More microinvasive foci in larger tumours of breast ductal carcinoma in situ

INTRODUCTION@#Microinvasion (Mi) is often thought to be an interim stage between ductal carcinoma in situ (DCIS) and invasive ductal carcinoma. This study aimed to investigate the potential influence of Mi on survival and assess its correlations with clinicopathological parameters, prognosis and molecular markers.@*METHODS@#The number of Mi foci in a cohort of 66 DCIS-Mi cases was assessed from haematoxylin and eosin-stained sections. Disease-free survival, clinicopathological parameters and biomarker expression were correlated with the number of Mi foci.@*RESULTS@#Higher numbers of Mi foci were found in larger tumours (P = 0.031).@*CONCLUSION@#Greater extent of DCIS is associated with multifocal Mi.

Comparative analysis of clinicopathological and mammographic findings between ductal carcinoma in situ with microinvasion and ductal carcinoma in situ / 中华放射学杂志

Objective:To comparative analyze mammographic and clinicopathological findings of ductal carcinoma in situ (DCIS) and DCIS with microinvasion (DCISM), and to investigate the predictive factors for DCISM.Methods:A total of 626 patients with DCISM and DCIS confirmed by surgery and pathology in the Affiliated Hospital of Qingdao University from January 2016 to July 2020 were collected and underwent preoperative mammography. The X-ray findings of DCISM and DCIS patients were classified and diagnosed according to the Breast Imaging Reporting and Data System (BI-RADS) criteria. The differences in clinicopathological and radiographic findings between DCISM and DCIS patients were analyzed using χ 2 test or Fisher exact test. The risk factors of DCISM were evaluated by using univariate and multivariate binary logistic regression analysis. Results:Among the 626 cases, 171 were diagnosed as DCISM, 455 were diagnosed as DCIS. Large diameter (≥2.7 cm), high nuclear grade, comedo type, axillary lymph node metastasis, high Ki67 proliferation index, negativity of estrogen receptor and progesterone receptor were found to be predictors of DCISM in the univariate analysis (all P<0.05). And large diameter (≥2.7 cm)(OR 2.229,95% CI 1.505-3.301, P<0.001), high nuclear grade(OR 1.711,95%CI 1.018-2.875, P=0.043) and axillary lymph node metastasis(OR 4.140,95% CI 1.342-12.773, P=0.013) were found to be independent predictors of DCISM in the multivariate analysis (all P<0.05). Mammographically, the lesion types, the presence and distribution of calcification were statistically significant between DCIS and DCISM patients (χ 2=17.42, 9.65, 9.10, P<0.05). Up to 17.6% (80/455) of DCIS were occult leisions, and DCISM showed more lesions with calcification in mass, asymmetry, and architectural distortion (49.1%, 84/171). Grouped calcifications were usually associated with DCIS (41.5%, 120/289), while regional calcification were commonly found in DCISM (35.9%, 47/131). Conclusions:Lesions with calcification and regional calcification were more likely associated with DCISM on mammography. Large diameter (≥2.7 cm), high nuclear grade and axillary lymph node metastasis were found to be independent predictors of DCISM.

Clinical comparison between ductal carcinoma in situ and ductal carcinoma in situ with microinvasion / 中华放射肿瘤学杂志

Objective To analyze the differences in the treatment patterns,clinical characteristics,treatment outcomes and prognostic factors between breast cancer patients with ductal carcinoma in situ (DCIS) and ductal carcinoma in situ with microinvasion (DCIS-MI).Methods Clinical data of 866 female patients including 631 DCIS cases and 235 DCIS-MI cases treated in our institution between 1999 and 2013 were retrospectively analyzed.The local control (LC),disease-free survival (DFS) and overall survival (OS) rates were calculated by Kaplan-Meier survival analysis.The prognostic factors were identified by Log-rank test.Results Similar LC,DFS and OS rates were obtained between two groups (all P＞ O.05).The univariate analysis demonstrated that Her-2-positive patients had worse OS and DFS than Her-2-negative counterparts.Patients undergoing breast-conserving surgery without radiotherapy had lower LC and DFS rates compared with those receiving radical mastectomy.Conclusions DCIS and DCIS-MI patients have similar clinical prognosis in terms of OS,LC and DFS.Her-2 positive is an unfavorable prognostic factor for DFS and OS.The LC and DFS rates in the breast-conserving surgery alone group are worse than those in the mastectomy group.

