Nuclear grade and comedo necrosis of ductal carcinoma <i>in situ</i> as histopathological eligible criteria for the Japan Clinical Oncology Group 1505 trial: an interobserver agreement study

Tsuda, Hitoshi; Yoshida, Masayuki; Akiyama, Futoshi; Ohi, Yasuyo; Kinowaki, Keiichi; Kumaki, Nobue; Kondo, Yoshitaka; Saito, Akihisa; Sasaki, Eiichi; Nishimura, Rieko; Fujii, Satoshi; Homma, Keiichi; Horii, Rie; Murata, Yuya; Itami, Makiko; Kajita, Sabine; Kato, Hiroyuki; Kurosumi, Masafumi; Sakatani, Takashi; Shimizu, Shigeki; Taniguchi, Kohei; Tamiya, Sadafumi; Kanbayashi, Chizuko; Shien, Tadahiko; Iwata, Hiroji

doi:10.1093/jjco/hyaa235

Cited by 5 publications

(1 citation statement)

References 33 publications

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“…[41][42][43][44][45]. They may be subject to confounding factors, bias, and interobserver variations which can further complicate the interpretation of data [41,46]. In addition, invasive and non-invasive recurrence of DCIS do not share the same prognostic factors, and analysing LRs as a whole can be another confounding issue.…”

Section: Prognostic Value Of Clinical and Histopathological Factorsmentioning

confidence: 99%

Tools to Guide Radiation Oncologists in the Management of DCIS

Leonardi,

Zerella,

Lazzeroni

et al. 2024

Healthcare

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Similar to invasive breast cancer, ductal carcinoma in situ is also going through a phase of changes not only from a technical but also a conceptual standpoint. From prescribing radiotherapy to everyone to personalized approaches, including radiotherapy omission, there is still a lack of a comprehensive framework to guide radiation oncologists in decision making. Many pieces of the puzzle are finding their place as high-quality data mature and are disseminated, but very often, the interpretation of risk factors and the perception of risk remain very highly subjective. Sharing the therapeutic choice with patients requires effective communication for an understanding of risks and benefits, facilitating an informed decision that does not increase anxiety and concerns about prognosis. The purpose of this narrative review is to summarize the current state of knowledge to highlight the tools available to radiation oncologists for managing DCIS, with an outlook on future developments.

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Section: Prognostic Value Of Clinical and Histopathological Factorsmentioning

confidence: 99%

Tools to Guide Radiation Oncologists in the Management of DCIS

Leonardi,

Zerella,

Lazzeroni

et al. 2024

Healthcare

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Erythrophagocytosis is not a reproducible finding in liver biopsies, and is not associated with clinical diagnosis of hemophagocytic lymphohistiocytosis

Desai,

Kudose,

Remotti

et al. 2023

Virchows Arch

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Should low-risk DCIS lose the cancer label? An evidence review

Semsarian

Barratt

et al. 2023

Breast Cancer Res Treat

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Background Population mammographic screening for breast cancer has led to large increases in the diagnosis and treatment of ductal carcinoma in situ (DCIS). Active surveillance has been proposed as a management strategy for low-risk DCIS to mitigate against potential overdiagnosis and overtreatment. However, clinicians and patients remain reluctant to choose active surveillance, even within a trial setting. Re-calibration of the diagnostic threshold for low-risk DCIS and/or use of a label that does not include the word ‘cancer’ might encourage the uptake of active surveillance and other conservative treatment options. We aimed to identify and collate relevant epidemiological evidence to inform further discussion on these ideas. Methods We searched PubMed and EMBASE databases for low-risk DCIS studies in four categories: (1) natural history; (2) subclinical cancer found at autopsy; (3) diagnostic reproducibility (two or more pathologist interpretations at a single time point); and (4) diagnostic drift (two or more pathologist interpretations at different time points). Where we identified a pre-existing systematic review, the search was restricted to studies published after the inclusion period of the review. Two authors screened records, extracted data, and performed risk of bias assessment. We undertook a narrative synthesis of the included evidence within each category. Results Natural History (n = 11): one systematic review and nine primary studies were included, but only five provided evidence on the prognosis of women with low-risk DCIS. These studies reported that women with low-risk DCIS had comparable outcomes whether or not they had surgery. The risk of invasive breast cancer in patients with low-risk DCIS ranged from 6.5% (7.5 years) to 10.8% (10 years). The risk of dying from breast cancer in patients with low-risk DCIS ranged from 1.2 to 2.2% (10 years). Subclinical cancer at autopsy (n = 1): one systematic review of 13 studies estimated the mean prevalence of subclinical in situ breast cancer to be 8.9%. Diagnostic reproducibility (n = 13): two systematic reviews and 11 primary studies found at most moderate agreement in differentiating low-grade DCIS from other diagnoses. Diagnostic drift: no studies found. Conclusion Epidemiological evidence supports consideration of relabelling and/or recalibrating diagnostic thresholds for low-risk DCIS. Such diagnostic changes would need agreement on the definition of low-risk DCIS and improved diagnostic reproducibility.

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Nuclear grade and comedo necrosis of ductal carcinoma in situ as histopathological eligible criteria for the Japan Clinical Oncology Group 1505 trial: an interobserver agreement study

Cited by 5 publications

References 33 publications

Tools to Guide Radiation Oncologists in the Management of DCIS

Tools to Guide Radiation Oncologists in the Management of DCIS

Erythrophagocytosis is not a reproducible finding in liver biopsies, and is not associated with clinical diagnosis of hemophagocytic lymphohistiocytosis

Should low-risk DCIS lose the cancer label? An evidence review

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