ARCH PATHOL LAB MED:并非所有导管原位癌都是IDLE

2019-02-05 MedSci MedSci原创

乳腺X线摄影筛查一定程度上增加了原位导管癌(DCIS)的发生率,但这并未伴随浸润癌(IC)发病率的下降。因此,DCIS的手术治疗最近受到质疑,一些人主张在DCIS的核心活组织检查诊断后进行监测(有或没有新辅助内分泌治疗)。

本研究的目标调查DCIS核心活组织检查诊断的预测价值,特别是IC的升级率,并确定相关因素。研究人员使用病理学数据库,确定了从2000年到2015年在核心活检中诊断出的2943DCIS病例,其中229例(8%)后期升级为IC

结果显示,研究对象年龄介于2590岁之间(平均年龄为59岁)。DCIS229例(65.9%)中有151例出现钙化,151例中有26例(17%)大量存在,229例中有70例(31%)有质量或密度, 70例例中有4463%)异质性回声特征。229例中有8例(3.5%)磁共振成像增强。在229例中,DCIS分级如下:29例(13%)低,79例(36%)中高,121例(53%)高。在229例中,152例(66.4%)出现坏死,99例(43%)出现坏死。在229IC中,肿瘤分期如下:microIC 36例(16%),T1a 119例(52%),T1b 35例(15%),T1c 28例(12%),T2 8例( 3%),T3 3例(1%)。167名患者的腋窝淋巴结分期如下:N0,141例(84%); N0I +),14例(8%); N1,12例(7%)。12N1例经T分期分类如下:T1a1例(8%); T1b4例(33%); T1c2例(17%); T24例(33%); T3,1例(8%)。阶段升级的IC病例主要小于2厘米(218个中的218; 95%),超过2/3小于0.5厘米(225个中的155; 95%),其中大多数伴有广泛的DCIS

本研究表明,大约一半的升级与高级DCIS相关,特别是伴有粉刺坏死。尽管如此,另外一半的升级是由于低级和中级DCIS造成的,这不应该低估。腋窝淋巴结活检的阳性结果很少,但它们发生在3%(218个中的7个)小于2 cm的癌中。本研究结果表明,当核心活检确诊的DCIS病例通过监测(有或没有新辅助内分泌治疗)进行非手术治疗时需要谨慎,由于病例数(2943中有229; 8%)会升级为IC和腋窝病例淋巴结转移(167例中的12; 7%)。

原始出处:

Melissa Alexander, Jessica Beyda, Anupma Nayak and Shabnam Jaffer ,Not All Ductal Carcinomas In Situ Are Created IDLE (Indolent Lesions of Epithelial Origin)

本文系梅斯医学(MedSci)原创编译整理,转载需授权!


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    2019-11-24 yb6560
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    2019-02-06 仁医06
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    2019-02-05 飛歌

    学习了很有用不错

    0

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    2019-02-05 txqjm

    谢谢了,学习

    0

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