Sikand K, Lee A H S, Pinder S E, Elston C W, Ellis I O
Department of Histopathology, City Hospital, Hucknall Road, Nottingham NG5 1PB, UK.
J Clin Pathol. 2005 May;58(5):543-5. doi: 10.1136/jcp.2004.022665.
To assess the value of nipple and quadrant sections in mastectomy specimens for carcinoma in detecting Paget's disease and multifocal carcinoma.
Two hundred and forty eight consecutive mastectomies performed for carcinoma were reviewed. The presence of Paget's disease of the nipple and mode of identification of any multifocal carcinoma was recorded.
Nipple sections showed Paget's disease in eight specimens: in five the diagnosis had been made on previous biopsy and in three (1%) this was a new diagnosis. In the 220 specimens in which all four quadrants were sampled, multifocal disease was identified more often in specimens with invasive carcinoma (39 of 186; 21%) than in those with only ductal carcinoma in situ (0 of 34). In specimens with invasive carcinoma, multifocality was identified macroscopically in 20: on microscopy of tumour sections in four, on microscopic examination of quadrant sections in 11, in the nipple in three, and in both quadrant and nipple sections in one. Overall, multifocality was found on microscopic examination of quadrant or nipple sections in 15 of 220 specimens (7%).
The low frequency of detection of multifocality or Paget's disease in nipple and quadrant sections from mastectomy specimens, combined with the fact that such findings do not affect patient management, suggest that nipple and quadrant sections should only be taken if resources permit.
评估乳房切除术标本中的乳头及象限切片在检测佩吉特病和多灶性癌方面对于癌的价值。
回顾了连续248例因癌行乳房切除术的病例。记录乳头佩吉特病的存在情况以及任何多灶性癌的识别方式。
乳头切片在8个标本中显示有佩吉特病：5个标本的诊断是基于之前的活检做出的，3个（1%）是新诊断。在对所有四个象限进行取材的220个标本中，浸润性癌标本中多灶性病变的发现率（186个中的39个；21%）高于仅原位导管癌标本（34个中的0个）。在浸润性癌标本中，20个在大体上可识别为多灶性；在肿瘤切片显微镜检查中发现4个，在象限切片显微镜检查中发现11个，在乳头中发现3个，在象限和乳头切片中均发现1个。总体而言，在220个标本中的15个（7%）通过象限或乳头切片显微镜检查发现有多灶性病变。
乳房切除术标本的乳头及象限切片中多灶性病变或佩吉特病的检出率较低，再加上这些发现不影响患者的治疗管理，这表明仅在资源允许的情况下才应进行乳头及象限切片检查。