Study on microscopic marginal extensions of malignant liver tumors based on tumor types and ultrasonic characteristics / 中华超声影像学杂志

Objective@#To study the relationships between microscopic marginal extensions and tumor types, and ultrasonic characteristics of malignant liver tumors.@*Methods@#Two-dimensional ultrasonography, contrast-enhanced ultrasonography and ultrasound-guided biopsy of hepatic tumors and surrounding hepatic tissues were performed in 78 patients with malignant liver tumor. Pathological microscopic extensions were observed after hematoxylin-eosin staining of biopsy specimens.@*Results@#The microscopic marginal extension rates of hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC) and metastatic liver cancer (MLC) were 62.5%(30/48), 87.5%(7/8), and 91.0% (20/22), respectively. For tumors with well-defined and poorly-defined two-dimensional ultrasound boundary, microscopic marginal extension rates were 50%(14/28), and 86%(43/50). Tumor type and two-dimensional ultrasound boundary were independent predictors for microscopic extension rate (P<0.05). The median microscopic extension distances of HCC, ICC and MLC were 1.0(0, 3.0)mm, 4.0(2.3, 4.0)mm, and 2.0(1.8, 4.0)mm, respectively. The distance of microscopic extension increased with tumor size. Tumor type and tumor size were independent predictors for the distance of microscopic extension (P<0.05).@*Conclusions@#ICC, MLC, and tumors with larger diameter or poorly-defined two-dimensional ultrasound boundary have a larger distance of microscopic extension.

Study on microscopic marginal extensions of malignant liver tumors based on tumor types and ultrasonic characteristics / 中华超声影像学杂志

Objective To study the relationships between microscopic marginal extensions and tumor types ,and ultrasonic characteristics of malignant liver tumors . Methods Two‐dimensional ultrasonography , contrast‐enhanced ultrasonography and ultrasound‐guided biopsy of hepatic tumors and surrounding hepatic tissues were performed in 78 patients with malignant liver tumor . Pathological microscopic extensions were observed after hematoxylin‐eosin staining of biopsy specimens . Results T he microscopic marginal extension rates of hepatocellular carcinoma ( HCC) ,intrahepatic cholangiocarcinoma ( ICC) and metastatic liver cancer ( M LC) were 62 .5% ( 30/48 ) ,87 .5% ( 7/8 ) ,and 91 .0% ( 20/22 ) ,respectively . For tumors with well‐defined and poorly‐defined two‐dimensional ultrasound boundary ,microscopic marginal extension rates were 50% ( 14/28) ,and 86% ( 43/50) . T umor type and two‐dimensional ultrasound boundary were independent predictors for microscopic extension rate ( P ＜ 0 .05 ) . T he median microscopic extension distances of HCC ,ICC and M LC were 1 .0 ( 0 ,3 .0 ) mm ,4 .0 ( 2 .3 ,4 .0 ) mm ,and 2 .0 ( 1 .8 ,4 .0 ) mm ,respectively . T he distance of microscopic extension increased with tumor size . T umor type and tumor size were independent predictors for the distance of microscopic extension ( P ＜0 .05) . Conclusions ICC ,MLC ,and tumors with larger diameter or poorly‐defined two‐dimensional ultrasound boundary have a larger distance of microscopic extension .

