腺样囊性癌(AdCC)是一种罕见的浸润性乳腺癌,预后良好。然而,有些案件具有侵略性。该研究旨在确定预后的临床病理预测因子。临床,放射学,记录了来自11个机构的76例AdCC病例的病理变量。以下组织学特征由每个机构的乳腺病理学家评估,包括诺丁汉等级(NG),各种生长模式的百分比(固体,cribriform,小梁管状),玄武岩成分的百分比,肿瘤边界(推挤,渗透),神经周浸润,淋巴管浸润,坏死,和离最近的边距的距离。评估了各种分级系统,包括NG,唾液腺型分级系统,和新的评分系统。新的分级系统纳入了增长模式(%固体,百分比筛形),基底细胞形态百分比,和有丝分裂计数使用Youden指数标准。所有变量均与无复发生存率相关。19名(25%)妇女出现局部和/或远处复发。在20例(26.3%)病例中发现了基底细胞形态(≥25%的肿瘤),在22例(28.9%)病例中发现了实体生长模式(使用≥60%的截止值)。在单变量分析中,以下变量与更差的无复发生存率显着相关:稳固的生长模式,玄武岩形态,淋巴管浸润,坏死,神经周浸润,和pN阶段。在包括基底细胞形态的多变量分析中,pN阶段,淋巴管浸润,和神经周浸润,基底动脉形态有统计学意义,风险比为3.872(95%CI,1.077;13.924;P=.038)。NG和新的分级系统都与无复发生存率相关。然而,在NG系统中,2级的风险与3级相似,在新的分级系统中,2级的风险与1级相似.对于固体生长模式和基底细胞形态,使用具有1个截止值的2层系统比具有2个截止值的3层系统更好。Basaloid形态和固体生长模式对AdCC具有预后价值,2层分级系统比3层系统表现更好。
Adenoid cystic carcinoma (AdCC) is an uncommon type of invasive breast carcinoma with a favorable prognosis. However, some cases are aggressive. The study aims to define the clinicopathologic predictors of outcome. Clinical, radiological, and pathologic variables were recorded for 76 AdCC cases from 11 institutions. The following histologic characteristics were evaluated by the breast pathologist in each respective institution, including Nottingham grade (NG), percentages of various growth patterns (
solid, cribriform, trabecular-tubular), percentage of basaloid component, tumor borders (pushing, infiltrative), perineural invasion, lymphovascular invasion, necrosis, and distance from the closest margin. Various grading systems were evaluated, including NG, salivary gland-type grading systems, and a new proposed grading system. The new grading system incorporated the growth pattern (percent
solid, percent cribriform), percent basaloid morphology, and mitotic count using the Youden index criterion. All variables were correlated with recurrence-free survival. Nineteen (25%) women developed local and/or distant recurrence. Basaloid morphology (≥25% of the tumor) was identified in 20 (26.3%) cases and a
solid growth pattern (using ≥60% cutoff) in 22 (28.9%) cases. In the univariate analysis, the following variables were significantly correlated with worse recurrence-free survival:
solid growth pattern, basaloid morphology, lymphovascular invasion, necrosis, perineural invasion, and pN-stage. In the multivariate analysis including basaloid morphology, pN-stage, lymphovascular invasion, and perineural invasion, basaloid morphology was statistically significant, with a hazard ratio of 3.872 (95% CI, 1.077; 13.924; P =.038). The NG and the new grading system both correlated with recurrence-free survival. However, grade 2 had a similar risk as grade 3 in the NG system and a similar risk as grade 1 in the new grading system. For
solid growth patterns and basaloid morphology, using a 2-tier system with 1 cutoff was better than a 3-tier system with 2 cutoffs. Basaloid morphology and solid growth pattern have prognostic values for AdCC, with a 2-tier grading system performing better than a 3-tier system.