切换至 "中华医学电子期刊资源库"

中华乳腺病杂志(电子版) ›› 2018, Vol. 12 ›› Issue (03) : 146 -149. doi: 10.3877/cma.j.issn.1674-0807.2018.03.004

所属专题: 文献

论著

多病灶乳腺癌临床病理特征分析
胡乐1, 陈旭1, 楼龙泉1, 于子溢1, 王聪2, 刘晓安1, 王水1, 肇毅1,()   
  1. 1. 210029 南京医科大学第一附属医院乳腺外科
    2. 210029 南京医科大学第一附属医院病理科
  • 收稿日期:2016-12-12 出版日期:2018-06-01
  • 通信作者: 肇毅

Clinicopathological characteristics of multifocal breast cancer

Le Hu1, Xu Chen1, Longquan Lou1, Ziyi Yu1, Cong Wang2, Xiaoan Liu1, Shui Wang1, Yi Zhao1,()   

  1. 1. Department of Breast Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
    2. Department of Pathology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
  • Received:2016-12-12 Published:2018-06-01
  • Corresponding author: Yi Zhao
  • About author:
    Corresponding author: Zhao Yi, Email:
引用本文:

胡乐, 陈旭, 楼龙泉, 于子溢, 王聪, 刘晓安, 王水, 肇毅. 多病灶乳腺癌临床病理特征分析[J/OL]. 中华乳腺病杂志(电子版), 2018, 12(03): 146-149.

Le Hu, Xu Chen, Longquan Lou, Ziyi Yu, Cong Wang, Xiaoan Liu, Shui Wang, Yi Zhao. Clinicopathological characteristics of multifocal breast cancer[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2018, 12(03): 146-149.

目的

探讨多病灶乳腺癌不同病灶临床病理特点的异同,以便更好地指导临床治疗。

方法

回顾性分析2014年11月至2016年8月南京医科大学第一附属医院乳腺外科收治的41例多病灶乳腺癌患者的临床病理资料。分析多病灶乳腺癌不同病灶的常规病理、免疫组织化学检测结果及分子亚型的异同,并采用χ2检验比较多病灶乳腺癌与同期150例单病灶乳腺癌的病灶直径、组织学分级、淋巴结状态和脉管内癌栓状况。

结果

41例多病灶乳腺癌患者中,有2处病灶者32例,3处病灶者8例,4处病灶者1例;病灶直径≤2 cm者18例,>2 cm者23例;不同病灶病理类型相同者33例(80%),不同者8例(20%);不同病灶组织学分级相同者38例(93%),不同者3例(7%);不同病灶免疫组织化学标志物ER、PR、HER-2、Ki67表达水平不同者分别为3例(7%)、6例(15%)、5例(12%)、3例(7%);分子亚型不同者5例(12%)。多病灶乳腺癌与单病灶乳腺癌患者相比,组织学分级3级、淋巴结转移及脉管内癌栓分布的差异均有统计学意义[51%(21/41)比32%(48/150), χ2=5.154 ,P=0.023;59%(24/41)比41%(61/150), χ2=4.163 ,P=0.041;29%(12/41)比8%(12/150), χ2=13.257,P<0.001],但病灶直径的差异无统计学意义[56%(23/41)比56%(84/150),χ2=0.001,P=0.991)]。

结论

多病灶乳腺癌不同病灶可存在不同的临床病理结果,因此,不同病灶均应进行常规病理与免疫组织化学检测,以便完整提供患者病理信息,选择最佳治疗方案。多病灶乳腺癌更易发生淋巴结转移及脉管内癌栓,提示可能预后较差。

Objective

To explore the clinicopathological characteristics of different lesions in multifocal breast cancer patients and provide the guidance for clinical treatment.

Methods

The clinical data of 41 multifocal breast cancer patients in the Department of Breast Surgery, the First Affiliated Hospital of Nanjing Medical University from November 2014 to August 2016 were retrospectively analyzed. Conventional pathological findings, immunohistochemical results and molecular subtypes between different lesions in multifocal breast cancer patients were analyzed. χ2 test was used to compare the lesion size, histological grade, lymph node status and intravascular tumor thrombus between 41 multifocal breast cancer patients and 150 unifocal breast cancer patients enrolled in the same period.

