Surgical management of ductal carcinoma in situ of the breast: A large retrospective study from a single institution

Miligy, Islam M.; Toss, Michael S.; Khout, Hazem; Whisker, Lisa; Burrell, H.C.; Ellis, Ian O.; Green, Andrew; Macmillan, Douglas; Rakha, Emad A.

doi:10.1111/tbj.13425

Cited by 9 publications

(12 citation statements)

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“…These findings were addressed in our previous work using on the same cohort which where we showed lower rates of high risk DCIS over the time which was reflected by higher rate of BCS as a primary surgical management, lower rate of second operation 27 and decrease the proportion of HER2 positive DCIS over time 29 . Moreover, the protocol for management of DCIS in routine practice changed over the time.…”

Section: Discussionmentioning

confidence: 79%

“…Management details including the operation type (BCS or mastectomy), and RT data were collected. Over the period of the study, the management of DCIS showed significant changes with an increase in rate of BCS over mastectomy, and more frequent use of local RT as previously described 27 . ER status was not routinely assessed in DCIS unless indicated for diagnostic purposes and was not used to guide further management.…”

Section: Methodsmentioning

confidence: 76%

“…Selective RT regimen was also introduced. RT was then recommended after BCS to those with high grade DCIS, women younger than 50 years old and lesions more than 30mm, regardless of tumour grade, following a multidisciplinary team discussion even if the margin is clear 27 . In this study, there were 6 cases of low-grade DCIS which showed ER expression negativity.…”

Section: Discussionmentioning

confidence: 99%

“…The final number of cases that were suitable for assessment for ER was 643/1249 (51%) cases, according to the availability of tumour tissue and informative cores in the TMA blocks. Data on Progesterone receptor (PR) and HER2 status based on retrospective staining of the TMA cores was available as previously described [27][28][29] .…”

Section: Methodsmentioning

confidence: 99%

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The clinical significance of oestrogen receptor expression in breast ductal carcinoma in situ

et al. 2020

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Background: Oestrogen receptor (ER) in invasive breast cancer (BC) predicts response to endocrine therapy (ET) and provides prognostic value. In this study, we investigated the value of ER expression in ductal carcinoma in situ (DCIS) in terms of outcome and the impact on ET decision.Methods: 643 pure DCIS, diagnosed at Nottingham University Hospitals, were assessed for ER. Clinicopathological data were correlated against ER status together with assessment of recurrence rate.Results: ER-positivity was observed in 74% (475/643) of cases. ER positivity was associated with clinicopathological variables of good prognosis; however, outcome analysis revealed that ER status was not associated with local recurrence. In the intermediate and high-grade ER-positive DCIS, 58% (11/19) and 63% (15/24) of the recurrences were invasive, respectively, comprising 7% and 6% of all ER-positive DCIS, respectively. Invasive recurrence in low-grade DCIS was infrequent (2%) and none of these patients died of BC. The ER status of the recurrent invasive tumours matched the primary DCIS ER status (94% in ipsilateral and 90% of contralateral recurrence). Conclusion:The strong correlation between DCIS and invasive recurrences ER status and the clinical impact of ET justify discussion of the use of ET in ER-positive DCIS treated by breast conserving surgery. The excellent outcome of low-grade DCIS, which was almost always ERpositive, does not, in the opinion of authors, justify the use of risk reducing ET. Therefore, the decision on ET for DCIS should be personalised and consider grade, ER status and other characteristics.

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Section: Discussionmentioning

confidence: 79%

Section: Methodsmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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The clinical significance of oestrogen receptor expression in breast ductal carcinoma in situ

et al. 2020

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“…We previously found that CD4+ and CD8+ TILs are correlated with a favorable prognosis in triple-negative breast cancer (TNBC) [11]. Although the prognostic correlation of TILs-T has been widely reported, there are few studies on infiltrating B lymphocytes (TILs-B) in breast cancer and there is no consensus on their prognostic impact [12][13][14][15][16][17][18][19][20]. In addition, few studies have investigated TILs-B and TILs-T in combination [21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

