MRI manifestations of breast encapsulated papillary carcinoma / 中国医学影像技术

Objective: To explore MRI manifestations of breast encapsulated papillary carcinoma (EPC). Methods: Data of 18 women with EPC confirmed by surgery and pathology were retrospectively analyzed. Pure EPC (n=7) and EPC with invasion or ductal carcinoma in situ (DCIS) (n=11) were compared. Results: All 18 EPC presented as masses, and 5 were accompanied by non-mass enhancement. Totally 11 masses were mixed cystic-solid and 7 purely solid, 10 were round/oval and 8 were irregular, 11 were margins circumscribed and 7 were irregular. The median apparent diffusion coefficient (ADC) value of the solid part of EPC was 1.12×10-3 mm2/s. The time-intensity curve (TIC) of EPC was washout in 13 cases and plateau in 5 cases. Delayed-enhancement capsules were observed in 15 masses, included 13 masses showing hypointense capsules on T2WI. The adjacent vessel sign (AVS) was present in 16 masses. No significant difference of clinical nor MRI features was found between pure EPC and EPC with invasion or DCIS. Conclusion: MRI findings of breast EPC were of certain characteristics, commonly manifested by mixed cystic-solid mass with circumscribed margin, delayed-enhancement capsules presenting hypointense on T2WI, washout TIC type and AVS positive.

DIFFICULTIES IN COLLECTING DATA ON DUCTAL CARCINOMA IN SITU AT A POPULATION-BASED CANCER REGISTRY / Dificuldades na coleta de dados de carcinoma ductal in situ em um Registro de Câncer de Base Populacional

Objective: To verify data-coding accuracy for ductal carcinoma in situ at the Goiânia population-based cancer registry in the Brazilian state of Goiás. Methods: Ecological time series analysis of cases coded as ductal carcinoma in situ in the state cancer database (ONCOSIS), considering data from the Goiânia population-based cancer registry, from 1994 to 2010. Results: Of 376 cases originally coded as ductal carcinoma in situ, 115 were excluded following a review of the pathology reports. These exclusions referred to cases of lobular carcinoma in situ (n=21), Paget's disease (n=4), invasive carcinoma (n=08), ductal carcinoma in situ associated with invasive carcinoma (n=14), microinvasive carcinoma (n=21), records on non-residents in Goiânia, and duplicated data (n=46). Conclusion: Many cases needed recoding and, as a consequence, altered the initial database. Standardizing pathology reports and training data collection staff are crucial steps to avoid omissions and errors when transcribing cases of ductal carcinoma in situ in a population-based cancer registry database.

Objetivo: Verificar a acurácia da codificação dos dados de carcinoma ductal in situ dentro do Registro de Câncer de Base Populacional de Goiânia, Goiás - Brasil. Métodos: Estudo ecológico de série temporal de casos codificados como carcinoma in situ da mama, pelo programa (ONCOSIS) do Registro de Câncer de Base Populacional de Goiânia, entre 1994 e 2010. Posteriormente realizou­se busca individual dos laudos histopatológicos de CDIS. Resultados: De 376 casos de CDIS, foram excluídos 115 casos após a revisão dos laudos anatomopatológicosas. As exclusões referem-se a carcinoma lobular in situ (21), Doença de Paget (4), carcinoma invasor (08); CDIS associado a carcinoma invasor (14); microinvasor (21), pacientes com endereço fora de Goiânia e dados duplicados (46). Conclusão: Há um grande número de casos que precisam ser recodificados, alterando o banco inicial. A padronização de laudos e o treinamento dos coletadores são etapas importantes para que não haja informações desconhecidas ao transcrever o CDIS para as fichas do RCBP.

Magnetic resonance imaging of the breast: role in the evaluation of ductal carcinoma in situ / Papel da ressonância magnética das mamas na avaliação do carcinoma ductal in situ

Abstract Ductal carcinoma in situ (DCIS) is a precursor mammary lesion whose malignant cells do not extend beyond the basement membrane and presents a risk of progression to malignant disease. Its early detection increased with screening mammography. The objective of this study was to review the literature on the main presentations of DCIS on magnetic resonance imaging (MRI), through searches of the Medline/PubMed, Latin-American and Caribbean Center on Health Sciences Information (Lilacs), and Scientific Electronic Library Online (SciELO) databases. DCIS can occur in its pure form or in conjunction with invasive disease, in the same lesion, in different foci, or in the contralateral breast. MRI has a high sensitivity for the detection of pure DCIS, being able to identify the non-calcified component, and its accuracy increases with the nuclear grade of the lesion. The most common pattern of presentation is non-nodular enhancement; heterogeneous internal structures; a kinetic curve showing washout or plateau enhancement; segmental distribution; and restricted diffusion. MRI plays an important role in the detection of DCIS, especially in the evaluation of its extent, contributing to more reliable surgical excision and reducing local recurrence.

