Subclinical ductal carcinoma in situ of the breast: Treatment by local excision and surveillance alone

Schwartz, Gordon F.; Finkel, Gerald C.; Garcı́a, Juan Carlos; Patchefsky, Arthur S.

doi:10.1002/1097-0142(19921115)70:10<2468::aid-cncr2820701013>3.0.co;2-k

Cited by 189 publications

(64 citation statements)

References 12 publications

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“…Most previous studies of recurrence following treatment of DCIS have found a higher incidence of both DCIS and invasive carcinoma following high-grade DCIS, at least in the short term (Lagios et al, 1989;Schwartz et al, 1992;Bellamy et al, 1993;Solin et al, 1993;Sneige et al, 1995;Silverstein et al, 1996;Fisher et al, 1999). In the EORTC study, although the risk of DCIS recurrence was found to be significantly related to the initial histology, the risk of invasive recurrence was not (Bijker et al, 2001a).…”

Section: Discussionmentioning

confidence: 95%

“…Owing to the potential for metastasis, the latter are of considerable significance as the chance of successful eradication of the disease may have been lost. In several studies the incidence of recurrence, at least in the short term, has been found to be higher following high-grade (poorly differentiated) DCIS than following low-grade (well differentiated) lesions (Lagios et al, 1989;Schwartz et al, 1992;Bellamy et al, 1993;Solin et al, 1993;Sneige et al, 1995;Silverstein et al, 1996;Fisher et al, 1999). Moreover, in some studies, the incidence of an invasive recurrence has been found to be higher after high-grade DCIS than after low-grade lesions (Lagios et al, 1989;Bellamy et al, 1993).…”

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Grade of recurrent in situ and invasive carcinoma following treatment of pure ductal carcinoma in situ of the breast

et al. 2004

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The grade of recurrent in situ and invasive carcinoma occurring after treatment of pure ductal carcinoma in situ (DCIS) has been compared with the grade of the original DCIS in 122 patients from four different centres (The Royal Marsden Hospitals, London and Sutton, 57 patients; Guy's Hospital, London, 19 patients; Nottingham City Hospital, 31 patients and The Royal Liverpool Hospital, 15 patients). The recurrent carcinoma was pure DCIS in 70 women (57%) and in 52 women (43%) invasive carcinoma was present, which was associated with an in situ element in 43. In all, 19 patients developed a second recurrence (pure DCIS in 11 and invasive with or without an in situ element in eight). The majority of invasive carcinomas followed high-grade DCIS. There was strong agreement between the grade of the original DCIS and that of the recurrent DCIS (k ¼ 0.679), which was the same in 95 of 113 patients (84%). The grade of the original DCIS showed only fair agreement with the grade of recurrent invasive carcinoma (k ¼ 0.241), although agreement was stronger with the pleomorphism score of the recurrent carcinoma (k ¼ 0.396). There was moderate agreement, in recurrent invasive lesions, between the grade of the DCIS and that of the associated invasive element (k ¼ 0.515). Other features that showed moderate or strong agreement between the original and recurrent DCIS were necrosis and periductal inflammation. The similarity between the histological findings of the original and subsequent DCIS is consistent with the concept that recurrent lesions represent regrowth of residual carcinoma. In addition, although agreement between the grade of the original DCIS and that of any subsequent invasive carcinoma was only fair, there is no suggestion that low-grade DCIS lesions progress to higher grade lesions or to the development of higher grade invasive carcinoma. This is in agreement with immunohistochemical and molecular data indicating that low-grade and high-grade mammary carcinomas are quite different lesions.

