Ductal Carcinoma In Situ —Pathological Considerations

AbstractPurpose of ReviewMammographic screening and radiological surveillance for local management has led to an exponential increase in diagnosis of ductal carcinoma in situ (DCIS) with limited impact on breast cancer specific mortality. Since definitive diagnosis of DCIS requires histopathological examination increase in radiological surveillance has resulted in significant increase in breast biopsies. Pathological characteristics of DCIS include grade, necrosis, size, anatomy, margins of excision, estrogen, and progesterone receptor status, and these features are useful for both prognostication and prediction.Recent FindingsDifferential diagnosis of DCIS extends from atypical ductal hyperplasia to micro-invasive carcinoma and increasingly pathologists recognize intraductal lesions at the borderline between atypical ductal hyperplasia and ductal carcinoma in situ. Clinicopathological characteristics of DCIS continue to be significant in prospective trials and have been integrated with predictive molecular tools.SummarySince most cases of DCIS do not progress to invasive cancer multiple tools which include clinicopathologic and molecular signatures are in the process of development and validation for personalizing treatment strategies for patients. Ongoing clinical trials are testing whether DCIS with favorable clinicopathologic characteristics may avoid loco-regional therapy which typically includes breast conserving surgery and radiotherapy.
Source: Current Breast Cancer Reports - Category: Cancer & Oncology Source Type: research

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AbstractPurpose of ReviewStandard options for the treatment of ductal carcinoma in situ (DCIS) include breast-conserving surgery (BCS) alone; BCS with radiotherapy or endocrine therapy, or both; and mastectomy. Survival is excellent with all options, but rates of local recurrence (LR) vary, as do quality-of-life measures. Here, we discuss treatment outcomes, risk factors for LR, and tools for risk estimation.Recent FindingsAfter BCS, radiotherapy reduces the risk of LR by half, and endocrine therapy reduces the risk by a third. Young age, inadequate margins, and greater volume of disease are associated with higher risk of ...
Source: Current Breast Cancer Reports - Category: Cancer & Oncology Source Type: research
AbstractPurpose of ReviewDuctal carcinoma in situ (DCIS) is commonly treated with radiotherapy as a part of breast-conserving therapy, though increasingly the use of routine radiation treatment is being questioned. The intent of this review is to summarize studies on the role of radiotherapy for DCIS, with an emphasis on more recent trials.Recent FindingsWhile older randomized clinical trials have established a local control benefit for adjuvant radiotherapy following breast-conserving surgery in all patients including those with low-risk DCIS, these and subsequent studies have failed to demonstrate any survival benefit. G...
Source: Current Breast Cancer Reports - Category: Cancer & Oncology Source Type: research
Abstract We aimed to evaluate the surgical margin outcomes and re-excision rates in patients undergoing bracketed seed localization of biopsy-proven breast cancer detected on screening mammogram. After approval by our Institutional Review Board, we retrospectively identified patients who had undergone iodine-125 seed localized lumpectomy at our institution from January 2010 to June 2017 by one of two fellowship-trained breast surgeons. Of those patients, a subset of 25 patients were identified who had undergone bracketed seed localization, defined as two or more seeds used to delineate the radiographic borders of ...
Source: The American Surgeon - Category: Surgery Authors: Tags: Am Surg Source Type: research
In this study, we aimed to evaluate the prognostic significance of CTSV in DCIS. METHODS: CTSV protein expression was immunohistochemically assessed in a well-characterised and annotated cohort of DCIS comprising pure DCIS (n=776) and DCIS coexisting with IBC (n=239). CTSV expression was analysed in tumour cells and surrounding stroma, including its association with clinicopathological parameters and outcome. RESULTS: In pure DCIS, high CTSV expression was observed in 29% of epithelial tumour cells and 20% of surrounding stroma. High expression in both components was associated with features of poor prognosis inc...
