259 Patients with DCIS of the breast applying USC/Van Nuys prognostic index: a retrospective review with long term follow up

Saverio, Salomone Di; Catena, Fausto; Santini, Donatella; Ansaloni, Luca; Fogacci, Tommaso; Mignani, S; Leone, Alessandro; Gazzotti, Filippo; Gagliardi, S; Cataldis, Angelo De; Taffurelli, Mario

doi:10.1007/s10549-007-9668-7

Cited by 117 publications

(82 citation statements)

References 64 publications

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“…Studies have suggested that magnification views can aid the prediction of extent of low-grade DCIS (Asjoe et al, 2007;Di Saverio et al, 2008). Our data show that the size discrepancies leading to failed primary BCS occur across all tumour grades and that, numerically, low-grade disease is uncommon (o10% of cases).…”

Section: Discussionmentioning

confidence: 59%

Radiological and pathological size estimations of pure ductal carcinoma in situ of the breast, specimen handling and the influence on the success of breast conservation surgery: a review of 2564 cases from the Sloane Project

et al. 2010

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BACKGROUND: The Sloane Project, an audit of UK screen-detected non-invasive carcinomas and atypical hyperplasias of the breast, has accrued over 5000 cases in 5 years; with paired radiological and pathological data for 2564 ductal carcinoma in situ (DCIS) cases at the point of this analysis. We have compared the radiological estimate of DCIS size with the pathological estimate of DCIS size. We have correlated these sizes with histological grade, specimen-handling methods, particularly the use of specimen slice radiographs, and the success or failure of breast-conserving surgery (BCS). METHODS: The Sloane Project database was interrogated to extract information on all patients diagnosed with DCIS with complete radiological and pathological data on the size of DCIS, nuclear grade, specimen handling (with particular reference to specimen radiographs) and whether primary BCS was successful or whether the patient required further conservation surgery or a mastectomy. RESULTS: Of 2564 patients in the study, 2013 (79%) had attempted BCS and 1430 (71%) had a successful single operation. Of the 583 BCS patients who required further surgery, 65% had successful conservation and 97% of them after a single further operation. In successful one-operation BCS patients, there was a close agreement between radiological and pathological DCIS size with radiology tending to marginally overestimate the disease extent. In multiple-operation BCS, radiology underestimated DCIS size in 59% of cases. The agreement between pathological and radiological size of DCIS was poor in mastectomies but was improved by specimen slice radiography, suggesting specimen-handling techniques as a cause. CONCLUSION: In 30% of patients undergoing BCS for DCIS, preoperative imaging underestimates the extent of disease resulting in a requirement for further surgery. This has implications for the further improvement of preoperative imaging and non-operative diagnosis of DCIS so that second operations are reduced to a minimum.

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Section: Discussionmentioning

confidence: 59%

Radiological and pathological size estimations of pure ductal carcinoma in situ of the breast, specimen handling and the influence on the success of breast conservation surgery: a review of 2564 cases from the Sloane Project

et al. 2010

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“…This finding about BCS only, consistent with other studies of women with DCIS or early stage invasive cancer, is a further cause for concern. 21,23,33 Over 25% of our subjects had BCS without RT and although there are a number of clinical factors associated with recurrence or invasive breast cancer after DCIS, [34][35][36] studies have found risks to generally be lower for women treated with BCS and RT opposed to BCS alone. 1,2,16,37,38 Lower screening among women with mastectomy is also problematic as women with DCIS are at higher risk for a second cancer in the opposite breast.…”

