Ki-67和CD34免疫组织化学表达模式在乳腺导管原位癌与导管原位癌样浸润性癌中的鉴别诊断价值

The value of immunohistochemical expression of Ki-67 and CD34 in differentiating ductal carcinoma in situ from ductal carcinoma in situ-like invasive breast cancer

目的探讨Ki-67和CD34免疫组织化学染色在乳腺导管原位癌(DCIS)与导管原位癌样浸润性癌(DLIBC)之间的鉴别诊断价值。方法收集烟台毓璜顶医院2019年1月至2022年3月病理诊断为DCIS的病例100例,DLIBC病例150例,使用免疫组织化学染色检测两组样本中p63、细胞角蛋白(CK)5/6、Ki-67及CD34的表达,观察DCIS和DLIBC的肌上皮表达情况及Ki-67与CD34的表达模式差异。结果100例DCIS包括低级别DCIS 11例、中级别DCIS 28例、高级别DCIS 61例,p63和CK5/6免疫组织化学染色显示癌性导管周围肌上皮完整或部分缺失;Ki-67表达显示两种模式:靠近癌巢周围区域高表达模式及癌巢内散在表达模式,大多数病例以周围高表达模式为主(77/100,77%),该模式在低、高级别DCIS间所占比例差异有统计学意义(P<0.05);所有病例均不同比例地显示CD34阳性的小血管呈完整环绕管周模式,即"血管项链征"。150例DLIBC包括部分伴有原位癌形态(筛状或较规则的实性巢)的浸润性导管癌142例(其中3例基底细胞样型乳腺癌)、分泌性癌2例、实性乳头状癌3例、腺样囊性癌2例、腺泡细胞癌1例。142例浸润性导管癌中WHO分级Ⅰ级13例、Ⅱ级77例、Ⅲ级52例。所有浸润性癌中具有原位癌形态的区域p63免疫组织化学染色显示肌上皮完全缺失;CK5/6在大多数病例中阴性,仅在3例基底细胞样型乳腺癌中弥漫表达;Ki-67呈癌巢内散在表达模式,无癌巢周围区域高表达的趋势;大多数病例CD34显示癌巢内血管散在阳性,仅2例呈现小血管不完整环绕癌巢模式(2/150,1.3%)。Ki-67和CD34在DCIS与DLIBC中不同表达模式的差异有统计学意义(P<0.05)。结论Ki-67和CD34的表达模式差异有助于DCIS和DLIBC的鉴别诊断,有助于DLIBC中浸润性成分的确定。CD34"血管项链征"的出现和Ki-67癌巢外围细胞高表达模式,高度支持DCIS,CD34癌巢内血管散在表达模式支持DLIBC。

Objective To investigate the expression of Ki-67 and CD34 in the differential diagnosis of ductal carcinoma in situ(DCIS)and DCIS-like invasive breast cancer(DLIBC).Methods A total of 100 cases of DCIS and 150 cases of DLIBC diagnosed pathologically in Yantai Yuhuangding Hospital from January 2019 to March 2022 were collected.The expression of p63,CK5/6,Ki-67 and CD34 in both groups were detected by immunohistochemical(IHC)staining and evaluated.Results The 100 cases of DCIS included 11 cases of low-grade DCIS,28 cases of intermediate-grade DCIS and 61 cases of high-grade DCIS.IHC staining of p63 and CK5/6 showed the myoepithelial cells around cancerous duct were complete or partial absence.Ki-67 expression showed two patterns:high expression in the basal layers and scattered expression within the tumor.Most cases showed mainly high basal expression(77/100,77%),and the proportion of this pattern was significantly different between low grade and high grade DCIS(P<0.05).All cases showed complete CD34 expression surrounding the cancerous duct with different proportion(vascular necklace)suggested small vessels proliferation.The 150 cases of DLIBC included 142 cases of invasive ductal carcinoma(IDC)(three cases of basal-like breast cancer was included),two cases of secretory carcinoma,three cases of solid papillary carcinoma,two cases of adenoid cystic carcinoma and one case of acinar cell carcinoma.Among 142 cases of IDC,13 cases were gradeⅠ,77 were gradeⅡand 52 were gradeⅢ.IHC staining of p63 showed complete absence of myoepithelium.CK5/6 was negative in most cases and only positively expressed within the tumor in 3 cases of basal-like breast cancer.Ki-67 indicated a scattered expression pattern within the tumor.In most cases,CD34 immunostaining showed scattered positive blood vessels within the tumor while only two cases showed incomplete expression of CD34 around the tumor(2/150,1.3%).The different expression patterns of Ki-67 and CD34 in DCIS and DLIBC was statistically significant(P<0.05).Conclusions The different expression patterns of Ki-67 and CD34 are helpful to distinguish DLIBC from DCIS.The appearance of"vascular necklace"with CD34 and the high expression of Ki-67 around the cancerous duct highly support the diagnosis of DCIS,and the scattered expression pattern of CD34 supports DLIBC.