Study On The Clinical Freatures Of Ductal Carcinoma In Situ And The Diagnostic Value Of The Three Common Used Breast Imaging Methords

OBJECTIVE:To investigate the clinical features of ductal carcinoma in situ of breast(DCIS),the diagnostic value of three commonly used imaging examination methods and the impact factors related to their sensitivity.METHODS:There were213eligible patients with primary DCIS diagnosed and surgically treated in shanghai cancer center from January2011-November2012, with postoperative paraffin biopsy confirmed pure DCIS,excluding those mergering other malignant lesions(invasive ductal carcinoma, mucinous adenocarcinoma,etc)and pathologically confirmed DCIS after preoperative chemotherapy, radiotherapy.Summarizes and analyzes its clinical features, pathological features, including age, menopause years,lesion sites, lymph node metastasis status, pathological grades, immunohistochemical molecular typing, the choice of surgical treatment.We compare the diagnostic values of three commonly used imaging methords,which inclueds ultrasound(US),mammography(MG),magnetic resonance(MR)and analyse their influential factors.RESULTS:A. The peak incidence age is40-60years;B. Most patients (122/213cases,57.3%) did not menopausal or post-menopausal year is less than1year;C.66.7%of patients (142/213cases) have complaints,including self-examination palpable breast lump, breast pain, nipple discharge or haemorrhagic, patients without any complaints who were found by auxiliary examination alone accounted for33.3%(71/213cases);D. Patients with palpable mass in physical examination accounted for80.3%(171/213cases), patients without palpable mass in examinationaccounted for19.2%(41/213cases), and there was one patient didn’t have medical physical examination in our hospital;E.47.9%of patients choose to accept the simple mastectomy joint sentinel lymph node resection (102/213cases), and there were some other patients selected the modified radical mastectomy or simple mastectomy, which accounted for22.1%(41/213cases) and15.5%(33/213cases),there were also10.8%patients accepted different surgical treatment twice (23/213cases);F. Mammary gland typing according to Mammography:small amount glands type accounted for16.9%(36/213cases), moderate amount glands type accounted for8.5%(18/213cases), large amounts glands type accounted for56.3%(120/213cases), with17.8%(39/213 cases) of patients glands type unknown;G. Most patients (74/213cases) have a single lesion located in the upper outer quadrant and some cases (6/213cases) have multifocal lesions;H. The majority of patients with lesions pathological classified as high-level, and the pathological grade is associated with the proportion of microinvasion;I.. Immunohistochemical molecular typing:Luminal B type accounted for the majority (57.7%,123/213cases), followed by HER-2over-expression of type (24.4%,52/213cases), Luminal A-type (8.9%,11/213cases), triple negative rare (1/213cases), with other cases molecular typing unknown (26/213cases); J. A very small portion of cases with ipsilateral axillary lymph node metastases (7/213cases), one patients with lymph node metastasis ststus unknown;K. The sensitivity of US,MR and MG were78.0%,86.1%,74.3%, with influencing factors which affect the detection rate of its inspection:US-pathological grading, with complaints or palpable mass, with microinvasion(P<0.05); MR-pathological grading, with complaints or palpable mass(P<0.05);MG-pathological grading,with calcification(P<0.05).CONCLUSIONS:213cases of breast DCIS, whose clinical and pathological features, diagnostic value of three commonly used imaging methods consists with studies which were reported earlier in literature. The proportion of patients with no complaints, who were found by auxiliary examination alone is significantly lower than previously reported in the literature abroad. While most of patients who came to our hospital because of complains had palpable lump in physical examination,which is,in some extent, related to great national improvment of awareness of breast disease and more accepted female self-examination in the last decade. The higher the pathological grade, the higher the diagnostic sensitivity of the three imaging tests. MG(mammography) is the primary means for the diagnosis of calcified breast DCIS, there is no significant correlation between the sensitivity and mammary glands mammography typing; US(ultrasound) and MR(magnetic resonance) have obvious diagbostic advantages in noncalcified DCIS and patients with positive clinical symptoms and/or positive signs. Due to non-invasive, easy and fast to operate, low-cost, US(ultrasound) still have an irreplaceable position in the clinical diagnosis and follow-up process. Breast MR(magnetic resonance) imaging has unique advantages in diagnosing multifocal DCIS and positioning before surgery,thus it could help clinical staging and guiding treatment.