Results

Among 41 multifocal breast cancer patients, 32 were detected with 2 lesions, 8 with 3 lesions, 1 with 4 lesions. The maximum diameter of the lesion was no less than 2 cm in 18 cases, more than 2 cm in 23 cases. The different lesions of one patient belonged to the same pathological type in 33 cases (80%), different pathological types in 8 cases (20%). The different lesions of one patient had the same histological grade in 38 cases (93%), different histological grades in 3 cases (7%). The different lesions of one patient presented the different expression levels of ER, PR, HER-2 and Ki67 in 3 cases (7%), 6 cases (15%), 5 cases (12%)and 3 cases (7%), respectively. Five cases (12%) had the different molecular subtypes. There were significant differences in histological grade 3 [51%(21/41) vs32%(48/150), χ2=5.154, P=0.023], lymph node metastasis [59%(24/41) vs 41%(61/150), χ2=4.163, P=0.041] and intravascular tumor thrombus [29%(12/41) vs8%(12/150), χ2=13.257, P<0.001] between multifocal and unifocal breast cancer patients, while the lesion size showed no significant difference [56%(23/41) vs 56%(84/150), χ2=0.001, P=0.991].

Conclusions

Clinicopathological results may vary in the lesions of multifocal breast cancer, so routine pathological and immunohistochemical examination should be carried out in all lesions so as to provide accurate and comprehensive pathological evidence for the optimal treatment. Multifocal breast cancer is prone to lymph node metastasis and intravascular tumor thrombus, indicating a poor prognosis.

