Academic Department of Breast Surgery, University Hospital of South Manchester, 2nd Floor, Education and Research Centre, Southmoor Road, Manchester M23 9LT, UK.
Academic Department of Breast Surgery, University Hospital of South Manchester, 2nd Floor, Education and Research Centre, Southmoor Road, Manchester M23 9LT, UK.
Eur J Surg Oncol. 2014 Mar;40(3):249-54. doi: 10.1016/j.ejso.2013.12.013. Epub 2014 Jan 3.
DCIS accounts for 20% of screen-detected breast cancers, but also presents symptomatically. Historically, approximately 5% of DCIS was thought to be symptomatic, but accurate evaluation of the presentation of symptomatic DCIS is needed to determine its incidence and tumour biology.
Clinico-pathological details of a consecutive series of patients presenting to a single breast-unit, with a pre-operative diagnosis of DCIS, were selected. Data included age, mode of presentation, pre-operative clinical and radiographical findings. The final tumour histology, operation, size, grade, ER status (and HER2 expression in invasive cases) were recorded.
375 patients had a pre-operative histological diagnosis of DCIS. 308 (82%) screen-detected (median age 59), 67 (18%) presented via symptomatic clinics (median age 50). At final histology 286 (74%) were pure DCIS, and 67 (23%) had an invasive focus. 43% (29/67) of symptomatic cases had an invasive focus at final histology versus 19% (60/308) screen-detected (p ≤ 0.001). 31% (9/29) of symptomatic, versus 10% (6/60) of screen-detected cases with invasion were node positive (p = 0.05). 45% (28/62) intermediate/high-grade symptomatic cases had an invasive focus at final histology, compared to 19% (57/297) intermediate/high-grade screen-detected cases. 86% (212/248) screen-detected pure DCIS was ER positive compared to 68% (26/38) symptomatically presenting pure DCIS (p ≤ 0.001). Overall, 13% (38/248) pure DCIS presented symptomatically (p = 0.001).
Overall, thirteen percent of pure DCIS present symptomatically. Nearly half of symptomatically presenting DCIS at core biopsy has an occult invasive focus and is more frequently ER negative. Symptomatic DCIS with an invasive focus is more likely to have lymph node involvement.
DCIS 占筛查性乳腺癌的 20%，但也有症状表现。过去，约 5%的 DCIS 被认为是有症状的，但需要准确评估有症状的 DCIS 的表现，以确定其发生率和肿瘤生物学特征。
选择连续系列患者的临床病理资料，这些患者在单一乳腺科就诊，术前诊断为 DCIS。数据包括年龄、发病模式、术前临床和影像学检查结果。记录最终肿瘤组织学、手术、大小、分级、ER 状态（以及浸润性病例中的 HER2 表达）。
375 例患者术前组织学诊断为 DCIS。308 例（82%）为筛查性发现（中位年龄 59 岁），67 例（18%）经症状性诊所就诊（中位年龄 50 岁）。最终组织学上，286 例（74%）为单纯 DCIS，67 例（23%）有浸润性病灶。67 例（43%）症状性病例最终组织学检查有浸润性病灶，而 308 例（19%）筛查性病例有浸润性病灶（p ≤ 0.001）。31%（9/29）症状性、10%（6/60）筛查性有浸润性病灶的病例淋巴结阳性（p = 0.05）。45%（28/62）中高级别症状性病例最终组织学检查有浸润性病灶，而 297 例（19%）中高级别筛查性病例有浸润性病灶。248 例（86%）筛查性单纯 DCIS 为 ER 阳性，而 38 例（68%）症状性单纯 DCIS 为 ER 阳性（p ≤ 0.001）。总的来说，13%（38/248）单纯 DCIS 有症状（p = 0.001）。
总的来说，13%的单纯 DCIS 有症状。近一半的核心活检有症状的 DCIS 有隐匿性浸润病灶，且更常为 ER 阴性。有浸润性病灶的症状性 DCIS 更有可能发生淋巴结受累。
Zotero 插件