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目的比较乳腺导管内癌(DCIS)与微浸润癌(DCIS-MI)的病理及生物学指标表达差异,探讨DCIS发展为浸润癌的过程中可能存在的病理或生物学特性改变。方法回顾分析40例DCIS和30例DCIS-MI,采用Pearson χ2检验比较两者导管内癌成分的病理学指标,采用Wilcoxon秩和检验比较两者雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体(HER-2)、P53及Ki67生物学指标的差异。结果 DCIS的病理分型中,粉刺型和非粉刺型的病例分别占25.0%(10/40)和75.0%(30/40),而DCIS-MI的导管内癌成分中粉刺型和非粉刺型分别占63.3%(19/30)和36.7%(11/30),两者差异有统计学意义(χ2=10.38,P=0.001);DCIS-MI的导管内癌成分中高级别的核分级和伴坏死的比例明显高于DCIS(χ2=9.52,P=0.009,χ2=8.57,P=0.003)。DCIS与DCIS-MI两组间ER、PR、HER-2和P53的表达差异均无统计学意义(P>0.050)。DCIS-MI中Ki67增殖指数高表达(>20%)比例明显高于DCIS(40.0%比17.5%;Z=-2.35,P=0.019)。结论 Ki67增殖指数对评价DCIS发生浸润有一定的临床价值。
OBJECTIVE: To compare the pathological and biological features between DCIS and DCIS-MI and to explore the possible pathological or biological changes of DCIS in invasive carcinoma. Methods Forty cases of DCIS and 30 cases of DCIS-MI were retrospectively analyzed. Pearson χ2 test was used to compare the pathological parameters of the two intraductal carcinomas. The Wilcoxon rank sum test was used to compare the expression of estrogen receptor (ER), progesterone receptor PR), human epidermal growth factor receptor (HER-2), P53 and Ki67 biological indicators. Results The pathological types of DCIS were 25.0% (10/40) and 75.0% (30/40) for acne and non-acne, respectively Accounting for 63.3% (19/30) and 36.7% (11/30) respectively, the difference was statistically significant (χ2 = 10.38, P = 0.001). Among the components of DCIS-MI, The proportion of necrosis was significantly higher than DCIS (χ2 = 9.52, P = 0.009, χ2 = 8.57, P = 0.003). The expression of ER, PR, HER-2 and P53 between DCIS and DCIS-MI had no significant difference (P> 0.050). Ki67 proliferation index was significantly higher (> 20%) in DCIS-MI than in DCIS (40.0% vs. 17.5%; Z = -2.35, P = 0.019). Conclusion The Ki67 proliferation index has some clinical value in evaluating the infiltration of DCIS.