Relationship Between the Size and Margin Status of Ductal Carcinoma In Situ of the Breast and Residual Disease

Liu, Cheng; Al‐Kaisi, Nadia; Gordon, Nahida H.; Liu, Alison Y.; Gebrail, Fadi; Shenk, Robert

doi:10.1093/jnci/89.18.1356

Cited by 99 publications

(42 citation statements)

References 24 publications

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“…Patients with DCIS (possibly the most prevalent precursor to invasive breast cancer [6][7][8][9][10][11]) currently undergo some combination of breast conserving surgery, radiation therapy, and hormonal therapy. Breast conserving surgery fails to remove the entire tumor 38-72% of the time, requiring up to three surgeries for adequate tumor excision [12][13][14]. In the absence of adjuvant radiation and hormonal therapy, the estimated rate of recurrence after surgery is up to 25%.…”

Section: Introductionmentioning

confidence: 99%

A Novel, Patient-Specific Mathematical Pathology Approach for Assessment of Surgical Volume: Application to Ductal Carcinomain situof The Breast

Edgerton

Chuang

Macklin

et al. 2011

Analytical Cellular Pathology

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Abstract. We introduce a novel "mathematical pathology" approach, founded on a biophysical model, to identify robust patientspecific predictors of tumor growth useful in clinical practice to improve the accuracy of diagnosis/prognosis and intervention. In accordance with biological observations, our model simulates the diffusion-limited in-situ tumors with a relatively short phase of fast initial growth, followed by a prolonged slow-growth phase where tumor size is constrained primarily by the relative weight of cell mitosis and death. The former phase may only last for a few months, so that at the time of diagnosis, we may assume that most tumors will have entered the phase where their size is changing slowly. Based on this prediction, we hypothesize that the volume of breast with ducts affected by in-situ tumors at the time of diagnosis will be closely approximated by a modelderived mathematical function based on the ratio of tumor cell proliferation-to-apoptosis indices and on the extent of diffusion of cell nutrients (diffusion penetration length), which can be measured from immunohistochemical and morphometric analysis of patient histopathology specimens without the need for multiple-time measurements. We tested this idea in a retrospective study of 17 patients by staining breast tumor specimens containing ductal carcinoma in situ for mitosis with Ki-67 and for apoptosis with cleaved caspase-3 and counting cells positive for each marker. We also determined diffusion penetration by measuring the thickness of viable rims of tumor cells within ducts. Using the ensuing ratios, we applied the model to determine a predicted surgical volume or tumor size. We then corroborated our hypothesis by comparing the predicted size of each tumor based on our model with the actual size of the pathological specimen after tumor excision (R 2 = 0.74-0.88). In addition, for the 17 cases studied, both histological grade and mammography were not found to correlate with tumor size (R 2 = 0.08-0.47). We conclude that our mathematical pathology approach yields a high degree of accuracy in predicting the size of tumors based on the mitotic/apoptotic index and on diffusion penetration. By obtaining these ratios at the time of initial biopsy, pathologists can employ our model to predict the size of the tumor and thereby inform surgeons how much tissue to remove (surgical volume). We discuss how results from the model have implications concerning the current debate on recommendations for screening mammography, while the model itself may contribute to better planning of breast conservation surgery.

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Section: Introductionmentioning

confidence: 99%

A Novel, Patient-Specific Mathematical Pathology Approach for Assessment of Surgical Volume: Application to Ductal Carcinomain situof The Breast

Edgerton

Chuang

Macklin

et al. 2011

Analytical Cellular Pathology

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“…14 e Melstrom et al 17 definiram margem comprometida como ausência de lesão na tinta; outros dois estudos 5,13 definiram como menor ou igual a um milímetro, e Dillon et al 16 como menor ou igual a dois milímetros. A taxa de margens comprometidas nos estudos variou de 29 a 72%.…”

Section: Resultsunclassified

“…Seguindo esses critérios de inclusão, foram selecionados cinco artigos [13][14][15][16][17] . Um estudo publicado em 1997 foi adicionado à revisão por ter sido usado como referência em outros trabalhos e ter apresentado resultado significativo 5 . O presente estudo avaliou, portanto, 6 trabalhos, correspondendo, assim, a 1.222 pacientes no total.…”

Section: Métodosunclassified

“…O tratamento do CDIS é basicamente cirúrgico: mastectomia ou cirurgia conservadora. A cirurgia conservadora, geralmente seguida de radioterapia e hormonioterapia, continua sendo o tratamento preferencial 5,6 . A mortalidade absoluta associada ao CDIS é bastante baixa, ficando em torno de 2% nos 10 anos seguintes ao diagnóstico 4,7 , e está associada aos casos que evoluíram para, ou recidivaram como, um carcinoma invasor.…”

Section: Introductionunclassified

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Fatores preditivos de margens cirúrgicas comprometidas no tratamento do carcinoma ductal in situ da mama

Hassan¹,

Dória²,

Baracat³

et al. 2017

Rev. Bras. Mastol. (Impr.)

