Clinical Pathological Analysis in 104 Ductal Breast Cancer Cases

Ductal breast cancer is a clinically heterogeneous disease;we investigate the correlation between tumor size, comedo necrosis, number of cell mitoses and axillary lymph node metastasis in ductal breast cancer. In this study, 104 ductal breast cancer specimens were collected and divided into 3 groups: T1 group (tumor size ≤ 2 cm), T2 group (2 5.0 cm). Among those specimens, 95 cases were diagnosed with invasive ducted carcinoma, and 9 cases were ductal carcinoma in-situ (DCIS). Results show that T3 group has a higher rate of axillary lymph node metastasis than T2 group and T1 group;T2 group has a higher rate of lymph node metastasis than T1 group. The patients with the number of cell mitoses (≥10) were also has a higher rate of axillary lymph node metastasis (P = 0.0139) than the patients with the number of cell mitoses (<10). No significance was found between comedo necrosis lesions and axillary lymph node metastasis, though the frequency of comedo necrosis lesions in patients with axillary lymph node metastasis was higher than those in non-metastatic patients. It is concluded that the tumor size and the number of cell mitoses were risk factors for axillary lymph node involvement in ductal breast cancer.

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.

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.

An AAS Dependent Method for Quantitative Analysis of Essential Trace Elements from Blood Samples of Pakistani Female Breast Cancer Patients

Breast cancer is the second leading cancer in the world. The long-term exposure of some metallic compounds induces different forms of cancer, including breast cancer. Trace elements are essential metals for the physiological functions of the cell on a molecular level and also contribute in treatment of many diseases. The aim of study was to compare the level of essential trace elements, sodium, potassium, calcium, iron, and zinc in breast cancer patients with normal healthy adult women. Total forty-five patients (age range from 25 - 73 years) were included in this study and divided into three groups according to three different stages of breast cancer including tumor-II, tumor-III and tumor-IV. Blood was collected from all participants after taking history, clinical data and taking consent. However, about fifteen non-cancer healthy women in age range from 26 - 69 years were subjected to this study. The elemental concentrations were determined through atomic absorption spectrophotometer subsequent to microwave-induced acid digestion. The results of Na, K, Zn, Fe, Ca, were observed to decrease in blood samples of breast cancer patients as compared to non-cancer subjects. The results are reliable with other numerous literature reported studies, the efficiency, and deficiency of these trace metals may contribute an important role in the progress of breast cancer.

Clinicopathological Profile of Breast Cancer Patients at a Tertiary Care Hospital in Kashmir Valley

Introduction: Breast cancer is the commonest malignancy in women worldwide. There are considerable variations in risk factors and presentation of the disease region wise. The present study aimed to describe clinical and pathological profile of breast cancer patients attending tertiary care hospital. Method: All consenting patients attending to surgical out-patient department (OPD) with complaints pertaining to breast disease were enrolled from 16th June 2015 to 15th June 2016. The patients were followed and demographic, clinical and pathologic information was recorded and analysed. Results: Total Of 180 patients with breast disease were enrolled. 34/100 were diagnosed of malignancy and formed the cases of the present study. Age of the patients ranged from 22 to 60 years with mean age of 42.06 ± 10.7 years. All the patients presented as breast lump variably associated with pain or discharge. Infiltrating Ductal Carcinoma Not Otherwise Specified (IDC NOS) was common histologic diagnosis (76.47%). Conclusion: Breast carcinoma presents with painless lump and patients are usually diagnosed in our setup at locally advanced stage. Implementation of the simple and effective screening programs for early detection is urgent need in our population.

乳腺MRI导管异常信号作为伴随征象的鉴别诊断意义

目的探讨乳腺MRI导管异常信号作为伴随征象的鉴别诊断意义。方法选取经病理证实的乳腺纤维腺瘤及(或)腺病、肉芽肿性小叶性乳腺炎(granulomatous lobular mastitis,GLM)、乳腺癌(breast cancer,BC)共172例患者,将172例患者按三类疾病分为三组;乳腺纤维腺瘤及(或)腺病组、GLM组、BC组,对预扫描导管高信号及导管样强化在三组数据的阳性率进行卡方检验,判断差异是否有统计学意义。多元logistic回归分析导管样异常信号对鉴别三类病变的价值。结果预扫描导管高信号三组阳性率差异无统计学意义(P>0.05),导管样强化三组阳性率差异有统计学意义(P<0.05)。多元logistic回归分析:以纤维腺瘤及(或)腺病组为对照,导管样强化增加GLM诊断的可能性差异有统计学意义(OR=10.011,95%CI 3.492-28.703,P<0.001)。以BC组为对照,导管样强化增加GLM诊断的可能性差异有统计学意义(OR=4.435,95%CI 1.772-11.096,P=0.001)。结论导管样强化对GLM诊断具有一定价值。

