady, khi c\u00f3 th\u00e0nh ph\u1ea7n ung th\u01b0 tr\u00ean Paget v\u00fa c\u1ea7n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb nh\u01b0 UTV th\u00f4ng th\u01b0\u1eddng v\u1edbi giai \u0111o\u1ea1n t\u01b0\u01a1ng \u1ee9ng.<\/p>\n<p>C\u00e1c y\u1ebfu t\u1ed1 ti\u00ean l\u01b0\u1ee3ng quan tr\u1ecdng bao g\u1ed3m: k\u00edch th\u01b0\u1edbc u nguy\u00ean ph\u00e1t, s\u1ed1 l\u01b0\u1ee3ng h\u1ea1ch di c\u0103n, th\u1ec3 m\u00f4 b\u1ec7nh h\u1ecdc, \u0111\u1ed9 m\u00f4 h\u1ecdc, t\u00ecnh tr\u1ea1ng th\u1ee5 th\u1ec3 n\u1ed9i ti\u1ebft, t\u00ecnh tr\u1ea1ng th\u1ee5 th\u1ec3 y\u1ebfu t\u1ed1 ph\u00e1t tri\u1ec3n bi\u1ec3u b\u00ec ng\u01b0\u1eddi s\u1ed1 2 (human epidermal growth factor receptor-HER2), tu\u1ed5i.<\/p>\n<figure id=\"attachment_24388\" aria-describedby=\"caption-attachment-24388\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"size-medium wp-image-24388\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/20210126_010853_906384_benh-ung-thu-vu1-1.max-1800x1800-1-300x225.jpg\" alt=\"minh-hoa-ung-thu-vu-o-phu-nu\" width=\"300\" height=\"225\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/20210126_010853_906384_benh-ung-thu-vu1-1.max-1800x1800-1-300x225.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/20210126_010853_906384_benh-ung-thu-vu1-1.max-1800x1800-1-1024x768.jpg 1024w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/20210126_010853_906384_benh-ung-thu-vu1-1.max-1800x1800-1-768x576.jpg 768w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/20210126_010853_906384_benh-ung-thu-vu1-1.max-1800x1800-1.jpg 1200w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-24388\" class=\"wp-caption-text\">Ung th\u01b0 v\u00fa l\u00e0 nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u g\u00e2y t\u1eed vong do ung th\u01b0 \u1edf ph\u1ee5 n\u1eef<\/figcaption><\/figure>\n<h2><a name=\"_Toc93203\"><\/a>2. Nguy\u00ean nh\u00e2n \u2013 C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1<\/h2>\n<ul>\n<li>Ti\u1ec1n s\u1eed gia \u0111\u00ecnh c\u00f3 ng\u01b0\u1eddi m\u1eafc UTV, \u0111\u1eb7c bi\u1ec7t c\u00f3 t\u1eeb 2 ng\u01b0\u1eddi m\u1eafc tr\u1edf l\u00ean \u1edf l\u1ee9a tu\u1ed5i tr\u1ebb<\/li>\n<li>\u0110\u1ed9t bi\u1ebfn gen <em>BRCA1<\/em> v\u00e0 <em>BRCA2<\/em><\/li>\n<li>C\u00f3 kinh l\u1ea7n \u0111\u1ea7u s\u1edbm, m\u00e3n kinh mu\u1ed9n, ph\u1ee5 n\u1eef \u0111\u1ed9c th\u00e2n, kh\u00f4ng sinh con, kh\u00f4ng cho con b\u00fa, sinh con \u0111\u1ea7u l\u00f2ng mu\u1ed9n<\/li>\n<li>B\u00e9o ph\u00ec, ch\u1ebf \u0111\u1ed9 \u0103n gi\u00e0u ch\u1ea5t b\u00e9o, s\u1eed d\u1ee5ng r\u01b0\u1ee3u c\u0169ng g\u00f3p ph\u1ea7n t\u0103ng nguy c\u01a1 b\u1ecb b\u1ec7nh<\/li>\n<li>Vi\u00eam v\u00fa trong khi sinh \u0111\u1ebb v\u00e0 m\u1ed9t s\u1ed1 b\u1ec7nh v\u00fa l\u00e0nh t\u00ednh<\/li>\n<li>Tu\u1ed5i c\u00e0ng cao<\/li>\n<\/ul>\n<h2><a name=\"_Toc93204\"><\/a>3. Ch\u1ea9n \u0111o\u00e1n ung th\u01b0 v\u00fa<\/h2>\n<h3><a name=\"_Toc93205\"><\/a><strong>3.1. L\u00e2m s\u00e0ng <\/strong><\/h3>\n<ul>\n<li>H\u1ecfi b\u1ec7nh:<\/li>\n<\/ul>\n<p>+ Qu\u00e1 tr\u00ecnh ph\u00e1t hi\u1ec7n u v\u00fa, h\u1ea1ch n\u00e1ch, h\u1ea1ch th\u01b0\u1ee3ng \u0111\u00f2n, ch\u1ea3y d\u1ecbch n\u00fam v\u00fa, c\u00e1c ph\u01b0\u01a1ng ph\u00e1p can thi\u1ec7p tr\u01b0\u1edbc \u0111\u00f3.