Diagnosis Of Pure Ductal Carcinoma In Situ Research Articles

Nipple-sparing Mastectomy with Immediate Implant-based Reconstruction for Patients with Pure Ductal Carcinoma in Situ.

The presence of an extensive intraductal component is associated to an increasing risk of relapse in the nipple-areola complex. The aim of the present study was to evaluate the outcomes of patients diagnosed with ductal carcinoma in situ (DCIS) who underwent nipple-sparing mastectomy (NSM) with immediate breast reconstruction using silicone implants. We retrospectively analyzed the postoperative complications and oncological safety of 67 breast cancer patients diagnosed with pure DCIS who underwent NSM with immediate breast reconstruction using silicone implants between 2004 and 2018. Among the 127 NSM procedures performed, 2 hematomas (1.5%) and 1 partial nipple necrosis (0.7%) were observed. After a mean follow-up of 60 months, the local recurrence rate was of 8.9%, the disease-free survival rate was of 90%, and 1 of the patients died. Despite the local recurrence rate, we showed that NSM with immediate breast reconstruction using silicone implants is a feasible surgical approach, with a low rate of complications and high survival rates for patients with a diagnosis of pure DCIS when breast-conserving surgery is not an option.

Sentinel node mapping and ductal carcinoma in situ.

Pure ductal carcinoma in situ (DCIS) is typically unassociated with a risk of regional lymph node involvement. Retrospective series maintain that larger tumors or high-grade histopathology may harbor a risk of lymph node involvement. Our community hospital retrospectively reviewed a series wherein women with DCIS were subjected to sentinel lymph node biopsy based on large tumor size and/or high-grade histopathology. 232 consecutive women with a diagnosis of pure DCIS were evaluated independently by two breast surgeons, one who typically offers sentinel node mapping to patients with tumors larger than 10mm and the other who offers sentinel node mapping to women with grade3 tumors. 60 women (26%) underwent sentinel node mapping along with appropriate surgery directed to the breast. Women were offered risk-adjusted adjuvant radiotherapy and anti-endocrine therapy. At a median follow-up of 18months (range 6-132months), 9 women (15%) were identified with regional axillary nodal disease. A statistical analysis was conducted between women who did or did not undergo sentinel node mapping because there was overlap in large tumor size and high grade between the two groups. A univariate logistic regression statistic showed a trend toward a significant relationship between grade3 tumors and a risk of occult nodal involvement. This was not confirmed by multivariate analysis. In our moderate-sized surgical experience evaluating women with pure DCIS who underwent a sentinel node mapping due to large tumor size or high grade histology, we were unable to confirm that either is predictive of occult node involvement.

Abstract P3-01-06: Can axillary evaluation be omitted in patients preoperatively diagnosed with ductal carcinoma in situ by core needle biopsy?

Abstract Background Patients diagnosed with ductal carcinoma in situ (DCIS) by core needle biopsy (CNB) have a great chance of upgrading invasive cancer on the final pathology. Positive axillary lymph nodes can be found in these patients. The present study sought to identify clinicopathological factors associated with upgrading and axillary lymph nodes metastasis in patients preoperatively diagnosed with DCIS by CNB. Materials and Methods This study identified 604 patients (cT1-3N0M0) with preoperative diagnosis of pure DCIS by CNB who had undergone axillary evaluation from August 2006 to December 2015 at Fudan University Shanghai Cancer Center (FUSCC). Predictors of upgrading and axillary lymph nodes metastasis were analyzed, respectively. Results Of all 604 patients, 513 (84.93%) and 91 (15.07%) patients had undergone sentinel lymph nodes biopsy (SLNB) and axillary lymph nodes dissection (ALND), respectively. Overall, 121 (20.03%) and 193 (31.95%) patients were upgraded to DCIS with microinvasion (DCISM) and IDC on final pathology, respectively. Positive axillary lymph nodes were identified in 41 (6.79%) patients, of which 35 (5.80%) patients had 1-2 positive axillary lymph nodes, 6 (0.99%) patients had 3 or more positive axillary lymph nodes. Among patients with axillary lymph nodes metastasis, 4 (9.76%), 4 (9.76%) and 33 (80.48%) patients were in DCIS, DCISM and IDC group, respectively. Predictors of upgrading included tumor size on ultrasonography (P=0.001), Ki-67 (P=0.046) and molecular subtype (P=0.007) in univariate analysis. In multivariate analysis, patients with larger tumor size on ultrasonography (>2cm) (OR 1.767, P=0.001) were more likely to be upgraded on final pathology. Also, ER+ HER2+ patients were more likely to be upgraded than ER+ HER2- patients (OR 1.659, P=0.047). Factors associated with axillary lymph nodes metastasis included nipple discharge (P<0.001), tumor size on pathology (P=0.037), number of lesions (P=0.039), axillary evaluation methods (P=0.029) and molecular subtype (P=0.049) in univariate analysis. Whereas, only nipple discharge and larger tumor size on pathology (>2cm) reached statistical significance in multivariate analysis (OR 5.959, P<0.001; OR 2.361, P=0.042). In addition, further analysis showed upgrading on final pathology had a significant influence on axillary lymph nodes status (P<0.001). However, this correlation was not shown between patients with DCIS and DCISM in pairwise comparison. Conclusion The data of upgrading and axillary lymph nodes metastasis in patients with an initial diagnosis of DCIS by CNB was comparable in this cohort with published data. Despite of a 51.98% upgrading rate, the rate of axillary lymph nodes metastasis in these patients is low, which supports the omission of axillary evaluation in selected patients. Citation Format: Si J, Yang B, Guo R, Huang N, Quan C, Chen J, Wu J. Can axillary evaluation be omitted in patients preoperatively diagnosed with ductal carcinoma in situ by core needle biopsy? [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-01-06.

