Her2 and Ki67 Biomarkers Predict Recurrence of Ductal Carcinoma in Situ

Davis, James E.; Nemesure, Barbara; Mehmood, Saira; Nayi, Vipul; Burke, Stephanie; Brzostek, Sabrina; Singh, Meenakshi

doi:10.1097/pai.0000000000000223

Cited by 31 publications

(16 citation statements)

References 30 publications

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“…Factors affecting distant metastasis after surgery for DCIS include young age (≤40 years), lymph node metastasis, microinvasion, comedo necrosis, ER negativity, poor differentiation, and previous or simultaneous local recurrence [ 10 , 12 , 13 ]. In addition, human epidermal growth factor receptor type 2 positivity and a high Ki-67 labeling index (>10%) have been reported to be pathological prognostic markers associated with recurrence and distant metastasis [ 14 , 15 ]. However, due to the small number of cases of distant metastasis after surgery for DCIS, these previously reported factors have not yet been shown to be statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Distant Metastasis after Surgery for Encapsulated Papillary Carcinoma of the Breast: A Case Report

et al. 2020

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In the absence of clear interstitial invasion, encapsulated papillary carcinoma (EPC) of the breast may be attributed to an extremely good prognosis if handled similarly to ductal carcinoma in situ (DCIS) with suitable local treatment. Here, we report our experience with a case of EPC of the breast that presented with carcinomatous pleuritis and lymphangitis carcinomatosa postoperatively, which rapidly resulted in a poor outcome. A 67-year-old woman was diagnosed with DCIS of the left breast and underwent left partial mastectomy and sentinel lymph node biopsy. EPC was diagnosed because the pathological examination showed no sign of interstitial infiltration. Postoperative radiation therapy was performed. Five years and 9 months postoperatively, the patient began experiencing cough and shortness of breath on exertion. Imaging showed right pleural effusion and consolidation of the lung field, but nothing suggesting local recurrence in the preserved left breast, local lymph nodes, or opposite breast was observed. Postoperative recurrence of breast cancer, carcinomatous pleuritis, and lymphangitis carcinomatosa were diagnosed based on the results of pleural fluid cytology. One month later, multiple brain metastases were found, and the patient died of the primary disease 5 months after recurrence. After surgery for EPC without clear interstitial infiltration, there was a small possibility of a poor outcome from distant metastasis. Therefore, although distant metastasis is uncommon, regular examination and testing should be performed.

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Section: Discussionmentioning

confidence: 99%

Distant Metastasis after Surgery for Encapsulated Papillary Carcinoma of the Breast: A Case Report

et al. 2020

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“…The factors associated with the development of DM in DCIS include younger age (<=40 years), positive lymph nodes metastasis, microinvasion, necrosis, negative expression of estrogen receptor, poorly differentiation, preceding or simultaneous invasive locoregional recurrence [2, 4, 5]. Other prognostic pathological markers associated with invasive or noninvasive recurrence and distant metastasis involve positive Her2 expression, high Ki67 staining (> 10%), alone or co-expression [6, 7]. However, due to the small amount of cases with DM after DCIS, these factors didn’t show a meaningful statistical significance in the published series.…”

Section: Discussionmentioning

confidence: 99%

Multiple metastases of bones and sigmoid colon after mastectomy for ductal carcinoma in situ of the breast: a case report

You

Fang

et al. 2019

BMC Cancer

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Background The prognosis of ductal carcinoma in situ (DCIS) is reportedly well. Extremely rare patients with DCIS develop distant breast cancer metastasis without locoregional or contralateral recurrence. This is the first report of multiple bones and sigmoid colon metastases from DCIS after mastectomy. Case presentation A 43-year-old woman was diagnosed with DCIS, and she received mastectomy, followed by endocrine therapy and target therapy. During the following-up, convulsions and pain on the legs were complaint. Therefore, Computed Tomography (CT) on bones and positron emission tomography (PET) for whole body were examined in order. Multiple bones and sigmoid colon were under the suspect of metastases, which were then verified by biopsy in the left ilium and colonoscopy respectively. Conclusions This case reveals the heterogeneous behavior and the potential poor outcome of DCIS, regular examination and surveillance are necessary even though the distant metastasis rate in DCIS is low.

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“…Studies investigating Ki67 as a predictive factor of DCIS upstaging are rare. However, Ki67, as a known proliferation marker, was shown to be associated with recurrence of DCIS, which may be associated with an underlying invasive component 18,19 .…”

Section: Discussionmentioning

confidence: 99%

Factors associated with upstaging in patients preoperatively diagnosed with ductal carcinoma in situ by core needle biopsy

Yang

Guo

et al. 2019

Cancer Biology & Medicine

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Objective Patients preoperatively diagnosed with ductal carcinoma in situ (DCIS) by core needle biopsy (CNB) exhibit a significant risk for upstaging on final pathology, which leads to major concerns of whether axillary staging is required at the primary operation. The present study aimed to identify clinicopathological factors associated with upstaging in patients preoperatively diagnosed with DCIS by CNB. Methods The present study enrolled 604 patients (cN0M0) with a preoperative diagnosis of pure DCIS by CNB, who underwent axillary staging between August 2006 and December 2015, at Fudan University Shanghai Cancer Center (Shanghai, China). Predictive factors of upstaging were analyzed retrospectively. Results Of the 604 patients, 20.03% ( n = 121) and 31.95% ( n = 193) were upstaged to DCIS with microinvasion (DCISM) and invasive breast cancer (IBC) on final pathology, respectively. Larger tumor size on ultrasonography (> 2 cm) was independently associated with upstaging [odds ratio (OR) 1.558, P = 0.014]. Additionally, patients in lower breast imaging reporting and data system (BI-RADS) categories were less likely to be upstaged (4B vs . 5: OR 0.435, P = 0.002; 4C vs . 5: OR 0.502, P = 0.001). Overall, axillary metastasis occurred in 6.79% ( n = 41) of patients. Among patients with axillary metastasis, 1.38% (4/290), 3.31% (4/121) and 17.10% (33/193) were in the DCIS, DCISM, and IBC groups, respectively. Conclusions For patients initially diagnosed with DCIS by CNB, larger tumor size on ultrasonography (> 2 cm) and higher BI-RADS category were independent predictive factors of upstaging on final pathology. Thus, axillary staging in patients with smaller tumor sizes and lower BI-RADS category may be omitted, with little downstream risk for upstaging.

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Her2 and Ki67 Biomarkers Predict Recurrence of Ductal Carcinoma in Situ

Abstract: Our results suggest that Her2 and Ki67 immunohistochemistry and the presence of intraductal necrosis aid in DCIS risk stratification.

Cited by 31 publications

References 30 publications

Distant Metastasis after Surgery for Encapsulated Papillary Carcinoma of the Breast: A Case Report

Distant Metastasis after Surgery for Encapsulated Papillary Carcinoma of the Breast: A Case Report

Multiple metastases of bones and sigmoid colon after mastectomy for ductal carcinoma in situ of the breast: a case report

Factors associated with upstaging in patients preoperatively diagnosed with ductal carcinoma in situ by core needle biopsy

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