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。     

乳腺导管内原位癌的超声表现分析

 目的　分析乳腺导管内原位癌的超声表现特点。方法　对12例经病理证实的乳腺导管内原位癌的超声表现进行回顾分析。结果　乳腺导管内癌在超声上主要表现为实性结节型、乳腺结构不良型、囊实性肿块型、导管扩张型。9例患者超声检查乳腺内见结节,结节纵横比大,边界不清,钙化发生率高。3例未见具体占位,其中2例局部腺体紊乱回声减低,超声诊断符合率50.0 %。钼靶检查8例可见钙化,诊断符合率66.7 %。结论　虽然乳腺导管内原位癌超声表现不典型,但在结节形态、纵横比、边界、微小钙化点等超声表现上有一定特点,结合钼靶检查结果,有助于提高诊断率。     

Sentinel lymph node biopsy in clinically detected ductal carcinoma in situ

AIM: To study the indications for sentinel lymph node biopsy (SLNB) in clinically-detected ductal carcinoma in situ (CD-DCIS). METHODS: A retrospective analysis of 20 patients with an initial diagnosis of pure DCIS by an image-guided core needle biopsy (CNB) between June 2006 and June 2012 was conducted at King Faisal Specialist Hospital. The accuracy of performing SLNB in CD-DCIS, the rate of sentinel and non-sentinel nodal metastasis, and the histologic underestimation rate of invasive cancer at initial diagnosis were analyzed. The inclusion criteria were a preoperative diagnosis of pure DCIS with no evidence of invasion. We excluded any patient with evidence of microinvasion or invasion. There were two cases of mammographically detected DCIS and 18 cases of CD-DCIS. All our patients were diagnosed by an image-guided CNB except two patients who were diagnosed by fine needle aspiration (FNA). All patients underwent breast surgery, SLNB, and axillary lymph node dissection (ALND) if the SLN was positive. RESULTS: Twenty patients with an initial diagnosis of pure DCIS underwent SLNB, 2 of whom had an ALND. The mean age of the patients was 49.7 years (range, 35-70). Twelve patients (60%) were premenopausal and 8 (40%) were postmenopausal. CNB was the diagnostic procedure for 18 patients, and 2 who were diagnosed by FNA were excluded from the calculation of the underestimation rate. Two out of 20 had a positive SLNB and underwent an ALND and neither had additional non sentinel lymph node metastasis. Both the sentinel visualization rate and the intraoperative sentinel identification rate were 100%. The false negative rate was 0%. Only 2 patients had a positive SLNB (10%) and neither had additional metastasis following an ALND. After definitive surgery, 3 patients were upstaged to invasive ductal carcinoma (3/18 = 16.6%) and 3 other patients were upstaged to DCIS with microinvasion (3/18 = 16.6%). Therefore the histologic underestimation rate of invasive disease was 33%. CONCLUSION: SLNB in CD-DCIS is technically feasible and highly accurate. We recommend limiting SLNB to patients undergoing a mastectomy.     

Predictors of local recurrence following excision alone for ductal carcinoma in situ

BACKGROUND: The treatment of ductal carcinoma in situ (DCIS) remains controversial, particularly in regard to the selection of patients who may be appropriately treated with wide excision alone. To help identify such patients, the authors assessed prognostic factors for local recurrence in patients with DCIS treated with excision alone. METHODS: The study population consisted of 59 patients diagnosed with DCIS between 1985 and 1990. All had been treated with excision alone, had their histologic slides available for re-review by a study pathologist, and had negative margins of excision on review. The median age at diagnosis was 54 years, and the median follow-up time was 95.5 months. Ninety-six percent presented with mammographic findings only; all patients had a reexcision. The size of the DCIS was assessed by the total number of low-power fields (LPF) in which DCIS was present (median LPF = 5). RESULTS: Ten patients experienced a local recurrence (LR) at 5-132 months (median, 37 months) after excision. The actuarial 5-year LR rate was 10%. Four of the recurrences were invasive carcinomas, and 6 were DCIS. No patients have developed metastatic disease or have died of disease. Lesion size >5 LPF was the only significant prognostic factor for local recurrence on univariate analysis (3% vs. 17% for < or = 5 vs. > or = 5 LPF, P = 0.02) and in proportional hazards models. Although patients with nuclear Grade 3 lesions had a higher LR rate than those with nuclear Grade 1 and 2 lesions (18% vs. 6% and 5%, respectively) and patients with close margins (< or = 1 mm) had a higher LR rate than patients with negative margins (>1 mm) (25% vs. 8%), these differences did not reach statistical significance. Among the 19 cases with margins negative by more than 1 mm, lesion size < or = 5 LPF, and nuclear Grade 1 or 2, there were no LRs; by contrast, the remaining 40 patients had a 5-year actuarial LR rate of 15% (P = 0.08). CONCLUSIONS: Lesion size was the only statistically significant prognostic factor for local recurrence in this series of patients with DCIS treated with excision alone. Other factors, such as margin status and nuclear grade, may also be useful in the identification of patients with DCIS who can be managed with excision alone. However, the most reliable and reproducible method of assessing these factors and the best way to combine them have not been determined.     

