乳腺导管原位癌的超声特征分析(稿号：Y201308101)

目的：探讨乳腺导管原位癌的超声表现特征及其超声诊断价值。方法：回顾性分析经病理证实的54例乳腺导管原位癌患者的超声表现,包括病灶形态、大小、边缘、边界、内部回声、后方回声、微钙化、导管改变及血供情况,并与病理结果进行对比分析。结果：本组54例病灶经术后病理证实均为乳腺导管原位癌,其中高级别34例,中级别13例,低级别7例,5例伴有微浸润灶,均未见腋窝淋巴结转移,本组病例的声像图表现为片状低回声型20例（39.22%）、肿块型17例（33.33%）、导管扩张型8例（15.69%）、单纯微钙化型6例（11.76%）。术前超声检出病灶51例,3例显示假阴性,检出率94.44%,正确诊断恶性肿瘤性病变44例,诊断准确率81.48%。结论：高频超声对乳腺导管原位癌的检出率较高,其超声表现具有一定特征性,正确认识导管原位癌的各种超声征象能有效提高乳腺导管原位癌的诊断符合率。     

乳腺导管原位癌超声图像特征及其与病理因素的关系

目的:观察乳腺导管原位癌(DCIS)超声图像特征,探讨其与Her-2蛋白表达等病理因素的关系.方法:回顾性分析66例乳腺导管原位癌的临床资料,分析患者超声图像的特征及肿块大小与钙化、浸润、Her-2表达的关系.结果:66例患者中,肿瘤＞1cm者42例,超声表现为形态不规则,边界不清的低回声区；肿瘤≤1 cm者24例,其中超声表现为导管扩张者7例,小结节9例,腺体增厚8例.超声检查肿块＞1cm的DCIS中,其钙化率低于≤1 cm者,但浸润率和Her-2阳性表达率均明显高于肿块≤1 cm者(均P＜0.05).超声检查诊断DCIS与病理结果的符合率为51％.结论:DCIS的超声表现具有特征性,肿块≤1 cm者常伴钙化,肿块＞1cm者提示预后不良.     

乳腺导管内癌及伴微浸润的病理和临床特征

目的　研究导管内癌(ductalcarcinomainsitu ,DCIS)及伴微浸润(DCISwithmicroinvasion ,DCIS MI)患者的病理与临床特征。方法　对1999年6月至2 0 0 3年6月收治的4 1例DCIS及Ⅰ、Ⅱ型DCIS MI患者的临床和病理学特点进行回顾性研究。结果　DCIS及Ⅰ、Ⅱ型DCIS MI的病理学特点不同;首发症状中,9 76 %的患者仅表现为乳腺摄影钙化灶(5 0 %为DCIS) ;乳腺摄影检查诊断符合率为80 % ,Ⅱ型DCIS MI乳腺摄影表现为肿块和腺体紊乱的比例为33 3% ,高于DCIS和Ⅰ型DCIS MI;5 7%的患者表现为乳头溢液,乳管内视镜诊断符合率为95 6 5 % ;局部复发2例,均为Ⅱ型DCIS MI患者。结论　DCIS与Ⅰ型、Ⅱ型DCIS MI病理和临床表现各有特点,因而预后也不同。     

X线检查阴性乳腺导管原位癌的临床病理特点

【摘要】〓目的〓探讨乳腺X线检查(MG)阴性的乳腺导管原位癌(DCIS)及DCIS伴微浸润(DCIS-MI)的临床及诊断特点。方法〓对我院2012年1月~2013年8月32例MG检查阴性的DCIS及DCIS-MI的临床病理资料进行回顾性分析。结果〓MG阴性导管原位癌临床表现为单纯乳头溢液占71.9%(23/32),乳腺肿块占15.6%(5/32)例,良性钙化12.5%(4/32)例。MG检查阴性导管原位癌中腺体高密度、低核分级、PR阳性、HER2(-)或(+)病例的比例明显高于同期MG检查阳性组,且差异有统计学意义(P<0.05)。补充其他诊断检查的结果显示,乳腺超声敏感性为18.7%(6/32),磁共振(MRI)敏感性可达为87.5%(28/32),对表现为乳头溢液的病例,乳管镜诊断的敏感性为52.2%(12/23)。结论〓MG阴性的导管原位癌临床病理生物学指标相对较好,MRI检查可进一步提高其检出率,乳管镜对于乳头溢液的病例是有益的补充检查手段。     

