Lillemoe Tamera J, Tsai Michaela L, Swenson Karen K, Susnik Barbara, Krueger Janet, Harris Kendra, Rueth Natasha, Grimm Erin, Leach Joseph W
Allina Health Laboratories, Minneapolis, MN, USA.
Allina Health System, Virginia Piper Cancer Institute, Minneapolis, MN, USA.
Breast J. 2018 Jul;24(4):574-579. doi: 10.1111/tbj.13001. Epub 2018 Feb 24.
Clinical management of microinvasive breast cancer (Tmic) remains controversial. Although metastases are infrequent in Tmic carcinoma patients, surgical treatment typically includes lymph node sampling. The objective of this study was to determine the rate and predictors of lymph node metastases, recurrence, and survival in a large series of Tmic breast carcinomas. Consecutive cases of Tmic were identified within our health care system from 2001 to 2015. We reviewed results of lymph node sampling and other pathologic factors including hormone receptor/HER2 status, associated in situ tumor size/grade, margin status, number of invasive foci, surgical/adjuvant therapies, and recurrence/survival outcomes. In this cohort, 294 Tmic cases were identified with mean follow-up of 4.6 years. Of 260 patients who underwent axillary staging, lymph node metastases were identified in 1.5% (all of which were ductal type). All Tmic cases with positive lymph node metastases had associated DCIS with size > 5 cm (5.3-8.5 cm) compared to a median DCIS tumor size of 2.5 cm (0.2-19.0 cm) for the entire cohort. No lymph node metastases were seen with microinvasive lobular carcinoma. During the follow-up period, there were no regional/distant recurrences or breast cancer-associated deaths in a mean follow-up period of 4.6 years. Two patients developed subsequent ipsilateral breast cancer (DCIS) in a different quadrant than the original Tmic. Clinical behavior of microinvasive breast cancer in this series is similar to DCIS. Lymph node metastases are uncommon and were only seen with ductal type microinvasive carcinoma. Our data suggest limited benefit for routine node sampling and support management of Tmic similar to DCIS, particularly for patients with DCIS < 5 cm in size.
微浸润性乳腺癌（Tmic）的临床管理仍存在争议。尽管Tmic癌患者发生转移的情况并不常见，但手术治疗通常包括淋巴结采样。本研究的目的是确定一大系列Tmic乳腺癌患者的淋巴结转移率、复发率及生存率，并找出相关预测因素。我们在医疗系统中识别出了2001年至2015年期间连续的Tmic病例。我们回顾了淋巴结采样结果以及其他病理因素，包括激素受体/HER2状态、相关原位肿瘤大小/分级、切缘状态、浸润灶数量、手术/辅助治疗以及复发/生存结果。在这个队列中，共识别出294例Tmic病例，平均随访时间为4.6年。在260例接受腋窝分期的患者中，有1.5%被发现有淋巴结转移（均为导管型）。与整个队列中DCIS肿瘤大小中位数为2.5cm（0.2 - 19.0cm）相比，所有淋巴结转移阳性的Tmic病例均伴有大小>5cm（5.3 - 8.5cm）的DCIS。小叶微浸润癌未见淋巴结转移。在平均4.6年的随访期内，未出现区域/远处复发或乳腺癌相关死亡。两名患者在与原Tmic不同象限发生了同侧乳腺癌（DCIS）。本系列中微浸润性乳腺癌的临床行为与DCIS相似。淋巴结转移并不常见，仅在导管型微浸润癌中出现。我们的数据表明，常规淋巴结采样的益处有限，并支持对Tmic采取与DCIS相似的管理方式，特别是对于DCIS大小<5cm的患者。