Time-effect reaction observation of micro-invasion embedded poly glycolide-co-lactide suture in Sanyinjiao (SP6) in healthy subjects by using magnetic resonance / 针刺研究

OBJECTIVE: To observe the time-effect of stimulation of the embedded poly glycolide-co-lactide (PGLA) suture in Sanyinjiao (SP6) area in normal human body, so as to provide an experimental evidence for clinical application of micro-invasion suture-embedding at an appropriate interval. METHODS: A total of 8 healthy volunteer students (3 boys and 5 girls, ranging in age from 24 to 27 years) were recruited in the present study. A piece of sterilized PGLA suture was implanted into the left SP6 using minimally invasive surgery after strict local skin disinfection. The fat-suppression T2 weighted magnetic resonance images (MRI, displaying local lesion after eliminating interference of fat tissue signals), and T2 mapping 8-echo train images were acquired before and 8 h, 3, 7, 10 and 14 days after PGLA suture embedment by using a MR imaging system. After transformation of the T2-mapping 8-echo train images into T2-mapping images by using a relevant software, the T2 values (meaning the relaxation time of the local muscle) of the left SP6 were measured, followed by analysis of the signal intensity of T2 weighted fat-suppression images and T2 values at different time-points. RESULTS: Before the suture embedding, no abnormal signals were found in the signal intensity of T2 weighted fat-suppression images. After PGLA suture embedment, the local signal intensity of T2WI fat-suppression images was relatively increased at the 8th h, and on day 3, 7, 10 and 14 relevant to pre-embedment, but gradually atte-nuated on day 10 and 14. The T2 values were significantly increased at the 5 time-points of post-embedment (all P0.05), and being markedly lowered on day 14 relevant to day 7 (P<0.01) in spite of being still markedly higher than that of pre-embedding (P<0.01). CONCLUSION: The signal intensity of T2 weighted fat-suppression images and T2 values acquired from PGLA-suture-embedded SP6 acupoint area in healthy subjects may keep at least for 2 weeks, suggesting that the stimulating reaction of suture-embedment persists more than 14 days. Hence, when a micro-invasion embedding with PGLA suture performed, the interval of two weeks would be appropriate.

Clinical application and stability of hydromorphone in an implantable imfusion system: Research advances / 国际药学研究杂志

Hydromorphone (HM), appeared in the Chinese market in 2013 is a more potent opioid analgesic than morphine and is used for moderate to severe pain. Micro-invasive drug administration methods,including continuous infusion and patientcontrolled analgesia(PCA), will provide hopes for controlling the outbreak of pain and improving patients' satisfaction. At present, hydromorphone is the most commonly used drug for the treatment of acute pain, chronic pain and cancer pain. However, we should also consider the stability and compatibility of hydromorphone in the implantable infusion system that is most commonly used in these patients. The purpose of this paper is to review the clinical application and stability (changes in color, pH and concentration) of hydromorphone in different infusion systems so as to provide the basis of rational clinical application.

Clinical application and stability of hydromorphone in an implantable imfusion system:research advances / 国际药学研究杂志

Hydromorphone(HM),appeared in the Chinese market in 2013 is a more potent opioid analgesic than morphine and is used for moderate to severe pain. Micro-invasive drug administration methods,including continuous infusion and patientcon?trolled analgesia(PCA),will provide hopes for controlling the outbreak of pain and improving patients' satisfaction. At present ,hydro?morphone is the most commonly used drug for the treatment of acute pain,chronic pain and cancer pain. However,we should also con?sider the stability and compatibility of hydromorphone in the implantable infusion system that is most commonly used in these patients. The purpose of this paper is to review the clinical application and stability(changes in color,pH and concentration)of hydromor?phone in different infusion systems so as to provide the basis of rational clinical application.

Risk factors of microinvasion in breast ductal carcinoma in situ / 中国肿瘤临床

Objective:To analyze risk factors of breast ductal carcinoma in situ (DCIS) with microinvasion (DCIS-MI) and explore suitable axillary lymph node surgery treatment for patients with DCIS-MI. Methods:The clinical characteristics, such as age, menopausal status at diagnosis, size of breast mass, and pathology reports of 45 patients with breast DCIS or DCIS-MI treated at Jinling Hospital, Medical School of Nanjing University from February 2013 to February 2016, were retrospectively collected and analyzed statistically to deter-mine the risk factors associated with microinvasion. Results:Premenopause (P=0.006), tumor size≥3.15 cm (P=0.006), and family his-tory of malignant tumor (P=0.002) were proven risk factors of DCIS-MI. Conclusion:Patients with clinical palpable axillary mass, pre-menopause, large breast mass, and family history of malignant tumor demonstrated high possibility of DCIS-MI. Hence, sentinel lymph node biopsy should be performed. Axillary lymph node dissection is highly recommended to patients whose main symptom is palpable axillary mass.