表1 多病灶乳腺癌与单病灶乳腺癌临床病理特征比较[例(%)]
表2 多病灶乳腺癌中各病灶常规病理及免疫组织化学检测结果[例(%)]
表3 5例多病灶乳腺癌各病灶分子亚型不同者的临床特征
[1]
赵平,陈万青. 2009中国肿瘤登记年报[M].北京:军事医学科学出版社,2010: 26-37.
[2]
中华人民共和国卫生部,陈竺. 全国第三次死因回顾抽样调查报告[M]. 北京:中国协和医科大学出版社,2008:10-22.
[3]
Bendifallah S, Werkoff G, Borie-Moutafoff C, et al. Multiple synchronous (multifocal and multicentric) breast cancer: clinical implications [J].Surg Oncol, 2010, 19(4): e115-123.
[4]
Eeles R, Knee G, Jhavar S, et al. Multicentric breast cancer: clonality and prognostic studies[J]. Breast Cancer Res Treat, 2011, 129(3): 703-716.
[5]
Jain S, Rezo A, Shadbolt B, et al. Synchronous multiple ipsilateral breast cancers: implications for patient management [J].Pathology, 2009, 41(1): 57-67.
[6]
中国抗癌协会乳腺癌专业委员会.中国抗癌协会乳腺癌诊治指南与规范(2015版)[J].中国癌症杂志,2015,25(9):692-754.
[7]
Goldhirsch A, Winer EP, Coates AS, et al. Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013[J].Ann Oncol, 2013, 24(9): 2206-2223.
[8]
Boros M, Podoleanu C, Georgescu R. Multifocal/multicentric breast carcinomas showing intertumoural heterogeneity: a comparison of histological tumour type and Nottingham histological grade of primary tumour and lymph node metastasis[J].Pol J Pathol, 2015, 66(2): 125-132.
[9]
Sardanelli F, Giuseppetti GM, Panizza P, et al. Sensitivity of MRI versus mammography for detecting foci of multifocal, multicentric breast cancer in fatty and dense breasts using the whole-breast pathologic examination as a gold standard [J]. AJR Am J Roentgenol, 2004, 183(4): 1149-1157.
[10]
Girardi V, Carbognin G, Camera L, et al. Multifocal, multicentric and contralateral breast cancers: breast MR imaging in the preoperative evaluation of patients with newly diagnosed breast cancer[J]. Radiol Med, 2011, 116(8): 1226-1238.
[11]
Ilic' IR, Petrovic' A, Živkovic' VV, et al. Immunohistochemical features of multifocal and multicentric lobular breast carcinoma [J].Adv Med Sci, 2017, 62(1): 78-82.
[12]
Sjöström-Mattson J, Von Boguslawski K, Bengtsson NO, et al. The expression of p53, bcl-2, bax, fas and fasL in the primary tumour and lymph node metastases of breast cancer[J]. Acta Oncol, 2009, 48(8): 1137-1143.
[13]
Middleton LP, Vlastos G, Mirza NQ, et al. Multicentric mammary carcinoma: evidence of monoclonal proliferation[J]. Cancer , 2002, 94(7): 1910-1916.
[14]
Choi Y, Kim EJ, Seol H, et al. The hormone receptor, human epidermal growth factor receptor 2, and molecular subtype status of individual tumor foci in multifocal/multicentric invasive ductal carcinoma of breast [J].Hum Pathol, 2012, 43(1): 48-55.
[15]
Wolters R, Wöckel A, Janni W, et al. Comparing the outcome between multicentric and multifocal breast cancer: what is the impact on survival, and is there a role for guideline-adherent adjuvant therapy? A retrospective multicenter cohort study of 8935 patients[J]. Breast Cancer Res Treat, 2013, 142(3): 579-590.
[1] 李洋, 蔡金玉, 党晓智, 常婉英, 巨艳, 高毅, 宋宏萍. 基于深度学习的乳腺超声应变弹性图像生成模型的应用研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(06): 563-570.
[2] 周荷妹, 金杰, 叶建东, 夏之一, 王进进, 丁宁. 罕见成人肋骨郎格汉斯细胞组织细胞增生症被误诊为乳腺癌术后骨转移一例[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 380-383.
[3] 河北省抗癌协会乳腺癌专业委员会护理协作组. 乳腺癌中心静脉通路护理管理专家共识[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 321-329.
[4] 刘晨鹭, 刘洁, 张帆, 严彩英, 陈倩, 陈双庆. 增强MRI 影像组学特征生境分析在预测乳腺癌HER-2 表达状态中的应用[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 339-345.
[5] 张晓宇, 殷雨来, 张银旭. 阿帕替尼联合新辅助化疗对三阴性乳腺癌的疗效及预后分析[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 346-352.
[6] 邱琳, 刘锦辉, 组木热提·吐尔洪, 马悦心, 冷晓玲. 超声影像组学对致密型乳腺背景中非肿块型乳腺癌的诊断价值[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 353-360.
[7] 程燕妮, 樊菁, 肖瑶, 舒瑞, 明昊, 党晓智, 宋宏萍. 乳腺组织定位标记夹的应用与进展[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 361-365.
[8] 涂盛楠, 胡芬, 张娟, 蔡海峰, 杨俊泉. 天然植物提取物在乳腺癌治疗中的应用[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 366-370.
[9] 高杰红, 黎平平, 齐婧, 代引海. ETFA和CD34在乳腺癌中的表达及与临床病理参数和预后的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 64-67.
[10] 韩萌萌, 冯雪园, 马宁. 乳腺癌改良根治术后桡神经损伤1例[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 117-118.
[11] 张志兆, 王睿, 郜苹苹, 王成方, 王成, 齐晓伟. DNMT3B与乳腺癌预后的关系及其生物学机制[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 624-629.
[12] 王玲艳, 高春晖, 冯雪园, 崔鑫淼, 刘欢, 赵文明, 张金库. 循环肿瘤细胞在乳腺癌新辅助及术后辅助治疗中的应用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 630-633.
[13] 赵林娟, 吕婕, 王文胜, 马德茂, 侯涛. 超声引导下染色剂标记切缘的梭柱型和圆柱型保乳区段切除术的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 634-637.
[14] 谭瑞义. 小细胞骨肉瘤诊断及治疗研究现状与进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 781-784.
[15] 王曦娅, 尹弘青, 丁伟, 徐滨, 于海源, 马东升, 邵军. 桥本背景下甲状腺乳头状癌多参数分析预测大容量淋巴结转移[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 548-554.
阅读次数
全文


摘要