-
[show abstract]
[hide abstract]
ABSTRACT: The optimal technique for sentinel lymph node biopsy (SLNB) is still debated. SLNB with peritumoral injection of Patent blue
dye was performed in 129 clinically T1-T2 and NO breast cancers in 127 patients (group A); it was later replaced by combined
dye and radiocolloid-guided SLNB preceded by lymphoscintigraphy in 72 breast cancer patients (group B). This study compares
these two methods. All patients underwent completion axillary dissection. Means of 1.4 and 1.3 SLNs were identified in groups
A and B, respectively. The mean number of non-SLNs for the whole series was 14.9 (range 5–42). The first 53 cases of lymphatic
mapping (dye only) comprised the institutional learning period during which the identification rate of at least 1 SLN in 30
consecutive attempts reached 90%. The identification rate for the subsequent 76 group A patients was 92%. The accuracy rate
of SLNBs for overall axillary nodal status prediction and the false-negative rate for group A patients (after excluding the
learning-phase cases) were 93% and 10%, respectively. All 72 group B cases had at least one SLN identified, and only one false-negative
case occurred in this group (accuracy and false-negative rates of 99% and 3%, respectively). Both the dye-only and the combined
SLNB methods are suitable for SLN identification, but the latter works better and results in higher accuracy, a higher negative
predictive value, and a lower false-negative rate. It is therefore the method of choice.
La technique optimale pour identifier le ganglion sentinelle (GS) est toujours débattèe. On a injecté en péritumorale, dans
le but d’une biopsie d’un GS, du bleu Patent chez 127 patientes porteuses de 129 tumeurs du sein, classées T1–T2 et NO cliniquement
(Groupe A); cette méthode a été remplacée ultérieurement par l’utilisation de la combinaison de colorant et de biopsie de
GS précédée d’une lymphoscintigraphie chez 72 patientes porteuses de cancer de sein (Groupe B). Cette étude compare les deux
méthodes de biopsie du GS. Toutes les patientes ont eu une lymphadénectomie axillaire. On a identifié 1.4 et 1.3 GS en moyenne,
respectivement, dans les groupes A et B. Le taux moyen pour toute la série a été de 14.9 (extrêmes 5–42). Les 53 premiers
cas de cartographie lymphatique (colorant uniquement) ont été considérés comme la période d’apprentissage initial, pendant
laquelle l’identification d’au moins un GS a atteint 90% parmi les 30 premiers essais consécutifs. Par la suite, le taux d’identification
dans le groupe A a été de 92%. La précision de la biopsie des GS pour la prédiction d’atteinte ganglionnaire globale et le
taux de faux négatifs pour le groupe A (après exclusion des cas de la courbe d’apprentissage) ont été, respectivement, de
93% et de 10%. On a identifié au moins un GS chez toutes les 72 patientes du groupe B, et seulement un faux négatif a été
reconnu dans ce groupe, c’est-à-dire une précision et un taux de faux négatifs de, respectivement, 99% et 3%. L≐utilisation
du colorant seul ou de l’ensemble colorant/lymphoscintigraphie est valable pour l’identification du GS, mais, pour cette dernière,
l’efficacité et la précision sont meilleures, la valeur prédictive négative plus élevée et le taux de faux-négatifs plus bas.
c’est donc la méthode de choix.
Todavía existe controversia sobre cual es la mejor técnica para la realización de la biopsia del ganglio centinela (SLNB).
La SLNB mediante la sola inyección peritumoral del contraste Patent azul se utilizó en 129 cánceres de mama en estadio T1–T2
N0, correspondientes a 127 pacientes (grupo A). Más tarde se sustituyó esta técnica por una SLNB guiada por la utilización
conjunta del colorante vital y de radiocoloides, precedida por una linfoescintigrafía. Este método se empleó en 72 pacientes
con cáncer de mama (grupo B). En todos los pacientes se realizó un vaciamiento completo de axila. Un promedio de 1.4 y 1.3
SLN se identificaron en el grupo A y en el B. Los primeros 53 casos de cartografía linfática (sólo con colorante vital) constituyen
el periodo de aprendizaje durante el cual se identificó al menos 1 SLN en 30 pacientes consecutivos, por lo que el porcentaje
de identificación alcanzó el 90%. El porcentaje de identificación en los 76 pacientes restantes del grupo A fue del 92%. La
precisión de la SLNB para el pronóstico global del estadio ganglionar axilar y el porcentaje de falsos negativos en pacientes
del grupo A (exclusión hecha de los casos utilizados durante el periodo de aprendizaje) fue respectivamente del 93% y 10%.
