超声引导下空芯针活检对于乳腺肿瘤诊断的意义

目的 探讨超声引导下空芯针活检对于乳腺肿瘤诊断的意义.方法 超声引导下空芯针活检乳腺肿瘤97例,对照组为252例乳腺肿瘤的触诊法空芯针活检.以手术后的病理诊断作为诊断的金标准,比较两种方法的符合率和穿刺次数.结果 (1)超声引导下空芯针活检符合率为96.9﹪,高于触诊法的85.7﹪,(P＜0.05);对于乳腺癌的诊断,超声引导下空芯针活检敏感度为96.9﹪,高于触诊法的84.8﹪,(P＜0.05);对于直径≤30 mm肿瘤超声引导下空芯针活检乳腺肿块的符合率为95.7﹪,高于触诊法的75.2﹪,(P＜0.05);(2)触诊法空芯针活检病例平均穿刺6.1次,超声引导下3.8次(P＜0.05).结论 超声引导下空芯针活检对于乳腺癌诊断准确,平均取材次数少,值得临床应用.     

彩超引导下空芯针穿刺在乳腺肿块诊断中的意义

目的:评价彩超引导下空芯针穿刺活检（US-CNB）在乳腺肿块诊断中的临床意义。方法:回顾性分析宿州市立医院肿瘤外科2011年1月至2014年6月行空芯针穿刺活检病人120例,对空芯针穿刺活检和切除活检标本的病理组织学诊断进行比较和分析。结果:120例乳腺疾病病人经空芯针穿刺活检组织学诊断乳腺癌为90例,7例假阴性,假阴性率为5.8%。US-CNB 与切除活检的病理诊断符合率为94.2%,无显著性差异（P＞0.05）,空芯针穿刺结果与肿瘤性质、部位、患者年龄、钙化等因素,无显著性差异（P＞0.05）,与肿瘤大小有显著性差异（P＜0.05）。结论:彩超引导下空芯针穿刺活检是一种敏感性高、特异性强、安全性较高的乳腺病变诊断方法。     

剪切波弹性成像对穿刺活检诊断为乳腺导管内原位癌的患者升级为浸润性癌的预测价值

目的评价超声剪切波弹性成像(SWE)对于超声引导下空芯针穿刺活检诊断为乳腺导管内原位癌(DCIS)的患者组织学升级为浸润性癌的预测价值。方法选取2013年1月至2019年2月在南京医科大学附属无锡人民医院经超声引导下空芯针穿刺活检诊断为单纯性DCIS患者159例。对患者行常规超声检查、SWE检查及组织病理学检查,记录患者临床病理特征(年龄、空芯针直径、钼靶腺体厚度、病理级别、手术方式)、常规超声图像特征(肿块最大直径、形态、回声、微钙化等)以及SWE图像特征[最大杨氏模量(E_(max))值和平均杨氏模量(E_(mean)值)]。采用多因素Logistic回归分析穿刺活检诊断为DCIS的患者组织学升级为浸润性癌的影响因素。结果 159例患者术后病理诊断为单纯性DCIS者(单纯DCIS组)105例,诊断为DCIS伴浸润性癌成分者(浸润性癌组)54例,组织学升级率为34.0%(54/159)。浸润性癌组与单纯DCIS组肿块可触及、超声测量肿块最大直径、超声显示微钙化位置、超声乳腺影像报告和数据系统(BI-RADS)分级、E_(mean)值及E_(max)值差异均有统计学意义(P0.05)。多因素Logistic回归分析结果显示,E_(mean)值是穿刺活检诊断为DCIS的患者组织学升级为浸润性癌的独立预测因素(OR=1.254,95%CI:1.029～1.827,P0.05)。E_(mean)值预测组织学升级的ROC曲线下面积为0.923(95%CI:0.825～1.000),最佳临界值为102.4 kPa,敏感性为94.9%,特异性为83.3%。结论 SWE测量得到的E_(mean)值是术前预测超声引导下穿刺活检诊断为DCIS的患者组织学升级为浸润性癌的有效辅助手段。     

