Article Commentary: Controversies Regarding the Diagnosis and Management of Ductal Carcinoma in Situ

Levinsohn, Erik; Altman, Marcus T; Chagpar, Anees B.

doi:10.1177/000313481808400102

Cited by 13 publications

(19 citation statements)

References 48 publications

(46 reference statements)

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“…It is widely accepted that most cases of DCIS are now diagnosed through breast cancer screening programs and 20% of all breast carcinomas are "in situ" lesions [2]. As most DCIS are surgically treated, it is not surprising that approximately 20-25% of surgical breast samples evaluated by pathologists refer to this disease [3,4]. The incidence of DCIS has increased over the last three decades, ranging from 1.87 cases per 100,000 person-years in the first years of the 1970s to 32.5 cases per 100,000 person-years in 2005 [5].…”

Section: Epidemiologymentioning

confidence: 99%

“…Mammography is a highly sensitive diagnostic procedure for detecting DCIS. Several studies show that the diagnosis of DCIS mainly depends on the detection of microcalcifications on mammographic screening (70-90% of cases) [4,6,7], while only a smaller percentage of cases is diagnosed as a palpable mass or a nipple discharge or ulceration (Paget's disease). In 2002, it was estimated that about 1/1300 screening mammographies was consistent with the diagnosis of DCIS, histologically proven by needle core biopsy [8].…”

Section: Radiologic Featuresmentioning

confidence: 99%

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Ductal Carcinoma In Situ of the Breast: An Update with Emphasis on Radiological and Morphological Features as Predictive Prognostic Factors

Salvatorelli

Puzzo

Vecchio

et al. 2020

Cancers

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Ductal carcinoma in situ (DCIS) shows overlapping epidemiology with invasive ductal carcinoma of the breast, sharing similar risk factorssuch as age, mammographic density, family history, and hormonal therapy as well as genetic factors such as BRCA1/BRCA2, histotypes, and molecular subtypes such as luminal A and B, HER2 enriched, and basal-type, thus suggesting its potential precursor role. A small percentage of patients with a history of DCIS die without a documented intermediate diagnosis of invasive breast carcinoma (IBC). The increased risk of death is usually associated with ipsilateral recurrence such as IBC. The slightly variable incidence of DCIS in different countries is mainly due to a different diffusion of mammographic screening and variability of the risk factors. The majority of DCIS lesions are not palpable lesions, which can be only radiologically detected because of the association with microcalcifications. Mammography is a highly sensitive diagnostic procedure for detecting DCIS with microcalcifications, while magnetic resonance imaging (MRI) is considered more sensitive to detect DCIS without calcifications and/or multifocal lesions. The aim of the present overview was to focus on the clinical, radiological, and pathological features of DCIS of the breast, with an emphasis on the practical diagnostic approach, predictive prognostic factors, and therapeutic options.

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Section: Epidemiologymentioning

confidence: 99%

Section: Radiologic Featuresmentioning

confidence: 99%

Ductal Carcinoma In Situ of the Breast: An Update with Emphasis on Radiological and Morphological Features as Predictive Prognostic Factors

Salvatorelli

Puzzo

Vecchio

et al. 2020

Cancers

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“…Epidemiologically, DCIS represents 20-25% of all new BC cases diagnosed [31] and this incidence is increasing as a result of an upgraded resolution of breast mammography [32]. Around 80% of the DCIS are identified by the presence of micro-calcifications and the remaining 20% by the detection of architectural deformation in mammography screening [33,34] (Figure 1B2).…”

Section: Relevance Of MD In the Dcis-to-icd Transitionmentioning

confidence: 99%

Breast Mammographic Density: Stromal Implications on Breast Cancer Detection and Therapy