<\/p>\n<p>+ M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng: c\u1ea3m gi\u00e1c \u0111au nh\u1eb9 nh\u01b0 ki\u1ebfn c\u1eafn trong v\u00fa, giai \u0111o\u1ea1n mu\u1ed9n c\u00f3 th\u1ec3 c\u0103ng t\u1ee9c kh\u00f3 ch\u1ecbu, \u0111au do u x\u00e2m l\u1ea5n, ch\u1ea3y d\u1ecbch h\u00f4i, ch\u1ea3y m\u00e1u\u2026 + Khai th\u00e1c ti\u1ec1n s\u1eed:<\/p>\n<ul>\n<li>Ti\u1ec1n s\u1eed b\u1ea3n th\u00e2n: b\u1ec7nh v\u00fa tr\u01b0\u1edbc \u0111\u00e2y, c\u00e1c b\u1ec7nh l\u00fd n\u1ed9i khoa, ngo\u1ea1i khoa\u2026, ti\u1ec1n s\u1eed s\u1ea3n, ph\u1ee5 khoa, t\u00ecnh tr\u1ea1ng kinh nguy\u1ec7t hi\u1ec7n t\u1ea1i.<\/li>\n<li>Ti\u1ec1n s\u1eed gia \u0111\u00ecnh, \u0111\u1eb7c bi\u1ec7t ti\u1ec1n s\u1eed ung th\u01b0 v\u00fa, bu\u1ed3ng tr\u1ee9ng.<\/li>\n<\/ul>\n<ul>\n<li>Kh\u00e1m th\u1ef1c th\u1ec3:<\/li>\n<\/ul>\n<p>+ Kh\u00e1m v\u00fa hai b\u00ean, h\u1ea1ch v\u00f9ng (n\u00e1ch, th\u01b0\u1ee3ng \u0111\u00f2n).<\/p>\n<p>+ Kh\u00e1m c\u00e1c c\u01a1 quan, b\u1ed9 ph\u1eadn kh\u00e1c<\/p>\n<p>+ Kh\u00e1m to\u00e0n th\u00e2n, l\u01b0u \u00fd c\u00e1c tri\u1ec7u ch\u1ee9ng, d\u1ea5u hi\u1ec7u di c\u0103n xa (\u0111au \u0111\u1ea7u, \u0111au x\u01b0\u01a1ng, kh\u00f3 th\u1edf v.v.).<\/p>\n<ul>\n<li>\u0110\u00e1nh gi\u00e1 to\u00e0n tr\u1ea1ng (ch\u1ec9 s\u1ed1 ho\u1ea1t \u0111\u1ed9ng c\u01a1 th\u1ec3).<\/li>\n<\/ul>\n<h3><a name=\"_Toc93206\"><\/a><strong>3.2. C\u1eadn l\u00e2m s\u00e0ng <\/strong><\/h3>\n<h4>3.2.1. Ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh<\/h4>\n<ul>\n<li><a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/tu-chup-x-quang-tuyen-vu-mammography\/\">Ch\u1ee5p X-quang tuy\u1ebfn v\u00fa (mammography)<\/a>: ch\u1ee5p v\u00fa 2 b\u00ean, m\u1ed7i b\u00ean \u00edt nh\u1ea5t 2 t\u01b0 th\u1ebf. Tr\u01b0\u1eddng h\u1ee3p m\u1eadt \u0111\u1ed9 m\u00f4 v\u00fa \u0111\u1eadm ho\u1eb7c kh\u00f3 ch\u1ea9n \u0111o\u00e1n, c\u00f3 th\u1ec3 c\u1ea7n ch\u1ee5p tuy\u1ebfn v\u00fa s\u1ed1 h\u00f3a c\u00f3 ti\u00eam thu\u1ed1c c\u1ea3n quang (contrast-enhanced digital mammography), ch\u1ee5p 3D (breast tomosynthesis), ch\u1ee5p \u1ed1ng d\u1eabn s\u1eefa c\u1ea3n quang (galactography).<\/li>\n<\/ul>\n<p>Nh\u1eefng ph\u1ee5 n\u1eef \u0111\u00e3 ph\u1eabu thu\u1eadt th\u1ea9m m\u1ef9 \u0111\u1eb7t t\u00fai ng\u1ef1c, ch\u1ee5p X-quang v\u00fa c\u00f3 th\u1ec3 g\u00e2y bi\u1ebfn d\u1ea1ng, d\u00f2, v\u1ee1 t\u00fai. Do v\u1eady, c\u1ea7n thay ch\u1ee5p X-quang v\u00fa b\u1eb1ng ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb (MRI) tuy\u1ebfn v\u00fa k\u1ebft h\u1ee3p si\u00eau \u00e2m v\u00fa.<\/p>\n<ul>\n<li>Si\u00eau \u00e2m v\u00fa v\u00e0 h\u1ea1ch v\u00f9ng: si\u00eau \u00e2m th\u00f4ng th\u01b0\u1eddng ho\u1eb7c si\u00eau \u00e2m 3D, si\u00eau \u00e2m \u0111\u00e0n h\u1ed3i, si\u00eau \u00e2m qu\u00e9t th\u1ec3 t\u00edch v\u00fa t\u1ef1 \u0111\u1ed9ng (automated volume breast scanner-AVBS) \u0111\u1ec3 c\u00f3 k\u1ebft qu\u1ea3 ch\u00ednh x\u00e1c h\u01a1n.