Grade of recurrent in situ and invasive carcinoma following treatment of pure ductal carcinoma in situ of the breast

Abstract

The grade of recurrent in situ and invasive carcinoma occurring after treatment of pure ductal carcinoma in situ (DCIS) has been compared with the grade of the original DCIS in 122 patients from four different centres (The Royal Marsden Hospitals, London and Sutton, 57 patients; Guy's Hospital, London, 19 patients; Nottingham City Hospital, 31 patients and The Royal Liverpool Hospital, 15 patients). The recurrent carcinoma was pure DCIS in 70 women (57%) and in 52 women (43%) invasive carcinoma was present, which was associated with an in situ element in 43. In all, 19 patients developed a second recurrence (pure DCIS in 11 and invasive with or without an in situ element in eight). The majority of invasive carcinomas followed high-grade DCIS. There was strong agreement between the grade of the original DCIS and that of the recurrent DCIS (k ¼ 0.679), which was the same in 95 of 113 patients (84%). The grade of the original DCIS showed only fair agreement with the grade of recurrent invasive carcinoma (k ¼ 0.241), although agreement was stronger with the pleomorphism score of the recurrent carcinoma (k ¼ 0.396). There was moderate agreement, in recurrent invasive lesions, between the grade of the DCIS and that of the associated invasive element (k ¼ 0.515). Other features that showed moderate or strong agreement between the original and recurrent DCIS were necrosis and periductal inflammation. The similarity between the histological findings of the original and subsequent DCIS is consistent with the concept that recurrent lesions represent regrowth of residual carcinoma. In addition, although agreement between the grade of the original DCIS and that of any subsequent invasive carcinoma was only fair, there is no suggestion that low-grade DCIS lesions progress to higher grade lesions or to the development of higher grade invasive carcinoma. This is in agreement with immunohistochemical and molecular data indicating that low-grade and high-grade mammary carcinomas are quite different lesions.

Abrogated Response to Cellular Stress Identifies DCIS Associated with Subsequent Tumor Events and Defines Basal-like Breast Tumors

“…Molecular phenotypes are of particular clinical significance if they outperform traditional histopathological parameters. Consistent with our previous findings, and that of others (Bijker et al, 2001;Kerlikowske et al, 2003;Millis et al, 2004;Silverstein et al, 1995) high nuclear grade predicts risk for a subsequent tumor event in a significant manner (HR 5.6, 95% CI 1.2 to 25.5). Although nuclear grade statistically stratifies a subpopulation of women with increased risk for a subsequent tumor event in this pilot set, roughly one third of women with high nuclear grade DCIS do not develop subsequent disease; while roughly one quarter of women with low grade DCIS develop subsequent disease.…”

“…Previous reports have demonstrated that ipsilateral tumors that develop subsequent to DCIS share many histological and genetic alterations with the primary lesion suggesting a clonal relationship (Bijker et al, 2001;Lininger et al, 1998;Millis et al, 2004;Waldman et al, 2000). Therefore, one might anticipate that high p16/high Ki67 in the initial DCIS lesion would characterize the subsequent invasive carcinoma.…”

Detection Rates of Ductal Carcinoma in Situ with Biennial Digital Mammography Screening: Radiologic Findings Support Pathologic Model of Tumor Progression

“…There is a correlation between the grade of DCIS and that of invasive carcinomas (3,4) and even with the grade of recurrent carcinoma and subsequent metastatic disease (5,6). Studies suggest that low-and high-grade DCIS evolve by means of distinct evolutionary pathways and that they show differences BREAST IMAGING: Detection Rates of Ductal Carcinoma in Situ with Biennial Digital Mammography Weigel et al (computed radiography and direct radiography technology) and conformed to national screening guidelines; none used digital breast tomosynthesis.…”

Contrast‐enhanced MRI of ductal carcinoma in situ: Characteristics of a new intensity‐modulated parametric mapping technique correlated with histopathologic findings

“…However, there are few scientific data regarding the accuracy of MRI as compared to mammography for evaluating DCIS (17). Previous studies showed variable sensitivities of breast CE‐MRI in detecting DCIS, ranging from 40% to 100% depending on the criteria used to define malignancy and the MRI features that were assessed (17–25). DCIS encompasses a histologically heterogeneous group of tumors that differ in growth patterns, cytologic features, and clinical behavior (1).…”