多模态影像组学列线图术前预测乳腺浸润性导管癌腋窝淋巴结转移的价值

目的探讨多模态影像组学列线图术前预测乳腺浸润性导管癌腋窝淋巴结(axillary lymph node,ALN)转移的价值。材料与方法回顾性分析2019年1月至2023年6月在我院经手术病理证实为乳腺浸润性导管癌的224例患者的临床及影像资料。首先,选取T2WI图像和动态对比增强MRI(dynamic contrast-enhanced MRI,DCE-MRI)第二期图像的病灶最大层面及同一病灶的钼靶(mammography,MG)头尾位、内外斜位图像勾画感兴趣区,并且提取病灶感兴趣区特征,按照7∶3比例将样本随机分为训练集156例和测试集68例,通过最小绝对收缩和选择算子(least absolute shrinkage and selection operator,LASSO)回归进行特征降维筛选,选择5种机器学习分类器[支持向量机(support vector machine,SVM)、K近邻(K nearest neighbors,KNN)、极端梯度提升决策树(extreme gradient boosting,XGBoost)、逻辑回归(logistic regression,LR)、随机森林(randomforest,RF)]构建多模态影像组学模型并选择预测性能最佳分类器建立MRI、MG影像组学模型。通过单-多因素logistic回归筛选临床高危因素构建临床模型。最终选择影像组学评分联合临床高危因素构建影像组学列线图模型。采用受试者工作特征(receiver operating characteristic,ROC)曲线及曲线下面积(area under the curve,AUC)评价模型预测乳腺癌患者ALN状态的性能,利用校准曲线评价模型的拟合能力,决策曲线评估预测模型的临床实用性。结果最终得到14个最佳影像组学特征。在测试集中5种机器学习分类器AUC值范围为0.764~0.864,其中SVM的AUC值最高(0.864)。淋巴结触诊(P<0.001)及MRI_ALN(P=0.005)是评估ALN是否转移的独立危险因素。列线图模型训练集AUC、敏感度、特异度及准确度分别为0.941、90.7%、88.9%、88.5%;测试集分别为0.926、84.4%、86.1%、85.3%。结论列线图模型性能最佳,在术前预测ALN状态具有重要的价值,可以协助临床制订科学有效的诊疗方案。

KCTD8基因在乳腺导管内癌中的蛋白表达及临床意义

目的:探讨KCTD8基因在乳腺导管内癌中的蛋白表达水平及其与临床因素、预后的相关性。方法:收集27例乳腺导管内癌患者癌组织和癌旁组织,应用免疫组织化学技术分析KCTD8基因在各组织中的蛋白表达水平,运用统计学方法分析KCTD8蛋白表达水平与乳腺导管内癌患者临床因素和预后生物指标间的相关性。利用TCGA数据库分析KCTD8基因与乳腺癌(含导管内癌)预后的关系。结果:KCTD8基因在乳腺导管内癌组织中的蛋白表达水平下降(P<0.05),且其蛋白表达水平的降低与肿瘤大小相关(P<0.05)。TCGA数据库发现乳腺癌(含导管内癌)组织中KCTD8基因的表达和异常高甲基化均影响患者的预后。结论:KCTD8基因蛋白表达水平降低可能参与乳腺癌的发展,影响患者预后。

