Intraductal carcinoma of the breast (208 cases): Clinical factors influencing treatment choice

Abstract

Two hundred eight cases of intraductal breast carcinoma (DCIS) were selectively treated; 97 with mastectomy, 96 with radiation therapy, and 15 using excisional biopsy only. Mastectomy patients tended to have larger tumors, involved biopsy margins, palpable and often multifocal tumors. Breast preservation patients tended to have smaller, often occult, tumors with clear surgical margins. Before 1983, mastectomy was more common; during and after 1983, breast preservation was more common. Comedocarcinomas were the most frequent tumors. They were the largest, had the highest percentage of microinvasion (20%), and had the highest recurrence rate (8%). Noncomedo DCIS had a recurrence rate of I%, one of 103 tumors. The recurrence rate for comedocarcinomas treated with radiation therapy was nearly three times higher than for those treated with mastectomy (11% versus 4%). One of 164 (0.6%) axillary lymph node dissections yielded positive nodes. Nine patients have recurred: two in the mastectomy group and seven in the breast conservation group (P < 0.1). Eight of nine recurrences were the comedo subtype (P < 0.05). Three patients developed metastatic disease, two of whom have died. Axillary dissection for intraductal carcinoma of the breast is unlikely to yield involved nodes and is not indicated for most cases. It should be reserved for lesions revealing microinvasion. Conservative therapy for comedocarcinoma must be viewed with caution. Cancer 66:102-108,1990.NTIL RECENTLY, intraductal carcinoma has been a U relatively uncommon lesion, representing only a few percent of all breast carcinomas.' As late as the mid-1980s, some lesions that were predominantly intraductal breast

Effects of patient selection on the applicability of results from a randomised clinical trial (EORTC 10853) investigating breast-conserving therapy for DCIS

“…Our study shows that in four of the five institutes clinicians did not enter eligible patients based on the histologic subtype of DCIS. Results of non-randomised studies based on (morphologic) classification of DCIS (Page et al, 1982;Lagios et al, 1989;Silverstein et al, 1990;Bellamy et al, 1993;Eusebi et al, 1994) have influenced the participating clinicians' opinions on the treatment of subtypes of the disease. Of all randomised patients the histology was reviewed.…”

Pharmacokinetic analysis of ductal carcinoma in situ of the breast using dynamic MR mammography

“…In the past, ductal carcinoma in situ (DCIS) accounted for only 1% of all breast cancer diagnoses, whereas more recently it has increased to 20-30% of new cases [1,2]. With this increase in the detection of DCIS, establishment of its optimal management has become a matter of urgent concern.…”

A transgenic mouse model for the ductal carcinoma in situ (DCIS) of the mammary gland

“…Although several prognostic factors have been elaborated for certain types of DCIS, the clinical outcome of DCIS in an individual patient is not exactly known (Holland et al, 1994;Silverstein et al, 1990Silverstein et al, , 1995aSolin et al, 1993). Molecular markers associated with speci®c forms of DCIS and their progression to invasive ductal carcinoma should provide improved, i.e.…”