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Rizzo V, Cicciarelli F, Galati F, Moffa G, Maroncelli R, Pasculli M, Pediconi F. Could breast multiparametric MRI discriminate between pure ductal carcinoma in situ and microinvasive carcinoma? Acta Radiol 2024; 65:565-574. [PMID: 38196268 DOI: 10.1177/02841851231225807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND Ductal carcinoma in situ (DCIS) is often reclassified as invasive cancer in the final pathology report of the surgical specimen. It is of significant clinical relevance to acknowledge the possibility of underestimating invasive disease when utilizing preoperative biopsies for a DCIS diagnosis. In cases where such histologic upgrades occur, it is imperative to consider them in the preoperative planning process, including the potential inclusion of sentinel lymph node biopsy due to the risk of axillary lymph node metastasis. PURPOSE To assess the capability of breast multiparametric magnetic resonance imaging (MP-MRI) in differentiating between pure DCIS and microinvasive carcinoma (MIC). MATERIAL AND METHODS Between January 2018 and November 2022, this retrospective study enrolled patients with biopsy-proven DCIS who had undergone preoperative breast MP-MRI. We assessed various MP-MRI features, including size, morphology, margins, internal enhancement pattern, extent of disease, presence of peritumoral edema, time-intensity curve value, diffusion restriction, and ADC value. Subsequently, a logistic regression analysis was conducted to explore the association of these features with the pathological outcome. RESULTS Of 129 patients with biopsy-proven DCIS, 36 had foci of micro-infiltration on surgical specimens and eight were diagnosed with invasive ductal carcinoma (IDC). The presence of micro-infiltration foci was significantly associated with several MP-MRI features, including tumor size (P <0.001), clustered ring enhancement (P <0.001), segmental distribution (P <0.001), diffusion restriction (P = 0.005), and ADC values <1.3 × 10-3 mm2/s (P = 0.004). CONCLUSION Breast MP-MRI has the potential to predict the presence of micro-infiltration foci in biopsy-proven DCIS and may serve as a valuable tool for guiding therapeutic planning.
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MESH Headings
- Humans
- Female
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/pathology
- Middle Aged
- Retrospective Studies
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Aged
- Adult
- Diagnosis, Differential
- Multiparametric Magnetic Resonance Imaging/methods
- Neoplasm Invasiveness
- Breast/diagnostic imaging
- Breast/pathology
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/pathology
- Aged, 80 and over
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Affiliation(s)
- Veronica Rizzo
- Department of Radiological, Oncological and Pathological Sciences; Sapienza, University of Rome, Rome, Italy
| | - Federica Cicciarelli
- Department of Radiological, Oncological and Pathological Sciences; Sapienza, University of Rome, Rome, Italy
| | - Francesca Galati
- Department of Radiological, Oncological and Pathological Sciences; Sapienza, University of Rome, Rome, Italy
| | - Giuliana Moffa
- Department of Radiological, Oncological and Pathological Sciences; Sapienza, University of Rome, Rome, Italy
| | - Roberto Maroncelli
- Department of Radiological, Oncological and Pathological Sciences; Sapienza, University of Rome, Rome, Italy
| | - Marcella Pasculli
- Department of Radiological, Oncological and Pathological Sciences; Sapienza, University of Rome, Rome, Italy
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences; Sapienza, University of Rome, Rome, Italy
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Zhu K, Sui Y, Zhu M, Gao Y, Yuan Y, Sun P, Meng L, Dai J, Li Z. Development and validation of a nomogram for predicting lymph node metastasis in ductal carcinoma in situ with microinvasion: A SEER population-based study. PLoS One 2024; 19:e0301057. [PMID: 38557552 PMCID: PMC10984531 DOI: 10.1371/journal.pone.0301057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/06/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Ductal carcinoma in situ with microinvasion (DCIS-MI) is a special type of breast cancer. It is an invasive lesion less than 1.0 mm in size related to simple ductal carcinoma in situ (DCIS). Lymph node metastasis (LNM) in DCIS-MI often indicates a poor prognosis. Therefore, the management of lymph nodes plays a vital role in the treatment strategy of DCIS-MI. Since DCIS-MI is often diagnosed by postoperative paraffin section and immunohistochemical detection, to obtain the best clinical benefits for such patients, we aim to establish and verify a nomogram to predict the possibility of lymph node