乳腺导管原位癌治疗的争议与共识

Controversy and consensus on the treatment of breast ductal carcinoma in situ

乳腺导管原位癌(DCIS)是非浸润性的恶性疾病,通常被认为是浸润性乳腺癌(IBC)的前驱病变。约14%～53%的病例在30年内可以进展为IBC;DCIS的主要治疗目标是预防其进展为IBC;阴性切缘的保乳手术(BCT)包括肿块切除术,辅以放疗为标准治疗策略。通常不必实施前哨淋巴结活检,除非是高风险病人;辅助内分泌治疗可降低复发风险。没有证据显示化疗或抗HER2治疗能有效抑制DCIS转化为IBC,但HER2阳性可能是DCIS预测复发的预后因素。

Ductal carcinoma in situ （DCIS） is a noninvasive malignant breast disease entity generally described as a precursor lesion to invasive breast cancer （IBC）. About 14% to 53% of women could develop IBC over 30 years. The goal of primary therapy for DCIS is to prevent progression to invasive breast carcinoma. Breast-conserving therapy （BCT） includes lumpectomy to remove the tumor with negative surgical margins followed by radiation therapy is standard strategy. Sentinel lymph node biopsy is not typically performed unless the patient is at high risk. Adjuvant endocrine therapy could reduce risk of recurrence. There is no evidence that chemotherapy or anti-HER2 therapy could effectively inhibit transformation form DCIS to IBC, but positive HER2 may be a prognostic factor in DCIS predicting recurrence.