乳腺癌全乳腺切片的病理组织学研究：Ⅰ.多厚发癌灶

From April 1988 to January 1989, histopathologic studies by whole organ subserial sections was done in 200 mastectomy specimens of female breast carcinoma. Multicentricity was demonstrated in 40 breast, with 68 multicentric lesions, an incidence of 20%. 80% of these 68 foci were clinically occult, measuring less than or equal to 1.0 cm. 72% was histologically noninvasive whereas only 28% invasive. Among the different pathologic types, intraductal carcinoma was more common (66%) than the others. Most (85%) of the multicentric lesions in the breast had one or two foci, rarely more than two. Multicentric lesions are usually distributed in the neighboring one or two quadrants of the primary cancer, seldom throughout three or four quadrants. They were less frequently seen in the same quadrant (22.5%). The multifocal growth was not related to age or menstrual status of the patient.     

乳腺导管内癌与乳腺浸润性导管癌的超声特征及病理对照分析

目的探讨乳腺导管内癌与乳腺浸润性导管癌的超声特征及病理情况。方法选取2014年2月至2016年1月间广东省肇庆市第一人民医院收治的45例乳腺导管内癌患者与45例乳腺浸润性导管癌,分析两种乳腺癌患者的超声声像特点与病理情况的差异。结果两种乳腺癌患者的病灶大小、形状、血流信号、病灶周边毛刺与边界情况比较,差异均有统计学意义(均P<0.05)。结论乳腺导管内癌与乳腺浸润性导管癌的超声特征及病理情况上有差异明显,有助于临床疾病的鉴别诊断。     

5例乳腺叶状囊肉瘤的组织学及免疫组化观察

探讨乳腺叶状囊肉瘤的组织学与免疫组化表达的关系。方法：应用HE染色和免疫组化S－P法等技术,对5例叶状囊肉瘤与5例纤维腺癌在光镜下对比观察。结果：5例叶状囊肉瘤间质细胞呈多形性、不典型性等改变;间质细胞ER、PR阳性表达率为80％（4／5）,PCNA均阳性表达。乳腺纤维瘤间质细胞无异型性。免疫组化显示：PR阳性表达率为40％（2/5）。结论：乳腺叶状囊肉瘤的组织学及抗原表达情况与乳腺纤维腺瘤有明显区别。提示ER和PCNA的共同表达在本瘤的发生发展过程中起重要作用。     

乳腺导管癌的临床病理特点及外科治疗探讨

乳腺导管癌的最适治疗方案仍不清,传统的治疗方法是根治性乳房切除。近来国外一些学者采用保守手术并辅以放射治疗乳腺导管癌,经多年随访已取得与传统治疗方法近似的疗效,然而国内此类报道尚少。本文对29例乳腺导管癌的临床病理特点及外科治疗结果进行分析,并结合文献报道探讨其最适治疗方案。临床病理资料 1980～1990年我院行乳腺癌根治术189例,术后经病理证实为导管癌的29例(15.3％),包括2例轻度浸润的Paget’s病.其中16例(55.2％)做了改良根治术,12例(41.4％)做了根治术,1例(3.4％)做了单纯乳房切除术。28例术后辅以放疗和CMF     

导管内癌的临床病理特点及治疗

导管内癌的发病率不断上升，根据导管内癌临床生物学特点制定合理的临床治疗方案已成为众多学者研究的热点。本文就导管内癌的临床病理特点及其治疗方案作一综述。     

乳腺导管内癌超声声像图特征和临床病理的相关性研究

目的:回顾性分析乳腺导管内癌常见超声表现,探讨导管内癌超声图像特征和临床病理的相关性.方法:回顾性分析59例乳腺导管内癌(其中21例伴微浸润)超声检查结果,总结导管内癌常见超声声像图特征.根据病灶超声声像图特征,将全部病例分为超声肿块型和超声非肿块型2大类,研究这两类图像特征与患者钼靶、病理分级及ER、PR、CerbB-2 、P53、bcl-2表达的相关性.结果:59例导管内癌(DCIS)超声声像图表现多样,31例(52.5%)为肿块型,28例为非肿块型包括:11例(18.6%)导管扩张型,5例(8.5%)微小结节型,4例(6.8%)片状低弱回声型,2例(3.4%)仅见钙化而无其他图像改变,6例(10.2%)超声未见异常.超声肿块型DCIS通常钼靶也多表现为肿块影(67.7%), 超声非肿块型DCIS钼靶上以钙化为主要表现 (64.3%),组间分布有统计学差异(P<0.01).超声肿块型组中,高级别DCIS较少,占38.7%, ER、PR阳性率较高,为83.9%和77.4%;超声非肿块型组中,高级别DCIS较多,占67.9%(P=0.02),ER、PR阳性率较低,为53.6% (P=0.01)和46.4% (P=0.01),组间分布均有统计学差异.结论:超声非肿块组DCIS高级别比例和激素受体阴性表达明显高于超声肿块组.DCIS非肿块的超声声像图特征提示肿瘤高级别和激素受体阴性可能性大,间接预示肿瘤分化差、侵袭性强.超声非肿块型可能是DCIS预后不良的指标.     

