Ductal carcinoma in situ in core biopsies containing invasive breast cancer: correlation with extensive intraductal component and lumpectomy margins

Dzierzanowski, Martin; Melville, Karen A; Barnes, Penny J.; MacIntosh, Rebecca F.; Caines, Judy; Porter, Geoffrey A.

doi:10.1002/jso.20242

Cited by 40 publications

(22 citation statements)

References 17 publications

(26 reference statements)

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“…This is an important finding, given that the presence of DCIS is identified in approximately 45% of core biopsies. 9,10 In this study, presence and amount of DCIS were significant factors associated with compromised margins. Given the clinical value of determining the extent and nature of DCIS in core biopsies, routine reporting of this level of detail in core biopsies should be encouraged, as an aid to more precisely gauging the suitability of patients for breast conservation or the need for wider margins in patients undergoing breast conservation.…”

Section: Resultsmentioning

confidence: 59%

“…25 The studies that have examined DCIS in core biopsy and the potential effects on margin status are conflicting, but have generally shown an association with the presence of DCIS in core biopsy and compromised margin status. [8][9][10] These studies have been small in nature and can be difficult to compare given their varied and frequently complex method of quantifying DCIS in core biopsy. In the present study, we quantified DCIS as a percentage of total carcinoma in the core biopsy.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 It is possible that those with DCIS in core biopsies may be at risk of either extratumoural DCIS or extensive intraductal component, which in turn may increase the risk of compromised margins. Although approximately 45% 9,10 of core biopsies with a diagnosis of carcinoma have some element of DCIS, this is not considered to have any clinical relevance and remains under-reported. The aim of this study was to characterise the DCIS element in core biopsies with respect to relative quantity, grade, type, presence of calcification and to determine whether this is related to the rate of compromised margins and re-operation rates in patients undergoing breast conservation for invasive ductal carcinoma.…”

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confidence: 99%

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Needle core biopsy characteristics identify patients at risk of compromised margins in breast conservation surgery

et al. 2008

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Selection of patients for breast-conserving surgery relies on inexact parameters such as the preoperative estimation of lesion size. This study investigates the value of needle core biopsy findings, in particular, the relative quantity of DCIS, in improving patient selection for breast conservation. Patients undergoing breastconserving surgery for invasive ductal carcinoma from 1999 to 2004 were identified. Only patients who had a preoperative diagnosis of carcinoma (DCIS and invasive) on core biopsy were included. All core biopsies were reviewed by a breast histopathologist to document the quantity and characteristics of the DCIS component. Of a total of 281 patients, 46% (n ¼ 129) had invasive disease on core biopsy (group 1) and 54% (n ¼ 152) had either invasive disease with an accompanying DCIS component or DCIS only on core biopsy (group 2). The compromised margin rate for group 1 was 23% compared to 39% for group 2 (P ¼ 0.004). The rate of compromised margins increased progressively as the core biopsy DCIS component increased until a rate of 75% (n ¼ 18/24) was reached in patients with DCIS only on core biopsy. In patients with a DCIS component on core biopsy, the presence of necrosis (P ¼ 0.002), solid type architecture (P ¼ 0.008), high grade DCIS (P ¼ 0.007), calcification (P ¼ 0.003), and the relative proportion of DCIS present (Po0.001) were associated with compromised margins on univariate analysis. On multivariate analysis of this subgroup, the proportion of DCIS in this subgroup (P ¼ 0.048) was an independent predictor of compromised margins. The presence and relative proportion of DCIS on core biopsy provides important information as to whether patients are at risk of compromised margins. Documentation of these parameters may assist patient selection for breast-conserving surgery or identify patients who may benefit from wider margins at the time of initial operation.

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Section: Resultsmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Needle core biopsy characteristics identify patients at risk of compromised margins in breast conservation surgery

et al. 2008

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“…Younger age, high nuclear grade, and the presence of lymphovascular invasion have also been associated with a higher rate of margin positivity (26,29,30,(32)(33)(34)(35)(36). In our study, clinical factors including age, family history, and personal history of breast cancer were not significantly associated with re-excision.…”

Section: Discussioncontrasting

confidence: 43%

Magnetic Resonance Imaging Factors Predicting Re-excision in Breast Cancer Patients Having Undergone Conserving Therapy

Jang

Kim

Yun

et al. 2014

J Korean Soc Magn Reson Med

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“…Prinzipiell problematisch ist das Vorhandensein einer extensiven intraduktalen Komponente (EIC) wie auch eines ausgeprägten DCIS. Das Vorhandensein einer EIC ist in 44% der Fälle mit distant vom primären Tumor nachweisbarem intramammärem DCIS vergesellschaftet [23] und führt häufig zu positiven Schnitträndern mit der Notwendigkeit einer Nachresektion [57], gleichbedeutend mit der Entfernung von intraoperativ bestrahltem Gewebe. Die zeitnahe Nachresektion von intraoperativ bestrahltem Gewebe ist für das operative Vorgehen nicht nachteilig.…”

