Abstract | METHOD AND RESULTS: A standardized histopathological protocol has been designed, in which different histological characteristics of ductal carcinoma in situ ( DCIS) are reported: nuclear grade (ng), growth pattern according to Andersen et al., necrosis, size of the lesion, resection margins and focality. Using this protocol a re-evaluation of a population-based consecutive series of 306 cases of DCIS has been done as well as a thorough clinical follow-up. After a median follow-up of 63 months, 13% have developed ipsilateral local recurrences, invasive and/or in situ. Ipsilateral local recurrence-free survival (IL-RFS) was significantly better for patients operated with mastectomy (ME) or breast conserving therapy (BCT) with radiotherapy (RT) than for patients operated with BCT without RT (5-year IL-RFS 96% vs 94% vs 79%, P<0.001). In the subgroup of BCT without RT there were significant differences in IL-RFS between histopathological subgroups: ng 1 + 2 (non-high grade) vs ng 3 (high grade; P=0.014), non-high-grade without comedo-type necrosis vs non-high-grade with comedo-type necrosis vs high-grade (the Van Nuys classification system; P=0.025). Growth pattern (not diffuse vs diffuse) and margins (free vs involved or not evaluated) showed a tendency (P=0.07 and 0.05, respectively) to be associated to IL-RFS. In contrast, no significant differences in IL-RFS were found in subgroups based on mode of detection, focality or size. Ninety-four per cent of the local recurrences after BCT appeared at the previous operation site. CONCLUSIONS: In the BCT without RT group, combinations of either non-high grade and not a diffuse growth pattern or non-high grade and free margins identified groups (constituting approximately 30% of the patients) were at low risk of developing ipsilateral recurrences (6-10%), compared to a 31-37% recurrence risk in the remaining groups during the observed follow-up time. The beneficial effect of post-operative RT for these low-risk groups can be questioned, and should be studied further.
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Authors | A Ringberg, I Idvall, M Fernö, H Anderson, L Anagnostaki, P Boiesen, L Bondesson, E Holm, S Johansson, K Lindholm, O Ljungberg, G Ostberg |
Journal | European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
(Eur J Surg Oncol)
Vol. 26
Issue 5
Pg. 444-51
(Aug 2000)
ISSN: 0748-7983 [Print] England |
PMID | 11016463
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Topics |
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms
(mortality, pathology, prevention & control, radiotherapy, surgery, therapy)
- Calcinosis
- Carcinoma, Intraductal, Noninfiltrating
(mortality, pathology, prevention & control, radiotherapy, surgery, therapy)
- Female
- Follow-Up Studies
- Forms and Records Control
(standards)
- Humans
- Mastectomy, Segmental
- Medical Records
(standards)
- Middle Aged
- Necrosis
- Neoplasm Recurrence, Local
(prevention & control)
- Radiotherapy, Adjuvant
- Risk
- Survival Analysis
- Treatment Outcome
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