Queen Elizabeth Hospital Birmingham and University of Birmingham, Birmingham, UK.
NHS England and NHS Improvement, Birmingham, UK.
Br J Cancer. 2022 Dec;127(12):2125-2132. doi: 10.1038/s41416-022-01983-4. Epub 2022 Oct 12.
The diagnosis, management and prognosis of microinvasive breast carcinoma remain controversial.
We analysed the outcomes of patients with DCIS with and without microinvasion diagnosed between 2003 and 2012 within the Sloane project.
Microinvasion was recorded in 521 of 11,285 patients (4.6%), with considerable variation in reported incidence among screening units (0-25%). Microinvasion was associated with high-grade DCIS, larger DCIS size, comedo necrosis and solid, cribriform architecture (all P < 0.001). Microinvasion was more frequent in patients who underwent mastectomy compared with breast-conserving surgery (BCS) (6.9% vs 3.6%, P < 0.001), and in those undergoing axillary nodal surgery (60.4% vs 30.3%, P < 0.001) including the subset undergoing BCS (43.4% vs 8.5%, P < 0.001). Nodal metastasis rate was low and not statistically significant difference from the DCIS only group (P = 0.68). Following median follow-up of 110 months, 3% of patients had recurrent ipsilateral high-grade DCIS, and 4.2% developed invasive carcinoma. The subsequent ipsilateral invasion was of Grade 3 in 71.4% of patients with microinvasion vs 30.4% in DCIS without microinvasion (P = 0.02). Distant metastasis and breast cancer mortality were higher with microinvasion compared with DCIS only (1.2% vs 0.3%, P = 0.01 and 2.1% vs 0.8%; P = 0.005).
The higher breast cancer mortality with microinvasion indicates a more aggressive disease.
微浸润性乳腺癌的诊断、治疗和预后仍存在争议。
我们分析了 2003 年至 2012 年 Sloane 项目中诊断为 DCIS 伴或不伴微浸润的患者的结局。
在 11285 例患者中，有 521 例（4.6%）记录有微浸润，各筛查单位的报告发病率差异较大（0-25%）。微浸润与高级别 DCIS、更大的 DCIS 大小、粉刺样坏死和实性、筛状结构有关（均 P<0.001）。与保乳手术（BCS）相比，接受乳房切除术的患者中微浸润更为常见（6.9%比 3.6%，P<0.001），接受腋窝淋巴结手术的患者也更为常见（60.4%比 30.3%，P<0.001），包括接受 BCS 的患者（43.4%比 8.5%，P<0.001）。淋巴结转移率较低，与仅 DCIS 组无统计学差异（P=0.68）。中位随访 110 个月后，3%的患者同侧出现高级别 DCIS 复发，4.2%发展为浸润性癌。有微浸润的患者同侧浸润性癌的分级为 3 级，无微浸润的患者为 30.4%（P=0.02）。与仅 DCIS 相比，有微浸润的患者远处转移和乳腺癌死亡率更高（1.2%比 0.3%，P=0.01；2.1%比 0.8%，P=0.005）。
微浸润与更高的乳腺癌死亡率相关，表明疾病更具侵袭性。