乳腺导管内癌超声声像图特征和临床病理的相关性研究

目的：回顾性分析乳腺导管内癌常见超声表现,探讨导管内癌超声图像特征和临床病理的相关性。方法：回顾性分析59例乳腺导管内癌（其中21例伴微浸润）超声检查结果,总结导管内癌常见超声声像图特征。根据病灶超声声像图特征,将全部病例分为超声肿块型和超声非肿块型2大类,研究这两类图像特征与患者钼靶、病理分级及ER、PR、CerbB-2、P53、bcl-2表达的相关性。结果：59例导管内癌（DCIS）超声声像图表现多样,31例（52．5％）为肿块型,28例为非肿块型包括：11例（18．6％）导管扩张型,5例（8．5％）微小结节型,4例（6．8％）片状低弱回声型,2例（3．4％）仅见钙化而无其他图像改变,6例（10．2％）超声未见异常。超声肿块型DCIS通常钼靶也多表现为肿块影（67．7％）,超声非肿块型DCIS钼靶上以钙化为主要表现（64．3％）,组间分布有统计学差异（P〈0．01）。超声肿块型组中,高级别DCIS较少,占38．7％,ER、PR阳性率较高,为83．9％和77．4％;超声非肿块型组中,高级别DCIS较多,占67．9％（P=0．02）,ER、PR阳性率较低,为53．6％（P=0．01）和46．4％（P=0．01）,组间分布均有统计学差异。结论：超声非肿块组DCIS高级别比例和激素受体阴性表达明显高于超声肿块组。DCIS非肿块的超声声像图特征提示肿瘤高级别和激素受体阴性可能性大,间接预示肿瘤分化差、侵袭性强。超声非肿块型可能是DCIS预后不良的指标。     

Utility of Intraoperative Frozen Section Examination of Sentinel Lymph Nodes in Ductal Carcinoma In Situ of the Breast

BackgroundIntraoperative frozen section (IFS) examination of sentinel lymph nodes (SLN) is useful in selecting patients with invasive breast cancer for immediate axillary lymph node dissection. However, whether IFS evaluation of the SLNs in ductal carcinoma in situ (DCIS) of the breast has any value has not been previously assessed.MethodsClinicopathologic data from patients with DCIS who underwent resection with SLN biopsy (2004-2010) were collected to assess the sensitivity, specificity, and accuracy of IFS, and its impact on axillary management.ResultsA total of 267 patients with DCIS underwent resection with SLN biopsy and IFS evaluation. Preoperative pathology was DCIS (n = 231), DCIS with microinvasion (n = 24), and DCIS with other lesions (n = 12). Fifty-two (19.5%) patients had invasive breast cancer on final pathology. SLN metastases were identified in 13 (4.8%) patients; however, only 4 (1.5%) were IFS positive. IFS examination was negative in 263 (98.5%) patients. Among patients with SLN metastases, the most common pattern of metastases was either micrometastasis (n = 6) or immunohistochemistry-positive individual tumor cells (n = 4), whereas 3 patients had a macrometastasis. IFS examination was falsely negative in 9 of these 13 patients for a false-negative rate of 69.3%, and a sensitivity and specificity of 31% and 100% respectively. Nine of the 13 patients underwent axillary lymph node dissection and only 1 patient had further axillary metastasis.ConclusionsSLN metastases in DCIS is rare and most commonly involves SLN micrometastasis or immunohistochemistry-positive individual tumor cells. SLN IFS evaluation in DCIS has a low yield and sensitivity, and can be safely omitted to reduce operative duration and cost.     

血清蛋白质指纹图谱模型在乳腺导管内癌诊断中的应用

摘 要：［目的］ 探讨蛋白质检测技术在乳腺导管内癌患者诊断中的应用价值。［方法］ 用SELDI-TOF-MS技术及配套蛋白质芯片检测40例乳腺导管内癌患者及40名健康者的血清蛋白质指纹图谱,建立诊断模型。［结果］ 3个蛋白质峰（质/荷比分别为4487.9、6468.1和7575.1）组合构建的诊断模型可鉴别乳腺导管内癌患者和健康者,灵敏度为92.50%(37/40),特异性为90.00%(36/40),阳性预测值为90.24%（37/41）,阴性预测值为92.30%（36/39）,准确率为91.25%（73/80）。［结论］ SELDI-TOF-MS在乳腺导管内乳头状癌诊断尤其是早期诊断以及候选标志物筛选等方面具有一定价值,值得进一步深入研究。     

Tubular Carcinoma of the Breast: Clinicopathologic Features and Survival Outcome Compared with Ductal Carcinoma In Situ

Purpose

Tubular carcinoma (TC) of the breast is an uncommon histological subtype of invasive breast cancer with an excellent prognosis compared with standard invasive ductal carcinoma. Recent studies suggested a possible precursor role for low grade ductal carcinoma in situ (DCIS) in the development of TC. The goal of this analysis was to understand the clinicopathologic features and outcomes of TC by comparing TC with DCIS.

