Tavassoli F A
Department of Gynecologic and Breast Pathology, Armed Forces Institute of Pathology, Washington, DC 20306, USA.
Mod Pathol. 1998 Feb;11(2):140-54.
The current definition, diagnostic criteria, grading, and approach to assessment of extent of ductal carcinoma in situ (DCIS) are presented. The problem areas, particularly the difficulties in separating low-grade DCIS from atypical intraductal hyperplasia (AIDH), accurate assessment of size and/or extent of DCIS, and their impact on patient management are critically reviewed. On the basis of the route of progression of DCIS, recently confirmed by three-dimensional reconstructed models, an optimal and simple approach to uniform excision, orientation, and processing of biopsy samples is presented. Emphasis is placed on the role of intraductal proliferative lesions (IDH, AIDH, and DCIS) as risk factors of variable magnitude in subsequent development of invasive breast carcinoma. It is proposed that these proliferations should be classified as "mammary intraepithelial neoplasia, ductal type" or as "ductal intraepithelial neoplasia" (DIN); the rational for the application of this classification system is provided. This approach obviates the current separation of AIDH and low-grade DCIS into two very drastically different categories of cancer and non-cancer without interfering with appropriate management of the various lesions. The DIN classification is presented in a simple translational table, along with the current terminology for various lesions.
本文介绍了导管原位癌（DCIS）的现行定义、诊断标准、分级及范围评估方法。对存在问题的领域进行了批判性回顾，尤其是难以区分低级别DCIS与非典型导管内增生（AIDH）、准确评估DCIS的大小和/或范围及其对患者管理的影响。基于最近通过三维重建模型证实的DCIS进展途径，提出了一种对活检样本进行统一切除、定位和处理的优化且简单的方法。重点强调了导管内增生性病变（IDH、AIDH和DCIS）作为后续浸润性乳腺癌不同程度风险因素的作用。建议将这些增生归类为“乳腺上皮内瘤变，导管型”或“导管上皮内瘤变”（DIN）；并给出了应用该分类系统的理由。这种方法避免了目前将AIDH和低级别DCIS分为癌症和非癌症这两个截然不同类别的做法，同时不影响对各种病变的适当管理。DIN分类以简单的转换表形式呈现，并列出了各种病变的现行术语。