超声引导空芯针穿刺活检在乳腺肿物诊断中的应用

目的探讨超声引导下14G空芯针穿刺组织活检在乳腺肿物诊断中的应用,并与手术病理结果相对照,确定其诊断的准确率,随访观察穿刺后近期及远期并发症。方法回顾性分析超声检查发现BIRADS 4b~4c乳腺肿物的患者170例,共173个乳腺肿物,均在超声引导下行乳腺肿物穿刺活检及病理学检查。所有肿物在穿刺结果回报后均接受外科手术切除。穿刺结果为浸润性乳腺癌则依据患者病情接受乳腺癌改良根治或保乳根治手术。穿刺结果为良性则行肿物切除术。最终均以外科手术切除后的病理结果为金标准。观察穿刺术后近期及远期并发症。结果穿刺活检病理报告浸润性乳腺癌的肿物141个（81.5%）,其余32个肿物（18.5%）均报告为良性病变：纤维腺瘤26个,其他良性病变6个。3例患者为双侧乳腺肿物,双侧浸润性乳腺癌1例;一侧为浸润性癌、对侧为纤维腺瘤2例。与手术病理结果相对照超声引导下14G空芯针穿刺的敏感度和特异性分别为99.3%和100%,阴性预测值为96.8%,假阴性1例,假阴性率0.7%。发生穿刺部位血肿2例,穿刺区皮下瘀斑45例,无感染病例。中位随访32月未发现局部复发病例。结论超声引导下14G空芯针穿刺活检是乳腺癌有效和安全的诊断方法。     

Encor微创旋切系统对乳腺癌的诊断价值

目的分析超声引导下EnCor乳腺真空辅助旋切系统对乳腺癌的诊断价值。方法对120例经术后病理组织学检查确诊的乳腺癌患者,术前超声引导下行Encor微创旋切活检术和空心针穿刺活检术(core needle biopsy,CNB),比较2种方法的诊断符合率、漏诊率以及不同肿块大小和病理类型的诊断符合率。结果 120例乳腺癌Encor微创旋切活检术和CNB诊断符合率分别为97.5%和80.8%(P<0.05),漏诊率分别为2.5%和10.8%(P<0.01);肿块直径≤1.0 cm、1.1～2.0 cm的两种检查方法诊断符合率分别为83.8%、100.0%和44.4%、69.4%(P<0.01);肿块直径2.1～5.0 cm、>5.0 cm以及除浸润性导管癌外其他病理类型乳腺癌诊断符合率,2种检查方法比较无统计学意义。结论超声引导下Encor微创旋切活检术对乳腺癌的诊断,具有高确诊率、低漏诊率、安全、微创等优势。     

超声引导穿刺活检对乳腺肿物的诊断价值

目的:探讨超声引导下穿刺活检（ultrasound guided-core needle biopsy,US-CNB）对乳腺肿物的诊断价值。方法:收集2014年1月至2014年12月在哈尔滨医科大学附属肿瘤医院门诊及住院期间进行超声引导下穿刺活检的乳腺肿物患者的病理诊断结果,并与其术后病理结果进行一致性分析,并将超声下病灶≤2 cm的单独列出,检验其一致性。结果:总体上,US-CNB病理诊断结果与术后病理诊断结果的一致率为96.8%,一致性极好,乳腺病灶≤2 cm的比例为54.5%,一致率为95.7%,较总体一致率相差不大,而在一致性方面极高。结论:US-CNB技术作为术前诊断方法之一,对超声下乳腺较小病灶具有较好的诊断价值。     

超声介导下BI-RADS 4级乳腺肿物行空心针穿刺活检的诊断意义

目的:探讨超声介导下BI-RADS 4级乳腺肿物患者行空心针穿刺活检对肿物性质的诊断价值。方法:随机抽取我科于2014年1月-2014年12月共500例已行手术治疗的乳腺肿块患者,收集其穿刺病理与切检病理（包括术中快速冰冻切片或术后病理）结果,应用SPSS 17.0对其空心针穿刺活检与切除活检结果一致性作比较分析,并将超声下BI-RADS 4级的病例单独列出,检验组间一致性。结果:超声介导下空心针穿刺活检（US-CNB）与切除活检的病理诊断结果符合率为96.23%,BI-RADS 4级病例诊断结果符合率为94.57%,与整体准确率相差不大,与切除活检具有良好的一致性。结论:US-CNB作为对乳腺肿瘤的术前诊断手段之一,对超声下良恶性难以鉴别的BI-RADS 4级乳腺肿物具有较好的诊断价值。     

