Mamoon Nadira, Sharif Muhammad Ashraf, Mushtaq Sajid, Khadim Muhammad Tahir, Jamal Shahid
Armed Forces Institute of Pathology, Rawalpindi, Pakistan.
J Pak Med Assoc. 2009 Dec;59(12):835-8.
To compare the histological prognostic markers in breast carcinoma over three decades in Northern Pakistani population and analyse for any change in trends in terms of prognostic markers.
Cross-sectional descriptive study was carried out from January 2004 to December 2006 at AFIP, Rawalpindi on 822 cases of female breast carcinoma. Assessment of tumour size on gross examination followed by microscopic evaluation of tumour type, tumour grade, lymph node metastasis and skin involvement was done. The results of the present data were compared with studies of Wahid et al (January 1994 to December 1997) and Malik et al (January 1984 to December 1986) from the same institute.
Total 822 cases of breast cancer were diagnosed with 541 (64.9%) cases of mastectomy. The mean age was 48 +/- 12 years with a mean tumour size of 4.6 +/- 2 cm. Atumour size of >5 cm was seen in 30.6% cases and only 18.8% cases had a size <2 cm. Infiltrating ductal carcinoma was the commonest subtype in 674 (81%) cases with histological grade II in 533 (64%) cases. Lymph node metastasis was present in 74.6% cases and skin involvement in 36% cases. The comparison of the results of the present study with those over the past two decades in Pakistan show that the mean age at diagnosis remains around 48 years. There is statistically significant increase in the tumours of <5 cm at presentation and a higher frequency of tumours with dermal invasion. No significant change is seen in frequency of lymph node metastasis at operation and tumour grade.
The comparison of results of other studies done over the past three decades in the region are not very encouraging. The age of presentation remains younger as compared to the West. A positive note is seen in terms of a decreasing tumour size but lack of DCIS cases in our material underlines the need of mammography and launching of effective screening programmes at the national level. Early detection of cases will help in treatment and subsequently improve prognosis in these patients as advocated by the West.
比较巴基斯坦北部人群三十多年来乳腺癌的组织学预后标志物，并分析预后标志物趋势的任何变化。
2004年1月至2006年12月在拉瓦尔品第的阿尤布医学研究生培训学院对822例女性乳腺癌患者进行了横断面描述性研究。在大体检查时评估肿瘤大小，随后对肿瘤类型、肿瘤分级、淋巴结转移和皮肤受累情况进行显微镜评估。将本研究的数据结果与同一机构的瓦希德等人（1994年1月至1997年12月）和马利克等人（1984年1月至1986年12月）的研究结果进行比较。
共诊断出822例乳腺癌患者，其中541例（64.9%）接受了乳房切除术。平均年龄为48±12岁，平均肿瘤大小为4.6±2厘米。30.6%的病例肿瘤大小>5厘米，只有18.8%的病例肿瘤大小<2厘米。浸润性导管癌是最常见的亚型，674例（81%），其中533例（64%）组织学分级为II级。74.6%的病例有淋巴结转移，36%的病例有皮肤受累。将本研究结果与巴基斯坦过去二十年的研究结果进行比较表明，诊断时的平均年龄仍在48岁左右。就诊时<5厘米的肿瘤有统计学意义的增加，且皮肤侵犯的肿瘤频率更高。手术时淋巴结转移频率和肿瘤分级未见显著变化。
该地区过去三十年的其他研究结果比较并不十分乐观。与西方相比，就诊年龄仍然较小。肿瘤大小减小是一个积极的方面，但我们的材料中缺乏导管原位癌病例凸显了乳房X线摄影的必要性以及在国家层面开展有效筛查项目的必要性。如西方所倡导的，早期发现病例将有助于治疗并随后改善这些患者的预后。
