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

导管内肿瘤的扩散是原发性乳腺癌的一个特征性特征，也是患者接受保乳手术时的一个重要考虑因素。然而，目前还没有研究这种与乳腺导管树相关的导管内延伸的报道。采用亚大体和体视显微镜技术对20例原发性浸润性乳腺癌行象限切除术，观察肿瘤在导管内的扩展情况。连续2 mm厚的切片进行二维（2-D）肿瘤标测，测量延伸的距离和角度，并通过计算机图形学进行乳腺导管-小叶系统的三维（3-D）重建。20例中16例（80.0%）导管内肿瘤延伸，从原发浸润癌连续延伸到乳腺导管树。在微钙化、乳头管状浸润性导管癌、30%或更多导管内成分和粉刺型导管内肿瘤扩展的肿瘤中，扩展的距离和角度较大。三维重建显示三种类型的扩展：中央（11例），周围（3例）和混合（2例）。此外，在不同的部位，还发现了一些导管分支覆盖了不同的乳腺导管-小叶系统。在一个标本中，导管内肿瘤广泛延伸通过一个分支连接相邻的乳腺导管小叶系统连续从原发性浸润癌。我们首次提出了浸润性乳腺癌导管内侵犯的三维重建图像。提出了导管内扩张的例子，应将其视为可能通过多个乳腺导管-小叶系统广泛导管内延伸的风险因素。

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.