特殊类型乳腺恶性病变与常见浸润性导管癌超声声像图的对比分析

目的 探讨少见的特殊类型乳腺恶性病变与常见乳腺浸润性导管癌的超声声像特征差异.方法 选取经术后病理证实的乳腺乳头状癌34例,乳腺黏液癌39例,同期诊断的乳腺浸润性导管癌100例,对3组患者的术前超声声像进行分析对比,探讨乳腺乳头状癌、乳腺黏液癌与乳腺浸润性导管癌的声像特征差异.结果 乳腺乳头状癌的病灶直径≥2 cm(76.47％)、边界清晰(52.94％)、边缘无毛刺(73.53％)、后方回声不衰减或增强(82.35％)、病灶内部等回声(35.29％)、无微小钙化灶(55.88％)的比例均高于乳腺浸润性导管癌,差异均有统计学意义(P﹤0.05);乳腺黏液癌的病灶边缘无强回声晕(79.49％)、后方回声不衰减或增强(84.62％)、病灶内部混杂回声(64.10％)、病灶内部等回声(25.64％)、无微小钙化灶(74.36％)的比例均高于乳腺浸润性导管癌,差异均有统计学意义(P﹤0.05).结论 乳腺乳头状癌、乳腺黏液癌与乳腺浸润性导管癌的声像特征存在差异,可以作为术前鉴别诊断的一种辅助手段应用.     

高频超声引导14G粗针活检在乳腺肿块诊断中的应用

目的：探讨高频超声引导下14G粗针活检在乳腺肿块诊断中的应用价值。方法：回顾性分析58例行高频超声引导下14G粗针活检术的乳腺肿块患者的超声、穿刺病理、手术病理及临床资料。结果：超声诊断符合率为93.1%（54/58）。超声引导14G 粗针活检病理诊断符合率为100%（58/58）。58例患者有36例行手术治疗,手术病理和穿刺病理符合率为100%（36/36）。取材满意率为96.6%（56/58）。58例均未发现严重并发症。结论：高频超声引导下14G粗针活检术对乳腺肿块的诊断具有确诊率高、创伤小、取材成功率高、并发症少等优势,能为临床治疗提供准确可靠的病理依据,具有较高的临床应用和推广价值。     

钼靶X线立体定位空芯针活检的临床应用

[目的]评价钼靶X线立体定位空芯针活检在乳腺病灶诊断中的应用价值。[方法]87例乳腺肿块的患者在X线立体定位下,利用空芯针活检术获取组织行病理学检查,随后全部患者行手术切除病理检查。[结果]87例患者空芯针活检病理诊断乳腺癌12例,导管上皮不典型增生19例,乳腺其他良性病变56例,灵敏度93.3％,特异度94．7％。[结论]X线立体定位引导空芯针活检术操作简单,并发症少,病理诊断准确性高。     

