乳腺导管内癌及乳腺导管内癌伴微浸润182例患者的临床分析

Clinical analysis of 182 patients with DCIS and DCIS with microinvasion

目的:探讨乳腺导管内癌(ductal carcinoma in situ,DCIS)及DCIS伴微浸润(DCIS with mucroinvasion,DCIS-MI)患者的临床病理特征及主要诊断方法。方法:回顾性分析2007年3月—2010年10月收治的182例DCIS及DCIS-MI患者的临床病历资料,收集临床体检、影像学检查和病理诊断资料,并进行术后随访。结果:182例患者中,DCIS患者97例,DCIS-MI患者85例,占同期收治乳腺癌患者数(1250例)的14.56%。其中,可触及乳腺肿块的患者有67例(36.81%),未触及乳腺肿块的患者有115例(63.19%)。在67例临床可触及的乳腺肿块中,乳腺彩色多普勒超声和乳腺数字钼靶X线摄片均提示为乳腺癌的有49例。在115例临床体检未触及乳腺肿块的患者中,仅乳腺彩色多普勒超声检查提示乳腺癌的有23例患者,乳腺彩色多普勒超声和乳腺数字钼靶X线摄片均提示乳腺癌的患者有31例,仅乳腺数字钼靶X线摄片提示乳腺癌的患者有40例,仅磁共振成像检查发现的患者有2例,单纯表现为乳头溢液而经乳管镜检查发现乳腺癌的患者有19例。182例患者中,肿瘤最大径≤2cm的有111例,>2cm的有71例。DCIS患者中,肿瘤最大径>2cm的患者占36.62%(26/97);DCIS-MI患者中,肿瘤最大径>2cm的患者占63.38%(45/85),差异有统计学意义(P=0.0003)。DCIS患者的雌激素受体(estrogen receptor,ER)/孕激素受体(progesterone receptor,PR)阳性率为71.13%,明显高于DCIS-MI患者的55.29%(P=0.01);DCIS和DCIS-MI患者HER-2过表达率的差异无统计学意义(P=0.12);DCIS患者中Ki-67>14%所占比例明显低于DCIS-MI患者(P=0.02)。术后随访15～57个月,除1例患者因脑血管病变死亡外,其余181例无复发或转移。结论:乳腺彩色多普勒超声联合乳腺数字钼靶X线摄片是诊断早期乳腺癌最主要的检查手段,而依据临床病理学指标来预测DCIS或DCIS-MI,有助于合理选择治疗手段。

Objective： To investigate the diagnostic methods and clinicopathological features of patients with DCIS （ductal carcinoma in situ） and DCIS-MI （DCIS with microinvasion）, and to provide the clinical evidence for early diagnosis and treatment selection. Methods： The clinical records of 182 patients with DCIS and DCIS-MI between March 2007 and October 2010 were retrospectively reviewed. The information of CBE （clinical breast examination）, imaging findings and pathology were collected. The follow-up was performed after operation. Results： In 182 patients, 97 of whom were DCIS and 85 were DCIS-MI, accounting for 14.56% of total patients with breast cancer （n = 1 250） recruited in our hospitals during the same period. Among them, 67 （36.81%） had palpable breast lesion and 115 （63.19%） had non- palpable breast lesion. Among 67 cases of non-palpable breast lesion, 49 were detectable through both of diagnostic mammography and ultrasound examination. Among 115 cases of non-palpable breast lesion, 23 were only detectable through ultrasound examination, 40 through mammography, 2 through MRI （maqnetic resonance imaqinq）, and 31 throuqh both mammoqraphy and ultrasound examination. Nineteen cases of simple nipple discharge were diagnosed through fiberoptic ductoscopy. Among 182 cases, 111 patients had breast cancer smaller than or equal to 2 cm, 71 patients had breast cancer larger than 2 cm. The proportions of breast cancer larger than 2 cm were 36.62% （26/97） and 63.38% （45/85） in DCIS patients and DCIS-IM patients, respectively （P = 0.000 3）. ER （estrogen receptor）/PR （progesterone receptor）-positive rate was significantly higher in DCIS patients than that in DCIS-MI patients （71.13% vs 55.29%, P = 0.01）, while there was no significant difference in HER-2 （human epidermal growth factor receptor-2） overexpression rate （P = 0.12）. The proportion of patients with Ki-67 〉 14% was significantly less in DCIS patients than that in DCIS-MI patients （P = 0.02）. All the patients were followed-up for 15 to 57 months, and only one patinet had died due to cerebrovascular accident, and the remaining 181 patinet had no recurrence or metastasis. Conclusion： Mammography combined with ultrasound examination is the most important imaging methods for early diagnosis of breast cancer. The prognostic predictors for DCIS or DCIS-MI based on the clinical and pathological measurements may facilitate the treatment decision.