Millis R R, Pinder S E, Ryder K, Howitt R, Lakhani S R
Hedley Atkins Cancer Research UK Breast Pathology Laboratory, Guy's Hospital, London SE1 9RT, UK.
Br J Cancer. 2004 Apr 19;90(8):1538-42. doi: 10.1038/sj.bjc.6601704.
The grade of recurrent in situ and invasive carcinoma occurring after treatment of pure ductal carcinoma in situ (DCIS) has been compared with the grade of the original DCIS in 122 patients from four different centres (The Royal Marsden Hospitals, London and Sutton, 57 patients; Guy's Hospital, London, 19 patients; Nottingham City Hospital, 31 patients and The Royal Liverpool Hospital, 15 patients). The recurrent carcinoma was pure DCIS in 70 women (57%) and in 52 women (43%) invasive carcinoma was present, which was associated with an in situ element in 43. In all, 19 patients developed a second recurrence (pure DCIS in 11 and invasive with or without an in situ element in eight). The majority of invasive carcinomas followed high-grade DCIS. There was strong agreement between the grade of the original DCIS and that of the recurrent DCIS (kappa=0.679), which was the same in 95 of 113 patients (84%). The grade of the original DCIS showed only fair agreement with the grade of recurrent invasive carcinoma (kappa=0.241), although agreement was stronger with the pleomorphism score of the recurrent carcinoma (kappa=0.396). There was moderate agreement, in recurrent invasive lesions, between the grade of the DCIS and that of the associated invasive element (kappa=0.515). Other features that showed moderate or strong agreement between the original and recurrent DCIS were necrosis and periductal inflammation. The similarity between the histological findings of the original and subsequent DCIS is consistent with the concept that recurrent lesions represent regrowth of residual carcinoma. In addition, although agreement between the grade of the original DCIS and that of any subsequent invasive carcinoma was only fair, there is no suggestion that low-grade DCIS lesions progress to higher grade lesions or to the development of higher grade invasive carcinoma. This is in agreement with immunohistochemical and molecular data indicating that low-grade and high-grade mammary carcinomas are quite different lesions.
在来自四个不同中心（伦敦和萨顿的皇家马斯登医院，57例患者；伦敦盖伊医院，19例患者；诺丁汉市医院，31例患者；皇家利物浦医院，15例患者）的122例患者中，对单纯导管原位癌（DCIS）治疗后发生的原位复发癌和浸润性癌的分级与原发DCIS的分级进行了比较。复发癌在70名女性（57%）中为单纯DCIS，在52名女性（43%）中为浸润性癌，其中43例伴有原位成分。总共有19例患者出现第二次复发（11例为单纯DCIS，8例为伴有或不伴有原位成分的浸润性癌）。大多数浸润性癌继发于高级别DCIS。原发DCIS的分级与复发DCIS的分级之间有很强的一致性（kappa=0.679），在113例患者中有95例（84%）相同。原发DCIS的分级与复发浸润性癌的分级仅显示出一般的一致性（kappa=0.241），尽管与复发癌的多形性评分一致性更强（kappa=0.396）。在复发浸润性病变中，DCIS的分级与相关浸润成分的分级之间有中度一致性（kappa=0.515）。在原发和复发DCIS之间显示出中度或强一致性的其他特征是坏死和导管周围炎症。原发和继发DCIS的组织学结果之间的相似性与复发病变代表残留癌再生长的概念一致。此外，虽然原发DCIS的分级与任何后续浸润性癌的分级之间仅为一般一致性，但没有迹象表明低级别DCIS病变会进展为高级别病变或发展为高级别浸润性癌。这与免疫组织化学和分子数据一致，表明低级别和高级别乳腺癌是截然不同的病变。