Source: Clinical Genitourinary Cancer - Category: Cancer & Oncology Authors: Tags: J Clin Pathol Source Type: research
Conclusion: The findings of this study are comparable to results in the literature on OPS and demonstrate that OPS is an attractive alternative to standard lumpectomy for Canadian general surgeons who treat breast cancer. PMID: 31995336 [PubMed - indexed for MEDLINE]
Source: Canadian Journal of Surgery - Category: Surgery Authors: Tags: Can J Surg Source Type: research
Publication date: Available online 5 December 2019Source: The LancetAuthor(s): Timothy J Whelan, Jim A Julian, Tanya S Berrang, Do-Hoon Kim, Isabelle Germain, Alan M Nichol, Mohamed Akra, Sophie Lavertu, Francois Germain, Anthony Fyles, Theresa Trotter, Francisco E Perera, Susan Balkwill, Susan Chafe, Thomas McGowan, Thierry Muanza, Wayne A Beckham, Boon H Chua, Chu Shu Gu, Mark N LevineSummaryBackgroundWhole breast irradiation delivered once per day over 3–5 weeks after breast conserving surgery reduces local recurrence with good cosmetic results. Accelerated partial breast irradiation (APBI) delivered over 1 week t...
Source: The Lancet - Category: General Medicine Source Type: research
This study sought to evaluate the impact of RT for DCIS on mortality after SBC in a larger cohort. PATIENTS AND METHODS: Using the SEER database, 3,407 patients were identified who received breast-conserving therapy with or without RT for primary DCIS in 2000 through 2013 and subsequently developed a stage I-III invasive SBC within the same time period. Fine-Gray competing risk models were used to study the association between receipt of RT and mortality after SBC. RESULTS: Prior RT was found to be associated with higher rates of breast cancer-specific mortality (hazard ratio [HR], 1.70; 95% CI, 1.18-2.45; P=.005),...
Source: Journal of the National Comprehensive Cancer Network : JNCCN - Category: Cancer & Oncology Tags: J Natl Compr Canc Netw Source Type: research
AbstractPurposeIt has been accepted that radiation therapy (RT) for ductal carcinoma in situ (DCIS) has no survival benefit despite increasing local control. However, a recent large database study reported a small but significant benefit. Using a Korean population-based large database, we examined the survival benefit of RT for DCIS after breast-conserving surgery (BCS) and analyzed which subgroup might derive benefit from it.MethodsData from 6038 female DCIS patients who underwent BCS with or without RT between 1993 and 2012 were included in this study. We used propensity score analysis to control for differences in basel...
Source: Breast Cancer Research and Treatment - Category: Cancer & Oncology Source Type: research
ConclusionsThe presence of multiple foci of MI in DCIS is associated with higher 15-year risks of invasive LR after breast-conserving therapy compared to women with pure DCIS but treatment with whole breast and boost RT can mitigate this risk.
Source: Breast Cancer Research and Treatment - Category: Cancer & Oncology Source Type: research
AbstractBackgroundGrowing evidence suggests that the tumor immune microenvironment influences breast cancer development and prognosis. Density of tumor-infiltrating lymphocytes (TILs) within invasive breast cancer is correlated with response to therapy, especially in triple-negative disease. The clinical relevance and outcomes of TILs within ductal carcinoma in situ (DCIS) are less understood.MethodsOur institutional database of 668 patients with pure DCIS from 2010 to 2018 was queried. TILs were evaluated by International TILs Working Group guidelines. Percentage of TILs was assessed from the densest focus (hotspot) in on...
Source: Annals of Surgical Oncology - Category: Cancer & Oncology Source Type: research
More News: Anatomy | Breast Cancer | Breast Carcinoma | Breast Conservation Surgery | Cancer | Cancer & Oncology | Carcinoma | Carcinoma in Situ | Clinical Trials | DCIS (Ductal Carcinoma in Situ) | Ductal Carcinoma | Pathology