Ductal Carcinoma in situ of the Breast. Comparison between the Van Nuys Classification and Nottingham Classification.
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概要
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Background : Assessment of the biological malignancy of DCIS is important as a factor related to indications for breast-conserving therapy and subsequent stump recurrence. We assessed the biological malignancy of each grade in the Van Nuys (VN) Classification and the Nottingham (Nott) Classification. Methods : The surgical specimens from 24 patients with DCIS were examined. Immonohistochemistry was used to assess the expression of ER, p53, Ki-67 (MIB-1), and Her2/nue in the tumor cell of 24 patients with DCIS. We classified DCIS by VN and Nott systems and compared Grade 3 tumors with the other grades (Grade 1 and 2).Results : VN Grade 3 (VN3) DCIS had high ER-negative (P=0.01) and P53-positive (P=0.05) rates, and frequently had a high Ki67 1. I. (P=0.03). Three of the 4 specimens highly positive for Her2/nue (P=0.08) were VN3. The Nott Grade 3 (Nott3) specimens were all ER-negative (P=0.03) and frequently P53-positive (P=0.04), and all had a high Ki67 L. I (P=0.04). Similar to VN3 DCIS, 3 of the 4 specimens highly positive for Her2/nue (P=0.003) were Nott3. However, 3 specimens that were judged to be nuclear grade (NG) 3 noncomedo type DCIS and VN3 were classified as Nott 1 and 2, not Nott 3. Of these 3 specimens, 2 were ER-negative, 1 was p53 positive, and 2 had a high Ki67 L. I., indicating that non-Nott 3 cancer is not necessarily low-malignant. Conversely, all Nott3 cancers were classified as VN3.Conclusion : The results suggested that the nuclear-grade-based VN system may be a more reliable classification in terms of grade of malignancy that the histological-type-based Nott systems.
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