影像引导真空辅助乳腺穿刺活检诊断乳腺微钙化的研究

目的评价影像引导真空辅助空心针乳腺穿刺活检(vacuum-assisted breast biopsy,VAB)在诊断乳腺微钙化中的临床应用价值。方法 2012年12月~2014年8月,对42例钼靶诊断乳腺微钙化行VAB,美国放射学会乳腺影像报告与诊断系统(BI-RADS)分级3级5例,4级34例,5级3例。其中31例钼靶引导,11例超声引导。结果 42例活检标本在影像上都能观察到钙化灶并经病理证实,24例簇状钙化灶完全切除,2例簇状及16例非簇状钙化灶部分切除。病理诊断导管原位癌13例,浸润性导管癌5例,浸润性小叶癌1例,均行手术治疗,其余23例病理为良性。钼靶微钙化及超声微钙化诊断乳腺癌的阳性预测值分别为45.2%(19/42)及70.0%(14/20)(χ2=3.337,P=0.068)。超声微钙化诊断乳腺癌的阴性预测值为77.3%(17/22)。术后并发症包括穿刺部位渗血1例,皮下瘀斑4例。随访时间6~26个月,平均13个月。19例乳腺癌均无复发,23例良性患者切口愈合良好,乳房外观满意,未发现恶性肿瘤。结论钼靶能发现超声不能发现的乳腺微钙化灶,钼靶及超声发现的乳腺微钙化灶在乳腺癌的诊断中有重要价值,VAB诊断乳腺微钙化准确,微创,术后并发症少。     

乳腺X线三维立体定位真空辅助乳腺活检在乳腺X线可疑钙化诊断中的价值北大核心CSCD

目的探讨乳腺X线三维立体定位真空辅助乳腺活检在可疑钙化中的应用价值。方法2016年1月~2018年12月对242例临床不可触及且超声检查阴性,乳腺X线可疑钙化,在乳腺X线三维立体定位下采用EnCor真空辅助乳腺活检系统旋切取活检,利用乳腺X线0°导航位和±15°立体定向确定病灶位置后,从该位置插入旋切刀进行微创旋切取活检。结果242例顺利完成活检,活检病理诊断良性病变205例(非典型病变16例),恶性病变37例(导管原位癌30例,浸润性导管癌7例)。37例恶性病变手术治疗,7例为浸润性导管癌,其中5例钙化完全切除,手术时无肿瘤残留,2例有残余微钙化和残余肿瘤;30例为导管原位癌(ductal carcinoma in situ,DCIS),其中28例钙化病灶完全切除,2例活检术中有肿瘤残留[手术切除标本示导管内癌伴早期浸润,DCIS升级率为6.7%(2/30)]。11例非典型性病变手术治疗,10例术后病理诊断为腺病,1例升级为DCIS,非典型增生升级率9.0%(1/11);5例非典型病变在3年的随访中无可疑发现。结论乳腺X线立体定位下真空辅助乳腺活检可以较好地应用于可疑钙化的微创活检,值得推广。     

乳腺导管原位癌伴微浸润与导管原位癌的X线与临床病理表现比较分析

目的 比较分析乳腺导管原位癌伴微浸润（DCISM）与导管原位癌（DCIS）的X线与临床病理表现。方法 选取本院2009年1月至2021年10月收治的经手术病理证实的DCISM及DCIS患者95例,患者术前均接受乳腺X摄影检查,比较两组患者X线与临床病理表现。结果 95例患者中,DCISM患者为27例,DCIS患者为68例。两组患者乳腺X线摄影比较,DCIS与DCISM患者X线钙化形态差异无统计学意义（P>0.05）,而病变类型、有无钙化及钙化分布差异具有统计学意义（P<0.05）。其中团簇状钙化多见于DCIS(39.71%),而区域性钙化在DCISM中更普遍（40.74%）。另外两组患者发病年龄、病变大小差异无统计学意义（P>0.05）,但两组患者雌激素受体（estrogen receptor,ER）、孕激素受体（progesterone receptor,PR）、淋巴结状态差异具有统计学意义（P<0.05）。结论 在DCISM中乳腺X线摄影较多表现为钙化性病变及区域性钙化,ER、PR、淋巴结阳性更为常见。     