Tumour-positive sentinel node findings in patients with ductal carcinoma in situ

BACKGROUND: Our aim was to evaluate the prevalence of and risk factors for tumour-positive sentinel node (SN) findings in patients with ductal carcinoma in situ (DCIS). METHODS: Altogether 1,470 patients underwent sentinel node biopsy (SNB) between April 2001 and March 2005 in our unit. According to a histopathological review, 11 of them had microinvasive and 74 pure DCIS and were included in the study. RESULTS: Five patients (7%) with pure DCIS had SN metastases. Three of them had isolated tumour cells (ITC) only. Axillary clearance without further metastatic findings was performed in three patients. The median histological size of DCIS was larger, 50 (45-60) mm in patients with metastatic SN findings than the median of 18 (2-110) mm in those with tumour-negative SN, P=0.0103. All five patients with metastatic SN findings underwent mastectomy. Metastatic SN findings were detected in one (9%) patient with microinvasive DCIS. CONCLUSIONS: Metastatic SN findings in patients with pure DCIS may be a sign of missed invasion.     

乳腺导管原位癌与导管原位癌伴微浸润的临床比较

目的 分析乳腺导管原位癌(DCIS)及原位癌伴微浸润(DCIS-MI)患者治疗模式变化、临床特征、治疗结果及预后因素。方法 回顾性分析中国医学科学院肿瘤医院1999-2013年收治的866例女性患者资料。DCIS患者631例,DCIS-MI患者235例。用Kaplan-Meier法计算局控(LC)、无瘤生存(DFS)、总生存(OS)率,并Logrank检验和单因素预后分析。结果 DCIS及DCIS-MI两组之间OS、LC及DFS相近(P>0.05)。单因素分析显示Her-2阳性为OS及DFS影响因素,保乳未放疗患者LC和DFS劣于全乳切除术患者。结论 导管原位癌和导管原位癌伴微浸润总体生存结果类似,Her-2阳性为OS及DFS预后不良因素,保乳未放疗患者的LC和DFS劣于全乳切除术。     

乳腺导管原位癌与导管原位癌伴微浸润的临床比较

目的 分析乳腺导管原位癌(DCIS)及原位癌伴微浸润(DCIS-MI)患者治疗模式变化、临床特征、治疗结果及预后因素。方法 回顾性分析中国医学科学院肿瘤医院1999-2013年收治的866例女性患者资料。DCIS患者631例,DCIS-MI患者235例。用Kaplan-Meier法计算局控(LC)、无瘤生存(DFS)、总生存(OS)率,并Logrank检验和单因素预后分析。结果 DCIS及DCIS-MI两组之间OS、LC及DFS相近(P>0.05)。单因素分析显示Her-2阳性为OS及DFS影响因素,保乳未放疗患者LC和DFS劣于全乳切除术患者。结论 导管原位癌和导管原位癌伴微浸润总体生存结果类似,Her-2阳性为OS及DFS预后不良因素,保乳未放疗患者的LC和DFS劣于全乳切除术。     

Recurrence of Breast Cancer following local excision alone for ductal carcinoma in situ

OBJECTIVE: To assess recurrence of breast cancer following local excision alone for ductal carcinoma in situ. METHODS: Eighteen patients who received complete resection for noninvasive ductal carcinoma between 1982 and 1997 were investigated in this study. The mean age of the patients was 45 (29-78) years old. The initial presentation was a clinically palpable tumor in 4 patients, nipple discharge in 6, and microcalcification on mammograms in 8. Patients with palpable tumor underwent wide excision with at least a 2-cm free margin. Patients whose mammograms showed microcalcification underwent lumpectomy, and those who showed nipple discharge underwent duct-lobular segmentectomy. Five patients who underwent lymph node dissection up to level I or II had no lymph node metastasis. The mean follow-up period was 86 months. RESULTS: Local recurrence in the conserved breast was seen in five (27.8%) of 18 patients. The actuarial five-year event-free survival was 76.2%. The histological type of the recurrent tumor was ductal carcinoma in situ in three patients and invasive carcinoma in two. There was no difference in age at initial operation or histological subtype between patients with and without recurrent disease, but patients presenting with nipple discharge initially had a significantly shorter ipsilateral disease-free interval than those presenting with tumor or microcalcification on mammograms. All patients with local recurrence in the conserved breast were treated with breast-conserving surgery or subcutaneous mastectomy. CONCLUSION: Local recurrence frequently occurs in patients presenting with nipple discharge treated by duct-lobular segmentectomy for noninvasive ductal carcinoma. Either wide excision with a larger free margin or adjuvant radiation therapy following duct-lobular segmentectomy should be considered for these patients.     

