Extent, distribution, and mammographic/ histological correlations of breast ductal carcinoma in situ

Holland, Roland; Stekhoven, J. H. Schuurmans; Hendriks, Jan H. C. L.; Verbeek, A.L.M.; Mravunac, M.

doi:10.1016/0140-6736(90)90747-s

Cited by 525 publications

(210 citation statements)

References 11 publications

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“…Most authors now agree that recurrences after local excision of DCIS most likely reflect residual disease, and several studies clearly suggest that 1 mm is an inadequate margin of excision (Lagios et al, 1982;Holland et al, 1990;Silverstein et al, 1994;. A tissue margin of 1-2 cm from the edge of the mammographically assessed lesion seems necessary to ensure that histological assessment of the margin is accurate.…”

Section: Discussionmentioning

confidence: 99%

The importance of complete excision in the prevention of local recurrence of ductal carcinoma in situ

Holland¹,

Gandhi²,

Knox³

et al. 1998

Br J Cancer

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Summary Mastectomy probably represents over-treatment for the majority of women with screen detected ductal carcinoma in situ (DCIS) and breast-conserving surgery is now widely advocated. In this study, biopsy cavity shavings were used to ensure Ductal carcinoma in situ (DCIS) has become clinically important only since the advent of routine high-quality mammography, and now accounts for 20-25% of screen-detected breast malignancies (Verbeek et al, 1984). The majority of screen detected DCIS lesions, however, are asymptomatic and impalpable (Gump et al, 1987).Despite the increase in diagnosis, the optimal surgical treatment for DCIS remains controversial. Until recently, DCIS was not differentiated from invasive breast carcinoma and was treated by mastectomy (Price et al, 1989). Since the widespread acceptance of breast-conserving surgery for early invasive breast cancer however, mastectomy is becoming more difficult to justify for localized screen-detected DCIS The main purpose of breast-conserving surgery for invasive or in situ disease is complete excision of the tumour (both macroscopically and microscopically) with a surrounding margin of normal tissue to prevent local recurrence, while maintaining a cosmetically acceptable breast. Unfortunately, there is no regular consensus regarding the definition of complete excision or of an adequate margin of excision. It is clear that the margin of clearance around an invasive tumour correlates with local control rates, with positive resection margins being associated with an increased risk of local recurrence (Veronesi et al, 1990). However, the volume of excised tissue is inversely proportional to the cosmetic outcome (Wazer et al, 1992 (Price et al, 1989).Inadequate excision of the primary lesion appears to be one of the most important causes of local failure after breast-conserving surgery (Silverstein et al, 1994), and new prognostic index for DCIS has been proposed recently that includes resection margins as one of its predictive factors (Silverstein et al, 1996). The Van Nuys prognostic index (VNPI) also quantifies two other predictors of local recurrence, namely DCIS size and pathological classification. A numerical system is used to predict patients more likely to recur after breast conserving surgery.The histological evaluation of excision margins is now known to be a critical part of the assessment of any patient with DCIS being considered for breast-conserving treatment, and various techniques have been used to improve the accuracy, including inking of specimen margins, two-dimensional radiography, cavity shavings and tumour bed biopsies. Biopsy cavity shavings are routinely used in our unit after wide local excision of invasive carcinomas to reduce the incidence of re-excision in patients with the tumour extending close to the main specimen margin.The aim of this study was to determine the effectiveness of using biopsy cavity shavings to ensure complete excision of screen-detected DCIS lesions. PATIENTS AND METHODSScreening mammography is performed at...

