Cancerization of lobules (COL) is defined as the involvement of lobular acini by ductal carcinoma in situ (DCIS). Whether it represents a morphological variation in DCIS or a secondary extension of DCIS into lobules is debatable. The relation between COL and the probability of invasion is conflicting among different studies. We assessed if COL is a predictor of adverse pathological outcomes in mastectomy specimens. We reviewed the clinicopathological data of patients who underwent partial or total mastectomy for DCIS during a 3-year period (January 2015 until December 2017). Pathological parameters and follow-up data were collected. Whole-tissue hematoxylin and eosin (H&E) slides were reviewed and re-evaluated for COL. Cases with COL were stained immunohistochemically for E-cadherin and p120 to confirm the ductal phenotype of the neoplasms. In total, 171 mastectomies were identified including 65 specimens with pure DCIS and 106 specimens with DCIS with invasive carcinoma. COL was identified in 73 specimens. COL was significantly associated with adverse pathological outcomes including higher DCIS nuclear grade (p-value = 0.006), central (expansive “comedo”) necrosis (p-value = 0.008), presence of DCIS within or less than 2 mm from the surgical resection margin(s) (p-value = 0.004), higher percentage of blocks/slides with DCIS (p-value < 0.001), and extensive intraductal component (EIC) (applicable in cases with invasion) (p-value < 0.001). Invasion was seen in approximately two-thirds of the cases regardless of the presence of COL, with no statistical significance. Ninety-eight patients achieved 60 months of follow-up, of which only one patient developed local DCIS recurrence and had COL and EIC. Four other patients developed metastatic disease related to the invasive component. While other studies have previously hypothesized that COL may be associated with a worse pathological outcome at mastectomy, our results show that it may indeed be a measure of a higher disease burden representing EIC; however, it is not associated with an increased risk of detecting invasive carcinoma.
小叶癌化（COL）被定义为导管原位癌（DCIS）累及小叶腺泡。其究竟是DCIS的形态学变异，还是DCIS向小叶的继发性延伸，目前尚存争议。关于COL与浸润概率之间的关系，不同研究的结果存在矛盾。本研究旨在评估COL是否是乳腺切除标本中不良病理结果的预测因子。我们回顾了在三年期间（2015年1月至2017年12月）因DCIS接受部分或全部乳房切除术患者的临床病理资料，收集了病理参数和随访数据。对所有组织的苏木精-伊红（H&E）染色切片进行复查并重新评估COL。对存在COL的病例进行E-钙粘蛋白和p120的免疫组化染色，以确认肿瘤的导管表型。总共确定了171例乳房切除术，其中65例为单纯DCIS标本，106例为DCIS伴浸润性癌标本。在73例标本中发现了COL。COL与多种不良病理结果显著相关，包括更高的DCIS核分级（p值=0.006）、中心（膨胀性“粉刺样”）坏死（p值=0.008）、手术切缘处或切缘2毫米内存在DCIS（p值=0.004）、含有DCIS的蜡块/切片比例更高（p值<0.001），以及广泛的导管内成分（EIC）（适用于存在浸润的病例）（p值<0.001）。无论是否存在COL，大约三分之二的病例均观察到浸润，但无统计学意义。98名患者完成了60个月的随访，其中仅1名患者出现局部DCIS复发，该患者存在COL和EIC。另有4名患者出现了与浸润成分相关的转移性疾病。尽管先前有其他研究推测COL可能与乳房切除术中更差的病理结果相关，但我们的结果表明，它实际上可能是代表EIC的更高疾病负荷的一个衡量指标；然而，它与检测到浸润性癌的风险增加无关。
肿瘤(癌症)患者之家