Subclinical ductal carcinoma in situ of the breast. Treatment by local excision and surveillance alone.

BACKGROUND. Mammography has led to earlier detection of subclinical ductal carcinoma in situ (DCIS) of the breast either as nonpalpable calcifications or as an incidental finding in a biopsy performed for another reason. Many women in whom DCIS was detected early may not be destined to have an invasive carcinoma. How should subclinical DCIS be treated if that is the case? What is the role of excision and surveillance only as an alternative to mastectomy or irradiation? METHODS. All patients with DCIS detected as nonpalpable calcifications or as an incidental finding were eligible for this study. Diagnosis was confirmed, and the histologic subtype was determined. Results of postbiopsy mammography confirmed excision of calcifications; wide local reexcision and assessment of margins was also performed in most patients. The maximum diameter of calcifications considered suitable for this treatment was 25 mm. RESULTS. Between 1978 and 1990, 70 women (72 breasts) were entered into this study (mean follow-up time, 49 months; median follow-up time, 47 months). Of this group, 66% were detected as calcifications and 33% were detected as incidental findings. The recurrence rate was 15.3%. All but one of the patients who experienced a recurrence had the comedo type of DCIS as the initial lesion. Each of the recurrences was of the comedo type. All but one recurrence was at the same site as the primary lesion. None of the patients with DCIS as an incidental finding experienced a recurrence. CONCLUSIONS. Excision and surveillance is a reasonable alternative to mastectomy or irradiation for selected women with DCIS that presents as nonpalpable calcifications or as an incidental finding.     

Histopathological characteristics of breast ductal carcinoma in situ and association with imaging findings

Background

The treatment policy for ductal cancer in situ (DCIS) of the breast greatly depends on the spreading diagnosis. However, a problem is that we cannot compare imaging findings with the histopathology of DCIS. The purpose of this study was to investigate the histopathological characteristics of DCIS and the association with imaging findings.

Method

Subjects were 185 patients from Tokai University Hospital, diagnosed with DCIS from April 2005 to December 2010. A positive finding on ultrasonography was defined as Breast Imaging Reporting and Data System (BI-RADS) of US category 3 or above, in mammography it was Japan Breast Cancer Society category 2 or above, and in MRI it was BI-RADS-MRI category 3 or above. Histopathologically, we re-classified flat and/or low papillary DCIS into type 1; papillary and/or cribriform DCIS into type 2; and comedo and/or solid DCIS into type 3.

Results

The clinical characteristics and association between imaging findings and histopathological classification of the 3 subtypes of DCIS are summarized as follows: (1) histopathologically, in type 3, there was a higher frequency of necrosis and calcification in the ducts of DCIS (χ ², p < 0.001), the number of dilated periductal capillaries was greater than in type 1 (p = 0.023), and the distribution of DCIS was concentrated in type 3 (p = 0.020); (2) on ultrasonography, type 3 was easier to detect than type 1 (p = 0.008); (3) on mammography and MRI, there were no significant differences between type 1 and type 3. The histopathological characteristics of small (<10 mm) DCIS and DCIS that cannot be detected by ultrasonography or MRI were also discussed.

Conclusion

When carrying out spreading diagnosis of DCIS, we need to keep the histopathological type in mind and interpret the imaging findings comprehensively.

     

Ductal carcinoma in situ and ductal carcinoma in situ with microinvasion: correlation of FDG uptake with histological and biological prognostic factors

Background

Several studies investigated the correlation between the intensity of fluorodeoxyglucose (FDG) uptake and some histological and biological characteristics in breast cancer. Ductal carcinoma in situ (DCIS) is generally thought to be a precursor lesion of invasive breast cancer. The aim of this study was to assess the correlation between FDG uptake values on positron emission tomography/computed tomography (PET/CT) with histological and biological prognostic factors in DCIS and ductal carcinoma in situ with microinvasion (DCIS-Mi).