乳腺髓样癌临床病理特征、治疗及预后的分析

目的:探讨和比较乳腺髓样癌(medullary breast carcinoma, MBC)与浸润性导管癌(invasive ductal carcinom, IDC)患者的临床病理特征、治疗和预后差异。方法:回顾性分析SEER数据库以及真实世界多中心(包括:四川省三家医院)2000年至2018年诊断为MBC和IDC的患者资料,对比分析临床病理特征、治疗及预后差异。结果:MBC与IDC患者相比,发病年龄更小、肿瘤直径更大、组织学分级更高、三阴型占比更多、TNM分期更晚、预后更好;单因素Cox回归分析显示,发病年龄、组织学分级、肿瘤大小、T分期、N分期、M分期、TNM分期、是否手术、手术方式、是否放疗及化疗与总生存率(overall survival, OS)具有相关性;发病年龄、种族、肿瘤大小、T分期、N分期、M分期、TNM分期、是否手术、手术方式及是否放疗与乳腺癌特异性生存率(breast cancer-specific survival, BCSS)具有相关性。多因素Cox模型校正后显示,发病年龄、T分期、N分期、M分期、肿瘤大小、是否手术及是否化疗是OS、BCSS的独立预后因素。MBC患者的10年OS和10年BCSS分别为83.0%和91.8%,与IDC相比差异有统计学意义(P<0.001)。PSM分析结果显示,无论是SEER数据还是真实世界多中心临床数据,MBC患者的OS、BCSS均较IDC患者好,差异有统计学意义。结论:MBC较IDC更具侵袭性,预后却更好;排除混杂变量影响后,SEER数据分析显示MBC预后仍较IDC好,差异具有统计学意义,预后更好的原因是MBC的独特病理类型及规范化诊疗,因此临床上更应该注重规范化诊疗。

乳腺浸润性导管癌高频超声不同参数弹性成像的特征分析及对淋巴结转移的诊断

目的:观察乳腺浸润性导管癌高频超声、不同参数弹性成像的特征,并分析其对淋巴结转移的诊断价值。方法:回顾性选取2021年1月至2023年1月于本院就诊且经病理学检查证实的96例乳腺浸润性导管癌患者,依据淋巴结转移情况将患者分为转移组与未转移组,所有患者入院时均接受高频超声与超声弹性成像检查,对比不同淋巴结转移情况的患者高频超声及超声弹性成像参数,采用Logistic回归分析其与乳腺浸润性导管癌患者淋巴结转移的关系,绘制ROC探讨高频超声、超声弹性成像参数对淋巴结转移的诊断价值。结果:96例乳腺浸润性导管癌患者中淋巴结转移59例(61.46%),未转移37例(38.54%);淋巴结转移组腋窝淋巴结皮质厚度、腋窝淋巴结纵径、纵横径比值大于未转移组,周边型或混合型血流模式占比、淋巴门消失占比高于未转移组(P<0.05);转移组最大弹性模量值、弹性数据离散度值、病灶与周边组织比值大于未转移组(P<0.05);经Logistic回归分析,结果显示,腋窝淋巴结皮质厚度大、腋窝淋巴结纵径大、纵横径比值大、周边型或混合型血流模式、淋巴门消失、最大弹性模量值大、弹性数据离散度值大、病灶与周边组织比值大是乳腺浸润性导管癌患者淋巴结转移的危险因素(OR>1,P<0.05);绘制ROC曲线,结果显示,腋窝淋巴结皮质厚度、腋窝淋巴结纵径、纵横径比值、血流模式、淋巴门消失、最大弹性模量值、弹性数据离散度值、病灶与周边组织比值对乳腺浸润性导管癌患者淋巴结转移具有一定预测价值(AUC=0.833、0.782、0.758、0.721、0.646、0.714、0.685、0.730),联合诊断价值更高(AUC=0.908)。结论:乳腺浸润性导管癌患者高频超声、超声弹性成像特征与淋巴结转移密切相关,可用于淋巴结转移的术前诊断。

超声检查征象logistics回归鉴别乳腺化生性癌和浸润性导管癌

目的 探讨乳腺病变超声检查征象在乳腺化生性癌和浸润性导管癌中的鉴别诊断价值。方法 选取在我院经手术病理证实的117例乳腺肿瘤患者的超声声像图,根据病理结果分为化生性癌组36例和浸润性导管癌组81例,就其超声检查征象进行单因素分析,将超声检查征象中有统计学意义的参数设为自变量进行Logistic回归分析。结果 单因素分析显示,超声检查肿瘤大小、回声类型、后方回声和生长方位在鉴别乳腺化生性癌和浸润性导管癌中差异均有统计学意义(P<0.05);多因素中肿瘤大小、回声类型、后方回声和生长方位是鉴别二者的独立影响因素,建立的回归方程为:Logistic (Y)=-2.209+1.335X1+2.186X2-1.149X3-1.734X4 (X1:肿瘤大小;X2:回声类型;X3:后方回声;X4:生长方位),ROC曲线下面积0.901,Logistic回归模型鉴别乳腺化生性癌和浸润性导管癌的灵敏度、特异度、准确率分别是61.1%、96.3%和87.2%。结论 多因素分析在鉴别乳腺化生性癌和浸润性导管癌中有较好的诊断效能,超声检查显示肿瘤大小、回声类型、后方回声和生长方位可作为综合判断二者的可靠指标。

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.