超声引导下空芯针穿刺活检诊断的乳腺导管原位癌病理学低估的危险因素分析

背景与目的：由于存在病理学低估,乳腺导管原位癌（ductal carcinoma in situ,DCIS）是否需要行腋窝前哨淋巴结活检（sentinel lymph node biopsy,SLNB）仍有争议。通过回顾性分析,探索超声引导下空芯针穿刺活检（core needle biopsy,CNB）诊断的DCIS出现病理学低估的危险因素,探讨穿刺病理学诊断为单纯DCIS的患者免除腋窝SLNB的可能性。方法：选取2005年3月—2014年10月北京大学肿瘤医院暨北京市肿瘤防治研究所乳腺癌预防治疗中心收治的符合以下条件的乳腺癌病例纳入研究：女性;超声引导下CNB诊断为乳腺DCIS（含微浸润）;腋窝淋巴结临床阴性;接受规范的手术、放疗或全身系统性治疗。统计患者的临床病理学特征,采用χ ² 检验或Fisher精确概率法进行临床病理学特征与病理学低估比例的相关性分析,采用logistic回归探索病理学低估可能的危险因素。结果：研究纳入单纯DCIS、DCIS伴微浸润和DCIS可疑微浸润分别360、63和31例。单纯DCIS术后病理未升级占56.4%,升级为微浸润癌和浸润癌分别为21.7%和21.9%;后两组术后病理学诊断为微浸润癌的比例为30.2%和35.5%,浸润癌的比例为66.7%和61.3%,组间差异有统计学意义（P<0.001）。肿瘤＞3 cm和核分级高发生病理学低估的风险,分别是肿瘤≤3 cm和核分级中低的1.97倍（95% CI：1.17~3.32,P=0.011）和2.30倍（95% CI：1.34~3.98,P=0.003）,而人表皮生长因子受体2（human epidemal growth factor receptor 2,HER2）不确定（OR=0.37,95% CI：0.19~0.72,P=0.003）和阳性（OR=0.38,95% CI：0.20~0.73,P=0.004）发生病理学低估的风险低于HER2阴性,差异有统计学意义。肿瘤>3 cm、核分级高、HER2阳性的CNB单纯原位癌的病理学低估比例最高,为73.1%;肿瘤>3 cm、核分级高、HER2不确定的病理学低估比例最低,为11.9%。结论：超声引导下CNB诊断的DCIS伴微浸润或DCIS可疑微浸润病理学低估的比例远高于单纯DCIS,二者不能免除SLNB。肿瘤＞3 cm、核分级高和HER2阴性是术前单纯DCIS出现病理学低估可能的危险因素,单纯DCIS仍需行腋窝SLNB。     

Personal experience of ultrasound-guided 14-gauge core biopsy of breast tumor.

AIM: This study was aimed to examine the efficacy of ultrasound-guided core needle biopsy of breast tumor and compared with the results of previous publications. METHODS: From January 2001 to September 2003, 546 lesions in 513 consecutive patients with the identification of a tumor on ultrasound examination categorized belong and above C3 according to BIRADS (Breast Image Reporting and Data Systems). A minimum of three samples was taken during the biopsy process. RESULTS: The patients' ages ranged from 17 to 89 years (mean, 43 years); tumors were from 5.7 to 41.6 mm in diameter (mean, 20.3 mm). There were 341 lesions with benign findings, 202 lesions with malignancy and 3 lesions with atypical ductal hyperplasia (ADH). Underestimates were found in five patients. Two patients were "ADH-DCIS (ductal carcinoma in situ) underestimate", and three patients were "DCIS-IDC (invasive ductal carcinoma) underestimate". The ADH underestimation rate was 40% (2/5) and DCIS underestimation rate was 43% (3/7). No false-positive results were observed. According to this study, the accuracy rate was 99%, sensitivity rate 97.6%, specificity rate 100%, and false-negative rate 2.4%. CONCLUSIONS: Both palpable and impalpable breast lesions should be examined under image guidance and automated core biopsy is the technique of first choice. Fourteen-gauge core biopsy can provide a definitive diagnosis in 99% of solid tumors in this series.     

Evaluation of histopathological criteria for identifying nodenegative breast cancer witn high risk of early recurrence in the nsas-bc protocol study

BACKGROUND: The histopathological criteria for high-risk node-negative primary breast cancer stated in the National Surgical Adjuvant Study of Breast Cancer (NSAS-BC) protocol were used to grade a consecutive series of 488 cases at our hospital. METHODS: To validate the criteria retrospectively, we examined the histological features of node-negative primary breast cancers which showed early relapse within 2 years after surgical therapy. RESULTS: Early relapse occurred in 12 patients, distant metastases in 11, and local recurrence in one. Among 278 cases followed for up to 1.5 years or longer, early systemic relapse was detected in 10 (5.8%) of 172 higher-grade tumors (9 invasive ductal carcinomas of nuclear grade 3 and one invasive ductal carcinoma of nuclear grade 2) and one stromal cell sarcoma. Among the 115 low-risk tumors, only one case (0.9%) of invasive ductal carcinomas with nuclear grade 1 showed early local recurrence. Early relapse occurred in only one (1.5%) of 67 tumors with an invasive component of 1.0 cm but in 11 (5.2%) of 211 tumors with an invasive component of 1.1 cm. The recurrence rate increased to 9.3% (8/86) when tumor invasion was 2.1 cm. In 12 cancers showing recurrence, strand structure, large central acellular zones, and squamoid features were histologically observed in four, two, and three cases, respectively. The present results confirmed the reported tendency of correlation between strand pattern and bone metastasis, large central acellular zones and lung and brain metastasis, and squamoid features and lung metastasis. Synchronous bilateral and unilateral multiple cancers were characterized by lower nuclear grades. CONCLUSIONS: At our hospital, the criteria used in the NSAS-BC protocol were demonstrated to identify node-negative cancers with high risk of early recurrence at a hospital level. To further identify groups prone to recurrence, longer follow-up would be necessary. In addition, the histological criteria could be improved to correlate with patient outcome more accurately.     

