Liberman L, Van Zee K J, Dershaw D D, Morris E A, Abramson A F, Samli B
Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
AJR Am J Roentgenol. 1997 Feb;168(2):489-93. doi: 10.2214/ajr.168.2.9016233.
This study was undertaken to evaluate the mammographic features of local recurrence in women who have undergone breast-conserving therapy for ductal carcinoma in situ (DCIS).
Retrospective review revealed 162 women with DCIS treated with breast-conserving therapy from 1978 to 1990 for whom follow-up data were available. Subsequent to therapy, 33 (20%) patients had a pathologically proven carcinoma in the treated breast. Mammograms at the time of local recurrence were available for 20 patients. We reviewed mammograms, clinical charts, and histopathologic findings in these 20 patients. For 14 of 20 patients, we also reviewed mammograms obtained at the time of the original DCIS.
The median interval from diagnosis of the original DCIS to local recurrence was 26 months (range, 6-168 months). Recurrences were detected solely by mammography in 17 (85%) of 20 patients, by mammography and physical examination in two (10%), and solely by physical examination in one (5%). Eighteen (90%) local recurrence contained calcifications and eighteen (90%) involved the tumorectomy quadrant. When we compared available mammographic findings of the original DCIS and the local recurrence we found the mammographic pattern and calcification morphology to be the same in 11 (79%) of 14 DCIS and nine (82%) of 11 DCIS, respectively. Histopathologic analysis of recurrences found DCIS in 13 (65%) of 20 patients and DCIS and infiltrating carcinoma in the remaining seven (35%) patients. Of 13 pure DCIS recurrences, 12 (92%) were detected solely by mammography.
In our study, local recurrence after breast-conserving therapy for DCIS invariably contained DCIS; 35% of recurrences also contained invasive carcinoma. The most common mammographic pattern of local recurrence was calcifications in the tumorectomy quadrant that were morphologically similar to the original DCIS. These findings suggest that many of these local recurrences reflect failure to eradicate the primary DCIS. Mammography achieved high sensitivity in revealing these lesions: 85% of local recurrences and 92% of recurrences that were pure DCIS were detected solely by mammography.
本研究旨在评估接受保乳治疗的导管原位癌（DCIS）女性患者局部复发的乳腺钼靶特征。
回顾性研究发现，1978年至1990年间接受保乳治疗的162例DCIS女性患者有随访数据。治疗后，33例（20%）患者在接受治疗的乳房中出现病理证实的癌。20例患者有局部复发时的乳腺钼靶片。我们回顾了这20例患者的乳腺钼靶片、临床病历和组织病理学检查结果。对于20例患者中的14例，我们还回顾了最初DCIS时获得的乳腺钼靶片。
从最初诊断DCIS到局部复发的中位间隔时间为26个月（范围6 - 168个月）。20例患者中有17例（85%）仅通过乳腺钼靶检查发现复发，2例（10%）通过乳腺钼靶检查和体格检查发现，1例（5%）仅通过体格检查发现。18例（90%）局部复发有钙化，18例（90%）累及肿瘤切除象限。当我们比较最初DCIS和局部复发时可获得的乳腺钼靶检查结果时，发现14例DCIS中的11例（79%）和11例DCIS中的9例（82%）乳腺钼靶表现和钙化形态相同。复发的组织病理学分析发现，20例患者中有13例（65%）为DCIS，其余7例（35%）为DCIS和浸润性癌。在13例单纯DCIS复发中，12例（92%）仅通过乳腺钼靶检查发现。
在我们的研究中，DCIS保乳治疗后的局部复发总是包含DCIS；35%的复发还包含浸润性癌。局部复发最常见的乳腺钼靶表现是肿瘤切除象限的钙化，其形态与最初的DCIS相似。这些发现表明，许多这些局部复发反映了未能根除原发性DCIS。乳腺钼靶在发现这些病变方面具有高敏感性：85%的局部复发和92%的单纯DCIS复发仅通过乳腺钼靶检查发现。
