INDICATION OF BREAST CONSERVATIVE SURGERY FOR PRIMARY BREAST CANCER USING COMPUTER GRAPHIC THREE-DIMENSIONAL RECONSTRUCTION OF THE MAMMARY DUCT-LOBULAR SYSTEMS

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Intraductal tumor extension is a characteristic feature of primary breast carcinoma, and is an important consideration in patients undergoing breast conservative surgery. However, there have been no reports studied this intraductal extension associated with the mammary ductal tree. Quadrantectomy specimens from 20 patients with primary invasive breast carcinomas were examined by subgross and stereomicroscopic technique in order to visualize intraductal tumor extension. Serial 2mm-thick sections were subjected to 2-dimensional (2-D) tumor mapping, measuring the distances and angles of extension, and to 3-dimensional (3-D) reconstruction of the mammary duct-lobular systems by means of a computer graphics. Intraductal tumor extension was found in 16 of 20 specimens (80.0%), extending continuously from the primary invasive carcinoma through the mammary ductal tree. The distances and angles of extension were larger in tumors with microcalcifications, papillotubular invasive ductal carcinoma, 30% or more intraductal components, and comedo type intraductal tumor extension. The 3-D reconstructions demonstrated three types of extension ; central (11 cases), peripheral (3 cases), and mixed (2 cases). Further, there found some ductal branches anastomosing the different mammary duct-lobular systems at various sites. In one specimen, intraductal tumor extended widely through a branch connecting adjacent mammary duct-lobular systems continuously from the primary invasive carcinoma. We presented 3-D reconstruction images of intraductal extension of invasive breast carcinomas for the first time. Examples of ductal anastomoses were presented, and should be considered as a risk factor for possible widespread intraductal extension through multiple mammary duct-lobular systems.