乳腺黏液癌常规超声和超声造影表现

目的观察乳腺黏液癌的常规超声和超声造影(CEUS)表现。方法回顾性分析16例经手术病理确诊的乳腺黏液癌患者(17个病灶),术前均接受常规超声及CEUS检查;以常规超声观察并记录病灶位置、大小、形态、内部回声、钙化、后方回声及血流特点等,CEUS观察病灶增强程度及增强方式等。结果 17个病灶中,常规超声显示16个(16/17, 94.12%)呈低回声、1个为等回声;15个(15/17, 88.24%)形态不规则或呈分叶状,14个(14/17, 82.35%)边界不清或有毛刺;10个(10/17, 58.82%)内部回声不均匀;3个(3/17, 17.65%)内部可见局灶性液化区,9个(9/17, 52.94%)可见砂砾样钙化;11个(11/17, 64.71%)内部可探及血流信号,其中8个可探及动脉频谱。CEUS表现为低增强15个、高增强2个;不均匀增强16个、均匀增强1个;16个病灶内见持续性无增强区;13个结节被膜呈稍高增强、4个无被膜高增强。结论乳腺黏液癌超声表现有一定特征性,对诊断该病具有一定临床价值。     

乳腺导管内癌:附123例(125侧)报告

目的 加深对导管内癌(DCIS)的认识,以提高其诊断率和治疗效果.方法 回顾性分析中国医科大学附属第一医院普通外科收治的123例DCIS患者的临床资料.包括发病年龄、临床表现、体检特征、超声和钼靶检查、病理特点、免疫组织化学检查和手术方式.结果 (1)该组发病的平均年龄为(47.7±9.3)岁.(2)体检特点以乳腺肿块79例,乳头溢液19例,乳房疼痛伴腺体增厚30例等为主要表现.(3)超声、钼靶45例,可能为恶性者分别为27例(60%),30例(66.7%),方法准确率差异无统计学意义.综合2种方法后,诊断可能恶性者37例(82.2%).(4)65例超声表现为实质性肿见块43例(66%);血流信号41例(63%);可见导管扩张52例(80%)和导管内点状强光团33例(50.7%).(5)52例钼靶摄影主要表现有泥沙样钙化,肿物伴簇状钙化,腺体局限性致密和乳腺肿物.(6)免疫组织化学检查包括雌激素受体(ER),孕激素受体(PR),p53和c-erbB-2.DCIS与DCISMI的阳性表达率差异均无统计学意义.(7)行乳腺癌标准根治术6例(其中3例为DCIS-MI).共行乳腺癌改良根治术86例,包括59例DCIS,27例DCIS-MI.DCIS伴有淋巴结转移者2例,DCIS-MI有淋巴结转移者5例.结论 乳腺超声检查和钼靶摄像联合诊断可提高DCIS的诊断率.     

乳腺导管原位癌的保乳手术疗效分析

目的:探讨乳腺导管内原位癌(DCIS)的保乳术临床效果。 方法: 对经病理确诊为DCIS行保乳手术加放疗患者62例与同期行保乳手术加放疗临床I，II期乳腺浸润性导管癌患者62例进行回顾性比较分析。结果:DCIS患者复发率6.4%（4/62），其中3例病理证实为粉刺型;浸润性导管癌患者复发率19.3%（11/62）。结论:DCIS的保乳治疗总体预后优于早期浸润性导管癌;粉刺型DCIS具有较高的复发危险性。     

Extensive pure ductal carcinoma in situ of the breast: Identification of predictors of associated infiltrating carcinoma and lymph node metastasis before immediate reconstructive surgery

