Surgery for low grade ductal carcinoma in situ does not improve survival, study finds

Purpose: The question of overtreatment of ductal carcinoma in situ (DCIS) was raised because a significant proportion of especially low-grade DCIS lesions never progress to invasive cancer. The rationale for the present study was to analyze the value of stereotactic vacuum-assisted biopsy (VAB) for complete removal of DCIS, focusing on the relationship between the absence of residual microcalcifications after stereotactic VAB and the histopathological diagnosis of the definitive surgical specimen. Patients and Methods: Data of 58 consecutive patients diagnosed with DCIS by stereotactic VAB in a single breast center between 2012 and 2017 were analyzed. Patient records from the hospital information system were retrieved, and mammogram reports and images as well as histopathology reports were evaluated. The extent of microcalcifications before and after biopsy as well as the occurrence of DCIS in biopsy and definitive surgical specimens were analyzed and correlated. Results: There was no correlation between the absence of residual microcalcifications in the post-biopsy mammogram and the absence of residual DCIS in the final surgical specimen (p = 0.085). Upstaging to invasive cancer was recorded in 4 cases (13%) but occurred only in the group that had high-grade DCIS on biopsy. Low-grade DCIS was never upgraded to high-grade DCIS in the definitive specimen. Conclusions: The radiological absence of microcalcifications after stereotactic biopsy does not rule out residual DCIS in the final surgical specimen. Since upstaging to invasive cancer is seen in a substantial proportion of high-grade DCIS, the surgical excision of high-grade DCIS should remain the treatment of choice.

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Transitions Between Flat Epithelial Atypia and Low-grade Ductal Carcinoma In Situ of the Breast

The American Journal of Surgical Pathology ◽

10.1097/pas.0b013e31825f9d6a ◽

2012 ◽

Vol 36 (8) ◽

pp. 1247-1252 ◽

Cited By ~ 8

Author(s):

Sebastian Aulmann ◽

Lisa Braun ◽

Friederike Mietzsch ◽

Thomas Longerich ◽

Roland Penzel ◽

...

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Flat Epithelial Atypia ◽

Low Grade ◽

Epithelial Atypia

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Low-Grade Ductal Carcinoma In Situ

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqz179 ◽

2019 ◽

Vol 153 (3) ◽

pp. 360-367 ◽

Cited By ~ 1

Author(s):

Sarah A Alghamdi ◽

Kritika Krishnamurthy ◽

Sofia A Garces Narvaez ◽

Khaled J Algashaamy ◽

Jessica Aoun ◽

...

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Interobserver Agreement ◽

Interobserver Variability ◽

Ductal Carcinoma ◽

Grading System ◽

Low Grade ◽

Interobserver Reproducibility ◽

Tiered System

Abstract Objectives We aimed to determine the interobserver reproducibility in diagnosing low-grade ductal carcinoma in situ (DCIS). We also aimed to compare the interobserver variability using a proposed two-tiered grading system as opposed to the current three-tiered system. Methods Three expert breast pathologists and one junior pathologist identified low-grade DCIS from a set of 300 DCIS slides. Months later, participants were asked to grade the 300 cases using the standard three-tiered system. Results Using the two-tiered system, interobserver agreement among breast pathologists was considered moderate (κ = 0.575). The agreement was similar (κ = 0.532) with the junior pathologist included. Using the three-tiered system, pathologists’ agreement was poor (κ = 0.235). Conclusions Pathologists’ reproducibility on diagnosing low-grade DCIS showed moderate agreement. Experience does not seem to influence reproducibility. Our proposed two-tiered system of low vs nonlow grade, where the intermediate grade is grouped in the nonlow category has shown improved concordance.

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