Presence Of Comedonecrosis Research Articles

Predicting Invasion in the Excision Specimen From Breast Core Needle Biopsy Specimens With Only Ductal Carcinoma In Situ

Some patients with ductal carcinoma in situ on breast core needle biopsy will have invasion at excision. The aim of this study was to determine if patients at increased risk for invasion could be identified. The results of all breast core needle biopsies with a diagnosis of ductal carcinoma in situ during a 50-month period were reviewed. A variety of histologic features were identified and correlated with the presence of invasion at excision. Of 3026 cases, 152 (5%) were diagnosed as ductal carcinoma in situ; excisional biopsies were available for 91 (60%) of these 152 cases, and 17 (19%) showed invasive tumor. Neither the radiographic findings, presence of comedonecrosis, comedo histology, lobular extension, size of the largest focus, nor aggregate size was significantly associated with an increased incidence of invasion (all P >.05). However, comedo histology with a cribriform/papillary architecture was significantly associated with an increased risk of invasion (5/7 [72%] cases with invasion, P =.002), as were tumors greater than 4 mm with lobular extension (6/15 [40%], P =.03). Patients with comedo ductal carcinoma in situ with a cribriform/papillary pattern or tumor involving more than 4 mm with lobular extension in breast core needle specimens are at increased risk for invasion at excision.

Ductal carcinoma in situ of the breast.

The increasing incidence and biological heterogeneity of ductal carcinoma in situ (DCIS) of the breast have made the management of this entity challenging and controversial. This paper reviews data on the natural history of the disease and results obtained with various management approaches. Computerized MEDLINE search of articles related to DCIS published since 1966. Randomized trials were given higher value; however, because these were relatively scarce, retrospective studies and data published in abstract form were also included. The authors reviewed all sources critically. No formal statistical calculations were made. The incidence of DCIS is increasing, and a greater proportion of diagnoses are being made in asymptomatic patients. No data from randomized trials compare mastectomy and breast-conserving therapy for the treatment of DCIS. A large randomized trial comparing lumpectomy with lumpectomy plus radiotherapy showed lumpectomy plus radiotherapy to be effective for management of this disease. The presence of comedo necrosis and surgical margin status are frequently used as predictors of subsequent recurrence, although this practice is controversial. The risk for in-breast recurrence at 5 years after lumpectomy and radiotherapy is approximately 8%. With more refined molecular analysis, the relation of DCIS to invasive breast cancer will be better defined. Treatment strategies for DCIS have evolved, and lumpectomy followed by radiotherapy is an appropriate alternative for most patients. The use of lumpectomy alone in selected patients remains controversial.

Ductal Carcinoma In Situ of the Female Breast

In a Danish nationwide prospective study of in situ carcinoma of the breast, 112 women with ductal carcinoma in situ, treated with excision only, were registered from 1982 to 1987. Within a median follow-up of 53 months, a crude recurrence rate of 22% (25 cases) was found, of which five cases recurred as invasive carcinomas and 20 cases as in situ carcinomas. The histopathologic review included a single-parameter analysis of histological growth pattern, size of lesion, nuclear size, presence of comedonecrosis, and subhistologic type. A strong inter-relationship was found for histological growth pattern, nuclear size, and comedonecrosis. These parameters were also significantly related to recurrence. Cases that had clinical symptoms had a high recurrence rate as compared with cases that were discovered by mammography only or incidentally.