AimTo identify predictors for infiltrating carcinoma and lymph node involvement, before immediate breast reconstructive surgery, in patients with an initial diagnosis of extensive pure ductal carcinoma in situ of the breast (DCIS).Patients and methodsBetween January 2000 and December 2009, 241 patients with pure extensive DCIS in preoperative biopsy had underwent mastectomy. Axillary staging (sentinel node and/or axillary dissection) was performed in 92% (n = 221) of patients. Patients with micro-invasive lesions at initial diagnosis, recurrence or contralateral breast cancer were excluded.ResultsRespectively 14% and 21% of patients had a final diagnosis of micro-invasive carcinoma (MIC) and invasive ductal carcinoma (IDC). Univariate analysis showed that the following variables at diagnosis were significantly correlated with the presence of either MIC or IDC in the mastectomy specimen: palpable tumor (p = 0.002), high grade DCIS (p = 0.002) and detection of an opacity by mammography (p = 0.019). Axillary lymph node (ALN) involvement was reported in 9% of patients. Univariate analysis suggested that a body mass index higher than 25 (p = 0.007), a palpable tumor (p = 0.012) and the detection of an opacity by mammography (p = 0.044) were associated with an increased rate of ALN involvement.ConclusionSkin-sparing mastectomy and immediate breast reconstruction (IBRS) has become increasingly popular, especially for patients with extended DCIS of the breast. This study confirmed that extended DCIS is associated with a substantial risk of finding MIC or IDC on the surgical specimen but also ALN involvement. Adjuvant systemic treatment and/or radiotherapy could be indicated for some of these patients after the surgery. Patients should be informed of the rate of 1) complications associated to IBRS that will potentially delay the introduction of systemic or local therapy 2) complications associated to radiotherapy after IBRS.     

What should be the width of radiological margin to optimize resection of non-palpable invasive or in situ ductal carcinoma?

Purposethe aim of our study was to investigate whether there is radiological margin that optimize resection of non-palpable invasive or in situ ductal carcinoma.Materials and methodsData were collected for all patients undergoing wire localization prior to therapeutic surgical excision between January 2010 and December 2013 at our institution. A 5 and 10-mm radiological margins were considered adequate for invasive ductal carcinoma (IDC) and in situ ductal carcinoma (DCIS) respectively. Clear histological margins were defined as no ink on the tumor for IDC and ≥2 mm for DCIS. Data were analyzed both in order to assess accuracy of the technique and in order to determine what radiological threshold should be taken.ResultsThree hundred seventy seven women were included to the study. The radiological thresholds permitted negative histological margins in 94.7%, 60.9% and 80.9% in the pure invasive ductal carcinoma group (IDC, n = 133), the pure ductal carcinoma in situ group (DCIS, n = 92) and the mixed group (both IDC and DCIS, n = 152) respectively. In an ROC analysis evaluating the ability of radiological thresholds to obtain free pathological margins: the AUC was 0.79 (0.71–0.87, 95% confident interval, p = .0007) for Pure IDC group, 0.67 (0.57–0.87, 95% confident interval, p = .0005) for pure DCIS group, and 0.72 (0.62–0.80, 95% confident interval, p < .0001) for the mixed group.ConclusionWe found that a radiological margin of 10 mm is needed in presence of an in situ component and 5-mm radiological margin seems enough in case of pure IDC tumors.     

Prognostic value of prominent DCIS component in the breast-conserving therapy of stage I and II invasive ductal breast cancer

The aim of this study was to determine the presence and histological grade of prominent ductal carcinoma in situ (DCIS) and the relationship between the histological grade of DCIS and the grade of invasive ductal carcinoma of the breast to local recurrence and survival. We have analysed 175 patients with stage I and II invasive ductal breast carcinoma who underwent breast-conserving therapy in the period 1987–1994. Patients were divided into those with carcinomas showing prominent DCIS (74 patients), and those with tumours without a DCIS component (101 patients). Ten patients developed recurrences and were treated by hormonal and/or chemotherapy. Local recurrence was observed in 2 (2%) patients without, and in 8 (10.8%) patients with prominent DCIS (χ₂=12.954, P<0.005). There was a highly significant correlation between DCIS type and the histological grade of the infiltrating carcinoma (χ₂=73.77, P<0.001). Our results suggest that the patients with poorly differentiated DCIS are significantly more likely to develop recurrence than patients with intermediately or well-differentiated DCIS.     

