Risk of invasion and axillary lymph node metastasis in ductal carcinoma <i>in situ</i> diagnosed by core-needle biopsy

“…16,21 It seems that evaluating the percentage of positive cores is more representative than merely the number of cores taken, as the former would yield a more accurate indication of the extensiveness of the lesion. In this context, one may suggest that size estimation may also be a good parameter to evaluate, as evident by the number of studies evaluating the size either pathologically 7,15,17,21 or radiologically, either using mammography 7,10,20 or ultrasound.…”

Section: Discussionmentioning

confidence: 99%

“…Many of these series evaluated various factors, but so far no single factor stood out to be a consistent predictor. The factors that had been evaluated could be categorized as radiological features (mass, density, radiologic extent as measured using mammography or sonography, and the extent and morphology of the calcifications), 8,10,13,14,16,19 histological features (size, grade, necrosis, calcifications, architecture, lobular extension, periductal inflammation and periductal stromal fibrosis), [7][8][9][10]12,[14][15][16][18][19][20][21] sampling adequacy as indicated by the number of cores sampled 16,18 and patient factor, such as age. 10,16 There were reports that either confirmed or refuted their roles as predictors for invasion in needle core biopsy showing DCIS only.…”

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confidence: 99%

“…Whether these factors are totally insignificant is still debatable, as all of these had been shown to be significant or insignificant in different series. For instance, some studies showed that age, 16 number of cores, 16,21 grade, [7][8][9]11,16,21 architecture, 7,16,21 necrosis, 9,11,16,21 periductal stromal fibrosis or desmoplasia [14][15][16]21 and calcification 16,18 were insignificant, whereas other studies showed the same factors, including number of cores, 13,18 grade, 10,14,15,20 comedo necrosis, 10,11,19 and periductal inflammatory cells infiltrate, 14 to be significant. It seems that prediction of eventual invasion in needle core biopsy showing only DCIS is still fraught with uncertainty.…”

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confidence: 99%

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Predictors of invasion in needle core biopsies of the breast with ductal carcinoma in situ

Chan

Vong

et al. 2010

Modern Pathology

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A significant proportion of ductal carcinomas in situ (DCISs) of the breast diagnosed on core biopsies had invasion upon excision. An assessment of various invasion predictors in the biopsies yielded conflicting results. A cohort of 157 cases with needle core biopsy diagnosed with DCISs (including 109 histologically proven DCISs, and 48 cases with invasion upon excision) were evaluated for the numbers of positive and total cores, the percentage of positivity, lobular cancerization, tumor nuclear grade, necrosis, calcification, predominate histological pattern, lymphocytic infiltrate and excisional tumor size. The mean positive core percentage and excisional tumor size were 76% and 2.8 cm for invasive and 66% and 1.9 cm for noninvasive groups. In the biopsy of the invasive group, cancerization of lobules was present in 52%, and nuclear grades 1, 2 and 3 were present in 31, 31 and 38%, respectively. Large comedo and small noncomedo necroses were present in 48 and 10%, whereas large and small calcifications were present in 16 and 21%. Solid, cribriform and papillary patterns were observed in 88, 38 and 21%, respectively. Moderate to marked lymphoid infiltrate was present in 31%. In the biopsy of the noninvasive group, cancerization of lobules was present in 69%, and the nuclear grades 1, 2 and 3 were present in 23, 48 and 29%, respectively. Large comedo and small noncomedo necroses were present in 35 and 11%, whereas large and small calcifications were present in 33 and 23%. Solid, cribriform and papillary patterns were observed in 85, 39 and 9%, respectively. Moderate to marked lymphoid infiltrate was present in 36%. Comparing these groups, a higher positive core percentage, papillary pattern and less cancerization of lobules in the cores and larger excisional tumor size were associated with a higher chance of invasion. Calcification, necrosis and nuclear grade were not significant invasion predictors.

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“…DCIS is also classified by nuclear grade, a distinct histological feature thought to be related to the behavior of DCIS [13]. High-grade DCIS is more likely to be associated with IBC [14]. Highgrade DCIS is commonly associated with necrosis and this combination has the most aggressive biological characteristics.…”

Section: Introductionmentioning

confidence: 99%

Current Treatment and Clinical Trial Developments for Ductal Carcinoma In Situ of the Breast

et al. 2007

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After completing this course, the reader will be able to:1. Discuss the role of radiation therapy in the adjuvant treatment of DCIS.2. Describe the impact of tamoxifen in the treatment of DCIS.3. Discuss evolving strategies in neoadjuvant treatment for DCIS.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACTDuctal carcinoma in situ (DCIS) is the fastest growing subtype of breast cancer, mainly because of the aging of our populations and improvements in diagnostic mammography and core biopsy. DCIS represents a proliferation of malignant-appearing cells that have not invaded beyond the ductal basement membrane and is a precursor for the development of invasive breast cancer (IBC). Approximately 40% of patients with DCIS treated with biopsy alone, without complete excision or further therapy, develop IBC. Most DCIS itself is harmless if it is detected and excised before it can progress to IBC, and the current approach to DCIS treatment is aimed at just that goal. Typically, it consists of multimodal treatment including segmental mastectomy followed by radiation therapy to the whole breast and then hormonal therapy or total mastectomy followed by hormonal therapy.This review discusses the state-of-the-art in DCIS detection and treatment and highlights promising new strategies in the care of DCIS patients. The data regarding the effectiveness of breast-conserving surgery versus total mastectomy, the possible avoidance of radiation therapy in some subgroups of patients, and the role of hormonal agents are reviewed. Neoadjuvant therapy and the use of trastuzumab for DCIS are currently under investigation and may be future treatment options for DCIS. The Oncologist

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Risk of invasion and axillary lymph node metastasis in ductal carcinoma in situ diagnosed by core-needle biopsy

Abstract: SN biopsy should be considered in women with an initial diagnosis of DCIS on core-needle biopsy who are at risk for invasion; this includes women with a palpable lump, a mass on mammography, and intermediate or poor tumour grade.

Cited by 76 publications

References 23 publications

One-day core needle biopsy in a breast clinic: 4 years experience

One-day core needle biopsy in a breast clinic: 4 years experience

Predictors of invasion in needle core biopsies of the breast with ductal carcinoma in situ

Current Treatment and Clinical Trial Developments for Ductal Carcinoma In Situ of the Breast

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