DUCTAL CARCINOMA IN SITU OF THE BREAST

Objective: To investigate the clinical characteristics, treatment and prognosis of ductal carcinomain situ (DCIS) of the breast. Methods: Clinicopathological and follow-up data were collected in 52 patients with DCIS. Results: The clinic data showed that 50 patients had signs of breast lumps or/and nipple discharges, 2 patients presented abnormal mammography; 2 patients had lymph node involved; and 14 patients were accompanied with intraductal papillomatosis. All patients were received surgical therapy. The follow-up data showed 1 patient locally recurred after lumpectomy, and was underwent mastectomy again, then cured. There were no patients died of DCIS. Conclusion: Mastectomy should be a standard surgical mode, and the prognosis of DCIS was favorable, but mammography for screening of asymptomatic women should be strengthened to find DCIS.

Histological Grading in Ductal Carcinoma in Situ of the Breast

Objective: To study the significance of histological grading as a prognostic factor in ductal carcinoma in situ of the breast. Methods: According to the Van Nuy’s classification, 32 cases of ductal carcinoma in situ (DCIS) of the breast were divided into three groups. Results: Low grade (well differentiated, low grade DCIS) 12 patients (37.5%); Intermediate grade, 9 patients (28.1%); High grade (poorly differentiated DCIS) 11 patients (34.4%). Among the high grade DCIS, the histologic subtypes were comedo (9 patients), micropapillary (1 patient) and solid (1 patient). The positive expression of c-erbB-2, p53 and MIB-1 in high grade DCIS was higher than that in intermediate and low grade DCIS. The difference between high grade and low grade DCIS was significant (p<0.05). The expression of ER in high grade DCIS was lower than that in intermediate and low grade DCIS. Conclusions: Histological grading of breast ductal carcinoma in situ may be a good prognostic factor.

Expression of E2F-1, Rb and ER in Peripheral Papil-loma and Ductal Carcinoma in Situ of the Breast and its Significance

OBJECTIVE To investigate the correlation of E2F-1, Rb and ER expression with peripheral papilloma （Peri-PM） and ductal carcinoma in situ of the breast （DCIS）, and further explore some molecular mechanisms of the canceratin of Peri-PM.METHODS Imunohistochemistry was used to examine the expression of E2F-1, Rb and ER in 60 Peri-PM, 60 Peri-PM with atypical ductal hyperplasia （Peri-PM with ADH） and 60 DCIS. Normal breast tissues were selected as a control group.RESULTS Based on immunohistochemical staining, the positive rate of E2F-1 expression in Peri-PM, Peri-PM with ADH and DCIS was 21.7%, 46.7% and 78.3% respectively. The positive rate of Rb expression was 83.3 %, 53.9% and 21.7% and the ER expression was 86.7%,61.7% and 55.0%. Significant differences were found among the 3 groups （Peri-PM, Peri-PM with ADH and DCIS） （P〈0.05）. Significant differences existed between any 2 groups （P〈0.05） except for the rate of ER positive expression comparing Peri-PM with ADH verus DCIS （P〉0.05）. The expression of E2F-1 was nega- tively correlated with ER and Rb, and at the same time the expression of ER was positively correlated with Rb. Following the degree of breast epithelial hyperplasia involved and its development into carcinoma, the positive rate of E2F-1 expression displayed an elevating tendency, but that of Rb and ER expression showed a tendency to decline.CONCLUSION The interaction of the 3 indexes studied may play an important role in the conversion of precancerous lesions to early in situ breast carcinoma, and the evaluation of these indexes might provide a valuable basis for screening high-risk cases of Peri-PM.