Resumo O carcinoma ductal in situ (CDIS) é uma lesão mamária precursora cujas células malignas não ultrapassam a membrana basal e possui risco de evolução para doença maligna. Sua detecção precoce aumentou com a mamografia de rastreamento. O objetivo deste estudo foi realizar uma revisão da literatura sobre as principais apresentações do CDIS na ressonância magnética (RM), utilizando mecanismos de busca na base de dados Medline/PubMed, Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde (Lilacs) e Scientific Electronic Library Online (SciELO). O CDIS pode ocorrer de forma pura ou associado a doença invasiva, na mesma lesão, em focos diferentes e na mama contralateral. A RM possui alta sensibilidade para a detecção do CDIS puro, sendo capaz de identificar o componente não calcificado da doença e sua precisão aumenta com o seu grau nuclear. O padrão de apresentação mais comum é o realce não nodular com padrão interno heterogêneo, curva cinética de lavagem rápida (washout) ou platô, de distribuição segmentar e com restrição na difusão. A RM tem importante papel na detecção do CDIS e, principalmente, na avaliação da sua extensão, contribuindo para uma exérese cirúrgica mais confiável e reduzindo as recidivas locais.

The value of preoperative CA19-9 combined with platelet-to-lymphocyte ratio in predicting invasive malignancy in intraductal papillary mucinous neoplasms / 中华外科杂志

Objective@#To explore preoperative predictive markers for invasive malignancy in intraductal papillary mucinous neoplasm(IPMN).@*Methods@#The retrospective case-controlled study was adopted.Seventy-nine patients who underwent surgery and with pathologically confirmed IPMN from January 2005 to December 2014 at Department of Pancreatic Surgery, Zhongshan Hospital Fudan University were enrolled.Forty-six patients were male and 33 were female,with an average age of (62.9±8.9)years (range:37-82 years).Tumor sites:56 tumors were located at the head of the pancreas,22 were located at the body and tail of the pancreas,and 1 was located across the whole pancreas.Surgical procedures: 51 patients underwent pancreaticoduodenectomy, 22 patients underwent distal pancreatectomy, 4 patients underwent segmental pancreatectomy and 2 patients underwent total pancreatectomy.IPMNs were classified into non-invasive lesions and invasive carcinomas according to the histopathological findings of the tumor.Thirty-two tumors were non-invasive lesions and 47 were invasive carcinomas.The preoperative findings were compared between patients with non-invasive IPMN and patients with invasive carcinoma by univariate analysis using t test and χ2 test accordingly,and factors with statistically significance were subsequently submitted to multivariate analysis.@*Results@#Univariate analysis showed that tumor size(P=0.022), carcinoembryonic antigen(P=0.012), CA19-9(P=0.011), lymphocytes(P=0.034), neutrophil-to-lymphocyte ratio(P=0.010)and platelet-to-lymphocyte ratio(PLR)(P=0.004)were predictive markers with statistical significance.Multivariate analysis showed that CA19-9(P=0.012)and PLR(P=0.025) were independent predictive markers for invasive malignancy in IPMN.The area under curve of the combination factor of CA19-9 and PLR(0.864) was larger than that of CA19-9(0.806) or PLR(0.685) alone, and all the authentic indicators of the combination factor were better than those of each alone.@*Conclusions@#CA19-9 and PLR are independent predictive markers for invasive malignancy in IPMN.The combination of CA19-9 and PLR has improved efficacy than each alone.

Ultrasonographic features of calcified and non-calcified ductal carcinoma in situ of breast and their expression of estrogen receptor and human epidermal growth factor receptor-2 / 中国医学影像技术

Objective: To compare the ultrasonographic features of calcified and non-calcified ductal carcinoma in situ (DCIS) of breast, and to explore the difference of the expression of estrogen receptor (ER) and human epidermal growth factor receptor-2 (Her-2). Methods A total of 148 patients with pathologically confirmed DCIS were retrospectively analyzed and divided into calcified DCIS group (n=66) and non-calcified DCIS group (n=82) according to the presence of microcalcification in ultrasonography. The differences of the ultrasonographic features, ER and Her-2 positive expression were analyzed. Results The signs of mass, ductal ectasia and elastographic scores showed statistically significant differences between the 2 groups (all P0.05). ER positive rate was 42.42% (28/66) in calcified DCIS group and 69.51% (57/82) in non-calcified DCIS group. The difference of ER positive rate between the two groups was statistically significant (P<0.01). Her-2 positive in calcified DCIS group was 30.30% (20/66), while in the non-calcified DCIS group was 14.63% (12/82; P=0.02). Conclusion The ultrasonographic features are different between calcified breast DCIS and non-calcified DCIS. Positive ER is more common in non-calcified DCIS, while high Her-2 expression is more common in calcified DCIS, indicating that calcified DCIS may have rather aggressive histological features.