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Section: Discussionmentioning

confidence: 99%

The importance of complete excision in the prevention of local recurrence of ductal carcinoma in situ

Holland¹,

Gandhi²,

Knox³

et al. 1998

Br J Cancer

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“…87,88 Most recently, the EORTC has reported the favorable impact of boost on local failure rates. 88 Several considerations may be involved in the decision to use a boost: histological studies show that residual cancer following resection of the primary cancer usually is in the vicinity of the primary site; 89 recurrences following treatment usually are seen at or near the primary site; 90 and boost treatment can be delivered without significant morbidity. 91 Although boost irradiation generally is used, the precise indications for its use are not well defined.…”

Section: Elements In the Technique Of Irradiationmentioning

confidence: 99%

Standard for Breast Conservation Therapy in the Management of Invasive Breast Carcinoma

Morrow

Strom

Bassett

et al. 2002

CA: A Cancer Journal for Clinicians

298

165

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Multidisciplinary guidelines for management of invasive breast carcinoma from the American College of Radiology, the American College of Surgeons, the College of American Pathology, and the Society of Surgical Oncology have been updated to reflect the continuing advances in the diagnosis and treatment of invasive breast cancer. The guidelines provide a framework for clinical decision‐making for patients with invasive breast carcinoma based on review of relevant literature and include information on patient selection and evaluation, technical aspects of surgical treatment, techniques of irradiation, and follow‐up care.

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“…In the study by Faverly et al23 showed that only 8% of DCIS have a multifocal distribution with gaps greater than 10 mm. In another study by Holland et al,24 81 of 82 mastectomy specimens of ductal carcinoma in situ showed only 1 region of tumor 23. Clinical observation indicates that most local recurrences occur at or near the primary lesion and likely results from inadequate surgical excision and residual disease, and all studies demonstrated that as the distance from the visible tumor border increases, the likelihood that microscopic residual cancer cells are present decreases.…”

Section: Methodsmentioning

confidence: 88%

Therapeutic analysis of Intrabeam‐based intraoperative radiation therapy in the treatment of unicentric breast cancer lesions utilizing a spherical target volume model

Schwid

Donnelly

Zhang

2017

J Applied Clin Med Phys

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It is postulated that the outcomes in treating breast cancer with intraoperative radiotherapy (IORT) would be affected by the residual cancer cell distribution within the tumor bed. The three‐dimensional (3D) radiation doses of IntrabeamTM (IB) IORT with a 4‐cm spherical applicator at the energy of 50 and 40 kV were calculated. The modified linear quadratic model (MLQ) was used to estimate the radiobiological responses of the cancer cells and interspersed normal tissues with various radiosensitivities. By comparing the average survival fraction of normal tissues in IB‐IORT and uniform dose treatment for the same level of cancer cell killing, the therapeutic ratios (TRs) were derived. The equivalent uniform dose (EUD) was found to increase with the prescription dose and decrease with the cancer cell infiltrating distance. For 50 kV beam at the 20 Gy prescription dose, the EUDs are 18.03, 16.49 and 13.56, 11. 29, and 9.28 Gy respectively, for 1.5, 3.0, 6.0, 9, and 15.0 mm of the cancer cell infiltrating distance into surrounding tissue. The dose rate of 50 kV is at least 1.87× higher than that of 40 kV beam. The EUDs of 50 kV beam are up to 15% higher than that of the 40 kV beam. The TR increases with the prescription dose, but decreases with the distance of cancer cell infiltration distance. Average TRs of 50 kV beam are up to 30% larger than that of 40 kV beam. In conclusion, IB‐IORT can provide a possible therapeutic advantage on sparing more normal tissue compared with the External Beam IORT (EB‐IORT) for shallowly populated unicentric breast lesion. Our data suggest that IB‐IORT dose size should be adjusted based on the individual patient's cancer cell infiltrating distance for delivering an effective dose, one dose‐fits‐all regimen may have undertreated some patients with large cancer infiltrating distance.

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Extent, distribution, and mammographic/ histological correlations of breast ductal carcinoma in situ

Cited by 525 publications

References 11 publications

The importance of complete excision in the prevention of local recurrence of ductal carcinoma in situ

The importance of complete excision in the prevention of local recurrence of ductal carcinoma in situ

Standard for Breast Conservation Therapy in the Management of Invasive Breast Carcinoma

Therapeutic analysis of Intrabeam‐based intraoperative radiation therapy in the treatment of unicentric breast cancer lesions utilizing a spherical target volume model

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