Ductal Carcinoma In Situ Component Research Articles

Intraductal carcinoma (ductal carcinoma in situ) of the breast. A comparison of pure noninvasive tumors with those including different proportions of infiltrating carcinoma

Several studies have suggested that ductal carcinoma in situ (DCIS) of the comedo type (variably defined) is biologically more aggressive than other patterns of DCIS and more likely to progress rapidly to invasive carcinoma. Eighty-five pure DCISs were compared histopathologically with 64 carcinomas containing both intraductal and infiltrating ductal components (mixed DCIS/IDC). Solid DCIS with and without necrosis was seen more frequently seen in the mixed DCIS/IDC series, especially in cases with less than 50% DCIS. Periductal stromal inflammation and multifocality also were seen more frequently in mixed DCIS/IDC than in pure DCIS. High nuclear grade and high mitotic activity were also more common in the DCIS component of the mixed cases and were well correlated with the intraductal and infiltrating components of the same tumors in most of the cases. The frequency of axillary lymph node metastases was correlated with the proportions of stromal invasion but not with the DCIS subtypes. When the criteria (solid growth pattern, high nuclear grade, and central necrosis) for the diagnosis of intraductal comedocarcinoma were analyzed separately, the first of these correlated most strongly with mixed DCIS/IDC compared with pure DCIS, the second less strongly, and the third not at all, although central necrosis has been considered the main or only diagnostic criterion for comedocarcinoma in several previous reports. Solid growth pattern and high nuclear grade are the most important histopathologic features of DCIS used to predict progression to invasive carcinoma. No major changes between the intraductal and invasive elements of the same tumors were noted, but other studies have suggested that markers of aggressiveness either increase or decrease in the progression to invasion. These conflicting data require further investigation.

Nm23-H1 metastasis suppressor gene expression in primary breast cancer: associations with axillary lymph node status, tumour size, type and grade

The nm23-H1 gene has tumour suppressor functions and is a putative metastasis suppressor. Higher levels of expression of the gene in breast carcinoma have been associated with the absence of lymph node metastasis, and with longer relapse free intervals and overall survival.Expression levels of nm23-H1 in breast carcinoma were examined by Northern and slot blot in a consecutive series of 105 patients. The levels of nm23-H1 mRNA expression were examined for associations with axillary lymph node metastasis, and with tumour size, tumour type and grade, mitotic rate, nuclear size and pleomorphism and vascular invastion, in 97 cases of invasive cancer. No statistically significant differences in nm23 expression levels between axillary node negative and axillary node positive infiltrating duct carcinomas were observed. There was no correlation between nm23-H1 expression levels and other histopathologically determined prognostic factors. Higher levels of gene expression were demonstrated in pure ductal carcinoma in situ (DCIS) lesions when compared to invasive tumours; further analysis suggested that DCIS components within invasive tumours contributed to measurements of nm23 expression, possibly masking the lower expression levels of the invasive component in some cases. Further correlative studies, using in situ hybridization or gene product immunohistochemistry would be most suited to determining the contribution of different tissue components in breast cancer.

The Impact of tumor size and histology on local control after breast-conserving therapy

To investigate possible contraindications for breast-conserving therapy (BCT) a retrospective clinicopathological study was carried out in 585 patients treated conservatively in The Netherlands Cancer Institute from 1979 to 1984. The local recurrence rate in the breast was 2% at 6 years and was similar in stages I and II breast cancer. Invasive cancer with extensive ductal carcinoma in situ (DCIS) component appeared to be the only main prognostic factor when local failure in the breast was considered. A multivariate analysis revealed that tumor size, microscopically incomplete excision of the primary tumor and age did not have a significant influence on local control alone, when this was corrected for extensive DCIS. When breast and axillary recurrences were taken together, age and extensive DCIS component appeared to be two independent prognostic factors according to a multivariate analysis. Especially patients younger than 40 years with an extensive DCIS component had a higher locoregional recurrence rate.