Time-effect observation of stimulating effect on acupoints after micro-invasion embedding in healthy subjects / 中国针灸

<p><b>OBJECTIVE</b>To in vivo dynamically observe the time-effect characteristic of local stimulating effect on acupoints after micro-invasion embedding, which could provide references for the interval period of micro-invasion embedding.</p><p><b>METHODS</b>With magnetic resonance imaging (MRI) technique, the local T2WI fat-suppression images and T2 Mapping 8-echo sequence images were collected at multiple time points from 8 healthy subjects who received embedding at left Sanyinjiao (SP 6).After the 8-echo sequence images were transformed into T2 Mapping images by using software FuncTool, the T2 average value of embedding area was measured, and the changes of local signal strength of T2WI fat-suppression images and T2 average value along with time after embedding at left Sanyinjiao (SP 6)were analyzed.</p><p><b>RESULTS</b>Compared before embedding, the signal strength of local T2WI fat-suppression images and the T2 average value began to increase 8 h after being embedded(<0.01); the signal strength of T2WI fat-suppression images and the T2 average value were significantly increased 3 d and 7 d after being embedded(all<0.01);the signal strength of local T2WI fat-suppression images and the T2 average value 14 d after being embedded were lower than those at previous 2 time points, but higher than those before embedding(both<0.01); 21 d, 28 d and 35 d after embedding, the signal strength of local T2WI fat-suppression images and the T2 average value were similar to those before treatment (all>0.05).</p><p><b>CONCLUSIONS</b>After micro-invasion embedding at Sanyinjiao (SP 6), the stimulation effect period on acupoint is approximately 21 days.When applying micro-invasion embedding under similar condition at acupoints which has similar structure as Sanyinjiao (SP 6), the interval period of embedding could consider 21 days as a reference.</p>

Prognostic factors and clinicopathological characteristics of small gastrointestinal stromal tumor of the stomach：A retrospective study of 31 cases / 中国肿瘤临床

10.3969/j.issn.1000-8179.2013.12.012

Proposal for Creating a Guideline for Cancer Registration of Microinvasive Tumors of the Breast and Ovary (II)

BACKGROUND: Cancer registration in Korea has a longer than 30-years of history, during which time cancer registration has improved and become well-organized. Cancer registries are fundamental for cancer control and multi-center collaborative research. However, there have been discrepancies in assigning behavior codes. Thus, we intend to propose appropriate behavior codes for the International Classification of Disease Oncology, 3rd edition (ICD-O-3) for microinvasive tumors of the ovary and breast not only to improve the quality of the cancer registry but also to prevent conflicts. METHODS: As in series I, two pathology study groups and the Cancer Registration Committee of the Korean Society of Pathologists (KSP) participated. To prepare a questionnaire on provisional behavior code, the relevant subjects were discussed in the workshop, and consensus was obtained by convergence of opinion from members of KSP. RESULTS: Microinvasive tumor of the breast should be designated as a microinvasive carcinoma which was proposed as malignant tumor (/3). Serous borderline tumor with microinvasion of the ovary was proposed as borderline tumor (/1), and mucinous borderline tumor with microinvasion of the ovary as either borderline (/1) or carcinoma (/3) according to the tumor cell nature. CONCLUSIONS: Some issues should be elucidated with the accumulation of more experience and knowledge. Here, however, we present our second proposal.

