Ductal Carcinoma In Situ and Margins &lt;2 mm

Tadros, Audree B; Smith, Benjamin D.; Shen, Yu; Lin, Heather; Krishnamurthy, Savitri; Lucci, Anthony; Barcenas, Carlos H.; Hwang, Rosa F.; Rauch, Gaiane M.; Santiago, Lumarie; Strom, Eric A.; DeSnyder, Sarah M.; Yang, Wei Tse; Black, Dalliah M.; Albarracin, Constance T.; Chávez-MacGregor, Mariana; Hunt, Kelly K.; Kuerer, Henry Mark

doi:10.1097/sla.0000000000002439

Cited by 31 publications

(11 citation statements)

References 28 publications

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“…[19] However, specifically for women who did not receive RT, in this series there was an association between a DCIS margin of <2mm and ipsilateral breast recurrence. This provides direct evidence in support of more recent reviews, meta-analysis and consensus guidelines [20,21] as well as recent studies [22].…”

Section: Discussionsupporting

confidence: 80%

“…Nevertheless, patients not receiving RT had a higher (7.2%) breast recurrence rate, confirming patient selection for RT could be improved. [22] Endocrine therapy was associated with a non-significant reduction in ipsilateral breast recurrence independent of RT, although the greatest effect was seen for the reduction of invasive further events in the absence of RT. In a contemporary analysis of the US retrospective National Cancer Data Base (70% of the US population), 36.5% of women (most commonly between 50 and 59 years of age) received adjuvant endocrine therapy for DCIS [23] compared with 12.2% in this UK-based study, and no-one in a cohort in the Netherlands [12], reflecting the inconsistent interpretation of evidence from trials examining the impact of endocrine therapy for DCIS on local recurrence, the associated toxicities and issues of adherence to adjuvant tamoxifen treatment.…”

Section: Discussionmentioning

confidence: 94%

See 1 more Smart Citation

Management and 5-year outcomes in 9938 women with screen-detected ductal carcinoma in situ: the UK Sloane Project

Thompson

Clements

Cheung

et al. 2018

European Journal of Cancer

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 94%

Management and 5-year outcomes in 9938 women with screen-detected ductal carcinoma in situ: the UK Sloane Project

Thompson

Clements

Cheung

et al. 2018

European Journal of Cancer

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“…Several studies have reported that women with clear margins after surgery for DCIS have lower rates of local recurrence than do women who have involved margins,12232425 as does our study. Although guidelines recommend that margin widths do not need to be more than 1 or 2 mm,2226 our study suggests that having margins greater than this may confer some further benefit.…”

Section: Discussionsupporting

confidence: 73%

Invasive breast cancer and breast cancer mortality after ductal carcinoma in situ in women attending for breast screening in England, 1988-2014: population based observational cohort study

Mannu

Wang

Broggio

et al. 2020

BMJ

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ObjectiveTo evaluate the long term risks of invasive breast cancer and death from breast cancer after ductal carcinoma in situ (DCIS) diagnosed through breast screening.DesignPopulation based observational cohort study.SettingData from the NHS Breast Screening Programme and the National Cancer Registration and Analysis Service.ParticipantsAll 35 024 women in England diagnosed as having DCIS by the NHS Breast Screening Programme from its start in 1988 until March 2014.Main outcome measuresIncident invasive breast cancer and death from breast cancer.ResultsBy December 2014, 13 606 women had been followed for up to five years, 10 998 for five to nine years, 6861 for 10-14 years, 2620 for 15-19 years, and 939 for at least 20 years. Among these women, 2076 developed invasive breast cancer, corresponding to an incidence rate of 8.82 (95% confidence interval 8.45 to 9.21) per 1000 women per year and more than double that expected from national cancer incidence rates (ratio of observed rate to expected rate 2.52, 95% confidence interval 2.41 to 2.63). The increase started in the second year after diagnosis of DCIS and continued until the end of follow-up. In the same group of women, 310 died from breast cancer, corresponding to a death rate of 1.26 (1.13 to 1.41) per 1000 women per year and 70% higher than that expected from national breast cancer mortality rates (observed:expected ratio 1.70, 1.52 to 1.90). During the first five years after diagnosis of DCIS, the breast cancer death rate was similar to that expected from national mortality rates (observed:expected ratio 0.87, 0.69 to 1.10), but it then increased, with values of 1.98 (1.65 to 2.37), 2.99 (2.41 to 3.70), and 2.77 (2.01 to 3.80) in years five to nine, 10-14, and 15 or more after DCIS diagnosis. Among 29 044 women with unilateral DCIS undergoing surgery, those who had more intensive treatment (mastectomy, radiotherapy for women who had breast conserving surgery, and endocrine treatment in oestrogen receptor positive disease) and those with larger final surgical margins had lower rates of invasive breast cancer.ConclusionsTo date, women with DCIS detected by screening have, on average, experienced higher long term risks of invasive breast cancer and death from breast cancer than women in the general population during a period of at least two decades after their diagnosis. More intensive treatment and larger final surgical margins were associated with lower risks of invasive breast cancer.