Evaluation of survivin immunoexpression in the differentiation of high- and low-grade breast ductal carcinoma in situ / Expressão da proteína survivina em carcinoma ductal in situ de mama de alto e de baixo grau

ABSTRACT Objective To evaluate the expression of survivin protein in low- and high-grade ductal carcinoma in situ. Methods Breast tissue fragments obtained by incisional biopsy and surgical procedures of 37 women with ductal carcinoma in situ of the breast were subdivided into two groups: Group A, composed of women with low-grade ductal carcinoma in situ, and Group B, women with high-grade ductal carcinoma in situ. Survivin protein expression test was performed by immunohistochemistry, using a monoclonal antibody clone I2C4. The criterion to evaluate survivin immunoexpression was based on the percentage of neoplastic cells that presented brown-gold staining. This criterion was positive when the percentage of stained cells was ≥10%. Results The survivin protein was expressed in 22 out of 24 cases of high-grade ductal carcinoma in situ (78%), whereas, in Group A, of low-grade ductal carcinoma in situ (n=13), it was positive in only 6 cases (21.40%; p=0.004). Conclusion The frequency of expression of survivin was significantly higher in the group of patients with high-grade ductal carcinoma in situ compared to those in the low-grade ductal carcinoma in situ group.

RESUMO Objetivo Avaliar a imunoexpressão da proteína survivina nos carcinomas ductais in situ de mama de baixo e de alto graus. Métodos Fragmentos de tecido mamários obtidos por biópsia incisional e procedimentos cirúrgicos de 37 mulheres acometidas por carcinoma ductal in situ de mama foram subdivididos em dois grupos: Grupo A, formado por mulheres com carcinoma ductal in situ de baixo grau; e Grupo B, por mulheres com carcinoma ductal in situ de alto grau. A pesquisa de expressão da proteína survivina foi realizada pela técnica de imuno-histoquímica, utilizando-se anticorpo monoclonal clone I2C4. O critério de avaliação da imunoexpressão da survivina baseou-se na percentagem de células neoplásicas que apresentava coloração castanho-dourada. Considerouse tal critério positivo quando a percentagem de células apresentasse marcação ≥10%. Resultados A proteína survivina apresentou-se expressa em 22 dos 24 casos de carcinoma ductal in situ de alto grau (78%), enquanto no Grupo A, de carcinoma ductal in situ de baixo grau (n=13), apresentou-se positiva em apenas 6 casos (21,40%; p=0,004). Conclusão O índice de frequência de expressão da survivina foi significativamente mais elevado no grupo de pacientes com carcinoma ductal in situ de alto grau, quando comparado às do grupo com carcinoma ductal in situ de baixo grau.

Mechanism of ductal carcinoma in situ to invasive breast cancer / 国际肿瘤学杂志

Ductal carcinoma in situ (DCIS) is a precursor of invasive ductal breast cancer,and up to 40％ of these lesions will progress to invasive disease if untreated.The micro-environment,genetic aberrations,signal pathways and epigenetics play important roles during the infiltration and transformation of DCIS.Further studies of the infiltration and transformation of DCIS will promote the accurate assessment and prognosis prediction of the patients with DCIS,for finding a comprehensive evaluation standard and the balance between the over and low treatment.

Fatores preditivos de margens cirúrgicas comprometidas no tratamento do carcinoma ductal in situ da mama / Predictive factors of positive margins in the treatment of ductal carcinoma in situ

O objetivo deste estudo foi determinar, através de revisão da literatura, possíveis fatores que possam estar associados com margens cirúrgicas comprometidas em portadoras de carcinoma ductal in situ (CDIS). Foi empregado o banco de dados do Medical Literature Analysis and Retrieval System Online (MEDLINE®), utilizando as expressões: "Ductal carcinoma in situ", "in situ breast cancer" e "DCIS". Os termos adicionais incluídos foram "surgery" e "margin". O período de referência desses estudos foi de fevereiro de 2000 a fevereiro de 2015. Dos 438 artigos encontrados, 6 foram incluí- dos nessa revisão, com um total de 1.222 pacientes. A taxa de margens comprometidas nos estudos variou de 29 a 72%. As principais variáveis relacionadas com margem comprometida foram o grau histológico e o tamanho nal da lesão na para na (três estudos), multifocalidade (um estudo) e volume da peça cirúrgica ressecada (um estudo). Margens cirúrgicas representam, indubitavelmen- te, um dos mais importantes fatores de recorrência local no tratamento do CDIS. São necessários estudos mais amplos e com metodologias adequadas para se estrati car, com segurança, os fatores de risco associados ao comprometimento das margens cirúrgicas.

e purpose of this study was to determinate, through a literature review, possible factors related to positive margins in patients treated with surgery for ductal carcinoma in situ (DCIS). e Medical Literature Analysis and Retrieval System Online (MEDLINE®) database were used to search the articles, with the expressions: "Ductal carcinoma in situ" "in situ breast cancer" and "DCIS". Ad- ditional terms included were "surgery" and "margin". e reference period of these studies was from February 2000 to February 2015. A total of 438 articles were found, and six of them were included in this review, with a total of 1,222 patients. e rate of positive margins studies varied from 29 to 72%. e main variables related to positive margins were the histological grade and the nal size of the lesion in para n (three studies), multifocality (one study) and volume of the resected specimen (one study). Surgical margins represent, undoubtedly, one of the most important factors of local recurrence in the treatment of DCIS. Larger studies are needed, with adequate methodology, to safely stratify the risk factors associated with surgical margins involvement.

