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receptor status in our study there was a prevalence of cases with both of the receptors (ER, PR)
being positive, or at least one of them positive, which made up 51.5 %. ER only was positive in 48
cases (49.5 %) and PR only in 26 cases (26.8 %). The relatively low incidence of ER and PR positive
cases can be explained by the prevalence of poorly differentiated DIC and high grade DCIS
(VNC 3). The positive ER and PR status is statistically significantly correlated with VNC DCIS categories.
Positive receptors were found mainly in non-high grade cases, while in the group of high
grade DCIS there was an increase of phenotypes with both receptors negative. The most striking
statistically significant differences in correlation with monitored parameters were noticed between
the groups of VNC 1 and VNC 3, and VNC 2 and VNC 3, respectively. However, when evaluating
VI, NPI, hormone-receptor phenotypes, there was not any statistically significant difference
found between the groups of VNC 1 and VNC 2. VNC 2 forms up a group, which substantially
does not differ from VNC 1, but shows different biological behavior against VNC 3.
VNC is correlated with the disease free interval and consecutive development of an invasive
carcinoma (9). VNC was used also in other studies (32,33). Kessar et al. (32) showed that most
of the mammographically detected cases in screening or non-screening programs are detected
already in stage VNC 3 DCIS.
Problems of the VNC are the criteria considering necrosis (22). The central zone of eosinophil
necrotic debris containing 5 or more pycnotic nuclei in whatever architectonic sample of DCIS
serves as a minimum requirement for necrosis (2,14). According to the architectonic classification
we consider comedo-type necrosis those ones, which are centrally localized and represent at
least 50 % of the diameter of the afflicted lumen (18).
One of the positive aspects of the VNC is its possible application in Van Nuys prognostic
index, on the basis of which it is possible to define 3 risk groups of DCIS and subsequent therapeutic
process. This index has been created from the results of retrospective studies of the 3
basic indicators, like the size of DCIS, VNC and the margins of the surgical specimen (34), which
were attested in other studies, as well (35).
It is known, that DCIS is a precursor of invasive carcinoma (3). The heterogeneity of genetic alterations
found in intraductal and invasive breast carcinomas supports the hypothesis of different
genetic mechanisms in clonal evolution of the breast cancer (36,37). From the latest observations it
can be assumed that cribriform / solid DCIS and comedo-type DCIS represent different subtypes of
DCIS expressing 2 different ways of progression: to low and high grade. The evolution of DCIS advances
from normal epithelium through hyperplasia and atypical hyperplasia to comedo-type DCIS in
high grade lesions. Low grade lesions progress from normal epithelium through hyperplasia to cribriform
and solid DCIS (38). Correlations between the evaluated characteristics of DCIS and DIC support
indirectly by phenotype current hypothesis about clonal evolution of the breast cancer.
On the basis of our results and review of literature, it is possible to evaluate VNC as a simple
and clinically relevant system clearly defining prognostic groups, what is indicated by dependencies
on some prognostic indices in invasive carcinomas. In comparison to architectonical
classification of DCIS the VNC shows less heterogeneity.
REFERENCES
1. Moreno A, Lloveras B, Figueras A, et al. Ductal carcinoma in situ of the breast: correlation between histologic classifications
and biologic markers. Mod Pathol 1997; 10: 1088 - 1092
2. Silverstein MJ. Ductal carcinoma in situ of the breast. BMJ 1998; 317: 734 - 739
3. Tavassoli FA. Ductal Carcinoma In situ: Introduction of the concept of ductal intraepithelial neoplasia. Mod Pathol 1998; 11:
140 - 154
4. Glöckner S, Lehmann U, Wilke N, Kleeberger W, Länger F, Kreipe H. Amplification of growth regulatory genes in intraductal
breast cancer is associated with higher nuclear grade but not with the progression to invasiveness. Lab Invest 2001; 81: 565
- 571
5. Lennington WJ, Jensen RA, Dalton LW, Page DL. Ductal carcinoma in situ of the breast. Heterogeneity of individual lesions.
Cancer 1994; 73: 118 - 124
6. Patchefsky AS, Schwartz GF, Finkelstein SD, et al. Heterogenity of intraductal carcinoma of the breast. Cancer 1989; 63: 731
- 741
7. National Coordinating Group for Breast Screening Pathology. Pathology Reporting in Breast Cancer Screening. 2nd Ed. 1995;
23 - 27
8. Holland R, Peterse JL, Millis RR, et al. Ductal carcinoma in situ: a proposal for a new classification. Semin Diagn Pathol 1994;
11: 167 - 180