p63/calponin和CK鸡尾酒双染对诊断乳腺导管原位癌伴微浸润的价值

Values of P63/calponin/CK cocktail double staining for diagnosis of breast ductal carcinoma in situ with microinvasion

目的探讨p63/calponin/CK鸡尾酒双染对诊断乳腺导管原位癌伴微浸润的价值。方法收集乳腺切除标本中诊断导管原位癌伴微浸润病例140例,行p63/calponin/CK鸡尾酒双染。收集患者的临床病理资料,并进行随访。结果鸡尾酒双染切片中导管原位癌及其微浸润成分或正常导管腺上皮胞质呈红色,导管原位癌的红色腺上皮周围有间断或连续的棕褐色肌上皮细胞,浸润性区域红色腺上皮周围无棕褐色肌上皮细胞围绕。140例中,11例患者失访,余129例均生存,无乳腺癌相关死亡;6例出现乳腺癌相关复发(BCRR),其中2例(1.4%)复发,2例(1.4%)发生远处转移,2例发现淋巴结转移。乳腺癌相关复发癌与患者的年龄、肿瘤大小、手术方式、肿瘤级别、ER、PR、Her-2状态无关,但与Ki-67增值指数相关。结论免疫组化p63/calponin/CK鸡尾酒抗体的应用,有助于导管原位癌伴微浸润(DCIS-MI)的诊断,值得推广应用。DCIS-MI总体预后较好,很少出现BCRR,高增值指数(Ki-67≥30%)容易发生BCRR。

Objective To investigate the diagnostic value and clinical significance of using P63/calponin/CK cocktail double staining for the diagnosis of breast ductal carcinoma in situ with microinvasion（ DCIS-MI）. Methods 140 cases of ductal carcinoma in situ with microinvasion were retrieved from the institutional database from January 2011 to July 2017.The expression of P63/calponin/CK cocktail antibody was examined in all cases. Clinicopathologic parameters of 140 cases were retrospectively analyzed and followed-up,including age,lesion size,surgical procedures,grade of ductal carcinoma in situ（ DCIS）,axillary or sentinel lymph node status,and immunohistochemical status of ER,PR and HER-2. Results Red cytoplasmic staining was observed in the epithelial cells of microinvasive cancer,ductal carcinoma in situ and normal breast epithelium. Discontinuous or consecutive brown myoepithelial cells were present around the red glandular epithelium of DCIS,but there were no brown myoepithelial cells around the red microinvasive cancer. There was no death in 129 patients,but 11 cases losing follow-up. The follow-up data showed that 6 of the 129 patients had breast cancer-related recurrence（ BCRR） with 2 cases of lymphatic metastasis,2 cases of recurrence,and 2 cases of distant metastasis. There was no relationship between BCRR and age,lesion size,surgical mode,grade of ductal carcinoma in situ（ DCIS）,axillary or sentinel lymph node status,and immunohistochemical staining of ER,PR and HER-2（ P 0. 05）. However,Ki-67 expression was associated with BCRR. Conclusion Inmmunohistochemical studies using P63/calponin/CK cocktail double staining can contribute to diagnosis（ DCIS-IM） and is worth of being generalized. DCIS-IM has a favorable prognosis with few BCRR after a long period of follow-up. Ki-67 expression（ Ki-67 〉30%） has a higher risk of developing BCRR.