Current approach and future perspective for ductal carcinoma in situ of the breast

Kanbayashi, Chizuko; Iwata, Hiroji

doi:10.1093/jjco/hyx059

Cited by 60 publications

(33 citation statements)

References 57 publications

(66 reference statements)

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“…Other studies have investigated the rate of upstaging among patients with a preoperative diagnosis of DCIS. The rate of upstaging in the present study is within the range reported previously in reviews: 9–52 per cent and 10–38 per cent. These reviews include studies that differ with regard to biopsy method (core needle versus excisional biopsy), inclusion criteria (such as including only non‐palpable DCIS lesions), and differences in classification of DCIS with microinvasion, which may explain the wide variation in upstaging rates.…”

Section: Discussionsupporting

confidence: 83%

Multicentre study of the risk of invasive cancer and use of sentinel node biopsy in women with a preoperative diagnosis of ductal carcinoma in situ

Munck

Clausen

Balslev

et al. 2020

Journal of British Surgery

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Background: Ductal carcinoma in situ (DCIS) in the breast that is diagnosed by biopsy implies a risk of upstaging to invasive carcinoma (IC) on final pathology. These patients require a sentinel lymph node biopsy (SLNB) for axillary staging. A two-stage procedure is not always feasible and precise selection of patients who should be offered SLNB is crucial. The aims were: to determine the rate of upstaging, and use of redundant and required SLNB in women with a preoperative diagnosis of DCIS; and to identify patient and tumour characteristics that increase the risk of upstaging.Methods: Patients with DCIS treated between 2008 and 2016 were identified using Orbit operation planning system software, and those suitable for the study were selected based on review of the medical records. Upstaging rates and proportions of redundant and required SLNBs were calculated. Associations between clinicopathological characteristics and upstaging were analysed using univariable and multivariable logistic regression analyses. Results: Of 1368 patients initially identified, 975 women with a preoperative diagnosis of DCIS were included in the study. Tumours in 246 of these patients (25⋅2 per cent) were upstaged to IC. Redundant SLNB was performed in 392 of 975 women (40⋅2 per cent). Forty-four patients (4⋅5 per cent) with a final diagnosis of IC were not offered SLNB and thus potentially undertreated. In adjusted analysis, DCIS size, palpability and mass formation identified by breast imaging were associated with increased risk of upstaging. The Van Nuys classification was not associated with upstaging. Conclusion: Most patients with IC on final pathology underwent SLNB, but a considerable number of patients with DCIS had a redundant SLNB. Lesion size, palpability and mass formation, but not Van Nuys classification group, are suggested risk factors for upstaging.

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Section: Discussionsupporting

confidence: 83%

Multicentre study of the risk of invasive cancer and use of sentinel node biopsy in women with a preoperative diagnosis of ductal carcinoma in situ

Munck

Clausen

Balslev

et al. 2020

Journal of British Surgery

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“… 3 Presently, surgical therapy and radiotherapy and chemotherapy were the major therapeutic strategies. 4 Dismally, some of patients having undergone surgical therapy still were died of postoperative metastasis, 5 the side-effects caused by radiotherapy were continuous, 6 , 7 drug resistance remained to be a several challenge. 8 , 9 These outcomes was probably attributed to poor understanding of BC pathogenesis or mechanism of drug action.…”

Section: Introductionmentioning

confidence: 99%

Overexpression of CLEC3A promotes tumor progression and poor prognosis in breast invasive ductal cancer