Comparison of laparoscopic distal pancreatectomy and open distal pancreatectomy in pancreatic ductal adenocarcinoma / 中华肿瘤杂志

Objective@#To compare and evaluate the curative effect of laparoscopic distal pancreatectomy(LDP) and traditional open distal pancreatectomy(ODP) in pancreatic ductal adenocarcinoma.@*Methods@#The clinical data of 15 patients treated by LDP and 87 contemporaneous cases treated by ODP from January 2010 to November 2015 was collected, and the curative effect and prognosis of these patients were retrospectively analyzed.@*Results@#The operation time of LDP group was (286.5±48.1) min, significantly longer than that of OPD group(226.6±56.8) min (P<0.05). The operative hemorrhage, postoperative exhaust time, recovery eating time, the whole and postoperative hospitalization time of LDP group were (188.7±108.9) ml, (2.2±1.3) d, (2.9±1.1) d, (13.2±10.4) d and (9.3±8.1) d, respectively, dramatically shorter than those of ODP group (625.2±982.1) ml, (4.3±1.7) d, (5.2±1.8) d, (20.7±8.7) d and (14.9±7.8) d, respectively (all of P<0.05). There were no intraoperative blood transfusion case in LDP group, however, 13 patients in ODP group received intraoperative blood transfusion, without significant difference (P=0.207). Alternatively, 6 cases occurred pancreatic fistula in LDP group, among them, 5 cases were grade A and 1 case was grade B; In ODP group, 17 cases occurred pancreatic fistula, among them 13 cases were grade A, 1 case was grade B and 3 cases were grade C, without significant differences (P=0.130). There were 2 cases of delayed gastric empty, 1 case of pulmonary infection in LDP group. In ODP group, there were 5 cases of postoperative delayed gastric empty, 3 cases of pulmonary infection and 6 cases of intra-abdominal infection, without significant differences (P>0.05). In both LDP group and ODP group, none occurred percutaneous drainage, re-admissions, second operation or perioperative death.@*Conclusions@#Compared to ODP, LDP is much safer and more steady in perioperative periodand operation. Patients of pancreatic ductal adenocarcinoma received LDP can acquire more benefit and recovery sooner, and LDP is a safe and effective operative method.

Surgical treatment and prognosis of ductal carcinoma in situ: 526 cases analysis / 中华外科杂志

Objective@#To evaluate the choice of surgical treatment of ductal carcinoma in situ (DCIS) and its impact on long-term outcomes.@*Methods@#A retrospective analysis of the clinicopathological features and treatment protocol of DCIS patients who underwent surgical treatment in Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine from January 2009 to August 2016 was done. The factors which could affect surgical treatment were analyzed by χ2 test and Logistic regression. Survival analysis were performed between different surgical approaches. Kaplan-Meier survival curves and Log-rank tests demonstrated the distribution of disease free survival and overall survival.@*Results@#A total of 526 patients were enrolled in this study, 405 cases (77.0%) underwent mastectomy, 121 cases (23.0%) underwent breast-conserving surgery, of which 88 cases received radiotherapy after breast-conserving surgery. It was shown by univariate and multivariate analysis that age>50 years (OR=0.631, 95% CI: 0.413 to 0.965, P=0.034), first symptom of nipple discharge (OR=0.316, 95% CI: 0.120 to 0.834, P=0.020), excision biopsy (OR=1.831, 95% CI: 1.182 to 2.835, P=0.007) and tumor size >3 cm (OR=0.422, 95% CI: 0.206 to 0.864, P=0.018) were significantly correlated with choice of surgical treatment for breast lesions. Axillary lymph node dissection was performed for 118 cases (22.4%), with sentinel lymph node biopsy for 327 cases (62.2%), and none for 81 cases (15.4%). There was significant statistical difference in the choice of axillary lymph node management in patients of different age (χ2=8.124, P=0.017), biopsy type (χ2=35.567, P=0.000), breast operation type (χ2=149.118, P=0.000) and tumor size (χ2=13.394, P=0.010). The 5-year disease free survival rates was 95.7%, 89.6% and 100%, respectively, for mastectomy group, breast-conserving surgery group and breast-conserving surgery plus radiotherapy group. And the 5-year overall survival rates for three groups were 99.0%, 100% and 100%. The differences were not statistically significant (P=0.427, 0.777).@*Conclusions@#For DCIS patients, age, first symptom and tumor size are independent predictors of breast surgery. The choice of axillary lymph node surgery is influenced by age, biopsy, operation type, and tumor size. Different surgical treatment options has no significant effect on disease-free survival and overall survival in DCIS patients.

