Karak Soma Ghosh, Quatrano Nicola, Buckley Judith, Ricci Andrew
Hartford Hospital, Hartford, USA.
Conn Med. 2010 Jan;74(1):17-21.
Lymphovascular invasion (LVI) is a poor prognostic feature in breast cancer. Perineural invasion (PNI), a sign of aggressive behavior potential in other tumor systems, is less frequently observed in mammary carcinoma and hence has been less well studied. The present work was conducted to determine the frequency of PNI in mammarycarcinoma and to describe the relationships between PNI, tumor characteristics (including LVI) and clinical outcome.
The Hartford Hospital pathology database was reviewed for cases of invasive mammary carcinoma diagnosed from 2000-2002. The search was then narrowed to include only those cases reporting PNI, LVI, or both. These targeted reports were then reviewed to abstract clinicopathologic data with regard to patient age, tumor stage and nuclear/ histologic grade. Histologic review was performed on all PNI(+)cases. Comparisons between tumor characteristics associated with PNI and LVI were generated. Nodalstatus andpatientoutcomewereobtainedfrom cancer registry records.
From a total of 1136 cases of invasive mammary carcinoma diagnosed from 2000-2002, 13 (1.14%) and 146 (12.9%) showed PNI and LVI, respectively. Of the 13 patients with PNI, 5/13 (38.5%) also had LVI. Both PNI and LVI were associated with higher T-stage and intermediate to high NG/HG.
PNI is a relatively rare histologic feature in invasive breast carcinoma occurring 10 times less frequently than LVI. Tumor characteristics associated with PNI include higher T-stage, higher tumor grade and LVI. Despite this, patients with PNI can expect a meaningful survival at five years with appropriately aggressive adjuvant therapy (only one of 13 patients in this study was known DOD after mean follow-up of 5.9 yr). When observed in tissue sections PNI should be reported (for completeness) but its role as an independent poor prognostic feature remains questionable.
淋巴管浸润（LVI）是乳腺癌预后不良的特征。神经周围浸润（PNI）在其他肿瘤系统中是侵袭性行为潜能的标志，在乳腺癌中较少见，因此研究较少。本研究旨在确定乳腺癌中PNI的发生率，并描述PNI、肿瘤特征（包括LVI）与临床结局之间的关系。
回顾哈特福德医院病理数据库中2000年至2002年诊断的浸润性乳腺癌病例。然后缩小搜索范围，仅纳入报告PNI、LVI或两者皆有的病例。接着对这些目标报告进行回顾，提取有关患者年龄、肿瘤分期和核/组织学分级的临床病理数据。对所有PNI（+）病例进行组织学复查。对与PNI和LVI相关的肿瘤特征进行比较。从癌症登记记录中获取淋巴结状态和患者结局。
在2000年至2002年诊断的1136例浸润性乳腺癌病例中，分别有13例（1.14%）和146例（12.9%）出现PNI和LVI。在13例PNI患者中，5/13（38.5%）也有LVI。PNI和LVI均与较高的T分期以及中高核分级/组织学分级相关。
PNI是浸润性乳腺癌中相对罕见的组织学特征，其发生率比LVI低10倍。与PNI相关的肿瘤特征包括较高的T分期、较高的肿瘤分级和LVI。尽管如此，通过适当积极的辅助治疗，PNI患者有望获得有意义的5年生存期（本研究中13例患者中只有1例在平均随访5.9年后死亡）。当在组织切片中观察到PNI时，应予以报告（为了完整性），但其作为独立预后不良特征的作用仍值得怀疑。
