乳腺导管原位癌、微浸润癌及浸润性癌临床病理指标表达差异分析

Characteristics of DCIS, DCIS with microinvasion, and invasive breast cancer

目的：比较乳腺导管原位癌（DCIS）、导管原位癌伴微浸润（DCIS-MI）及浸润性乳腺癌（IDC）临床病理及免疫组化特征。方法回顾性分析2008至2013年的214例乳腺癌患者的临床病理资料，其中DCIS 66例，DCIS-MI 48例，IDC 100例。根据免疫组化结果分为4组：Luminal-A [ER（＋）和／或 PR（＋），HER2（－）]，Luminal-B [ER（＋）和／或 PR（＋），HER2（＋）]，HER2（＋）型[ER（－），PR（－），HER2（＋）]，和三阴型[ER（－），PR（－），HER2（－）]。结果从DCIS、DCIS-MI到IDC，肿瘤大小逐渐增加（P＜0．001）。IDC腋窝淋巴结阳性率高于DCIS和DCIS-MI（P＜0．001）。ER、PR、HER2阳性表达在纯DCIS、DCIS-MI与IDC之间的表达显著差异，P值均小于0．05。随着浸润的发展，Luminal-like 型比例下降，而HER2＋型和三阴型的比例增加（P＝0．016）。Ki-67指数分别为DCIS（10．4±12．9）％，DCIS-MI（13．9±16．3）％，IDC（43．9±26．4）％（P＜0．001）。结论在DCIS、DCIS-MI、IDC中不同亚型的分布以及各自的临床病理特点表明它们之间存在很大不同。

Objective To compare the clinicopathologic and immunohistochemical characteristicsof ductal carcinoma in situ（DCIS）,ductal carcinoma in situ with microinvasion（DCISMI）and invasivebreast cancer（IDC）.Methods The clinicopathologic data of 214 cases of breast cancer from 2008 to2013 were retrospectively reviewed,including 66 cases of DCIS,48 cases of DCISMi and 100 cases of IDC.According to the immunohistochemical results,they were divided into four groups：LuminalA [ER（＋）,HER2（-）and/or PR（＋）]group,LuminalB [HER2（＋）,ER（＋）and/or PR（＋）]group,HER2（＋）[ER（-）,PR（-）,and HER2（＋）]group,and triplenegative [ER（-）,PR（-）and HER2（-）]group.Results From DCIS and DCISMI to IDC,the tumor size increased（P 〈0.001）.The incidence of IDC with positive axillary lymph node was significantly higher than DCIS and DCISMi （P 〈0.001）.There were significant differences in ER,PR and HER2 expressions among the groups （P 〈0.05）.With the development of infiltration,the ratio of Luminallike tumors decreased,whereas HER2（＋）and triplenegative tumors increased（P =0.016）.There was a significant difference among DCIS（10.4 ±12.9）%,DCISMI（13.9 ±16.3）% and IDC（43.9 ±26.4）% in Ki67 index（P 〈0.001）.Conclusion Different distribution of distinctive characteristics and subtypes among DCIS,DCISMI andIDC indicates that they are distinct entities.