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.

术前MRI检查在乳腺导管原位癌保乳手术的临床应用研究

目的:评估乳腺导管原位癌(ductal carcinoma in situ,DCIS)病人术前乳腺磁共振成像(magnetic reso⁃nance imaging,MRI)检查与保乳手术成功率及预后之间的关系。方法:回顾性分析上海交通大学乳腺癌病历数据库中2009年1月至2017年1月接受保乳手术的DCIS病人。将术前接受MRI检查的病人组定义为MRI组,未接受MRI检查的为非MRI组。结果:共纳入210例DCIS病人,MRI组和非MRI组分别有167例和43例。MRI与非MRI组接受保乳手术的首次手术切缘阴性率相似(91.0%比97.7%,P=0.142)。最终保乳手术的成功率差异也无统计学意义(95.2%比100.0%,P=0.143)。在预后方面,MRI与非MRI组10年局部区域复发(4.8%比2.3%,P=0.426)和乳腺癌相关死亡率(0.9%比0.5%,P=0.668)差异无统计学意义。结论:DCIS病人术前乳腺MRI检查对保乳手术切缘阴性率、保乳成功率及预后均无影响。

mDixon-Quant技术在乳腺浸润性导管癌诊断与预后评估中的价值研究

目的利用mDixon-Quant技术探讨脂肪分数(fat fraction,FF)和T2*值与乳腺浸润性导管癌病理组织学分级及预后因素之间的关系。材料与方法回顾性分析经手术病理证实的乳腺浸润性导管癌女性患者病例88例,低级别57例和高级别31例。术前均行mDixon-Quant扫描,分析两组间的FF和T2*值、临床基本资料包括年龄、绝经情况、肿块大小、肿块类型、身体质量指数(body mass index,BMI)、纤维腺体组织量(amount of fibroglandular tissue,FGT)以及乳腺实质背景强化(background parenchymal enhancement,BPE)。同时比较FF值和T2*值与组织学分级、雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)、人表皮生长因子受体2(human epidermal growth factor receptor 2,HER-2)、Ki-67以及分子分型等乳腺癌预后病理特征的关系。连续变量采用独立样本Mann-Whitney U检验或t检验;分类变量使用R×C列联表χ2检验;相关性检验使用Spearman秩相关检验。绘制受试者工作特征(receiving operator characteristic,ROC)曲线,利用曲线下面积(area under the curve,AUC)比较诊断性能。结果最终纳入88例乳腺浸润性导管癌患者(平均年龄48.93±9.49,范围31~68岁)的88个病灶,FF值和T2*值测量具有良好的观察者间和观察者内一致性,组内相关系数(intra-class correlation coefficient,ICC)分别为0.964和0.909。两组病例在年龄、绝经情况、肿块大小、病灶最大径、肿块类型、FGT以及乳腺BPE间差异均无统计学意义。FF值和T2*值在不同组织学分级两组间的差异均具有显著统计学意义(P均<0.001);与低级别组相比,高级别组的FF值较小(5.06%±2.56%vs.8.33%±3.92%),FF值与组织学分级呈负相关(r=-0.406,P<0.001)。高级别组的T2*值高于低级别组[(29.94±8.55)ms vs.(22.85±5.39)ms],T2*值与组织学分级呈正相关(r=0.397,P<0.001)。对于FF值和T2*值预测组织学分级,AUC分别为0.738和0.748。FF和T2*值联合预测的AUC为0.797,但与单一参数相比预测效能差异无统计学意义。FF值在不同ER和分子分型组间分布上差异有统计学意义(P=0.038和0.005);FF值与ER呈正相关(P=0.037),但与PR、Ki-67、HER-2及分子分型间无显著相关性(P均>0.05)。T2*值在不同ER、PR、Ki-67和分子分型组间差异均有统计学意义(P均<0.05);T2*值与ER、PR均呈负相关(P<0.001和P=0.003),与Ki-67和分子分型呈正相关(P均<0.001)。结论mDixon-Quant衍生的FF值和T2*值是乳腺浸润性导管癌组织学分级的独立预测因素,两参数值联合有助于提高诊断的特异度,且与预后病理特征具有一定的相关性。