Tumor characteristics of ductal carcinoma in situ of breast visualized on [F-18] fluorodeoxyglucose-positron emission tomography/computed tomography: Results from a retrospective study

AIM To clarify clinicopathological features of ductal carcinoma in situ(DCIS) visualized on [F-18] fluorodeoxyglucosepositron emission tomography/computed tomography(FDG-PET/CT).METHODS This study retrospectively reviewed 52 consecutive tumors in 50 patients with pathologically proven pure DCIS who underwent [F-18] FDG-PET/CT before surgery. [F-18] FDG-PET/CT was performed after biopsy in all patients. The mean interval from biopsy to [F-18] FDGPET/CT was 29.2 d. [F-18] FDG uptake by visual analysis and maximum standardized uptake value(SUVmax) was compared with clinicopathological characteristics.RESULTS[F-18] FDG uptake was visualized in 28 lesions(53.8%) and the mean and standard deviation of SUVmax was 1.63 and 0.90. On univariate analysis, visual analysis and the SUVmax were associated with symptomatic presentation(P = 0.012 and 0.002, respectively), palpability(P = 0.030 and 0.024, respectively), use of core-needle biopsy(CNB)(P = 0.023 and 0.012, respectively), ultrasound-guided biopsy(P = 0.040 and 0.006, respectively), enhancing lesion ≥ 20 mm on magnetic resonance imaging(MRI)(P = 0.001 and 0.010, respectively), tumor size ≥ 20 mm on histopathology(P = 0.002 and 0.008, respectively). However, [F-18] FDG uptake parameters were not significantly associated with age, presence of calcification on mammography, mass formation on MRI, presence of comedo necrosis, hormone status(estrogen receptor, progesterone receptor and human epidermal growth factor receptor-2), and nuclear grade. The factors significantly associated with visual analysis and SUVmax were symptomatic presentation(P = 0.019 and 0.001, respectively), use of CNB(P = 0.001 and 0.031, respectively), and enhancing lesion ≥ 20 mm on MRI(P = 0.001 and 0.049, respectively) on multivariate analysis.CONCLUSION Although DCIS of breast is generally non-avid tumor, symptomatic and large tumors(≥ 20 mm) tend to be visualized on [F-18] FDG-PET/CT.

Is sentinel lymph node biopsy necessary for the patients diagnosed with breast ductal carcinoma in situ using core needle biopsy or vacuum-assisted biopsy as the initial diagnostic method？

Axillary lymph node status is one of the most important prognostic indicator of survival for breast cancer, especially in ductal carcinoma in situ （DCIS）. The purpose of this study was to investigate whether sentinel lymph node biopsy （SLNB） should be performed in patients with an initial diagnosis of DCIS. Methods： A retrospective study was performed of 124 patients with an initial diagnosis of DCIS between March 2000 and June 2014. The patients were treated with either SLNB or axillary node dissection during the surgery, and we compared the clinicopathologic characteristics, image features, and immunohistochemical results. Results： Eighty-two patients （66.1%） had pure DCIS and 25 （20.2%） had DCIS with microinvasion （DCISM）, 17 （13.7%） updated to invasive breast cancer （IBC）. 115 patients （92.7%） underwent SLNB, among them, 70 patients （56.5%） underwent axillary node dissection. 3 of 115 patients （2.6%） had a positive sentinel lymph node, only 1 （1.4%） of 70 patients had axillary lymph node metastasis, in 84 patients （66.7%） who were diagnosed DCIS by core needle biopsy （CNB） and vacuum-assisted biopsy （VAB）. 26 patients （31.0%） were upstaged into IBC or DCISM in the final histological diagnosis. The statistically significant factors predictive of underestimation were large tumor size, microcalcifications, comedo necrosis, positive Her-2 status, negative estrogen receptor status. Conclusion： The metastasis of sentinel lymph nodes in pure DCIS is very low, but the underestimation of invasive carcinoma in patients with an initial diagnosis of DCIS is an usual incident, especially in the cases when DCIS is diagnosed by CNB or VAB. Our findings suggest patients presenting with a preoperative diagnosis of DCIS associated with large tumor sizes, microcalcifications, comedo necrosis, positive Her-2 status, negative ER status are more likely to be DCISM and IBC in final diagnosis. SLNB should be performed in this part of patients.

