Dereere E, Papadimitriou K, Tjalma W, Altintas S
Antwerp University, Faculty of Medicine and Health Sciences, Campus Drie Eiken, Wilrijk, Belgium -
Minerva Chir. 2015 Aug;70(4):231-9. Epub 2015 Apr 28.
Ductal carcinoma in situ (DCIS) is a non-invasive breast carcinoma that remains in the milk ducts. It is a poorly understood disease and its natural history is not well known. This is because once diagnosed, DCIS is usually treated. It is known however that ductal carcinoma is a precursor of invasive breast carcinoma, as 14-53% can become invasive over a period of 10 years, if left untreated. With increasing knowledge about the molecular biology of DCIS, more insight is given in its relation to invasive breast cancer. Diagnosis of ductal carcinoma in situ is increasing in the last few years. This is likely caused by the increased mammographic screening for breast cancer and the higher quality of mammographic images. DCIS represents about one fifth of all mammographically detected breast cancers. Risk factors for the development of ductal carcinoma in situ are: low parity, late age at first birth and menopause, and Body Mass Index. The Van Nuys Prognostic Index is a useful scoring system to grade DCIS. DCIS is graded by scoring four characteristics: patient's age, margin width, tumor size and pathological classification. It allows us to divide DCIS lesions into different groups according to risk of local recurrence: low risk, intermediate risk and high risk. Each group requires a different treatment, respectively: local excision of the tumor; local excision and radiotherapy; and mastectomy. The use of tamoxifen in the treatment of DCIS is still controversial, but research so far has encouraging results. Interesting developments have been made in the use of Her-2 pulsed dendritic cell vaccination before DCIS surgery.
导管原位癌（DCIS）是一种非侵袭性乳腺癌，局限于乳腺导管内。这是一种了解较少的疾病，其自然病史尚不明确。这是因为一旦确诊，DCIS通常会接受治疗。然而，已知导管癌是浸润性乳腺癌的前驱病变，因为如果不进行治疗，14% - 53%的DCIS在10年内可能会发展为浸润性癌。随着对DCIS分子生物学认识的不断增加，人们对其与浸润性乳腺癌的关系有了更多了解。近年来，导管原位癌的诊断率在上升。这可能是由于乳腺癌钼靶筛查的增加以及钼靶图像质量的提高。DCIS约占所有钼靶检测出的乳腺癌的五分之一。导管原位癌发生的危险因素包括：低生育次数、初产和绝经年龄晚以及体重指数。范努伊斯预后指数是一种用于对DCIS进行分级的有用评分系统。DCIS通过对四个特征进行评分来分级：患者年龄、切缘宽度、肿瘤大小和病理分类。它使我们能够根据局部复发风险将DCIS病变分为不同组：低风险、中风险和高风险。每组分别需要不同的治疗方法：肿瘤局部切除；局部切除加放疗；以及乳房切除术。他莫昔芬在DCIS治疗中的应用仍存在争议，但目前的研究结果令人鼓舞。在DCIS手术前使用Her-2脉冲树突状细胞疫苗方面已经取得了有趣的进展。
