Abeer M Shaaban1, Bridget Hilton2, Karen Clements2, David Dodwell3, Nisha Sharma4, Cliona Kirwan5, Elinor Sawyer6, Anthony Maxwell5, Matthew Wallis7, Hilary Stobart8, Senthurun Mylvaganam9, Janet Litherland10, Samantha Brace-McDonnell8, Joanne Dulson-Cox2, Olive Kearins2, Elena Provenzano7, Ian O Ellis11,12, Sarah E Pinder6, Alastair M Thompson13. 1. Queen Elizabeth Hospital Birmingham and University of Birmingham, Birmingham, UK. a.shaaban@bham.ac.uk. 2. NHS England and NHS Improvement, Birmingham, UK. 3. Nuffield Department of Population Health, University of Oxford, Oxford, UK. 4. Leeds Teaching Hospitals NHS Trust, Leeds, UK. 5. Division of Informatics, Imaging & Data Sciences. School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PT, UK. 6. School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Comprehensive Cancer Centre at Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK. 7. Addenbrookes Hospital, Cambridge and Cambridge Breast Unit, and NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Trust, Cambridge, UK. 8. Independent Cancer Patients' Voice, London, UK. 9. Royal Wolverhampton Hospital NHS Trust, Wolverhampton, UK. 10. NHS Greater Glasgow and Clyde, Glasgow, UK. 11. Nottingham University Hospitals, Nottingham, UK. 12. Nottingham Breast Cancer Research Centre, Division of Cancer and Stem Cells, School of Medicine, Nottingham City Hospital, The University of Nottingham, Nottingham, UK. 13. Baylor College of Medicine, Houston, TX, USA.
Abstract
BACKGROUND: The diagnosis, management and prognosis of microinvasive breast carcinoma remain controversial. METHODS: We analysed the outcomes of patients with DCIS with and without microinvasion diagnosed between 2003 and 2012 within the Sloane project. RESULTS: Microinvasion was recorded in 521 of 11,285 patients (4.6%), with considerable variation in reported incidence among screening units (0-25%). Microinvasion was associated with high-grade DCIS, larger DCIS size, comedo necrosis and solid, cribriform architecture (all P < 0.001). Microinvasion was more frequent in patients who underwent mastectomy compared with breast-conserving surgery (BCS) (6.9% vs 3.6%, P < 0.001), and in those undergoing axillary nodal surgery (60.4% vs 30.3%, P < 0.001) including the subset undergoing BCS (43.4% vs 8.5%, P < 0.001). Nodal metastasis rate was low and not statistically significant difference from the DCIS only group (P = 0.68). Following median follow-up of 110 months, 3% of patients had recurrent ipsilateral high-grade DCIS, and 4.2% developed invasive carcinoma. The subsequent ipsilateral invasion was of Grade 3 in 71.4% of patients with microinvasion vs 30.4% in DCIS without microinvasion (P = 0.02). Distant metastasis and breast cancer mortality were higher with microinvasion compared with DCIS only (1.2% vs 0.3%, P = 0.01 and 2.1% vs 0.8%; P = 0.005). CONCLUSIONS: The higher breast cancer mortality with microinvasion indicates a more aggressive disease.
BACKGROUND: The diagnosis, management and prognosis of microinvasive breast carcinoma remain controversial. METHODS: We analysed the outcomes of patients with DCIS with and without microinvasion diagnosed between 2003 and 2012 within the Sloane project. RESULTS: Microinvasion was recorded in 521 of 11,285 patients (4.6%), with considerable variation in reported incidence among screening units (0-25%). Microinvasion was associated with high-grade DCIS, larger DCIS size, comedo necrosis and solid, cribriform architecture (all P < 0.001). Microinvasion was more frequent in patients who underwent mastectomy compared with breast-conserving surgery (BCS) (6.9% vs 3.6%, P < 0.001), and in those undergoing axillary nodal surgery (60.4% vs 30.3%, P < 0.001) including the subset undergoing BCS (43.4% vs 8.5%, P < 0.001). Nodal metastasis rate was low and not statistically significant difference from the DCIS only group (P = 0.68). Following median follow-up of 110 months, 3% of patients had recurrent ipsilateral high-grade DCIS, and 4.2% developed invasive carcinoma. The subsequent ipsilateral invasion was of Grade 3 in 71.4% of patients with microinvasion vs 30.4% in DCIS without microinvasion (P = 0.02). Distant metastasis and breast cancer mortality were higher with microinvasion compared with DCIS only (1.2% vs 0.3%, P = 0.01 and 2.1% vs 0.8%; P = 0.005). CONCLUSIONS: The higher breast cancer mortality with microinvasion indicates a more aggressive disease.
Authors: Alastair M Thompson; Karen Clements; Shan Cheung; Sarah E Pinder; Gill Lawrence; Elinor Sawyer; Olive Kearins; Graham R Ball; Ian Tomlinson; Andrew Hanby; Jeremy St J Thomas; Anthony J Maxwell; Matthew G Wallis; David J Dodwell Journal: Eur J Cancer Date: 2018-08-06 Impact factor: 9.162
Authors: Abeer M Shaaban; Bridget Hilton; Karen Clements; Sarah E Pinder; Alastair M Thompson Journal: Br J Cancer Date: 2021-02-16 Impact factor: 7.640
Authors: Abeer M Shaaban; Bridget Hilton; Karen Clements; Elena Provenzano; Shan Cheung; Matthew G Wallis; Elinor Sawyer; Jeremy S Thomas; Andrew M Hanby; Sarah E Pinder; Alastair M Thompson Journal: Br J Cancer Date: 2020-11-17 Impact factor: 7.640