metastasis in DCIS-MI patients and help preoperative or intraoperative clinical decision-making. METHODS A retrospective analysis of patients with DCIS-MI in the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2019 was performed. The study cohort was randomly divided into a training cohort and a validation cohort at a ratio of 7:3. The risk factors were determined by univariate and multivariate logistic regression analyses in the training cohort, and a nomogram was constructed. The receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were used to evaluate the nomogram in the training set and validation set. An independent data cohort was obtained from the Shanghai Jiao Tong University Breast Cancer Database (SJTU-BCDB) for external validation. RESULTS This study included 3951 female patients from SEER with DCIS-MI, including 244 patients with regional lymph node metastasis, accounting for 6.18% of the total. An independent test set of 323 patients from SJTU-BCDB was used for external validation. According to the multifactorial logistic regression analysis results, age at diagnosis, ethnicity, grade, and surgical modality were included in the prediction model. The areas under the ROC curves (AUCs) were 0.739 (95% CI: 0.702~0.775), 0.732 (95% CI: 0.675~0.788), and 0.707 (95%CI: 0.607-0.807) in the training, validation and external test groups, suggesting that the column line graphs had excellent differentiation. The calibration curves slope was close to 1, and the model's predicted values were in good agreement with the actual values. The DCA curves showed good clinical utility. CONCLUSION In this study, we constructed accurate and practical columnar maps with some clinical benefit to predict the likelihood of lymph node metastasis in patients with postoperatively diagnosed DCIS-MI and provide a reference value for specifying treatment strategies.
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Affiliation(s)
- Kaijun Zhu
- School of Medicine, Shaoxing University, Shaoxing, Zhejiang, P. R. China
| | - Yuan Sui
- School of Medicine, Shaoxing University, Shaoxing, Zhejiang, P. R. China
| | - Mingliao Zhu
- School of Medicine, Shaoxing University, Shaoxing, Zhejiang, P. R. China
| | - Yuan Gao
- Department of Breast and Thyroid Surgery, Shaoxing People’s Hospital, The First Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang Province, People’s Republic of China
| | - Ying Yuan
- School of Medicine, Shaoxing University, Shaoxing, Zhejiang, P. R. China
| | - Pujian Sun
- School of Medicine, Shaoxing University, Shaoxing, Zhejiang, P. R. China
| | - Liwei Meng
- Department of Breast and Thyroid Surgery, Shaoxing People’s Hospital, The First Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang Province, People’s Republic of China
| | - Jiangfeng Dai
- Department of Oncological Surgery, Shaoxing Second Hospital, Shaoxing, Zhejiang, China
| | - Zhian Li
- Department of Oncological Surgery, Shaoxing Second Hospital, Shaoxing, Zhejiang, China
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Tao L, Feng Z, Qi Y, Shao N, Wang X, Ma F, Wang C, Qiu Z, Liang W, Chen X. The Application of Mixed Reality to Sentinel Lymph Node Biopsy in Breast Cancer. World J Surg 2023; 47:1961-1970. [PMID: 37149555 DOI: 10.1007/s00268-023-07028-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To explore the value of mixed reality (MR) in sentinel lymph node biopsy (SLNB) in patients with breast cancer. METHODS A total of 300 patients with breast cancer who underwent SLNB enrolled and were randomly divided into two groups. In group A, only dye (an injection of methylene blue) was used to detect sentinel lymph nodes, while in group B MR was used for positioning in addition to dye. (MR localization method: Before the surgery, we built a 1:1 3D reconstruction model based on the patient's CT or MRI original data, and after the patient was injected with dye, we completed MR localization by overlapping the pre-marked image with the model.) RESULTS: During surgery, the detection time in group B was significantly shorter than in group A (3.62 ± 1.20 vs.7.87 ± 1.86; p < 0.001). At 1-month post-surgery follow-up, the incidence of pain in group B was lower than that in group A (2.70 vs. 8.28%, p = 0.036). The incidence of upper limb dysfunction was lower in group B than in group A (2.03 vs. 8.97%, p = 0.009). In terms of the incidence of pain, group B was better than group A (0.68 vs. 3.45%, p = 0.094). The satisfaction of the two groups was scored, and the results showed that group B was better than group A (4.04 ± 0.91 vs.3.32 ± 0.94, p < 0.001). CONCLUSION The application of MR to SLNB in breast cancer can significantly reduce the detection time and the occurrence of complications and improve patient satisfaction.
