乳腺导管原位癌病理形态及c-erbB-2、p53和PCNA表达

目的：对乳腺导管原位癌进行病理形态分析，并行ｃ－ｅｒｂＢ－２、ｐ５３癌基因蛋白、增殖细胞核抗原（ＰＣＮＡ）表达以及相关性的研究，以期为临床判断潜在恶性程度及预后提供参考指标。方法：运用病理形态分析以及枸橼酸－微波－ＡＢＣ免疫组化法对２５例常规福尔马林固定、石蜡包埋乳腺导管原位癌组织进行回顾性研究。结果：（１）２５例乳腺原位导管癌ｃ－ｅｒｂＢ－２、ｐ５３、ＰＣＮＡ表达的阳性率分别为３６．０％，４０．０％和４０．０％；（２）粉刺型ｃ－ｅｒｂＢ－２、ｐ５３、ＰＣＮＡ表达的阳性率均高于非粉刺型，而且ｃ－ｅｒｂＢ－２阳性率相差有显著性（Ｐ＜０．０５）；（３）坏死、核异型性、核分裂数与ｃ－ｅｒｂＢ－２、ｐ５３、ＰＣＮＡ的表达有关，其中，坏死与ＰＣＮＡ阳性表达显著相关（Ｐ＜０．０５），核异型性与ｃ－ｅｒｂＢ－２蛋白表达显著相关（Ｐ＜０．０５）。结论：乳腺导管原位癌无论病理形态还是生物学行为都是异质性的，除了组织学亚型，某些形态指标以及ｃ－ｅｒｂＢ－２癌基因蛋白的表达也可作为恶性度指标。     

c-erbB-2、p53、bcl-2和nm23-H1在肺癌中的表达

目的：探讨ｃｅｒｂＢ２、ｐ５３、ｂｃｌ２和ｎｍ２３Ｈ１基因在肺癌发生发展过程中的作用。方法：用免疫组化ＡＢＣ法对原发性肺癌组织中４种基因的表达和突变进行检测。结果：５８例肺癌中,３１例（５３４５％）ｐ５３过度表达,１８例（３１０３％）ｂｃｌ２过度表达。ｃｅｒｂＢ２与ｎｍ２３Ｈ１在１０例小细胞肺癌（ＳＣＬＣ）中未见表达。而在４８例非小细胞肺癌（ＮＳＣＬＣｓ）中两者过度表达率均为５０％。ｃｅｒｂＢ２与ｎｍ２３Ｈ１表达呈正相关（Ｐ＜００５）。腺癌ｎｍ２３Ｈ１的表达明显高于鳞癌（Ｐ＜００５）。ｐ５３、ｂｃｌ２蛋白表达在肺癌分化程度中呈负相关（Ｐ＜００５）。ｎｍ２３Ｈ１、ｐ５３和ｂｃｌ２的表达与患者的生存率有关（Ｐ＜００５）。结论：ｃｅｒｂＢ２、ｐ５３、ｂｃｌ２和ｎｍ２３Ｈ１基因蛋白产物的检测对肺癌患者的诊治和预后评估有积极意义。     

乳腺导管原位癌病理形态及c—erbB—2,p53和PCN…

目的：对乳腺导管原位癌进行病理形态分析，并行ｃ－ｅｒｂＢ－２、ｐ５３癌基因蛋白、增殖细胞抗原（ＰＣＮＡ）表达以及相关性的研究，以期为临床判断潜在恶性程度及预后提供参考指标。方法：运用病理形态分析以及枸橼酸－微波－ＡＢＣ免疫组化法对２５例 马林固定、石蜡包蛙乳腺导管原位癌组织进行回顾性研究。结果：（１）２５例乳腺原位导管癌ｃ－ｅｒｂＢ－２、ｐ５３、ＰＣＮＡ表达的阳性率分别为３６．０％，４０．０和４０     

