Ideas in pathology. XXXX in situ of the breast: a proposal for a new simplified histological classification association between cellular proliferation and c-erbB-2 protein expression.

@entity1 @entity3821 @entity0 @entity39 @entity5 @entity189 @entity513
The diagnosis of @entity513 in situ of the breast ( @entity3821 ) has become common with the advent of breast screening programs. METHODS: Proliferation indices (S-phase fraction) were studied in 76 cases of pure @entity3821 . @entity5 were classified according to conventional criteria and also according to a novel simplified classification based on cellular @entity39 and morphology. This new classification defines three distinct @entity5 groups: pure comedo in 19 (25.0%) cases, @entity3821 with @entity39 (non-pure comedo) in 21 (27.6%) @entity1 , and @entity3821 without @entity39 in 36 (47.4%) of cases, the latter group comprising largely classical cribriform or micropapillary architectural subtypes. RESULTS: Flow cytometric DNA analysis showed a significantly higher S-phase fraction in comedo @entity3821 than in the subgroup of @entity5 without @entity39 (P < 0.01 [anova]). A preliminary analysis of disease recurrence and disease-free survival in a large series of 391 cases of pure @entity3821 showed that of 181 cases of pure comedo @entity3821 there were 19 local recurrences at the 7-year stage (82% 7-year disease-free survival), with 5 local recurrences in 51 cases of @entity3821 with @entity39 (non-pure comedo) (85% 7-year disease-free survival) and only 6 local recurrences in the 159 cases of the @entity3821 -without- @entity39 subgroup (94% 7-year disease-free survival). The chi 2 value for the frequency of disease recurrence of all cases of @entity3821 with @entity39 (i.e., combining the groups of comedo @entity3821 and @entity3821 with @entity39 (non-pure comedo)) as compared to @entity3821 without histological evidence of @entity39 was 5705 (df = 2; P = 0.0001), and the chi 2 for disease-free survival of types of @entity3821 with @entity39 as compared to cases without @entity39 was 178 (df = 2; P = 0.0001). This analysis indicates that the histological presence of @entity39 appears to be a relatively powerful predictor of increased disease recurrence and poorer disease-free survival after treatment for @entity3821 . CONCLUSIONS: Necrosis in @entity3821 in the absence of pure classical comedo morphology is a feature of more biologically aggressive in situ @entity0 with an intermediate proliferative fraction as compared with the high proliferative fraction of pure comedo @entity3821 and the low proliferative fraction of @entity3821 without @entity39 . There was no significant difference in DNA ploidy (diploid or aneuploid) between the subgroups as assessed by chi 2 analysis. Further larger studies are required to establish if @entity3821 with @entity39 (non-pure comedo) also shows a greater tendency to local recurrence after breast conservation treatment than do subtypes of @entity3821 without @entity39 . @entity3821 with @entity39 (non-pure comedo) should be adopted as a distinct histological subgroup of @entity3821 in future clinical studies of in situ @entity189 .