Tumor-infiltrating B cells and T cells correlate with postoperative prognosis in triple-negative carcinoma of the breast

et al. 2021

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Background In this study, we investigated CD20+ TILs in triple-negative breast cancer (TNBC) and their relationship with T lymphocyte subsets (CD4+, CD8+, CD25+, and FOXP3+), including their combined prognostic value using an immunohistochemical staining method. Methods We investigated 107 patients with TNBC for whom a full-face section stained by hematoxylin and eosin between 2006 and 2018 at Dokkyo Medical University Hospital was available. Results The strongest association of infiltrating CD20+ TILs was with CD4+ TILs. There was a significant relationship between CD20+ and CD4+ TILs (r = 0.177; p < 0.001), CD8+ TILs (r = 0.085; p = 0.002), and FOXP3+ TILs (r = 0.0043; p = 0.032). No significant relationships were observed between the CD20+ and CD25+ TILs (r = 0.012; p = 0.264). Multivariate analysis revealed that only the CD20+/FOXP3 ratio was an independent factor for relapse-free survival (p < 0.001) and overall survival (p < 0.001). Patients with tumors highly infiltrated by CD4+, CD8+, and CD20+ TILs had a good prognosis. In contrast, those with tumors weakly infiltrated by CD20+ TILs but highly infiltrated by CD25+ and FOXP3+ TILs had a poor prognosis. Conclusions CD20+ TILs may support an increase in CD4+ and CD8+ TILs, which altered the anti-tumor response, resulting in a positive prognosis. CD20+ TILs correlated with FOXP3+ Treg lymphocytes, which were reported to be correlated with a poor prognosis. Our study suggested that TIL-B cells have dual and conflicting roles in TIL-T immune reactions in TNBC.

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Subtypes of high-grade breast ductal carcinoma in situ (DCIS): incidence and potential clinical impact

Schandiz

Park

Kaiser

et al. 2023

Breast Cancer Res Treat

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Objective The purpose of this study was to investigate and classify the molecular subtypes of high-grade ductal carcinoma in situ (DCIS) and identify possible high-risk subtypes. The heterogenicity of DCIS with variable clinical and histopathological presentations has been recognized. Nevertheless, only histopathological grading and diameter are currently implemented in clinical decision-making following the diagnosis of DCIS. The molecular subtypes of DCIS and their IHC surrogate markers have not been defined in conventional treatment guidelines and recommendations. We applied the definitions of molecular subtypes according to the IHC surrogate markers defined for IBC and subclassified high-grade DCIS, accordingly. Methods Histopathological specimens were collected, revised, and regraded from 494 patients diagnosed with DCIS between 1996 and 2018. Other in situ and papillary lesions observed in breast biopsies were excluded from this study. 357 high-grade DCIS cases were submitted to IHC analysis. The markers investigated were ER, PR, HER2, and Ki67. Results 45 cases were classified as grade 1, 19 as grade 2, and 430 as grade 3. Sixty patients with high-grade DCIS had an additional invasive component in the surgical specimen. Thirty-three patients were diagnosed with recurrent DCIS or invasive cancer (minimum one year after their primary DCIS diagnosis). The proportions of luminal A and luminal B HER2-negative subtypes varied depending on whether 2011 or 2013 St. Gallen Consensus Conference guidelines were adopted. Luminal A was the most prevalent subtype, according to both classifications. The luminal B HER2-positive subtype was found in 22.1% of cases, HER2-enriched subtype in 21.8%, and TPN subtype in 5.6%. There were strong indications that HER2-enriched subtype was significantly more frequent among DCIS with invasive component (p = 0.0169). Conclusions High-grade DCIS exhibits all the molecular subtypes previously identified in IBC, but with a somewhat different distribution in our cohort. HER2-enriched subtype is substantially related to the presence of an invasive component in DCIS; consequently, it is regarded as a high-risk entity.

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Surgical management of ductal carcinoma in situ of the breast: A large retrospective study from a single institution

Cited by 9 publications

References 50 publications

The clinical significance of oestrogen receptor expression in breast ductal carcinoma in situ

The clinical significance of oestrogen receptor expression in breast ductal carcinoma in situ

Tumor-infiltrating B cells and T cells correlate with postoperative prognosis in triple-negative carcinoma of the breast

Subtypes of high-grade breast ductal carcinoma in situ (DCIS): incidence and potential clinical impact

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