Σύγκριση των αποτελεσμάτων της κλινικής εξέτασης της μαστογραφίας της βιοψίας δια λεπτής βελόνης και των προγνωσικών δεικτών σε ογκόμορφες αλλοιώσεις του μαστού

Abstract

At the beginning of 80 a new era for the Mammography and the breast cancer started with the use of the technique dose Mammography, with the correct information of women for the prevention of the breast cancer and the application of mass screening in asymptomatic women, with the result to increase the number of palpable and no- palpable breast cancers diagnosed in early stages (0,I,II,IIIA etr) with better prognosis and therapy. Previous clinical studies have attempted to correlate the radiological with the histological characteristics of breast cancer but did not succeed to show significant differences as for us the histological and biological characteristics among the symptomatic and the mammographically localized non- palpable breast cancers. Furthermore, many investigators see to conclude that the best prognostic characteristics of breast cancers that are identified with the preventive mammography are directly or indirectly related by the effect of biological factors. The aim of the present study is to mark out indicators that are related with the mammographic appearance of malignant palpable and no- palpable lesions and the aggressiveness of disease. In total five hundred seventy four palpable and no- palpable breast lesions have been studied in five hundred seventy patients that were localized during the mammographic screening in our department, between 1994 to 2004. All the patients were subjered to line needle biopsy (FNA) or mammographically guided open surgical biopsy. Histological examination showed 410/574 (71.4%) malignant lesions and 164/574 (28.5%) benign lesions. Immunohistochemistry was performed in paraffin sections in 390 of 410 malignant lesions using a variety of monoclonal and polyclonal antibodies against the following proteins ER,PR, P53, HER-2, Ki67and KATH D. The malignant lesions were classified from their mammographic appearance (according to Breast Imaging Reporting and Dada System BI RADS) in three categories: category A (lesions with poorly defined or partially poorly defined margins)were 36%, category B (speculated malignant lesions) were 44.8% and category C (lesions wih calcifications) were 18.2% of all malignant lesions. The analysis of our results between the mammographic appearance of the malignant lesions and their histological and biological characteristic showed the following: 1) Significant correlation existed between the mammographic appearance and the size of the lesions (p=0.01<0.05). 2) Significant correlation existed with the degree of differentiaton of malignancy (p=0.005<0.05). 3) Significant correlation existed with over expression of proteins P53 (p=0.015). and Ki- 67 (p=0.02). No significant correlation was observed between the appearance of lesins with the age of the patients (p=0.08>0.05), with the detection of nuclear positivity of the estrogens (ER) and progesterone (PR) receptors (p=0.4>0.05) and also with the proteins HER-2 and KATH D. Furthermore a bode line correlation was observed between the appearance of the malignant lesions and lymph notes. In summary, it was found that the category B patients with the speculated lesions had a more favorable effect than category A with the poorly defined or partially poorly defined limits, and the category C lesions with calcifications. The poorly defined or partially poorly defined limits malignant lesions (category A) are related with low grade malignancy (grade 3, with over expression of P53 and Ki-67 and with negative receptors (PR and ER). These are large size lesions and are difficulty diagnosed from benign lesions.