乳管内视镜在乳头溢液疾病中的诊治意义

目的了解乳管内视镜检查在乳头溢液患者中的诊治意义。方法回顾性总结１９９７年１０月至１９９８年８月在我院门诊开展的１８０例乳管内视镜检查的表现、临床和随访结果，评价其诊治效果。结果１８０例乳头溢液患者中，导管扩张症者７４例，乳头状瘤者７９例，乳头状瘤病者６例，导管内癌３例，导管炎症１４例，其他４例。随访发现导管扩张症、导管内乳头状瘤、导管内癌、导管炎症乳管内视镜的诊断率分别为８８．９％、９１．１％、１００％、１００％。乳管内视镜下正常的乳管管壁光滑，表面光亮，分支有３～５级，最多７级；炎性导管有局部或广泛的充血，管壁欠光滑，散在絮状渗出物，经冲洗后可使管腔通畅，大多患者检查后无乳头溢液；管内乳头状瘤以单个多见，形状多样，表面大多光滑；乳腺癌一般表现为导管内弥漫性病变，颜色较苍白，伴絮状渗出。本检查安全检查后无一例出现乳头部的感染。结论对乳头溢液的患者而言，乳管内视镜检查是一项安全、经济、有效的检查方法；为乳腺疾病的早期发现。

乳腺浸润性导管癌PTEN表达与临床病理因素的关系

目的:探讨PTEN基因在人乳腺浸润性导管癌组织中的表达及乳腺浸润性导管癌组织中PTEN表达与各临床病理因素的关系。方法:选取80例乳腺浸润性导管癌的石蜡标本,采用S-P法检测PTEN蛋白的表达程度,分析其与乳腺浸润性导管癌患者年龄、绝经状态、肿瘤位置、肿块大小、组织学分级、临床分期、腋窝淋巴结转移情况的关系。并取非癌乳腺组织石蜡标本进行对照。结果:非癌乳腺组织的PTEN蛋白高表达率明显高于乳腺浸润性导管癌组织,差异有统计学意义(P<0.05);乳腺浸润性导管癌组织中PTEN蛋白高表达率随腋窝淋巴结转移数目增加而降低,差异有统计学意义(P<0.05);随着组织学分级增高PTEN高表达率依次降低,存在下降趋势;与年龄、绝经状态、肿瘤位置、肿块大小、临床分期无关。结论:乳腺浸润性导管癌中存在着PTEN蛋白表达降低,乳腺浸润性导管癌组织中PTEN蛋白低表达与腋窝淋巴结转移有关;PTEN蛋白表达有可能成为评估乳腺浸润性导管癌浸润、转移的指标之一。

上皮间质转化分子标记物在乳腺浸润性导管癌组织中的表达及临床意义

目的探讨乳腺浸润性导管癌组织中上皮间质转化(EMT)分子标记物E-钙黏蛋白、N-钙黏蛋白、基质金属蛋白酶9(MMP-9)和MDM2蛋白的表达及其与临床病理特征和预后的关系。方法应用免疫组织化学法检测242例乳腺浸润性导管癌患者手术标本中E-钙黏蛋白、N-钙黏蛋白、MMP-9和MDM2蛋白的表达水平,并进行统计分析。结果在乳腺浸润性导管癌组织中,E-钙黏蛋白、N-钙黏蛋白、MMP-9和MDM2的阳性表达率分别为70.7%、2.9%、54.9%和49.6%,其中,E-钙黏蛋白与MMP-9的表达呈正相关(r=0.238,P=0.000),MDM2与MMP-9的表达也呈正相关(r=0.171,P=0.012)。E-钙黏蛋白的表达与肿瘤大小及雌激素受体(ER)状态有关,肿瘤较小及ER阳性者的E-钙黏蛋白阳性表达率高;MDM2的表达与肿瘤大小也存在显著相关性(P=0.028),肿瘤较小者的MDM2阳性表达率高。生存分析显示,肿瘤较大、淋巴结转移及MDM2表达阳性者的术后无病生存期较短,其中淋巴结转移(HR=11.33,95%CI:3.46～37.13,P<0.001)和MDM2表达阳性(HR=5.17,95%CI:1.66～16.10,P=0.005)是乳腺浸润性导管癌患者的独立不良预后因素。结论 MDM2是乳腺浸润性导管癌的不良预后因子之一,MDM2可能通过上调MMP-9的表达,介导EMT发生,导致肿瘤浸润转移影响预后。