Proposal for Creating a Guideline for Cancer Registration of Microinvasive Tumors of the Breast and Ovary (II)

BACKGROUND: Cancer registration in Korea has a longer than 30-years of history, during which time cancer registration has improved and become well-organized. Cancer registries are fundamental for cancer control and multi-center collaborative research. However, there have been discrepancies in assigning behavior codes. Thus, we intend to propose appropriate behavior codes for the International Classification of Disease Oncology, 3rd edition (ICD-O-3) for microinvasive tumors of the ovary and breast not only to improve the quality of the cancer registry but also to prevent conflicts. METHODS: As in series I, two pathology study groups and the Cancer Registration Committee of the Korean Society of Pathologists (KSP) participated. To prepare a questionnaire on provisional behavior code, the relevant subjects were discussed in the workshop, and consensus was obtained by convergence of opinion from members of KSP. RESULTS: Microinvasive tumor of the breast should be designated as a microinvasive carcinoma which was proposed as malignant tumor (/3). Serous borderline tumor with microinvasion of the ovary was proposed as borderline tumor (/1), and mucinous borderline tumor with microinvasion of the ovary as either borderline (/1) or carcinoma (/3) according to the tumor cell nature. CONCLUSIONS: Some issues should be elucidated with the accumulation of more experience and knowledge. Here, however, we present our second proposal.

Borderline Clear Cell Adenofibromatous Tumors of the Ovary: Two Case Reports

Borderline clear cell adenofibromatous tumors are rare with only 26 cases reported in the English literature. Five of these cases exhibited microinvasion and 4 demonstrated intraepithelial carcinoma. We report 2 cases, one typical case and the other with microinvasion. The histological findings revealed widely spaced and focally crowded, variably-sized atypical glands or tubules lined by clear, eosinophilic or hobnail cells set in a dense fibrous stroma. One of the two cases had small solid nests or single cells in the stroma around the proliferative glands less than 1 mm in length that was considered to be a microinvasion.

A clinical study of borderline ovarian tumor: The significance of microinvasion / 부인종양

OBJECTIVE: To identify the clinical features, survival rate, and prognostic factors of the borderline ovarian tumor. METHODS: Data on 48 patients with borderline ovarian tumor were analyzed with regard to histologic type, age, staging, operation method, tumor size, preoperative CA 125 level, menopause status and presence of stromal microinvasion. Most informations were obtained from hospital record and were analyzed retrospectively. RESULTS: There were 43 patients with stage I and 5 with stage III by FIGO classification. The mean age was 47.3 years (range 17-84). The mean size of tumor between patients with serous tumor and patients with mucinous tumor was 12.3 cm and 17.8 cm, respectively, and there was statistical difference between the two groups (p0.05), and no difference between premenopausal group and postmenopausal group (p>0.05), but difference between stage I patients and stage III patients (p0.05), and no difference among stage III patients according to operation method (>0.05). There was no statistical difference in stage between patients with microinvasive tumor and patients without microinvasive tumor (p>0.05). And there was no difference in disease free survival between patients with microinvasive tumor and patients without microinvasive tumor (p>0.05). CONCLUSION: The FIGO stage is the prognostic factor in the borderline ovarian tumor. The implication of microinvasion may need to be evaluated further.

Axillary Lymph Node Metastasis in Patients of Ductal Carcinoma in Situ or Ductal Carcinoma in Situ with Microinvasion / 한국유방암학회지

PURPOSE: The development of publicized screening methods for breast carcinoma detection has led to a marked increase in the discovery of ductal carcinoma in situ (DCIS) or DCIS with microinvasion (DCIS-MI). Axillary lymph node status has been believed to be not only an indicator of prognosis, but also a direction of adjuvant therapy. But the incidence of axillary metastasis in DCIS or DCIS-MI has diversely found in from 0% to 20%. This study was performed to analyze the incidence of axillary metastasis and the predictive factors associated with axillary lymph node metastasis in DCIS or DCIS-MI. METHODS: Patients with DCIS or DCIS-MI and axillary lymph node dissection from 1987 to 2004 were selected from Korea University Medical Center. We reviewed their medical records for age, palpability and size of the tumor, histolgic subtype, nuclear grade, hormone receptor status, and pathologic slides. RESULTS: Fifty two patients in DCIS and Thirty eight patients in DCIS-MI were included in the study. Axillary lymph node metastases were identified in 2 patients (3.8%) in DCIS and 4 patients (10.5%) in DCIS-MI. Tumor size and nuclear grade in DCIS had a borderline significance in association with microinvasion. We could not be able to find any predictive factor associated with axillary lymph node metastasis in DCIS and DCIS-MI. CONCLUSION: Axillary lymph node metastasis in DCIS or DCIS-MI appeared to be not low and there was no predictive factor associated with axillary lymph node metastasis in DCIS and DCIS-MI. But DCIS patients with large tumor size and poor nuclear grade have the high possibility associated with microinvasion, therefore, in that cases, there is a need to consider the possibility of axillary metastasis.

