Goldstein N S, Kestin L, Vicini F
Department of Anatomic Pathology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
Am J Surg Pathol. 2000 Aug;24(8):1058-67. doi: 10.1097/00000478-200008000-00003.
Local excision and radiation therapy is a standard treatment option for duct carcinoma in situ (DCIS) of the breast. There is no consensus regarding the significant histologic features associated with recurrence. The authors studied a large group of patients with mammographically detected DCIS treated with breast-conserving therapy to explore DCIS volume relationships, DCIS features, specimen characteristics, and the effect of patient age at diagnosis. Thirteen patients (10%) developed a recurrent carcinoma in the ipsilateral breast, resulting in 5- and 10-year actuarial recurrence rates of 8.9% and 10.3%, respectively. Local recurrences were identified as a true recurrence/marginal miss (TR/MM) in nine patients, and elsewhere in the breast in four patients. The notable features associated with TR/MM recurrences on univariate analysis included patient age less than 45 years old, six or more slides with DCIS, no microscopic calcifications within DCIS ducts, and five or more DCIS ducts or terminal duct lobular units (TDLUs) with cancerization of lobules (COL) within 0.42 cm of the final surgical margin. DCIS tumor size, nuclear grade, amount of central necrosis, and margin status were not associated with outcome. Multivariate analysis found that the absence of microcalcifications within DCIS ducts, patient age, number of slides with DCIS or TDLUs with COL, and the number of DCIS ducts or TDLUs with COL within 0.42 cm of the final margin were related significantly to TR/MM recurrence. Patients with a total of six or more slides with DCIS, or who have 11 or more DCIS ducts or TDLUs with COL near the final margin are at increased risk of having a substantial volume of residual DCIS in the adjacent unexcised breast. These results suggest that the volume of DCIS in the specimen, and the volume of DCIS near the margin are associated with local recurrence. These features can be used to identify those patients with a higher chance of local recurrence.
局部切除和放射治疗是乳腺导管原位癌（DCIS）的标准治疗选择。对于与复发相关的重要组织学特征，目前尚无共识。作者研究了一大组经乳房保留疗法治疗的乳腺钼靶检测出的DCIS患者，以探讨DCIS体积关系、DCIS特征、标本特征以及诊断时患者年龄的影响。13名患者（10%）在同侧乳房发生复发性癌，5年和10年精算复发率分别为8.9%和10.3%。9名患者的局部复发被确定为真正复发/边缘遗漏（TR/MM），4名患者的局部复发发生在乳房其他部位。单因素分析中与TR/MM复发相关的显著特征包括患者年龄小于45岁、有6张或更多载玻片显示DCIS、DCIS导管内无微小钙化、最终手术切缘0.42 cm内有5个或更多DCIS导管或终末导管小叶单位（TDLU）伴有小叶癌变（COL）。DCIS肿瘤大小、核分级、中央坏死量和切缘状态与预后无关。多因素分析发现，DCIS导管内无微小钙化、患者年龄、有DCIS或伴有COL的TDLU的载玻片数量以及最终切缘0.42 cm内伴有COL的DCIS导管或TDLU数量与TR/MM复发显著相关。共有6张或更多载玻片显示DCIS，或最终切缘附近有11个或更多伴有COL的DCIS导管或TDLU的患者，其相邻未切除乳房中残留大量DCIS的风险增加。这些结果表明，标本中DCIS的体积以及切缘附近DCIS的体积与局部复发相关。这些特征可用于识别局部复发可能性较高的患者。
