多病灶乳腺癌临床病理特征分析

Clinicopathological characteristics of multifocal breast cancer

目的探讨多病灶乳腺癌不同病灶临床病理特点的异同,以便更好地指导临床治疗。方法回顾性分析2014年11月至2016年8月南京医科大学第一附属医院乳腺外科收治的41例多病灶乳腺癌患者的临床病理资料。分析多病灶乳腺癌不同病灶的常规病理、免疫组织化学检测结果及分子亚型的异同,并采用χ~2检验比较多病灶乳腺癌与同期150例单病灶乳腺癌的病灶直径、组织学分级、淋巴结状态和脉管内癌栓状况。结果 41例多病灶乳腺癌患者中,有2处病灶者32例,3处病灶者8例,4处病灶者1例;病灶直径≤2 cm者18例,>2 cm者23例;不同病灶病理类型相同者33例(80%),不同者8例(20%);不同病灶组织学分级相同者38例(93%),不同者3例(7%);不同病灶免疫组织化学标志物ER、PR、HER-2、Ki67表达水平不同者分别为3例(7%)、6例(15%)、5例(12%)、3例(7%);分子亚型不同者5例(12%)。多病灶乳腺癌与单病灶乳腺癌患者相比,组织学分级3级、淋巴结转移及脉管内癌栓分布的差异均有统计学意义[51%(21/41)比32%(48/150),χ~2=5.154,P=0.023;59%(24/41)比41%(61/150),χ~2=4.163,P=0.041;29%(12/41)比8%(12/150),χ~2=13.257,P<0.001],但病灶直径的差异无统计学意义[56%(23/41)比56%(84/150),χ~2=0.001,P=0.991)]。结论多病灶乳腺癌不同病灶可存在不同的临床病理结果,因此,不同病灶均应进行常规病理与免疫组织化学检测,以便完整提供患者病理信息,选择最佳治疗方案。多病灶乳腺癌更易发生淋巴结转移及脉管内癌栓,提示可能预后较差。

Objective To explore the clinicopathological characteristics of different lesions in multifocal breast cancer patients and provide the guidance for clinical treatment. Methods The clinical data of 41 multifocal breast cancer patients in the Department of Breast Surgery,the First Affiliated Hospital of Nanjing Medical University from November 2014 to August 2016 were retrospectively analyzed. Conventional pathological findings, immunohistochemical results and molecular subtypes between different lesions in multifocal breast cancer patients were analyzed. χ~2 test was used to compare the lesion size,histological grade,lymph node status and intravascular tumor thrombus between 41 multifocal breast cancer patients and150 unifocal breast cancer patients enrolled in the same period. Results Among 41 multifocal breast cancer patients,32 were detected with 2 lesions,8 with 3 lesions,1 with 4 lesions. The maximum diameter of the lesion was no less than 2 cm in 18 cases,more than 2 cm in 23 cases. The different lesions of one patient belonged to the same pathological type in 33 cases（ 80%）,different pathological types in 8 cases（ 20%）. The different lesions of one patient had the same histological grade in 38 cases（ 93%）,different histological grades in 3 cases（ 7%）. The different lesions of one patient presented the different expression levels of ER,PR,HER-2 and Ki67 in 3 cases（ 7%）,6 cases（ 15%）,5 cases（ 12%） and 3 cases（ 7%）,respectively. Five cases（ 12%） had the different molecular subtypes. There were significant differences in histological grade 3[51%（ 21/41） vs 32%（ 48/150）,χ2= 5. 154,P = 0. 023],lymph node metastasis [59%（ 24/41） vs 41%（ 61/150）,χ^2= 4.163,P = 0.041] and intravascular tumor thrombus [29%（ 12/41） vs 8%（ 12/150）,χ^2=13.257,P 0. 001] between multifocal and unifocal breast cancer patients,while the lesion size showed no significant difference [56%（ 23/41） vs 56%（ 84/150）, χ^2= 0. 001,P = 0. 991]. Conclusions Clinicopathological results may vary in the lesions of multifocal breast cancer,so routine pathological and immunohistochemical examination should be carried out in all lesions so as to provide accurate and comprehensive pathological evidence for the optimal treatment. Multifocal breast cancer is prone to lymph node metastasis and intravascular tumor thrombus,indicating a poor prognosis.