scholarly journals Ductal CarcinomaIn Situ: What the Pathologist Needs to Know and Why

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Anita Bane
Keyword(s):  
Breast Cancer ◽  
Clinical Decision Making ◽  
Ductal Carcinoma ◽  
Clinical Decision ◽  
Invasive Disease ◽  
Screening Mammography ◽  
Pathology Report ◽  
Ductal Carcinomain Situ ◽  
Carcinomain Situ

Ductal carcinomain situis a proliferation of malignant epithelial cells confined to the ductolobular system of the breast. It is considered a pre-cursor lesion for invasive breast cancer and when identified patients are treated with some combination of surgery, +/− radiation therapy, and +/adjuvant tamoxifen. However, no good biomarkers exist that can predict with accuracy those cases of DCIS destined to progress to invasive disease or once treated those patients that are likely to suffer a recurrence; thus, in the era of screening mammography it seems likely that many patients with DCIS are overtreated. This paper details the parameters that should be included in a pathology report for a case of DClS with some explanations as to their importance for good clinical decision making.

scholarly journals Controversies in Breast Cancer

1997 ◽  
Vol 4 (3) ◽  
pp. 226-235 ◽  
Author(s):  
Frank J. Cummings ◽  
Nabil Saba
Keyword(s):  
Breast Cancer ◽  
Clinical Decision Making ◽  
Ductal Carcinoma ◽  
Clinical Decision ◽  
Cancer Management ◽  
New Approaches ◽  
True Value ◽  
Staging Systems ◽  
Breast Cancer Management

Background A large number of controversies about the management of breast cancer produce uncertainties for patients and physicians alike. In addition, questions are constantly raised about the true value of new approaches or treatments. Methods The authors have conducted a critical review of the literature on several of these issues, and they present a balanced view that can be useful for clinical decision making. Results Although new staging systems for ductal carcinoma in situ have been proposed, a consensus has not yet been reached regarding the criteria to allow tumor excision alone. The extent of benefit of the main adjuvant therapies is becoming better established, and improvement in outcomes may accrue from dose-intensive treatments and autologous stem cell or hematopoietic growth factor support. Conclusions Progress in breast cancer management continues to evolve. Several new approaches either reduce morbidity or improve outcomes.

scholarly journals Genomic profiling defines variable clonal relatedness between invasive breast cancer and primary ductal carcinoma in situ

2021 ◽  
Author(s):  
Esther H. Lips ◽  
Tapsi Kumar ◽  
Anargyros Megalios ◽  
Lindy L. Visser ◽  
Michael Sheinman ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Single Cell ◽  
Ductal Carcinoma In Situ ◽  
Invasive Breast Cancer ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Invasive Disease ◽  
Clonal Relatedness ◽  
Increased Risk

Pure ductal carcinoma in situ (DCIS) is being diagnosed more frequently through breast screening programmes and is associated with an increased risk of developing invasive breast cancer. We assessed the clonal relatedness of 143 cases of pure DCIS and their subsequent events using a combination of whole exome, targeted and copy number sequencing, supplemented by single cell analysis. Unexpectedly, 18% of all invasive events after DCIS were clonally unrelated to the primary DCIS. Single cell sequencing of selected pairs confirmed our findings. In contrast, synchronous DCIS and invasive disease (n=44) were almost always (93%) clonally related. This challenges the dogma that most invasive events after DCIS represent invasive transformation of the initial DCIS and suggests that DCIS could be an independent risk factor for developing invasive disease as well as a precursor lesion.

scholarly journals Modelling and analysis of DCIS detection and reduction in invasive carcinoma – a review

2005 ◽  
Vol 8 (7) ◽  
Author(s):  
S. W. Duffy
Keyword(s):  
Breast Cancer ◽  
Invasive Breast Cancer ◽  
Breast Screening ◽  
Invasive Carcinoma ◽  
Ductal Carcinoma ◽  
Invasive Disease

