Early invasive cancer of the breast. Clinico-pathological analysis for establishment a new disease entity

大多数乳腺浸润性导管癌（IDC）可发展到原位癌（DCIS）阶段。因此，我们对“早期”浸润性癌进行了分析，以阐明这些病变的发病机制和临床意义。(1)微创（小于1mm）癌的临床病理检查显示其非侵入性成分主要由粉刺结构和高核分级组成。淋巴结转移情况与单纯DCISs无明显差异。(2)浸润性微乳头状癌是一种空间型乳腺癌，预后较差。随访3年以上均表现为核分级高，淋巴结转移数多，预后不佳。由于这种特殊类型的肿瘤没有广泛地通过导管-小叶系统扩张，这将是具有早期远处转移事件的浸润性癌的模型之一。细胞学分析显示了一些特征性的发现。我们有可能通过细针穿刺细胞学早期发现这种类型。(3)我们利用13种微卫星标记物进行LOH分析，以检查肿瘤侵袭的早期事件。在相同的手术材料中，IDC与DCIS具有相同的LOH模式和不典型增生。此外，IDC和之前活检的DCIS之间存在相同的LOH模式。因此，我们有理由考虑IDC基因改变发生的可能早于癌的早期侵袭。

Most of the cases of invasive ductal carcinoma (IDC) of the breast may be developed through the stage of in situ carcinoma (DCIS). Thus we have analyzed the "early" invasive carcinomas to clarify the pathogenesis and clinical significances of these lesions. (1) Clinicopathological review of the minimally invasive (less than 1 mm) carcinomas revealed that their noninvasive components were mainly composed by comedo architecture and high nuclear grade. Lymph node metastatic status was not different from pure DCISs. (2) Invasive micropapillary carcinoma, which is a spacial type of breast carcinoma with poor prognosis were examined. They were also showed high nuclear grade, higher number of lymph node metastasis frequently, and prognosis were not so good by more than 3 years follow-up. As this special type cancer is not expanding through the duct-lobular system extensively, this will be one of the model of invasive carcinoma with earlier event of distant metastasis. Cytological analysis revealed that some of the characteristic findings. There is a possibility that we can detect this type earlier by fine needle aspiration cytology. (3) We have done the LOH analysis by 13 of well known microsatellite markers to check the early event of carcinoma invasion. IDC had the same pattern of LOH with the s DCIS and atypical hyperplasia in the same operated material. Additionaly, there were the same LOH pattern between IDC and previously biopsied DCIS. Thus it may reasonable to consider the possibility that the genetic change of IDC had been occurred earlier than the early invasion of carcinoma.