Relationships of ductal carcinoma in situ calcification feature and ER, PR and HER2 expression / 国际肿瘤学杂志

Objective To discuss the relationships of ductal carcinoma in situ calcification feature and estrogen receptor (ER),progesterone receptor (PR),human epidermal growth factor receptor 2 (HER2) expression.Methods The mammary gland molybdenum target X-ray results of 226 patients with ductal carcinoma in situ were retrospectively analyzed in our hospital during January 2013 to December 2016.All patients were divided into calcification group (n =110) and no calcium group (n =116).Immunohistochemical method was used to detect the expressions of ER,PR and HER2,and their relationships with calcification feature were analyzed.Results The positive expression rates of ER and PR in calcification group were 72.73％ and 54.55％ significantly higher than those in no calcium group (39.66％ and 38.79％;x2=25.033,P ＜0.001;x2 =5.632,P =0.036).The positive expression rate of HER2 in calcification group was 45.45％,significantly lower than that of the no calcium group (82.76％,x2 =34.358,P ＜ 0.001).According to the single factor analysis,the calcified form (x2 =31.098,P ＜ 0.001;x2 =24.117,P =0.003),distribution (x2=30.272 P＜0.001;x2=11.811,P=0.008),number (x2 =15.533 P＜0.001;x2 =7.875,P=0.019) and concomitant situation (x2 =27.915,P ＜0.001;x2 =7.229,P =0.027) were associated with ER and PR expressions,and the calcified distribution (x2 =8.068,P =0.035),number (x2 =60.768,P ＜0.001) and concomitant situation (x2 =24.915,P ＜ 0.001) were associated with HER2 expression.Logistic regression analysis shows that the small polymorphic form,cluster distribution,number ＞ 30,with mass were the independent prediction factors of ER,PR and HER2 expressions (all P ＜ 0.001).Conclusion The mammary gland molybdenum target calcification features of ductal carcinoma in situ are associated with ER,PR and HER2 expressions,the small polymorphic form,cluster distribution,number ＞ 30,with mass can be used as important reference indexes to preliminarily predict biological therapy and expressions of prognostic factors.

Sonographic findings and pathological features of ductal carcinoma in situ without microcalcifications on mammography / 中华医学超声杂志（电子版）

Objective To investigate the characteristic sonographic and pathological features of breast ductal carcinoma in situ (DCIS) without microcalcifications on mammography (MG).Methods Forty cases of DCIS without microcalcifications on MG were retrospectively reviewed.The 40 lesions were classified into mass and non-mass groups according to their sonographic findings.The pathological subtypes and nuclear grades of these cases were also analyzed.Fisher exact test was used to compare the differences of the sonographic accuracy rate,sonographic microcalcification rate,pathological nuclear grade and subtype rate between mass and non-mass groups.Results No abnormal finding was found in sixteen cases (40.0％)on MG and only one case (2.5％) on ultrasonography (US),respectively.The most common sonographic feature of DCIS without microcalcifications on MG were masses (75.0％,30/40),and other sonographic findings were round/oval and irregular shape,microlobulated margin,heterogeneous hypoechogenicity and isoechogenicity,and posterior acoustic feature.Ductal dilatations and heterogeneous isoechogenicity were present in most non-mass lesions of DCIS without microcalcifications on MG (22.5％,9/40).The ultrasonographic microcalcifications were found in 5 cases of DCIS without microcalcifications on MG.The common pathological features of DCIS without microcalcifications on MG were medium-low nuclear grade (85.0％,34/40) and noncomedo (87.5％,35/40).The difference of US accuracy rate in mass and non-mass groups was statistically significant [73.3％ (22/30) vs 33.3％ (3/9),P=0.047].The differences of US microcalcification rate,pathological subtype and nuclear grade were not significant (P=1.000,0.070).Conclusions The mass appearance and medium-low nuclear grade were most common sonographic findings and pathological features of DCIS without microcalcifications on MG.Ultrasonography should be an helpful tool for improving the diagnostic sensitivity ofmammography in breast DCIS.

The diagnosis and treatment of breast ductal carcinoma in situ / 国际肿瘤学杂志

Accurate knowledge,diagnosis and treatment of breast ductal carcinoma in situ(DCIS),are crucial in controlling the development of breast cancer.In the diagnosis phase,breast ultrasound is commonly used as a screening tool,and a clear diagnosis can be made by mammography.Meanwhile,serological tests contribute to the detection of DCIS in early stages.In the treatment,the optimal surgical operation method remains debatable.It is widely acknowledged that the radiotherapy of postoperative patients should become more individualized.In addition,corresponding endocrine therapy helps those ER positive patients to reduce the recurrence.In the development of DCIS to invasive cancer,there are changes in gene and protein expressions,which may be a potential direction for further research.

