Chen Ying, Klingen Tor A, Wik Elisabeth, Aas Hans, Vigeland Einar, Liestøl Knut, Garred Øystein, Mæhlen Jan, Akslen Lars A, Lømo Jon
Department of Pathology, Vestfold Hospital, Tønsberg, Norway.
Department of Pathology, Akershus University Hospital, Lørenskog, Norway.
Diagn Pathol. 2014 Dec 19;9:230. doi: 10.1186/s13000-014-0230-8.
Mammography screen-detected breast cancers have a better prognosis than predicted from established prognostic markers. A search for additional features that are characteristic for these tumours and their prognosis is needed to reduce overtreatment, a recognized challenge in breast cancer patient management today. Here, we have investigated the occurrence and importance of tumour elastosis.
We performed a population based retrospective study of breast cancers detected in the Norwegian Breast Cancer Screening Programme in Vestfold County during 2004-2009. In total, 197 invasive screen-detected cancers and 75 interval cancers in patients aged 50-69 years were compared with regard to standard clinico-pathological parameters and tumour shape, as well as ER, PR, HER2 and Ki67 expression. In particular, the presence of elastotic material in tumours was graded on a 4-tiered scale (score 0-3).
Screen-detected cancers had a significantly higher content of stromal elastosis than interval cancers (p < 0.001). High content of elastosis (score 3) correlated strongly with stellate tumour shape, low histological grade, and ER+/HER2- status. Further, high elastosis score was significantly associated with lower Ki67 expression. In survival analyses, cases with high elastosis demonstrated increased recurrence free (p = 0.03) and disease-specific survival (p = 0.11) compared to cases with low elastosis.
There is a strong correlation between the presence of tumour elastosis, stellate tumour shape and mammography detection of breast cancers. To our knowledge, this is the first time elastosis has been studied in relation to breast cancer detection method. Presence of elastosis is associated with low tumour cell proliferation (Ki67) and a good prognosis.
The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/13000_2014_230.
乳腺钼靶筛查发现的乳腺癌预后比根据既定预后标志物预测的要好。为了减少过度治疗（这是当今乳腺癌患者管理中公认的挑战），需要寻找这些肿瘤及其预后所特有的其他特征。在此，我们研究了肿瘤弹性组织变性的发生情况及其重要性。
我们对2004年至2009年期间在韦斯特福尔郡挪威乳腺癌筛查项目中发现的乳腺癌进行了一项基于人群的回顾性研究。总共比较了197例50至69岁患者中经筛查发现的浸润性癌和75例间期癌的标准临床病理参数、肿瘤形状以及雌激素受体（ER）、孕激素受体（PR）、人表皮生长因子受体2（HER2）和Ki67的表达情况。特别地，根据四级量表（评分0 - 3）对肿瘤中弹性组织变性物质的存在情况进行分级。
筛查发现的癌症间质弹性组织变性含量显著高于间期癌（p < 0.001）。高弹性组织变性含量（评分3）与星状肿瘤形状、低组织学分级以及ER + /HER2 - 状态密切相关。此外，高弹性组织变性评分与较低的Ki67表达显著相关。在生存分析中，与低弹性组织变性的病例相比，高弹性组织变性的病例无复发生存率增加（p = 0.03），疾病特异性生存率增加（p = 0.11）。
肿瘤弹性组织变性的存在、星状肿瘤形状与乳腺癌的钼靶检测之间存在很强的相关性。据我们所知，这是首次将弹性组织变性与乳腺癌检测方法相关联进行研究。弹性组织变性的存在与低肿瘤细胞增殖（Ki67）及良好预后相关。
本文的虚拟切片可在此处找到：http://www.diagnosticpathology.diagnomx.eu/vs/13000_2014_230 。