Predictors of invasive disease in breast cancer when core biopsy demonstrates DCIS only

BACKGROUND AND OBJECTIVES: Ductal carcinoma in-situ on core biopsy does not preclude invasive disease within the excision specimen, resulting in the need for further axillary surgery. We sought to identify predictors of invasion when DCIS is present on core biopsy. METHODS: From a database of 895 breast cancer patients, patients with DCIS on core biopsy who had subsequent surgical excision were identified. Their excision pathology and preoperative mammography were correlated with risk of invasion. RESULTS: Patients (93) with a preoperative diagnosis of DCIS on core biopsy were identified. On excision, 31 patients (33%) had invasive carcinoma and 13 patients (14%) had microinvasion. A preoperative finding of calcification only on mammogram was associated with DCIS on excision (P = 0.014), whereas the presence of other mammographic features increased the risk of invasion. Size > or =5 cm on excision pathology was associated with increased risk of invasion (P = 0.002). Forty-eight percent (n = 11/23) of those diagnosed by ultrasound-guided core biopsy had frank invasion on excision compared to 21% (n = 12/57) diagnosed by stereotactic techniques (P = 0.017). CONCLUSION: Mammographic features and tumor size can help predict invasion in patients who have DCIS on core biopsy. Patients who have features other than calcification on mammography or have tumor size > or =5 cm should be considered for a sentinel node biopsy.     

超声引导下两种乳腺肿物活检方式对导管内原位癌误诊率的比较:空芯针穿刺与微创旋切系统两种不同活检方式对比研究(英文)

Objective:The objective of this study was to compare the underestimation rate of invasive carcinoma cases with ductal carcinoma in situ (DCIS) at percutaneous ultrasound-guided core biopsies of breast lesions between 14-gauge automated core needle biopsy (ACNB) and 11-gauge vacuum-assisted biopsy (VAB), and analyze the diagnostic advantages and insufficiencies in DCIS between this two methods, and to determine the relationship between the lesion type (masses or microcalcifications on radiological findings ) and DCIS underestimation rate. Methods:We collected 152 breast lesions which were diagnosed as DCIS by retrospectively reviewing data about ultrasound-guided biopsies of breast lesions (from February 2003 to July 2010). There were 98 lesions in 95 patients by 14-gauge ACNB, and 54 lesions in 52 patients by 11-gauge VAB (The system used in this study called Mammatome, MMT). The clinical and radiological findings were reviewed; meanwhile all the selected patients had histological results of the biopsies and follow-up surgeries which also achieved the reliable pathological results to compare with the biopsy results. The differences between two correlated histological results defined as underestimation, and the histological DCIS underestimation rates were compared between the two groups. According to the radiological characteristics, each group was classified into two subgroups (masses or microcalcifications group), and the differences between subgroups were also analyzed. Results:The DCIS underestimation rate was 45.9% (45/98) for 14-gauge ACNB and 16.6% (9/54) for MMT. According to the lesion type on ultrasonography, DCIS underestimation was 31.0% (26/84) in masses (43.1% using ACNB and 12.1% using MMT; P = 0.003) and 42.6% (29/68) in microcalcifications (48.9% using ACNB and 23.8% using MMT; P = 0.036). Conclusion:The underestimation rate of invasive carcinoma in cases with DCIS at ultrasound-guided core biopsies is significantly higher for ACNB than for MMT. Furthermore, this difference does not alter among the two lesion types presented on ultrasonography. So ultrasound-guided VAB (MMT system) could be an effective and useful method for the diagnosis of DCIS lesions no matter what the lesion type is.     

