Asioli S, Morandi L, Cavatorta C, Cucchi M C, Foschini M P
Department of Biomedical and Neuromuscular Sciences, Anatomic Pathology Section "M. Malpighi", University of Bologna, Italy.
Unit of Oncologic Surgery, Bellaria Hospital, 40139 Bologna, Italy.
Eur J Surg Oncol. 2016 Dec;42(12):1806-1813. doi: 10.1016/j.ejso.2016.07.005. Epub 2016 Aug 9.
Aim of the present study is to evaluate the risk of residual neoplastic foci, in patients treated with breast conservative surgery, based on duct carcinoma in situ (DCIS) grading.
The study is based on a retrospective analysis of 419 resection specimens relative to 161 patients. All these patients underwent surgical re-excision when the first specimen had shown one or more margins involved by DCIS. Margins were oriented and the side of margin involved was recorded. Clonal analysis, using the mitochondrial DNA (mtDNA) technique, was obtained in selected cases.
Residual neoplastic foci were found in 145 out of 419 (34.6%) re-excised specimens. Specifically, residual foci of DCIS grade 2 and 3 were found more frequently in the margin facing the nipple (33.3% and 51.6%, respectively). On the contrary foci of DCIS grade 1 did not show any specific distribution. Clonal mt DNA analysis evidenced that DCIS grade 3 foci present in the re-excision specimens were genetically similar to the tumor removed in the first specimen, while DCIS grade 1 foci were not clonally related each other.
The present data further confirm that DCIS grade 3 is characterized by a circumscribed neoplastic process extending along the large ducts probably of a single mammary lobe. On the contrary DCIS grade 1 is characterized by multiple independent neoplastic foci, dispersed through several lobes indicating a field where multiple independent foci of cancer harbor.
本研究的目的是基于导管原位癌（DCIS）分级，评估接受保乳手术治疗的患者残留肿瘤病灶的风险。
本研究基于对161例患者的419份切除标本的回顾性分析。所有这些患者在首个标本显示有一个或多个切缘被DCIS累及的情况下均接受了手术再次切除。对切缘进行定向，并记录切缘受累的一侧。在选定的病例中采用线粒体DNA（mtDNA）技术进行克隆分析。
在419份再次切除的标本中，有145份（34.6%）发现了残留肿瘤病灶。具体而言，2级和3级DCIS的残留病灶在乳头方向的切缘中更为常见（分别为33.3%和51.6%）。相反，1级DCIS病灶未显示出任何特定分布。克隆性mtDNA分析表明，再次切除标本中存在的3级DCIS病灶在基因上与首个标本中切除的肿瘤相似，而1级DCIS病灶彼此之间不存在克隆相关性。
目前的数据进一步证实，3级DCIS的特征是沿可能单个乳腺叶的大导管延伸的局限性肿瘤过程。相反，1级DCIS的特征是多个独立的肿瘤病灶，分散在多个叶中，表明存在多个独立癌灶的区域。
