Ductal Carcinoma in Situ: A French National Survey. Analysis of 2125 Patients

Abstract

This was an analysis of 2125 ductal carcinoma in situ features/treatments from 71 French centers. Mastectomy and breast-conserving surgery was performed in 25% and 75% of cases, respectively; the median tumor size was 15 mm, and the low, intermediate, and high nuclear grade distribution was 12%, 36%, and 47%, respectively. After breast-conserving surgery, 97% underwent whole breast irradiation. This survey reflects the daily ductal carcinoma in situ treatment in France, and the results are in accordance with national guidelines. Background: Ductal carcinoma in situ (DCIS) represents 15% of all breast cancers in France. The first national survey was conducted in 2003. The present multi-center real-life practice survey aimed at assessing possible changes in demographic, clinical, pathologic, and treatment features. Material and Methods: From March 2014 to September 2015, patients diagnosed with DCIS from 71 centers with complete information about age, diagnostic features, and treatment modalities were prospectively included. Results: A total of 2125 patients with a median age of 58.6 years from 71 centers were studied. DCIS was diagnosed by mammography in 87.5% of cases. Preoperative biopsy was performed in 96% of cases. The median tumor size was 15 mm. Nuclear grade was low, intermediate, and high in 12%, 36%, and 47% of cases, respectively. Margins were considered to be negative in 83% of cases. Overall mastectomy and lumpectomy rates were 25% and 75%, respectively. The immediate breast reconstruction rate was 50%. Sentinel node biopsy and axillary dissection rates were 41% and 2.6%, respectively. After lumpectomy, 97% of patients underwent radiotherapy, and 32% received a boost dose. Only 1% of patients received endocrine therapy. Compared with our previous survey, the median tumor size remained the same, and the proportion of high-grade lesions increased by 9%. The mastectomy rate decreased by 4%. Conclusions: The clinical practice identified in this survey complies with French DCIS guidelines. About 10% of patients with low-grade DCIS may be eligible to participate in treatment de-escalation trials.

Grading variation in 2,934 patients with ductal carcinoma in situ of the breast: the effect of laboratory- and pathologist-specific feedback reports

“…Furthermore, over 80% of breast resection specimens is reported via the synoptic protocol [39]. The mean numbers per histologic grade in this study (13.0% for grade I, 39.6% for grade II and 47.4% for grade III) are in line with other studies [20,40,41]. Interestingly, we observed a significant change in grade distribution after feedback as the proportion of grade I tumors increased by over 3%, while the proportion of grade III tumors decreased by a similar percentage.…”

Isolated ductal carcinoma in situ in patients presenting to two breast units in Johannesburg

“…8 Internationally, 75% of DCIS cases have BCS. 22 Of our patietnts, 58.6% had mastectomies, and 20.6% had BCS. This high rate of mastectomy can be attributed to a number of factors.…”

Is it feasible to selectively perform axillary lymph node surgery for patients with biopsy diagnosed Ductal Carcinoma in Situ? A study based on developed and validation of nomogram

“…In clinical practice, because of reluctance to return to the operating room for the second time, some DCIS patients who underwent BCS also have a lymph node biopsy done directly. Approximately 71-92% undergo lymph node assessment at time of mastectomy, and 18-56% of patients with DCIS have SLNB [13][14][15][16][17].…”