Ultrasonographic features of breast ductalcarcinoma in situ

Objective The aims of this study were to analyze ultrasound features of breast ductal carcinoma in situ(DCIS) and to evaluate the value of ultrasonography(US) in early diagnosis of DCIS.Methods From July 2013 to March 2015,180 patients with histologically proven DCIS were evaluated.US features recorded included the size,shape,margins,internal echogenicity,microcalcifications,posterior echogenicity,and blood supply.The data were analyzed and compared with mammographic and histologic findings.Results Among 180 cases of DCIS,168 patients had positive findings on US;the lesions were divided into 3 categories:(1) hypoechoic lesions with or without microcalcifications(n=94);(2) hypoechoic dilated ducts with or without microcalcifications(n=59);(3) microcalcifications alone without any other findings(n=15).Of the 180 lesions,microcalcifications were demonstrated by mammography in 128(71%);among these 128 lesions,90 were identified with microcalcifications on US.Only 80 cases(44%) manifested as masses or asymmetric densities on mammography.The diagnostic accuracy of US and mammography was 67%(120/180) and 69%(124/180),respectively,which can be improved to 80%(144/180) if US is combined with mammography.Conclusion US can be used as an important tool in diagnosis of DCIS.The combination of US and mammography can improve the diagnostic accuracy of breast DCIS.

Low-Grade and High-Grade Invasive Ductal Carcinomas of the Breast Follow Divergent routes of Progression

Low-grade invasive ductal carcinoma is almost diploid, and has frequent losses of chromosome 16q, which is shared by other precancerous lesions of the mammary gland such as flat epithelial atypia （FEA）, atypical ductal hyperplasia （ADH）, and lownuclear grade ductal carcinoma in situ （DCIS）. The genetic alterations accumulate in a stepwise fashion as the precancerous lesions progress to invasve ductal carcinoma. This supports the linear progression model of breast cancer from FEA, through ADH, to low- nuclear grade DCIS as non-obligate early events in low-grade IDC evolution. In contrast, high-grade carcinoma tends to aneuploidy with complex genetic alterations--most importantly, frequent gains at chromosome 16q. Frequent losses at chromosome 16q in low-grade IDC and gains in the same arm of the same chromosome in high-grade IDC imply that these lesions are two end outcomes of different disease processes and that they do not lie in the same continuum of a process. Therefore, low-grade and high-grade IDC are two distinct diseases with a divergent route of progression.

The Impact of Ethnicity on the Incidence, Tumor Characteristics and Treatment of Ductal Carcinoma in Situ—An 11-Year Clinical Experience at a High Volume Teaching Hospital

Introduction: Screening mammography has led to a marked increase in detection of in situ breast tumors in the United States. The University of Southern California/Van Nuys Prognostic Index (USC/VNPI) predicts the recurrence rates of ductal carcinoma in situ (DCIS);however variations in tumor characteristics, USC/VNPI scores, receptor and human epithelial growth factor receptor (HER)-2/neu status across different ethnicities/races have not been well studied. This study aimed to evaluate the racial trends in incidence, patient demographics, tumor characteristics and treatment variations for patients with DCIS at a high volume teaching hospital. Methods: 395 women underwent surgical intervention for DCIS between 2000 and 2011. Their race/ethnicity was divided into five mutually exclusive categories and demographic and clinicopathological data was collected. Multivariate analysis was performed to evaluate variations in patient and tumor factors with respect to age, size and surgical management among different ethnicities and races. Results: 82.1% of Caucasian women underwent simple mastectomy with sentinel lymph node biopsy (SLNB) while lumpectomy with SLNB was highest in Hispanics (40%, p = 0.005). Overall, there was no significant difference in the incidence of receptor or HER-2/neu positivity, multicentricity, necrosis or grade of DCIS in the various racial groups, but there was a significant racial difference in the USC/VNPI scores (p < 0.001). Conclusion: On a community level, screening detected DCIS accounted for the vast majority of DCIS diagnosed, which reflected national trends. Although no racial variation in DCIS with respect to patient or tumor characteristics was observed, a racial difference in USC/VNPI score was identified among the Hispanic population. Additional studies are required to validate the significance of these findings.