癌基因c─erbB─2、抗癌基因p53在乳腺癌中表达的临床病理研究

应用ＡＢＣ法、ＬＳＡＢ法对１４４例乳腺癌及癌旁组织进行了ｃ─ｅｒｂＢ─２、ｐ５３基因蛋白表达的研究。结果：ｃ─ｅｒｂＢ─２表达阳性率为４８．６％，浸润性导管癌阳性率最高（７４．１％）；其表达与肿瘤体积、淋巴结转移、组织分级、核分裂计数、临床分期呈正相关，与雌激素受体（ＥＲ）、孕激素受体（ＰＲ）状况呈负相关，表达者５年生存率显著低于表达阴性者．因而ｃ─ｅｒｂＢ─２表达的检测可作为评估乳腺癌预后的有力指标。ｐ５３表达的阳性率为２４．７％，髓样癌阳性率较高（３８．５％）；ｐ５３表达与组织分级和淋巴结转移状况呈正相关；阳性率随肿瘤体积增大和临床分期升高而增加；在ＥＲ或ＰＲ阴性者中ｐ５３阳性率高于ＥＲ或ＰＲ阳性者。本文未发现ｃ─ｅｒｂＢ─２与ｐ５３表达的相关性；两者表达均阳性者与仅一种阳性者在肿瘤体积、淋巴结转移和临床分期方面差异无显著性。     

p53、c-erbB-2、PCNA和EGFR在膀胱癌中过表达及其意义

目的：研究癌基因和抑癌基因蛋白产物在膀胱移行细胞癌中异常表达与病理分级、临床分期、复发和预后的关系。方法：应用免疫组化Ｓ－Ｐ法检查１１７例膀胱移行细胞癌组织中ｐ５３、ｃ－ｅｒｂＢ－２、ＰＣＮＡ和ＥＧＦＲ的表达水平。结果：１１７例膀胱移行细胞癌中ｐ５３、ｃ－ｅｒｂＢ－２、ＰＣＮＡ和ＥＧＦＲ阳性表达率分别为４７．０％、２９．９％、５３．８％和４８．７％。ｐ５３和ＰＣＮＡ阳性表达产物定位于肿瘤细胞核内，ｃ－ｅｒｂＢ－２阳性表达产物定位于细胞膜上，ＥＧＦＲ阳性表达产物定位于细胞膜或细胞浆内。结果表明ｐ５３、ｃ－ｅｒｂＢ－２、ＰＣＮＡ和ＥＧＦＲ异常表达与膀胱癌的分级、分期、复发及术后生存率等之间有统计学意义。结论：ｐ５３、ｃ－ｅｒｂＢ－２、ＰＣＮＡ和ＥＧＦＲ异常表达有助于评估膀胱癌预后，多基因异常表达作为预后评价指标更有意义。     

癌基因c—erbB—2,抗癌基因P53在乳腺癌中表达的临床病理研究

应用ＡＢＣ法、ＬＳＡＢＩ地对１４４例乳腺癌及癌旁组织进行了ｃ－ｅｒｂＢ－２，ｐ５３基因蛋白表达的研究。结果，ｃ－ｅｒｂＢ－２表达阳性率为４８．６％，浸润性导管是性率最高（７４．１％），其表达与肿瘤体积、淋巴结转移、组织分级、核分裂计数、临床分期呈正相关，与雌激素受体（ＥＲ）、孕激素受体（ＰＲ）状况呈负相关，表达者 ５年生存率显著低于表达阴性者，因而ｃ－ｅｒｂＢ－２表达的检测可作为评估乳腺癌预后的有     