Section: Systemische Therapieunclassified

Intraoperative Radiotherapie (IORT) des Mammakarzinoms mit Elektronen – eigene Erfahrungen, aktuelle Aspekte und Literaturübersicht

Piroth¹,

Heindrichs²,

Pinkawa³

et al. 2010

Geburtshilfe Frauenheilkd

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Fragestellung: Ist eine Boost-Bestrahlung im Rahmen der Radiotherapie des Mammakarzinoms indiziert, stellt die intraoperative Radiotherapie (IORT) eine Alternative zur perkutanen Boost-Bestrahlung dar. Material und Methodik: Insgesamt 54 Patientinnen mit Mammakarzinom wurden von 1/2006-2/2009 im Rahmen einer BET einer Boost-IORT zugeführt. Die IORT wurde mittels dediziertem mobilem Linearbeschleuniger (NOVAC7 ® ) durchgeführt. Das Follow-up beträgt bisher 25 (6-56) Monate. Die Boost-IORT-Indikation wurde bei einem Alter ≤ 50 Jahre und/oder einer bildgebenden Tumorgröße von ≥ 2 cm gestellt. Nach Tumorresektion erfolgte eine Mobilisierung und Approximation des Gewebes. Anschließend erfolgte unter direkter visueller Kontrolle die Tubusplatzierung im Situs. Die Boost-Dosis betrug 10 Gray. Im Anschluss an die Boost-IORT folgte postoperativ die perkutane Ganzbrustbestrahlung. Ergebnisse: Bisher trat 1 lokales Rezidiv auf. Das lokalrezidivfreie bzw. Gesamtüberleben liegt bei 98,2 bzw. 96,3 %. Es trat keine Grad-III/IV-Toxizität auf. Leichtgradige Erytheme, Hyperpigmentierungen, Teleangiektasien oder Fibrosierungen zeigten sich bei 70,4, 7,4, 5,6 oder 25,9 % der Patientinnen. Das kosmetische Ergebnis wurde von 90,7 % der Patientinnen und 94,4 % der Ärzte als sehr gut oder gut beurteilt. Eine Boost-IORT wür-den, wenn nötig, 96,9 % der Patientinnen wieder durchführen lassen. Schlussfolgerung: Die Boost-IORT ist mit einer geringen Teleangiektasie-, Hyperpigmentierungs-sowie sukutanen Fibroserate assoziiert. Die Gefahr eines "geographical miss", bedingt durch postoperative Wundbettveränderungen, onkoplastische Gewebsverlagerungen oder Migration gesetzter Markierungsclips, ist bei der Boost-IORT ausgeschlossen. Die Ergebnisse unserer Analyse zeigen vergleichbar mit den Daten Abstract ! Purpose: If boost irradiation is indicated as a radiotherapy for breast cancer, intraoperative radiotherapy (IORT) can be an alternative to a percutaneous boost. Materials and Methods: A total of 54 patients with breast cancer were treated with IORT boost as part of a breast conserving therapy from 1/ 2006-2/2009, using the dedicated mobile linear accelerator NOVAC7 ® . Mean follow-up time was 25 (range: 6-56) months. The indications for IORT boost were age ≤ 50 years and/or tumor size ≥ 2 cm in preoperative imaging. After tumor resection the tissue was mobilized and approximated. The irradiation tube was placed into the situs under direct visual control. The boost dose was 10 Gy. Percutaneous whole breast irradiation was performed subsequently to the IORT boost. Results: One local relapse was seen to date. Freedom from local relapse and overall survival rates are 98.2 and 96.3 %, respectively. No patient suffered grade III/IV toxicity. Mild erythema, hyperpigmentation, telangiectasia or fibrosis occurred in 70.4, 7.4, 5.6 and 25.9 % of patients. The cosmetic result was assessed as very good or good by 90.7 % of patients and 94.4 % of physicians. Overall, 96.9 % of the patients would undergo boost IORT again, if necessary. Conclusion: Boost IOR...

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Ductal carcinoma in situ in core biopsies containing invasive breast cancer: correlation with extensive intraductal component and lumpectomy margins

Cited by 40 publications

References 17 publications

Needle core biopsy characteristics identify patients at risk of compromised margins in breast conservation surgery

Needle core biopsy characteristics identify patients at risk of compromised margins in breast conservation surgery

Magnetic Resonance Imaging Factors Predicting Re-excision in Breast Cancer Patients Having Undergone Conserving Therapy

Intraoperative Radiotherapie (IORT) des Mammakarzinoms mit Elektronen – eigene Erfahrungen, aktuelle Aspekte und Literaturübersicht

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