Simple magnetic resonance imaging criteria can differentiate ductal carcinomasin situ from invasive carcinomas / Critérios simples de imagem por ressonância mangética podem diferenciar carcinomas ductais in situ de carcinomas invasivos

Objective: To investigate if apparent diffusion coefficient (ADC) values can discriminate ductal carcinomas in situ (DCIS) from invasive carcinomas and to test the incremental gain of a model combining these measurements to dynamic contrast-enhanced (DCE) main pattern (mass versus non-mass). Methods: Forty-four lesions (12 DCIS and 32 invasive cancers) were reviewed by two examiners, their ADCs were averaged, and they were classified according to enhancement patterns. A logistic regression model with ADC values and enhancement patterns was devised. Receiver operating characteristic (ROC) curves were used to compare the discriminative performance of isolated ADCs to the regression model by their areas under the curve (AUCs). Results: ADC values were significantly different between lesion types (p=0.034), with mean of 1.23x10-3 mm2/s for DCIS and 1.05x10-3 mm2 /s for invasive cancers. The model grouping enhancement patterns and ADC values had better performance AUC=0.80) than isolated ADCs (AUC=0.71), though the difference was not statistically significant (p=0.105). Conclusion: ADC measurements of pre-invasive breast lesions are substantially different from those of invasive cancers. When ADC measurements are associated with main enhancement patterns, the performance of the technique is increased.

Objetivo: Investigar se valores de coeficiente de difusão aparente (ADC) podem discriminar carcinomas ductais in situ (CDIS) de carcinomas invasivos e testar o ganho incremental de modelo combinando tais medidas ao padrão principal de realce (nódulo versus realce não nodular) do estudo contrastado dinâmico (ECD). Métodos: Quarenta e quatro lesões (12 CDIS e 32 cânceres invasivos) foram revisadas por dois examinadores, seus ADCs médios calculados e elas foram classificadas de acordo com padrões de realce. Um modelo de regressão logística com valores de ADC e padrões de realce foi delineado. Curvas receiver operating characteristic (ROC) foram utilizadas para comparar a performance discriminativa dos ADCs isolados ao modelo de regressão através de suas áreas sob a curva (AUCs). Resultados: Os valores de ADC foram significantemente diferentes entre tipos de lesão (p=0,034), com média de 1,23x10-3 mm2 /s para CDIS e 1,05x10-3 mm2 /s para cânceres invasivos. O modelo agrupando padrões de realce e valores de ADC teve melhor performance (AUC=0,80) do que ADCs isolados (AUC=0,71), ainda que a diferença não tenha sido estatisticamente significante (p=0,105). Conclusão: Medidas de ADC de lesões mamárias pré-invasivas são substancialmente diferentes daquelas de cânceres invasivos. Quando medidas de ADC são associadas aos principais padrões de realce, a performance da técnica é aumentada.

Ductal carcinoma in situ diagnosed using an ultrasound-guided 14-gauge core needle biopsy of breast masses: can underestimation be predicted preoperatively?

PURPOSE: This study was designed to determine the rate of ductal carcinoma in situ (DCIS) underestimation diagnosed after an ultrasound-guided 14-gauge core needle biopsy (US-14G-CNB) of breast masses and to compare the clinical and imaging characteristics between true DCIS and underestimated DCIS identified following surgical excision. METHODS: Among 3,124 US-14G-CNBs performed for breast masses, 69 lesions in 60 patients were pathologically-determined to be pure DCIS. We classified these patients according to the final pathology after surgical excision as those with invasive ductal carcinoma (underestimated group) and those with DCIS (non-underestimated group). We retrospectively reviewed and compared the clinical and imaging characteristics between the two groups. RESULTS: Of the 69 lesions, 21 were shown after surgery to be invasive carcinomas; the rate of DCIS underestimation was 30.4%. There were no statistically significant differences with respect to the clinical symptoms, age, lesion size, mammographic findings, and ultrasonographic findings except for the presence of abnormal axillary lymph nodes as detected on ultrasound. The lesions in 2 patients in the non-underestimated group (2/41, 4.9%) and 5 patients in the underestimated group (5/19, 26.3%) were associated with abnormal lymph nodes on axillary ultrasound, and the presence of abnormal axillary lymph nodes on ultrasound was statistically significant (P=0.016). CONCLUSION: We found a 30.4% rate of DCIS underestimation in breast masses based on a US-14G-CNB. The presence of abnormal lymph nodes as detected on axillary ultrasound may be useful to preoperatively predict underestimation.

Ductal carcinoma in situ of the breast, report of 430 cases / 中华普通外科杂志

Objective To explore the clinical characteristics,treatment and prognosis of ductal carcinoma in situ of the breast.Methods We retrospectively analysed 430 patients with a diagnosis of DCIS in Cancer Hospital of Tianjin Medical University from January 1991 to December 2005,to evaluate the clinical characteristics,treatment and prognosis.Results Overall survival rate of 430 patients was 94.9％ (408/430).10 cases died of breast cancer recurrence,7 for local recurrence,3 for metastsis.Tumor size,TNM stages and structural pattern of pathlogy were prognosis impacting factors (P ＜ 0.05).The 5-year survival rate for combination radiotherapy and breast-conserving surgery group was 100％,and 10-year survival rate was 97.1％,comparing traditional modified radical mastectomy 5-year survival rate of 98.3％and 10-year survival of 96.7％ (P ＞ 0.05).The overall survival rate of surgery alone group (89.9％) was lower than the post-operative comprehensive treatment group (96.8％),(P ＜ 0.05).Conclusions Treatment of DCIS should be based on primary tumor's clinical stage and histologic characters.Breast-conserving surgery enjoys the same outcome as traditional modified radical mastectomy.