p53、ras p21、c-erbB-2和nm23在肺癌组织中的表达

目的：探讨癌基因与肺癌临床病理特征及预后的关系。方法：应用免疫组化ＳＰ法对５８ 例肺癌行ｐ５３、ｒａｓｐ２１、ｃｅｒｂＢ２和ｎｍ２３ 的检测。结果：癌组织中阳性反应检出率分别为４６－６％ 、２４－１ ％ 、５０－０ ％ 和５３－４ ％ ,腺癌和差分化癌ｒａｓ ｐ２１ 、ｃｅｒｂＢ２表达高于鳞癌和分化好的癌（ Ｐ＜ ０－０５） ,术后长期生存患者ｒａｓｐ２１ 、ｃｅｒｂＢ２ 表达低于短期死亡患者（Ｐ＜ ０－０５ ,Ｐ＜ ０－０１）,吸烟患者ｒａｓ ｐ２１ 表达高于不吸烟患者（Ｐ＜ ０－０５） ,淋巴结癌转移阴性组ｎｍ２３ 表达高于淋巴结癌转移阳性组（ Ｐ＜ ０－０１）,ｐ５３ 与ｒａｓ ｐ２１、ｃｅｒｂＢ２ 阳性表达具有协同性（ Ｐ＜ ０－０５） 。结论：肺癌发生发展和转移与ｒａｓｐ２１ 、ｃｅｒｂＢ２ 的激活和ｐ５３ 、ｎｍ２３ 的失活密切相关,部分基因的改变存在协同性,ｒａｓ ｐ２１ 基因的激活与吸烟有关,ｒａｓ ｐ２１、ｃｅｒｂＢ２ 的检测对判断肺癌预后有价值。     

PCR法检测EB病毒BNLF1基因

目前已建立分子杂交和ＰＣＲ检测ＥｐｓｔｅｉｎＢａｒｒ病毒（ＥＢＶ）ＤＮＡ的方法。近年来研究发现ＥＢＶ致癌作用与ＬＭＰ１蛋白的表达密切相关〔１〕。为此,我们针对ＥＢＶ表达ＬＭＰ１蛋白的ＢＮＬＦ１基因片段建立ＰＣＲ检测方法。１　材料与方法１１　标准病毒和对照病毒　含有ＥＢＶ的Ｒａｊｉ细胞系和带有ＰＧＥＭＩＢＮＬＦ１的菌种有美国国立卫生研究院（ＮＩＨ）Ｊａｃｋｓｏｎ博士赠送。ＨＣＭＶＡＤ１６９、ＨＳＶⅠ、ＶＺＶ购自于上海第二医科大学。１２　主要试剂与仪器　限制性内切酶ＳｔｙＩ,Ｍａｒｋｅｒ购…     

p53,p21,p185蛋白表达与横纹肌肉瘤分化及预后的关系

研究ｐ５３，ｒａｓ和ｃ－ｅｒｂＢ－２癌基因蛋白产物ｐ２１，ｐ１８５在横纹肌肉瘤听表达及其与ＲＭＳ的分型，分级和顾后的关系。     

伯基特淋巴瘤与EB病毒的关系及其p53和bcl-2蛋白的表达

目的 了解柏基特淋巴瘤和ＥＢ病毒的关系及ｐ５３和ｂｃｌ－２蛋白的表达。方法 采用ＰＣＲ、原位ＰＣＲ及免疫组化ＬＳＡＢ方法,检测了２８例伯基特淋巴瘤石蜡包埋的组织块。结果 发现８例ＥＢ病毒ＤＮＡ阳性,阳性率为２８．５％,８例阳性病例做了原位杂交,其中３例为阳性。２７例做了ｐ５３和ｂｃｌ－２免疫组化检测,生病例各为１２例（４４．４％）和１３例（４８．１％）。Ⅰ￣Ⅱ期和Ⅲ￣Ⅳ期ｐ５３和ｂｃｌ－２阳性病例     

Elevated expression of LSD1 (Lysine-specific demethylase 1) during tumour progression from pre-invasive to invasive ductal carcinoma of the breast