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Affiliation(s)
- Lin Tao
- Inpatient Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, Heilongjiang, China
| | - Zhenchu Feng
- Department of Mammary Surgery, The Second Affiliated Hospital of Harbin Medical University, NO. 246 Xuefu Road, Nangang District, Harbin, 150081, Heilongjiang, China
| | - Yuan Qi
- Department of Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, 150081, Heilongjiang, China
| | - Nan Shao
- Department of Mammary Surgery, The Second Affiliated Hospital of Harbin Medical University, NO. 246 Xuefu Road, Nangang District, Harbin, 150081, Heilongjiang, China
| | - Xi Wang
- Department of Mammary Surgery, The Second Affiliated Hospital of Harbin Medical University, NO. 246 Xuefu Road, Nangang District, Harbin, 150081, Heilongjiang, China
| | - Fei Ma
- Department of Mammary Surgery, The Second Affiliated Hospital of Harbin Medical University, NO. 246 Xuefu Road, Nangang District, Harbin, 150081, Heilongjiang, China
| | - Chao Wang
- Department of Mammary Surgery, The Second Affiliated Hospital of Harbin Medical University, NO. 246 Xuefu Road, Nangang District, Harbin, 150081, Heilongjiang, China
| | - Zhaowen Qiu
- College of Information and Computer Engineering, Northeast Forestry University, No. 26 Hexing Road, Xiangfang District, Harbin, 150040, Heilongjiang, China.
| | - Wenlong Liang
- Department of Mammary Surgery, The Second Affiliated Hospital of Harbin Medical University, NO. 246 Xuefu Road, Nangang District, Harbin, 150081, Heilongjiang, China.
| | - Xi Chen
- Department of Mammary Surgery, The Second Affiliated Hospital of Harbin Medical University, NO. 246 Xuefu Road, Nangang District, Harbin, 150081, Heilongjiang, China.
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Ambrosini-Spaltro A, Di Donato F, Saragoni L, Cserni G, Rakha E, Foschini MP. Prognostic Markers of Microinvasive Breast Carcinoma: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:cancers15113007. [PMID: 37296968 DOI: 10.3390/cancers15113007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
(1) Background: The prognostic factors of microinvasive (≤1 mm) breast carcinoma are not completely clear. The aim of this study was to perform a systematic review and meta-analysis to clarify these factors. (2) Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was followed. Two databases were interrogated, PubMed and Embase, and papers in English were included to address this question. The selected studies were those that reported on female patients affected by microinvasive carcinoma, and on prognostic factors with a hazard ratio (HR) for disease-free survival (DFS) and overall survival (OS). (3) Results: In total, 618 records were identified. After removing duplicates (166), identification, and screening (336 by title and abstract alone, 116 by full text and eventual supplementary material), 5 papers were selected. Seven different meta-analyses were conducted in this study, all referring to DFS, analyzing the following prognostic factors: estrogen receptor, progesterone receptor, HER2 status, multifocality and grade of microinvasion, patient's age, and lymph node status. Only lymph node status was associated with prognosis and DFS (total number of cases: 1528; Z = 1.94; p = 0.05). The other factors examined did not significantly affect prognosis (p > 0.05). (4) Conclusions: Positive lymph node status significantly worsens prognosis in patients with microinvasive breast carcinoma.
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Affiliation(s)
| | - Francesco Di Donato
- Pathology Unit, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
- School of Anatomic Pathology, Department of Biomedical and Neuromotor Sciences, University of Bologna, 40139 Bologna, Italy
| | - Luca Saragoni
- Pathology Unit, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
| | - Gábor Cserni
- Department of Pathology, Bács-Kiskun County Teaching Hospital, 6000 Kecskemét, Hungary
- Department of Pathology, University of Szeged, 6725 Szeged, Hungary
| | - Emad Rakha
- Histopathology Department, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
| | - Maria Pia Foschini
- Unit of Anatomic Pathology, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bellaria Hospital, 40139 Bologna, Italy
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Canas-Marques R, Schnitt SJ. Ductal carcinoma in situ with and without microinvasion: is there a clinically meaningful difference in outcome? Br J Cancer 2023; 128:713-714. [PMID: 36707635 PMCID: PMC9977739 DOI: 10.1038/s41416-023-02152-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/28/2023] Open
Affiliation(s)
| | - Stuart J Schnitt
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Breast Oncology Program, Dana-Farber Cancer Institute, Boston, MA, USA.
