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中华乳腺病杂志(电子版) ›› 2018, Vol. 12 ›› Issue (05) : 257 -262. doi: 10.3877/cma.j.issn.1674-0807.2018.05.001

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乳腺癌新辅助化疗效果的病理评估
唐小燕1,(), 郎荣刚2, 付丽2   
  1. 1. 173-8610 东京,日本大学医学部病态病理学系肿瘤病理学教研室
    2. 300060 天津医科大学肿瘤医院乳腺病理研究室
  • 收稿日期:2016-12-20 出版日期:2018-10-01
  • 通信作者: 唐小燕

Pathological assessment after neoadjuvant chemotherapy in breast cancer

Xiaoyan Tang1,(), Ronggang Lang2, Li Fu2   

  1. 1. Division of Oncologic Pathology, Department of Pathology and Microbiology, School of Medicine, Nihon University, Tokyo 173-8610, Japan
    2. Department of Breast Pathology, Tianjin Cancer Hospital, Tianjin Medical University, Tianjin 300060, China
  • Received:2016-12-20 Published:2018-10-01
  • Corresponding author: Xiaoyan Tang
  • About author:
    Corresponding author: Tang Xiaoyan, Email:
引用本文:

唐小燕, 郎荣刚, 付丽. 乳腺癌新辅助化疗效果的病理评估[J/OL]. 中华乳腺病杂志(电子版), 2018, 12(05): 257-262.

Xiaoyan Tang, Ronggang Lang, Li Fu. Pathological assessment after neoadjuvant chemotherapy in breast cancer[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2018, 12(05): 257-262.

乳腺癌新辅助化疗是乳腺癌标准化治疗方法之一,因此,新辅助治疗后的病理评估以及评估的标准化非常重要。不同病理评估标准的主要区别在于pCR的定义不同。现阶段一般把ypT0/is ypN0定义为pCR,即化疗后乳腺内可残留DCIS,但腋窝淋巴结内无癌细胞残留。笔者将着重介绍日本乳腺癌学会所采用的病理评估标准,并把该标准与美国MD Anderson癌症中心的残余肿瘤量(Residual Cancer Burden)系统、英国的Millar和Payne法,以及天津市肿瘤医院推荐的病理评估标准等进行比较。大量的临床研究表明,新辅助化疗后乳腺癌pCR者相比非pCR者,其DFS率和OS率均有明显提高。但是,pCR对于各种乳腺癌亚型的意义不尽相同,而pCR可能不是新辅助化疗的唯一预测因子。

Neoadjuvant chemotherapy is one of the standardized treatment methods for breast cancer. Pathological assessment and standardized evaluation after neoadjuvant therapy are very important. The main differences between the different criteria of pathological assessments are their definitions of pathologic complete response (pCR), which is currently generally defined as ypT0/is ypN0, that is, residual ductal carcinoma in situ in the breast after chemotherapy, without residual cancer cells in the axillary lymph nodes. This paper introduces the histological response criteria of the Japanese Breast Cancer Society and compares it with the Residual Cancer Burden system of MD Anderson Cancer Center, the Millar and Payne method of the United Kingdom, and the pathologic evaluation standard recommended by Tianjin Cancer Hospital. A large number of clinical studies show that the DFS and OS of breast cancer patients with pCR are significantly higher than those of non-pCR patients after neoadjuvant chemotherapy. However, pCR has different meanings in different breast cancer subtypes and pCR may not be the only predictor in neoadjuvant chemotherapy.

图1 乳腺癌新辅助治疗后的组织学变化(日本乳腺癌学会病理评估标准) a图所示乳腺癌为1b级(轻度变化):癌细胞有轻度核固缩,细胞质更加嗜酸性,有时伴有空胞变性(HE ×20);b图所示,乳腺癌为2b级(高度变化):轻度水肿的间质内有少数变性的癌细胞(HE ×20),癌细胞核深染及固缩,周围纤维排列紊乱,伴有少数淋巴细胞浸润;c图所示乳腺癌为3级:癌细胞消失后间质发生水肿以及胶原纤维断裂,可对比左下方的正常间质部分(HE ×10),并且,右上方插图所示,高倍镜下可见少数组织细胞(HE ×40);d图所示乳腺癌为3级:癌细胞全部坏死(HE ×20)
图2 乳腺癌新辅助治疗后高度变性(日本乳腺癌学会病理评估标准:2a级) a图所示,细胞占瘤床面积比例明显低于1/3 (即2/3以上癌细胞可见明显变化,但仍残留明显癌巢) (HE ×0.43a);b图所示,在高倍镜下,中间部分癌细胞完全消失,只能发现少数组织细胞,并且,间质水肿且胶原纤维排列紊乱,而纤维断裂不太明显(HE ×20);c图为a图右边蓝色箭头部分瘤床边缘残留癌细胞的高倍放大图像,残留癌细胞虽然显示有变性,但明显为可存活细胞,并且形成肿瘤块(HE ×20)
图3 乳腺癌患者新辅助治疗后淋巴结高度变化(日本乳腺癌学会病理评估标准:2b级) a图所示,淋巴组织高度萎缩,淋巴结内部纤维化(HE ×4);b图所示,高倍镜下可以发现少数变性的癌细胞(HE ×40)
表1 日本乳腺癌学会乳腺癌新辅助治疗后病理评估标准[10]
表2 3种乳腺癌新辅助治疗后病理评估标准比较[10,12,13]
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