Ductal Carcinoma-In-Situ of the Breast with Subsequent Distant Metastasis and Death

Roses, Robert E.; Arun, Banu K.; Lari, Sara A.; Mittendorf, Elizabeth A.; Lucci, Anthony; Hunt, Kelly K.; Kuerer, Henry Mark

doi:10.1245/s10434-011-1707-2

Cited by 47 publications

(40 citation statements)

References 17 publications

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“…Of the 8 cases of direct metastasis, 6 had tumour sizes C20 mm. Progression from DCIS to metastasis is an indication of aggressive biological behaviour [53]. In our patients with direct distant metastasis, only 2 were from the screen-detected group, while the rest were symptomatic cases, suggesting that symptomatic DCIS is more likely to recur and even potentially metastasise.…”

Section: Discussionmentioning

confidence: 75%

“…DCIS is, by definition, not invasive and therefore theoretically unable to metastasise to regional lymph nodes [52]. Roses et al [53] documented a distant metastases rate of 1.0 % after an initial diagnosis of pure DCIS, where some of the patients also had no prior invasive locoregional recurrences. Donker et al [15] also disclosed 3.2 % of direct distant metastasis in their study cohort.…”

Section: Discussionmentioning

confidence: 99%

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Characteristics and behaviour of screen-detected ductal carcinoma in situ of the breast: comparison with symptomatic patients

Koh

Lim

Thike

et al. 2015

Breast Cancer Res Treat

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Breast cancer is the most common malignancy in Singapore women. Ductal carcinoma in situ (DCIS) is the putative, non-obligate precursor of the majority of invasive breast cancers. The efficacy of the Singapore breast-screening pilot project in detecting early stage breast cancer led to the launch of a national breast-screening programme, BreastScreen Singapore (BSS), in January 2002. In this study, we compared clinicopathological and immunohistochemical characteristics, as well as clinical outcomes, between screen-detected and symptomatic DCIS. The study cohort comprised 1202 cases of DCIS diagnosed at Singapore General Hospital from 1994 to 2010. Comparison of clinicopathological parameters, immunohistochemical results of ER, PR, HER2, CK14, EGFR, and 34βE12, and clinical outcomes was carried out between the 2 groups. Amongst 1202 cases, 610 (50.7%) were screen-detected and 592 (49.3%) were symptomatic DCIS. Screen-detected cases were smaller in size (P < 0.001), of lower nuclear grade (P = 0.004), and more frequently expressed ER (P < 0.001). Luminal A phenotype was more frequently observed in screen-detected DCIS, while triple-negative and HER2 phenotypes were more common in symptomatic DCIS (P < 0.001). The basal-like phenotype was also more frequent in symptomatic DCIS (P = 0.041). Mean and median follow-up was 99.7 and 97.8 months, respectively, with a maximum follow-up of 246.0 months. More symptomatic patients developed invasive recurrences compared to screen-detected patients (P = 0.001). A trend for better disease-free survival was observed in screen-detected patients (P = 0.076). Patients who were screen-detected experienced better overall survival than those with symptomatic DCIS (P = 0.007). Our data indicate a more favourable outcome of screen-detected DCIS patients confirming the role of BSS in early identification of this curable disease.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Characteristics and behaviour of screen-detected ductal carcinoma in situ of the breast: comparison with symptomatic patients

Koh

Lim

Thike

et al. 2015

Breast Cancer Res Treat

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“…However, different behaviors have been observed after the initial treatment; some DCISs remain indolent or are associated with a low risk of developing into invasive cancer, whereas others show a higher tendency to progress to invasive breast cancer or to recur (3). Published reports have shown that rates of recurrence after treatment for pure DCIS range from 5% to 20%, and approximately 50% of these are invasive (4,5).…”

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confidence: 99%

Breast Scintigraphy with Breast-Specific γ-Camera in the Detection of Ductal Carcinoma In Situ: A Correlation with Mammography and Histologic Subtype