En los 72 casos del grupo B se identificó, como mínimo, 1 SLN registrándose tan solo 1 falso negativo lo que implica una exactitud
del 99% y un porcentaje de falsos negativos del 3%. Tanto el contraste vital solo como asociado a una escintografía son métodos
apropiados para la SLNB y la identificación del ganglio centinela (SLN) pero la asociación de ambos métodos es mejor, pues
proporciona una gran exactitud, mayores valores predictivos negativos, y menor porcentaje de falsos negativos. Por ello, constituye
el método de elección.
World Journal of Surgery 04/2012; 26(5):592-597. · 2.36 Impact Factor
-
Magyar Sebészet (Hungarian Journal of Surgery) 06/2010; 63(3):132-40.
-
[show abstract]
[hide abstract]
ABSTRACT: Small breast cancers often require different treatment than larger ones. The frequency and predictability of further nodal involvement was evaluated in patients with positive sentinel lymph nodes and breast cancers < or =15 mm by means of 8 different predictive tools. Of 506 patients with such small tumors 138 with positive sentinel nodes underwent axillary dissection and 39 of these had non-sentinel node involvement too. The Stanford nomogram and the micrometastatic nomogram were the predictive tools identifying a small group of patients with low probability of further axillary involvement that might not require completion axillary lymph node dissection. Our data also suggest that the Tenon score can separate subsets of patients with a low and a higher risk of non-sentinel node metastasis. Predictive tools based on multivariate models can help in omitting completion axillary dissection in patients with low risk of non-sentinel lymph node metastasis based on their small tumor size.
Orvosi Hetilap 11/2009; 150(48):2182-8.
-
Oldrich Coufal,
Tomás Pavlík,
Pavel Fabian,
Rita Bori, Gábor Boross,
István Sejben,
Róbert Maráz,
Jaroslav Koca,
Eva Krejcí,
Iva Horáková,
Vendula Foltinová,
Pavlína Vrtelová,
Vojtech Chrenko,
Wolde Eliza Tekle,
Mária Rajtár,
Mihály Svébis,
Vuk Fait,
Gábor Cserni
[show abstract]
[hide abstract]
ABSTRACT: Several models have previously been proposed to predict the probability of non-sentinel lymph node (NSLN) metastases after a positive sentinel lymph node (SLN) biopsy in breast cancer. The aim of this study was to assess the accuracy of two previously published nomograms (MSKCC, Stanford) and to develop an alternative model with the best predictive accuracy in a Czech population. In the basic population of 330 SLN-positive patients from the Czech Republic, the accuracy of the MSKCC and the Stanford nomograms was tested by the area under the receiver operating characteristics curve (AUC). A new model (MOU nomogram) was proposed according to the results of multivariate analysis of relevant clinicopathologic variables. The new model was validated in an independent test population from Hungary (383 patients). In the basic population, six of 27 patients with isolated tumor cells (ITC) in the SLN harbored additional NSLN metastases. The AUCs of the MSKCC and Stanford nomograms were 0.68 and 0.66, respectively; for the MOU nomogram it reached 0.76. In the test population, the AUC of the MOU nomogram was similar to that of the basic population (0.74). The presence of only ITC in SLN does not preclude further nodal involvement. Additional variables are beneficial when considering the probability of NSLN metastases. In the basic population, the previously published nomograms (MSKCC and Stanford) showed only limited accuracy. The developed MOU nomogram proved more suitable for the basic population, such as for another independent population from a mid-European country.