<\/li>\n<li>Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb (MRI) tuy\u1ebfn v\u00fa: \u0111\u1eb7c bi\u1ec7t v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c kh\u1ed1i u tr\u00ean ch\u1ee5p X-quang v\u00fa, v\u00fa \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u1eabu thu\u1eadt t\u1ea1o h\u00ecnh, th\u1ec3 ti\u1ec3u th\u00f9y, nghi ng\u1edd \u0111a \u1ed5, ho\u1eb7c \u0111\u00e1nh gi\u00e1 tr\u01b0\u1edbc khi ph\u1eabu thu\u1eadt b\u1ea3o t\u1ed3n, tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb t\u00e2n b\u1ed5 tr\u1ee3. \u0110\u1ed1i v\u1edbi UTBM th\u1ec3 \u1ed1ng t\u1ea1i ch\u1ed7, MRI tuy\u1ebfn v\u00fa ch\u1ec9 c\u00f3 \u00fd ngh\u0129a trong m\u1ed9t s\u1ed1 t\u00ecnh hu\u1ed1ng nh\u1ea5t \u0111\u1ecbnh, \u0111\u1eb7c bi\u1ec7t khi c\u1ea7n th\u00eam th\u00f4ng tin m\u00e0 tr\u00ean ch\u1ee5p Xquang v\u00fa c\u1ea3nh b\u00e1o c\u00f3 kh\u1ea3 n\u0103ng u lan r\u1ed9ng.<\/li>\n<li>Ch\u1ee5p X-quang ng\u1ef1c th\u1eb3ng, nghi\u00eang.<\/li>\n<li>Si\u00eau \u00e2m \u1ed5 b\u1ee5ng.<\/li>\n<li>Ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh l\u1ed3ng ng\u1ef1c, \u1ed5 b\u1ee5ng, ti\u1ec3u khung, s\u1ecd n\u00e3o&#8230;<\/li>\n<li>Ch\u1ee5p MRI s\u1ecd n\u00e3o; x\u01b0\u01a1ng, kh\u1edbp (\u0111\u1eb7c bi\u1ec7t c\u1ed9t s\u1ed1ng); \u1ed5 b\u1ee5ng &#8211; ti\u1ec3u khung&#8230;<\/li>\n<\/ul>\n<h4>3.2.2. Y h\u1ecdc h\u1ea1t nh\u00e2n<\/h4>\n<ul>\n<li>X\u1ea1 h\u00ecnh x\u01b0\u01a1ng b\u1eb1ng m\u00e1y SPECT, SPECT\/CT v\u1edbi <sup>99m<\/sup>Tc-MDP \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u1ed5n th\u01b0\u01a1ng di c\u0103n x\u01b0\u01a1ng, ch\u1ea9n \u0111o\u00e1n giai \u0111o\u1ea1n b\u1ec7nh tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb, theo d\u00f5i \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb, \u0111\u00e1nh gi\u00e1 t\u00e1i ph\u00e1t v\u00e0 di c\u0103n. X\u1ea1 h\u00ecnh x\u01b0\u01a1ng gi\u00fap ph\u00e1t hi\u1ec7n di c\u0103n x\u01b0\u01a1ng s\u1edbm h\u01a1n CLVT, MRI, m\u1eb7c d\u00f9 ch\u01b0a c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng.<\/li>\n<li>X\u1ea1 h\u00ecnh kh\u1ed1i u b\u1eb1ng m\u00e1y SPECT, SPECT\/CT v\u1edbi <sup>99m<\/sup>Tc-MIBI \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n u nguy\u00ean ph\u00e1t, t\u1ed5n th\u01b0\u01a1ng di c\u0103n.<\/li>\n<li>X\u1ea1 h\u00ecnh th\u1eadn ch\u1ee9c n\u0103ng b\u1eb1ng m\u00e1y SPECT, SPECT\/CT v\u1edbi <sup>99m<\/sup>Tc-DTPA \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng th\u1eadn tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb v\u00e0 sau \u0111i\u1ec1u tr\u1ecb.<\/li>\n<li>Ch\u1ee5p PET\/CT: gi\u00fap \u0111\u00e1nh gi\u00e1 gia \u0111o\u1ea1n, ph\u00e1t hi\u1ec7n t\u00e1i ph\u00e1t, di c\u0103n, m\u00f4 ph\u1ecfng l\u1eadp k\u1ebf ho\u1ea1ch x\u1ea1 tr\u1ecb.<\/li>\n<li>X\u00e1c \u0111\u1ecbnh h\u1ea1ch c\u1eeda (h\u1ea1ch g\u00e1c): S\u1eed d\u1ee5ng \u0111\u1ed3ng v\u1ecb ph\u00f3ng x\u1ea1 <sup>99m<\/sup>Tc- Nanocolloid c\u00f9ng \u0111\u1ea7u d\u00f2 Gamma ho\u1eb7c x\u1ea1 h\u00ecnh h\u1ea1ch c\u1eeda v\u1edbi <sup>99m<\/sup>Tc-Nanocolloid tr\u00ean m\u00e1y Gamma camera ho\u1eb7c SPECT.