In situ duct carcinoma of the breast: clinical and histopathologic factors and association with recurrent carcinoma.
In situ duct carcinoma of the breast: clinical and histopathologic factors and association with recurrent carcinoma.
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DOI：
10.1046/j.1524-4741.2001.99124.x
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发表时间：
2001-09-01
期刊：
影响因子：
--
通讯作者：
Hanna, W M
中科院分区：
文献类型：
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作者：
Miller, N A;Chapman, J A;Hanna, W M
最近，由于乳房X线摄影筛查，乳腺原位导管癌（DCIS）的诊断有所增加。DCIS的表现具有异质性，预后可能较好。没有普遍接受的模型来预测进展为浸润性癌。我们研究了临床表现和病理因素对诊断为原发性DCIS的妇女的预后影响。在1979年至1994年期间收集了124例患者的队列，并随访至1997年; 78例乳腺X线检查发现DCIS，88例仅接受乳房肿瘤切除术。在这篇文章中，我们提供了有关影响主要治疗方式选择的特征的详细信息，并检查了两个患者亚组的进展因素的影响。血性乳头溢液与DCIS复发率显著增加相关（p=0.07）。导管分布的模式很重要：与受累导管较集中的DCIS相比，受累导管较分散的DCIS的复发率显著更高（乳腺X线检查发现DCIS的p=0.08，仅行乳房肿瘤切除术的患者p=0.07）。对于乳腺摄影检测到的DCIS，年轻患者的DCIS复发率更高（p=0.07）。我们发现核分级存在相当大的异质性; 50%的患者表现出一个以上的等级。核分级、坏死和结构与DCIS的复发或浸润性癌的发展无显著相关性。更长时间的随访将允许进一步评估评估因素的预后相关性。
There has been a recent increase in the diagnosis of in situ duct carcinoma of the breast (DCIS) as a result of mammographic screening. DCIS is heterogeneous in appearance and likely in prognosis. There is no generally accepted model to predict progression to invasive carcinoma. We investigated the prognostic effect of clinical presentation and pathologic factors for women diagnosed with primary DCIS. A cohort of 124 patients was accrued between 1979 and 1994 and was followed to 1997; 78 had DCIS detected mammographically, and 88 underwent lumpectomy alone. In this article, we provide details about characteristics affecting the choice of primary therapeutic modality, and we examine the effects of factors on progression for the two patient subgroups. Presentation with bloody nipple discharge was associated with a significant increase in DCIS recurrence (p=0.07). The pattern of duct distribution was important: DCIS in which the involved ducts were more widely separated had a significantly greater recurrence of DCIS than when the involved ducts were more concentrated (p=0.08 for mammographically detected DCIS, p=0.07 for patients who underwent lumpectomy alone). For mammographically detected DCIS, younger patients had more DCIS recurrence (p=0.07). We found considerable heterogeneity in nuclear grade; 50% of patients exhibited more than one grade. Nuclear grade, necrosis, and architecture were not significantly associated with either recurrence of DCIS or development of invasive carcinoma. Longer follow-up will allow further evaluation of the prognostic relevance of the factors assessed.