Complete Removal of the Lesion as a Guidance in the Management of Patients with Breast Ductal Carcinoma In Situ

Nicosia, Luca; Giulio, Giuseppe Di; Bozzini, Anna Carla; Fanizza, Marianna; Ballati, Francesco; Rotili, Anna; Lazzeroni, Matteo; Latronico, Antuono; Abbate, Francesca; Renne, Giuseppe; Addante, Francesca; Lucioni, Marco; Cassano, Enrico; Mastropasqua, Mauro G.

doi:10.3390/cancers13040868

Cited by 10 publications

(5 citation statements)

References 23 publications

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“…In our study, we found a statistically significant reduction of the upgrade rate considering the following parameters: age of the patients, lesion size, BIRADs and the complete macroscopical removal of the lesion by VABB, as already documented for the upgrading rate of DCIS to IC [ 39 ]. Moreover, the upgrade rate to IC is significantly reduced when ADH is found only in specimens showing microcalcifications.…”

Section: Discussionsupporting

confidence: 82%

Atypical Ductal Hyperplasia after Vacuum-Assisted Breast Biopsy: Can We Reduce the Upgrade to Breast Cancer to an Acceptable Rate?

et al. 2021

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(1) Background: to evaluate which factors can reduce the upgrade rate of atypical ductal hyperplasia (ADH) to in situ or invasive carcinoma in patients who underwent vacuum-assisted breast biopsy (VABB) and subsequent surgical excision. (2) Methods: 2955 VABBs were reviewed; 141 patients with a diagnosis of ADH were selected for subsequent surgical excision. The association between patients’ characteristics and the upgrade rate to breast cancer was evaluated in both univariate and multivariate analyses. (3) Results: the upgrade rates to ductal carcinoma in situ (DCIS) and invasive carcinoma (IC) were, respectively, 29.1% and 7.8%. The pooled upgrade rate to DCIS or IC was statistically lower at univariate analysis, considering the following parameters: complete removal of the lesion (p-value < 0.001); BIRADS ≤ 4a (p-value < 0.001); size of the lesion ≤15 mm (p-value: 0.002); age of the patients <50 years (p-value: 0.035). (4) Conclusions: the overall upgrade rate of ADH to DCIS or IC is high and, as already known, surgery should be recommended. However, ADH cases should always be discussed in multidisciplinary meetings: some parameters appear to be related to a lower upgrade rate. Patients presenting these parameters could be strictly followed up to avoid overtreatment.

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Section: Discussionsupporting

confidence: 82%

Atypical Ductal Hyperplasia after Vacuum-Assisted Breast Biopsy: Can We Reduce the Upgrade to Breast Cancer to an Acceptable Rate?

et al. 2021

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“…All upstaged cases were good-prognosis invasive carcinomas: all were node negative and HER2 negative. Furthermore, a proportion of women with DCIS will have complete removal of the lesion at biopsy, and subsequently experience a low upgrade rate (8.2%) [31]. A study in the Netherlands addressed the issue of the reliability of preoperative biopsy, and identified several factors that can aid in further risk stratification of women being considered for non-operative management [32].…”

Section: Discussionmentioning

confidence: 99%

Preferences of Treatment Strategies among Women with Low-Risk DCIS and Oncologists

Byng

Retèl

Engelhardt

et al. 2021

Cancers

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As ongoing trials study the safety of an active surveillance strategy for low-risk ductal carcinoma in situ (DCIS), there is a need to explain why particular choices regarding treatment strategies are made by eligible women as well as their oncologists, what factors enter the decision process, and how much each factor affects their choice. To measure preferences for treatment and surveillance strategies, women with newly-diagnosed, primary low-risk DCIS enrolled in the Dutch CONTROL DCIS Registration and LORD trial, and oncologists participating in the Dutch Health Professionals Study were invited to complete a discrete choice experiment (DCE). The relative importance of treatment strategy-related attributes (locoregional intervention, 10-year risk of ipsilateral invasive breast cancer (iIBC), and follow-up interval) were discerned using conditional logit models. A total of n = 172 patients and n = 30 oncologists completed the DCE. Patient respondents had very strong preferences for an active surveillance strategy with no surgery, irrespective of the 10-year risk of iIBC. Extensiveness of the locoregional treatment was consistently shown to be an important factor for patients and oncologists in deciding upon treatment strategies. Risk of iIBC was least important to patients and most important to oncologists. There was a stronger inclination toward a twice-yearly follow-up for both groups compared to annual follow-up.

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“…Although ultrasound and mammogram indicated a high complete excision rate, residual tumors were con rmed in 77.5% of cases under the guidance of histologically golden standards. In other studies regarding malignant tumors, complete excision rates were around 33-86% [14,[20][21][22][23][24] . Although the imaging-complete excision of malignant lesions may be achieved, the VABB procedure is not able to entirely replace surgery for breast cancer [18,19,25] .…”

Section: Discussionmentioning

confidence: 83%

Urinary Catheter-Directed Breast-Conserving Surgery for Incidentally Discovered Breast Cancer After Vacuum-assisted Breast Biopsy (VABB) Therapeutic Excision

Lu,

Qin,

Zhou

et al. 2023

Preprint

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Purpose Vacuum-assisted breast biopsy (VABB) offers high accuracy in the diagnosis of breast tumors but makes the location of the original lesion difficult to identify when the subsequent breast-conserving surgery (BCS) is to be carried out. The aim of this study was to describe an effective technique to identify the exact location of the VABB cavity and to make breast-conserving resection more precise. Methods In this study, a balloon urinary catheter was inserted through the biopsy track; thus, the inflated balloon and catheter perfectly reconstructed the VABB cavity and biopsy track. Then breast-conserving resection with the guidance of the catheter was performed. Six patients were enrolled and assessed for their surgical findings, pathological results, surgical margins, and postoperative complications. Results Residual tumors were confirmed in 4 out of 6 patients after VABB. All the patients gained negative margins and underwent successful breast-conserving surgery. None of them required re-excisions. Satisfactory cosmetic results were observed after the catheter-directed BCS. Conclusions The results of this study show the effectiveness of urinary catheter-guided breast-conserving surgery after VABB. The procedure is simple and inexpensive. This new technique enabled precise breast-conserving resection of the targeted lesion and potentially improve successful rate of breast-conserving surgery.

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Complete Removal of the Lesion as a Guidance in the Management of Patients with Breast Ductal Carcinoma In Situ

Cited by 10 publications

References 23 publications

Atypical Ductal Hyperplasia after Vacuum-Assisted Breast Biopsy: Can We Reduce the Upgrade to Breast Cancer to an Acceptable Rate?

Atypical Ductal Hyperplasia after Vacuum-Assisted Breast Biopsy: Can We Reduce the Upgrade to Breast Cancer to an Acceptable Rate?

Preferences of Treatment Strategies among Women with Low-Risk DCIS and Oncologists

Urinary Catheter-Directed Breast-Conserving Surgery for Incidentally Discovered Breast Cancer After Vacuum-assisted Breast Biopsy (VABB) Therapeutic Excision

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