Andersen J, Blichert-Toft M, Dyreborg U
Eur J Surg Oncol. 1987 Apr;13(2):105-11.
The paper presents a prospective study comprising 40 consecutive patients with in situ carcinomas of the breast and two with atypical ductal hyperplasia (ADH) who underwent operation during a 2-year period at a single hospital. Out of the 40 in situ carcinomas 13 were of the lobular type (LCIS) and 27 of the ductal type (DCIS). They made up about 9% of all newly diagnosed breast cancers. Histologically a distinction could be made between three different growth patterns: microfocal, tumour-forming, and a diffuse form. With the exception of one case, the 26 microfocal growths (2 ADH, 13 LCIS, 11 DCIS) were accidental findings in otherwise benign breast biopsies, whereas the tumour-forming and diffuse forms (16 DCIS) were diagnosed in the great majority clinically and/or by mammography. Of the tumour-forming and diffuse DCIS 25% were demonstrated solely by mammography. The surgical treatment in the 26 patients showing microfocal changes was exclusively biopsy in 23, while three had mastectomy, because of a papillary focus in two and patient preference in one. Of six patients with tumour-forming DCIS three had segmental resection and three mastectomy, the latter because of papillary foci, while all 10 with diffuse growth had mastectomy. On the basis of their experience of types and growth patterns, the authors set up a surgical strategy which might add new aspects to our knowledge about the biological nature of in situ lesions.
本文介绍了一项前瞻性研究，该研究纳入了在一家医院2年期间连续接受手术的40例乳腺原位癌患者和2例非典型导管增生（ADH）患者。在40例原位癌中，13例为小叶型（LCIS），27例为导管型（DCIS）。它们约占所有新诊断乳腺癌的9%。组织学上可区分出三种不同的生长模式：微灶型、肿瘤形成型和弥漫型。除1例病例外，26例微灶型生长（2例ADH、13例LCIS、11例DCIS）是在其他方面为良性的乳腺活检中偶然发现的，而肿瘤形成型和弥漫型（16例DCIS）在大多数情况下是通过临床和/或乳腺X线摄影诊断的。在肿瘤形成型和弥漫型DCIS中，25%仅通过乳腺X线摄影显示。26例表现为微灶型改变的患者中，23例仅进行了活检，3例进行了乳房切除术，其中2例是因为存在乳头状病灶，1例是因为患者的偏好。6例肿瘤形成型DCIS患者中，3例进行了区段切除，3例进行了乳房切除术，后者是因为存在乳头状病灶，而所有10例弥漫型生长的患者均进行了乳房切除术。基于他们对类型和生长模式的经验，作者制定了一种手术策略，这可能会为我们对原位病变生物学性质的认识增添新的内容。