HER-2 overexpression is not associated with increased ipsilateral breast tumor recurrence in DCIS treated with breast-conserving surgery followed by radiotherapy

BackgroundWe evaluated the clinical implications of human epidermal growth factor receptor (HER)-2 overexpression after adjuvant radiotherapy (RT) for ductal carcinoma in situ (DCIS).MethodsWe reviewed 215 patients with DCIS who underwent breast-conserving surgery followed by RT. The association between HER-2 overexpression and ipsilateral breast tumor recurrence (IBTR) was evaluated.ResultsHER-2 overexpression was associated with comedo-type architecture, high nuclear grade, and negative hormonal receptors. The median follow-up duration was 75 months. Sixteen patients experienced IBTR; seven as DCIS recurrence and nine as invasive recurrence. The IBTR rate was 11.4% at 10 years. There was no significant difference in IBTR according to HER-2 expression (P = 0.1764), neither in invasive nor DCIS recurrence. Time to recurrence was shorter in HER-2 positive tumors (P = 0.0697).ConclusionAdjuvant RT seems to counteract the negative effect of HER-2 overexpression in DCIS, while time to recurrence was relatively shorter.     

Time trends and inter-hospital variation in treatment and axillary staging of patients with ductal carcinoma in situ of the breast in the era of screening in Southern Netherlands

BackgroundTo examine variation in time and place in axillary staging and treatment of patients with ductal carcinoma in situ (DCIS) of the breast.MethodsTrends in patients with DCIS recorded in the Eindhoven Cancer Registry diagnosed in 1991–2010 (n = 2449) were examined.ResultsThe use of breast conserving surgery (BCS) went from 17% to 67% in 1991–2010 and administration of radiotherapy after BCS increased to 89%. Axillary lymph node dissection decreased to almost 0%, while sentinel node biopsy was performed in 65% of patients in 2010. The proportion who underwent BCS varied between hospitals from 49% to 80%; the proportion without axillary staging ranged from 21% to 60%. Patients with screen-detected DCIS were more likely to receive BCS.ConclusionThere was considerable variation in the use of BCS, radiotherapy, and axillary staging of DCIS over time and between hospitals. Patients with DCIS were more likely to be treated with BCS if their disease was detected by screening.     

Trends in incidence of ductal carcinoma in situ: the effect of a population-based screening programme

BackgroundThe incidence of ductal carcinoma in situ (DCIS) has increased substantially in the western world in recent decades. The aim of this study was to investigate the incidence according to grade distribution, age, and implementation of a population-based screening programme.MethodsCases of primary pure DCIS (n = 3167) were obtained from the Cancer Registry of Norway. Poisson regression was used to estimate trends in incidence.ResultsAge-adjusted incidence of DCIS increased from 4 to 11 per 100 000 women-years from 1993 to 2007, in parallel with the implementation of screening. Higher incidence was observed among prevalent (IRR 3.3) and subsequent (IRR 2.8) invited women compared with those not invited. The proportion of DCIS among breast malignancies increased throughout the period, most markedly in the age range of screening.ConclusionThe increased proportion of DCIS during the study period is probably due to improved diagnostics resulting from the implementation of population-based screening.     

