乳腺导管内癌：附123例(125侧)报告

Ductal carcinoma in situ of breast:a report of 123 cases

目的加深对导管内癌(DCIS)的认识,以提高其诊断率和治疗效果。方法回顾性分析中国医科大学附属第一医院普通外科收治的123例DCIS患者的临床资料。包括发病年龄、临床表现、体检特征、超声和钼靶检查、病理特点、免疫组织化学检查和手术方式。结果(1)该组发病的平均年龄为(47.7±9.3)岁。(2)体检特点以乳腺肿块79例,乳头溢液19例,乳房疼痛伴腺体增厚30例等为主要表现。(3)超声、钼靶45例,可能为恶性者分别为27例(60%),30例(66.7%),方法准确率差异无统计学意义。综合2种方法后,诊断可能恶性者37例(82.2%)。(4)65例超声表现为实质性肿见块43例(66%);血流信号41例(63%);可见导管扩张52例(80%)和导管内点状强光团33例(50.7%)。(5)52例钼靶摄影主要表现有泥沙样钙化,肿物伴簇状钙化,腺体局限性致密和乳腺肿物。(6)免疫组织化学检查包括雌激素受体(ER),孕激素受体(PR),p53和c-erbB-2。DCIS与DCIS-MI的阳性表达率差异均无统计学意义。(7)行乳腺癌标准根治术6例(其中3例为DCIS-MI)。共行乳腺癌改良根治术86例,包括59例DCIS,27例DCIS-MI。DCIS伴有淋巴结转移者2例,DCIS-MI有淋巴结转移者5例。结论乳腺超声检查和钼靶摄像联合诊断可提高DCIS的诊断率。

Objective In order to deeper understand DCIS, improve the rate of diagnosis and therapeutic efficacy. Methods The clinical data of 123 DCIS treated at the First Affiliated Hospital of China Medical University were retrospectively analyzed in regards to age at onset of disease, clinical features, breast ultrasound examination, mammography examination, pathology, immunohistochemistry examination, and surgical methods. Results （ 1 ） The average age at onset was （47. 7 ± 9. 3 ） years. （ 2 ） The major features on physical examination were breast lump in 79eases, nipple discharge in 19cases, and breast pain with glandular thickening in 30 cases. （3） Among 45 cases that underwent both ultrasound and mammography examination, in 17cases （60%） and 30 cases （66.7%） respectively, might be positive for malignancy, but the difference between the 2 melhods was not significant. With the use of both methods togather, diagmosis of possible malignant lesion was made in 37 cases （ 82. 2% ）. （ 4 ） Sixty-five cases underwent breast ultrasound examination, substantive mass was found in 43 cases （66%）, blood flow signals in 41 cases （63%） ,ductal dilatation in 52 cases （80%） and intraductal spotty strong light beam in 33 cases （50. 7 % ）. （5） Fifty-two cases underwent breast mammography examination, which showed sand-like calcification, mass with calcification clusters, localized gland density and breast tumor. （6）The immunohistochemistry examination included estrogen receptor （ ER ） , progesterone receptor （ PR ） , p53 and c-erbB-2, but the rate of positive expressios of those indices showed no significance difference between DCIS and DIS with microvasion （DCIS-MI）. （7）Six cases underwent radical mastectomy （of which there were 3 cases of DCIS-MI）. Modified radical mastectomy was done in 86 cases, including 59 cases of DCIS, 27 cases of DCIS-MI. Lymph node metastasis was found in 2 cases of DCIS, and 5 cases of DCIS-MI. Conclusions Combined breast ultrasound and mammography can increase the rate of DCIS diagnosis.