Ductal carcinoma in-situ: An update for clinical practice
The London Breast Institute, The Princess Grace Hospital, London, UK. Surgical Oncology
(Impact Factor: 3.27).
03/2011; 20(1):e23-31. DOI: 10.1016/j.suronc.2010.08.007
Ductal carcinoma in-situ (DCIS) is a heterogeneous entity with an elusive natural history. The objective of radiological, histological and molecular characterisation remains to reliably predict the biological behaviour and optimise clinical management strategies. Increases in diagnostic frequency have followed the introduction of mammographic screening and increased utility of magnetic resonance imaging. However, progress remains limited in distinguishing non-progressive incidental lesions from their progressive and clinically relevant counterparts. This article reviews current management strategies for DCIS in the context of recent randomized trials, including the role of sentinel lymph node biopsy (SLNB), adjuvant radiotherapy (RT) and endocrine treatment.
Available from: Kefah Mokbel
- "Although it is considered to be the precursor of the most invasive breast cancers, however not all DCIS will progress to this stage. The overall progression to invasive breast cancer has been reported to range from 14% to 75% . Therefore the challenge in the modern management of DCIS is to avoid over-treatment. "
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ABSTRACT: Abstract: Ductal carcinoma in-situ DCIS is a heterogeneous entity in breast neoplasm with unpredictable biological behavior. This poses challenge in the management of DCIS. Various trials on DCIS have shown good outcome with integral treatment of adequate surgery, radiotherapy and hormonal therapy. Identification of subgroup of DCIS for radiotherapy and hormonal therapy could improve recurrence rate, contralateral tumours incidence and perhaps overall survival. Various risk score calculations could help to direct radiotherapy and hormonal treatment verses surgery alone and to avoid over treatment. Oncotype DX assay could be a new way of risk calculation to direct types of DCIS treatment. The recent increased use of MRI could increase the detection of DCIS and a more accurate extent of disease estimation. This article is a summary of major literatures and major trials result for DCIS.
Available from: Paolo Orsaria
- "The survival curves from the Van Nuys series showed that, regardless of the presence of high nuclear grade, comedonecrosis, large tumor size, or young age, the risk of local relapse remains slight if wide margins of resection are achieved. Consistent with the NSABP B-17 and EORTC trial findings, the absolute reduction of LR by RT increased with time from 7% at 4 years to 11% at 10.5 years but successive studies recognized that postoperative RT may not significantly improve the local outcome in all types of DCIS . "
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ABSTRACT: Counseling patients with DCIS in a rational manner can be extremely difficult when the range of treatment criteria results in diverse and confusing clinical recommendations. Surgeons need tools that quantify measurable prognostic factors to be used in conjunction with clinical experience for the complex decision-making process. Combination of statistically significant tumor recurrence predictors and lesion parameters obtained after initial excision suggests that patients with DCIS can be stratified into specific subsets allowing a scientifically based discussion. The goal is to choose the treatment regimen that will significantly benefit each patient group without subjecting the patients to unnecessary risks. Exploring the effectiveness of complete excision may offer a starting place in a new way of reasoning and conceiving surgical modalities in terms of "downscoring" or "upscoring" patient risk, perhaps changing clinical approach. Reexcison may lower the specific subsets' score and improve local recurrence-free survival also by revealing a larger tumor size, a higher nuclear grade, or an involved margin and so suggesting the best management. It seems, that the key could be identifying significant relapse predictive factors, according to validated risk investigation models, whose value is modifiable by the surgical approach which avails of different diagnostic and therapeutic potentials to be optimal. Certainly DCIS clinical question cannot have a single curative mode due to heterogeneity of pathological lesions and histologic classification.
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