ABSTRACT: AimLysine-specific demethylase1 (LSD1) is a nuclear protein which belongs to the aminooxidase-enzymes playing an important role in controlling gene expression. It has also been found highly expressed in several human malignancies including breast carcinoma. Our aim was to detect LSD1 expression also in pre-invasive neoplasias of the breast. In the current study we therefore analysed LSD1 protein expression in ductal carcinoma in situ (DCIS) in comparison to invasive ductal breast cancer (IDC). METHODS: Using immunohistochemistry we systematically analysed LSD1 expression in low grade DCIS (n = 27), intermediate grade DCIS (n = 30), high grade DCIS (n = 31) and in invasive ductal breast cancer (n = 32). SPSS version 18.0 was used for statistical analysis. RESULTS: LSD1 was differentially expressed in DCIS and invasive ductal breast cancer. Interestingly, LSD1 was significantly overexpressed in high grade DCIS versus low grade DCIS. Differences in LSD1 expression levels were also statistically significant between low/intermediate DCIS and invasive ductal breast carcinoma. CONCLUSION: LSD1 is also expressed in pre-invasive neoplasias of the breast. Additionally, there is a gradual increase of LSD1 expression within tumour progression from pre-invasive DCIS to invasive ductal breast carcinoma. Therefore upregulation of LSD1 may be an early tumour promoting event.     

Matriptase and survivin expression associated with tumor progression and malignant potential in breast cancer of Chinese women: tissue microarray analysis of immunostaining scores with clinicopathological parameters

Objective: The aim of this study was to examine the expression of matriptase and survivin in breast carcinoma and correlate with clinicopathological parameters. Methods: Immunohistochemical analysis of matriptase and survivin were performed in tissue microarray slides of 290 cases, including 11 normal breast tissue; 27 fibrocystic disease; 17 fibroadenoma; 6 atypical ductal hyperplasia; 39 ductal carcinoma in situ, low grade (DCIS, low grade); 39 ductal carcinoma in situ, high grade (DCIS, high grade); 27 invasive ductal carcinoma, grade I (IDC, grade I); 78 invasive ductal carcinoma, grade II (IDC, grade II); and 46 invasive ductal carcinoma, grade III (IDC, grade III). Results: The average immunostaining scores of matriptase were 44.1 in normal breast tissue, 52.7 in fibrocystic disease, 76.5 in fibroadenoma, 81.7 in atypical ductal hyperplasia, 133.7 in low-grade DCIS, and 155.8 in high-grade DCIS. Among 151 breast IDC cases, the average immunostaining scores of matriptase were 172.7 in grade I, 211.7 in grade II, and 221.2 in grade III. Additionally, the average immunostaining scores of surviving also correlate with tumor grades and stages. Conclusions: Higher expressions of matriptase and survivin correlate significantly with clinicopathological parameters in breast cancer and the malignant potential in premalignant lesions. In addition, higher survivin expression had poorer prognosis of breast IDC cases.     

Expression of MT-1 MMP, MMP2, MMP9 and TIMP2 mRNAs in ductal carcinoma in situ and invasive ductal carcinoma of the breast

We investigated the expression of membrane type-1 (MT1)-MMP, MMP2, MMP9 and TIMP2 mRNAs and their roles in ductal carcinoma in situ (DCIS) and T1 and T2 invasive ductal carcinoma of the breast. We further compared these two types of carcinomas for differences in microvessel density, and expression of angiogenic factors and CD44std. MT1-MMP, MMP2, MMP9 and TIMP2 mRNA were expressed in both DCIS and invasive ductal carcinomas. Expression rates of MT1-MMP, MMP2, MMP9 and TIMP2 mRNAs were not statistically different between DCIS and invasive ductal carcinomas, nor did they differ statistically when grouped by tumor size, histologic grade or nuclear grade of invasive ductal carcinoma. Microvessel density and expression of VEGF and TGF-beta1 were not statistically different between DCIS and invasive ductal carcinoma. CD44std expression was significantly increased in DCIS compared to invasive ductal carcinoma (p < 0.05) and it was also significantly increased in lower clinical stage, histologic grade and nuclear grade of invasive ductal carcinoma (p < 0.05). Axillary node metastasis was significantly correlated with MT1-MMP mRNA, VEGF and TGF-beta1 expression (p < 0.05) and MT1-MMP mRNA was positively correlated with VEGF expression and TIMP2 mRNA (p < 0.05). In summary, patterns of MMP mRNA expression in DCIS and invasive ductal carcinoma suggest that the invasive potential of breast carcinoma is already achieved before morphologically overt invasive growth is observed. As MT1-MMP mRNA expression is significantly correlated with axillary nodal metastasis, it may be useful as a prognostic indicator of invasive ductal carcinoma. Considering the positive correlation of MT1-MMP mRNA and TIMP2mRNA expression, our finding supports a role for TIMP2 in tumor growth, as well as the utility of CD44std as a prognostic indicator of breast cancer.     

