Leopoldo Costarelli1, Ettore Cianchetti2, Fabio Corsi3, Daniele Friedman4, Matteo Ghilli5, MariaTeresa Lacaria6, Lorenzo Menghini7, Roberto Murgo8, Antonio Ponti9, Stefano Rinaldi10, Marco Rosselli Del Turco11, Mario Taffurelli12, Corrado Tinterri13, Mariano Tomatis14, Lucio Fortunato15. 1. Breast Unit, San Giovanni-Addolorata Hospital, Rome, Italy. Electronic address: lcostarelli@hsangiovanni.roma.it. 2. Breast Centre Asl02 Abruzzo, P.O. G. Bernabeo, Ortona, Italy. Electronic address: cianchet@unich.it. 3. Surgery Department, Breast Unit, ICS Maugeri S.p.A, Pavia, Italy; Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy. Electronic address: fabio.corsi@unimi.it. 4. UO Chirurgia Senologica, Ospedale Policlinico San Martino, Genova, Italy. Electronic address: friedman@unige.it. 5. Breast Cancer Center, University Hospital of Pisa, Italy. Electronic address: matteo.ghilli@gmail.com. 6. Breast Unit, San Giovanni-Addolorata Hospital, Rome, Italy. Electronic address: lakymt@libero.it. 7. Breast Unit Rimini-Sant'Arcangelo di Romagna, Italy. Electronic address: lorenzo.menghini@auslromagna.it. 8. IRCCS, Ospedale Casa Sollievo Della Sofferenza, San Giovanni Rotondo, FG, Italy. Electronic address: romurgo@libero.it. 9. CPO Piemonte, SSD Epidemiologia Screening, CRPT, AOU Città Della Salute e Della Scienza di Torino, Italy. Electronic address: antonio.ponti@cpo.it. 10. Chirurgia Senologica, Ospedale San Paolo, Bari, Italy. Electronic address: solostefano@alice.it. 11. Senonetwok Italia Onlus, Florence, Italy. Electronic address: marco.rossellidt@gmail.com. 12. UOC di Chirurgia Generale e Della Mammella Policlinico di Sant'Orsola, Università di Bologna, Italy. Electronic address: mario.taffurelli@aosp.bo.it. 13. Breast Unit Humanitas Cancer Center, Rozzano, Italy. Electronic address: corrado.tinterri@cancercenter.humanitas.it. 14. CPO Piemonte, SSD Epidemiologia Screening, CRPT, AOU Città Della Salute e Della Scienza di Torino, Italy. Electronic address: mariano.tomatis@gmail.com. 15. Breast Unit, San Giovanni-Addolorata Hospital, Rome, Italy. Electronic address: lfortunato@hsangiovanni.roma.it.
Abstract
BACKGROUND AND OBJECTIVES: We studied a large series of ductal carcinoma in situ with microinvasion (MIDC) an infrequent disease whose diagnosis and management are not well defined. METHODS: 17,431 cases of breast carcinoma were treated between 2011 and 2016 by ten Italian Breast Units. Our analysis included diagnostic and clinic-pathological characteristics, surgical management, and the use of adjuvant therapies. RESULTS: 15,091 cases (86.6%) were infiltrating carcinomas (IC), 2107 (12.1%) ductal carcinoma in situ (DCIS), and 233 (1.3%) MIDC. Age at diagnosis did not differ between DCIS and MIDC. MIDC were usually larger and expressed more frequently biologically aggressive features (higher Ki67 values, hormone receptor negativity and HER2/neu over-expression) (p < 0.01). Axillary lymph nodes were involved in 25 MIDC cases (12%), but >3 lymph nodes were involved in two cases only (1%). At multivariable analysis, only lymphovascular invasion (LVI) was associated with lymph node status (p < 0.01). Hormone therapy was prescribed in 388/1462 DCIS cases (26.5%), in 84/200 MIDC cases (42%), and in 11,086/14,188 IC cases (84.7%) (p < 0.01). Chemotherapy was administered in 28/190 MIDC cases (14.7%), and in 4080/11,548 IC cases (35.3%) (p < 0.001). CONCLUSIONS: This is one of the largest studies of MIDC reported in the literature. Approximately 10% of DCIS harbor one or more foci of MIDC, and the latter often expresses aggressive biological features. LVI is a predictor of axillary node involvement, but this is infrequent and usually limited. Conservative surgery is performed less often than in DCIS, and adjuvant chemotherapy is less frequently utilized compared to IC.
BACKGROUND AND OBJECTIVES: We studied a large series of ductal carcinoma in situ with microinvasion (MIDC) an infrequent disease whose diagnosis and management are not well defined. METHODS: 17,431 cases of breast carcinoma were treated between 2011 and 2016 by ten Italian Breast Units. Our analysis included diagnostic and clinic-pathological characteristics, surgical management, and the use of adjuvant therapies. RESULTS: 15,091 cases (86.6%) were infiltrating carcinomas (IC), 2107 (12.1%) ductal carcinoma in situ (DCIS), and 233 (1.3%) MIDC. Age at diagnosis did not differ between DCIS and MIDC. MIDC were usually larger and expressed more frequently biologically aggressive features (higher Ki67 values, hormone receptor negativity and HER2/neu over-expression) (p < 0.01). Axillary lymph nodes were involved in 25 MIDC cases (12%), but >3 lymph nodes were involved in two cases only (1%). At multivariable analysis, only lymphovascular invasion (LVI) was associated with lymph node status (p < 0.01). Hormone therapy was prescribed in 388/1462 DCIS cases (26.5%), in 84/200 MIDC cases (42%), and in 11,086/14,188 IC cases (84.7%) (p < 0.01). Chemotherapy was administered in 28/190 MIDC cases (14.7%), and in 4080/11,548 IC cases (35.3%) (p < 0.001). CONCLUSIONS: This is one of the largest studies of MIDC reported in the literature. Approximately 10% of DCIS harbor one or more foci of MIDC, and the latter often expresses aggressive biological features. LVI is a predictor of axillary node involvement, but this is infrequent and usually limited. Conservative surgery is performed less often than in DCIS, and adjuvant chemotherapy is less frequently utilized compared to IC.