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“…As discriminating the two tissue types with DRS seems impossible, this might have implications for what is detected by DRS as a positive resection margin. Importantly, there is ongoing controversy around the current definition of a positive resection margin for DCIS and this could further shift towards an even more liberal definition in the future [ 5 , 39 – 42 ]. There are some indications that a less stringent interpretation of a positive resection margin is safe for DCIS as long as post-operative radiotherapy is not omitted [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Optical tissue measurements of invasive carcinoma and ductal carcinoma in situ for surgical guidance

et al. 2021

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Background Although the incidence of positive resection margins in breast-conserving surgery has decreased, both incomplete resection and unnecessary large resections still occur. This is especially the case in the surgical treatment of ductal carcinoma in situ (DCIS). Diffuse reflectance spectroscopy (DRS), an optical technology based on light tissue interactions, can potentially characterize tissue during surgery thereby guiding the surgeon intraoperatively. DRS has shown to be able to discriminate pure healthy breast tissue from pure invasive carcinoma (IC) but limited research has been done on (1) the actual optical characteristics of DCIS and (2) the ability of DRS to characterize measurements that are a mixture of tissue types. Methods In this study, DRS spectra were acquired from 107 breast specimens from 107 patients with proven IC and/or DCIS (1488 measurement locations). With a generalized estimating equation model, the differences between the DRS spectra of locations with DCIS and IC and only healthy tissue were compared to see if there were significant differences between these spectra. Subsequently, different classification models were developed to be able to predict if the DRS spectrum of a measurement location represented a measurement location with “healthy” or “malignant” tissue. In the development and testing of the models, different definitions for “healthy” and “malignant” were used. This allowed varying the level of homogeneity in the train and test data. Results It was found that the optical characteristics of IC and DCIS were similar. Regarding the classification of tissue with a mixture of tissue types, it was found that using mixed measurement locations in the development of the classification models did not tremendously improve the accuracy of the classification of other measurement locations with a mixture of tissue types. The evaluated classification models were able to classify measurement locations with > 5% malignant cells with a Matthews correlation coefficient of 0.41 or 0.40. Some models showed better sensitivity whereas others had better specificity. Conclusion The results suggest that DRS has the potential to detect malignant tissue, including DCIS, in healthy breast tissue and could thus be helpful for surgical guidance.

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Ductal Carcinoma In Situ and Margins <2 mm

Abstract: Routine additional surgery may not be justified for patients with negative margins <2 mm who undergo RT but should be performed in patients who forego RT.

Cited by 31 publications

References 28 publications

Management and 5-year outcomes in 9938 women with screen-detected ductal carcinoma in situ: the UK Sloane Project

Management and 5-year outcomes in 9938 women with screen-detected ductal carcinoma in situ: the UK Sloane Project

Invasive breast cancer and breast cancer mortality after ductal carcinoma in situ in women attending for breast screening in England, 1988-2014: population based observational cohort study

Optical tissue measurements of invasive carcinoma and ductal carcinoma in situ for surgical guidance

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