Histopathologische Beurteilung des
Mammakarzinoms: Grundlage für die lokoregionale und systemische Therapie

Zusammenfassung

In der präoperativen Diagnostik von Mammaläsionen sind Stanzbiopsien eine zuverlässige Untersuchungsmethode auch bei nichtpalpablen, nur mammografisch sichtbaren Läsionen. Sie können die Zahl der offenen Biopsien und intraoperativen Schnellschnittuntersuchungen zur Dignitätsbestimmung vermindern. Resektate sollten einer standardisierten pathologisch-anatomischen Aufarbeitung unterzogen werden, die bei Brust-erhaltender Therapie eine topografische Markierung des Präparates zur Voraussetzung hat. Bei der Exzision von nicht palpablen, mammografisch sichtbaren Läsionen sollte eine Präparatradiografie zur Detektion von Mikrokalk durchgeführt werden, der intraoperative Schnellschnitt ist hier und bei kleinen Läsionen unter 1 cm Größe ungeeignet. Lichtmikroskopisch eruierbare histopathologische Prognosefaktoren beim Mammakarzinom sind Tumorgröße, regionärer Lymphknotenstatus, histologischer Typ, Status der Resektionsränder und histologischer Differenzierungsgrad. Immunhistochemisch werden der Rezeptorstatus (Östrogenrezeptor, Progesteronrezeptor), die Wachstumsfraktion (MIB-1) und die Expression des Onkogens erbB-2 bestimmt. Eine Standardisierung ist hier allerdings zur Erhöhung ihres diagnostischen Aussagewertes nötig. Neuere Staging-Verfahren zur Prognoseabschätzung wie Untersuchung eines Wächter-(„Sentinel”)-Lymphknotens und die Tumorzelldissemination im Knochenmark sind noch in der Erprobung.

Abstract

Core-needle biopsy is a sensitive method in preoperative diagnosis of breast lesions, especially in analysis of nonpalpable, only mammographically detectable ones. This offers the opportunity to reduce the amount of open biopsies for frozen section examination of breast lesions. Topographical orientation of the excision specimen is recommended to perform a standardised pathological examination. This procedure has become more important because of the increasing possibility of breast-conserving therapy. Examining excision biopsies of nonpalpable, only mammographically detectable lesions it is useful to perform a radiography of the specimen to search for microcalcifications. In this case and in case of breast lesions smaller than 1 cm intraoperative frozen sections should not be performed. Prognostic parameters evaluable through simple light microscopic examination are tumour size, staging of axillary lymph nodes, histologic type, histological grading and status of the margins. Immunohistochemical examination is performed for determining receptor status, proliferative activity and expression of the oncogene erbB-2. However, to increase the diagnostic impact, the procedure should be standardised. New staging procedures for determination of prognosis include investigation of the sentinel lymph node and detection of disseminated tumour cells in bone marrow aspirates. These methods are still under investigation.

Mammakarzinom - präoperative Diagnostik - standardisierte pathologisch-anatomische Aufarbeitung - histologische Diagnostik - Immunhistochemie

Breast cancer - preoperative diagnosis - standardized pathological examination - histological diagnosis - immunohistochemistry

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