乳腺导管内癌及乳腺导管内癌伴微小浸润癌临床、X线与病理表现对照

Comparison of clinical,X-ray and pathology findings of breast ductal carcinoma in situ and breast ductal carcinoma in situ with mirco-invasion

目的探讨乳腺导管内癌(DCIS)及乳腺导管内癌伴微小浸润癌(DCIS-MI)的临床、X线及病理表现差异。方法回顾性分析133例经手术病理证实的DCIS及DCIS-MI患者的临床、X线及病理学资料,其中DCIS组93例(96侧),DCIS-MI组40例(40侧)。结果 DCIS组49侧(49/96.51.04%)、DCIS-MI组10侧(10/40,25.00%)触诊阴性,差异有统计学意义(P<0.05)。DCIS组淋巴结转移均为阴性,DClS-MI组4侧(4/40,10.00%)前哨淋巴结转移,7侧(7/40,17.50%)腋淋巴结转移,差异有统计学意义(P均<0.05)。两组X线主要征象差异有统计学意义(P<0.001),其中DCIS组单纯钙化比例较高(41/96,42.71%),DCIS-MI组钙化伴局灶性不对称/肿块比例较高(24/40,60.00%);两组钙化形态及分布差异有统计学意义(P均<0.05),DCIS组钙化形态主要呈细小多形性(39/57,68.42%),成簇(25/57,43.86%)及段样(31/57,54.39%)分布,DCIS-MI组钙化形态多呈线样分支状(14/27,51.85%),段样(18/27,66.67%)分布。两组病灶最大径、组织学分级、分子亚型及Ki-67指数差异有统计学意义(P均<0.05)。结论 DCIS与DCIS-MI临床表现、X线征象及病理学特征具有一定差异,DCIS-MI更具浸润性癌特征。

Objective To investigate the differences of clinical, X-ray and pathological findings between ductal carcinoma in situ （DCIS） and ductal carcinoma in situ with micro-invasive （DCIS-MI）. Methods Clinical, X-ray and pathological data of 93 patients of DCIS （96 lateral breasts） and 40 patients of DCIS-MI （40 lateral breasts） were retrospectively analyzed. Results There were 49 （49/96, 51.04%） DCIS and 10 （10/40, 25.00%） DCIS-MI with negative sign （P〈0.05）. No metastasis of lymph node＇s occurred in DCIS, and 4 （4/40, 10.00%） DCIS-MI had sentinel lymph node meatastasis, 7 （7/ 40, 17.50%） DCIS-MI had axillary lymph node meatastasis （P〈0.05）. There were significant differences of primary findings between DCIS and DCIS-MI （P〈0.05）, that was more lesions appeared as pure calcification in DCIS （41/96, 42.71%）, while as micro-calcification complicated with focal asymmetry/mass in DCIS-MI （24/40, 60.00%）. The morphology and distribution of calcification were different between DCIS and DCIS-MI （both P〈0.05）, that was calcification was mostly fine pleomorphic calcifications （39/57, 68.42%） with clustering （25/57, 43, 86%） or segment （31/57, 54.39%） distribution in DCIS, and mostly linear or linear branching calcifications （14/27, 51.85%） with segment distribution （18/27, 66.67%） in DCIS-MI. There were significant differences of lesion＇s maximum diameter, histological grade, molecular subtype and Ki-67 index （all P〈0.05）. Conclusion There are differences of clinical, X-ray and pathological findings between DCIS and DCIS-MI, and the features of DCIS are more inclined to infiltrating cancer.