<\/li>\n<\/ul>\n<h4>3.2.3. Gi\u1ea3i ph\u1eabu b\u1ec7nh, t\u1ebf b\u00e0o<\/h4>\n<ul>\n<li>T\u1ebf b\u00e0o h\u1ecdc: Ch\u1ecdc h\u00fat b\u1eb1ng kim nh\u1ecf (fine needle aspiration \u2013 FNA) kh\u1ed1i u, h\u1ea1ch, c\u00e1c t\u1ed5n th\u01b0\u01a1ng nghi ng\u1edd. \u0110\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u00f3 x\u00e1c \u0111\u1ecbnh t\u1ed5n th\u01b0\u01a1ng, c\u1ea7n ch\u1ecdc h\u00fat t\u1ebf b\u00e0o d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn c\u1ee7a ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh. T\u1ebf b\u00e0o h\u1ecdc c\u00f3 th\u1ec3 l\u00e0m v\u1edbi d\u1ecbch ti\u1ebft n\u00fam v\u00fa, d\u1ecbch c\u00e1c m\u00e0ng.<\/li>\n<li>Sinh thi\u1ebft t\u1ed5n th\u01b0\u01a1ng (u nguy\u00ean ph\u00e1t, h\u1ea1ch, c\u00e1c t\u1ed5n th\u01b0\u01a1ng nghi ng\u1edd di c\u0103n): \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n m\u00f4 b\u1ec7nh h\u1ecdc v\u00e0 \u0111\u00e1nh gi\u00e1 c\u00e1c d\u1ea5u \u1ea5n sinh h\u1ecdc. T\u00f9y t\u1eebng tr\u01b0\u1eddng h\u1ee3p m\u00e0 \u00e1p d\u1ee5ng c\u00e1c bi\u1ec7n ph\u00e1p: sinh thi\u1ebft kim l\u00f5i, sinh thi\u1ebft v\u00fa c\u00f3 h\u1ed7 tr\u1ee3 h\u00fat ch\u00e2n kh\u00f4ng (vacuum-assisted breast biopsy -VABB), sinh thi\u1ebft \u0111\u1ecbnh v\u1ecb d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn c\u1ee7a ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh, sinh thi\u1ebft \u0111\u1ecbnh v\u1ecb kim d\u00e2y, sinh thi\u1ebft m\u1edf, sinh thi\u1ebft t\u1ee9c th\u00ec trong m\u1ed5. \u0110\u1ed1i v\u1edbi t\u1ed5n th\u01b0\u01a1ng nghi ng\u1edd b\u1ec7nh Paget c\u1ea7n sinh thi\u1ebft kim t\u1ed5n th\u01b0\u01a1ng v\u00fa (n\u1ebfu c\u00f3) v\u00e0 sinh thi\u1ebft da ph\u1ee9c h\u1ee3p qu\u1ea7ng-n\u00fam v\u00fa v\u1edbi \u0111\u1ee7 \u0111\u1ed9 s\u00e2u (fullthickness skin biopsy).<\/li>\n<li>\u0110\u00e1nh gi\u00e1 tr\u00ean m\u00f4 b\u1ec7nh h\u1ecdc c\u1ea7n bao g\u1ed3m s\u1ed1 l\u01b0\u1ee3ng u, v\u1ecb tr\u00ed u, \u0111\u01b0\u1eddng k\u00ednh l\u1edbn nh\u1ea5t c\u1ee7a kh\u1ed1i u, \u0111\u00e1nh gi\u00e1 b\u1edd di\u1ec7n c\u1eaft, th\u1ec3 m\u00f4 b\u1ec7nh h\u1ecdc, \u0111\u1ed9 m\u00f4 h\u1ecdc, x\u00e2m l\u1ea5n m\u1ea1ch, s\u1ed1 l\u01b0\u1ee3ng h\u1ea1ch di c\u0103n tr\u00ean s\u1ed1 l\u01b0\u1ee3ng h\u1ea1ch l\u1ea5y \u0111\u01b0\u1ee3c.<\/li>\n<li>\u0110\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p ung th\u01b0 v\u00fa \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb h\u00f3a ch\u1ea5t t\u00e2n b\u1ed5 tr\u1ee3, c\u1ea7n l\u00e0m x\u00e9t nghi\u1ec7m m\u00f4 b\u1ec7nh h\u1ecdc \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 \u0111\u00e1p \u1ee9ng tr\u00ean b\u1ec7nh ph\u1ea9m ph\u1eabu thu\u1eadt.<\/li>\n<li>C\u00e1c tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh t\u00e1i ph\u00e1t, di c\u0103n c\u0169ng c\u1ea7n sinh thi\u1ebft c\u00e1c t\u1ed5n th\u01b0\u01a1ng di c\u0103n m\u1ed7i khi c\u00f3 th\u1ec3.