Breast Carcinoma In Situ

Mammary ductal carcinoma in Situ with microinvasion

“…25,26 Moreover, in several published reports addressing management issues related to microinvasive carcinoma, specific criteria for the diagnosis of microinvasion were not provided. 9,[27][28][29] Interpretation of data from the literature relating to axillary lymph node status and clinical outcome is likely to be inconclusive if meticulous attention is not paid to the diagnostic criteria and methodologies used in the evaluation of microinvasion. It is therefore not surprising that there has been considerable controversy regarding the management of DCIS accompanied by a focus (or foci) of microinvasion.…”

“…Although our results and those of others 3,6,19,40 suggest that microinvasive carcinoma is an extremely favorable lesion, several deaths among lymph node positive patients attributed to carcinoma have been reported. 9,17 (Table 3). However, with one exception, all studies that have reported axillary lymph node positivity in this setting have either allowed a larger maximum size to qualify as microinvasion than that used in the current study or have not even defined microinvasion (Table 3).…”

“…Silverstein et al, 37 using a definition roughly comparable to ours, reported axillary metastases in one (4.2%) of 24 cases of microinvasion. Unfortunately, because the majority of cited studies 1,3,5,9,17,37 have not directly addressed the adequacy of sampling of their reported cases, the possibility of occult frank invasion accounting for lymph node metastases cannot entirely be excluded. Given that routine axillary dissection for patients with early stage (T1) breast carcinoma and clinically negative lymph nodes has been questioned in light of the low incidence of lymph node metastases, 7,41,42 the lack of conclusive therapeutic value, 43,44 the potential for significant morbidity, 45 and the exorbitantly high cost--to-benefit ratio, 46,47 additional studies that pay meticulous attention to sampling are indicated to evaluate further the efficacy of routine axillary staging for this subset of T1a tumors.…”

Frequency and factors associated with injury to the axillary vein in women that underwent axillary lymphadenectomy during breast cancer surgical treatment

“…Another subgroup with low potential of axillary metastases is microinvasive carcinoma. Most of the papers 19,20 show a 5% incidence of axillary metastases, even though Schuh et al 21 and Kinne et al 22 found axillary damage rates between 20 and 10%, respectively. The different definitions of what a microinvasive or invasive tumor is would result in this frequency variation of the axillary metastasis process.…”

Overview of the biology and management of ductal carcinoma in situ of the breast

“…The presence of stromal invasion classically has denoted an entirely different entity with different prognostic and therapeutic implications, in view of the potential for systemic metastasis and death that is not theoretically possible with purely in situ lesions.22e24, [64][65][66] Despite this, several recent series have continued to include cases of microinvasion in studies of DCIS,25,46,49,67 a practice that is supported by some retrospective studies that suggest that microinvasion may have no impact on ultimate o~t c o m e .~~,~~ A distinction between "microinvasion", defined as nests of malignant cells that have invaded within only 0.1 mm beyond a duct, and "focal invasion", which are clearly invasive lesions that suggest a certain risk of systemic disease, recently has been c o n j e c t~r e d .~~,~~ It must be emphasized, however, that such a theoretic distinction has never been supported by hard evidence. In fact, currently available evidence confirms that even the very smallest invasive breast carcinomas (<0.5 cm) still have a definite potential for metastatic spread.…”