Clinical Features And Prognosis Of Ductal Carcinoma In Situ With Microinvasion Of Breast

Objective:With the enhancement of people’s awareness of early diagnosis and treatment,breast cancer screening has been popularized,and the rapid development of imaging technology(breast ultrasound,molybdenum target,magnetic resonance)and pathological biopsy technology,so more and more breast cancer can be detected at an early stage.The detection rate of ductal carcinoma in situ with microinvasion(dacis-mi)was also improved.Many studies have shown that dcis-mi is an intermediate stage from ductal carcinoma in situ(DCIS)to Invasive ductal carcinoma(IDC).This study collected and compared patients with DCIS,dcis-mi and T1a stage invasive ductal carcinoma(tla-idc)who underwent surgical treatment in the affiliated hospital of southwest medical university from January 2013 to December 2018,the differences in the medical history,clinical manifestations,breast ultrasound,mammary molybdenum target and pathological features of the three groups were compared to explore the clinical characteristics of DCIS-MI and its stage in the development of breast cancer;In order to more accurately screen the patients with micro-infiltration from DCIS,the variables with statistical and clinical significance in the clinicopathological and imaging features of the DCIS group and the dcis-mi group were as follows:the variables of tumor size,lymph node metastasis,histological grading,PR expression,her-2 expression,major manifestations of breast ultrasound images,abnormal enlargement of axillary lymph nodes by ultrasound,and simple calcification under molybdenum target were compared to analyze the risk factors affecting the formation of micro-infiltration;By collecting the follow-up information of patients in the three groups of DCIS,dcis-mi and t1a-idc,the differences of survival and prognosis among the three groups were analyzed and studiedMethods:We collected and compared breast cancer patients who underwent surgical treatment in affiliated hospital of southwest medical university from January 2013 to December 2018,270 patients with complete data and meeting the research criteria were included,among which 126 were dcis,74 were dcis-mi and 70 were tla-idc.The clinicopathological,imaging characteristics and follow-up data of the three groups of patients were collected.The classification data were represented by the composition ratio n(%),and Chi-square tests are used to compare differences between qualitative data.The survival curve was plotted by kaplan-meier method,and log-rank test was performed(equation=0.05).The ROC curve was drawn based on the presence or absence of microinvasion,and the AUC’s ability to measure the tumor size and predict the microinvasion was obtained.The optimal cutoff value of the tumor size was obtained by calculating the Jordan index.Will DCIS with DCIS-MI group was statistically significant in clinical pathology and the imaging features and clinical significance of variables such as:tumor size,lymph node metastasis and histological grading,PR expression,its her-2 expression,breast ultrasound images mainly,abnormal ultrasonic axillary lymph node enlargement,molybdenum target under pure calcification in Logistic regression analysis,the risk factors influencing the micro infiltration.Results:There are differences in clinicopathological and imaging morphology between dcis-mi and DCIS,which are mainly manifested in the following aspects:tumor size,lymph node metastasis status,histological grading,PR expression,her-2 expression,major manifestations of breast ultrasound images,abnormal enlargement of axillary lymph nodes by ultrasound,and morphology and distribution of calcification under molybdenum target;The differences between dcis-mi and tla-idc were mainly manifested in the following aspects:the expression of PR,the expression of her-2,the blood flow signal in ultrasound,the posterior echo,the aspect ratio of tumor,and the distribution of calcification under molybdenum target;The survival time without recurrence and metastasis of DCIS-MI(77.17±3.882)was similar to that of T1a-IDC(78.46±4.891)and lower than that of DCIS(81.84±2.844),with no statistically significant difference(P>0.05,table 22);Patients with tumor diameter≥1.6cm,high expression of her-2,breast occupying ultrasound manifestations of tumor,abnormal enlargement of axillary lymph nodes under ultrasound are more likely to have micro-infiltration,and positive PR expression and simple calcification under molybdenum target are protective factors for micro-infiltration.Conclusion:1.Compared with DCIS,the tumor of DCIS-MI has a large diameter,a high rate of axillary lymph node metastasis,a high histological grade in the components of carcinoma in situ,a high proportion of high expression of her-2,and segment-like fine-line branching calcification is more common.Compared with tla-idc,DCIS-MI has little difference in clinicopathological features and similar prognosis,so it can be considered that DCIS-MI is a subgroup of tla-idc;2.Patients with tumor diameter≥1.6cm in DCIS,high expression of her-2,ultrasonic manifestations of tumor,and abnormal enlargement of ultrasonic lymph nodes have a higher risk of micro-infiltration;3.DCIS-MI lymph node metastasis rate is higher than that of DCIS,so sentinel lymph node biopsy should be used as a routine operation to avoid missed diagnosis or excessive treatment;4.The survival time without recurrence and metastasis of dcis-mi was similar to that of tla-idc,but lower than that of DCIS.Therefore,patients with micro-infiltration should be identified as far as possible before surgery and treated individually.