Although much has been written about overdiagnosis in mammographical screening, analytical estimates of the extent of overdiagnosis are rare in the literature. Estimates specific to ductal carcinomain situ(DCIS) and the implications for future invasive disease are even more difficult to find. In this paper, we review studies of incidence of DCIS within breast screening programmes and its association with subsequent incidence of invasive breast cancer. Although sparse, published results suggest that the majority of DCIS cases have the propensity to progress to invasive disease.

scholarly journals Changes in Invasive Breast Cancer and Ductal Carcinoma In Situ Rates in Relation to the Decline in Hormone Therapy Use

2010 ◽  
Vol 28 (35) ◽  
pp. 5140-5146 ◽  
Author(s):  
Ghada N. Farhat ◽  
Rod Walker ◽  
Diana S.M. Buist ◽  
Tracy Onega ◽  
Karla Kerlikowske
Keyword(s):  
Breast Cancer ◽  
Hormone Therapy ◽  
Ductal Carcinoma In Situ ◽  
Invasive Breast Cancer ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Screening Mammography ◽  
Breast Cancers ◽  
Cancer Rates

Purpose To assess trends in invasive breast cancer and ductal carcinoma in situ (DCIS) incidence in association with changes in hormone therapy (HT) use in regular mammography screeners. Methods We included 2,071,814 screening mammography examinations performed between January 1997 and December 2006 on 696,385 women age 40 to 79 years; 9,586 breast cancers were diagnosed within 12 months of a screening examination. We calculated adjusted annual rates (mammogram level) for prevalent HT use, incident invasive breast cancer (overall and by tumor histology and estrogen receptor [ER] status), and incident DCIS. Results After a precipitous decrease in HT use in 2002, the incidence of invasive breast cancer decreased significantly in 2002 to 2006 among women age 50 to 69 years (Ptrend(2002–2006) = .005) and 70 to 79 years (Ptrend(2002–2006) = .003) but not in women age 40 to 49 years (Ptrend(2002–2006) = .45). DCIS rates significantly decreased in women age 50 to 69 years after 2002 (Ptrend(2002–2006) = .02). Invasive ductal tumors significantly declined in women age 50 to 69 years and 70 to 79 years in 2002 to 2006. In women age 50 to 69 years, invasive lobular and ER-positive cancer rates declined steadily in 2002 to 2005 (Ptrend(2002–2005) = .02 and .03, respectively), but an elevated rate in 2006 rendered the overall trend nonsignificant (Ptrend(2002–2006) = .89 and .91, respectively). Conclusion In parallel to the sharp decline in HT use in women undergoing regular mammography screening, invasive breast cancer rates decreased in women age 50 to 69 and 70 to 79 years after 2002, and DCIS rates decreased in women age 50 to 69 years, consistent with evidence that HT cessation reduces breast cancer risk. However, the decrease in incidence may have started to level off in 2006; this finding has not been uniformly reported in other populations, warranting further investigation.

Surgical margins and the risk of local-regional recurrence (LRR) following mastectomy for early-stage breast cancer.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 95-95
Author(s):  
S. K. Childs ◽  
Y. Chen ◽  
S. Pochebit ◽  
M. Golshan ◽  
M. M. Duggan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ductal Carcinoma ◽  
Early Stage ◽  
Surgical Margin ◽  
Invasive Disease ◽  
Study Cohort ◽  
Kaplan Meier ◽  
Deep Margin ◽  
Local Regional Recurrence