Ni¹,

Peng²,

Yang³

et al. 2018

OTT

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IntroductionThe aim of this study was to evaluate the expression of C-type lectin domain family 3 member A (CLEC3A) and its clinical significance in breast invasive ductal cancer (IDC) as well as its effect on breast cancer (BC) cell proliferation and metastasis. In this study, the level of CLEC3A expression in The Cancer Genome Atlas (TCGA) datasets was analyzed.Materials and methodsClinical collected samples and BC cells were measured using quantitative reverse transcription polymerase chain reaction. Its correlations with patients’ clinicopathological characteristics were analyzed by Pearson’s chi-squared test. Overall survival (OS) analysis was performed by the Kaplan–Meier method and Cox’s proportional-hazards model. BC cell proliferation, migration, and invasion by CLEC3A knockdown were assessed using Cell Counting Kit-8 and colony formation assay, wound healing model and transwell assay, respectively, in BT474 cell line. Activities of survival factors and phosphatidylinositol-3-kinase (PI3K)/protein kinase B (AKT) signaling were measured by testing key molecules using Western blot assay.ResultsCLEC3A expression was markedly higher in breast IDC tissues than normal breast tissues or adjacent normal tissue. Patients with high CLEC3A expression related to higher lymph node and poorer OS of breast IDC. CLEC3A knockdown by siRNA could inhibit the BC cells BT474 proliferation, migration, and invasion, together with a decrease in expression of key proteins in survival factors and PI3K/AKT signaling pathway.ConclusionElevated CLEC3A expression may correlate with breast IDC metastatic potential and indicated a poor prognosis in breast IDC. CLEC3A knockdown inhibited BC cell growth and metastasis might be through suppressing PI3K/AKT signaling activity. These findings unravel that CLEC3A is a promising therapeutic target for BC in the future.

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“…A recently published Swedish study showed a new promising approach to SLNB by using superparamagnetic iron oxide, enabling SLNB to be performed later only on those with invasive cancer after tumour resection and allowing up to 80% of women to avoid SLNB altogether 37 . Four ongoing trials, LORD, LORETTA, COMET and LORTIS are independently assessing active surveillance and/or endocrine therapy as an alternative non-inferiority treatment to low-risk DCIS 38 – 41 . The implications are that an equally safe but less harmful treatment alternative might be on the horizon, especially for patient groups with low risk DCIS and of older age.…”

Section: Discussionmentioning

confidence: 99%

In situ breast cancer incidence patterns in Iceland and differences in ductal carcinoma in situ treatment compared to Sweden

Ágústsson

Birgisson

Agnarsson

et al. 2020

Sci Rep

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The purpose was to review the incidence of in situ carcinoma in Iceland after initiating population-based mammography screening in 1987 and to compare management of ductal carcinoma in situ (DCIS) between Iceland and the Uppsala–Örebro region (UÖR) in Central Sweden. The Icelandic Cancer Registry provided data on in situ breast carcinomas for women between 1957 and 2017. Clinical data for women with DCIS between 2008 and 2014 was extracted from hospital records and compared to women diagnosed in UÖR. In Iceland, in situ carcinoma incidence increased from 7 to 30 per 100 000 women per year, following the introduction of organised mammography screening. The proportion of in situ carcinoma of all breast carcinomas increased from 4 to 12%. More than one third (35%) of women diagnosed with DCIS in Iceland were older than 70 years versus 18% in UÖR. In Iceland, 49% of all DCIS women underwent mastectomy compared to 40% in UÖR. The incidence of in situ carcinoma in Iceland increased four-fold after the uptake of population-based mammography screening causing considerable risk of overtreatment. Differences in treatment of DCIS were seen between Iceland and UÖR, revealing the importance of quality registration for monitoring patterns of management.

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Current approach and future perspective for ductal carcinoma in situ of the breast

Abstract: This review presents an overview of the current treatment approaches, problems with overdiagnosis and potential future management strategies for ductal carcinoma in situ of the breast.

Cited by 60 publications

References 57 publications

Multicentre study of the risk of invasive cancer and use of sentinel node biopsy in women with a preoperative diagnosis of ductal carcinoma in situ

Multicentre study of the risk of invasive cancer and use of sentinel node biopsy in women with a preoperative diagnosis of ductal carcinoma in situ

Overexpression of CLEC3A promotes tumor progression and poor prognosis in breast invasive ductal cancer

In situ breast cancer incidence patterns in Iceland and differences in ductal carcinoma in situ treatment compared to Sweden

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