Large palpable ductal carcinoma in situ is Her-2 positive with high nuclear grade

Ductal carcinoma in situ (DCIS) of the breast is a heterogeneous group with variable clinical presentation. The exact molecular mechanism is not known why some ductal carcinomas may reach to such a large size but still remains in situ. Although, molecular classification of DCIS lesions and nuclear grading are important for identification of more aggressive lesions but it is not sufficient. Our aim was to examine the expression pattern of immunohistochemical (IHC) markers of ER, PR, HER-2 in palpable DCIS lesions and compare with clinicopathological findings. Our center is referral hospital from South of Iran. Samples were obtained from fifty four patients with a diagnosis of palpable DCIS. Equivocal (2+) case in HER-2 IHC testing was more characterized by chromogenic in situ hybridization. The positive frequency of HER2, ER, and PR was 92%, 48%, and 37% respectively. Palpable DCIS lesions were significantly more HER-2 positive (92%). The DCIS cases were more likely to be of high nuclear grade (grade III) and Her-2 positive cases were more likely to be of high nuclear grade than intermediate grade. All ER negative tumors had high nuclear grade. The Her-2 positivity is suggested as the most important factor responsible for marked in situ proliferation and production of palpable mass.     

Breast carcinoma in women 35 years and younger: a pathological study

AIMS: To document the pathological features of breast carcinoma diagnosed in women aged 35 years or less. METHODS: The files of the Department of Pathology, Singapore General Hospital, were searched for cases of breast cancer diagnosed in individuals aged 35 years or less between January 1993 and December 2004. Histological slides and pathology reports were retrieved and reviewed. Pathologic parameters of tumour size, histological grade, accompanying ductal carcinoma in situ (DCIS), lymphovascular invasion, nodal status, hormone receptor and c-erbB-2 profiles, were documented. RESULTS: Of 112 cases of breast cancer, 91 (81.3%) were invasive carcinomas, 17 (15.2%) pure DCIS, three (2.7%) were diagnosed on needle aspirates. No residual tumour was available for microscopic assessment in one (0.9%) patient who underwent bilateral mastectomy in our institution but had her initial surgery elsewhere. Invasive tumour size ranged from 0.3 to 11.5 cm (mean 2.7 cm, median 2.1 cm), with 84 (92.3%) infiltrative ductal, two (2.2%) lobular, two (2.2%) mucinous, two (2.2%) atypical medullary, and one (1.1%) mixed ductal-lobular. The majority were grade 3 (54 cases, 59.3%), with 24 (26.4%) grade 2 and 7 (7.7%) grade 1, while grading was not accomplished in six (6.6%) cases. Nodal status was positive in 39 (42.9%), negative in 25 (27.4%), unknown in the rest (27 cases, 29.7%). Oestrogen and progesterone receptors (ER, PR) were positive in 51 (61.4%) and 43 (51.8%) cases, respectively, out of 83 (91.2%) cases in which they were evaluated. c-erbB-2 immunostaining, carried out in 54 (59.3%) invasive cancers, showed positivity in 16 (29.6%) cases.DCIS cases ranged from 0.25 to 6.2 cm (mean 2.2 cm, median 2 cm) in size. Nuclear grade was low in seven (41.2%), intermediate in four (23.5%), and high in six (35.3%). CONCLUSION: The majority of breast carcinomas in young women are invasive, with T2 disease at presentation, and of poor histological grade. The recent rise in numbers suggests increased detection, plausibly due to improved awareness of breast disease among the younger female population. Pathogenetic causes that differ from breast carcinogenesis in older women have to be further clarified.     