环氧化酶2和血管内皮生长因子在乳腺浸润性导管癌中的表达及其临床意义

目的 探讨环氧化酶2（COX-2）、血管内皮生长因子（VEGF）mRNA及其蛋白在乳腺浸润性导管癌中的表达及其与临床病理特征的关系.方法 采用原位杂交和免疫组织化学技术检测70例乳腺浸润性导管癌和30例乳腺纤维腺瘤中COX-2、VEGF mRNA及蛋白的表达.计数资料的分析运用χ2检验,相关性分析采用Spearman检验.结果 乳腺浸润性导管癌COX-2 mRNA阳性率明显高于乳腺纤维腺瘤[74.2%（52/70）比30.0%（9/30）,χ2=17.31,P=0.00],COX-2 蛋白阳性率也明显高于乳腺纤维腺瘤[72.8%（51/70）比23.3% （7/30）,χ2=21.14,P=0.00].乳腺浸润性导管癌COX-2 mRNA及蛋白的表达均与淋巴结转移有关（χ2=7.54,P=0.00;χ2=6.36,P=0.01）,与年龄、肿瘤大小和组织学分级无关（P〉0.05）.乳腺浸润性导管癌VEGF mRNA阳性率明显高于乳腺纤维腺瘤[71.4%（50/70）比33.3% （10/30）,χ2 =12.70,P=0.00],其VEGF蛋白阳性率也明显高于乳腺纤维腺瘤[65.7%（46/70）比26.7%（8/30）,χ2 =12.89,P=0.00].乳腺浸润性导管癌VEGF mRNA表达与淋巴结转移有关（χ2=8.33,P=0.00）,与年龄、肿瘤大小及组织学分级无关（P〉0.05）;而VEGF蛋白表达与组织学分级、淋巴结转移有关（P〈0.05）,与年龄及肿瘤大小无关（P〉0.05）.在乳腺浸润性导管癌中,COX-2 mRNA表达与VEGF mRNA表达之间以及COX-2蛋白表达与VEGF蛋白表达之间均呈正相关关系（r=0.64,P=0.00;r=0.44,P=0.00）.结论 COX-2和VEGF的mRNA及蛋白在乳腺浸润性导管癌中表达均上调且与淋巴结转移有关,因此,COX-2、VEGF可作为判断乳腺浸润性导管癌预后的生物学标志物.     

Paget's病伴浸润性导管癌的临床病理特征及预后因素分析:基于SEER的回顾性研究

目的:分析佩吉特氏病伴浸润性导管癌（Paget's disease with invasive ductal carcinoma,PD-IDC）患者的临床病理特征、治疗和预后情况。方法:通过美国 SEER*Stat 软件搜集2010至2014年病理明确诊断为PD-IDC及浸润性乳腺癌（invasive ductal carcinoma,IDC）并接受手术治疗的患者分别550例和207 221例。用SPSS 21.0进行统计学分析和绘制生存曲线。结果:与IDC相比,PD-IDC患者男性乳腺癌比例更大,可能有更大的体积、更多的淋巴结受累、更高级别以及更晚期的肿瘤（P均<0.05）;且更可能是激素受体（HR）阴性［ER阴性（37.3% vs 18.5%）、PR阴性（52.0% vs 28.5%）］和Her-2阳性（53.3% vs 15.4%）;在治疗方案中更有可能接受乳房切除术（85.8% vs 43.9%）和腋窝淋巴结清扫术（45.1% vs 29.5%）（P均<0.05）;但预后更差,死亡率更高,且乳腺癌相关死亡率（BCSM）更高。此外,Cox回归分析显示肿瘤分级和Her-2状态与PD-IDC患者的总生存时间（OS）显著相关（P<0.05）,而患者性别和肿瘤分级与PD-IDC患者的BCSM相关（P<0.05）,且Her-2阳性者相较于阴性者（OS:HR=0.019,P=0.009;BCSM:HR=0.000,P=0.623）与PD-IDC患者的OS显著相关,淋巴结手术方式也与PD-IDC患者的OS有一定的相关性。结论:与IDC相比,PD-IDC患者更可能是HR阴性和Her-2阳性且预后较差。同时,淋巴结的处理在PD-IDC的治疗中有一定的必要性。     

