Goldstein N S, Lacerna M, Vicini F
Department of Anatomic Pathology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
Am J Clin Pathol. 1998 Sep;110(3):357-67. doi: 10.1093/ajcp/110.3.357.
Recurrent carcinoma develops in approximately 10% of patients with ductal carcinoma in situ (DCIS) of the breast treated with local excision and radiation therapy. Cancerization of lobules (COL) and atypical ductal hyperplasia (ADH)frequently occur at the edge of DCIS. We postulated that recurrent carcinoma is associated with ADH or COL near the DCIS excision margin, and the amount of DCIS left in the breast may be too large for eradication by radiation therapy. To identify histologic features associated with recurrence, we retrospectively studied specimens of 94 patients with DCIS treated by local excision and radiation. We analyzed the rim of tissue near the final margin for the amount of COL, ADH, and DCIS. During a median follow-up of 78 months, local recurrence developed in 9 patients. COL or ADH with DCIS near the final margin was associated with recurrence; the strongest relationship was with recurrences in the same site as the lumpectomy bed. DCIS with ADH was significantly associated with recurrence in the low-grade DCIS group; DCIS with COL was associated with recurrence in the high-grade group. Other features were not associated with outcome. We believe that ADH composed of cells identified as those of DCIS should be considered part of the DCIS lesion. DCIS may be inadequately excised if ADH and DCIS or COL and DCIS are near the margin.
在接受局部切除和放射治疗的乳腺导管原位癌（DCIS）患者中，约10%会发生复发性癌。小叶癌变（COL）和非典型导管增生（ADH）常发生在DCIS边缘。我们推测复发性癌与DCIS切除边缘附近的ADH或COL有关，且乳腺中残留的DCIS量可能太大，无法通过放射治疗根除。为了确定与复发相关的组织学特征，我们回顾性研究了94例接受局部切除和放射治疗的DCIS患者的标本。我们分析了最终边缘附近组织边缘的COL、ADH和DCIS量。在中位随访78个月期间，9例患者发生了局部复发。最终边缘附近伴有DCIS的COL或ADH与复发相关；最强的关联是与乳房肿瘤切除术床相同部位的复发有关。伴有ADH的DCIS在低级别DCIS组中与复发显著相关；伴有COL的DCIS在高级别组中与复发相关。其他特征与预后无关。我们认为，由被鉴定为DCIS细胞组成的ADH应被视为DCIS病变的一部分。如果ADH与DCIS或COL与DCIS靠近边缘，DCIS可能切除不充分。