Abstract P3-02-04: Is breast magnetic resonance imaging (MRI) useful for diagnosis of additional sites of disease in patients recently diagnosed with ductal carcinoma in situ (DCIS)?

Abstract Purpose: To determine if breast MRI is useful for detecting additional sites of disease in patients initially diagnosed with pure DCIS. Materials and Methods: A retrospective review of women diagnosed with pure DCIS who underwent a breast MRI for evaluation of extent of disease was performed at a single institution from January 2013 to April 2015. Data analysis included imaging (mammography, ultrasound and MRI) and pathology characteristics (histology and biomarker status) of the primary DCIS as well as descriptors for the additional sites of disease incidentally found by breast MRI. Results: A total of 94 patients were diagnosed with pure DCIS during this time period, ages ranging from 38 to 79 years old (median, 58.5 years); sizes ranging from 0.6 to 16 cm (mean, 4.5 cm). A total of 28 patients (30%) had other MRI findings suspicious for additional sites of disease in either breast. From this group of patients, 23 (82%) patients underwent MRI-guided biopsy. The 5 patients who did not have the MRI guided-biopsy either underwent total mastectomies or declined biopsy. Five out of the twenty-three patients (22%) were diagnosed with an additional site of cancer. Three of these patients were Hispanic, one was Asian/Pacific and one was Caucasian. Of the five patients, five had contralateral disease (100%) and none had a second site of disease in the ipsilateral breast. The size of the additional sites of disease ranged from 0.4 to 7.2 cm (mean, 2.1 cm) and the size of the primary lesion in this selected group ranged from 0.4 to 9 cm (mean, 3.4 cm). Ages ranged from 47 to 63 years old (median, 55 years). Four out of five patients (80%) presented with the first site of disease as pure DCIS with estrogen (ER) and progesterone (PR) receptors positive and one case (20%) was pure DCIS ER/PR- negative. The second incidental lesion found on MRI demonstrated 3 cases of contralateral pure DCIS. From this group, all the biomarkers status for the first and second site were concordant. From the 5 cases of second disease, 2 (40%) presented with invasive component in the contralateral side of the initially biopsy-proven pure DCIS and, one of these cases had discordant biomarkers compared with the first site of disease, the first site of pure DCIS was ER/PR-negative and the second site of invasive ductal carcinoma (IDC) presented with ER/PR-positive status. Conclusion: From a total of 94 patients with recent diagnosis of pure DCIS who underwent breast MRI examination for diagnosis of additional sites of disease, approximately 5% were diagnosed with an additional site of cancer and 2% of the total cases had invasive disease in the additional sites with different biomarker status; changing their management and prognosis. Breast MRI plays a role in the setting of staging patients initially diagnosed with pure DCIS. Citation Format: Ortiz-Perez T, Benveniste AP, Ebuoma LO, Sepulveda KA, Severs FJ, Kapoor M, Sedgwick EL. Is breast magnetic resonance imaging (MRI) useful for diagnosis of additional sites of disease in patients recently diagnosed with ductal carcinoma in situ (DCIS)? [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-02-04.

Abstract P4-16-12: Outcomes of low- risk Ductal Carcinoma in situ in South East Asian women treated with breast conservation surgery.

