scholarly journals Low-grade ductal carcinoma in situ (DCIS) arising in a fibroadenoma of the breast during 5 years follow-up

Medicine ◽  
2021 ◽  
Vol 100 (10) ◽  
pp. e24023
Author(s):  
Hiroko Shojaku ◽  
Ryota Hori ◽  
Toru Yoshida ◽  
Kazuhiro Matsui ◽  
Katsuo Shimada ◽  
...  
2018 ◽  
Vol 142 (9) ◽  
pp. 1120-1126 ◽  
Author(s):  
Mirna B. Podoll ◽  
Emily S. Reisenbichler ◽  
Lania Roland ◽  
Andrew Bruner ◽  
Sarah Mizuguchi ◽  
...  

Context.— Ductal carcinoma in situ (DCIS) represents 20% of screen-detected breast cancers. The likelihood that certain types of DCIS are slow growing and may never progress to invasion suggests that our current standards of treating DCIS could result in overtreatment. The LORIS (LOw RISk DCIS) and LORD (LOw Risk DCIS) trials address these concerns by randomizing patients with low-risk DCIS to either active surveillance or conventional treatment. Objective.— To determine the upgrade rate of DCIS diagnosed on core needle biopsy to invasive carcinoma at surgery and to evaluate the safety of managing low-risk DCIS with surveillance alone, by characterizing the pathologic and clinical features of upgraded cases and applying criteria of the LORD and LORIS trials to these cases. Design.— A 10-year retrospective analysis of DCIS on core needle biopsy with subsequent surgery. Results.— We identified 1271 cases of DCIS on core needle biopsy: 200 (16%) low grade, 649 (51%) intermediate grade, and 422 (33%) high grade. Of the 1271 cases, we found an 8% upgrade rate to invasive carcinoma (n = 105). Nineteen of the 105 upgraded cases (18%) had positive lymph nodes. Low-grade DCIS was least likely to upgrade to invasion, comprising 10% (10 of 105) of upgraded cases. Three of the 105 upgraded cases (3%) met criteria for the LORD trial, and all were low-grade DCIS on core needle biopsy with favorable biology on follow-up. Conclusions.— There is a clear risk of upgrade to invasion on follow-up excision; however, applying strict criteria of the LORD trial effectively decreases the likelihood of a missed invasive component or missed aggressive pathologic features.


Author(s):  
Abeer M. Shaaban ◽  
◽  
Bridget Hilton ◽  
Karen Clements ◽  
Elena Provenzano ◽  
...  

Abstract Background The Sloane audit compares screen-detected ductal carcinoma in situ (DCIS) pathology with subsequent management and outcomes. Methods This was a national, prospective cohort study of DCIS diagnosed during 2003–2012. Results Among 11,337 patients, 7204 (64%) had high-grade DCIS. Over time, the proportion of high-grade disease increased (from 60 to 65%), low-grade DCIS decreased (from 10 to 6%) and mean size increased (from 21.4 to 24.1 mm). Mastectomy was more common for high-grade (36%) than for low-grade DCIS (15%). Few (6%) patients treated with breast-conserving surgery (BCS) had a surgical margin <1 mm. Of the 9191 women diagnosed in England (median follow-up 9.4 years), 7% developed DCIS or invasive malignancy in the ipsilateral and 5% in the contralateral breast. The commonest ipsilateral event was invasive carcinoma (n = 413), median time 62 months, followed by DCIS (n = 225), at median 37 months. Radiotherapy (RT) was most protective against recurrence for high-grade DCIS (3.2% for high-grade DCIS with RT compared to 6.9% without, compared with 2.3 and 3.0%, respectively, for low/intermediate-grade DCIS). Ipsilateral DCIS events lessened after 5 years, while the risk of ipsilateral invasive cancer remained consistent to beyond 10 years. Conclusion DCIS pathology informs patient management and highlights the need for prolonged follow-up of screen-detected DCIS.


2006 ◽  
Vol 24 (21) ◽  
pp. 3381-3387 ◽  
Author(s):  
Nina Bijker ◽  
Philip Meijnen ◽  
Johannes L. Peterse ◽  
Jan Bogaerts ◽  
Irène Van Hoorebeeck ◽  
...  

Purpose The European Organisation for Research and Treatment of Cancer conducted a randomized trial investigating the role of radiotherapy (RT) after local excision (LE) of ductal carcinoma-in-situ (DCIS) of the breast. We analyzed the efficacy of RT with 10 years follow-up on both the overall risk of local recurrence (LR) and related to clinical, histologic, and treatment factors. Patients and Methods After complete LE, women with DCIS were randomly assigned to no further treatment or RT (50 Gy). One thousand ten women with mostly (71%) mammographically detected DCIS were included. The median follow-up was 10.5 years. Results The 10-year LR-free rate was 74% in the group treated with LE alone compared with 85% in the women treated by LE plus RT (log-rank P < .0001; hazard ratio [HR] = 0.53). The risk of DCIS and invasive LR was reduced by 48% (P = .0011) and 42% (P = .0065) respectively. Both groups had similar low risks of metastases and death. At multivariate analysis, factors significantly associated with an increased LR risk were young age (≤ 40 years; HR = 1.89), symptomatic detection (HR = 1.55), intermediately or poorly differentiated DCIS (as opposed to well-differentiated DCIS; HR = 1.85 and HR = 1.61 respectively), cribriform or solid growth pattern (as opposed to clinging/micropapillary subtypes; HR = 2.39 and HR = 2.25 respectively), doubtful margins (HR = 1.84), and treatment by LE alone (HR = 1.82). The effect of RT was homogeneous across all assessed risk factors. Conclusion With long-term follow-up, RT after LE for DCIS continued to reduce the risk of LR, with a 47% reduction at 10 years. All patient subgroups benefited from RT.


1999 ◽  
Vol 435 (4) ◽  
pp. 413-421 ◽  
Author(s):  
Tetsunari Oyama ◽  
Horacio Maluf ◽  
F. Koerner

Author(s):  
Amara Ndumele ◽  
Amy Kerger ◽  
Gary Tozbikian ◽  
Samilia Obeng-Gyasi ◽  
Bridget Oppong

We report an unusual finding of DCIS within a cystic lesion in a black man highlighting the need for adequate workup, and timely follow-up for men with breast/chest wall masses given the lack of screening in this population. Furthermore, we will explore how race contributes to prognosis and health outcomes.


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