<\/li>\n<li>D\u01b0\u1edbi \u0111\u00e2y l\u00e0 tr\u00edch l\u01b0\u1ee3c ph\u00e2n lo\u1ea1i h\u00ecnh th\u00e1i m\u00f4 b\u1ec7nh h\u1ecdc c\u1ee7a UTBM v\u00fa theo T\u1ed5 ch\u1ee9c Y t\u1ebf Th\u1ebf gi\u1edbi n\u0103m 2012:<\/li>\n<\/ul>\n<p><strong><em>*C\u00e1c kh\u1ed1i u bi\u1ec3u m\u00f4 (Epithelial tumours) <\/em><\/strong><\/p>\n<p>+ UTBM vi x\u00e2m nh\u1eadp (Microinvasive carcinoma)<\/p>\n<p><strong><em>*UTBM v\u00fa x\u00e2m nh\u1eadp (Invasive breast carcinoma)<\/em><\/strong><\/p>\n<p>+ UTBM x\u00e2m nh\u1eadp kh\u00f4ng ph\u1ea3i lo\u1ea1i \u0111\u1eb7c bi\u1ec7t (Invasive carcinoma of no special type)<\/p>\n<p>+ UTBM ti\u1ec3u th\u00f9y x\u00e2m nh\u1eadp (Invasive lobular carcinoma)<\/p>\n<p>+ UTBM \u1ed1ng nh\u1ecf (Tubular carcinoma)<\/p>\n<p>+ UTBM th\u1ec3 m\u1eb7t s\u00e0ng (Cribriform carcinoma)<\/p>\n<p>+ UTBM th\u1ec3 nh\u1ea7y (Mucinous carcinoma)<\/p>\n<p>+ UTBM v\u1edbi \u0111\u1eb7c \u0111i\u1ec3m t\u1ee7y (Carcinoma with medullary features)<\/p>\n<p style=\"padding-left: 40px;\">\u25ca UTBM th\u1ec3 t\u1ee7y (Medullary carcinoma)<\/p>\n<p style=\"padding-left: 40px;\">\u25ca UTBM th\u1ec3 t\u1ee7y kh\u00f4ng \u0111i\u1ec3n h\u00ecnh (Atypical medullary carcinoma)<\/p>\n<p style=\"padding-left: 40px;\">\u25ca UTBM x\u00e2m l\u1ea5n kh\u00f4ng ph\u1ea3i lo\u1ea1i \u0111\u1eb7c bi\u1ec7t v\u1edbi c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m t\u1ee7y(Invasive carcinoma NST with medullary features)<\/p>\n<p>+ UTBM v\u1edbi bi\u1ec7t h\u00f3a ti\u1ebft r\u1ee5ng \u0111\u1ea7u (Carcinoma with apocrine differentiation)<\/p>\n<p>+ UTBM v\u1edbi bi\u1ec7t h\u00f3a t\u1ebf b\u00e0o nh\u1eabn (Carcinoma with signet-ring-cell<\/p>\n<p>differentiation)<\/p>\n<p>+ UTBM th\u1ec3 vi nh\u00fa x\u00e2m nh\u1eadp (Invasive micropapillary carcinoma)<\/p>\n<p>+ UTBM th\u1ec3 d\u1ecb s\u1ea3n kh\u00f4ng ph\u1ea3i lo\u1ea1i \u0111\u1eb7c bi\u1ec7t (Metaplastic carcinoma of<\/p>\n<p>no special type)<\/p>\n<p>+ C\u00e1c lo\u1ea1i hi\u1ebfm g\u1eb7p (Rare types)<\/p>\n<p>*<strong>C\u00e1c t\u1ed5n th\u01b0\u01a1ng ti\u1ec1n ung th\u01b0 (Precursor lesions) <\/strong><\/p>\n<p>+ UTBM \u1ed1ng t\u1ea1i ch\u1ed7 (Ductal carcinoma in situ) \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <strong><em>\u00a0<\/em><\/strong><\/p>\n<p>+ T\u00e2n s\u1ea3n ti\u1ec3u th\u00f9y (Lobular neoplasia)<\/p>\n<p style=\"padding-left: 40px;\">\u25ca UTBM ti\u1ec3u th\u00f9y t\u1ea1i ch\u1ed7 (Lobular carcinoma in situ)<\/p>\n<p style=\"padding-left: 40px;\">\u25ca Qu\u00e1 s\u1ea3n ti\u1ec3u th\u00f9y kh\u00f4ng \u0111i\u1ec3n h\u00ecnh (Atypical lobular hyperplasia)<\/p>\n<p><strong><em>*C\u00e1c t\u1ed5n th\u01b0\u01a1ng th\u1ec3 nh\u00fa (<\/em><\/strong>Papillary lesions)<\/p>\n<p>+ U nh\u00fa n\u1ed9i \u1ed1ng (Intraductal papilloma)<\/p>\n<p>+ UTBM nh\u00fa n\u1ed9i \u1ed1ng (Intraductal papillary carcinoma)<\/p>\n<p>+ UTBM nh\u00fa trong v\u1ecf (Encapsulated papillary carcinoma)<\/p>\n<p>+ UTBM nh\u00fa \u0111\u1eb7c (Solid papillary carcinoma)<\/p>\n<p style=\"padding-left: 40px;\">\u25ca T\u1ea1i