Sentinel lymph node biopsy in clinically detected ductal carcinoma in situ

AIM:To study the indications for sentinel lymph node biopsy(SLNB) in clinically-detected ductal carcinoma in situ(CD-DCIS).METHODS:A retrospective analysis of 20 patients with an initial diagnosis of pure DCIS by an image-guided core needle biopsy(CNB) between June 2006 and June 2012 was conducted at King Faisal Specialist Hospital.The accuracy of performing SLNB in CD-DCIS,the rate of sentinel and non-sentinel nodal metastasis,and the histologic underestimation rate of invasive cancer at initial diagnosis were analyzed.The inclusion criteria were a preoperative diagnosis of pure DCIS with no evidence of invasion.We excluded any patient with evidence of microinvasion or invasion.There were two cases of mammographically detected DCIS and 18 cases of CDDCIS.All our patients were diagnosed by an imageguided CNB except two patients who were diagnosed by fine needle aspiration(FNA).All patients underwent breast surgery,SLNB,and axillary lymph node dissection(ALND) if the SLN was positive.RESULTS:Twenty patients with an initial diagnosis of pure DCIS underwent SLNB,2 of whom had an ALND.The mean age of the patients was 49.7 years(range,35-70).Twelve patients(60%) were premenopausal and 8(40%) were postmenopausal.CNB was the diagnostic procedure for 18 patients,and 2 who were diagnosed by FNA were excluded from the calculation of the underestimation rate.Two out of 20 had a positive SLNB and underwent an ALND and neither had additional non sentinel lymph node metastasis.Both the sentinel visualization rate and the intraoperative sentinel identification rate were 100%.The false negative rate was 0%.Only 2 patients had a positive SLNB(10%) and neither had additional metastasis following an ALND.After definitive surgery,3 patients were upstaged to invasive ductal carcinoma(3/18 = 16.6%) and 3 other patients were upstaged to DCIS with microinvasion(3/18 = 16.6%).Therefore the histologic underestimation rate of invasive disease was 33%.CONCLUSION:SLNB in CD-DCIS is technically feasible and highly accurate.We recommend limiting SLNB to patients undergoing a mastectomy.

Breast Conserving Surgery: Has the Standard of Care Enhanced Outcomes for Patients?

Breast Conserving Surgery (BCS) is a rapidly emerging field increasingly adopted to facilitate breast conservation and preserve breast aesthetics. Since the publication of the Randomized Controlled Trials (RCTs) of Breast Conserving Surgery versus mastectomy in early breast cancer, the adoption of BCS for breast cancer patients’ surgical management has been comprehensive. A computerized bibliographic search was performed on PubMed/MEDLINE, Embase, Google Scholar and Cochrane library databases. This article aims to perform a thorough review of new data regarding invasive cancer and margins while evaluating patient outcomes related to BCS after neoadjuvant chemotherapy focusing on margins, imaging evaluation, the extent of resection, and local regional recurrence outcomes. The growth pattern and biopsy of Ductal Carcinoma In Situ (DCIS) differ from invasive cancer, impacting margins. It is essential to understand how the Society of Surgical Oncology (SSO) DCIS margin guideline has influenced practice. Early breast cancer surgical management should be unique to each patient, driven by evidence-based medicine, and focused on specific clinical, histological, and molecular characteristics of the tumor. Conclusion: The current management for early breast cancer should be tailored and evidence-based to each patient based on the clinical, histological and molecular characteristics of the tumor. Presumably, the standard of care in BCS has enhanced the outcomes for this patient population. This review made by peers will help surgeons to stay up to date with the current literature and help them manage breast cancer while improving multiple clinical parameters such as Disease-Free Survival (DFS), Recurrence-Free Survival (RFS) and most importantly Overall Survival (OS).

