유방의 관상피내암과 미세침윤을 동반한 관상피내암의 임상 양상 및 병리학적 특성 비교
Ductal Carcinoma in Situ (DCIS) and Ductal Carcinoma in Situ with Microinvasion (DCIS-MI) of the Breast
최기홍, 고승상, 김승기, 박병우, 이경식,
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최기홍 ( Choi Gi-Hong )
연세대학교 의과대학 외과학교실
고승상 ( Ko Seung-Sang )
연세대학교 의과대학 외과학교실
김승기 ( Kim Seung-Ki )
포천중문의과대학교 외과학교실
박병우 ( Park Byeong-Woo )
연세대학교 의과대학 외과학교실
이경식 ( Lee Kyung-Sik )
연세대학교 의과대학 외과학교실
KMID : 0371320020630030193
Abstract
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 ㎜ 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 ㎝ vs. 2.6±0.12 ㎝, 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.
키워드
유방암; 관상피내암; 미세침윤; Breast cancer; Ductal carcinoma in situ; Microinvasion;
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