Low, intermediate and high grade breast carcinomas as determined by histotyping, immunohistochemical prognosticators and histological grading.

Low grade breast cancers i.e. mucinous (17 cases--3.2%), tubular (7 cases--1.3%) and invasive cribriform carcinomas (3 cases--0.5%) have been identified within a series of 524 breast cancers only by histotyping in hematoxylin-eosin stained sections: the reactivities of immunohistochemical prognosticators as estrogen/progesterone receptors (ER, PgR), growth fraction (GF: Ki67), p53 and c-erbB-2 oncoproteins are in agreement with clinical behaviours. Invasive papillary carcinomas (9 cases--1.6%) are not to be considered low grade carcinomas. Intermediate grade cancers are also determined by histotyping. Medullary carcinoma (13 cases--3.4%) has a paradoxical behaviour displaying a favourable clinical prognosis together with high grading and GF, absence of ER, PgR, high p53 and c-erbB-2 values, as compared with invasive ductal carcinomas: an extensive tissue immune response as suggested by a heavy lymphocyte infiltration may explain this behaviour. Invasive lobular carcinoma (62--11.6%) shows an intermediate immunohistochemical pattern, paralleling an intermediate prognosis, when compared with low and high grade carcinomas: ER, PgR and GF positivities are nearly the same as in ductal carcinomas whereas grading, p53 and c-erbB-2 are less expressed. These data are confirmed both for lobular carcinomas as a whole and for all variants of this kind of tumors. Invasive ductal carcinomas (413 cases--79%) may be stratified on three prognostic classes corresponding to histological grading (G1, G2, G3). Significant relationships of grading with all the immunohistochemical prognosticators studied has been observed. It may be concluded that grading is a parameter of paramount importance in this group of tumors.     

Apocrine ductal carcinoma in situ of the breast: histologic classification and expression of biologic markers

Apocrine ductal carcinoma in situ (ADCIS) has been called a special type of ductal carcinoma in situ (DCIS) because the histologic grading is considered difficult using the classification schemes that have been proposed for common DCIS. However, ADCIS encompasses a spectrum of lesions with different morphologic aspects ranging from minimally atypical to overtly malignant. To define a classification scheme for ADCIS, 35 cases (22 pure and 13 associated with invasive carcinoma) were selected on the basis of conventional morphology on hematoxylin and eosin (H&E)-stained sections. Each case was assigned to 1 of 3 histologic grades (low, intermediate, and high) based on nuclear morphology and the presence of necrosis. In addition, the expression of hormone receptors p53, bcl-2, c-erbB-2, and Ki-67 was evaluated by immunohistochemistry, and the DNA ploidy was determined by image cytometry. Fifteen cases were classified as high histologic grade, 10 as low histologic grade, and the other 10 as intermediate grade. All but 4 cases, irrespective of grade, had the same hormonal immunophenotype: androgen receptor positivity (97.1%) and estrogen receptor and progesterone receptor negativity (94.3% and 97.1% respectively). Twenty-one cases (61.8%) showed p53 expression, and 47.1% of the cases were positive for c-erbB-2. The median positivity for Ki-67 was 5.2%. ADCIS has a unique morphologic and hormonal profile, distinct from common DCIS, deserving a specific classification. The proposed classification scheme allows for categorization of ADCIS according to the most important morphologic features already seen in common DCIS, ie, nuclear grade and necrosis. The expression of biologic markers other than hormonal receptors and bcl2 in ADCIS seems in general to be similar to that in common DCIS. Ki-67 and c-erbB-2 are expressed more frequently in intermediate and high histologic grade ADCIS.     

