78例乳腺导管内癌临床分析

Ductal carcinoma in situ of the breast(Report of 78 cases)

目的探讨不同肿块大小的乳腺导管内癌（ductal carcinoma in situ,DCIS）的临床、病理特点。方法回顾性分析河北大学附属医院2011年2月至2013年9月收治的78例DCIS病例特点,以肿块大小1.0 cm及3.0 cm为分界点,进行对比分析。结果肿块≤1.0cm及肿块1.0-3.0cm临床特征差异无统计学意义（P〉0.05）,而肿块〉3.0 cm与前2者相比差异有统计学意义（P〈0.05）,多表现为微浸润,多灶性比例高以及前哨淋巴结阳性比例高。DCIS与浸润性导管癌（infiltrating ductal carcinoma,IDC）进行病理学指标的差异性分析,ER、PR、Ki67阳性表达相对低、HER-2阳性表达相对高（P〈0.05）,差异有统计学意义,而IDC与肿块〉3.0 cm的DCIS进行分析,各指标差异无统计学意义（P〉0.05）。结论肿块〉3.0 cm的DCIS是一种特殊类型的癌,更具有侵袭性,生物学特点更接近于IDC,治疗推荐按IDC方式处理。

Objective To explore the clinical and pathological characteristics of ductal carcinoma in situ（DCIS） with tumor size examination. Methods We retrospectively analyzed 78 DCIS cases in Affiliated Hospital of Hebei University from Feb. 2011 to Sep. 2013. A comparative analysis was conducted with the cut-off points of 1.0cm and 3.0cm tumor size. Results When tumor size≤1.0cm and tumor size between 1.0-3.0cm, the clinical characteristics had no significant difference, when tumor size〉3.0cm, the characteristics were significantly different from the above two（P〈0.05） shown as micro infiltration, high multifocal proportion, and high sentinel lymph node positive rate. The variance analysis of pathological indicators of DCIS and IDC showed that the positive expression of ER, PR, Ki67 was relatively low, while the positive expression of HER-2 was relatively high（P〈0.05）, this difference was significant. When tumor size 〉3cm, all the indicators had no significant difference. Conclusion When tumor size3.0 cm, the DCIS is more aggressive and its biology characteristics are similarly to IDC. The IDC treatment is recommended.