Breast cancer is the second leading cause of death due to cancer in women. In recent years, with the improvement of diagnostic methods, the detection rate of breast cancer has been increasing. DCIS accounts for approximately 10% to 15% of breast cancers detected by mammography in China[17, 18]. Now the data suggest that carcinoma in situ can recur or progress to IDC and breast DCIS-Mi is considered to be the interim stage in the progression from DCIS to IDC[9, 10]. The diagnosis and the ability to predict the outcome of patients with DCIS/DCIS-Mi are not satisfactory, leaded to inappropriate treatment choices. To the authors’ knowledge, the hunt for molecular prognostic markers for DCIS and DCIS-Mi has not succeeded. Therefore, we urgently want to find the difference in clinicopathological, IHC, and imaging features between DCIS, DCIS-Mi, and IDC in order to describe the process of DCIS to IDC from the clinical aspects and discuss those results, contact treatment, and reduce the incidence.
We studied the differences of clinicopathological, IHC, and imaging features among DCIS, DCIS-Mi, and IDC. We found that there was no significant difference between patients with DCIS, DCIS-Mi, and IDC in the first symptoms in patients with previous breast history and tumor size, but there were significant different in patients’ age and menopausal state. It suggested that even if patient get diseases the situations are consistent, patients with old age and menopause were more likely to have IDC. It was found that there was a significant difference in the number of patients with lymph node metastasis, and the former two were significantly less than the latter, suggesting that the latter degree of malignancy was significantly higher than former two. The first clinical performance, family history, and previous history of breast disease had no difference between DCIS, DCIS-Mi, and IDC, while the degree of malignancy in IDC was higher than in DCIS and DCIS-Mi. Except for the age and the status of menopause, we found that US and mammography played an important role in differentiating DCIS, DCIS-Mi, and IDC. US was usually routinely performed for patients because of its advantages (non-traumatic, repetitive), and it could find a mass which is >2 cm. This paper studied the difference of US features among DCIS, DCIS-Mi, and IDC, and found that the mass imaging of IDC patients by US were more obvious, which may be due to IDC patients’ late incidence, large mass, type of intraductal carcinoma, calcification, and ill-defined infiltration. The number of DCIS and DCIS-Mi patients with catheter widened imaging by US was greater than IDC patients, which may be explained that the latter’s large tumor image cover the widened catheter. Mammography played an important role in the early detection of breast cancer, especially in DCIS. According to the literature, mammography was important for detecting calcifications with high sensitivity, especially for the detection accuracy rate of DCIS. We also studied the differences among them in the mammography imaging, and found that there was no significant difference in calcification, but significant differences found in mass images. This may be due to DCIS patients’ early incidence and large mass, and IDC, DCIS, and DCIS-Mi all had calcification, so mammography was not obvious, but important in the diagnosis of early DCIS with micro-calcification.
In molecular biology, the breast is a sex hormone-dependent organ. Its growth, development, and cell proliferation are all influenced by estrogen and progesterone. The regulation works by estrogen receptor (ER) and progesterone receptor (PR) binding the receptors in the breast cell. ER and PR play an important role in the incidence of breast cancer; normal breast tissue of ER-positive expression will increase the risk of breast cancer. ER and PR were closely related to the prognosis and endocrine therapy. The positive expression of endocrine therapy is an effective rate of 80% ER-positive tamoxifen treatment which can effectively reduce the local recurrence of DCIS. A report showed that ER and PR expression range from 60% to 78%in DCIS. This article basically confirmed the literature. At the same time, we found molecular markers ER and PR expression were similar in DCIS, DCIS-Mi, and IDC, which suggested hormone receptor status was determined in DCIS stage. Although there was no accurate conclusion in the breast cancer pathway, it may be a very close relationship between DCIS and IDC in the event of the development and occurrence.
Her-2 proto-oncogene product is one of the epidermal growth factor receptor (EGFR) family, with binding with ligand, changing the conformation, and causing a series of ‘waterfall’ types of chain reaction, then accelerating cell proliferation, accelerating cell cycle, and enhancing malignant behavior. Most studies suggested that Her-2 over-expression was related to breast cancer invasion and poor prognosis[23, 24]. Our study found that Her-2 positive expression was 64.3% in DCIS, 66.67% in DCIS-Mi, and 42.5% in IDC. Consistent with previous reports, Her-2 express was lower in IDC than in DCIS, and was over-expressed in DCIS[25–27]. At the same time, several studies have found that normal breast tissue or benign lesions generally do not over-express HER-2[25, 27]. Some researches thought Her-2 positive expression was due to the process of atypical hyperplasia in DCIS, but in developing into IDC Her-2 frequently lose, or Her-2 caused the direct immune response. Another assumption was that the Her-2 negative in IDC was not developed from DCIS, but from the atypical hyperplasia[28, 29]. According to data, we agreed with this hypothesis. So we regarded Her-2 as one of the indicators of prognosis and treatment.
We then tried to discover whether patients with DCIS, DCIS-Mi, and IDC were associated with a history of breast disease. Now due to the development of breast imaging examination, lesions could be found in the early stages. Breast disease history is helpful to evaluate the subsequent risk of breast cancer. Previous reports showed that women with proliferative breast lesions without atypia have a slightly increased risk of breast cancer, whereas women with atypical hyperplasia have a substantially increased risk[13, 30–34]. In this retrospective study of breast operation history or biopsy history of patients who got DCIS, DCIS-Mi, and IDC, we found there was no difference in the proportion of previous breast operation and biopsy. We also found that DCIS, DCIS-Mi, and IDC patients whose previous medical history of lobular hyperplasia without atypia accounts for the large proportion may be explained by its high incidence in normal people. At the same time, hyperplasia with atypia accounts less than lobular hyperplasia without atypia, but it was accounted more than other breast disease and it also agreed with the above point of view. Finally, one case of DCIS patients recurred into IDC, indicating that DCIS has the possibility of recurrence. However, this retrospective study excluded patients with breast cancer who had not performed biopsy or operation, so it was not very accurate, and further analysis remains to be systematic prospective studies and large-scale system examination.