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Section: Discussionmentioning

confidence: 95%

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Grade of recurrent in situ and invasive carcinoma following treatment of pure ductal carcinoma in situ of the breast

et al. 2004

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“…Although, RT is shown to be effective on local tumor, BCS without postoperative RT has been widely used for the treatment of DCIS. The largest series of 256 patients was reported by Schwartz et al 21 At a median follow-up of 66.5 months (range: 12-247 months), there have been 71 second ipsilateral breast recurrences (27.7%), including 26 invasive (37%) and 45 DCIS only (63%) recurrences. The 10-year actuarial local recurrence rate was 41% with the long-term projection of local recurrence being as high as 50% at 20 years.…”

Section: Discussionmentioning

confidence: 99%

Management of Ductal Carcinoma In Situ Patients Receiving Postoperative Radiotherapy after Breast Conserving Surgery: Hacettepe Experience

Özyiğit¹,

Ülger²,

Yıldız³

et al. 2011

UHOD

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We retrospectively evaluated our therapetic results in ductal carcinoma in situ (DCIS) patients treated with postoperative radiotherapy following breast-conserving surgery (BCS). Sixty-seven DCIS patients were treated with curative radiotherapy (RT) after BCS, in our department from December 1998 to January 2008. All patients have been treated with 6 MV photon energy on lineer accelerator machine. Radiotherapy treatment fields were opposed tangential to the whole breast. A total dose of median 50 Gy (48-50 Gy) was delivered in five fractions in a week. In twenty patients, boost dose to the tumour region was applied. Fifty patients received systemic hormonotherapy. Median follow-up time was 44 moths (range 12-122 months). Five-year OS, DFS and local control rates were found as 96%, 97% and 97%, respectively. There was only one ipsilateral breast recurrence in our study (2%). Two patients died due to other causes except disease (3%). Grade III dermatitis was seen in only one patient (2%), and there was no serious acute side effects in 41 patients (63%). There was no late side effect in our patients. Sixty-two patients were alive without evidence of tumour recurrence, with their intact breast and with good cosmesis. Our survival rates and side effects were in consistent with literature, and RT is an effective option for DCIS patients following BCS.Keywords: Ductal carcinoma In Situ, Radiotherapy, Breast conserving surgery ÖZET Duktal Karsinoma ‹n Situ Olgular›nda Meme Koruyucu Cerrahi Sonras› Postoperatif Radyoterapi: Hacettepe DeneyimiBu retrospektif çal›flmada meme koruyucu cerrahi (MKC) sonras› postoperatif radyoterapi uygulad›¤›m›z duktal karsinoma in situ (DK‹S) olgular›nda tedavi sonuçlar›m›z retrospektif olarak de¤erlendirilmifltir. Anabilim Dal›m›z'da Aral›k 1998 ile Ocak 2008 aras›nda 67 DK‹S olgusuna MKC sonras› küratif radyoterapi uygulanm›flt›r. Tüm hastalar 6 MV fotonlarla lineer akseleratör cihaz› ile tedavi edilmifltir. Radyoterapi iki paralel tanjansiyel alanla tüm memeye uygulanm›flt›r. Ortanca total doz 50 Gy (48-50 Gy) haftada 5 fraksiyonlar halinde verilmifltir. Yirmi hastada tümör yata¤›na ek doz uygulanm›flt›r. Elli olgu sistemik hormonal tedavi alm›flt›r. Ortanca izlem süresi 44 ayd›r (12-122 ay). 5-y›ll›k genel sa¤kal›m, hastal›ks›z sa¤kal›m ve lokal kontrol oranlar› s›ras› ile %96, %97 ve %97 olarak saptanm›flt›r. Çal›flmam›zda sadece 1 ipsilateral nüks (%2) gözlenmifltir. ‹ki hastam›z hastal›k d›fl› nedenlerle kaybedilmifltir (%3). Bir hastada (%2) 3. derece dermatit saptan›rken, 41 olguda (%63) hiçbir ciddi akut yan etki saptanmam›flt›r. Olgular›m›zda ciddi geç yan etki gözlenmemifltir. Altm›fl iki olgu iyi kozmetik sonuçla hastal›ks›z hayattad›r. Sa¤kal›m ve yan etki sonuçlar›m›z literatür ile uyumlu olup, DK‹S olgular›nda MKC sonras› radyoterapi etkin bir tedavi seçene¤idir.Anahtar Kelimeler: Duktal karsinoma ‹n Situ, Radyoterapi, Meme koruyucu cerrahi ULUSLARARASı HEMATOLOJI-ONKOLOJI DERGISI ARTICLE

