DCIS: Risk Assessment in the Molecular Era

Knowlton, Christin A.; Jimenez, Rachel; Moran, Meena S.

doi:10.1016/j.semradonc.2022.01.005

Cited by 8 publications

(9 citation statements)

References 58 publications

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“…Well-known CPFs (age, grade, size, margins, multifocality, comedonecrosis, palpable presentation, hormonal receptor status, receipt of endocrine therapy, and comorbidities) [51,99,141] have been included in several nomograms to predict the LR risk with and without WBRT. The clinical utility is controversial since the linear algorithms behind the nomograms singularly weighted the parameters and do not consider the molecular interdependency [142,143].…”

Section: Decision Support Tools: Traditional Prediction Modelsmentioning

confidence: 99%

“…Although the VNPI is simple to use and provides a simple solution, depending on the score, some shortcomings have undermined its diffusion and use [141], in particular, the development from retrospective monoinstitutional series, the inconclusive attempts to perform external validation [142,[151][152][153][154][155], the lack of consideration for hormonal receptor status, and the use of endocrine therapy. In addition, the threshold of 20% for recurrence at 12 years as a determinant of adding RT is not widely accepted, since it might be considered too high.…”

Section: The Van Nuys Prognostic Indexmentioning

confidence: 99%

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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: Decision Support Tools: Traditional Prediction Modelsmentioning

confidence: 99%

Section: The Van Nuys Prognostic Indexmentioning

confidence: 99%

Tools to Guide Radiation Oncologists in the Management of DCIS

Leonardi,

Zerella,

Lazzeroni

et al. 2024

Healthcare

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show abstract

“… 26 Moreover, the clinical and pathological markers that are currently used to predict prognosis mostly rely on a combination of factors including patient age, surgical margins, tumor size, and nuclear grade, however, all these factors fail to predict prognosis independently with high confidence. 27 – 30 Thus, the question whether current treatment is overly aggressive for indolent DCIS or insufficient for progressive DCIS remains unanswered. This ongoing debate highlights the need for further research and a better understanding of the natural history and biology of DCIS in order to develop personalized and targeted management approaches for each individual patient.…”

Section: Introductionmentioning

confidence: 99%

Progression from ductal carcinoma in situ to invasive breast cancer: molecular features and clinical significance

Wang,

Li,

Luo

et al. 2024

Sig Transduct Target Ther

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Ductal carcinoma in situ (DCIS) represents pre-invasive breast carcinoma. In untreated cases, 25–60% DCIS progress to invasive ductal carcinoma (IDC). The challenge lies in distinguishing between non-progressive and progressive DCIS, often resulting in over- or under-treatment in many cases. With increasing screen-detected DCIS in these years, the nature of DCIS has aroused worldwide attention. A deeper understanding of the biological nature of DCIS and the molecular journey of the DCIS-IDC transition is crucial for more effective clinical management. Here, we reviewed the key signaling pathways in breast cancer that may contribute to DCIS initiation and progression. We also explored the molecular features of DCIS and IDC, shedding light on the progression of DCIS through both inherent changes within tumor cells and alterations in the tumor microenvironment. In addition, valuable research tools utilized in studying DCIS including preclinical models and newer advanced technologies such as single-cell sequencing, spatial transcriptomics and artificial intelligence, have been systematically summarized. Further, we thoroughly discussed the clinical advancements in DCIS and IDC, including prognostic biomarkers and clinical managements, with the aim of facilitating more personalized treatment strategies in the future. Research on DCIS has already yielded significant insights into breast carcinogenesis and will continue to pave the way for practical clinical applications.

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“…With the increasing prevalence of breast cancer screening, the discovery rate has dramatically increased [1]. To reduce the risk of recurrence and progression, DCIS is currently treated primarily with surgery and radiotherapy, some with endocrine therapy [2,3]. However, recent studies have shown that many DCIS lesions do not progress to invasive carcinoma during a person's lifetime [4], so avoidance of surgery has been suggested for patients with low-risk DCIS.…”

Section: Introductionmentioning

confidence: 99%

Prediction of coexisting invasive carcinoma on ductal carcinoma in situ (DCIS) lesions by mass spectrometry imaging

Chen

et al. 2023

The Journal of Pathology

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Due to limited biopsy samples, ~20% of DCIS lesions confirmed by biopsy are upgraded to invasive ductal carcinoma (IDC) upon surgical resection. Avoiding underestimation of IDC when diagnosing DCIS has become an urgent challenge in an era discouraging overtreatment of DCIS. In this study, the metabolic profiles of 284 fresh frozen breast samples, including tumor tissues and adjacent benign tissues (ABTs) and distant surrounding tissues (DSTs), were analyzed using desorption electrospray ionization‐mass spectrometry (DESI‐MS) imaging. Metabolomics analysis using DESI‐MS data revealed significant differences in metabolite levels, including small‐molecule antioxidants, long‐chain polyunsaturated fatty acids (PUFAs) and phospholipids between pure DCIS and IDC. However, the metabolic profile in DCIS with invasive carcinoma components clearly shifts to be closer to adjacent IDC components. For instance, DCIS with invasive carcinoma components showed lower levels of antioxidants and higher levels of free fatty acids compared to pure DCIS. Furthermore, the accumulation of long‐chain PUFAs and the phosphatidylinositols (PIs) containing PUFA residues may also be associated with the progression of DCIS. These distinctive metabolic characteristics may offer valuable indications for investigating the malignant potential of DCIS. By combining DESI‐MS data with machine learning (ML) methods, various breast lesions were discriminated. Importantly, the pure DCIS components were successfully distinguished from the DCIS components in samples with invasion in postoperative specimens by a Lasso prediction model, achieving an AUC value of 0.851. In addition, pixel‐level prediction based on DESI‐MS data enabled automatic visualization of tissue properties across whole tissue sections. Summarily, DESI‐MS imaging on histopathological sections can provide abundant metabolic information about breast lesions. By analyzing the spatial metabolic characteristics in tissue sections, this technology has the potential to facilitate accurate diagnosis and individualized treatment of DCIS by inferring the presence of IDC components surrounding DCIS lesions. © 2023 The Pathological Society of Great Britain and Ireland.

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DCIS: Risk Assessment in the Molecular Era

Cited by 8 publications

References 58 publications

Tools to Guide Radiation Oncologists in the Management of DCIS

Tools to Guide Radiation Oncologists in the Management of DCIS

Progression from ductal carcinoma in situ to invasive breast cancer: molecular features and clinical significance

Prediction of coexisting invasive carcinoma on ductal carcinoma in situ (DCIS) lesions by mass spectrometry imaging

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