Meme duktal karsinoma in situ hastalarında mikroinvazyonun bağımsız bir öngörücüsü olarak palpabl kitle varlığı

Yıl 2025, Cilt: 18 Sayı: 3, 5 - 5

Sevda Yılmaz , Taha Yasin Baran , Utku Ozgen , Alim Akdağ , Yeliz Arman Karakaya

https://doi.org/10.31362/patd.1589977

Öz

Amaç: Meme kanseri, Dünya genelinde kadınlar arasında en sık görülen kanser türüdür. Duktal Karsinoma İn Situ (DKIS), bu kanserlerin en yaygın türlerinden biridir. Mikroinvazyonla ilişkili faktörlerin daha fazla araştırılması gerekmektedir.
Gereç ve yöntem: Bu retrospektif çalışmada, 2011-2024 yılları arasında bir üçüncü basamak sağlık merkezinde DKIS tanısı almış ve tedavi edilmiş 70 kadın hastanın verileri analiz edildi. Hastaların demografik parametreleri, klinikopatolojik özellikleri ve immünohistokimyasal bulguları, mikroinvazyon durumlarına göre karşılaştırıldı.
Bulgular: Ortalama yaşı 51 olan 70 kadın hasta incelendi. Bu hastalar arasında 17 vakada (%24,3) mikroinvazyon tespit edildi. Demografik parametreler arasında sadece vücut kitle indeksi (VKİ) mikroinvazyon durumu ile ilişkili bulundu. Daha yüksek VKİ'ye sahip hastalarda mikroinvazyon riski daha düşük olarak saptandı (p=0,038). Mikroinvazyonu olan hastalarda ele gelen kitlenin varlığı anlamlı derecede daha yüksekti (p=0,001). Bu durum, tümörün palpabilitesi ile invazyon arasında potansiyel bir bağlantıyı düşündürmektedir. İmmünohistokimyasal analizler, hormon reseptör durumu, HER2 ekspresyonu ve mikroinvazyon arasında ilişkiler olduğunu ortaya koydu. HER2 varlığı, mikroinvazyon ile anlamlı şekilde ilişkili bulundu (p=0,026). Ancak, çok değişkenli analizler sonucunda, tümör palpabilitesinin mikroinvazyon durumuyla ilişkili tek bağımsız faktör olduğu belirlendi (Odds Ratio: 5,233; 1,339 - 20,455; p=0,017).
Sonuç: DCIS'de, ele gelen kitlenin varlığı, mikroinvazyonla ilişkili tek bağımsız faktör olarak öne çıkmıştır.

Anahtar Kelimeler

DKIS, palpabl kitle, mikroinvazyon, meme kanseri, sentinel lenf nodu

Proje Numarası

E-60116787-020-604967

The presence of a palpable mass is an independent predictor of microinvasion in Ductal Carcinoma in situ of the Breast

Öz

Purpose: Breast cancer is the most common cancer among women worldwide. Ductal Carcinoma in situ (DCIS) is one of the most common types of these cancers. Factors associated with microinvasion still need to be investigated.
Materials and methods: In this retrospective study, we analyzed data from 70 female patients diagnosed with DCIS and managed at a tertiary center between 2011 and 2024. Demographic parameters, clinicopathological characteristics, and immunohistochemical findings of the patients were examined in comparison with their microinvasion status.
Results: 70 female patients with Ductal Carcinoma in situ, with a median age of 51 years, were investigated. Among these patients, 17 cases (24.3%) had microinvasion. Compared with demographic parameters, only BMI was associated with microinvasion status. Patients with higher BMI had lower risk of microinvasion (p=0.038).
The presence of a palpable mass was significantly higher in patients with microinvasion (p=0.001), suggesting a potential link between tumor palpability and invasion.
Immunohistochemical analysis demonstrated associations between hormone receptor status, HER2 expression, and microinvasion. The presence of HER2 was significantly associated with microinvasion (p=0.026). Multivariate analysis however, revealed that tumor palpability was the only independent factor associated with microinvasion status (Odds Ratio: 5.233; 1.339 - 20.455; p=0.017).
Conclusion: The presence of a palpable mass emerged as the only independent factor associated with microinvasion in DCIS.

