乳腺浸润性癌伴导管原位癌误诊为单纯导管原位癌的临床分析

Clinical Analysis of Breast Invasive Carcinoma with Ductal Carcinoma in Situ Misdiagnosed as Pure Ductal Carcinoma in Situ

目的探讨乳腺浸润性癌伴导管原位癌(DCIS)误诊为单纯DCIS的原因,并总结防范误诊措施。方法回顾性分析2019年3月—2020年3月收治9例误诊为乳腺单纯DCIS的浸润性癌伴DCIS临床资料。结果本组9例以均乳房肿块就诊,其中右侧7例,左侧2例。9例术前均经超声引导下空芯针穿刺活检诊断为单纯DCIS,误诊时间为9~19 d。所有患者行包括完整病灶在内的保乳术或乳房全切术,术后病理确诊乳腺浸润性癌伴DCIS,并均行前哨淋巴结活检术,4例发现腋窝淋巴结转移性腺癌。所有患者依据术后浸润灶大小、病理类型、手术方式等,完成后续治疗方案。预后均良好,随访期间未见复发。结论对穿刺活检为DCIS的患者需提高警惕性,应结合临床查体、影像学检查、病理分级和分型等综合分析原发病灶和腋窝淋巴结,必要时再次对原发灶和(或)腋窝淋巴结进行穿刺活检,尽可能避免特定类型乳腺癌或腋窝淋巴结转移患者过早进入手术流程,错失新辅助治疗等更佳方案。

Objective To investigate the causes of misdiagnosis of invasive breast carcinoma with ductal carcinoma in situ(DCIS)as pure DCIS,and to summarize the preventive measures.Methods Retrospective analysis was performed on the clinical data of 9 patients with invasive breast carcinoma and DCIS misdiagnosed as pure breast DCIS treated from March 2019 to March 2020.Results In this group,all 9 patients presented with breast mass,including 7 on the right side and 2 on the left side.All the 9 cases were diagnosed as DCIS by ultrasound-guided core needle biopsy before surgery,and the duration of misdiagnosis was 9-19 d.All patients underwent breast conserving surgery or total mastectomy including complete lesions,and were pathologically confirmed to be invasive breast carcinoma with DCIS after operation.Sentinel lymph node biopsy was performed in all patients,and metastatic adenocarcinoma of axillary lymph nodes was found in 4 cases.All patients completed the follow-up treatment plan according to the size of postoperative infiltration lesion,pathological type and surgical method.The prognosis was favorable and no recurrence was observed during follow-up.Conclusion For patients with DCIS by puncture biopsy,it is necessary to increase vigilance.The primary lesion and axillary lymph node should be comprehensively analyzed in combination with clinical physical examination,imaging examination,pathological grading and classification.When necessary,the primary lesion and/or axillary lymph node should be biopsied again,so as to avoid premature operation for patients with specific types of breast cancer or axillary lymph node metastasis as much as possible,thus missing out on better options such as neoadjuvant therapy.