Immunohistochemical Biomarkers in Ductal Carcinoma <i>In Situ</i>

Introduction: Breast ductal carcinoma In Situ (DCIS) can be defined as a malignant epithelial proliferation with growth limited by the basal membrane of the ductal epithelium, with no evidence of stromal invasion. There has been a trend of trying to subcategorize DCIS based on cell proliferation assays (Ki67) and the expression of hormone receptors and the human epidermal growth receptor (HER-2) as detected by immunohistochemistry, similar to invasive breast carcinomas (IBC). The aims were to evaluate the expression of breast cancer marker proteins in DCIS by immunohistochemistry to better categorize it. Methods: 46 biopsies from women with DCIS and IBC Luminal A-like were evaluated by immunohistochemistry staining of proteins already known to be biomarkers in IBC. For controls, normal breast tissue from mammoplasty (n = 3) was used. Results: Our results showed an increase of estrogen receptor (ER) and progesterone receptor (PR) expression relative to that in normal tissue samples (p < 0.0001). No differences in steroid hormone expression patterns were seen between DCIS and IBC tumors (p = 0.3145;p = 0.7341, respectively). The proliferation levels of the DCIS and IBC samples were similar as evaluated by the Ki67 labeling index. Only 12.90% of samples showed amplification of HER-2. Conclusion: The biology of DCIS is not well understood given the complexity and heterogeneity of the disease, which makes it important to better sub-categorize this tumor, especially considering the possibility of identifying DCIS cases with the potential for recurrence and evolution into IBC.

Clinicopathological characteristics,treatments,and prognosis of breast ductal carcinoma in situ with microinvasion:A narrative review

Background:Ductal carcinoma in situ with microinvasion(DCIS-MI)is defined as ductal carcinoma in situ(DCIS)with a microscopic invasive focus≤1 mm in the longest diameter.The current literature is controversial concerning the clinical prognostic features and management of DCIS-MI.This narrative review described recently reported literature regarding the characteristics,treatment,and prognosis of it.Methods:Searching PubMed for relevant articles covering the period of 1982 to 2021 using the following terms by MeSH and free-word:breast cancer,microinvasion,DCIS,DCIS-MI,and invasive ductal carcinoma(IDC).Results:DCIS-MI tends to express more aggressive pathological features such as necrosis,HER2+,ER-or PR-,and high nuclear grade.The overall prognosis of DCIS-MI is typically good,however,some indicators such as young age,HR-,HER2+and multimicroinvasive lesions,were associated with worse prognoses.And there are also conflicting results on the differences between the prognoses of DCIS-MI and DCIS or T1a-IDC.Postoperative chemotherapy and anti-HER2 therapy still have uncertain benefits and are more likely to be used to treat high-risk patients who are HR-orHER2+to improve the prognosis.Conclusion:DCIS-MI has more aggressive pathological features,which may suggest its biological behavior is worse than that of DCIS and similar to early IDC.Although the overall prognosis of DCIS-MI is good,when making decisions about adjuvant therapy clinicians need to give priority to the hormone receptor status,HER2 expression and axillary lymph node status of patients,because these may affect the prognosis and treatment response.

Roles of micro RNA-140 in stem cell-associated early stage breast cancer

An increasing body of evidence supports a stepwise model for progression of breast cancer from ductal carcinoma in situ(DCIS) to invasive ductal carcinoma(IDC). Due to the high level of DCIS heterogeneity, we cannot currently predict which patients are at highest risk for disease recurrence or progression. The mechanisms of progression are still largely unknown, however cancer stem cell populations in DCIS lesions may serve as malignant precursor cells intimately involved in progression. While genetic and epigenetic alterations found in DCIS are often shared by IDC, m RNA and mi RNA expression profiles are significantly altered. Therapeutic targeting of cancer stem cell pathways and differentially expressed mi RNA could have significant clinical benefit. As tumor grade increases, mi RNA-140 is progressively downregulated. mi R-140 plays an important tumor suppressive role in the Wnt, SOX2 and SOX9 stem cell regulator pathways. Downregulation of mi R-140 removes inhibition of these pathways, leading to higher cancer stem cell populations and breast cancer progression. mi R-140 downregulation is mediated through both an estrogen response element in the mi R-140 promoter region and differential methylation of Cp G islands. These mechanisms are novel targets for epigenetic therapy to activate tumor suppressor signaling via mi R-140. Additionally, we briefly explored the emerging role of exosomes in mediating intercellular mi R-140 signaling. The purpose of this review is to examine the cancer stem cell signaling pathways involved in breast cancer progression, and the role of dysregulation of mi R-140 in regulating DCIS to IDC transition.