Ductal Carcinoma in Situ (DCIS) and Ductal Carcinoma in Situ with Microinvasion (DCIS-MI) of the Breast

PURPOSE: The use of mammographic screening has led to the early detection of breast cancers as well as the increasing incidence of ductal carcinoma in situ (DCIS) and DCIS with microinvasion (MI). The biologic behaviors and management of DCIS and DCIS with MI remain uncertain and controversial. We designed this study to investigate the differences in clinical behavior and association with pathological parameter of both DCIS and DCIS with MI. METHODS: DCIS with MI was defined as DCIS with and invasive area of 1 mm or less in greatest dimension. We analyzed and compared the clinico-pathological features and treatment outcomes of 155 DCIS patients and 73 DCIS with MI patients. Chi-square test, student t-test and Kaplan-Meier method using SPSS 9.0 for MS-windows were used to verify the statistical significance. RESULTS: Both DCIS with MI and DCIS were most prevalent in women in the fifth decade, and the mean ages of the two groups were 45.0 and 46.8 years old, respectively. The primary tumors of DCIS with MI were more palpable (72.6% vs. 56.8%, P=0.032) upon physical examination and larger (3.1+/-0.21 cm vs. 2.6+/-0.12 cm, P=0.037) than those of the DCIS group. The rate of axillary lymph node metastasis was higher in the DCIS with MI group (8.3% vs. 0.7%, P=0.003). The DCIS with MI group was more commonly associated with high nuclear grade (50% vs. 28%, P=0.028). The DCIS with MI group was also linked with comedo type, although not to a statistically significant degree (67.6% vs. 52.6%, P=0.095). In terms of hormone receptor, there was no significant difference between the groups. There were three systemic metastases in DCIS patients and two DCIS with MI patients (P>0.05). There were no local-regional recurrences in either groups. The 8-year disease-free survival rates of the DCIS and DCIS with MI groups were 98.1% and 95.8% respectively (P>0.05). CONCLUSION: DCIS with MI has several clinical-pathological characterisitcs: more palpable on physical examination, larger in size, higher incidence of lesions with comedo necrosis and high nuclear grade. Examination of the axillary lymph node with less invasive techniques may be necessary in cases with suspicious invasion. Since DCIS with MI is thought to be a transitional disease entity between DCIS and invasive ductal carcinoma and has a metastatic potential, a careful histologic evaluation is necessary for the diagnosis of DCIS.

Clinicopathological Analysis of Ductal Carcinoma in situ (DCIS) and Ductal Carcinoma in situ with Microinvasion

