乳腺导管原位癌组织学分级与其他预后因素的关系

目的　探讨乳腺导管原位癌组织学分级与分型以及ｃｅｒｂＢ２ 蛋白、ｐ５３ 蛋白、ＭＩＢ１ 、雌激素受体（ＥＲ） 表达的关系,以期为临床判断潜在恶性程度及预后提供参数。方法　参照Ｖａｎ Ｎｕｙｓ 分类方法,对３２ 例乳腺导管原位癌按核的分级、有无坏死进行组织学分级,并将标本行ｃｅｒｂＢ２ 蛋白、ｐ５３ 蛋白、ＭＩＢ１、ＥＲ的枸橼酸微波ＡＢＣ免疫组化法染色。结果　Ⅰ级（分化好）１２ 例（３７．５％ ） ,Ⅱ级（中度分化）９ 例（２８．１％ ） ,Ⅲ级１１ 例（３４．４％ ）。Ⅲ级患者中,９ 例为粉刺型,１ 例为微乳头状型,１ 例为实体型,Ⅲ级的ｃｅｒｂＢ２、ｐ５３ 和ＭＩＢ１ 蛋白表达的阳性率分别高于Ⅱ级和Ⅰ级,并与Ⅰ级比较差异有显著意义（ Ｐ＜０．０５） ,ＥＲ阳性率低于Ⅱ级和Ⅰ级。结论　乳腺导管原位癌Ｖａｎ Ｎｕｙｓ 组织学分级可能是一个较好的预后指标。

Histological grading in ductal carcinoma in situ of the breast

Objective To study the significance of histological grading as a prognostic factor in ductal carcinoma in situ of the breast. Methods According to Van Nuy's classification, 32 cases of ductal carcinoma in situ (DCIS) of the breast were divided into three grades. Results Low grade (well differentiated, low grade DCIS) 12 patients (37.5%); Intermediate grade, 9 patients (28.1%); High grade (poorly differentiated DCIS) 11 patients (34.4%). Among the high grade DCIS, the histological subtypes were comedo (9 patients), micto papillary (1 patient) and solid (1 patient). The positive expression of c erbB 2, p53 and MIB 1 in high grade DCIS was higher than that in intermediate and low grade DCIS. The difference between high grade and low grade DCIS was significant ( P <0.05). The expression of ER in high grade DCIS was lower than that in intermediate and low grade DCIS. Conclusions Histological grading of breast ductal carcinoma in situ may be a good prognostic factor.