磁共振胰胆管造影联合容积内插体部检查多期动态增强扫描诊断梗阻性黄疸病因

目的探讨MRCP联合容积内插体部检查(VIBE)多期动态增强扫描诊断梗阻性黄疸病因的价值。方法回顾性分析经术后病理证实的125例梗阻性黄疸患者的MRCP和VIBE多期动态增强扫描资料,计算和比较MRCP、VIBE多期动态增强扫描及二者联合诊断梗阻性黄疸病因的准确率。结果 MRCP、VIBE多期动态增强扫描及二者联合诊断梗阻性黄疸病因的总准确率分别为76.80%(96/125)、80.80%(101/125)和84.80%(106/125),三者比较差异无统计学意义(P=0.275);良性梗阻74例,三者诊断其病因总准确率分别为91.89%(68/74)、86.49%(64/74)和90.54%(67/74),差异无统计学意义(P=0.532);恶性梗阻51例,三者诊断其病因总准确率分别为54.90%(28/51)、72.55%(37/51)和76.47%(39/51),其中VIBE多期动态增强扫描联合MRCP准确率明显高于单纯MRCP(P=0.022)。结论 MRCP联合VIBE多期动态增强扫描诊断梗阻性黄疸、尤其是恶性梗阻性黄疸病因准确率高。     

Hormonal receptor status,Ki-67 and HER2 expression: Prognostic value in the recurrence of ductal carcinoma in situ of the breast?

PurposeLocal recurrence is considered a major concern in patients diagnosed with ductal carcinoma in situ (DCIS), as its invasive occurrence is associated with high rates of distant disease and mortality. This study aims to assess the possible correlation of hormonal receptor status, Ki-67 and HER2 expression with recurrence rates in women with DCIS, taking also into account the potential prognostic effects of grade and age at diagnosis.Methods230 consecutive patients with DCIS were included in this study. Invasive and non-invasive recurrence events were recorded, as a total. Clinicopathological information, as well as PR positivity, ER positivity, HER2 positivity and ki-67 expression were analyzed. Multivariable Cox regression analysis was performed, examining the risk factors for recurrence.ResultsRecurrence was noted in 17.8% of cases; the median follow-up was 44 months. Higher grade (adjusted HR = 1.72, 95%CI: 1.06–2.78), age at diagnosis (adjusted HR = 0.60, 95%CI: 0.43–0.83), Ki-67 expression (adjusted HR = 1.78, 95%CI: 1.11–2.88), and type of administered treatment were independently associated with increased recurrence rates. Recurrence rates were not significantly associated with ER, PR status or HER2 expression.ConclusionIn addition to high grade, administered treatment and younger age at diagnosis, high Ki-67 expression seems to be independently associated with increased likelihood of recurrence in patients with DCIS. Future studies with additional molecular markers seem necessary to further improve the identification of high-risk patients for DCIS recurrence.     

The Florid Subtype of Lobular Carcinoma In Situ: Marker or Precursor for Invasive Lobular Carcinoma?

Background

Lobular carcinoma in situ (LCIS) is considered a risk factor—not a precursor—for both invasive lobular and ductal carcinoma. Florid LCIS (F-LCIS) is an architectural subtype of LCIS that does not express E-cadherin, yet has the histologic and often radiographic appearance of solid-type ductal carcinoma in situ (DCIS). Since DCIS is considered a precursor to invasive ductal carcinoma, should F-LCIS be considered a precursor to invasive lobular carcinoma (ILC)?

Methods

Review of an institutional database identified cases of LCIS and solid-type DCIS diagnosed by excisional biopsy, segmentectomy, or mastectomy between 1991 and 2000 to determine the prevalence of associated invasive breast cancer. Archival specimens were evaluated for florid and nonflorid LCIS, nuclear grade of LCIS, and the presence and subtype of invasive breast cancer. Solid-type DCIS that lacked E-cadherin expression was classified as F-LCIS.

Results

Of 210 consecutive specimens of LCIS examined, 171 had nonflorid LCIS (81%) and 39 had F-LCIS (19%). Nonflorid LCIS had a diffuse pattern, whereas F-LCIS appeared as discrete foci adjacent to ILC. An invasive component was identified with 87% of F-LCIS lesions versus 73% of nonflorid LCIS lesions (P = 0.064); this component was lobular in 100% of F-LCIS lesions versus 82% of nonflorid LCIS lesions, a significant difference (P = 0.0044) that persisted when the analysis was adjusted for nuclear grade (P = 0.0082).

Conclusion

Its close spatial relationship to an invasive component and increased association with ILC suggest that F-LCIS may be a precursor for ILC.