Quinn C M, Ostrowski J L
Department of Histopathology, Algernon Firth Institute of Pathology, General Infirmary at Leeds, UK.
J Clin Pathol. 1997 Jul;50(7):596-9. doi: 10.1136/jcp.50.7.596.
The traditional architecture based classification system of ductal carcinoma in situ (DCIS) has been criticised on the grounds that individual lesions often show more than one pattern resulting in a large mixed category. New DCIS classification systems have emphasised the importance of cytological grade, which is reputed to be more uniformly expressed throughout a lesion. This study investigates the hypothesis that cytological heterogeneity is less common than architectural heterogeneity within DCIS lesions.
121 cases of DCIS were graded as poorly, intermediately, or well differentiated according to a recently developed classification system that employs cytonuclear morphology as the major diagnostic criterion. Cases were categorised as pure when only one grade was present and as mixed if more than one grade was observed. Architecturally the cases were classified as solid, cribriform, micropapillary, or papillary and were described as pure if only one architectural pattern was present and as mixed if more than one pattern was seen. The incidence of cytological heterogeneity was compared with that of architectural heterogeneity. The presence of necrosis was assessed as an independent parameter and the relation to DCIS grade evaluated.
Using the cytology based classification system 102 cases (84%) were classified as pure (65 poorly differentiated, 25 intermediately differentiated, and 12 well differentiated) and 19 cases (16%) as mixed. Extensive necrosis was observed in 61 (50%) cases and was closely correlated to DCIS grade. Architecturally 46 cases (38%) were classified as pure (38 solid, 5 cribriform, 2 micropapillary, and 1 papillary) and 75 (62%) as mixed.
Cytological heterogeneity is much less common than architectural heterogeneity in DCIS lesions. The assessment of cytonuclear morphology is therefore likely to provide more consistent information about DCIS, particularly in small biopsy specimens where only part of the lesion may be available for examination.
基于传统架构的导管原位癌（DCIS）分类系统受到了批评，原因是单个病变通常表现出不止一种模式，导致出现一个很大的混合类别。新的DCIS分类系统强调了细胞学分级的重要性，据称其在整个病变中表达更为一致。本研究调查了DCIS病变中细胞学异质性比架构异质性少见这一假设。
根据最近开发的一种以细胞核形态为主要诊断标准的分类系统，将121例DCIS病例分为低分化、中分化或高分化。若仅有一种分级，则病例分类为单纯型；若观察到不止一种分级，则分类为混合型。在架构上，病例分为实性、筛状、微乳头状或乳头状，若仅有一种架构模式，则描述为单纯型；若看到不止一种模式，则描述为混合型。比较细胞学异质性与架构异质性的发生率。将坏死的存在作为一个独立参数进行评估，并评估其与DCIS分级的关系。
使用基于细胞学的分类系统，102例（84%）被分类为单纯型（65例低分化、25例中分化和12例高分化），19例（16%）为混合型。61例（50%）观察到广泛坏死，且与DCIS分级密切相关。在架构上，46例（38%）被分类为单纯型（38例实性、5例筛状、2例微乳头状和1例乳头状），75例（62%）为混合型。
在DCIS病变中，细胞学异质性比架构异质性少见得多。因此，细胞核形态评估可能会为DCIS提供更一致的信息，特别是在小活检标本中，可能只有部分病变可供检查。