ch\u1ed7 (In situ)<\/p>\n<p style=\"padding-left: 40px;\">\u25ca X\u00e2m nh\u1eadp (Invasive)<\/p>\n<p><strong><em>*C\u00e1c kh\u1ed1i u v\u00fa nam (Tumours of the male breast) <\/em><\/strong><\/p>\n<p>+ Ph\u00ec \u0111\u1ea1i tuy\u1ebfn v\u00fa (Gynaecomastia)<\/p>\n<p>+ UTBM (Carcinoma)<\/p>\n<p style=\"padding-left: 40px;\">\u25ca UTBM x\u00e2m nh\u1eadp (Invasive carcinoma)<\/p>\n<p style=\"padding-left: 40px;\">\u25ca UTBM t\u1ea1i ch\u1ed7 (In situ carcinoma)<\/p>\n<ul>\n<li>L\u00e0m x\u00e9t nghi\u1ec7m h\u00f3a m\u00f4 mi\u1ec5n d\u1ecbch: \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng th\u1ee5 th\u1ec3 estrogen (estrogen receptor- ER), th\u1ee5 th\u1ec3 progesteron (progesteron receptor- PR), HER2 v\u00e0 Ki67. \u0110\u1ed1i v\u1edbi UTBM th\u1ec3 \u1ed1ng t\u1ea1i ch\u1ed7 \u0111\u01a1n thu\u1ea7n kh\u00f4ng c\u1ea7n x\u00e1c \u0111\u1ecbnh t\u00ecnh tr\u1ea1ng HER2 (kh\u00f4ng thay \u0111\u1ed5i ti\u00ean l\u01b0\u1ee3ng, can thi\u1ec7p) nh\u01b0ng c\u1ea7n x\u00e1c \u0111\u1ecbnh t\u00ecnh tr\u1ea1ng ER \u0111\u1ec3 c\u00e2n nh\u1eafc \u0111i\u1ec1u tr\u1ecb n\u1ed9i ti\u1ebft b\u1ed5 tr\u1ee3. \u0110\u00e1nh gi\u00e1 MSI, MMR gi\u00fap ti\u00ean l\u01b0\u1ee3ng b\u1ec7nh.<\/li>\n<li>X\u00e1c \u0111\u1ecbnh t\u00ecnh tr\u1ea1ng gen <em>ErbB2<\/em> (quy \u0111\u1ecbnh HER2): c\u00e1c x\u00e9t nghi\u1ec7m lai t\u1ea1i ch\u1ed7 (in situ hybridization- ISH)&#8230;, \u0111\u1eb7c bi\u1ec7t c\u1ea7n thi\u1ebft khi k\u1ebft qu\u1ea3 nhu\u1ed9m h\u00f3a m\u00f4 mi\u1ec5n d\u1ecbch HER2 (++).<\/li>\n<li>X\u00e9t nghi\u1ec7m \u0111\u1ed9t bi\u1ebfn <em>BRCA1\/2<\/em> v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p HER2 \u00e2m t\u00ednh c\u00f3 d\u1ef1 \u0111\u1ecbnh s\u1eed d\u1ee5ng thu\u1ed1c \u1ee9c ch\u1ebf PARP, ph\u00e1c \u0111\u1ed3 h\u00f3a tr\u1ecb c\u00f3 platin. C\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u00e1c c\u0169ng c\u00f3 th\u1ec3 l\u00e0m x\u00e9t nghi\u1ec7m n\u00e0y, \u0111\u1eb7c bi\u1ec7t nh\u1eefng ng\u01b0\u1eddi c\u00f3 ti\u1ec1n s\u1eed gia \u0111\u00ecnh b\u1ecb UTV, ung th\u01b0 bu\u1ed3ng tr\u1ee9ng.<\/li>\n<li>X\u00e1c \u0111\u1ecbnh t\u00ecnh tr\u1ea1ng \u0111\u1ed9t bi\u1ebfn <em>PIK3CA<\/em> (phosphatidylinositol-4,5-bisphosphate 3kinase catalytic subunit alpha) t\u1ea1i kh\u1ed1i u ho\u1eb7c t\u1ebf b\u00e0o u l\u01b0u h\u00e0nh trong m\u00e1u v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p th\u1ee5 th\u1ec3 n\u1ed9i ti\u1ebft d\u01b0\u01a1ng t\u00ednh, HER2 \u00e2m t\u00ednh d\u1ef1 ki\u1ebfn d\u00f9ng thu\u1ed1c \u1ee9c ch\u1ebf PI3K.<\/li>\n<li>X\u00e1c \u0111\u1ecbnh t\u00ecnh tr\u1ea1ng PD-L1 tr\u00ean c\u00e1c t\u1ebf b\u00e0o mi\u1ec5n d\u1ecbch x\u00e2m nh\u1eadp kh\u1ed1i u \u0111\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p b\u1ed9 ba \u00e2m t\u00ednh c\u00f3 d\u1ef1 \u0111\u1ecbnh s\u1eed d\u1ee5ng thu\u1ed1c kh\u00e1ng PD-L1.