Department of Radiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea.
Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea.
Ann Surg Oncol. 2021 Dec;28(13):8699-8709. doi: 10.1245/s10434-021-10378-3. Epub 2021 Jul 1.
Because no prior studies have evaluated the chronological trends of ductal carcinoma in situ (DCIS) despite the increasing number of surgeries performed for DCIS, this study analyzed how the clinical, radiologic, and pathologic characteristics of DCIS changed during a 10-year period.
Of 7123 patients who underwent primary breast cancer surgery at a single institution from 2006 to 2015, 792 patients with pure DCIS were included in this study. The chronological trends of age, symptoms, method for detecting either mammography or ultrasonography, tumor size, nuclear grade, comedonecrosis, and molecular markers were calculated using Poisson regression for all patients and asymptomatic patients.
During 10 years, DCIS surgery rates significantly increased (p < 0.001). Despite the high percentage of DCIS detected on mammography, the detection rate for DCIS by mammography significantly decreased (97.3% in 2006 to 67.6% in 2015; p = 0.025), whereas the detection rate by ultrasound significantly increased (2.7% to 31.0%; p < 0.001). Conservation surgery rates (odds ratio [OR], 1.058), low-to-intermediate nuclear grade rates (OR, 1.069), and the absence of comedonecrosis (OR, 1.104) significantly increased over time (all p < 0.05). Estrogen receptor (ER) negativity (OR, 0.935) and human epidermal growth factor receptor 2 (HER2) positivity rates (OR, 0.953) significantly decreased (all p < 0.05). The same trends were observed for the 613 asymptomatic patients.
The rate of DCIS detected on ultrasound only significantly increased during 10 years. Low-to-intermediate nuclear grade rates significantly increased, whereas ER negativity and HER2 positivity rates significantly decreased during the same period. These findings suggest that DCIS detected on screening ultrasound is less aggressive than DCIS detected on mammography.
尽管因导管原位癌（DCIS）而行的手术数量不断增加，但此前尚无研究评估其时间趋势。因此，本研究分析了 10 年间 DCIS 的临床、影像学和病理学特征的变化。
本研究纳入了 2006 年至 2015 年期间在一家医疗机构行原发性乳腺癌手术的 7123 例患者，其中 792 例为单纯 DCIS 患者。采用泊松回归分析了所有患者和无症状患者的年龄、症状、乳腺钼靶或超声检测方法、肿瘤大小、核分级、粉刺样坏死和分子标志物的时间趋势。
10 年间，DCIS 手术比例显著增加（p<0.001）。尽管乳腺钼靶检出的 DCIS 比例较高，但乳腺钼靶检出 DCIS 的比例显著降低（2006 年为 97.3%，2015 年为 67.6%；p=0.025），而超声检出比例显著升高（2.7%升至 31.0%；p<0.001）。保乳手术比例（比值比 [OR]，1.058）、低-中核分级比例（OR，1.069）和无粉刺样坏死（OR，1.104）随时间推移呈上升趋势（均 p<0.05）。雌激素受体（ER）阴性（OR，0.935）和人表皮生长因子受体 2（HER2）阳性比例（OR，0.953）显著降低（均 p<0.05）。在 613 例无症状患者中也观察到了相同的趋势。
10 年间仅通过超声检出的 DCIS 比例显著增加。低-中核分级比例显著升高，而同期 ER 阴性和 HER2 阳性比例显著降低。这些发现提示，筛查超声检出的 DCIS 比乳腺钼靶检出的 DCIS 侵袭性更低。
