METHOD AND RESULTS: A standardized histopathological protocol has been designed, in which different histological characteristics of ductal carcinoma in situ (DCIS) are reported: nuclear grade (ng), growth pattern according to Andersen et al., necrosis, size of the lesion, resection margins and focality. Using this protocol a re-evaluation of a population-based consecutive series of 306 cases of DCIS has been done as well as a thorough clinical follow-up. After a median follow-up of 63 months, 13% have developed ipsilateral local recurrences, invasive and/or in situ. Ipsilateral local recurrence-free survival (IL-RFS) was significantly better for patients operated with mastectomy (ME) or breast conserving therapy (BCT) with radiotherapy (RT) than for patients operated with BCT without RT (5-year IL-RFS 96% vs 94% vs 79%, P<0.001). In the subgroup of BCT without RT there were significant differences in IL-RFS between histopathological subgroups: ng 1 + 2 (non-high grade) vs ng 3 (high grade; P=0.014), non-high-grade without comedo-type necrosis vs non-high-grade with comedo-type necrosis vs high-grade (the Van Nuys classification system; P=0.025). Growth pattern (not diffuse vs diffuse) and margins (free vs involved or not evaluated) showed a tendency (P=0.07 and 0.05, respectively) to be associated to IL-RFS. In contrast, no significant differences in IL-RFS were found in subgroups based on mode of detection, focality or size. Ninety-four per cent of the local recurrences after BCT appeared at the previous operation site. CONCLUSIONS: In the BCT without RT group, combinations of either non-high grade and not a diffuse growth pattern or non-high grade and free margins identified groups (constituting approximately 30% of the patients) were at low risk of developing ipsilateral recurrences (6-10%), compared to a 31-37% recurrence risk in the remaining groups during the observed follow-up time. The beneficial effect of post-operative RT for these low-risk groups can be questioned, and should be studied further.
METHOD AND RESULTS: A standardized histopathological protocol has been designed, in which different histological characteristics of ductal carcinoma in situ (DCIS) are reported: nuclear grade (ng), growth pattern according to Andersen et al., necrosis, size of the lesion, resection margins and focality. Using this protocol a re-evaluation of a population-based consecutive series of 306 cases of DCIS has been done as well as a thorough clinical follow-up. After a median follow-up of 63 months, 13% have developed ipsilateral local recurrences, invasive and/or in situ. Ipsilateral local recurrence-free survival (IL-RFS) was significantly better for patients operated with mastectomy (ME) or breast conserving therapy (BCT) with radiotherapy (RT) than for patients operated with BCT without RT (5-year IL-RFS 96% vs 94% vs 79%, P<0.001). In the subgroup of BCT without RT there were significant differences in IL-RFS between histopathological subgroups: ng 1 + 2 (non-high grade) vs ng 3 (high grade; P=0.014), non-high-grade without comedo-type necrosis vs non-high-grade with comedo-type necrosis vs high-grade (the Van Nuys classification system; P=0.025). Growth pattern (not diffuse vs diffuse) and margins (free vs involved or not evaluated) showed a tendency (P=0.07 and 0.05, respectively) to be associated to IL-RFS. In contrast, no significant differences in IL-RFS were found in subgroups based on mode of detection, focality or size. Ninety-four per cent of the local recurrences after BCT appeared at the previous operation site. CONCLUSIONS: In the BCT without RT group, combinations of either non-high grade and not a diffuse growth pattern or non-high grade and free margins identified groups (constituting approximately 30% of the patients) were at low risk of developing ipsilateral recurrences (6-10%), compared to a 31-37% recurrence risk in the remaining groups during the observed follow-up time. The beneficial effect of post-operative RT for these low-risk groups can be questioned, and should be studied further.
Authors: Tracy Onega; Donald L Weaver; Paul D Frederick; Kimberly H Allison; Anna N A Tosteson; Patricia A Carney; Berta M Geller; Gary M Longton; Heidi D Nelson; Natalia V Oster; Margaret S Pepe; Joann G Elmore Journal: Eur J Cancer Date: 2017-05-20 Impact factor: 9.162
Authors: M Luke Marinovich; Lamiae Azizi; Petra Macaskill; Les Irwig; Monica Morrow; Lawrence J Solin; Nehmat Houssami Journal: Ann Surg Oncol Date: 2016-08-15 Impact factor: 5.344
Authors: Csaba Polgár; Zsuzsanna Kahán; Zsolt Orosz; Gabriella Gábor; Janaki Hadijev; Gábor Cserni; Janina Kulka; Nóra Jani; Zoltán Sulyok; György Lázár; Gábor Boross; Csaba Diczházi; Eva Szabó; Zsolt László; Zoltán Péntek; Tibor Major; János Fodor Journal: Pathol Oncol Res Date: 2008-04-26 Impact factor: 3.201
Authors: Meena S Moran; Yinjun Zhao; Shuangge Ma; Youlia Kirova; Alain Fourquet; Peter Chen; Karen Hoffman; Kelly Hunt; Julia Wong; Lia M Halasz; Gary Freedman; Robert Prosnitz; Michael Yassa; David H A Nguyen; Tarek Hijal; Bruce G Haffty; Elaine S Wai; Pauline T Truong Journal: JAMA Oncol Date: 2017-08-01 Impact factor: 33.006