Pathology & Oncology Research 06/2009; 15(4):733-40. · 1.37 Impact Factor
-
Csaba Polgár,
Zsolt Orosz,
Zsuzsanna Kahán,
Gabriella Gábor,
Nóra Jani,
Gábor Cserni,
Janaki Hadijev,
Janina Kulka,
Zoltán Sulyok, Gábor Boross,
György Lázár,
Zsolt László,
Csaba Diczházi,
Nóra Udvarhelyi,
Eva Szabó,
Zoltán Péntek,
Tibor Major,
János Fodor
[show abstract]
[hide abstract]
ABSTRACT: The aim of this work is to report the preliminary results of the Hungarian multicentric randomised DCIS study. Between 2000 and 2007, 278 patients with ductal carcinoma in situ (DCIS) treated by breast-conserving surgery were randomised according to predetermined risk groups. Low/intermediate-risk patients (n=29) were randomised to 50 Gy whole-breast irradiation (WBI) or observation. High-risk cases (n=235) were allocated to receive 50 Gy WBI vs. 50 Gy WBI plus 16 Gy tumour bed boost. Very high-risk patients (patients with involved surgical margins; n=14) were randomised to 50 Gy WBI plus 16 Gy tumour bed boost or reoperation (reexcision plus radiotherapy or mastectomy alone). Immunohistochemistry (IHC) was performed to detect the expression of potential molecular prognostic markers (ER, PR, Her2, p53, Bcl-2 and Ki-67). At a median follow-up of 36 months no recurrence was observed in the low/intermediate- and very high-risk patient groups. In the high-risk group, 4 (1.7%) local recurrences and 1 (0.4%) distant metastasis occurred. No patient died of breast cancer. In the high-risk group of patients, the 3- and 5-year probability of local recurrence was 1.1% and 3.1%, respectively. The positive immunostaining for Her2 (38%), p53 (37%) and Ki-67 (44%) correlated with a high nuclear grade. Significant inverse correlation was found between the expression of ER (77%), PR (67%), Bcl-2 (64%) and grade. Preliminary results suggest that breast-conserving surgery followed by radiotherapy yields an annual local recurrence rate of less than 1% in patients with DCIS. IHC of molecular prognostic markers can assist to gain insight into the biologic heterogeneity of DCIS.
Magyar Onkológia 10/2008; 52(3):269-77.
-
Csaba Polgár,
Zsuzsanna Kahán,
Zsolt Orosz,
Gabriella Gábor,
Janaki Hadijev,
Gábor Cserni,
Janina Kulka,
Nóra Jani,
Zoltán Sulyok,
György Lázár, Gábor Boross,
Csaba Diczházi,
Eva Szabó,
Zsolt László,
Zoltán Péntek,
Tibor Major,
János Fodor
[show abstract]
[hide abstract]
ABSTRACT: Breast-conserving surgery (BCS) followed by radiotherapy (RT) has become the standard of care for the treatment of early-stage (St. I-II) invasive breast carcinoma. However, controversy exists regarding the value of RT in the conservative treatment of ductal carcinoma in situ (DCIS). In this article we review the role of RT in the management of DCIS. Retrospective and prospective trials and meta-analyses published between 1975 and 2007 in the MEDLINE database, and recent issues of relevant journals/handbooks relating to DCIS, BCS and RT were searched for. In retrospective series (10,194 patients) the 10-year rate of local recurrence (LR) with and without RT was reported in the range of 9-28% and 22-54%, respectively. In four large randomised controlled trials (NSABP-B-17, EORTC-10853, UKCCCR, SweDCIS; 4,568 patients) 50 Gy whole-breast RT significantly decreased the 5-year LR rate from 16-22% (annual LR rate: 2.6-5.0%) to 7-10% (annual LR rate: 1.3-1.9%). In a recent meta-analysis of randomised trials the addition of RT to BCS resulted in a 60% risk reduction of both invasive and in situ recurrences. In a multicentre retrospective study, an additional dose of 10 Gy to the tumour bed yielded a further 55% risk reduction compared to RT without boost. To date, no subgroups have been reliably identified that do not benefit from RT after BCS. In the NSABP-B-24 trial, the addition of tamoxifen (TAM) to RT reduced ipsilateral (11.1% vs. 7.7%) and contralateral (4.9% vs. 2.3%) breast events significantly. In contrast, in the UKCCCR study, TAM produced no significant reduction in all breast events. Based on available evidence obtained from retrospective and prospective trials, all patients with DCIS have potential benefit from RT after BCS. Further prospective studies are warranted to identify subgroups of low-risk patients with DCIS for whom RT can be safely omitted. Until long-term results of ongoing studies on outcomes of patients treated with BCS alone (with or without TAM or aromatase inhibitors) are available, RT should be routinely recommended after BCS for all patients except those with contraindication.