Anahtar Kelimeler

DCIS, palpable mass, microinvasion, breast cancer, sentinel iymph node

Proje Numarası

E-60116787-020-604967

Kaynakça

• Tomlinson Hansen SE, Khan M, Cassaro S. Breast ductal carcinoma in situ. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Available from: https://www.statpearls.com. Accessed February 27, 2023
• Kerlikowske K. Epidemiology of ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010;2010(41):139-141. doi:10.1093/jncimonographs/lgq027
• Shiino S, Quinn C, Ball G, et al. Prognostic significance of microinvasion with ductal carcinoma in situ of the breast: a meta-analysis. Breast Cancer Res Treat. 2023;197(2):245-254. doi:10.1007/s10549-022-06800-3
• Stanciu Pop C, Nollevaux MC, Berlière M, et al. Morphological intratumor heterogeneity in ductal carcinoma in situ of the breast. Virchows Arch. 2021;479(1):33-43. doi:10.1007/s00428-021-03040-6
• Wapnir IL, Dignam JJ, Fisher B, et al. Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst. 2011;103(6):478-488. doi:10.1093/jnci/djr027
• Lyman GH, Giuliano AE, Somerfield MR, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol. 2005;23(30):7703-7720. doi:10.1200/JCO.2005.08.001
• Parker C, Damodaran S, Bland KI, Hunt KK. The breast. In: Brunicardi FC, Andersen DK, Billiar TR, et al., editors. Schwartz's principles of surgery. 11th ed. New York, NY: McGraw-Hill Education; 2019.
• Boler DE, Cabioglu N, Ince U, Esen G, Uras C. Sentinel lymph node biopsy in pure DCIS: is it necessary? ISRN Surg. 2012;2012:394095. doi:10.5402/2012/394095
• Julian TB, Land SR, Fourchotte V, et al. Is sentinel node biopsy necessary in conservatively treated DCIS? Ann Surg Oncol. 2007;14(8):2202-2208. doi:10.1245/s10434-007-9353-4
• Aksoy SÖ, Sevinç Aİ, Güray M, Balcı P. Duktal karsinoma in situ'da sentinel lenf nodu biyopsisi gerekli midir? DEU Tıp Derg. 2017;31(3):147-151. doi:10.5505/deutip.2017.50023
• Watanabe Y, Anan K, Saimura M, et al. Upstaging to invasive ductal carcinoma after mastectomy for ductal carcinoma in situ: predictive factors and role of sentinel lymph node biopsy. Breast Cancer. 2018;25(6):663-670. doi:10.1007/s12282-018-0871-7
• Ozkan Gurdal S, Cabioglu N, Ozcinar B, et al. Factors predicting microinvasion in ductal carcinoma in situ. Asian Pac J Cancer Prev. 2014;15(1):55-60. doi:10.7314/apjcp.2014.15.1.55
• Cardoso F, Kyriakides S, Ohno S, et al. Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2019;30(8):1194-1220
• Jia H, Zhao P, Chen Z, et al. Clinicopathological characteristics and prognostic analysis of tumor-infiltrating lymphocytes (TILs) in ductal carcinoma in situ (DCIS) and DCIS with microinvasion (DCIS-Mi) of the breast. Breast Cancer Res Treat. 2022;193(1):111-120. doi:10.1007/s10549-022-06553-z
• Kuerer HM, Lari SA, Arun BK, et al. Biologic features and prognosis of ductal carcinoma in situ are not adversely impacted by initial large body mass. Breast Cancer Res Treat. 2012;133(3):1131-1141. doi:10.1007/s10549-012-1999-3
• Porter GA, Inglis KM, Wood LA, et al. Effect of obesity on presentation of breast cancer. Ann Surg Oncol. 2006;13(3):327-332. doi:10.1245/ASO.2006.03.049
• Canbay E, Cercel A, Aydoğan F, Gazioğlu E, Ferahman M, Kocael A, Aydın Ö, Calay Z, Çelik V. Indications for sentinel lymph node biopsy in patients with ductal carcinoma in situ. Basic and Clinical Sciences. 2013;2(2):47-56. doi:10.12808/bcs.v2i2.25
• Diaz Casas SE, Serrano Muñoz WA, Buelvas Gómez NA, et al. When is Sentinel Lymph Node Biopsy Useful in Ductal Carcinoma In Situ? The Experience at a Latin American Cancer Center. Cureus. 2021;13(7):e16134. doi:10.7759/cureus.16134
• Magnoni F, Massari G, Santomauro G, et al. Sentinel lymph node biopsy in microinvasive ductal carcinoma in situ. Br J Surg. 2019;106(4):375-383. doi:10.1002/bjs.11079
• Champion CD, Ren Y, Thomas SM, et al. DCIS with Microinvasion: Is It In Situ or Invasive Disease?. Ann Surg Oncol. 2019;26(10):3124-3132. doi:10.1245/s10434-019-07556-9
• Daly MB. Tamoxifen in ductal carcinoma in situ. Semin Oncol. 2006;33(6):647-649. doi:10.1053/j.seminoncol.2006.08.019
• Van Bockstal MR, Wesseling J, Lips EH, Smidt M, Galant C, van Deurzen CHM. Systematic assessment of HER2 status in ductal carcinoma in situ of the breast: a perspective on the potential clinical relevance. Breast Cancer Res. 2024;26(1):125. doi:10.1186/s13058-024-01875-w
• Roses RE, Paulson EC, Sharma A, et al. HER-2/neu overexpression as a predictor for the transition from in situ to invasive breast cancer. Cancer Epidemiol Biomarkers Prev. 2009;18(5):1386-1389. doi:10.1158/1055-9965.EPI-08-1101
• Yu KD, Wu LM, Liu GY, et al. Different distribution of breast cancer subtypes in breast ductal carcinoma in situ (DCIS), DCIS with microinvasion, and DCIS with invasion component. Ann Surg Oncol. 2011;18(5):1342-1348. doi:10.1245/s10434-010-1407-3
• Silver SA, Tavassoli FA. Mammary ductal carcinoma in situ with microinvasion. Cancer. 1998;82(12):2382-2390. doi:10.1002/(sici)1097-0142(19980615)82:12<2382::aid-cncr12>3.0.co;2-l
• Maffuz A, Barroso Bravo S, Nájera I, Zarco G, Alvarado Cabrero I, Rodríguez Cuevas SA. Tumor size as predictor of microinvasion, invasion, and axillary metastasis in ductal carcinoma in situ. J Exp Clin Cancer Res. 2006;25(2):223-227.
• Lagios MD, Margolin FR, Westdahl PR, Rose MR. Mammographically detected duct carcinoma in situ. Frequency of local recurrence following tylectomy and prognostic effect of nuclear grade on local recurrence. Cancer. 1989;63(4):618-624. doi:10.1002/1097-0142(19890215)63:4<618::aid-cncr2820630403>3.0.co;2-j
• Balac N, Tungate RM, Jeong YJ, et al. Is palpable DCIS more aggressive than screen-detected DCIS?. Surg Open Sci. 2022;11:83-87. doi:10.1016/j.sopen.2022.12.002