Page D L, Dupont W D, Rogers L W, Jensen R A, Schuyler P A
Vanderbilt University School of Medicine, Department of Pathology, Nashville, Tennessee, USA.
Cancer. 1995 Oct 1;76(7):1197-200. doi: 10.1002/1097-0142(19951001)76:7<1197::aid-cncr2820760715>3.0.co;2-0.
The stratification of ductal carcinoma in situ (DCIS) of the human breast into prognostically relevant categories by size and histologic pattern is a current concern. Few studies have been able to follow women after the identification of any type of DCIS when they have had biopsy only.
This is an extension of a follow-up study of a group of 28 women with small, noncomedo ductal carcinomas in situ that were excised by biopsy only, published in 1982. All these women have now been successfully followed for an average of almost 30 years.
The overall risk of development of invasive carcinoma for these women over almost 30 years is nine times that of the general population (95% confidence interval, 4.7-17). This is similar to the 11-fold elevation in relative risk that was determined after about 15 years of follow-up. All invasive carcinomas have developed in the same area in the same breast. There were two women in whom invasive carcinoma developed between 20 and 30 years after initial biopsy. One other woman had an extensive noncomedo DCIS that was identified 25 years after her initial biopsy, but had no evidence of invasive disease.
The natural history of small, noncomedo DCIS can last over at least 2 decades, with invasive carcinoma developing at the same site in which DCIS was previously discovered in a significant percentage of women (broadly, between 25%-50%). This is quite different from the natural history of comedo DCIS or any type of DCIS treated purposefully by surgery alone.
依据大小和组织学模式将人类乳腺导管原位癌（DCIS）分层为具有预后相关性的类别是当前关注的问题。仅有少数研究能够在仅进行活检确诊任何类型DCIS的女性中进行随访。
这是一项对一组28例仅通过活检切除的小的、非粉刺型导管原位癌女性进行随访研究的扩展，该研究于1982年发表。现在所有这些女性均已成功随访平均近30年。
这些女性在近30年中发生浸润性癌的总体风险是普通人群的9倍（95%置信区间，4.7 - 17）。这与随访约15年后确定的相对风险升高11倍相似。所有浸润性癌均在同一乳腺的相同区域发生。有两名女性在初次活检后20至30年之间发生浸润性癌。另一名女性在初次活检25年后发现广泛的非粉刺型DCIS，但无浸润性疾病证据。
小的、非粉刺型DCIS的自然病程至少可持续20年以上，在相当比例的女性（大致在25% - 50%之间）中，浸润性癌在先前发现DCIS的同一部位发生。这与粉刺型DCIS或仅通过手术进行针对性治疗的任何类型DCIS的自然病程有很大不同。