P53、PCNA、bcl-2和bax与乳腺癌关系的实验研究

目的 研究P5 3蛋白 ,增殖细胞抗原 (PCNA) ,bcl 2 ,bax基因蛋白在乳腺浸润性导管癌中表达的相关性及预后的关系。方法 应用免疫组织化学ABC法检测乳腺浸润性导管癌组织P5 3蛋白和PCNA ,bcl 2 ,bax基因蛋白的表达。结果 死亡组P5 3蛋白阳性表达率 (32 / 35 )和PCNA指数 (PI) (5 6 .5± 2 6 .5 4) % ,明显高于存活组的P5 3蛋白阳性率 (31/ 6 5 )和PI(31.5± 2 6 .5 8) %。且两者表达与淋巴结转移和临床分期有显著关系。存活组bcl 2基因蛋白阳性表达率 (46 / 6 5 )明显高于死亡组bcl 2阳性表达率 (12 / 35 ) ,且bcl 2基因蛋白表达与淋巴结转移和临床分期呈负相关关系 ,而bax在死亡组的阳性率 (31/ 35 )显著高于存活组 (2 6 / 6 5 ) ,与淋巴结转移和临床分期呈正相关。结论 P5 3蛋白 ,PCNA ,bcl 2 。

Clusterin、Livin、Caspase-3蛋白在乳腺浸润性导管癌中的表达

目的:探讨细胞凋亡相关因子Clusterin、Livin、Caspase-3在乳腺浸润性导管癌组织中的表达及临床意义。方法:应用免疫组织化学SP法检测70例乳腺浸润性导管癌、20例乳腺增生和10例乳腺癌旁组织(距癌组织≥4cm,组织学结构正常)标本中Clusterin、Livin、Caspase-3的表达情况,探讨三者的相关性及其与乳腺癌各临床病理学参数间的关系。结果:Clusterin、Livin蛋白在癌组织中的阳性表达率分别为71.4%和64.3%,均明显高于乳腺增生和乳腺癌旁组织的20%、25%(P<0.05)和0%、10%(P<0.05),且Clusterin蛋白与Livin蛋白表达呈正相关(P<0.05)。Caspase-3蛋白在癌组织中的阳性表达率为45.7%,明显低于乳腺增生和乳腺癌旁组织中的75%和80%(P<0.05),且Clusterin、Livin蛋白与Caspase-3蛋白表达呈负相关(P<0.05)。Clusterin蛋白在乳腺浸润性导管癌中的表达随着临床分期的增加阳性表达率显著升高且与组织学分级及淋巴结转移情况有关(P<0.05),与患者年龄、肿瘤大小无关(P>0.05),而Livin蛋白的阳性表达率随着临床分期增加显著升高(P<0.05),但与患者年龄、肿瘤大小、组织学分级、淋巴结转移无关(P>0.05),Caspase-3蛋白的表达随着临床分期的增加其阳性表达率下降(P<0.05),与患者年龄、肿瘤大小、组织学分级和淋巴结转移无相关性(P>0.05)。在乳腺浸润性导管癌组织中Clusterin、Livin蛋白与ER、PR的表达负相关(P<0.05),与C-erbB-2的表达无相关性(P>0.05),Caspase-3蛋白与ER、PR表达显著正相关(P<0.05),与C-erbB-2表达无相关性(P>0.05)。结论:Clusterin、Livin可能通过抑制细胞凋亡在乳腺癌的发生发展中发挥重要促进作用,二者可能成为乳腺浸润性导管癌诊断的重要标志物和评估预后的潜在指标;Clusterin与Livin的联合靶向治疗,有望成为乳腺浸润性导管癌治疗的新方法。Caspase-3在Clusterin、Livin抗凋亡通路中发挥着重要作用。