Analysis of 676 Cases of Ductal Carcinoma in Situ of the Breast From 1971 to 1995

Abstract

Six hundred seventy-six patients with ductal carcinoma in situ of the breast (DCIS) from 1971 to 1995 were included in the study. Computerized patient files were retrospectively analyzed. Clinical findings were less frequently reported to reveal DCIS after 1989. Positive mammographic findings were obtained in 87% of patients and were mainly represented by microcalcifications (79.4%). Treatment procedures were breast-conserving surgery (BCS) alone (37.5%), BCS followed by radiation (BCSR) (25.5%), or mastectomy (M) (37%). The actuarial local recurrence was 2.6% in the M group (94 months of follow-up), 14.5% in the BCS group (85,7 months of follow-up), and 7.5% in the BCSR group (78.8 months of follow-up). Predictive factors of recurrence in all patients were invaded margin status and age. In the BCS group, grade was also a predictive factor. The analysis per decade shows that the lesions currently diagnosed are less serious than those of the past. All the recurrence in patients with positive margins was in the same quadrant as the original lesion. This further emphasizes the need for clear margins.

Ductal Carcinoma in Situ of the Breast

“…In the NSABP B-24 study, women < 50 years also display an increase in risk by a factor of 2 [12]. This is confirmed by a range of retrospective series [8,39,42,45,47] (see below). In an overview, Vicini & Recht [48] found that younger women also more often have other unfavorable prognostic factors such as necroses, that they display unfavorable degrees of differentiation and have more advanced tumors.…”

“…In a multicentric study, Solin et al [42] observed a lower local recurrence rate after additional irradiation at 9% for free resection margins as compared to 24% for afflicted resection margins (p = 0.03), which was confirmed by two French studies [8,45]. By contrast, Rodrigues et al [30], in a monocentric study, and Solin et al [43], in a first evaluation of the multicentric analysis, found no indication of this.…”

“…In a subsequent study, this group of authors [26] found a resection margin of 1 mm to be sufficient. Tunon-de-Lara et al [45] also discovered the tumor-afflicted resection margin after excision alone as an independent prognostic parameter.…”

“…Tunon-de-Lara et al [45] found an influence of the degree of differentiation for tumors which had only been excised, but not after additional irradiation.…”

Modern concepts of ductal carcinoma in situ (DCIS) and its diagnosis through percutaneous biopsy

“…The strongest correlate with recurrence rate is the tissue margin surrounding the DCIS lesion [59]. Most recurrences occur around the original tumor site and are attributed to nonexcised tumor tissue [61]. Therefore, the goal of breast-conserving therapy is to completely excise the lesion obtaining tumor-free margins.…”