Goldstein N S, Vicini F A, Kestin L L, Thomas M
Department of Anatomic Pathology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
Cancer. 2000 Jun 1;88(11):2553-60. doi: 10.1002/1097-0142(20000601)88:11<2553::aid-cncr18>3.0.co;2-v.
BACKGROUND: Young patient age at diagnosis has been reported as a risk factor for recurrence in patients with ductal carcinoma in situ (DCIS) of the breast treated with breast-conserving therapy (BCT). The authors examined pathologic features of DCIS in three different age groups of patients to identify differences that might explain why young patient age at the time of diagnosis is a risk factor for recurrence. METHODS: Excised specimens from 177 breasts of 172 patients with DCIS treated with BCT were studied. All slides from all specimens were reviewed. Patients were divided into 3 age groups: those age < 45 years, those ages 45-59 years, and those age >/= 60 years. The histologic features that were quantified included most common and highest nuclear grades, DCIS architectural pattern, amount of central necrosis (quartiles), calcifications, amount of DCIS, and number of terminal duct lobular units (TDLUs) with cancerization of lobules (COL) within 0.42 cm of the margin, margin status, and size and volume of excision specimens. RESULTS: Patients age < 45 years at the time of diagnosis more frequently had higher nuclear grade DCIS (highest nuclear Grade 3: 69%, 60%, and 39%; P = 0.003), respectively and central necrosis (72%, 62%, and 44%; P = 0. 01), respectively. Although not statistically significant, younger patients tended to have comedo subtype DCIS more often (31%, 23%, and 19%; P = 0.35), respectively. Younger patients also more often had smaller initial biopsy specimen maximum dimensions (4.3 cm, 5.2 cm, and 5.7 cm; P = 0.004), respectively, with close or positive margins (89%, 61%, and 64%; P = 0.03), and more TDLUs with COL in the 0.42-cm rim of tissue adjacent to the margin (5.2, 3.6, and 1.9; P = 0.23), respectively. No other features including the amount of DCIS when classified as > 50% or > 75% of ducts, calcifications within DCIS ducts, pattern of DCIS involvement, number of slides examined, number of slides with DCIS, and mean number of DCIS ducts near the margin were found to occur more frequently in younger patients. CONCLUSIONS: Younger patients with DCIS may have an increased risk of local recurrence when treated with BCT due to smaller initial excision volumes, a greater proportion of high nuclear grade DCIS, and central necrosis.
背景：据报道，对于接受保乳治疗（BCT）的乳腺导管原位癌（DCIS）患者，诊断时年龄较轻是复发的一个危险因素。作者研究了三个不同年龄组DCIS患者的病理特征，以确定可能解释为何诊断时年龄较轻是复发危险因素的差异。 方法：对172例接受BCT治疗的DCIS患者的177个乳房切除标本进行研究。对所有标本的所有切片进行复查。患者分为3个年龄组：年龄<45岁、年龄45 - 59岁、年龄≥60岁。定量的组织学特征包括最常见和最高核分级、DCIS的结构模式、中央坏死量（四分位数）、钙化、DCIS量、以及距切缘0.42 cm内有小叶癌变（COL）的终末导管小叶单位（TDLU）数量、切缘状态、切除标本的大小和体积。 结果：诊断时年龄<45岁的患者更常出现核分级较高的DCIS（最高核分级3级：分别为69%、60%和39%；P = 0.003），以及中央坏死（分别为72%、62%和44%；P = 0.01）。虽然无统计学意义，但年轻患者更倾向于出现粉刺型DCIS（分别为31%、23%和19%；P = 0.35）。年轻患者初始活检标本的最大尺寸也更小（分别为4.3 cm、5.2 cm和5.7 cm；P = 0.004），切缘接近或阳性者更多（分别为89%、61%和64%；P = 0.03），且在距切缘0.42 cm的组织边缘内有COL的TDLU更多（分别为5.2、3.6和1.9；P = 0.23）。未发现其他特征在年轻患者中更频繁出现，包括DCIS量分类为>50%或 >75%导管时、DCIS导管内的钙化、DCIS累及模式、检查的切片数量、有DCIS的切片数量以及切缘附近DCIS导管的平均数量。 结论：接受BCT治疗的年轻DCIS患者可能因初始切除体积较小、高核分级DCIS比例较高以及中央坏死而局部复发风险增加。
Facts Views Vis Obgyn. 2014
BMC Cancer. 2014-8-11
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