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Song G, Zhang Y, Cui Y. Clinicopathological characteristics, treatments, and prognosis of breast ductal carcinoma in situ with microinvasion: A narrative review. Chronic Dis Transl Med 2023; 9:5-13. [PMID: 36926252 PMCID: PMC10011663 DOI: 10.1002/cdt3.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/20/2022] [Accepted: 11/09/2022] [Indexed: 11/28/2022] Open
Abstract
Background Ductal carcinoma in situ with microinvasion (DCIS-MI) is defined as ductal carcinoma in situ (DCIS) with a microscopic invasive focus ≤1 mm in the longest diameter. The current literature is controversial concerning the clinical prognostic features and management of DCIS-MI. This narrative review described recently reported literature regarding the characteristics, treatment, and prognosis of it. Methods Searching PubMed for relevant articles covering the period of 1982 to 2021 using the following terms by MeSH and free-word: breast cancer, microinvasion, DCIS, DCIS-MI, and invasive ductal carcinoma (IDC). Results DCIS-MI tends to express more aggressive pathological features such as necrosis, HER2+, ER- or PR-, and high nuclear grade. The overall prognosis of DCIS-MI is typically good, however, some indicators such as young age, HR-, HER2+ and multimicroinvasive lesions, were associated with worse prognoses. And there are also conflicting results on the differences between the prognoses of DCIS-MI and DCIS or T1a-IDC. Postoperative chemotherapy and anti-HER2 therapy still have uncertain benefits and are more likely to be used to treat high-risk patients who are HR- orHER2+ to improve the prognosis. Conclusion DCIS-MI has more aggressive pathological features, which may suggest its biological behavior is worse than that of DCIS and similar to early IDC. Although the overall prognosis of DCIS-MI is good, when making decisions about adjuvant therapy clinicians need to give priority to the hormone receptor status, HER2 expression and axillary lymph node status of patients, because these may affect the prognosis and treatment response.
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Affiliation(s)
- Ge Song
- Department of Oncology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing China.,Graduate School of Peking Union Medical College Chinese Academy of Medical Sciences Beijing China
| | - Yongqiang Zhang
- Department of Oncology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing China
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Prognostic significance of microinvasion with ductal carcinoma in situ of the breast: a meta-analysis. Breast Cancer Res Treat 2023; 197:245-254. [PMID: 36427119 PMCID: PMC9823049 DOI: 10.1007/s10549-022-06800-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 11/03/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Ductal carcinoma in situ (DCIS) associated with invasive carcinoma ≤ 1 mm in size is defined as DCIS with microinvasion (DCIS/microinvasion) rather than as invasive breast carcinoma. The number of patients with microinvasion accounts for < 1% of all breast cancer in published studies. As the numbers are limited, the prognostic significance of DCIS/microinvasion has not been clearly elucidated. This meta-analysis aimed to investigate the survival differences between patients with DCIS/microinvasion and those with pure DCIS. METHODS A meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was performed. We searched three electronic databases (MEDLINE, Cochrane Library, and EMBASE) and included observational studies published in English that contained survival details of patients with either DCIS or DCIS/microinvasion. RESULTS This study identified 26 studies that described the clinicopathological characteristics of patients in both the DCIS and DCIS/microinvasion groups. Survival differences were evaluated in 10 of 26 studies. Disease-free survival and loco-regional recurrence-free survival were significantly shorter in patients with DCIS/microinvasion than in those with DCIS (Hazard ratio, 1.52; 95% confidence interval, 1.11-2.08; p = 0.01 and hazard ratio, 2.53; 95% confidence interval, 1.45-4.41; p = 0.001, respectively). Both overall survival and distant metastasis-free survival tended to be shorter in patients with DCIS/microinvasion than in patients with DCIS (Hazard ratio, 1.63; 95% CI, 0.63-4.23; p = 0.31 and hazard ratio, 1.85; 95% confidence interval, 0.74-4.66; p = 0.19, respectively) but the difference was not statistically significant. CONCLUSION Our meta-analysis suggests that DCIS/microinvasion may display more aggressive biological and clinical behavior than pure DCIS, highlighting the potential need for closer follow-up and consideration of adjuvant treatment strategies in DCIS patients with microinvasive disease.