Fernández‐Nogueira

Mancino

Fuster

et al. 2020

JCM

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Current evidences state clear that both normal development of breast tissue as well as its malignant progression need many-sided local and systemic communications between epithelial cells and stromal components. During development, the stroma, through remarkably regulated contextual signals, affects the fate of the different mammary cells regarding their specification and differentiation. Likewise, the stroma can generate tumour environments that facilitate the neoplastic growth of the breast carcinoma. Mammographic density has been described as a risk factor in the development of breast cancer and is ascribed to modifications in the composition of breast tissue, including both stromal and glandular compartments. Thus, stroma composition can dramatically affect the progression of breast cancer but also its early detection since it is mainly responsible for the differences in mammographic density among individuals. This review highlights both the pathological and biological evidences for a pivotal role of the breast stroma in mammographic density, with particular emphasis on dense and malignant stromas, their clinical meaning and potential therapeutic implications for breast cancer patients.

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“…The implementation of widespread mammography screening has led to significant increase in the diagnosis of ductal carcinoma in situ (DCIS), which nowadays accounts for~20-25% of resected breast specimens [1][2][3]. DCIS is defined by the World Health Organization as a neoplastic proliferation of mammary ductal epithelial cells confined to the ductal-lobular system [4].…”

mentioning

confidence: 99%

“…The main dilemma, presently, for clinicians is how to reliably predict the prognosis of DCIS and to tailor individual patient treatment accordingly [3], knowing that the natural history of DCIS shows us that even low-risk subtypes can recur after 30 years, of follow-up [9]. The spectrum of treatment spans from surveillance only, breastconserving surgery only, to breast-conserving surgery plus radiotherapy and/or hormonal therapy, and mastectomy with or without radiotherapy.…”

mentioning

confidence: 99%

Ductal carcinoma in situ of the breast: an update for the pathologist in the era of individualized risk assessment and tailored therapies

Hanna

Parra‐Herran

et al. 2019

Modern Pathology

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Ductal carcinoma in situ (DCIS) is a neoplastic proliferation of mammary ductal epithelial cells confined to the ductallobular system, and a non-obligate precursor of invasive disease. While there has been a significant increase in the diagnosis of DCIS in recent years due to uptake of mammography screening, there has been little change in the rate of invasive recurrence, indicating that a large proportion of patients diagnosed with DCIS will never develop invasive disease. The main issue for clinicians is how to reliably predict the prognosis of DCIS in order to individualize patient treatment, especially as treatment ranges from surveillance only, breast-conserving surgery only, to breast-conserving surgery plus radiotherapy and/ or hormonal therapy, and mastectomy with or without radiotherapy. We conducted a semi-structured literature review to address the above issues relating to "pure" DCIS. Here we discuss the pathology of DCIS, risk factors for recurrence, biomarkers and molecular signatures, and disease management. Potential mechanisms of progression from DCIS to invasive cancer and problems faced by clinicians and pathologists in diagnosing and treating this disease are also discussed. Despite the tremendous research efforts to identify accurate risk stratification predictors of invasive recurrence and response to radiotherapy and endocrine therapy, to date there is no simple, well-validated marker or group of variables for risk estimation, particularly in the setting of adjuvant treatment after breast-conserving surgery. Thus, the standard of care to date remains breast-conserving surgery plus radiotherapy, with or without hormonal therapy. Emerging tools, such as pathologic or biologic markers, may soon change such practice. Our review also includes recent advances towards innovative treatment strategies, including targeted therapies, immune modulators, and vaccines.

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Article Commentary: Controversies Regarding the Diagnosis and Management of Ductal Carcinoma in Situ

Cited by 13 publications

References 48 publications

Ductal Carcinoma In Situ of the Breast: An Update with Emphasis on Radiological and Morphological Features as Predictive Prognostic Factors

Ductal Carcinoma In Situ of the Breast: An Update with Emphasis on Radiological and Morphological Features as Predictive Prognostic Factors

Breast Mammographic Density: Stromal Implications on Breast Cancer Detection and Therapy

Ductal carcinoma in situ of the breast: an update for the pathologist in the era of individualized risk assessment and tailored therapies

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