PROGNOSTIC FACTORS IN PRIMARY BREAST-CARCINOMA
PROGNOSTIC FACTORS IN PRIMARY BREAST-CARCINOMA
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DOI：
10.1136/jcp.48.11.981
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发表时间：
1995-11-01
影响因子：
3.4
通讯作者：
ELSTON, CW
中科院分区：
文献类型：
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作者：
PINDER, SE;ELLIS, IO;ELSTON, CW
近年来，原发性乳腺癌患者的治疗选择范围已大大扩大。乳房X线检查的引入导致了更多的小的第一阶段癌症的识别。因此，临床医生获得最准确的预后信息以选择最佳治疗方案变得越来越重要。通过这种方式，可以避免治疗不足和过度。这种对信息的临床需求导致了对原发性乳腺癌理想预后因素的不断扩大的搜索，因此许多论文提出了许多具有不同程度意义的推定预后因素。目前对高科技的痴迷在某种程度上导致了传统组织病理学的价值被忽视，尽管肿瘤形态学和恶性程度之间的相关性在100多年前就被首次描述。这是不幸的，因为乳腺癌标本的常规组织病理学检查可以产生大量的临床有用的信息。组织学分级提供了许多肿瘤的预后信息，包括乳腺癌。两种主要的方法已经发展，基于核因子或细胞特征（核，细胞学和建筑）的组合。后一种方法是最广泛接受的乳腺癌分级，并已与更严格的定义更客观的标准。“因此，以前受到质疑的乳腺癌组织学分级系统的可重复性得到了改善;最近的几项研究证实，如果使用严格的标准，病理学家之间可以获得良好的相关性。2”在诺丁汉乳腺癌分级方法中，评估的三个特征是小管形成、核大小/多形性和线粒体计数。小于10%的癌形成小管的肿瘤评分为3，10 - 75%的肿瘤评分为2，如果超过75%的癌形成中央管腔，则评分为1。与正常上皮细胞评分相比，轻度、中度和高度核大小/多形性分别为1、2和3。对于有丝分裂计数，根据所用高倍透镜的视野面积进行评分。只包括具有明显的中期、后期或末期特征的细胞核;
The range of therapeutic options for the treat-ment of patients with primary breast cancer has widened considerably in recent years. The introduction of mammographic screening has led to the identification of greater numbers of small, stage 1 cancers. It is therefore in-creasingly important that clinicians are given the most accurate prognostic information on which to base the selection of the optimum therapy for eachwoman. In this way both under and over treatment can be avoided. This clinical need for information has resulted in an ever widening search for the ideal prognostic factor in primary breast cancer and consequently a multitude of papers have proposed numerous putative prognostic factors with differing degrees of significance. The current obsession with high technology has, to some extent, led to the value of traditional histopathology being overlooked, although the correlation between tumour morphology and degree of malignancy was first described over 100 years ago. This is unfortunate because routine histopathological examination of breast cancer specimens can yield a great deal of clinically useful information.Histological grade provides prognostic information in many tumours, including breast cancers. Two main methods have evolved, based either on nuclear factors or a com-bination of cellular features (nuclear, cyto-logical and architectural). The latter method is the most widelyaccepted for grading breast cancer and has been refined with the stricter definition of more objective criteria.'As a result, the reproducibility of histological grad-ing systems for breast carcinoma, previously questioned, has been improved; several recent studies have confirmed that good correlation between pathologists can be obtained if strict criteria are used. 2" In the Nottingham breast cancer grading method the three features assessed are tubule formation, nuclear size/pleomorphism andmi-totic count. Tumours in which less than 10% of the carcinoma is forming tubules score 3, those with 10 to 75% score 2 and if more than 75% of the cancer is forming central lumina, a score of 1 is given. Mild, moderate and high nuclear size/pleomorphism, when compared with normal epithelial cells score, 1, 2 and 3, respectively. For mitotic counts, a score is given according to the field area of thehigh power lens used. Only nuclei with clear features of metaphase, anaphase or telophase are included;