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Salama M, Khater A, Adel I, Selim M. National Cancer Institute Experience in Micro-invasive Breast Carcinoma Treatment and Outcome. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AbstractBackground: Significant relationship between breast cancer immunophenotype and risk of recurrence either local and/or distant may help determine which patients might benefit more from axillary staging and whether axillary staging is warranted in all cases or not. Patients with microinvasive carcinoma can present with axillary LN. metastasis, with incidence ranges from 0% to 20% . Thus, sentinel node biopsies are considered for patients with microinvasive carcinoma. The role of axillary staging in MIBC is not well defined, with the rate of axillary L.N. metastases ranging 0–11 %. Current studies focus on the clinical characteristics of MIBC. However, only a few studies have evaluated the survival and treatment, especially adjuvant chemotherapy after surgery, for patients with MIBC.Methods: This is a retrospective study of 139 cases diagnosed with microinvasive breast carcinoma from 2011 to 2015 who were identified in the National Cancer Institute, Cairo University. The pathologic database of our hospital was searched to identify patients with a pathologic diagnosis of MIBC on surgical specimens. The clinical features, sonographic and mammographic images and pathology records were reviewed.Results: There is increased incidence of MIBC over the past decade. Patients with MIBC were managed surgically with BCS. MIBC have the good prognosis. However, patients who are negative hormonal receptors have relatively substantial risk of relapse within the first 5 years after surgical operation. Adjuvant chemotherapy can only improve the outcomes of patients with negative hormonal receptors. Further studies with prolonged follow-up of large cohort are warranted to assess the prognostic significance and treatment of this lesion.Keywords: MIBC, CIS, DCIS, BC
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Davey MG, O’Flaherty C, Cleere EF, Nohilly A, Phelan J, Ronane E, Lowery AJ, Kerin MJ. OUP accepted manuscript. BJS Open 2022; 6:6563503. [PMID: 35380620 PMCID: PMC8982203 DOI: 10.1093/bjsopen/zrac022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background Axillary lymph node status remains the most powerful prognostic indicator in invasive breast cancer. Ductal carcinoma in situ (DCIS) is a non-invasive disease and does not spread to axillary lymph nodes. The presence of an invasive component to DCIS mandates nodal evaluation through sentinel lymph node biopsy (SLNB). Quantification of the necessity of upfront SLNB for DCIS requires investigation. The aim was to establish the likelihood of having a positive SLNB (SLNB+) for DCIS and to establish parameters predictive of SLNB+. Methods A systematic review was performed as per the PRISMA guidelines. Prospective studies only were included. Characteristics predictive of SLNB+ were expressed as dichotomous variables and pooled as odds ratios (o.r.) and associated 95 per cent confidence intervals (c.i.) using the Mantel–Haenszel method. Results Overall, 16 studies including 4388 patients were included (mean patient age 54.8 (range 24 to 92) years). Of these, 72.5 per cent of patients underwent SLNB (3156 of 4356 patients) and 4.9 per cent had SLNB+ (153 of 3153 patients). The likelihood of having SLNB+ for DCIS was less than 1 per cent (o.r. <0.01, 95 per cent c.i. 0.00 to 0.01; P < 0.001, I2 = 93 per cent). Palpable DCIS (o.r. 2.01, 95 per cent c.i. 0.64 to 6.24; P = 0.230, I2 = 0 per cent), tumour necrosis (o.r. 3.84, 95 per cent c.i. 0.85 to 17.44; P = 0.080, I2 = 83 per cent), and grade 3 DCIS (o.r. 1.34, 95 per cent c.i. 0.80 to 2.23; P = 0.270, I2 = 0 per cent) all trended towards significance in predicting SLNB+. Conclusion While aggressive clinicopathological parameters may guide SLNB for patients with DCIS, the absolute and relative risk of SLNB+ for DCIS is less than 5 per cent and 1 per cent, respectively. Well-designed randomized controlled trials are required to establish fully the necessity of SLNB for patients diagnosed with DCIS. Registration number CRD42021284194 (https://www.crd.york.ac.uk/prospero/)
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Affiliation(s)
- Matthew G. Davey
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
- Correspondence to: Matthew G. Davey, Department of Surgery, Galway University Hospitals, Galway H91YR71, Republic of Ireland (e-mail: )
| | - Colm O’Flaherty
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Eoin F. Cleere
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Aoife Nohilly
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - James Phelan
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Evan Ronane
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Aoife J. Lowery