Pathology & Oncology Research 02/2008; 14(2):179-92. · 1.37 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Sentinel node biopsy (SNB) is controversial for in situ breast cancers. We reviewed our experience with in situ and microinvasive carcinomas and surveyed the literature.
SNB was performed with intraparenchymal administration of vital dye alone or combined with radiocolloid. The SNs were assessed histologically with haematoxylin eosin staining and cytokeratin immunohistochemistry.
Patients with in situ (36) or microinvasive (20) carcinomas underwent SNB: 59 axillary and 1 parasternal, and 39 axillary and 1 parasternal SNs were recovered, respectively. The SNs were positive in 4 patients and 1 patient, respectively: 1 micrometastasis and 3 isolated tumour cells, and 1 micrometastasis in the respective groups. No further axillary nodes were found positive after dissection. Further 21 invasive carcinomas (often with extensive intraductal component) had an in situ carcinoma diagnosis preoperatively: of 39 axillary and 3 parasternal SNs 10 patients had nodal involvement in 13 axillary SNs; 5 patients also had further lymph nodes involved after dissection.
The definitive diagnosis of in situ carcinoma does not warrant SNB. This procedure should be considered if the tumour is to be removed by mastectomy, or if the diagnosis is preoperative and there are associated high-risk factors for the subsequent diagnosis of invasive cancer.
Magyar Sebészet (Hungarian Journal of Surgery) 07/2006; 59(3):164-72.
-
[show abstract]
[hide abstract]
ABSTRACT: The neoadjuvant chemotherapy is increasingly being used in the treatment of patients with locally advanced breast cancer. We describe the hypothesis of the biological behaviour of breast cancer supporting the reason for the existence of this treatment. The improvement of neoadjuvant chemotherapy is being discussed as well as the advantages, disadvantages and problems of the treatment. THE AIM OF EXAMINATION: To study the results of neoadjuvant chemotherapy in patients with locally advanced breast cancer and the proportion of breast preserving surgery after the treatment.
Sixty seven patients were given neoadjuvant chemotherapy treatment between 01.01.1999 and 12.31.2003. Twenty three patients were stage III A while 35 stage III B and 9 stage III C. 63% of the patients received CEF chemotherapy and 19% were given MMM. 18% were given neoadjuvant Taxotere + Carboplatin and 4% were given Taxotere + Farmorubicin chemotherapy.
After neoadjuvant chemotherapy 5 patients had SD (stable disease), 32 patients had MR (minor response) and in 28 cases patients had PR (partial response). Two patients showed pCR (complete pathologic response). Twenty patients (30%) had breast preserving surgery.
On the basis of our own experience neoadjuvant therapy is justified in patients with locally advanced breast cancer as they have bigger chance for breast preserving surgery. If mastectomy and axillary block dissection has to be carried out they are easier to perform. Taxans must be introduced for neoadjuvant treatment in order to improve our results. A longer follow-up is necessary before drawing final conclusions.
Magyar Sebészet (Hungarian Journal of Surgery) 09/2005; 58(4):225-32.
-
[show abstract]
[hide abstract]
ABSTRACT: After a positive sentinel lymph node (SLN) biopsy, some patients may be considered to have a very low risk of non-SLN involvement and could be candidates for axillary sparing. The aim of this study was to validate the nomogram created at the Memorial Sloan-Kettering Cancer Center (MSKCC) for the prediction of non-SLN involvement in an independent set of 140 patients with both positive SLNs and axillary dissection. The predicted proportions of positive non-SLNs were compared with the observed percentages of non-SLN metastasis. Although the SLN metastasis size and tumor size did influence the risk of non-SLN involvement, the correlation between the predicted and observed proportions was weaker for our patients (R: 0.84) than for the patients assessed at the MSKCC (R: 0.97). Differences were noted in the intraoperative assessment and in the final histology of the SLNs (imprints vs frozen sections and more detailed vs less detailed, respectively), and these could partly explain the lower level of the correlation. The nomogram could not be validated and was found to be of only limited use for the prediction of non-SLN involvement in patients operated on under similar, though not fully identical conditions. We therefore warn against the unvalidated use of this prediction tool.
