30例乳腺导管内癌诊断方法的探讨

Diagnostic Methods for Ductal Carcinoma in Situ:an Analysis of 30 Cases

目的探讨彩色多普勒超声、X线钼靶、术中冰冻检查、常规病理检查及免疫组织化学检测对乳腺导管内癌(ductal carcinoma in situ,DCIS)患者术前、术中、术后的诊断价值。方法对30例DCIS患者的临床资料,X线钼靶、彩色多普勒超声、术中冰冻检查结果及CK5/6、CK8/18、34βE12、Ki67等免疫组织化学检测结果进行回顾性分析。结果 30例DCIS患者中症状为乳腺肿块或乳腺局限性增厚23例、单独或伴发乳头溢液5例、不随月经周期而改变的乳腺疼痛1例、没有任何症状1例。彩色多普勒超声检测阳性符合率为66.7%,X线钼靶检测阳性符合率为76.7%,2种检测方法比较差异无统计学意义(χ2=0.82,P>0.05);彩色多普勒超声联合X线钼靶检测阳性符合率明显高于彩色多普勒超声单独检测阳性符合率(90.0%比66.7%,χ2=4.812,P<0.05)。术中冰冻DCIS检出率为66.7%。CK5/6在DCIS及乳脉导管不典型增生(ADH)区域几乎为阴性,仅1例增生导管上皮CK5/6及CK8/18呈阳性;4例34βE12在ADH和DCIS增生细胞中均有表达;15例CK8/18在常规组织学病理中明确的DCIS区域及ADH区域中呈阳性表达;Ki67在DCIS区域中的表达较ADH区域略有增高趋势。结论彩色多普勒超声、X线钼靶、术中冰冻检查、常规病理检查及免疫组织化学检测对DCIS患者术前、术中、术后诊断各有优点及局限性,临床医生应综合考虑有利于DCIS的诊断,减少漏诊。

Objective To explore the values of color Doppler ultrasound,X-ray mammography, frozen section examination,routine pathological examination and immunohistochemical assay in preoperative,intraoperative and postoperative diagnosis of ductal carcinoma in situ （DCIS）.Meth-ods The findings of color Doppler ultrasound,X-ray mammography and frozen section examina-tion and the results of immunohistochemical assay for CK5/6,CK8/18,34βE12 and Ki67 were ret-rospectively analyzed in 30 patients with DCIS.Results Among the 30 patients,23 had breast mass or local mammary gland thickening,5 had nipple discharge,1 had breast pain which was not affected by menstrual cycle,and 1 had no symptoms.There was no significant difference in the positive coincidence rate between color Doppler ultrasound and X-ray mammography （66.7% vs 76.7%,χ2 =0.82,P 〉0.05）.The combination of color Doppler ultrasound and X-ray mammogra-phy resulted in a higher positive coincidence rate than color Doppler ultrasound alone （90.0% vs 66.7%,χ2 =4.812,P 〈0.05）.The detection rate of intraoperative frozen section examination for DCIS was 66.7%.Immunohistochemical assay showed negative staining for CK5/6 in DCIS and a-typical duct hyperplasia （ADH）regions,positive staining for CK5/6 and CK8/18 in hyperplastic ductal epithelium （1 patient）,and positive staining for 34βE12 in hyperplastic cells in DCIS and＆nbsp;ADH regions （4 patients）.Furthermore,15 patients showed positive staining for CK8/18 in DCIS and ADH regions confirmed by routine pathological examination.Compared with ADH regions, Ki67 expression increased slightly in DCIS regions.Conclusion Color Doppler ultrasound,X-ray mammography,frozen section examination,routine pathological examination and immunohisto-chemical assay have their own respective advantages and limitations in preoperative,intraoperative and postoperative diagnosis of DCIS.Therefore,clinicians should comprehensively consider the di-agnosis of DCIS to reduce the missed diagnosis.