Multiple developmental pathways of highly aggressive breast cancers disclosed by comparison of histological grades and c-erbB-2 expression patterns in both the non-invasive and invasive portions

To determine the developmental stages at which the highly malignant phenotype of breast carcinoma is acquired, the histological grade and c- erbB -2 oncoprotein expression status were examined for both the ductal carcinoma in situ (DCIS) and Invasive components of 437 separate Invasive breast carcinomas. In 218 invasive carcinomas with high-grade atypla (grade 3), the DCIS components were grade 2–3 In 158 cases (73%). Twenty-seven (12%) showed an obvious stepwise Increase from grade 1 DCIS to grade 3 invasive carcinoma, and 25 of these tumors had DCIS components covering > 325% of their area. Ductal carcinoma in situ components were undetectable In 33 (15%) of invasive carcinomas. The Incidence of c-erb B -2 overexpression was higher in grade 3 carcinomas with grade 2–3 DCIS components (55%, 80 of 146) than in those with grade 1 DCIS components (5%, one of 25). The Incidence was also higher in grade 3 carcinomas with DCIS components covering ≥ 25% of the tumor area (71%, 39 of 55) than in those with DCIS over > 325% of the total area (36%, 42 of 116) or without DCIS components (6%, two of 33). There appeared to be three prototypic pathways to high-grade breast carcinoma: (i) invasion by a high-grade DCIS regardless of the extent of DCIS spread; (II) invasion by a low-grade DCIS during the microscopic stages, accompanied by an obvious enhancement of the grade; and (iii) development of an invasive carcinoma ab inltlo. c-erb B-2 overexpression appeared to be frequently involved in the early development of the first group but showed little relation to the invasive process in any of these three pathways. The histological grade and c- ert B-2 overexpression appeared to be largely established during the early microscopic stages of a DCIS or invasive carcinoma.     

A critical appraisal of six modern classifications of ductal carcinoma in situ of the breast (DCIS): correlation with grade of associated invasive carcinoma

The in-situ component of 180 cases of screen detected infiltrating duct carcinoma of the breast was classified according to six published classifications for ductal carcinoma in situ based on architecture, necrosis and cytology. All cases were assessed independently by two experienced observers to assess inter-observer variation. The differentiation of ductal carcinoma in situ as assessed by all the classification systems correlated with the grade of the associated invasive carcinoma (chi-squared between 50 and 107: P <0.0001). Disagreements were commonest in the assessment of architecture and least common in the assessment of necrosis. For cytonuclear grade most disagreements (62.2%) involved the distinction between low and intermediate as against 33.9% disagreements for intermediate vs. high. Nuclear grade alone and necrosis alone were correlated with the grade of invasive carcinoma associated with the ductal carcinoma in situ and the Nottingham prognostic index of the patient. The Van Nuys classification of ductal carcinoma in situ is commended because it has a low inter-observer disagreement, is significantly correlated with the grade of the infiltrating carcinoma, uses simple well-defined criteria (with no requirement for percentage estimations), is applicable to small numbers of ducts and, most importantly, appears to correlate with disease-free survival.     

Biologic markers in ductal carcinoma in situ and concurrent infiltrating carcinoma. A comparison of eight contemporary grading systems

The relevance of 8 contemporary classification and grading systems for ductal carcinoma in situ (DCIS) of the breast was examined in 100 tumors by comparing DCIS grade with grade of the concurrent infiltrating ductal carcinoma (IDC). Besides tumor size and nodal status, the immunohistochemical parameters in both lesions were compared, including estrogen receptor, progesterone receptor, c-erbB-2 protein, E-cadherin, vimentin, Ki-67 (MIB1), and p27. Nuclear grading of DCIS alone or in combination with architectural pattern and necrosis showed the best correlation with grade of the invasive component. There also was a positive correlation between every biologic marker expressed in DCIS and in the concurrent IDC, supporting a clonal relationship. Biologic markers varied between the different grades of DCIS. DCIS is heterogeneous, and the progression of DCIS to IDC may be from low-grade DCIS to low-grade IDC and high-grade DCIS to high-grade IDC. This concept is different from the conventional model held for intraepithelial neoplasia in the cervix, vulva, vagina, and skin, in which there is increasing severity of in situ atypia (dysplasia) before the development of stromal invasion.