Risk Factors Of Breast Ductal Carcinoma In Situ With Microinvasion

Background and purposeAs one of the three most common malignancy in the world(along with lung and colon carcinoma),breast cancer is also the most common cancer in female.In the year of 2012,approximately 1.7million people were diagnosed worldwide and about half million people died from this disease.In China,the mobility of breast carcinoma varies from place to place,fluctuating from 10 to 60 in 100 000 with a rising trend.Meanwhile,the detection rate of breast ductal carcinoma in situ(DCIS)has increased,account for 20%-30% of newly diagnosed breast cancer,which is mostly attributable to the wide spread use of mammography.The concept of breast ductal carcinoma in situ is initially proposed by Lagios.The American Joint Committee on Cancer(AJCC)define breast ductal carcinoma in situ with microinvation(DCIS-Mi)as invasive mammary carcinoma with no focus exceeding 1 mm in greatest dimension.Predicting their microinvasive and handling axillary lymph nodes of those patients that diagnosed with DCIS and DCIS-Mi through postoperative pathological examination became a serious problem.Although problem above have analyzed by researchers recently,the conclusion remain controversial.This research dedicate to find the risk factors and the relationship between clinicopathological features and distant metastasis of breast ductal carcinoma in situ with microinvasion.Object and methodA retrospective study is performed involving 138 cases diagnosed as DCIS or DCIS-Mi from April 2008 to August 2012 in the First Affiliated Hospital of Zhengzhou University.Clinical and pathological data of all cases were collected to find the risk factors and the relationship between clinicopathological features and distant metastasis of breast ductal carcinoma in situ with microinvasion.I divided them into two groups according to the diagnosis,DCIS group and DCIS-Mi group,each of them has 63 cases and 75 cases respectively.Baseline characteristics before operation(including age,menopausal status,clinical tumor size,with Paget's disease or not,have multiple breast lesions or not)were analyzed through statistical method to identify risk factors of DCIS-Mi.Followed-up was measured from the date of breast surgery.The endpoint is local recurrence or distant metastasis.And patients without an event were censored at the last date known alive.Pathological features after surgery(including hormonal status(estrogen receptor,progestrone receptor,HER-2,molecular subtypes)and baseline characteristics before operation(including age,menopausal status,clinical tumor size,with Paget's disease or not,have multiple breast lesions or not)were analyzed through Kaplan-Meier approach and log-rank test to detect the relationship between clinicopathological features and distant metastasis of breast ductal carcinoma in situ with microinvasion.Result138 cases were evaluated in this period.The microinvasion were almost always encountered in the setting of DCIS.Diagnosed with multiple lump was proven as risk factor of DCIS-Mi(P=0.005).There was significant difference between two survival curves,and the survival rate of the group with tumor size less than 3.5cm was higher than that of the group with tumor size greater than or equal to 3.5cm(?2 =11.88,P=0.003).ConclusionPatients with multiple breast lesions were demonstrated high possibility of DCIS-Mi.The group with tumor size less than 3.5cm has higher survival rate.No relationship was found between clinicopathological features and distant metastasis of breast ductal carcinoma in situ with microinvasion.