et al. 2012

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Ductal carcinoma in situ (DCIS) is a subtype of breast cancer encountered increasingly in clinical practice because of the widespread use of screening mammography. In the present study, we evaluated the usefulness of breast-specific g-camera (BSGC) scintigraphy in DCIS identification, describing the scintigraphic findings and their correlation with mammography and histologic subtype. Methods: Thirty-three women, aged 41-81 y, with surgically proven DCIS were retrospectively reviewed. Before surgery, all patients underwent breast scintigraphy using a high-resolution semiconductor-based BSGC, starting 10 min after intravenous injection of 740 MBq of 99m Tc-tetrofosmin. All patients had previously undergone mammography. A definitive histologic diagnosis was obtained in all cases after scintigraphy, and the scintigraphic findings were correlated with mammography and histologic subtype. Results: Mammography was positive in 30 of 33 patients (sensitivity, 90.9%), showing calcifications in 22 of 30 (73.3%), masses in 3 of 30 (10%), and masses plus calcifications in the remaining 5 of 30 (16.7%). Scintigraphy was positive in 31 of 33 patients (sensitivity, 93.9%), showing patchy irregular uptake in patients with calcifications and focal uptake in masses; sensitivity was higher in low-to intermediate-grade DCIS than in intermediate/high-and high-grade DCIS (100% vs. 91.3%), but the difference was not statistically significant. Two comedo-type DCIS (one 20-mm intermediate/high-grade and one 15-mm high-grade) with heterogeneously or highly dense breasts at mammography and one papillary low/intermediate-grade DCIS associated with Paget disease were true positive only at scintigraphy. Moreover, scintigraphy better assessed disease extent than did mammography in 5 additional patients. Two comedo-type DCIS (one 6-mm intermediate/highgrade and one 15-mm high-grade) were true positive only at mammography. The difference in sensitivity between scintigraphy and mammography was not statistically significant. The combined use of mammography and scintigraphy achieved 100% sensitivity. Conclusion: BSGC scintigraphy proved to be a highly sensitive diagnostic tool in the detection of DCIS, irrespective of histologic subtype, and with a scintigraphic pattern of uptake that correlated well with mammography findings. In our series, BSGC scintigraphy demonstrated a slightly higher sensitivity than mammography and a better assessment of local disease extent. Thus, BSGC scintigraphy should represent a useful adjunctive tool in breast cancer diagnosis.Key Words: DCIS; breast-specific g-camera scintigraphy; mammography Duct al carcinoma in situ (DCIS) of the breast is a noninvasive subtype of primary breast cancer characterized by a malignant proliferation of ductal epithelium with no histologic evidence of invasion through the ductal basement membrane (1). The mortality associated with a pure DCIS without invasion is thus extremely low, generally lower than 1%-2% (2).However, different behaviors have been observed after the initial treatment; ...

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“…There is a general consensus that DCIS represents a noninvasive, nonobligate precursor of invasive breast cancer (11). Therefore, the early diagnosis and management of DCIS are critical in preventing the development of invasive cancer (12,13). It has been proposed that the biological aggressiveness of breast cancer can also be predicted by mammographic characteristics (13,14).…”

Section: Introductionmentioning

confidence: 99%

Importance of microcalcifications in mammographic differentiation of the invasive ductal breast cancer and of the ductal carcinoma in situ

Sarac¹,

Nadrljanski²

2017

Med podmladak

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Introduction: Microcalcifications represent a significant and reliable sign of the presence of the malignant breast lesion. Aim: The aim of the paper is to radiologically evaluate the type and distribution of suspicious microcalcifications, in patients with invasive ductal carcinoma (IDC) and ductal carcinoma in situ (DCIS). Material and Methods: Retrospective analysis includes the evaluation of the type and distribution of suspicious microcalcifications, in patients with histologically verified malignant lesions: invasive ductal carcinoma (N1=40 pts.) and ductal carcinoma in situ (N2=40 pts.). Standardised mediolateral oblique and cranicaudal views were selected for the evaluation of the images, taken on the full-field digital mammograph (FFDM «Selenia», Institute of Oncology and Radiology of Serbia, Belgrade), on the dedicated workstation of the mammography unit, with the aid of the software for lesion evaluation. Results: Eight patients with invasive ductal carcinoma (20%) had no suspicious microcalcifications, as opposed to the patients with ductal in situ carcinoma, where all patients had suspicious microcalcifications (p<0.05). In the subgroup of patients with invasive ductal carcinoma, the most frequent type of microcalcifications included the fine pleomorphic calcifications (75%). In patients with ductal carcinoma in situ, amorphous (57.5%) and linear/ branching microcalcifications were more frequent than other types (55%). Conclusion:The results of this study show that the amorphous microcalcifications segmental distribution usually detected in the subgroup with DCIS, which coincides with published results. With acceptable sensitivity and specificity, amorphous microcalcifications and linear distribution segment represents a specific mammographic findings in the detection of DCIS.

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Ductal Carcinoma-In-Situ of the Breast with Subsequent Distant Metastasis and Death

Abstract: DM after a diagnosis of pure DCIS is rare. Although most patients with DM have a preceding invasive LRR, some present with subsequent DM alone. Further study is required to identify clinical and pathologic predictors of this more rapid disease progression.

Cited by 47 publications

References 17 publications

Characteristics and behaviour of screen-detected ductal carcinoma in situ of the breast: comparison with symptomatic patients

Characteristics and behaviour of screen-detected ductal carcinoma in situ of the breast: comparison with symptomatic patients

Breast Scintigraphy with Breast-Specific γ-Camera in the Detection of Ductal Carcinoma In Situ: A Correlation with Mammography and Histologic Subtype

Importance of microcalcifications in mammographic differentiation of the invasive ductal breast cancer and of the ductal carcinoma in situ

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