Abstract Background: Singapore is the first South East Asian country to establish a nationwide breast cancer screening programme in 2002. Since then, the incidence of breast cancer and pre-invasive disease, in particular, has increased tremendously. Ductal carcinoma in situ (DCIS) constitutes over a quarter of all screen-detected cancers. In Singapore, most patients with DCIS are managed with breast conserving surgery (BCS). In almost all cases, this is followed by adjuvant radiotherapy (RT) to the whole breast. However, the optimum management of low-risk DCIS remains contentious. Non-randomized data in Caucasian women suggests benefits in the reduction of local recurrence despite already low recurrence rates. Similar information in Asian women is lacking. We examined the outcomes of South East Asian women with low-risk DCIS treated with BCS. Methods: Retrospective chart reviews of patients treated with BCS for DCIS from 1995 to 2011 was performed. Patients meeting the pathological criteria from ECOG 5194 were included: Low-Intermediate grade (LG) DCIS ≥0.3cm but ≤2.5cm excised with final margins ≥3mm and High grade (HG) DCIS ≥3mm but ≤1.0cm. Most patients received adjuvant RT consisting of whole breast RT to 50Gy followed by a 10Gy boost to the tumour bed. Patients deemed to have especially low recurrence risks did not receive RT and some patient declined adjuvant RT. Patients who are oestrogen receptor positive were offered 5 years of tamoxifen. Results: A total of 744 patients with pathological diagnosis of pure DCIS were identified, of which 273 meets the selection criteria: LG (N = 219); HG (N = 54). Median follow-up for these patients is 60 months. Median age at diagnosis is 50 years old. About 70% of patients were screen detected; only 21 of which (7.7%) were diagnosed before the introduction of breast screening. There were 8 ipsilateral breast tumour recurrences (IBTR) in total; 7 of which were DCIS. The estimated actuarial IBTR rates at 5- and 10-year for the entire cohort are 1.8% and 4.3% respectively. In comparison, 10 contralateral new breast primaries were diagnosed in this cohort, giving 5- and 10-year contralateral relapse rates of 1.9% and 7.2% respectively. All patients with LG DCIS received RT except for 9. There were 7 recurrences in this group, two among the 9 patients who did not receive RT. The estimated IBTR rates at 5- and 10-year are 2.3% and 4.2% respectively. All patients with HG DCIS received RT. There was only 1 IBTR occurring beyond 5 years giving an estimated IBTR rate of 4.5% at 10-year. These results compare favourably with the 5-year IBTR rates of 6.1% and 15.3% in the LG and HG patients respectively in the ECOG 5194 study where patients were managed with BCS alone. One patient died of metastatic breast cancer from the contralateral breast giving a 10-year overall survival of 98.5%. Conclusions: South East Asian women with screen detected DCIS have exceedingly low rates of IBTR after breast conservation therapy. The addition of adjuvant RT approximately halved the IBTR rates in our study patients. The high proportion of recurrence in the small group of patients who did not receive RT warns of the potential hazards of managing even these low-risk patients without radiation. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-16-12.

Ductal carcinoma-in-situ of the breast with subsequent distant metastasis and death.

The rare patient diagnosed with pure ductal carcinoma-in-situ (DCIS) develops distant breast cancer metastases (DM). We sought to identify clinical and pathologic predictors of DM. The clinical and pathologic characteristics of patients with DM after a diagnosis of pure DCIS from 1996 to 2009 were analyzed. Twenty five patients with DM after an initial diagnosis of DCIS were identified; 3 were treated at our institution and 22 were originally treated elsewhere. The rate of DM was 0.14% among 2,123 patients originally treated at our institution. Among all patients with DM, 73.7% had DCIS with necrosis, and 62% had DCIS that did not express estrogen receptor. Twenty-four percent of patients with DM were African American, compared to 11.5% of the total study population. The median time from DCIS to DM was 4.5 years. Sixteen patients (66%) had a preceding or simultaneous invasive locoregional recurrence (LRR); nine (34%) did not. At last follow-up, 14 patients (56%) had died of disease; median time to death was 2.4 years. No dominant variables could be identified in patients who developed DM with or without a LRR. 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.

Lymphatic mapping of ductal carcinoma in situ diagnosed by stereotactic core needle biopsy

10507 Background: About 20% of ductal carcinoma in situ (DCIS) lesions diagnosed by stereotactic core needle biopsy (SCNB) are shown to be invasive on postoperative pathology examination. Sentinel lymph node biopsy (SLNB) is an accurate method of evaluating axillary lymph nodes in patients with invasive breast cancer. The aim of this study was to review our experience with lymphatic mapping in patients with a SCNB diagnosis of pure DCIS, to evaluate the DCIS underestimation rate and consequently the risk of lymph node metastases. Methods: Files from 160 patients diagnosed with pure DCIS by SCNB between July 1999 and March 2005 were retrieved from our database. Patients with DCIS were selected for SLNB if there was concern for presence of an invasive component on the basis of size, palpability or imaging. Results: The median age of the study group was 55 years (range 29–85 years) and median DCIS size on mammography was 25 mm (range 4–96 mm). Thirty-six (23%) out of the 160 women underwent a SLNB. Macrometastases in the sentinel node were detected in seven (19%) patients and one (3%) patient was found to have a micrometastasis. Twenty (56%) of these 36 patients had invasive lesions on final pathology. Of the 124 women who did not receive SLNB, 29 (24%) turned out to have invasive lesions on postoperative evaluation. In total, 49/160 (31%) patients with pure DCIS diagnosed by SCNB had invasive breast cancer (range pT1mic-pT2) on final pathology. Finally, 88 patients underwent lymphatic staging by SLNB, basal node sampling or complete axillary lymph node dissection. Nodal involvement was present in 14 (16%) out of these 88 patients with initially diagnosed DCIS: 36% in patients with invasive breast cancer and 2% with pure DCIS on final pathology. Conclusion: Postoperative pathology examination of the specimen demonstrates DCIS underestimation in nearly one third of SCNB diagnosed DCIS patients. SLNB is of benefit for these patients as in 19% of the patients who undergo a SLNB macrometastatic disease in the sentinel node can be found. No significant financial relationships to disclose.