Materials and methods

PET/CT images for initial staging of confirmed DCIS and DCIS-Mi patients, taken between July 2004 and December 2009, were reviewed retrospectively. Maximum standardized uptake values (SUVmax) and tumor background count density ratio on PET/CT were compared with tumor characteristics. Histological and biological prognostic factors included tumor size, nuclear grade, Van Nuys Prognostic Index, estrogen receptor, progesterone receptor, HER2, and Ki-67 index.

Results

In total, 87 lesions from 83 patients (all females; mean age 51 ± 9 years) were studied. The Van Nuys Prognostic Index group was 1 in 25 lesions, 2 in 36, and 3 in 26. On statistical analysis, significant differences in SUVmax and tumor background count density ratio were seen between the Van Nuys Prognostic Index groups and according to tumor size and HER2. The correlation between SUVmax and Ki-67 was significant. However, the correlation between tumor background count density ratio and Ki-67 was not statistically significant.

Conclusion

In DCIS and DCIS-Mi cases, significant correlations were found between increased FDG uptake and several histological and biological factors for poor prognosis (tumor size, Van Nuys Prognostic Index, and HER2).

     

Radiographic features for triple negative ductal carcinoma in situ of the breast

Background  

Triple negative (TN) breast cancer is characterized as having a high malignancy potential and a poor prognosis. An understanding of the radiological features of TN DCIS will enable the early detection of intractable TN invasive breast cancer.     

Accuracy of mammography in predicting histological extent of ductal carcinoma in situ (DCIS)

Accuracy of mammography in predicting pathological extent of ductal carcinoma in situ (DCIS). BACKGROUND AND AIMS: Mammographic extent is the main determinant for offering wide local excision (WLE) for DCIS. It is recognized that this is not always accurate. Patients who prove to have larger lesions than predicted require further surgery. The aim of this study was to define the degree of variance between mammographic (MMG) and pathological (path) measurements of DCIS and to analyse the factors predicting a significant discrepancy. METHODS: The pathological and mammographic data for 174 cases of DCIS were reviewed. RESULTS: The mammographic size was bigger than the histological size in 97 (55.7%) and there was >10mm difference in 18 (10.3%) cases. The histological size was bigger than the mammographic size in 69 (39.7%) cases and >10mm difference was found in 30 (17.2%) cases. There was a significant relationship between larger MMG size, MMG size measured in two dimensions (MMG bi-dimensional product) and MMG-path size discrepancy (p<0.01). In addition, the larger the size discrepancy, the greater the chance of requiring more than one therapeutic procedure (p<0.01). There was no significant correlation between age, histological grade, mammographic density and shortest distance from nipple with degree of mammographic-pathological size discrepancy.     

Epidemiology of ductal carcinoma in situ

Ductal carcinoma in situ (DCIS) is a relatively common diagnosis among women undergoing screening mammography. The greatest increases in DCIS incidence have been in non-comedo subtypes of DCIS that are not associated with subsequent invasive cancer. After a 500% increase in DCIS from 1983 to 2003, the incidence of DCIS declined in women aged 50 years and older, whereas the incidence in women younger than age 50 continues to increase. Having undergone mammography is one of the strongest and most prevalent risk factors associated with a diagnosis of DCIS. Other risk factors for DCIS are similar to that for invasive cancer including increasing age, family history of breast cancer, high mammographic breast density, and postmenopausal hormone therapy use. Treatment for DCIS is relatively aggressive with the use of both surgery and radiation therapy and most recently adjuvant hormonal therapy. Breast cancer mortality is low and similar with all types of treatment. New information regarding incidence of DCIS and subtypes of DCIS according to frequency of mammography and risk factors could lead to insights into the biology of DCIS.     

Tamoxifen in ductal carcinoma in situ

The widespread adoption of screening mammography has resulted in an increased incidence of ductal carcinoma in situ (DCIS), which now accounts for 20% to 30% of new breast cancer diagnoses. Despite treatment with combined lumpectomy and radiation therapy, up to 15% of women will experience an ipsilateral breast recurrence, with 50% of these recurrences containing invasive disease. There is also a 6% incidence of contralateral breast cancers in women treated for DCIS. The recognition that adjuvant tamoxifen reduces local, regional, and distant disease in women diagnosed with invasive breast cancer led to the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-24 study, which randomized more than 1,800 women undergoing breast-sparing surgery and radiation for DCIS to adjuvant tamoxifen versus placebo for 5 years. At 7 years of follow-up, there was a statistically significant 27% reduction in the annual incidence rate of all breast cancer-related events for those women receiving tamoxifen, including a 48% reduction in invasive breast cancer. The benefit attributable to tamoxifen was confined to those tumors that were estrogen receptor (ER)-positive. However, adverse events, including endometrial cancer, thromboembolic events, and cataracts, are more common in older women. Tamoxifen should be considered as an adjunct to treatment for women undergoing breast-conserving surgery for ER-positive DCIS.     

