Ringberg A, Palmer B, Linell F, Rychterova V, Ljungberg O
Department of Plastic and Reconstructive Surgery, University of Lund, Malmö General Hospital, Sweden.
Eur J Surg Oncol. 1991 Feb;17(1):20-9.
Bilateral clinical breast carcinoma has been reported to appear in up to approximately 10% of patients with breast carcinoma. Increasing diagnostic activity has raised figures of bilaterality, mainly due to detection of lesions of the in situ type. Knowledge of the natural history of carcinoma in situ is incomplete and clinical implications are uncertain. In the present study bilateral lesions were analysed by extensive histological examination in the following groups of patients: (1) Forty-six women (median age 44 years) with clinical and mammographical unilateral invasive breast carcinoma, where the contralateral breast was removed at subcutaneous mastectomy (SCM) during the course of breast reconstruction, 24/46 (52%) had bilateral malignant lesions, four invasive carcinomas and 20 in situ carcinomas (two ductal carcinomas in situ /DCIS/, 15 lobular carcinomas in situ (LCIS), three both DCIS and LCIS). (2) Fifty-two women (median age 50 years) with a unilateral diagnosis of in situ carcinoma (32 DCIS, 16 LCIS, four both DCIS and LCIS), in whom both breasts were removed at SCM. 25/52 (48%) had bilateral malignant lesions, one invasive carcinoma, 24 in situ carcinomas (three DCIS, 18 LCIS, three both DCIS and LCIS). Twelve of 20 cases with LCIS (60%) were bilateral. Of 36 cases with DCIS, seven (19%) were bilateral. (3) The contralateral breast was removed at autopsy in 64 women previously unilaterally mastectomized (at median age 65) for invasive breast carcinoma. Fifteen of 64 (23%) had contralateral primary carcinoma at autopsy, four invasive carcinomas, 11 in situ carcinomas (six DCIS, five LCIS) and 8/64 (13%) had metastases in the breast. Multifocal malignant findings were also analysed in 47 SCM specimens after excisional biopsy for in situ carcinoma. In 35/47 (75%) further malignant lesions were present in spite of normal mammographic and clinical findings. Four were invasive and 31 had in situ lesions (16 DCIS, 10 LCIS, five both DCIS and LCIS): These findings may favour the hypothesis that some carcinomas in situ may remain silent or even regress. It is thus important to embark upon randomized trials to clarify the natural history of breast carcinoma in situ. Such a trial has been started in the southern region of Sweden.
据报道，双侧临床乳腺癌在高达约10%的乳腺癌患者中出现。诊断活动的增加使双侧性的比例有所上升，主要是由于原位癌病变的检出。原位癌自然史的知识尚不完整，其临床意义也不确定。在本研究中，通过广泛的组织学检查对以下几组患者的双侧病变进行了分析：（1）46名女性（中位年龄44岁），患有临床和乳腺钼靶检查显示的单侧浸润性乳腺癌，在乳房重建过程中，对侧乳房在皮下乳房切除术（SCM）时被切除，24/46（52%）有双侧恶性病变，4例浸润性癌和20例原位癌（2例导管原位癌/DCIS/，15例小叶原位癌（LCIS），3例同时有DCIS和LCIS）。（2）52名女性（中位年龄50岁），单侧诊断为原位癌（32例DCIS，16例LCIS，4例同时有DCIS和LCIS），在SCM时双侧乳房均被切除。25/52（48%）有双侧恶性病变，1例浸润性癌，24例原位癌（3例DCIS，18例LCIS，3例同时有DCIS和LCIS）。20例LCIS病例中有12例（60%）为双侧性。36例DCIS病例中有7例（19%）为双侧性。（3）对64名先前因浸润性乳腺癌单侧乳房切除（中位年龄65岁）的女性进行尸检时切除了对侧乳房。64例中有15例（23%）在尸检时有对侧原发性癌，4例浸润性癌，11例原位癌（6例DCIS，5例LCIS），8/64（13%）在乳房中有转移灶。对47例因原位癌切除活检后的SCM标本中的多灶性恶性发现也进行了分析。在35/47（约75%）中，尽管乳腺钼靶和临床检查结果正常，但仍存在进一步的恶性病变。4例为浸润性，31例有原位病变（16例DCIS，10例LCIS，5例同时有DCIS和LCIS）：这些发现可能支持这样一种假说，即一些原位癌可能保持隐匿甚至消退。因此，开展随机试验以阐明原位乳腺癌的自然史很重要。瑞典南部地区已经启动了这样一项试验。
