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）的病例可能发展到原位癌（DCIS）阶段。因此，我们分析了“早期”浸润性癌，以阐明这些病变的发病机制和临床意义。(1)临床病理回顾的最低限度的浸润性（小于1毫米）癌显示，其非侵袭性成分主要由粉刺状结构和高核分级组成。淋巴结转移状态与单纯DCIS无差异。(2)浸润性微乳头状癌是乳腺癌的一种特殊类型，预后差。随访3年以上，肿瘤细胞核分级高，淋巴结转移多，预后差。由于这种特殊类型的癌症不会通过导管-小叶系统广泛扩展，因此这将是具有早期远处转移事件的浸润性癌的模型之一。细胞学分析揭示了一些特征性的发现。我们有可能通过细针穿刺细胞学更早地发现这种类型。(3)我们对13个已知的微卫星标记进行了洛丢失分析，以检测癌细胞浸润的早期事件。IDC的洛缺失模式与s型DCIS和不典型增生相同。此外，IDC与先前活检的DCIS之间存在相同的洛模式。因此，IDC的基因改变可能早于癌的早期浸润。

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.