Pan X Y, Wu J K, Lang Z Q, Qu L, Jiang Lei
School of Clinical Medicine, Weifang Medical University, Weifang 261000, China Department of Pathology, Yantai Yuhuangding Hospital, Yantai 264000, China.
Department of Pathology, Yantai Yuhuangding Hospital, Yantai 264000, China.
Zhonghua Bing Li Xue Za Zhi. 2022 Sep 8;51(9):838-842. doi: 10.3760/cma.j.cn112151-20220428-00339.
To investigate the expression of Ki-67 and CD34 in the differential diagnosis of ductal carcinoma in situ (DCIS) and DCIS-like invasive breast cancer (DLIBC). A total of 100 cases of DCIS and 150 cases of DLIBC diagnosed pathologically in Yantai Yuhuangding Hospital from January 2019 to March 2022 were collected. The expression of p63, CK5/6, Ki-67 and CD34 in both groups were detected by immunohistochemical (IHC) staining and evaluated. The 100 cases of DCIS included 11 cases of low-grade DCIS, 28 cases of intermediate-grade DCIS and 61 cases of high-grade DCIS. IHC staining of p63 and CK5/6 showed the myoepithelial cells around cancerous duct were complete or partial absence. Ki-67 expression showed two patterns: high expression in the basal layers and scattered expression within the tumor. Most cases showed mainly high basal expression (77/100, 77%), and the proportion of this pattern was significantly different between low grade and high grade DCIS (<0.05). All cases showed complete CD34 expression surrounding the cancerous duct with different proportion (vascular necklace) suggested small vessels proliferation. The 150 cases of DLIBC included 142 cases of invasive ductal carcinoma (IDC) (three cases of basal-like breast cancer was included), two cases of secretory carcinoma, three cases of solid papillary carcinoma, two cases of adenoid cystic carcinoma and one case of acinar cell carcinoma. Among 142 cases of IDC, 13 cases were grade Ⅰ, 77 were grade Ⅱ and 52 were grade Ⅲ. IHC staining of p63 showed complete absence of myoepithelium. CK5/6 was negative in most cases and only positively expressed within the tumor in 3 cases of basal-like breast cancer. Ki-67 indicated a scattered expression pattern within the tumor. In most cases, CD34 immunostaining showed scattered positive blood vessels within the tumor while only two cases showed incomplete expression of CD34 around the tumor (2/150, 1.3%). The different expression patterns of Ki-67 and CD34 in DCIS and DLIBC was statistically significant (<0.05). The different expression patterns of Ki-67 and CD34 are helpful to distinguish DLIBC from DCIS. The appearance of "vascular necklace" with CD34 and the high expression of Ki-67 around the cancerous duct highly support the diagnosis of DCIS, and the scattered expression pattern of CD34 supports DLIBC.
探讨Ki-67和CD34在导管原位癌（DCIS）与导管原位癌样浸润性乳腺癌（DLIBC）鉴别诊断中的表达。收集2019年1月至2022年3月在烟台毓璜顶医院病理诊断的100例DCIS和150例DLIBC。采用免疫组织化学（IHC）染色检测两组中p63、CK5/6、Ki-67和CD34的表达并进行评估。100例DCIS中，低级别DCIS 11例，中级别DCIS 28例，高级别DCIS 61例。p63和CK5/6的IHC染色显示癌导管周围肌上皮细胞完全或部分缺失。Ki-67表达呈两种模式：基底层高表达和肿瘤内散在表达。多数病例主要表现为基底层高表达（77/100，77%），低级别和高级别DCIS中该模式的比例有显著差异（<0.05）。所有病例癌导管周围均有不同比例的CD34完整表达（血管套），提示小血管增生。150例DLIBC中，浸润性导管癌（IDC）142例（包括3例基底样乳腺癌），分泌性癌2例，实性乳头状癌3例，腺样囊性癌2例，腺泡细胞癌1例。142例IDC中，Ⅰ级13例，Ⅱ级77例，Ⅲ级52例。p63的IHC染色显示肌上皮完全缺失。CK5/6多数病例为阴性，仅3例基底样乳腺癌在肿瘤内呈阳性表达。Ki-67在肿瘤内呈散在表达模式。多数病例中，CD34免疫染色显示肿瘤内散在阳性血管，仅2例肿瘤周围CD34表达不完整（2/150，1.3%）。DCIS和DLIBC中Ki-67和CD34的不同表达模式具有统计学意义（<0.05）。Ki-67和CD34的不同表达模式有助于鉴别DLIBC和DCIS。CD34出现“血管套”以及癌导管周围Ki-67高表达高度支持DCIS的诊断，而CD34散在表达模式支持DLIBC的诊断。