<\/li>\n<li>Ph\u00e2n t\u00edch b\u1ed9 gen \u0111\u00e1nh gi\u00e1 ti\u00ean l\u01b0\u1ee3ng (b\u1eb1ng RT-PCR ho\u1eb7c gi\u1ea3i tr\u00ecnh t\u1ef1 nhi\u1ec1u gen, v.v.) \u0111\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p l\u00f2ng \u1ed1ng A ho\u1eb7c l\u00f2ng \u1ed1ng B, HER2 \u00e2m t\u00ednh kh\u00f3 quy\u1ebft \u0111\u1ecbnh c\u00f3 h\u00f3a tr\u1ecb b\u1ed5 tr\u1ee3 hay kh\u00f4ng.<\/li>\n<li>Do t\u00ednh \u0111a d\u1ea1ng c\u1ee7a kh\u1ed1i u, c\u1ea7n x\u00e9t nghi\u1ec7m m\u00f4 b\u1ec7nh h\u1ecdc v\u00e0 \u0111\u00e1nh gi\u00e1 c\u00e1c d\u1ea5u \u1ea5n ER, PR, HER2, Ki67 (c\u1ea3 ISH n\u1ebfu c\u1ea7n thi\u1ebft)&#8230;. tr\u00ean b\u1ec7nh ph\u1ea9m tr\u01b0\u1edbc v\u00e0 sau ph\u1eabu thu\u1eadt, tr\u01b0\u1edbc v\u00e0 sau \u0111i\u1ec1u tr\u1ecb t\u00e2n b\u1ed5 tr\u1ee3, t\u1ed5n th\u01b0\u01a1ng t\u00e1i ph\u00e1t, di c\u0103n.<\/li>\n<li>Ph\u00e2n lo\u1ea1i ph\u00e2n t\u1eed UTV d\u1ef1a v\u00e0o c\u00e1c d\u1eef li\u1ec7u c\u1ee7a h\u00f3a m\u00f4 mi\u1ec5n d\u1ecbch v\u00e0 ISH (B\u1ea3ng 1).<\/li>\n<li style=\"list-style-type: none;\"><\/li>\n<\/ul>\n<h5><strong>B\u1ea3ng 1. C\u00e1c th\u1ec3 ph\u00e2n t\u1eed ung th\u01b0 v\u00fa theo H\u1ed9i ngh\u1ecb \u0111\u1ed3ng thu\u1eadn St. Gallen 2015\u00a0\u00a0 <\/strong><\/h5>\n<table width=\"593\">\n<tbody>\n<tr>\n<td width=\"262\"><strong>Th\u1ec3 b\u1ec7nh h\u1ecdc <\/strong><\/td>\n<td width=\"331\"><strong>\u0110\u1eb7c \u0111i\u1ec3m ph\u00e2n \u0111\u1ecbnh <\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"262\">&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>L\u00f2ng \u1ed1ng A<\/p>\n<p>&nbsp;<\/td>\n<td width=\"331\">ER d\u01b0\u01a1ng t\u00ednh<\/p>\n<p>HER2 \u00e2m t\u00ednh<\/p>\n<p>Ki-67 th\u1ea5p*<\/p>\n<p>PR cao**<\/p>\n<p>X\u00e9t nghi\u1ec7m ph\u00e2n t\u1eed (n\u1ebfu c\u00f3): nguy c\u01a1 th\u1ea5p<\/td>\n<\/tr>\n<tr>\n<td width=\"262\">&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>L\u00f2ng \u1ed1ng B &#8211; HER2 \u00e2m t\u00ednh<\/p>\n<p>&nbsp;<\/td>\n<td width=\"331\">ER d\u01b0\u01a1ng t\u00ednh<\/p>\n<p>HER2 \u00e2m t\u00ednh<\/p>\n<p>Ki-67 cao ho\u1eb7c<\/p>\n<p>PR th\u1ea5p<\/p>\n<p>X\u00e9t nghi\u1ec7m ph\u00e2n t\u1eed (n\u1ebfu c\u00f3): nguy c\u01a1 cao<\/td>\n<\/tr>\n<tr>\n<td width=\"262\">&nbsp;<\/p>\n<p>L\u00f2ng \u1ed1ng B &#8211; HER2 d\u01b0\u01a1ng t\u00ednh<\/p>\n<p>&nbsp;<\/td>\n<td width=\"331\">ER d\u01b0\u01a1ng t\u00ednh<\/p>\n<p>HER2 d\u01b0\u01a1ng t\u00ednh<\/p>\n<p>Ki-67 b\u1ea5t k\u1ef3<\/p>\n<p>PR b\u1ea5t k\u1ef3<\/td>\n<\/tr>\n<tr>\n<td width=\"262\">HER2 d\u01b0\u01a1ng t\u00ednh (kh\u00f4ng l\u00f2ng<\/p>\n<p>\u1ed1ng)<\/td>\n<td width=\"331\">HER2 d\u01b0\u01a1ng t\u00ednh ER v\u00e0 PR \u00e2m t\u00ednh<\/td>\n<\/tr>\n<tr>\n<td width=\"262\">B\u1ed9 ba \u00e2m t\u00ednh (th\u1ec3 \u1ed1ng-ductal***)<\/td>\n<td width=\"331\">ER, PR, HER2 \u00e2m t\u00ednh<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong>Ch\u00fa th\u00edch:\u00a0 <\/strong><\/p>\n<p>* \u0110i\u1ec3m c\u1ee7a Ki67 t\u00f9y thu\u1ed9c gi\u00e1 tr\u1ecb c\u1ee7a t\u1eebng ph\u00f2ng x\u00e9t nghi\u1ec7m. V\u00ed d\u1ee5: n\u1ebfu m\u1ed9t ph\u00f2ng x\u00e9t nghi\u1ec7m c\u00f3 trung v\u1ecb c\u1ee7a \u0111i\u1ec3m Ki67 \u0111\u1ed1i v\u1edbi b\u1ec7nh c\u00f3 th\u1ee5 th\u1ec3 n\u1ed9i ti\u1ebft d\u01b0\u01a1ng t\u00ednh l\u00e0 20% th\u00ec gi\u00e1 tr\u1ecb t\u1eeb 30% tr\u1edf l\u00ean \u0111\u01b0\u1ee3c coi l\u00e0 cao, 10% tr\u1edf xu\u1ed1ng l\u00e0 th\u1ea5p.