Loss of the tight junction protein claudin-7 correlates with histological grade in both ductal carcinoma in situ and invasive ductal carcinoma of the breast

Claudins are transmembrane proteins that seal tight junctions, and are critical for maintaining cell-to-cell adhesion in epithelial cell sheets. However, their role in cancer progression remains largely unexplored. Here, we report that Claudin-7 (CLDN-7) expression is lower in invasive ductal carcinomas (IDC) of the breast than in normal breast epithelium, as determined by both RT-PCR (9/10) and Western analysis (6/8). Immunohistochemical (IHC) analysis of ductal carcinoma in situ (DCIS) and IDC showed that the loss of CLDN-7 expression correlated with histological grade in both DCIS (P<0.001, n=38) and IDC (P=0.014, n=31), occurring predominantly in high-grade (Nuclear and Elston grade 3) lesions. Tissue array analysis of 355 IDC cases further confirmed the inverse correlation between CLDN-7 expression and histological grade (P=0.03). This pattern of expression is consistent with the biological function of CLDN-7, as greater discohesion is typically observed in high-grade lesions. In line with this observation, by IHC analysis, CLDN-7 expression was lost in the vast majority (13/17) of cases of lobular carcinoma in situ, which is defined by cellular discohesion. In fact, inducing disassociation of MCF-7 and T47D cells in culture by treating with HGF/scatter factor resulted in a loss of CLDN-7 expression within 24 h. Silencing of CLDN-7 expression correlated with promoter hypermethylation as determined by methylation-specific PCR (MSP) and nucleotide sequencing in breast cancer cell lines (3/3), but not in IDCs (0/5). In summary, these studies provide insight into the potential role of CLDN-7 in the progression and ability of breast cancer cells to disseminate.     

Radiotherapy for ductal carcinoma in situ

AimsThe introduction of breast screening mammography has led to an increase in the diagnosis of ductal carcinoma in situ (DCIS). Mastectomy gives high rates of local control. However, most cases are suitable for local excision. The aim of this article is to review the role of radiotherapy in the treatment of DCIS after breast conserving surgery.Material and methodsA review of the literature relating to radiotherapy and DCISResultsThe published trials show that adjuvant radiotherapy after breast conserving surgery halves the ipsilateral recurrence rates of DCIS and invasive cancer. No subgroups have been reliably identified that do not benefit from adjuvant radiotherapy. Risk factors for recurrence are discussed.DiscussionAll patients with DCIS have potential benefit to gain from adjuvant radiotherapy. However, radiotherapy also has adverse effects and represents over-treatment from many women. Support should be given to current trials which are assessing endocrine treatment of DCIS, and whether radiotherapy can reasonably be omitted in lower risk disease.     

Prognostic markers and long-term outcomes in ductal carcinoma in situ of the breast treated with excision alone

BACKGROUND:

Increased use of breast cancer screening has led to an increase in the number of diagnosed cases of ductal carcinoma in situ (DCIS). However, there is no definite way to predict progression or recurrence of DCIS. We analyzed the significance of biological markers and tumor characteristics in predicting recurrence in a large series of DCIS patients with long‐term follow‐up treated with breast conservation surgery (BCS) alone.

METHODS:

Clinical and pathological data were analyzed for 141 patients who underwent BCS for DCIS. All had negative surgical margins. Using local disease recurrence as an endpoint, we sought to determine the prognostic significance of several histopathological characteristics (tumor size, presence of necrosis, and subtype) and biological markers (estrogen receptor, progesterone receptor, and Her‐2/neu.)

RESULTS:

At a median follow‐up of 122 months (maximum follow‐up, 294 months), 60 recurrences occurred, with a median time to recurrence of 191 months. On multivariate analysis, Her‐2 positivity (3+) was found to be significantly associated with reduced time to tumor recurrence (P = .028). Tumor size and higher grade were marginally statistically significant (P = .099, P = .070). Neither necrosis nor tumor pathological characteristics were found to be significantly related to time to disease recurrence.

CONCLUSIONS:

Our results suggested that status of Her‐2/neu, larger tumor size, and higher nuclear grade were significantly correlated with time to tumor recurrence in patients treated with BCS alone. Using logistical analyses, no significant correlation was found between tumor pathological characteristics and disease recurrence. Cancer 2011. © 2011 American Cancer Society.