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

导管内肿瘤扩展是原发性乳腺癌的一个特征性特征，是乳房保守手术患者的重要考虑因素。然而，尚无关于导管内扩张与乳腺导管树相关的报道。本文对20例原发性浸润性乳腺癌的四象限切除术标本进行了亚大体和立体显微镜检查，以观察导管内肿瘤的扩展情况。连续2mm厚的切片进行二维（2-D）肿瘤测绘，测量延伸的距离和角度，并通过计算机图形学对乳腺导管-小叶系统进行三维（3-D）重建。导管内肿瘤延伸16例（80.0%），从原发性浸润性癌持续延伸至乳腺导管树。微钙化、乳头状管浸润性导管癌、导管内成分30%及以上、粉刺型导管内肿瘤扩展的距离和角度较大。三维重建显示出三种类型的扩展；中央（11例），周围（3例），混合性（2例）。此外，还发现一些导管分支在不同部位吻合不同的乳腺导管小叶系统。在一个标本中，导管内肿瘤从原发性浸润性癌开始，通过连接邻近乳腺导管-小叶系统的分支广泛扩展。我们首次提出了浸润性乳腺癌导管内扩张的三维重建图像。导管吻合术的例子被提出，应该被认为是可能通过多个乳腺导管小叶系统广泛导管内延伸的危险因素。

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.