Yao Jie-Jie, Zhan Wei-Wei, Chen Man, Zhang Xiao-Xiao, Zhu Ying, Fei Xiao-Chun, Chen Xiao-Song
Departments of Ultrasound (J.-J.Y., W.-W.Z., M.C., X.-X.Z., Y.Z.,) and Pathology (X.-C.F.) and Comprehensive Breast Health Center (X.-S.C.), Rui-Jin Hospital, School of Medicine, Shanghai Jiao-Tong University, Shanghai, China.
J Ultrasound Med. 2015 Oct;34(10):1761-8. doi: 10.7863/ultra.15.14.07059. Epub 2015 Aug 31.
To compare the sonographic results, clinicopathologic characteristics, and biomarkers in pure ductal carcinoma in situ (DCIS) of the breast and DCIS with microinvasion.
A total of 218 patients with pathologically proven DCIS based on sonography in our hospital (2009-2013) were retrospectively enrolled. Clinicopathologic characteristics and biomarkers were examined. Grayscale sonographic results were investigated according to the American College of Radiology Breast Imaging Reporting and Data System lexicon, and color Doppler sonography was used to assess the vascularization distribution and degree. All variables were compared by univariate and multivariate logistic regression analyses.
All patients were female, with a mean age of 55.3 years (range, 32-78 years). One hundred sixty patients with 160 lesions had pure DCIS, and 58 patients with 58 lesions had DCIS with microinvasion. Ductal carcinoma in situ with microinvasion was more likely to have sentinel lymph node metastases, larger tumors, a higher tumor grade, human epidermal growth factor receptor 2 positivity, and a high Ki-67 index (all P < .05). Univariate analysis showed that DCIS with microinvasion was more likely to be hypoechoic with microcalcifications, have a mixed vascularization distribution (equal peripheral and internal blood flow signals), and have a high degree of vascularization (at least 2 penetrating vessels; all P < .05). Multivariate analysis indicated that the presence of microcalcifications and a high degree of vascularization were significantly and independently associated with microinvasion (both P < .001).
Our findings suggest that DCIS with microinvasion is more likely to have microcalcifications and a high degree of vascularization than pure DCIS. Patients with these sonographic features are more likely to have a high tumor grade, sentinel lymph node metastases, larger tumors, a high Ki-67 index, and human epidermal growth factor receptor 2 positivity.
比较乳腺单纯导管原位癌（DCIS）与伴有微浸润的DCIS的超声检查结果、临床病理特征及生物标志物。
回顾性纳入我院2009年至2013年期间经超声检查病理证实为DCIS的218例患者。检查临床病理特征及生物标志物。根据美国放射学会乳腺影像报告和数据系统词典研究灰阶超声检查结果，采用彩色多普勒超声评估血管分布及程度。通过单因素和多因素逻辑回归分析比较所有变量。
所有患者均为女性，平均年龄55.3岁（范围32 - 78岁）。160例患者有160个病灶为单纯DCIS，58例患者有58个病灶为伴有微浸润的DCIS。伴有微浸润的导管原位癌更易发生前哨淋巴结转移、肿瘤更大、肿瘤分级更高、人表皮生长因子受体2阳性及Ki-67指数高（均P <.05）。单因素分析显示，伴有微浸润的DCIS更易表现为低回声伴微钙化、血管分布混合（周边和内部血流信号相等）及血管化程度高（至少2条穿入血管；均P <.05）。多因素分析表明，微钙化的存在及血管化程度高与微浸润显著且独立相关（均P <.001）。
我们的研究结果表明，与单纯DCIS相比，伴有微浸润的DCIS更易出现微钙化和高度血管化。具有这些超声特征的患者更易出现肿瘤分级高、前哨淋巴结转移、肿瘤更大、Ki-67指数高及人表皮生长因子受体2阳性。
