Salvage treatment for recurrence in the breast following breast-conserving surgery and definitive irradiation for ductal carcinoma in situ (intraductal carcinoma) of the breast

White, Jaclyn J.; Gustafson, Gary; Levine, Allan J.; Ingold, John; Pettinga, Jane; Matter, Richard C.; Martinez, A.; Vicini, F.A.

doi:10.1016/0360-3016(93)90660-n

Cited by 10 publications

(10 citation statements)

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“…The aggregate experience of the observational series and clinical trials, however, suggests that risk of breast cancer death in women treated for DCIS is quite low, with estimates ranging from 0% to 6% up to a decade or more following diagnosis. [7][8][9][10][11][12] However, most previous analyses have been based on small numbers of deaths, and therefore mortality estimates in those studies are associated with wide confidence intervals.…”

Section: Original Investigationmentioning

confidence: 99%

Mortality Among Women With Ductal Carcinoma In Situ of the Breast in the Population-Based Surveillance, Epidemiology and End Results Program

Ernster

Barclay²,

Kerlikowske³

et al. 2000

Arch Intern Med

279

181

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Section: Original Investigationmentioning

confidence: 99%

Mortality Among Women With Ductal Carcinoma In Situ of the Breast in the Population-Based Surveillance, Epidemiology and End Results Program

Ernster

Barclay²,

Kerlikowske³

et al. 2000

Arch Intern Med

279

181

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“…Before the 1980s, treatment of DCIS was primarily by mastectomy. More recently, breast-conserving surgery, often accompanied by radiotherapy, has been recommended (3)(4)(5)(6).…”

mentioning

confidence: 99%

Chromosomal Alterations in Ductal Carcinomas In Situ and Their In Situ Recurrences

Waldman

DeVries²,

Chew³

et al. 2000

Journal of the National Cancer Institute

157

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Background: Ductal carcinoma in situ (DCIS) recurs in the same breast following breast-conserving surgery in 5%-25% of patients, with the rate influenced by the presence or absence of involved surgical margins, tumor size and nuclear grade, and whether or not radiation therapy was performed. A recurrent lesion arising soon after excision of an initial DCIS may reflect residual disease, whereas in situ tumors arising after longer periods are sometimes considered to be second independent events. The purpose of this study was to determine the clonal relationship between initial DCIS lesions and their recurrences.

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“…These have included young age, tumor size, nuclear grade, intraductal necrosis, mammographic appearance, histological presence of calcifications and margin status. 5,10,[12][13][14][15][16][17][18][22][23][24][25][26] Results have been inconsistent and various reasons have been cited, including the lack of data with the necessary prolonged follow-up.…”

Section: Discussionmentioning

confidence: 99%

Histological margin assessment for breast ductal carcinoma in situ: precision and implications

Sigal‐Zafrani

Klimberg²

2003

Mod Pathol

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Local recurrence after lumpectomy for ductal carcinoma in situ (DCIS) is a major concern and is related to residual disease in the breast. We studied the predictive value of lumpectomy margins for residual DCIS and compared our results and pathological processing techniques with those published in the literature. Margin status was determined for 89 patients with screen-detected DCIS who had lumpectomy and re-excision, for the presence and extent of residual disease. Margin width was defined as the narrowest distance between tumor and any inked margin or, where margins were positive, classified into focal involvement (o1 mm of the inked surface involved), minimal (Z1o15 mm) and extensive (Z15 mm). The amount of residual tumor was quantified according to the number of ducts involved with tumor: small (fewer than 10 ducts) or large (10 or more ducts) residuum. The initial margin status was a significant predictor for the presence of residual tumor in re-excision specimens (P ¼ 0.006). There was residual tumor in 44 and 45% of close non-involved (41 and r1 mm width) margins, 67% of focally, 71% of moderately and 94% of extensively positive margins. The pathologic tumor size was also a predictor for the presence of residual tumor with 27, 68 and 74% of lesions measuring r10, 11-25, 425 mm,respectively, showing residual disease. The presence of residual tumor was not significantly related to age, mammographic appearance, nuclear grade or intraductal necrosis. The initial margin status was found to predict for the amount of residual tumor. With careful margin assessment, margin status after lumpectomy for DCIS can be used to predict for the presence and amount of residual tumor in the breast and is a guide to further management decisions. A standard for margin status reporting and pathological processing of screen-detected DCIS in situ lesions will help in the interpretation of data from different institutions. Keywords: ductal carcinoma in situ; lumpectomy; margin; residual disease; histopathology; classification With the widespread use of mammographic screening for breast cancer, more cases of ductal carcinoma in situ (DCIS) are being detected. Between 1983 and 1992, there was a 500% increase in the prevalence of diagnosis of DCIS.1 DCIS now accounts for over 14% of breast cancers diagnosed annually in the United States. 2Treatment options for patients with DCIS and DCIS associated with microinvasion have moved from mastectomy to breast-conserving surgery, as conservation of the breast for DCIS allows comparable survival rates with mastectomy.3-5 Local recurrences for DCIS are of major concern as half of these are invasive cancers that could impair survival 4,[6][7][8][9][10][11] Achieving a low recurrence rate is therefore a major goal. One of the potential predictors for local recurrence in DCIS is the margin status of the excised specimen. 5,10,[12][13][14][15][16][17][18] It is therefore a major determinant for further treatment decisions in breast-conserving surgery for DCIS as it is the only factor that can be ...

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Salvage treatment for recurrence in the breast following breast-conserving surgery and definitive irradiation for ductal carcinoma in situ (intraductal carcinoma) of the breast

Cited by 10 publications

References 0 publications

Mortality Among Women With Ductal Carcinoma In Situ of the Breast in the Population-Based Surveillance, Epidemiology and End Results Program

Mortality Among Women With Ductal Carcinoma In Situ of the Breast in the Population-Based Surveillance, Epidemiology and End Results Program

Chromosomal Alterations in Ductal Carcinomas In Situ and Their In Situ Recurrences

Histological margin assessment for breast ductal carcinoma in situ: precision and implications

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