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“…As DCIS recurrences occur most often in the same quadrant 4,[27][28][29] and have similar pathological characteristics to the original tumor, 30 it has been suggested that they might be related to residual tumor. Various studies have shown that margin involvement is a risk factor for local recurrence.…”

Section: Discussionmentioning

confidence: 99%

Histological margin assessment for breast ductal carcinoma in situ: precision and implications

Sigal‐Zafrani

Klimberg²

2003

Mod Pathol

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Local recurrence after lumpectomy for ductal carcinoma in situ (DCIS) is a major concern and is related to residual disease in the breast. We studied the predictive value of lumpectomy margins for residual DCIS and compared our results and pathological processing techniques with those published in the literature. Margin status was determined for 89 patients with screen-detected DCIS who had lumpectomy and re-excision, for the presence and extent of residual disease. Margin width was defined as the narrowest distance between tumor and any inked margin or, where margins were positive, classified into focal involvement (o1 mm of the inked surface involved), minimal (Z1o15 mm) and extensive (Z15 mm). The amount of residual tumor was quantified according to the number of ducts involved with tumor: small (fewer than 10 ducts) or large (10 or more ducts) residuum. The initial margin status was a significant predictor for the presence of residual tumor in re-excision specimens (P ¼ 0.006). There was residual tumor in 44 and 45% of close non-involved (41 and r1 mm width) margins, 67% of focally, 71% of moderately and 94% of extensively positive margins. The pathologic tumor size was also a predictor for the presence of residual tumor with 27, 68 and 74% of lesions measuring r10, 11-25, 425 mm,respectively, showing residual disease. The presence of residual tumor was not significantly related to age, mammographic appearance, nuclear grade or intraductal necrosis. The initial margin status was found to predict for the amount of residual tumor. With careful margin assessment, margin status after lumpectomy for DCIS can be used to predict for the presence and amount of residual tumor in the breast and is a guide to further management decisions. A standard for margin status reporting and pathological processing of screen-detected DCIS in situ lesions will help in the interpretation of data from different institutions. Keywords: ductal carcinoma in situ; lumpectomy; margin; residual disease; histopathology; classification With the widespread use of mammographic screening for breast cancer, more cases of ductal carcinoma in situ (DCIS) are being detected. Between 1983 and 1992, there was a 500% increase in the prevalence of diagnosis of DCIS.1 DCIS now accounts for over 14% of breast cancers diagnosed annually in the United States. 2Treatment options for patients with DCIS and DCIS associated with microinvasion have moved from mastectomy to breast-conserving surgery, as conservation of the breast for DCIS allows comparable survival rates with mastectomy.3-5 Local recurrences for DCIS are of major concern as half of these are invasive cancers that could impair survival 4,[6][7][8][9][10][11] Achieving a low recurrence rate is therefore a major goal. One of the potential predictors for local recurrence in DCIS is the margin status of the excised specimen. 5,10,[12][13][14][15][16][17][18] It is therefore a major determinant for further treatment decisions in breast-conserving surgery for DCIS as it is the only factor that can be ...

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Subclinical ductal carcinoma in situ of the breast: Treatment by local excision and surveillance alone

Cited by 189 publications

References 12 publications

Grade of recurrent in situ and invasive carcinoma following treatment of pure ductal carcinoma in situ of the breast

Grade of recurrent in situ and invasive carcinoma following treatment of pure ductal carcinoma in situ of the breast

Management of Ductal Carcinoma In Situ Patients Receiving Postoperative Radiotherapy after Breast Conserving Surgery: Hacettepe Experience

Histological margin assessment for breast ductal carcinoma in situ: precision and implications

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