乳腺导管内癌及其微浸润癌病理和生物学指标表达差异的临床意义

目的比较乳腺导管内癌（DCIS）与微浸润癌（DCIS—MI）的病理及生物学指标表达差异，探讨DCIS发展为浸润癌的过程中可能存在的病理或生物学特性改变。方法回顾分析40例DCIS和30例DCIS-MI，采用Pearsonx。检验比较两者导管内癌成分的病理学指标，采用Wilcoxon秩和检验比较两者雌激素受体（ER）、孕激素受体（PR）、人表皮生长因子受体（HER-2）、P53及Ki67生物学指标的差异。结果DCIS的病理分型中，粉刺型和非粉刺型的病例分别占25．0％（10／40）和75．0％（30／40），而DCIS。MI的导管内癌成分中粉刺型和非粉刺型分别占63．3％（19／30）和36．7％（11／30），两者差异有统计学意义（0=10．38，P=0．001）；DCIS—MI的导管内癌成分中高级别的核分级和伴坏死的比例明显高于DCIS（x2=9．52，P=0．009，x2=8．57，P=0．003）。DCIS与DCIS—MI两组间ER、PR、HER-2和P53的表达差异均无统计学意义（P〉0．050）。DCIS—MI中Ki67增殖指数高表达（〉20％）比例明显高于DCIS（40．0％比17．5％；Z=-2．35，P=0．019）。结论Ki67增殖指数对评价DCIS发生浸润有一定的临床价值。

Differences of pathological indicators and biological markers between ductal carcinoma in situ (DCIS) and DCIS with microinvasion

Objective To compare the pathological indicators and biological markers between ductal carcinoma in situ（DCIS） and DCIS with microinvasion（DCIS-MI） for investigating the possible pathological and biological alterations during the progression of DCIS to DCIS-MI. Methods Forty patients with DCIS and 30 patients with DCIS-MI were retrospectively analyzed. Pearson X2 test was applied for comparison of the pathological indicators of the intraductal components between DCIS and DCIS-MI. Wilcoxon rank sum test was used for comparison of the differences of biological markers as estrogen receptor （ER） , progesterone receptor （PR）, human epidermal growth factor receptor 2 （HER-2）, P53 and Ki67 between DCIS and DCIS-MI. Results For the pathological type, comedo and non-comedo types were 25.0% （10/40） and 75.0% （30/40） in the DICS group, and 63.3% （19/30） and 36.7% （11/30） in the DCIS-MI group, respectively; and there was statistically significant difference between the two groups（ x2 = 10.38 ,P =0,001 ）. The proportions of high nuclear grade and necrosis were significantly higher in the DCIS-MI group than in the DICS group（ x2 = 9.52, P = 0. 009;x2 = 8. 572, P = 0. 003）. There were no differences in the expressions of ER, PR, HER-2 and P53 between the DCIS and the DCIS-MI groups （P 〉 0. 050）. But Ki67 index was significantly higher in the DCIS- MI group than in the DICS group （40.0% vs 17. 5%,Z = -2. 351,P =0. 019）. Conclusion Cell proliferation capacity and expression of Ki67 may have a role to predict the progression of DCIS to DCIS-MI.