Clonal Analysis of Peripheral Papilloma and Cancerous Cells of the Breast

OBJECTIVE Because almost all malignancies represent monoclonal proliferations, we have studied the clonal status of peripheral papillomas （peri-PM）, ductal carcinomas in situ （DCIS）, and normal breast tissues to explore a reliable way to distinguish benign and malignant （or pre-malignant） cases previously diagnosed morphologically. METHODS Twenty-six cases of peri-PM, 25 cases of peri-PM with atypical ductal hyperplasia （ADH）, 27 cases of DCIS, 16 cases of developed canceration and 20 specimens of normal tissue were examined in the study. The clonal status of these tissues was studied using an assay based on inactivation mosaicism of the lenth-polymorphic X-chromosomes at the androgen receptor （AR） locus. RESULTS Loss of polymorphism at the AR locus was found in all DCIS cases and 10 cases （10/25, 40.0%） of peri-PM with ADH, in.dicating the monoclonality of the tumors. Twenty-four out of 26 （92.3%） cases with peri- PM and 19 specimens of normal tissue were shown to be polyclonal. In 16 cases of developed Canceration, identical X chromosome inactivation （monoclonal alterations） was observed from both the peri-PM with ADH part, and the DCIS part in each Case. CONCLUSION These results contribute to the understanding of the genetic changes of peri-PM, and confirm the peri-PM with ADH as a precancerous lesion of the breast. Clonal analysis might be a useful modality to screen high-risk cases from precancerous lesions or to distinguish between benign hyperplasia and early carcinoma.

Application of Dual-Energy Computed Tomography for Breast Cancer Diagnosis

The present study aimed to investigate the possibility of using dual-energy computed tomography (CT) before therapy to discriminate between normal breast tissue and tumor tissue in patients with breast cancer, without the need to use a contrast medium. The following patient data were extracted by interview and from the hospital’s radiology information system: height, weight, age, menstrual cycle, CT images of normal tissue and tumors with or without contrast medium, and the histopathological diagnosis of the aspiration biopsy. The median age of the 43 participants was 56 years (range, 30 - 80 years). The CT values were evaluated using a clinical analytical program based on the three-material decomposition technique. Breast cancer was classified into ductal carcinoma in situ, invasive ductal carcinoma, invasive lobular carcinoma, fibromatosis-like metaplastic carcinoma, and apocrine carcinoma. In all conditions, regardless of contrast medium, the CT values of tumor tissues were higher than those of normal breast tissue, indicating the effectiveness of dual-energy CT (DE-CT) in the diagnosis of breast cancer. By contrast, DE-CT showed limited potential for distinguishing ductal carcinoma in situ from invasive ductal carcinoma. There have only been a few reports regarding CT examination of breast cancer, and it is expected this study encourage the development of DE-CT imaging to improve tumor detection in patients with breast cancer.