95 Background: We sought to clarify the influence of a positive or close superficial or deep mastectomy margin on the risk of LRR. Methods: We reviewed the charts of 561 consecutive women who underwent mastectomy without radiation for newly diagnosed in situ or invasive breast cancer between 1998 and 2005. The study cohort consists of 167 of these women who had a positive or close (≤2 mm) superficial or deep surgical margin. LRR as the site of first recurrence (+/− simultaneous distant disease) and distant metastasis (DM) rates were calculated using the Kaplan-Meier method. The median age was 50 years. Forty-five (27%) had ductal carcinoma in situ (DCIS) only. Of the 122 women with invasive disease, 79% had T1, 18% T2, and 3% T3 tumors, and 25% had positive axillary nodes (range, 1-4; 68% 1 positive node). Twenty-nine (24%) of those with invasive disease had lymphovascular invasion. The superficial margin was positive in 61 (37%) and close in 69 (41%). The deep margin was positive in 28 (17%) and close in 51 (31%). Results: The median follow-up was 6.3 years (range, 1-12.4). The 5-year LRR rate was 5% (95% CI 2-10%) and the DM rate was 3% (95% CI 1-8%). Twelve patients had a LRR; this included the chest wall in 9 and the axilla in 4. Five of the 12 had positive nodes. Four of 92 (4%) with close margins had a LRR vs. 8/75 (11%) with positive margins (log-rank p=0.15). Of the 45 with pure DCIS, 1 (2%) had a LRR. Of those with invasive disease, LRR occurred in 1/28 (4%) who had invasive disease at (positive) or near (close) the superficial margin, 3/38 (8%) with DCIS at or near the superficial margin, 0/12 with invasive disease at or near the deep margin, and 1/12 (8%) with DCIS at or near the deep margin. Both margins were positive or close in 32/122 patients with invasive disease; 6 of these (19%) had a LRR. Conclusions: The risk of LRR in patients with a positive or close surgical margin after mastectomy is generally low. The benefit of post-mastectomy radiation in this population with otherwise favorable features is likely to be small. While there may be a higher risk of LRR in patients with disease at or close to both margins (likely representing extent of disease), numbers in these categories are small and these results should be interpreted with caution.

scholarly journals Interobserver Variability in Ductal Carcinoma In Situ of the Breast

2020 ◽  
Vol 154 (5) ◽  
pp. 596-609
Author(s):  
Mieke R Van Bockstal ◽  
Martine Berlière ◽  
Francois P Duhoux ◽  
Christine Galant
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Clinical Decision Making ◽  
Interobserver Variability ◽  
Ductal Carcinoma ◽  
Digital Pathology ◽  
Clinical Decision ◽  
Classification Systems ◽  
Histopathologic Evaluation

Abstract Objectives Since most patients with ductal carcinoma in situ (DCIS) of the breast are treated upon diagnosis, evidence on its natural progression to invasive carcinoma is limited. It is estimated that around half of the screen-detected DCIS lesions would have remained indolent if they had never been detected. Many patients with DCIS are therefore probably overtreated. Four ongoing randomized noninferiority trials explore active surveillance as a treatment option. Eligibility for these trials is mainly based on histopathologic features. Hence, the call for reproducible histopathologic assessment has never sounded louder. Methods Here, the available classification systems for DCIS are discussed in depth. Results This comprehensive review illustrates that histopathologic evaluation of DCIS is characterized by significant interobserver variability. Future digitalization of pathology, combined with development of deep learning algorithms or so-called artificial intelligence, may be an innovative solution to tackle this problem. However, implementation of digital pathology is not within reach for each laboratory worldwide. An alternative classification system could reduce the disagreement among histopathologists who use “conventional” light microscopy: the introduction of dichotomous histopathologic assessment is likely to increase interobserver concordance. Conclusions Reproducible histopathologic assessment is a prerequisite for robust risk stratification and adequate clinical decision-making. Two-tier histopathologic assessment might enhance the quality of care.

Screening mammography-detected ductal carcinoma in situ: mammographic features based on breast cancer subtypes

2015 ◽  
Vol 39 (6) ◽  
pp. 983-986 ◽  
Author(s):  
Mi Young Kim ◽  
Hyeon Sook Kim ◽  
Nami Choi ◽  
Jung-Hyun Yang ◽  
Young Bum Yoo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Screening Mammography ◽  
Breast Cancer Subtypes ◽  
Cancer Subtypes
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