Behaviour and characteristics of low‐grade ductal carcinoma in situ of the breast: literature review and single‐centre retrospective series

Abstract

Aims Ductal carcinoma in situ (DCIS) of the breast is a heterogeneous disease that has risen to prominence and more recently controversy, with the advent of screening mammography. Debate concerning the true biological potential of low nuclear grade DCIS continues to challenge therapeutic considerations. In this study, we carried out a comprehensive literature review of the behaviour, outcomes and current management trials of low‐grade DCIS, as well as a retrospective study of a large single institutional series of low‐grade DCIS diagnosed at our hospital. Methods and results The study cohort comprised 195 cases of low‐grade DCIS diagnosed at the Singapore General Hospital from 1994 to 2010. Clinicopathological parameters and follow‐up data were retrieved and compared between screen‐detected and symptomatic low‐grade DCIS. Immunohistochemistry was performed for ER, PR and HER2. Among 195 cases, 123 (63.1%) were screen‐detected, while 72 (36.9%) were symptomatic. Screen‐detected cases had frequent calcifications (P < 0.001) and were smaller (P = 0.018) than symptomatic cases. All cases were ER‐positive and rate of PR expression was high. No HER2 overexpression was observed. Mean and median follow‐up periods were 107.8 and 109.6 months, respectively. Six patients recurred ipsilaterally, and one patient developed direct distant metastasis. One breast cancer‐related death was recorded. Positive surgical margins (P = 0.023) were significantly associated with a higher risk of ipsilateral recurrences, as well as poorer disease‐free survivals (P = 0.010). Conclusion Our data indicate that low‐grade DCIS may be followed by invasive recurrences and even metastatic disease, requiring more study before being regarded as innocuous and indolent.

Patterns of aggressiveness: risk of progression to invasive breast cancer by mammographic features of calcifications in screen-detected ductal carcinoma in situ

“…Concerns related to overdiagnosis and overtreatment have initiated groundbreaking trials of active surveillance among women with non-high-grade DCIS: the LORIS trial (UK) (37); the LORD trial (Belgium and Netherlands) (38); the COMET trial (US) (39); and the Loretta trial (Japan) (40). There is, however, an ongoing debate regarding the active surveillance trials, concerning whether the inclusion criteria will succeed in identifying a population of sufficiently low risk of progression (3,(41)(42)(43)(44).…”

Stereotactic breast biopsies: Radiological-pathological concordance in a South African referral unit

“…According to nuclear grade, DCIS is classified as low-, intermediate-or highgrade. 15 Considering its malignant potential and proclivity for local recurrence (albeit over a longer period of time), lowgrade DCIS has been included in the malignancy category. 15,16 Patient data were collected from the biopsy procedural recording sheets, breast imaging records, the Picture Archiving and Communication System (PACS) and the National Health Laboratory Service (NHLS).…”

“…According to nuclear grade, DCIS is classified as low-, intermediate- or high-grade. 15 Considering its malignant potential and proclivity for local recurrence (albeit over a longer period of time), low-grade DCIS has been included in the malignancy category. 15 , 16 …”

Low-risk DCIS. What is it? Observe or excise?

“…As noted, deaths have rarely been reported following surgically excised low-grade DCIS; 3 of 195 patients with low-grade DCIS diagnosed at the Singapore General Hospital died, but only one (0.5%) was breast cancer-related [40]. The patient who died from breast cancer-related disease had presented with DCIS symptomatically and subsequently developed a contralateral invasive carcinoma which metastasized to the pleura and bone, and subsequently led to her death.…”