乳腺导管原位癌、导管原位癌伴微浸润及浸润性导管癌的分子分型差异性

目的:研究乳腺导管原位癌(DCIS)、导管原位癌伴微浸润(DCIS-MI)及浸润性导管癌(IDC)不同临床病理特征及分子分型间的差异。方法:回顾性分析本院2015年01月至2022年06月经病理确诊的乳腺癌患者。分析其临床病理资料,包括患者的年龄、雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体-2(HER-2)、肿瘤细胞增殖活性标记物(Ki-67)、分子分型。采用χ^(2)检验或Fisher确切概率法比较三组患者临床病理表现的差异性。结果:本研究共计选取患者1167例,其中DCIS组为180例(15.42%),DCIS-MI组为67例(5.74%),IDC组为920例(78.83%)。DCIS、DCIS-MI及IDC患者在ER、PR、HER-2、Ki-67中阳性分布及分子分型均有显著差异,具有统计学意义(P<0.05),DCIS-MI患者多以HER-2过表达型为主,ER、PR状态多呈阴性,HER-2多呈阳性,高核分级。DCIS患者多以Luminal A型为主,Ki-67多呈低表达。高核级别、HER-2过表达、ER阴性、PR阴性是影响并促进乳腺DCIS进展为DCIS-MI的预测因子。IDC患者多以Luminal B型为主,ER、PR状态多呈阳性,Ki-67多呈高表达。而在年龄分布上无差异,无统计学意义(P>0.05)。结论:乳腺DCIS、DCIS-MI及IDC间免疫组化标记物和分子分型分布不同,与DCIS相比,DCIS-MI核异型性多呈高核分级,ER、PR阴性比例多,HER-2过表达型比例多,考虑DCIS-MI是独立存在的一种病变,较DCIS有“质”的改变,提示两者处于乳腺癌进展的不同阶段。

乳腺X线及MRI特征联合临床病理预测乳腺导管原位癌伴微浸润

目的探讨基于临床病理、乳腺X线(mammography,MG)和MRI特征预测乳腺导管原位癌伴微浸润(ductal carcinoma in situ with microinvasion,DCISM)的价值。材料与方法回顾性收集宁夏医科大学总医院2019年6月至2022年6月最终经手术病理证实为纯导管原位癌(ductal carcinoma in situ,DCIS)和DCISM的首诊女性患者的病例资料为训练组,评估术前患者的临床病理、MG和MRI特征。采用单、多因素logistic回归分析明确DCISM的独立危险因素,并建立联合模型。通过受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under the curve,AUC)及校准图评估模型的诊断效能,应用决策曲线分析(decision curve analysis,DCA)观察联合模型的临床实用性。前瞻性收集2022年7月至2023年7月符合纳入、排除标准的患者作为验证组进行验证。应用沙普利加和解释(Shapley Additive exPlanation,SHAP)分析联合模型中病灶最长径、核级别、坏死、Ki-67指数、P63状态、钙化状态和最小ADC值(minimum value of apparent diffusion coefficient,ADCmin)预测DCISM的价值。收集535例患者共550个病灶(15例患者为同时性双乳癌),患者年龄23~81岁,中位年龄50岁。训练组(n=382)中102个病灶(27%)和验证组(n=168)中52个病灶(31%)被诊断为DCISM。结果多因素logistic回归结果显示,病灶最长径、核级别、坏死、Ki-67指数、P63状态、钙化状态和ADCmin是DCISM的独立危险因素。基于上述参数构建临床病理及联合模型,在训练组和验证组中均表现出较高的预测效能(AUC:0.937、0.899)。根据SHAP分析,病灶最长径、Ki-67指数和ADCmin在联合模型中对预测DCISM起主要贡献,而钙化状态、核级别、P63状态和坏死是补充因素。结论联合临床病理及术前MG和MRI特征的预测模型可有效从纯DCIS区分出DCISM,从而提升临床决策和治疗规划的准确性。