Carcinoma in situ de la mama: actualización / In situ breast cancer: an update

Los carcinomas in situ de la mama son el primer estado de cáncer de mama morfológicamente reconocible y pueden evolucionar a un carcinoma de mama invasivo, aunque se desconoce la tasa precisa de progresión. Debido a que el carcinoma ductal in situ es un predictor de carcinoma ductal invasivo en el futuro, es importante la participación de la paciente en la toma de decisiones sobre el tratamiento; actualmente, existen indicaciones precisas para realizar tratamiento conservador o radical, pero cada caso se debe analizar en forma independiente. Por su parte, el carcinoma lobulillar in situ es solo un marcador de riesgo de carcinoma invasivo, muchas de las pacientes no requieren tratamiento y se pueden dejar bajo observación. En este módulo se presentan los avances sobre el carcinoma in situ de mama en sus dos variedades, ductal y lobulillar, en lo relacionado con las manifestaciones clínicas, las alteraciones genéticas, el diagnóstico, el pronóstico, el tratamiento y el seguimiento. De igual forma, se hará una actualización de la enfermedad de Paget.

Carcinoma in situ of the breast is the first morphologically recognizable stage of breast cancer; it can progress to invasive disease; however, the precise rate of progression to invasive cancer is yet unknown. As ductal carcinoma in situ is a predictor of invasive ductal carcinoma, the decision-making process for treatment should be achieved with the patient. Currently, there are particular indications on which cases require conservative treatment and which require a radical treatment; nevertheless, each case must be considered independently. Regarding lobular carcinoma in situ, it is only considered a risk factor to develop invasive cancer, many of the patients do not need treatment and a close follow-up is suggested. In this review article, an update in signs and symptoms of ductal carcinoma in situ and lobular carcinoma in situ is included, as well as an update of their genetic abnormalities, diagnosis, prognosis, treatment and follow-up. In addition, an update in Paget disease is included.

Application of three dimensional volumetric interpolated breath-hold examination MRI in breast tumor diagnosi / 肿瘤研究与临床

Objective Make a scientific approach to the validity of 3D-VIBE MRI on breast tumor's evaluation.Methods 141 breast processes were examined by 3D Dynamic scanning technique with high speed and resolution, Compared with postop pathological appearance, the diagnosis of breast tumor, the ductal carcinoma in situ, their circumscriptions, and axillary lymph node metastasis were evaluated. Results The coincidence of tumor existence diagnosis was 97.2 ％(137/141). The accuracy, sensitivity and specificity of progression in duct were 69.4 ％(93/134), 75 ％(100/134), 57.1％(77/134), respectively.The accuracy,sensitivity and specificity of axillary lymph node metastasis were 92.5 ％(124/134), 53.8 ％(72/134), and 96.7 ％(129/134) respectively. Conclusion The reconstruction images through 3D Dynamic scanning technique with high speed and resolution could discover minute breast tumor and the extent of axillary lymph node metastasis around breast,and the extent of diseases in duct can also be effectively evalnated.

Cyclooxygenase-2 and human epidermal growth factor receptor type 2 (HER-2) expression simultaneously in invasive and in situ breast ductal carcinoma / Expressão da ciclo-oxigenase-2 e receptor tipo 2 do fator de crescimento epidérmico humano (HER-2) simultaneamente em carcinoma ductal de mama in situ e invasivo

CONTEXT AND OBJECTIVE: Cyclooxygenase-2 (COX-2) and human epidermal growth factor receptor type 2 (HER-2) are associated with tumorigenesis. Studies have shown that HER-2 can regulate COX-2 expression. The aim of this study was to evaluate the correlation between COX-2 and HER-2 expression in normal breast epithelium and in ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC) present in the same breast. DESIGN AND SETTING: Cross-sectional study at the Mastology Unit of the Department of Gynecology and Obstetrics, Santa Casa de Misericórdia de São Paulo Hospital. METHODS: COX-2 and HER-2 were detected using immunohistochemistry on 100 tissue fragments. HER-2 > +2 was subjected to fluorescence in situ hybridization (FISH). RESULTS: COX-2 expression was detected in 87 percent, 85 percent and 75 percent of IDC, DCIS and normal epithelium, respectively. HER-2 expression was detected in 34 percent of IDC and 34 percent of DCIS. COX-2 in DCIS correlated with HER-2 in IDC (P = 0.049) and DCIS (P = 0.049). COX-2 in normal epithelium correlated with HER-2 in IDC (P = 0.046) and DCIS (P = 0.046). COX-2 in IDC was not associated with HER-2 (P = 0.235). Comparison between COX-2 and HER-2 in DCIS showed that there was a statistically significant difference with regard to nuclear grades II and III and presence of comedonecrosis (P < 0.001). In IDC, there was significant expression with nuclear grades II and III and histological grade II (P < 0.001). CONCLUSIONS: Our findings provide evidence that HER-2 and COX-2 regulate each other.