The American surgeon 12/2004; 70(11):1019-24. · 1.28 Impact Factor
-
Gábor Cserni,
Tomasz Burzykowski,
Vincent Vinh-Hung,
Lajos Kocsis, Gábor Boross,
Mária Sinkó,
Miklós Tarján,
Rita Bori,
Mária Rajtár,
Eliza Tekle,
Róbert Maráz,
Béla Baltás,
Mihály Svébis
[show abstract]
[hide abstract]
ABSTRACT: After completion of axillary dissection, many breast cancer patients with axillary sentinel nodal involvement are found to have regional disease limited to the sentinel nodes. These patients are exposed to the morbidity of axillary clearance without any expected therapeutic benefit.
Sentinel node biopsy was performed either with Patent blue dye or with a combined dye, radiocolloid and gamma-probe-guided method involving peritumoral tracer administration. For a series of 150 consecutive patients with involved axillary sentinel nodes and axillary dissection, factors associated with non-sentinel nodal involvement were analysed in a multivariate analysis based on logistic regression with the use of fractional polynomials.
The following variables were found to be potentially associated with non-sentinel node metastases: tumour size, sentinel node metastasis size, number of examined sentinel nodes, percentage of involved sentinel nodes (the latter two were found to be significant only when in combination), and extracapsular perinodal spread.
Isolated tumour cells and micrometastases in axillary sentinel nodes carry a low risk of non-sentinel node metastasis. The risk of metastasis to further echelon nodes is higher with macrometastases, especially if there is extracapsular growth and the proportion of involved sentinel nodes is high.
Japanese Journal of Clinical Oncology 10/2004; 34(9):519-24. · 1.78 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The optimal technique for sentinel lymph node biopsy (SLNB) is still debated. SLNB with peritumoral injection of Patent blue dye was performed in 129 clinically T1-T2 and N0 breast cancers in 127 patients (group A); it was later replaced by combined dye and radiocolloid-guided SLNB preceded by lymphoscintigraphy in 72 breast cancer patients (group B). This study compares these two methods. All patients underwent completion axillary dissection. Means of 1.4 and 1.3 SLNs were identified in groups A and B, respectively. The mean number of non-SLNs for the whole series was 14.9 (range 5-42). The first 53 cases of lymphatic mapping (dye only) comprised the institutional learning period during which the identification rate of at least 1 SLN in 30 consecutive attempts reached 90%. The identification rate for the subsequent 76 group A patients was 92%. The accuracy rate of SLNBs for overall axillary nodal status prediction and the false-negative rate for group A patients (after excluding the learning-phase cases) were 93% and 10%, respectively. All 72 group B cases had at least one SLN identified, and only one false-negative case occurred in this group (accuracy and false-negative rates of 99% and 3%, respectively). Both the dye-only and the combined SLNB methods are suitable for SLN identification, but the latter works better and results in higher accuracy, a higher negative predictive value, and a lower false-negative rate. It is therefore the method of choice.
World Journal of Surgery 06/2002; 26(5):592-7. · 2.36 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The optimal technique of sentinel node biopsy (SNB) is still debated.
To compare two methods of SNB, describe the learning phase, the validation of the methods and the first results after implementing SNB as standard of care in selected breast cancer patients.
SNB with peritumoral or intratumoral injection of Patent blue dye only was performed in 129 clinically T1-T2 and N0 breast cancers in 127 patients (Group A); it was later replaced by combined dye and radiocolloid-guided SNB preceded by lymphoscintigraphy in 72 breast cancer patients (Group B). All patients underwent completion axillary dissection. Group C, to date, comprises 50 patients, in whom axillary dissection was performed on the basis of the SNB. Intraoperative imprint cytology was performed, and whenever positive, the axillary dissection was completed in the same step, whereas in cases of negative cytology findings but positive final histology, the dissection was done as a second operation. Histopathological assessment of SNs involved step sectioning and immunohistochemistry.
Means of 1.4 and 1.3 SNs were identified in Groups A and B, respectively. The mean number of non-SNs for the whole series was 14.7 (range 5-42). The first 53 cases of lymphatic mapping with patent blue dye comprised the institutional learning period, during which the identification rate of at least 1 SN in 30 consecutive attempts reached 90%. The identification rate for the subsequent 76 Group A patients was 92%. The accuracy of SNB for overall axillary nodal status prediction and the false-negative rate for Group A patients (after exclusion of the learning-phase cases) were 93% and 10%, respectively. All 72 Group B cases had at least 1 SN identified, and only 1 false-negative case occurred in this group, i.e. the accuracy and false-negative rate were 99% and 3%, respectively. The identification rate in Group C was 98%; axillary dissection could be avoided in 25 patients, it was performed at the same time as the SNB in 15 and as a second operation in 10. Till now, no axillary recurrence was detected in Group C patients, although the follow-up period is short for the moment.