乳腺乳头状瘤病和导管原位癌cyclinD1、p16和Ki-67表达

目的 探讨细胞周期调控因子cyclinD1、p16和Ki 6 7与乳腺乳头状瘤病及导管内癌的相关性及其临床病理意义。方法 通过免疫组化S P法检测轻度乳头状瘤病、重度乳头状瘤病和导管内癌各 4 0例中cyclinD1、p16和Ki 6 7的蛋白表达情况 ,并用 2 0例正常乳腺组织作对照。结果 cyclinD1在轻度、重度乳头状瘤病和导管内癌组中阳性率分别为 2 7 5 %、5 0 0 %、6 0 0 % ,3组间差异有显著性 (χ2 =8 92 9,P <0 0 5 )。p16蛋白表达分别为 80 0 %、5 2 5 %、4 0 0 % ,3组间差异均有显著性 (χ2 =8 6 87,P <0 0 1)。轻度与重度乳头状瘤病组比较均有差异 ,但重度乳头状瘤病与导管内癌组间差异无显著性。Ki 6 7阳性率在 3组间差异有显著性 ,组间两两比较也分别有统计学差异。在各组中 ,Ki 6 7与cyclinD1呈正相关 ,与 p16呈负相关 ,cyclinD1与 p16呈负相关。结论 cyclinD1、p16和Ki 6 7表达异常在乳腺癌发生、发展演进过程中是一种早期事件。重度乳头状瘤病是重要的癌前病变。调节cyclinD1和

对比增强能谱乳腺摄影用于非肿块样强化乳腺癌的诊断价值

目的探讨对比增强能谱乳腺摄影(CESM)影像特征对非肿块样强化(NME)乳腺导管癌不同组织学类型与腋窝淋巴结(ALN)转移的诊断价值。方法回顾性纳入完成CESM检查的NME乳腺癌女性病人63例,经病理确诊为导管原位癌(DCIS)或浸润性导管癌(IDC)。根据组织学类型分为DCIS组(32例)和IDC组(31例);根据有无微浸润将32例DCIS病人分为单纯DCIS组(18例)和DCIS伴微浸润(DCIS-MI)组(14例);根据ALN转移情况分为转移阳性组(19例)和转移阴性组(44例)。采用t检验、Mann-Whitney U检验、χ^(2)检验比较各分组的CESM影像特征的差异。将筛选出来有统计学意义的CESM影像特征行多因素Logistic回归分析,确定IDC、DCIS-MI及ALN转移的独立预测因素。绘制受试者操作特征(ROC)曲线,计算并比较ROC曲线下面积(AUC)、敏感度、特异度。结果DCIS与IDC间在内部强化方式、头足位减影影像相对强化比值(%RSCC)及时间信号强化曲线(TIC)类型存在统计学差异(均P<0.05);单纯DCIS与DCIS-MI的最大截面面积、%RSCC及TIC类型间差异有统计学意义(均P<0.05);ALN转移阳性组与阴性组间内部强化方式、形态分布特征、%RSCC及TIC类型差异有统计学意义(均P≤0.05)。%RSCC>3.42%和集簇/簇环强化是IDC的独立预测因素(均P<0.05),其AUC值分别为0.732、0.704;%RSCC>2.47%和最大截面面积大于4.37 cm2是DCIS-MI的独立预测因素(均P<0.05),其AUC值分别为0.802、0.764;%RSCC>2.71%和集簇/簇环强化是ALN转移的独立预测因素(均P<0.05),其AUC值分别为0.717、0.786。结论在CESM上测得的%RSCC、最大截面面积、TIC、形态分布特征及内部强化特征对于非肿块型乳腺导管癌组织学类型及ALN转移具有一定的诊断价值,可为临床医生决策及病人预后提供参考依据。

Tenascin-C在乳腺导管原位癌的表达及其意义

目的:探讨Tenascin-C(Tn-C)在乳腺导管原位癌中的表达及其意义。方法:应用免疫组化S-P方法检测52例乳腺导管原位癌Tn-C的表达,及其与ER、PR和HER-2等表达的相关性。结果:Tn-C表达阳性率为60%,其中Van-Nuys1组的阳性率为38%,Van-Nuys2组的阳性率为70%,Van-Nuys3组的阳性率为88%,组间阳性表达差异有统计学意义(P<0.01)。Tenascin-C的阳性表达和ER、PR阴性表达及HER-2阳性表达呈正相关(P<0.05)。结论:Tn-C可以作为判断乳腺导管原位癌恶性程度、预后的一个指标。