Methods

A retrospective review identified 70 patients with TC and 1,106 patients with DCIS between 1995 and 2011. Student t-test and Fisher exact test were used to compare the clinicopathologic characteristics of TC patients with those of DCIS patients. The Kaplan-Meier method and Cox regression analysis were used to determine disease-free survival (DFS) rates.

Results

Compared to DCIS, TC exhibited favorable clinicopathologic characteristics such as a lower nuclear grade (92.3%), higher expression of hormonal receptors (estrogen receptor-positive, 92.9%; progesterone receptor-positive, 87.0%), and less frequent overexpression of human epidermal growth receptor 2 (12.9%). DFS did not differ significantly between the TC and DCIS groups (5-year DFS, 100% vs. 96.7%; 10-year DFS, 92.3% vs. 93.3%; p=0.324), and cancer-specific deaths were not noted in either group. However, axillary lymph node involvement was observed in six (8.6%) of the 70 patients with TC. Three of these patients had small tumors (≤1 cm).

Conclusion

In our study cohort, TC was associated with an excellent prognosis and a low rate of lymph node metastasis. However, lymph nodes metastases were found even in patients with small tumors (≤1 cm). Axillary staging must be considered for all patients with TC of the breast.     

The Role of Radiotherapy in the Conservative Treatment of Ductal Carcinoma in Situ of the Breast

Breast-conserving surgery (BCS) followed by radiotherapy (RT) has become the standard of care for the treatment of early-stage (St. I-II) invasive breast carcinoma. However, controversy exists regarding the value of RT in the conservative treatment of ductal carcinoma in situ (DCIS). In this article we review the role of RT in the management of DCIS. Retrospective and prospective trials and meta-analyses published between 1975 and 2007 in the MEDLINE database, and recent issues of relevant journals/handbooks relating to DCIS, BCS and RT were searched for. In retrospective series (10,194 patients) the 10-year rate of local recurrence (LR) with and without RT was reported in the range of 9-28% and 22-54%, respectively. In four large randomised controlled trials (NSABP-B-17, EORTC-10853, UKCCCR, SweDCIS; 4,568 patients) 50 Gy whole-breast RT significantly decreased the 5-year LR rate from 16-22% (annual LR rate: 2.6-5.0%) to 7-10% (annual LR rate: 1.3-1.9%). In a recent meta-analysis of randomised trials the addition of RT to BCS resulted in a 60% risk reduction of both invasive and in situ recurrences. In a multicentre retrospective study, an additional dose of 10 Gy to the tumour bed yielded a further 55% risk reduction compared to RT without boost. To date, no subgroups have been reliably identified that do not benefit from RT after BCS. In the NSABP-B-24 trial, the addition of tamoxifen (TAM) to RT reduced ipsilateral (11.1% vs. 7.7%) and contralateral (4.9% vs. 2.3%) breast events significantly. In contrast, in the UKCCCR study, TAM produced no significant reduction in all breast events. Based on available evidence obtained from retrospective and prospective trials, all patients with DCIS have potential benefit from RT after BCS. Further prospective studies are warranted to identify subgroups of low-risk patients with DCIS for whom RT can be safely omitted. Until long-term results of ongoing studies on outcomes of patients treated with BCS alone (with or without TAM or aromatase inhibitors) are available, RT should be routinely recommended after BCS for all patients except those with contraindication.     

Possible Prognostic Role of HER2/Neu in Ductal Carcinoma In Situ and Atypical Ductal Proliferative Lesions of the Breast

HER2/neu is a well-established prognostic and predictive factor for invasive breast cancer. However, the role of HER2/neu in ductal breast carcinoma in situ (DCIS) is debated and recent data have suggested that it is mainly linked to in situ local recurrence. Although molecular data suggest that atypical ductal hyperplasia (ADH) and duct carcinoma in situ (DCIS) are related lesions, albeit with vastly different clinical implications, the role of HER2/neu expression in atypical ductal hyperplasia is not well de ned either. The aim of this study was to evaluate over expression of HER2/neu in DCIS and cases of ADH in comparison with invasive breast carcinoma. Archival primary breast carcinoma paraf n blocks (n15), DCIS only (n10) and ductal epithelial hyperplasia and other breast benign lesions (n25) were analyzed for HER2/neu immunoexpression. Follow up was available for 40% of the patients. HER2/neu was positive in 80%of both DCIS and invasive carcinoma, and 67% of atypical ductal hyperplasia (ADH) cases. Thus at least a subset of patients with preinvasive breast lesions were positive, which strongly suggests a role for Her2/neu in identifying high-risk patients for malignant transformation. Although these are preliminary data, which need further studies of gene ampli cation within these patients as well as a larger patient cohort with longer periods of follow up, they support the implementation of routine Her2/neu testing in patients diagnosed as pure DCIS and in orid ADH.