Current management of DCIS: a review

Patani, Neill; Cutuli, B.; Mokbel, Kefah

doi:10.1007/s10549-007-9760-z

Cited by 45 publications

(32 citation statements)

References 71 publications

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“…The low rate of local recurrence and excellent overall survival in these patients has been suggested to provide further circumstantial evidence against the significance of MM. However, DCIS is a clinically heterogeneous lesion, the natural history of which remains elusive [3]. Hence, it may not be appropriate to make inferences about MM, given the extent to which the tumour biology of DCIS is likely to differ from BC.…”

Section: Evidence Againstmentioning

confidence: 99%

“…SLNB now represents the standard of care for women with early stage BC which is clinically node negative. SLNB is not routinely necessary for patients with ductal carcinoma in-situ (DCIS), although it has been offered to individuals undergoing mastectomy or those with large, palpable, highgrade or recurrent lesions, in view of the risk of accompanying invasive disease [3]. In patients where the sentinel lymph node (SLN) is free of tumour, ALND is considered unnecessary.…”

mentioning

confidence: 99%

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The clinical significance of sentinel lymph node micrometastasis in breast cancer

Patani

Mokbel

2008

Breast Cancer Res Treat

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Section: Evidence Againstmentioning

confidence: 99%

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confidence: 99%

The clinical significance of sentinel lymph node micrometastasis in breast cancer

Patani

Mokbel

2008

Breast Cancer Res Treat

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“…In the absence of adjuvant radiation and hormonal therapy, the estimated rate of recurrence after surgery is up to 25%. With adjuvant radiation it is approximately 10% [15]. Half of these recurrences already show progression to invasive cancer, and at least 85% of the recurrences are either in the same site or in the same quadrant of the breast.…”

Section: Introductionmentioning

confidence: 99%

A Novel, Patient-Specific Mathematical Pathology Approach for Assessment of Surgical Volume: Application to Ductal Carcinomain situof The Breast

Edgerton

Chuang

Macklin

et al. 2011

Analytical Cellular Pathology

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Abstract. We introduce a novel "mathematical pathology" approach, founded on a biophysical model, to identify robust patientspecific predictors of tumor growth useful in clinical practice to improve the accuracy of diagnosis/prognosis and intervention. In accordance with biological observations, our model simulates the diffusion-limited in-situ tumors with a relatively short phase of fast initial growth, followed by a prolonged slow-growth phase where tumor size is constrained primarily by the relative weight of cell mitosis and death. The former phase may only last for a few months, so that at the time of diagnosis, we may assume that most tumors will have entered the phase where their size is changing slowly. Based on this prediction, we hypothesize that the volume of breast with ducts affected by in-situ tumors at the time of diagnosis will be closely approximated by a modelderived mathematical function based on the ratio of tumor cell proliferation-to-apoptosis indices and on the extent of diffusion of cell nutrients (diffusion penetration length), which can be measured from immunohistochemical and morphometric analysis of patient histopathology specimens without the need for multiple-time measurements. We tested this idea in a retrospective study of 17 patients by staining breast tumor specimens containing ductal carcinoma in situ for mitosis with Ki-67 and for apoptosis with cleaved caspase-3 and counting cells positive for each marker. We also determined diffusion penetration by measuring the thickness of viable rims of tumor cells within ducts. Using the ensuing ratios, we applied the model to determine a predicted surgical volume or tumor size. We then corroborated our hypothesis by comparing the predicted size of each tumor based on our model with the actual size of the pathological specimen after tumor excision (R 2 = 0.74-0.88). In addition, for the 17 cases studied, both histological grade and mammography were not found to correlate with tumor size (R 2 = 0.08-0.47). We conclude that our mathematical pathology approach yields a high degree of accuracy in predicting the size of tumors based on the mitotic/apoptotic index and on diffusion penetration. By obtaining these ratios at the time of initial biopsy, pathologists can employ our model to predict the size of the tumor and thereby inform surgeons how much tissue to remove (surgical volume). We discuss how results from the model have implications concerning the current debate on recommendations for screening mammography, while the model itself may contribute to better planning of breast conservation surgery.

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“…1,3 Although ϳ64,000 cases of DCIS are diagnosed annually in the United States, the optimal care of such patients remains a significant challenge. 1,4 Surgical resection is the primary therapy, but adjuvant radiotherapy and hormone therapy are commonly used with potential side effects and limited evidence for improved overall survival. 5 Importantly, data have emerged that the retinoblastoma (RB) tumor suppressor pathway is a determinant in predicting the risk of recurrence in DCIS.…”

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confidence: 99%

Association of RB/p16-Pathway Perturbations with DCIS Recurrence

Witkiewicz

Rivadeneira

Ertel

et al. 2011

The American Journal of Pathology

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The prevalence of ductal carcinoma in situ (DCIS) diagnoses has significantly increased as a result of active radiographic screening. Surgical resection and hormone and radiation therapies are effective treatments, but not all DCIS will progress to invasive breast cancer. Therefore, markers are needed to define tumors at low risk of recurrence and progression that can be treated by surgery alone rather than by adjuvant therapies. Initial analyses indicate that retinoblastoma (RB)-pathway perturbations occur at high frequency in DCIS and mirror the molecular alterations observed in invasive breast cancer. Particularly, the elevated expression of p16ink4a in DCIS was associated with loss of RB function and estrogen receptor-negative biology. Furthermore, high expression of p16ink4a in conjunction with Ki-67 was associated with increased risk of DCIS recurrence and progression to invasive disease in multivariate analyses. These data are consistent with a functional role for RB in modulating the invasive behavior of mammary epithelial cells. The tissue microenvironment is particularly relevant to the behavior of DCIS, and, surprisingly, elevated expression of p16ink4a in nonproliferative stroma was observed in a substantial fraction of cases. In this tissue compartment, p16ink4a expression was strongly associated with disease recurrence, independent of standard histopathologic features. Together, the data herein describe dual aspects of RB-pathway biology that are associated with disease recurrence through the epithelial or stromal compartment of DCIS. (Am J Pathol

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Current management of DCIS: a review

Cited by 45 publications

References 71 publications

The clinical significance of sentinel lymph node micrometastasis in breast cancer

The clinical significance of sentinel lymph node micrometastasis in breast cancer

A Novel, Patient-Specific Mathematical Pathology Approach for Assessment of Surgical Volume: Application to Ductal Carcinomain situof The Breast

Association of RB/p16-Pathway Perturbations with DCIS Recurrence

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