<\/p>\n<p>** Gi\u00e1 tr\u1ecb cut-off g\u1ee3i \u00fd l\u00e0 20%.<\/p>\n<p>*** B\u1ed9 ba \u00e2m t\u00ednh c\u0169ng bao g\u1ed3m c\u00e1c th\u1ec3 m\u00f4 h\u1ecdc \u0111\u1eb7c bi\u1ec7t nh\u01b0 ung th\u01b0 bi\u1ec3u m\u00f4 th\u1ec3 t\u1ee7y (\u0111i\u1ec3n h\u00ecnh) v\u00e0 ung th\u01b0 bi\u1ec3u m\u00f4 d\u1ea1ng tuy\u1ebfn nang (adenoid cystic carcinoma) v\u1edbi nguy c\u01a1 th\u1ea5p b\u1ecb t\u00e1i ph\u00e1t di c\u0103n xa.<\/p>\n<h4>3.2.4. Ch\u1ea5t ch\u1ec9 \u0111i\u1ec3m u<\/h4>\n<ul>\n<li>CA15-3, CEA, CA27-29<\/li>\n<\/ul>\n<h4>3.2.5. C\u00e1c x\u00e9t nghi\u1ec7m kh\u00e1c<\/h4>\n<ul>\n<li>B\u1ed9 x\u00e9t nghi\u1ec7m ho\u00e0n ch\u1ec9nh v\u1ec1 chuy\u1ec3n h\u00f3a: glucose m\u00e1u, protein to\u00e0n ph\u1ea7n, albumin, ch\u1ee9c n\u0103ng gan (AST, ALT, bilirubin), ch\u1ee9c n\u0103ng th\u1eadn (ure, creatinine), phosphatase ki\u1ec1m (ALP), \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3 (can-xi huy\u1ebft c\u00f3 th\u1ec3 t\u0103ng trong di c\u0103n x\u01b0\u01a1ng).<\/li>\n<li>N\u1ed3ng \u0111\u1ed9 estradiolv\u00e0 FSH n\u1ebfu l\u00e2m s\u00e0ng kh\u00f4ng r\u00f5 t\u00ecnh tr\u1ea1ng m\u00e3n kinh.<\/li>\n<li>Beta HCG v\u1edbi b\u1ec7nh nh\u00e2n \u0111ang \u0111\u1ed9 tu\u1ed5i sinh \u0111\u1ebb.<\/li>\n<li>C\u00e1c x\u00e9t nghi\u1ec7m th\u01b0\u1eddng quy tr\u01b0\u1edbc khi ph\u1eabu thu\u1eadt, x\u1ea1 tr\u1ecb, ho\u00e1 tr\u1ecb: C\u00f4ng th\u1ee9c m\u00e1u, nh\u00f3m m\u00e1u, ch\u1ee9c n\u0103ng \u0111\u00f4ng m\u00e1u, HIV, vi\u00eam gan vir\u00fat, \u0111i\u1ec7n t\u00e2m \u0111\u1ed3, si\u00eau \u00e2m tim\u2026<\/li>\n<li>C\u00e1c x\u00e9t nghi\u1ec7m kh\u00e1c t\u00f9y theo t\u1eebng tr\u01b0\u1eddng h\u1ee3p c\u1ee5 th\u1ec3\u2026<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Ung th\u01b0 v\u00fa l\u00e0 m\u1ed9t trong nh\u1eefng lo\u1ea1i ung th\u01b0 ph\u1ed5 bi\u1ebfn nh\u1ea5t \u1edf ph\u1ee5 n\u1eef tr\u00ean to\u00e0n th\u1ebf gi\u1edbi. Vi\u1ec7c ch\u1ea9n \u0111o\u00e1n ung th\u01b0 v\u00fa l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi v\u00e0 c\u1ea3i thi\u1ec7n c\u01a1 h\u1ed9i s\u1ed1ng s\u00f3t c\u1ee7a b\u1ec7nh nh\u00e2n. B\u00e0i vi\u1ebft n\u00e0y s\u1ebd gi\u1edbi thi\u1ec7u ph\u00e1c \u0111\u1ed3 [&hellip;]<\/p>\n","protected":false},"author":43,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[6,33],"tags":[3],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Ph\u00e1c \u0111\u1ed3 ch\u1ea9n \u0111o\u00e1n ung th\u01b0 v\u00fa theo b\u1ed9 Y t\u1ebf: L\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng<\/title>\n<meta name=\"description\" content=\"B\u00e0i vi\u1ebft gi\u1edbi thi\u1ec7u v\u1ec1 ph\u00e1c \u0111\u1ed3 ch\u1ea9n \u0111o\u00e1n ung th\u01b0 v\u00fa theo b\u1ed9 Y t\u1ebf, bao g\u1ed3m c\u00e1c ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, 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