Pathologic findings from the national surgical adjuvant breast project (protocol 6) I. Intraductal carcinoma (DCIS)

Abstract

Seventy-eight examples of intraductal carcinoma (DCIS) were identified after pathologic review of 2072 specimens obtained from National Surgical Adjuvant Breast Project protocol 6. This randomized clinical trial compares the therapeutic merit of total mastectomy (TM) with lumpectomy (L), with (LX) and without (LO) postoperative irradiation. All patients were subjected to axillary lymph node dissection. Seven (14%) of the 51 patients with DCIS treated by L exhibited breast recurrence within or close to the site of the initial lesion 4 to 53 months (average, 16 months) after L. Only 2 (7%) of these events occurred in the 29 women treated by LX, as opposed to 23% in the LO group. No pathologic features were noticed that might have been considered predictive of local breast recurrence. The three DCIS recurrences and the four invasive forms noted are considered to represent overlooked or incompletely excised foci of cancer because of the multifocality (not multicentricity) of some breast cancers. The possibility that DCIS may represent a marker of risk for the development of cancer rather than a precursor lesion per se is suggested. Despite apparent difficulties in the pathologic diagnosis of DCIS as well as uncertainty concerning its natural history, no evidence was found to indicate that it represents a more ominous disease than invasive cancer. Indeed, treatment failure occurred in only one patient treated by LX and a similar number subjected to TM (4% versus 2%). Although these observations are short term (average follow-up, 39 months), estimates of the probability of local recurrence or survival suggest that they will not be significantly altered after longer periods of surveillance. Thus, there are no compelling reasons why DCIS may not be treated in a cosmetically acceptable manner by LX. A randomized clinical trial addressing this issue is now in progress.

Breast cancer and atypia among young and middle-aged women: a study of 110 medicolegal autopsies

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(Andersen, 1981;Moskowitz, 1981; Tabiar et al, 1985), and from clinically based series of self-selected women (Betsill et al, 1978;Fisher et al, 1986;Moskowitz, 1983;Page et al, 1978;Page et al, 1982). However, as in situ breast carcinoma (in situ BC) is rarely symptomatic and the sensitivity of mammography in detecting malignancy is limited despite improved techniques (Holland et al, 1983), much uncertainty exists concerning these lesions.

Histopathologic examination of the breast is a reliable method for detection of clinically and radiologically occult malignant and atypical lesions but extensive sampling is mandatory to detect these small lesions.

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“…, and from clinically based series of self-selected women (Betsill et al, 1978;Fisher et al, 1986;Moskowitz, 1983;Page et al, 1978;Page et al, 1982). However, as in situ breast carcinoma (in situ BC) is rarely symptomatic and the sensitivity of mammography in detecting malignancy is limited despite improved techniques (Holland et al, 1983), much uncertainty exists concerning these lesions.…”

Treatment of Early Breast Cancer with Conservation of the Breast a Review

“…There is no general agreement about treatment of this disease; mastectomy (157), as well as limited surgery with (159) or without (160) radiotherapy, has been used. After limited surgery without radiotherapy, a high local relapse rate (about 20-60%) has been reported (153,(160)(161)(162)(163)(164)(165), about 50% of the relapses being invasive cancer (161,162, 164). However, most series mainly contain clinical palpable tumours with a diameter of several cm, and the risk of occult invasion as well as multicentricity depends on tumour size (157).…”

“…It has been reported to account for 2-5% of all malignant breast tumours detected clinically as a lump in the breast (123,152,153), but 10-16% of malignant breast tumours diagnosed by mammographic screening ( 154, 155). The disease is often multicentric (156)(157)(158), and careful histopathological examination is required to exclude occult microinvasion ( 157,158).…”

The Treatment of in Situ Breast Cancer

“…If patients with DCIS are treated by excision biopsy alone recurrent carcinoma will occur in 40% of cases ( 1 , 7, [16][17][18][19][20][21]. If a wide excision is carried out the recurrence rate falls to 20% (22)(23)(24).…”