The dye only and the radioguided SNB methods are complementary, their combination improves the performance, and can be the basis of performing axillary dissection on the basis of SNB results. After the technique of SNB has been validated in a given institution, it can become standard of care in a well selected group of patients, but requires a close follow up.
Orvosi Hetilap 04/2002; 143(9):437-46.
-
Csaba Polgár, Gábor Boross,
Gábor Cserni,
Csaba Diczházi,
János Fodor,
Gabriella Gábor,
Rozália Hajnal Papp,
Zsuzsanna Kahán,
Janina Kulka,
György Lázár,
Katalin Ormándi,
Zsolt Orosz,
Gábor Péley,
Péter jr. Sótonyi,
Zoltán Sulyok,
Éva Szabó,
Zoltán Takácsi-Nagy
[show abstract]
[hide abstract]
ABSTRACT: 289 duktális in situ emlőrák (DCIS) miatt emlőmegtartó műtéttel kezelt beteget randomizáltunk a lokális recidíva szempontjából meghatározott rizikó csoportok szerinti besorolás után. Immunhisztokémiai (IHK) módszerrel vizsgáltuk a lehetséges molekuláris prognosztikai markerek (ER, PR, Her2, p53, Bcl2 és Ki-67) expresszióját. A pozitív IHK reakció a Her2 (38%), p53 (36%) és Ki-67 (47%) markereknél a nukleáris grade-del korrelált. Ezzel szemben az ER (77%), PR (67%) és Bcl2 (67%) pozitivitás szignifikáns inverz összefüggésben volt a grade-del. A klinikai eredményeket 3 éves medián követési idő után 278 betegnél elemeztük. A magas rizikójú betegcsoportban emlőmegtartó műtét és sugárkezelés után 4 (1,7%) lokális recidíva és 1 (0,4%) távoli áttét alakult ki, emlődaganatos haláleset nem volt. A helyi daganatkiújulás 3 és 5 éves valószínűsége 1,1% és 3,1% volt. Tapasztalataink alapján a DCIS egyértelmű diagnózisa esetén az őrszem nyirokcsomó biopszia rutinszerű elvégzése nem indokolt. Korai eredményeink alapján az emlő DCIS kezelésében az emlőmegtartó műtét és posztoperatív sugárkezelés alkalmazásával a helyi daganatkiújulás éves aránya 1% alatt marad. A tumorágy "boost" kezelés hatékonyságának megítélésére és a vizsgált molekuláris markerek prognosztikai/prediktív értékének elemzésére hosszabb követési idő után lesz lehetőségünk. A molekuláris prognosztikai faktorok IHK vizsgálata segítségünkre lehet a DCIS biológiai heterogenitásának feltérképezésében. | 289 patients with ductal carcinoma in situ (DCIS) treated by breast-conserving surgery were randomised according to predetermined risk groups. Immunohistochemistry (IHC) was performed to detect the expression of potential molecular prognostic markers (ER, PR, Her2, p53, Bcl2, and Ki-67). The positive immunostaining for Her2 (38%), p53 (36%), and Ki-67 (47%) correlated with a high nuclear grade. Significant inverse correlation was found between the expression of ER (77%), PR (67%), Bcl2 (67%) and grade. Clinical results was analysed for 278 patients at a median follow-up of 36 months. In the high-risk patient group 4 (1.7%) local recurrences and 1 (0.4%) distant metastasis occurred. No patient died of breast cancer. The 3- and 5-year probability of local recurrence was 1.1% and 3.1%, respectively. Based on our experience, the definitive diagnosis of DCIS does not warrant sentinel lymph node biopsy. Preliminary results suggest that breast-conserving surgery followed by radiotherapy yields an annual local recurrence rate of less than 1% in patients with DCIS. Further follow-up is needed to define the clinical benefit of tumour bed boost irradiation and to analyse the prognostic/predictive value of molecular prognostic factors. IHC of molecular prognostic markers can assist to gain insight into the biologic heterogeneity of DCIS.