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), utilizando as expressões: "Ductal carcinoma in situ", "in situ breast cancer" e "DCIS". Os termos adicionais incluídos foram "surgery" e "margin". O período de referência desses estudos foi de fevereiro de 2000 a fevereiro de 2015. Dos 438 artigos encontrados, 6 foram incluí-dos nessa revisão, com um total de 1.222 pacientes. A taxa de margens comprometidas nos estudos variou de 29 a 72%. As principais variáveis relacionadas com margem comprometida foram o grau histológico e o tamanho final da lesão na parafina (três estudos), multifocalidade (um estudo) e volume da peça cirúrgica ressecada (um estudo). Margens cirúrgicas representam, indubitavelmente, um dos mais importantes fatores de recorrência local no tratamento do CDIS. São necessários estudos mais amplos e com metodologias adequadas para se estratificar, com segurança, os fatores de risco associados ao comprometimento das margens cirúrgicas. ABSTRACT The purpose of this study was to determinate, through a literature review, possible factors related to positive margins in patients treated with surgery for ductal carcinoma in situ (DCIS). The Medical Literature Analysis and Retrieval System Online (MEDLINE

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“…(1) The main cancer to affect Brazilian women is non-melanoma skin cancer (71.000 new cases), followed in order of frequency by malignant neoplasms of the breast (53.000), cervix uteri (18.000), colon/rectum (16.000) and lung (10.000). (1) Clinical presentation of pure Ductal Carcinoma in Situ (DCIS) is often described as extension small tumors (4)(5)(6)(7)(8)(9)(10)(11) detected mainly by mammography. Recognizing this type of tumor may manifest as palpable lesion, it is necessary to know and to apply methods that allow diagnosis early: self-breast examination, and clinical examination by a trained team.…”

Section: Introductionmentioning

confidence: 99%

Ductal Carcinoma in Situ of the Breast: A Case Report With an Atypical Clinical Presentation

Campodonio

Oliveira

Machado

2013

BJMHH

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Ductal carcinoma in situ (DCIS) of the breast is a proliferative lesion, precursor of cancer, which has been increasingly diagnosed due to mammographic screening. Tumor size itself does not determine whether the lesion is in situ or invasive, so it is essential to emphasize that DCIS can present with variable extension. We report a case of a 44-year-old female patient that was diagnosed a great (12 cm) DCIS of the breast without microinvasion through pathologic examination. The patient presented with an increase of the right breast, acyclic mastalgia and right bloody nipple discharge. Mammography was inconclusive, the ultrasound suggested inflammation and the incisional biopsy revealed DCIS nuclear grade 3 with compromised lateral margins. It was performed simple mastectomy and axillary node sampling. The clinical presentations of benign and malignant diseases of the breast are variable. The most common symptoms reported by women are pain, palpable mass or nipple discharge. The literature reveals that the extent of this type of cancer is variable, being found in a review intraductal lesions up to 5.4 cm, size smaller than that one that was found in this patient. This finding makes the clinical apresentation interesting to be discussed. Although mammography is the most efficient method to diagnose this injury, clinical breast exam should be performed in all gynecological independent of patient age because it is useful for diagnosing early lesion, considering that it is a palpable lesion.Keywords: Breast cancer; Clinical presentation; Diagnosis. INTRODUCTIONBreast cancer is a common disease among women and in recent decades, has been noticing an increase in incidence and mortality associated with this neoplasm. (1,2,3) According to the Ministry of Health (2012), (1) even being considered as a good prognosis cancer when diagnosed and treated appropriately, mortality from breast cancer still present with high rates in Brazil, probably by the diagnosis in advanced stages (III or IV). The DCIS of the breast involves a heterogeneous group of neoplastic proliferation, non-invasive, with risk of recurrence and malignant transformation. (16) According to Boff and Wisintainer (2006), (17) the increase in the incidence of DCIS is due to mammographic imaging technology that is diagnosing non-palpable breast lesions. They claim that the diagnosis and treatment of non-invasive breast cancer will reduce the mortality rate in up to 46%. In patients adequately treated, the survival rate in 16 years is 95%. (18) DCIS does not invade the lymphatics and blood vessels, therefore, can not spread. It is composed of a population of malignant cells confined to the ducts by the basement membrane. It is therefore a clonal proliferation involving, in general, a single ductal system and the myoepithelial cells are preserved. (19,20) But, may be involved more than one duct or a single duct with more than one target area, separated by parenchyma without lesions. (21) This work aimed to report a case of DCIS of the breast in extensive...

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Relationship Between the Size and Margin Status of Ductal Carcinoma In Situ of the Breast and Residual Disease

Abstract: The size and margin status of DCIS each were found to be independent predictors of residual disease.

Cited by 99 publications

References 24 publications

A Novel, Patient-Specific Mathematical Pathology Approach for Assessment of Surgical Volume: Application to Ductal Carcinomain situof The Breast

A Novel, Patient-Specific Mathematical Pathology Approach for Assessment of Surgical Volume: Application to Ductal Carcinomain situof The Breast

Fatores preditivos de margens cirúrgicas comprometidas no tratamento do carcinoma ductal in situ da mama

Ductal Carcinoma in Situ of the Breast: A Case Report With an Atypical Clinical Presentation

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