Clinical Analysis Of Ductal Carcinoma In Situ Of The Breast

Background and Objective:The detection rate of ductal carcinoma in situ (DCIS) is increasing drastically in recent years. DCIS is a group of heterogeneous disease,the biological behavior of which is different from one to another.Some could keep in situ for a long time,while some may develop to invasive cancer very soon.Although it has the potential risk to develop to the invasive breast cancer, after surgery and other assistant therapies most patients would have good prognosis.Therefore prompt diagnosis and proper therapy are particularly important.Here we want to analyze the clinical characteristics of DCIS of the breast,and try to provide evidence for diagnosis and treatment.Methods:The clinical and pathological data of 112 cases patients with ductal carcinoma in situ treated at Department of breast surgery of Qilu Hospital of Shandong University from January 1,2008 to December 31,2010 were analyzed.Results:(1)DCIS accounted for 11% of breast cancer.(2) The 112 cases were all occurred in women with a mean age of 48.3 years (range,25～83 years),the age distribution was similar to that of breast cancer.(3)95% patients were found because of abnormal clinical symptom,while only 2% were found by mammography, and 3% by ultrasound.(4)Most lesions were occurred in the lateroinferior quadrant of breast.(5)The low-grade and intermediate-grade DCIS were mostly ER positive and PR positive,while high-grade DCIS were usually negative in ER,PR but over-express in CerbB-2.(6)the comedo-necrosis was found in 31% of all cases, ductal carcinoma in situ with microinvasion (DCIS-Mi) in 25%,and the multicentric or multifocal lesion in 9%.(6)The risk of microinvasion raised as high as 37.8% when the size of mass lesion was larger than 2cm. The incidence of microinvasion revealed a positive correlation with the present of comedo-necrosis(P=0.038),and also with the risk of lymph node metastasis(P<0.001), but no correlation with the expression of ER, PR or CerbB-2.(7)The present of comedo-necrosis revealed a positive correlation with the positive expression of CerbB-2(P<0.001),a positive correlation with the negative expression or co-exprssion of ER and PR.(P <0.001), but no correlation with the risk of lymph node metastasis(P=0.168).(8)The incidence of lymph node metastasis is 4.7%,while that of DCIS-Mi is 17.9% and that of pure DCIS is 0%.Conclusions:Most of DCIS patient were found because of abnormal clinical symptom rather than mammography or ultrasound findings. The incidence of microinvasion was correlation with the size of mass lesion and the risk of lymph node metastasis,but not with the expression of ER, PR or CerbB-2,suggesting that axillary lymph node dissection is necessary for DCIS-Mi.The present of comedo-necrosis was correlation with the incidence of microinvasion,the expression of ER,PR and CerbB-2,suggesting that radical surgery could be a better choice for DCIS with comedo-necrosis.