A retrospective analysis was performed to the 69 follow-up cases of ducal carcinoma in situ(DCIS) treated from Jan. 1981 to Dec. 1995 at Department of Surgery, Seoul National University Hospital.
@ES The results are as follows:
@EN Mean age was 45.4 years with ranges from 28 to 69.
The proportion of DCIS to breast cancer was increased from 1.3% to 7.2% for 15 years. Clinical presentations of DCIS were mass, nipple discharge and suspicious mammographic findings. Patients presenting mass were decreased, while mammographically
detected
DCIS were increased.
In 49.3% of cases, tumor size was smaller than 2 cm and in 21.3% of the cases, tumor was not palpable.
Treatment modality was changed to more conservative procedures. All of the patients survived well without local recurrence or distant metastasis for a mean follow-up of 36.3 months(range 7 to 146).
Histopathologic review was also performed to 52 cases of which paraffin block were saved, by one pathologist and diagnosis was confirmed.
Pure DCIS-was 16 cases(30.8%), and DCIS with micromvasion was 36 cases(69.2%).
Clinical presentation of DCIS, such as age, nipple discharge, calcification on mammography and mass size were not related to the microinvasion, but mass palpability was related to microinvasion(p=0.018). There was no histopathologic features to
predict
progression to invasive carcinoma, regardless of comedo type, histologic grad and nuclear grade.
The expression of cathepsin-D, nm23, p53 and o-erbB-2 protein, was also evaluated using immunohistochemical methods. The relationship between expression of immunohistochemical antibodies and prognostic variables such as tumor size, histologic
grade,
nuclear grade, and microinvasion was assessed. The overexpression of c-erbB-2 protein was associated with lower nuclear grade(p=0.033), and strong correlation was seen between tumor size and cathepsin-D and p53 protein(p=0.035, p=0.016).
In this study, we conclude that fine classification and analysis of DCIS subtype, not only by histopathologic but also by immunohistochemical study can be helpful to predict biological behaviour of DCIS and decide the modality of treatment.
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