Section: Discussionmentioning

confidence: 95%

Use of Annual Mammography Among Older Women with Ductal Carcinoma In Situ

et al. 2011

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BACKGROUND: As ductal carcinoma in situ (DCIS) is a risk factor for invasive breast cancer, ongoing annual mammography is important for cancer control, yet little is known about racial/ethnic and other disparities in use among older women with DCIS. METHODS: SEER-Medicare data was used to identify women age 65-85 years, diagnosed with DCIS from 1992 to 2005 and treated with surgery, but not bilateral mastectomy. We examined factors associated with receipt of an initial mammogram within 1 year of treatment and subsequent annual mammograms for 3 and 5 years. We examined whether follow-up care, by a primary care physician or cancer specialist, or neighborhood characteristics mediated disparities in mammography use. RESULTS: Overall, 91.3% of women had an initial mammogram. After adjustment, blacks and Hispanics were less likely than whites to receive an initial mammogram (odds ratio (OR) 0.74, 95% confidence interval (CI) 0.55-0.99 and OR 0.65, CI 0.46-0.93, respectively, as were women of lower socioeconomic status (SES), women who had a mastectomy or breast conserving surgery without radiation therapy, and women who did not have a physician visit. Overall rates of annual mammography decreased over time. Disparities by SES, initial treatment type, and physician visit did not diminish over time. Physician visits had a modest effect on reducing initial racial/ethnic disparities. CONCLUSIONS: Annual mammography among women age 65 to 85 with DCIS declines as women get further from diagnosis. Interventions should focus on reducing disparities in the use of initial surveillance mammography, and increasing surveillance over time.KEY WORDS: ductal carcinoma in situ (breast); mammography; disparities.

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“…On the other hand, the Van Nuys Prognostic Index (VNPI), combining tumour size, grade and margin width, was used to select 'low-risk' patients not requiring RT (Silverstein et al, 1996), but was widely criticised in two large American and English studies including 222 and 237 patients, respectively (Boland et al, 2003;MacAusland et al, 2007). A recent Italian study (Di Saverio et al, 2008) including 259 patients also used VNPI and concluded in the absence of statistically significant advantage in the CS þ RT vs the CS group. However, the CS þ RT group had several unfavourable factors widely increasing LR risk, such as lesion size 415 mm (67 vs 30%) and excision margins o1 mm (29 vs 4%).…”

Section: Discussionmentioning

confidence: 99%

Breast-conserving surgery with or without radiotherapy vs mastectomy for ductal carcinoma in situ: French Survey experience

et al. 2009

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physicians throughout France prospectively recruited 1289 ductal carcinoma in situ (DCIS) patients and collected data on diagnosis, patient and tumour characteristics, and treatments. Median age was 56 years (range, 30 -84). Ductal carcinoma in situ was diagnosed by mammography in 87.6% of patients. Mastectomy, conservative surgery alone (CS) and CS with radiotherapy (CS þ RT) were performed in 30.5, 7.8 and 61.7% of patients, respectively. Thus, 89% of patients treated by CS received adjuvant RT. Sentinel node biopsy (SNB) and axillary dissection (AD) were performed in 21.3 and 10.4% of patients, respectively. Hormone therapy was administered to 13.4% of the patients (80% tamoxifen). Median tumour size was 14.5 mm (6, 11 and 35 mm for CS, CS þ RT and mastectomy, respectively, Po0.0001). Nuclear grade was high in 21% of patients, intermediate in 38.5% and low in 40.5%. Excision was considered complete in 92% (CS) and 88.3% (CS þ RT) of patients. Oestrogen receptors were positive in 69.8% of assessed cases (31%). Treatment modalities varied widely according to region: mastectomy rate, 20 -37%; adjuvant RT, 84 -96%; hormone treatment, 6 -34%. Our survey on current DCIS management in France has highlighted correlations between pathological features (tumour size, margin and grade) and treatment options, with several similar variations to those observed in recent UK and US studies.

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259 Patients with DCIS of the breast applying USC/Van Nuys prognostic index: a retrospective review with long term follow up

Cited by 117 publications

References 64 publications

Radiological and pathological size estimations of pure ductal carcinoma in situ of the breast, specimen handling and the influence on the success of breast conservation surgery: a review of 2564 cases from the Sloane Project

Radiological and pathological size estimations of pure ductal carcinoma in situ of the breast, specimen handling and the influence on the success of breast conservation surgery: a review of 2564 cases from the Sloane Project

Use of Annual Mammography Among Older Women with Ductal Carcinoma In Situ

Breast-conserving surgery with or without radiotherapy vs mastectomy for ductal carcinoma in situ: French Survey experience

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