In Situ Duct Carcinoma of the Breast: Clinical and Histopathologic Factors and Association with Recurrent Carcinoma

Abstract

There has been a recent increase in the diagnosis of in situ duct carcinoma of the breast (DCIS) as a result of mammographic screening. DCIS is heterogeneous in appearance and likely in prognosis. There is no generally accepted model to predict progression to invasive carcinoma. We investigated the prognostic effect of clinical presentation and pathologic factors for women diagnosed with primary DCIS. A cohort of 124 patients was accrued between 1979 and 1994 and was followed to 1997; 78 had DCIS detected mammographically, and 88 underwent lumpectomy alone. In this article, we provide details about characteristics affecting the choice of primary therapeutic modality, and we examine the effects of factors on progression for the two patient subgroups. Presentation with bloody nipple discharge was associated with a significant increase in DCIS recurrence (p=0.07). The pattern of duct distribution was important: DCIS in which the involved ducts were more widely separated had a significantly greater recurrence of DCIS than when the involved ducts were more concentrated (p=0.08 for mammographically detected DCIS, p=0.07 for patients who underwent lumpectomy alone). For mammographically detected DCIS, younger patients had more DCIS recurrence (p=0.07). We found considerable heterogeneity in nuclear grade; 50% of patients exhibited more than one grade. Nuclear grade, necrosis, and architecture were not significantly associated with either recurrence of DCIS or development of invasive carcinoma. Longer follow-up will allow further evaluation of the prognostic relevance of the factors assessed.

Is p63 reliable in detecting microinvasion in ductal carcinomain situ of the breast?

“…21 The recent increase in the diagnosis of DCIS is a result of current routine mammographic screening. 11 Of critical importance to the diagnosis of intraductal carcinoma is the integrity of the basement RIBEIRO-SILVA et a1 membrane. When carcinoma is confined to the duct system, without violation of the basement membrane, axillary lymph node involvement is unlikely.…”

Tumor characteristics as predictors of local recurrence after treatment of ductal carcinoma in situ: a meta-analysis

“…The subgroup data of three RCTs were analyzed because tumor characteristics of interest were not included in their multivariate analysis [16,18,21]. Seven observational studies that did not report the risk estimate or its corresponding 95% confidence interval were not included in the pooled analyses [52][53][54][55][56][57][58].…”

“…Compared to those without postoperative mammogram, Vargas et al found that women with postoperative mammogram have lower IBTR (HR = 0.21 with P-value = 0.04) [58]. Method of detection Three RCTs and nine observational studies examined the association between method of detection and outcome [15,17,21,26,28,30,34,35,[44][45][46]56]. We excluded one observational study because its relative risk estimate was not reported [56].…”

“…Method of detection Three RCTs and nine observational studies examined the association between method of detection and outcome [15,17,21,26,28,30,34,35,[44][45][46]56]. We excluded one observational study because its relative risk estimate was not reported [56]. Women without palpable mass or nipple discharge tended to have decreased IBTR [15,17,21,26,28,34,45].…”

Learning invariant features of tumor signatures

“…In some cases, tumor grading has been associated with recurrence, progression, and invasion carcinoma (e.g., breast DCIS), but such an association is highly dependent on tumor heterogeneity and mixed grading (e.g., presence of more than one grade), which offers significant challenges to the pathologists as mixed grading appears to be present in 50 percent of patients [8]. A recent study indicates that detailed segmentation and multivariate representation of nuclear features from H&E stained sections can predict DCIS recurrence [9] in patients with more than one nuclear grade.…”