Rosner D, Lane W W, Penetrante R
Department of Breast Surgery, Roswell Park Cancer Institute, Buffalo, New York.
Cancer. 1991 Mar 15;67(6):1498-503. doi: 10.1002/1097-0142(19910315)67:6<1498::aid-cncr2820670606>3.0.co;2-i.
Of 408 negative axillary node (NAN) patients surgically treated at Roswell Park Cancer Institute (Buffalo, NY, 1976 through 1987), 36 (8.8%) presented with ductal carcinoma in situ with microinvasion (DCISM). In more than 50% of the patients (20/36) the disease was detected solely by mammography (microcalcifications and/or radiological density less than 1.5 cm). Thirty-three patients underwent modified radical mastectomy; three had wide excision +/- axillary dissection. Residual disease after excisional biopsy was found in 22 of 33 mastectomy specimens (67%): 11 (33%) pure ductal carcinoma in situ, five (15%) DCISM, and six (18%) frankly invasive. Of the 22 incidents of residual disease, 50% (11) were multicentric (one third of all specimens). These findings imply a high likelihood of residual cancer after excisional biopsy in these patients. All patients were free of disease for a mean follow-up of 57 months (range, 16 to 137). These findings indicate that DCISM is an entirely curable disease when treated by mastectomy alone, without the need for adjuvant therapy, regardless of the status of other prognostic factors such as tumor size, histologic differentiation, age, or steroid receptor status.
在罗斯韦尔帕克癌症研究所（纽约州布法罗，1976年至1987年）接受手术治疗的408例腋窝淋巴结阴性（NAN）患者中，36例（8.8%）表现为伴有微浸润的导管原位癌（DCISM）。超过50%的患者（20/36）仅通过乳房X线摄影（微钙化和/或小于1.5厘米的放射密度）检测到该病。33例患者接受了改良根治性乳房切除术；3例接受了广泛切除加/减腋窝淋巴结清扫术。在33例乳房切除标本中的22例（67%）发现切除活检后有残留疾病：11例（33%）为单纯导管原位癌，5例（15%）为DCISM，6例（18%）为明显浸润性癌。在22例残留疾病事件中，50%（11例）为多中心性（占所有标本的三分之一）。这些发现表明这些患者切除活检后残留癌症的可能性很高。所有患者平均随访57个月（范围16至137个月）均无疾病。这些发现表明，DCISM单独通过乳房切除术治疗时是一种完全可治愈的疾病，无需辅助治疗，无论肿瘤大小、组织学分化、年龄或类固醇受体状态等其他预后因素如何。