Tumor size as predictor of microinvasion, invasion, and axillary metastasis in ductal carcinoma in situ

Ductal carcinoma in situ (DCIS) represents a small number of cases in countries with inadequate breast cancer screening programs, and in the majority of cases is diagnosed as a palpable lump. It has been proposed that DCIS with palpable lump > or = 2.5 cm can be associated with microinvasion or invasive carcinoma and risk of axillary metastasis. The purpose of the present study is to evaluate incidence of microinvasion, invasion, and the role of lymphatic mapping and sentinel lymph node biopsy in DCIS > or = 2.5 cm.We conducted a retrospective analysis of patients with histologically proven incisional, excisional, or core biopsy of DCIS lump > or = 2.5 cm at a tertiary-care hospital. All patients underwent lymphatic mapping with sentinel lymph node biopsy.A total of 24 patients were included with average tumor size of 4 cm (range, 2.5-6 cm); 29% had microinvasive and 12.5% had invasive disease, three patients (12.5%) had positive sentinel lymph node, all had micrometastasis, and no metastasis were found in non-sentinel lymph nodes. Incidence of microinvasion and invasion were directly related with tumor size (10% for DCIS tumor size of 2.5-3.5 cm, 57% for 3.6-4.5 cm, and 71% for tumors between 4.5 and 6 cm). In addition, axillary metastasis incidence had a direct relationship with tumor size. (0% in 2.5-3.5-cm tumor size, 14% for 3.6-4.5 cm, and 28% in DCIS between 4.6 and 6.0 cm).The present study shows high incidence of microinvasion and invasion in DCIS diagnosed in tumors > or = 2.5 cm and supports the importance of axillary evaluation in patients with tumors >3.5 cm by means of lymphatic mapping and sentinel lymph node biopsy.     

A case of multicentric breast cancer in which an effect of neoadjuvant chemotherapy had a disparity

A 61-year-old woman was visited our hospital for a left breast tumor. Ultrasonography (US) demonstrated two tumors comprising a tumor 3.3 cm in diameter in the A area and another one 0.9 cm in diameter in the C area of the left breast, and US-guided core needle biopsy (CNB) was performed. The histological findings showed invasive ductal carcinoma, ER (+)/PR (-)/HER2 (+) in the A lesion and ER (+)/PR (+)/HER2 (-) in the C lesion. At this point in time, US demonstrated a new tumor 1.9 cm in diameter in the outside C area of the left breast, and CNB was performed. The histological findings showed invasive ductal carcinoma, ER (+)/PR (+)/HER2 (-) in the outside C lesion. Chemotherapy was estimated as PD, and an operation was performed (Bt + Ax). Histopathological examination showed pCR in the A lesion, invasive lobular carcinoma in the C lesion and solid-tubular carcinoma in the outside C new lesion. Depend on each subtype, HER2/new targeting trastuzumab therapy, radiation therapy and ER/PR targeting hormone therapy were tried as a post operative treatment.     

Breast carcinoma with osteoclast-like giant cells: a case report and review of the Japanese literature

A 41-year-old premenopausal woman with a 3.5 cm freely mobile mass in the upper outer quadrant of the right breast was admitted to our hospital. Fine needle aspiration showed malignant epithelial cells and many multinucleated osteoclast-like giant cells (OGCs). Excisional biopsy revealed an invasive ductal carcinoma. A right modified radical mastectomy was subsequently performed. Macroscopically the tumor was well circumscribed with a dark brown cut surface. Microscopically, the tumor was a grade 2 invasive ductal carcinoma with many multinucleated OGCs adjacent the tumor cells and hemorrhage and infiltration of inflammatory cells in the stroma. The intra-mammary metastasis also contained OGCs and stromal reactions. By enzyme immunoassay, the tumor cells were negative for estrogen receptor but positive for progesterone receptor. The tumor cells were negative for both c-erbB-2 and p53. The OGCs showed positive immunostaining with the monoclonal antibody CD68, demonstrating a histiocytic origin. Lymph nodes were free of metastasis. We also review the Japanese literature concerning breast carcinoma with OGCs.