CONTEXTO E OBJETIVO: Ciclo-oxigenase (COX-2) e receptor tipo 2 do fator de crescimento epidérmico humano (HER-2) estão associados com tumorigênese. Estudos mostraram que HER-2 pode regular a expressão de COX-2. O objetivo deste estudo foi avaliar a correlação entre expressão da COX-2 e HER-2 no epitélio normal de mama, no carcinoma ductal in situ (DCIS) e carcinoma ductal invasivo (IDC) presentes na mesma mama. TIPO DE ESTUDO E LOCAL: Estudo transversal na clínica de Mastologia do Departamento de Obstetrícia e Ginecologia do Hospital da Santa Casa de Misericórdia de São Paulo. MÉTODOS: A detecção da COX-2 e HER-2 foi realizada por imunoistoquímica em 100 fragmentos teciduais. HER-2 > +2 foi submetido a hibridização fluorescente in situ (FISH). RESULTADOS: Expressão de COX-2 foi detectada em 87 por cento, 85 por cento e 75 por cento dos IDC, DCIS e epitélio normal, respectivamente. Expressão de HER-2 foi detectada em 34 por cento dos IDC e 34 por cento de DCIS. COX-2 em DCIS correlacionou-se com HER-2 em IDC (P = 0,049) e DCIS (P = 0,049). COX-2 no epitélio normal correlacionou-se com HER-2 em IDC (P = 0,046) e DCIS (P = 0,046). COX-2 no IDC não foi associada com HER-2 (P = 0,235). Quando comparado COX-2 com HER-2 em DCIS houve diferença estatisticamente significante com relação ao grau nuclear II e III e presença de comedonecrose (P < 0,001) e no IDC, houve expressão significativa no grau nuclear II e III e histológico II (P < 0,001). CONCLUSÕES: Nossos achados mostram evidências que HER-2 e COX-2 se autorregulam.

Carcinoma intraductal bilateral em adolescente de 17 anos com ginecomastia: relato de caso / Bilateral intraductal carcinoma in a 17-year-old boy

Ginecomastia é uma alteração mamária comum na adolescência, que é, geralmente, tratadacomo problema estético. O carcinoma intraductal é uma proliferação anormal de células do revestimentodo epitélio ductal da glândula mamária, não invasiva, com potencial de desenvolverinvasão. Apresentou-se o caso de um jovem de 17 anos, que se encontrava em acompanhamentohá sete anos por ginecomastia puberal bilateral idiopática. Foi submetido à exérese de glândulasmamárias bilaterais, com resultado anatomopatológico de carcinoma intraductal dos tipos sólidoe cribiforme, de baixo grau, multifocal, com margens comprometidas, em ambas as mamas. Foiencaminhado ao Serviço de Mastologia do Hospital Amaral Carvalho, em Jaú, no estado deSão Paulo, para tratamento adicional, realizando-se mastectomia simples bilateral, sem terapiaadjuvante. Após 22 meses, encontrou-se em seguimento ambulatorial sem evidência de doençaativa. Concluiu-se que o carcinoma intraductal em homens é uma patologia rara, especialmentequando bilateral e associado à ginecomastia puberal. Por essa razão, a ginecomastia não deveser subestimada, especialmente quando a regressão espontânea não ocorrer, fazendo-se semprenecessário que o cirurgião envie a glândula mamária excisada à avaliação histológica.

Gynecomastia is a common breast change during adolescence, which is generally treated as an esthetic problem.Intraductal carcinoma is an abnormal proliferation of cells lining the ductal epithelium of the noninvasive,mammary gland, with potential to develop invasion. A case of a 17-year-old boy who was monitored for sevenyears for bilateral idiopathic pubertal gynecomastia was presented. He underwent an excision of bilateral mammaryglands with pathological results of intraductal carcinoma of solid and cribriform types, low-grade, multifocal,with positive margins in both breasts. He was referred to Serviço de Mastologia from Hospital AmaralCarvalho, in Jaú, São Paulo, for further treatment, a bilateral mastectomy was performed, without adjuvanttherapy. After 22 months, he was in follow-up without evidence of active disease. We concluded that intraductalcarcinoma in men is a rare condition, especially when bilateral and associated with pubertal gynecomastia.Therefore, gynecomastia should not be underestimated, especially when spontaneous regression does not occur,making it is always necessary for the surgeon to send the excised mammary gland to the histological evaluation.