A critical appraisal of six modern classifications of ductal carcinoma in situ of the breast (DCIS): correlation with grade of associated invasive carcinoma

Context Radial scars are benign sclerosing lesions that are routinely excised when diagnosed in a needle core biopsy. Optimal management for patients with incidental and small (≤5 mm) radial scars is uncertain. Objective To assess pathologic upgrade of radial scars diagnosed in needle core biopsy samples and identify a subset of patients who could benefit from conservative management. Design Patients with a diagnosis of radial scar in a needle core biopsy who underwent excision of the biopsied area were identified. Radial scars greater than 5 mm in size and those with coexisting atypia, carcinoma, and papillary lesions were excluded. After histologic-radiographic correlation, rates of pathologic upgrade were assessed. Results Seventy-seven radial scars diagnosed in 66 patients were included. Overall, 9 of 77 (12%) showed upgrade to a high-risk lesion (6 lobular carcinoma in situ, 2 atypical ductal hyperplasia, 1 atypical lobular hyperplasia), while none (0%) showed upgrade to invasive carcinoma or ductal carcinoma in situ. One of 22 incidental radial scars (4.5%) showed upgrade on excision versus 6 of 36 (16.7%) for radial scars considered to be the radiographic target (P = .23). Older age was associated with upgrade (P < .001). Conclusions No incidental or small (≤5 mm) radial scars excised revealed invasive carcinoma or ductal carcinoma in situ on excision. Provided there is good pathologic-radiologic concordance, it appears reasonable for these patients to be managed conservatively.

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Do Eligibility Criteria for Ductal Carcinoma In Situ (DCIS) Active Surveillance Trials Identify Patients at Low Risk for Upgrade to Invasive Carcinoma?

Annals of Surgical Oncology ◽

10.1245/s10434-020-08576-6 ◽

2020 ◽

Vol 27 (11) ◽

pp. 4459-4465 ◽

Cited By ~ 1

Author(s):

Tawakalitu O. Oseni ◽

Barbara L. Smith ◽

Constance D. Lehman ◽

Charmi A. Vijapura ◽

Niveditha Pinnamaneni ◽

...

Keyword(s):

Active Surveillance ◽

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Invasive Carcinoma ◽

Ductal Carcinoma ◽

Low Risk ◽

Eligibility Criteria

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Sentinel node procedure is warranted in Ductal Carcinoma In Situ (DCIS) with high risk of occult invasive carcinoma and Micro Invasive Carcinoma (DCIS MIC) treated by mastectomy

European Journal of Cancer Supplements ◽

10.1016/s1359-6349(06)80146-1 ◽

2006 ◽

Vol 4 (2) ◽

pp. 79

Author(s):

C. Tunon de Lara ◽

Giard ◽

M. Buttarelli ◽

J. Blanchot ◽

J. Classe ◽

...

Keyword(s):

High Risk ◽

Sentinel Node ◽

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Invasive Carcinoma ◽

Ductal Carcinoma ◽

Sentinel Node Procedure

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Ductal carcinoma in situ with periductal fibrosis-is it in reality an invasive carcinoma?

Human Pathology ◽

10.1016/s0046-8177(96)90409-8 ◽

1996 ◽

Vol 27 (7) ◽

pp. 744 ◽

Cited By ~ 3

Author(s):

K.N Naresh ◽

Anita M Borges

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Invasive Carcinoma ◽

Ductal Carcinoma

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Evaluation of margins in invasive carcinoma and ductal carcinoma in situ: The pathologist's perspective

The Breast ◽

10.1016/j.breast.2017.06.029 ◽

2017 ◽

Vol 34 ◽

pp. S58-S60 ◽

Cited By ~ 1

Author(s):

Stuart J. Schnitt

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Invasive Carcinoma ◽

Ductal Carcinoma

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Sentinel Lymph Node Biopsy Should Be Included with the Initial Surgery for High-Risk Ductal Carcinoma-In-Situ

International Scholarly Research Notices ◽

10.1155/2014/624185 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7

Author(s):

Ern Yu Tan ◽

Z. W. Joseph Lo ◽

Chuan Han Ang ◽

Christine Teo ◽

Melanie D. W. Seah ◽

...

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Preoperative Diagnosis ◽

Invasive Carcinoma ◽

Ductal Carcinoma ◽

Repeat Surgery ◽

Initial Surgery

Background. A proportion of those diagnosed preoperatively with ductal carcinoma-in-situ (DCIS) will be histologically upgraded to invasive carcinoma. Repeat surgery for sentinel lymph node (SLN) biopsy will be required if it had not been included with the initial surgery. We reviewed the outcome of SLN biopsy performed with the initial surgery based on a preoperative diagnosis of DCIS and aimed to identify patients at risk of histological upgrade. Methods. Retrospective review of 294 consecutive female patients diagnosed with DCIS was performed at our institute from January 1, 2001, to December 31, 2008. Results. Of the 294 patients, 132 (44.9%) underwent SLN biopsy together with the initial surgery. The SLN was positive for metastases in 5 patients, all of whom had tumours that were histologically upgraded. Histological upgrade also occurred in 43 of the 127 patients (33.9%) in whom the SLN was negative for metastases. On multivariate analysis, histological upgrade was more likely if a mass was detected on mammogram, if the preoperative diagnosis was obtained with core biopsy and if microinvasion was reported in the biopsy. Conclusion. Patients in whom a preoperative diagnosis of DCIS is likely to be upgraded to invasive carcinoma will benefit from SLN biopsy being performed with the initial surgery.

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