乳腺微小浸润癌临床病理特点及其与腋窝淋巴结转移的相关性分析  

Microinvasive breast cancer: clinicopathologic characteristics and their correlation with axillary lymph nodes invasion result of a large single-institution series

作　　者：王一澎[1] 马沛卿[2] 张丽华[3] 张扬[1] 宣立学[1] 高纪东[1] 王靖[1] 王翔[1] 陈国际[1] 

机构地区：[1]国家癌症中心中国医学科学院北京协和医学院肿瘤医院乳腺外科,北京100021 [2]国家癌症中心中国医学科学院北京协和医学院肿瘤医院病理科,北京100021 [3]华北石油管理局总医院普外科,河北任丘062552

出　　处：《中国医刊》2016年第6期53-58,共6页Chinese Journal of Medicine

摘　　要：目的分析乳腺微小浸润癌的临床病理特点及其与腋窝淋巴结转移的相关性。方法收集中国医学科学院肿瘤医院2010年7月至2015年6月间接受手术且经病理确诊的所有乳腺微小浸润癌的病例,对其临床病理资料进行回顾性的研究。除此之外,对所有接受腋窝淋巴结手术评估的患者进行统计分析,以寻找与淋巴结转移相关的危险因素。结果共199例患者入组,占同期乳腺癌手术患者的1.7%。所有微小浸润癌均在导管原位癌的背景下发生。在对微小浸润癌的临床病理特点分析中发现,无论在其浸润灶成分还是在其原位癌成分中,出现HER-2高表达的比例均较高,分别达到了52.4%和69.8%。有182例患者接受腋窝淋巴结状态的手术评估,其中10例(5.5%)患者出现淋巴结转移,分别为8例(4.4%)宏转移和2例(1.1%)微转移。淋巴结转移数目最多为2枚(2例),其余均为1枚(8例)。10例淋巴结转移患者中有4例接受前哨淋巴结活检,其余均直接行腋窝淋巴结清扫。未发现非前哨淋巴结转移病例。多因素分析显示:肿瘤≥2.5cm(P=0.044)和浸润灶≥2个(P=0.011)与发生淋巴结转移相关联。结论微小浸润癌中往往存在HER-2蛋白的高表达,这可能与其从原位癌进展至浸润癌有关。微小浸润癌发生淋巴结转移的风险低,是否应进行常规腋窝淋巴结状态手术评估目前仍处于争议中。肿瘤≥2.5cm和浸润灶≥2个是发生淋巴结转移的独立危险因素。Objective To evaluate the clinicopathologic characteristics and their correlation with axillary lymph nodes invasion in a large cohort of patients with microinvasive breast cancer（MIBC）. Method All cases of microinvasive breast cancer were retrieved from institutional database from July 2010 to June 2015. Clinicopathologic parameters were analyzed for entire cohort. Moreover, cases underwent axillary lymph node evaluation were identified. Multivariate analysis was used to identify factors predictive of lymph node involvement. Result 199 cases（1.7% of operated breast cancers） were evaluated in this period. The MIBC were almost always encountered in the setting of ductal carcinoma in situ（DCIS）. Patients with MIBC had a higher frequency of HER-2 overexpression, with the microinvasive component being 52.4% and the in situ component being 69.8%. 182 cases were selected for axillary staging analysis. Lymph nodes metastases were identified in 10 patients（5.5%）： 8 macrometastases（4.4%） and 2 micrometastases（1.1%）. The maximum involved lymph nodes were 2（2 cases）, with only 1 involved lymph nodes in the other 8 cases. Among the 10 lymph nodes positive patients, 4 underwent sentinel lymph node biopsy（SLNB） and the other 6 underwent axillary lymph node dissection（ALND）. No additional positive lymph nodes were found in all SLNB cases. Tumor size ≥2.5cm（P=0.044） and patients with ≥2 foci of microinvasion（P=0.011） were significant predictors of lymph node metastasis by multivariable analysis. Conclusion The higher frequency of HER-2 overexpression in MIBC and its associated in situ component implied that it might play an important role in the process of first invasion from in situ to invasive breast cancer. MIBC is associated with a low rate of lymph node metastases and therefore whether axillary lymph nodes evaluation（especially the SLNB） should be performed routinely is still in debate. Patients with ≥2 foci of microinvasion and tumor size ≥2.5cm are independent risk

关 键 词：乳腺肿瘤 乳腺微小浸润癌 导管原位癌 导管原位癌伴微小浸润 

分 类 号：R737.9[医药卫生—肿瘤]