PURPOSE: The natural history of patients with ductal carcinoma in situ (DCIS) with microinvasion is poorly defined, and the clinical management of these patients, with particular reference to management of the axilla, has been controversial. Previous studies of this lesion have used arbitrary criteria for the evaluation of microinvasion. METHODS: In order to compare the clinicopathologic features and treatment outcomes between DCIS and DCIS with microinvasion, the medical records of 101 patients of DCIS with or without microinvasion who had been treated at Yongdong Severance hospital from April 1991, to October 1998, were reviewed retrospectively. RESULTS: The mean age of the DCIS with microinvasion group was 44.8 years-old and that of the DCIS group was 47.4 years-old. The peak age group within both study groups was the 5th decade. The primary tumors of the DCIS-MI group were larger (2.16 vs 1.93 cm) and more easily palpated (66.3% vs 36.6%) upon the physical examination than that of the DCIS group. The rate of axillary lymph node metastasis was higher in the DCIS-MI group (10% vs 1.3%). In terms of nuclear grade, comedo type, hormone receptor status, and c-erbB2 immunohistochemical positivity, there were no statistically significant differences between the DCIS and DCIS-MI groups. The recurrence rate within the DCIS-MI group was higher than that of DCIS group (10% vs 1.4%). The 5-year disease free survival rate of the DCIS and DCIS-MI groups were 98% and 89% respectively. CONCLUSION: Ductal carcinoma in situ with microinvasion is thought to be a transitional disease entity between ductal carcinoma in situ and invasive ductal carcinoma. However, the treatment options for ductal carcinoma in situ with microinvasion have been similar to that of the invasive carcinoma. More long-term follow-up and a multicenter study seem to be necessary to identify differences in the clinical features and to determine the optimal methods of treatment.

Clinicopathological analysis of ductal carcinoma in situ(DCIS) and ductal carcinoma in situ with microinvasion / 한국유방암학회지

BACKGROUND: The natural history of the patients of ductal carcinoma in situ(DCIS) with microinvasion is poorly defined, and the clinical management of these patients, with particular reference to management of the axilla, has been controversial. Previous studies of this lesion have used and/or arbitrary criteria for the evaluation of microinvasion. METHODS: To compare the clinicopathologic features and the outcomes of treatment between DCIS and DCIS with microinvasion, the medical records of 101 patients of DCIS with/without microinvasion who had been treated at Yongdong Severance hospital from Apr. 1991, to Oct 1998, were reviewed retrospectively. RESULTS: The mean age of the patients of DCIS with microinvasion group was 44.8 years and that of the patients of DCIS group was 47.4 years. The peak age group of both was 5th decade. The primary tumors of DCIS-MI group were larger(2.16 vs 1.93cm) and more easily palpated(66.3% vs 36.6%) on the physical examination than that of DCIS group. The rate of the axillary lymph node metastasis was higher in DCIS-MI group.(10% vs 1.3%) In terms of nuclear grade, comedo type, hormone receptor status, and c-erbB2 immunohistochemical positivity, there were no statistical significances between DCIS group and DCIS-MI group. The recurrence rate of DCIS-MI group was higher than that of DCIS group.(10% vs 1.4%) The 5-year disease free survival rate of the DCIS group and DCIS-MI group were 98% and 89% respectively. CONCLUSIONS: Ductal carcinoma in situ with microinvasion is thought to be transitional disease entity between ductal carcinoma in situ and invasive ductal carcinoma. But the treatment options of ductal carcinoma in situ with microinvasion were similar to that of the invasive carcinoma. More long-term follow-up and multicenter studies seem to be necessary to identify differences in clinical features and to determine the optimal methods of treatment.

Expression of p53 Protein and Ki-67 in Atypical Ductal Hyperplasia, Ductal Carcinoma in Situ, and Microinvasive Ductal Carcinoma of the Breast

Mutation of the p53 gene is one of the most common genetic alterations in invasive breast carcinoma. However, it is unclear that the mutation usually occurs in noninvasive breast lesions. It might be expected that there is a correlation between histologic progression of breast lesions and proliferative rate. We investigated the expression of p53 protein and Ki-67 labelling index (LI) using immunohistochemistry in 16 ductal carcinoma in situ with microinvasion (DCIS-Mi), 56 DCIS, 15 atypical ductal hyperplasia (ADH), and 7 intraductal hyperplasia (IDH). Expression of p53 protein was detected in 33.9% of DCIS and 56.3% of DCIS-Mi and was confined exclusively in Van Nuys DCIS group 2 and 3. In ADH and IDH, no expression of p53 protein was found. There was no significant correlation between Van Nuys DCIS groups and Ki-67 LI. In conclusion, p53 mutation may be involved in the neoplastic progression from ADH to DCIS and is directly related to high nuclear grade and associated necrosis of DCIS.