Breast conserving therapy for DCIS—Does size matter?

Kantor, Olga; Winchester, David J.

doi:10.1002/jso.23657

Cited by 13 publications

(10 citation statements)

References 68 publications

(82 reference statements)

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“…On univariate competing risk analysis, the risk of IBTR was significantly higher when the index DCIS was diagnosed at a younger age, presented clinically, and of large size or of 3+ HER2 status, consistent with previous studies. 32,33 However, the lower rates of IBTR compared with CBC after BCS for DCIS patients whose margin was negative by the polygon method observed in our study are in sharp contrast with those in prior literature that consistently showed higher rates of IBTR than CBC following BCS with or without radiotherapy. According to the National Surgical Adjuvant Breast and Bowel Project study reported by Fisher et al, in the lumpectomy alone group, 16.3% (64/391) women developed IBTR whereas 2.0% (8/391) women developed CBC.…”

contrasting

confidence: 99%

Polygon method: A systematic margin assessment for breast conservation

et al. 2019

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Background Radiation therapy (RT) for women with ductal carcinoma in situ (DCIS) undergoing breast‐conserving surgery (BCS) may be overtreatment for some, especially for those in which DCIS is eradicated, and ipsilateral breast tumor recurrence (IBTR) risk approaches the contralateral breast cancer (CBC) level. The aim of this study was to clarify whether the polygon method, a new systematic method of en face (tangential, shaved) margin assessment, can identify a subset of DCIS that can be safely treated by BCS alone. Methods A key tool of the polygon method is an adjustable mold that prevents the “pancake phenomenon” (flattening) of breast tissue after surgical removal so that the specimen is fixed in the shape of a polygonal prism. This preanalytical procedure enables us to command a panoramic view of entire en face margins 3‐5‐mm deep from the real peripheral cut surfaces. Competing risk analysis was used to quantify rates of IBTR and CBC and to evaluate risk factors. Results From 2000 to 2013, we identified 146 DCIS patients undergoing BCS with a contralateral breast at risk. In 100 DCIS patients whose margin was negative by the polygon method, 5 IBTR (3 DCIS and 2 invasive ductal carcinoma [IDC]) and 10 CBC (6 DCIS and 4 IDC) cases were identified during a median follow‐up of 7.6 years (range, 0.9‐17.4). Five‐ and 10‐year cumulative incidence rates were 3.0% and 5.3% for IBTR, and 7.1% and 13.3% for CBC, respectively. Thus, patients with a negative margin consistently showed at least twofold lower IBTR than CBC despite omission of RT. Conclusions Japanese women classified with a negative margin by the polygon method show a very low risk of IBTR and account for approximately half of CBC cases. In this subset of DCIS patients, additional RT is not beneficial.

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confidence: 99%

Polygon method: A systematic margin assessment for breast conservation

et al. 2019

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“…The histologic diagnosis of DCIS is commonly made by examination of core‐needle biopsy, followed by excision and definitive pathologic examination. Approximately 25% of lesions diagnosed as DCIS on core biopsy will be found to also include invasive carcinoma after surgical resection; factors associated with the finding of invasive cancer include larger lesion size, intermediate or high nuclear grade, and negative hormone receptor status . Because of the potential for finding invasive disease, the National Comprehensive Cancer Network (NCCN) guidelines recommend that sentinel lymph node biopsy (SLNB) be considered for patients to be treated with mastectomy or with excision in an anatomic location (eg, tail of the breast) that could compromise the performance of a future sentinel lymph node biopsy…”

Section: Methodsmentioning

confidence: 99%

“…Size may be difficult to measure, because DCIS often involves the ductal system in a complex, 3‐dimensional branching pattern. Positive or close surgical margins are associated with a higher risk of recurrence, and some women who undergo BCS require reexcision to achieve clear margins . In addition to having prognostic significance, ER status is important because tamoxifen therapy is an option for women with ER‐positive tumors to decrease the risk of recurrence or to prevent second primary breast cancers from developing.…”

Section: Methodsmentioning

confidence: 99%

“…Approximately 25% of lesions diagnosed as DCIS on core biopsy will be found to also include invasive carcinoma after surgical resection; factors associated with the finding of invasive cancer include larger lesion size, intermediate or high nuclear grade, and negative hormone receptor status. 20,21 Because of the potential for finding invasive disease, the National Comprehensive Cancer Network (NCCN) guidelines recommend that sentinel lymph node biopsy (SLNB) be considered for patients to be treated with mastectomy or with excision in an anatomic location (eg, tail of the breast) that could compromise the performance of a future sentinel lymph node biopsy. 22 The identification of foci of invasion within a lesion consisting largely of DCIS is influenced by the proportion of excised tissue that is examined microscopically.…”

Section: Dcismentioning

confidence: 99%

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Cancer statistics: Breast cancer in situ

Ward

DeSantis

Lin

et al. 2015

CA A Cancer J Clinicians

195

142

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An estimated 60,290 new cases of breast carcinoma in situ are expected to be diagnosed in 2015, and approximately 1 in 33 women is likely to receive an in situ breast cancer diagnosis in her lifetime. Although in situ breast cancers are relatively common, their clinical significance and optimal treatment are topics of uncertainty and concern for both patients and clinicians. In this article, the American Cancer Society provides information about occurrence and treatment patterns for the 2 major subtypes of in situ breast cancer in the United States-ductal carcinoma in situ and lobular carcinoma in situ-using data from the North American Association of Central Cancer Registries and the 13 oldest Surveillance, Epidemiology, and End Results registries. The authors also present an overview of in situ breast cancer detection, treatment, risk factors, and prevention and discuss research needs and initiatives.

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“…A wide range of recurrence rates is reported in the literature due to variable follow up times and the use of adjuvant radiation. [4][5][6][7] Other factors that influence recurrence rate include patient age, presentation as a palpable mass, nuclear grade of the DCIS, margin status at the time of excision in cases of breast conservation, and the extent of DCIS. Each of these are statistically significant independent prognostic factors, some of which are used in combination to generate the University of Southern California/Van Nuys Prognostic Index (USC/VNPI), a numeric score used to help guide clinicians regarding the need for radiation with breast conservation.…”

Section: Introductionmentioning

confidence: 99%