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - Michael J. Kerin
- Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
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Li C, Yang Y, Wang J, Jin K, Yang Z, Yu X, Guo X, Chen X. Characteristics, prognosis, risk factors, and management of recently diagnosed ductal carcinoma in situ with microinvasion. Cancer Med 2021; 10:7203-7212. [PMID: 34547183 PMCID: PMC8525113 DOI: 10.1002/cam4.4263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 08/02/2021] [Accepted: 08/27/2021] [Indexed: 12/30/2022] Open
Abstract
Background Ductal carcinoma in situ with microinvasion (DCISM) represents ~1% of all breast cancer cases and is arguably a more aggressive subtype of ductal carcinoma in situ (DCIS). Lacking studies with a large population, the survival outcomes of DCISM are still poorly understood and the treatment recommendations remain controversial. This study aims to investigate the long‐term outcome of patients with DCISM, potential risk factors for their prognosis, and the difference of survival between patients treated with breast‐conserving surgery plus radiotherapy (BCT + RT) and mastectomy only. Methods In total, 1299 patients from 2008 to 2019 with DCISM were retrospectively retrieved. Clinicopathological features were analyzed. Subgroup analysis was conducted between patients who underwent BCT + RT and mastectomy only. Univariate and multivariate analyses were performed to identify prognostic factors for survival. Differences of survival between two groups were compared using the log‐rank test. Results Totally, 1286 patients had follow‐up information, the median follow‐up is 54.57 months, the 5‐year local–regional‐free survival (LRFS), distant metastasis‐free survival (DMFS), and overall survival (OS) were 98.6%, 97.1%, and 99.4%, respectively, two deaths were due to breast cancer. Multivariate analysis identified age <40 (p = 0.028) and close margin (≤2 mm) as independent negative prognostic factors for LRFS. No prognostic factors were identified for DMFS and OS. The 5‐year LRFS, DMFS, and OS of patients who had DCIS component ≥5 cm and underwent mastectomy without adjuvant radiotherapy were 100%, 98.4%, and 98.4%, respectively. After propensity score matching (PSM), no survival difference was observed between patients treated with BCT + RT or mastectomy only. Conclusions DCISM patients had a good survival, even those with DCIS component ≥5 cm. Patients aged <40 or with close margin (≤2 mm) had a poorer LRFS, but not DMFS or OS. BCT + RT is a feasible choice for DCISM patients.
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Affiliation(s)
- Chunyan Li
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Yilan Yang
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Jiangfeng Wang
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Kairui Jin
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Zhaozhi Yang
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Xiaoli Yu
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Xiaomao Guo
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Xingxing Chen
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Shanghai Medical CollegeFudan UniversityShanghaiChina
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Zhang M, Lin Q, Su XH, Cui CX, Bian TT, Wang CQ, Zhao J, Li LL, Ma JZ, Huang JL. Breast ductal carcinoma in situ with micro-invasion versus ductal carcinoma in situ: a comparative analysis of clinicopathological and mammographic findings. Clin Radiol 2021; 76:787.e1-787.e7. [PMID: 34052010 DOI: 10.1016/j.crad.2021.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/21/2021] [Indexed: 12/24/2022]
Abstract
AIM To determine the differences in clinicopathological and mammographic findings between ductal carcinoma in situ (DCIS) and ductal carcinoma in situ with micro-invasion (DCIS-MI) and explore clinicopathological and mammographic factors associated with DCIS-MI. MATERIALS AND METHODS All DCIS patients with or without micro-invasion who underwent preoperative mammography at The Affiliated Hospital of Qingdao University from January 2016 through June 2020 were identified retrospectively. The correlations of clinicopathological findings with DCIS-MI were evaluated using univariate and multivariate binary logistic regression analyses. Imaging findings were compared between the groups by using the Pearson chi-square test. RESULTS A total of 445 DCIS lesions and 151 DCIS-MI lesions were included in the final analysis. Large extent (≥2.7 cm), high nuclear grade, comedo-type, negative progesterone receptor (PR), negative oestrogen receptor (ER), high Ki-67 and axillary lymph node metastasis were more frequently found in DCIS-MI than in DCIS (all p<0.05), and the first four of these were found to be independent predictors of DCIS-MI in the multivariate analysis (all p<0.05). Regarding imaging findings, compared to DCIS, DCIS-MI showed fewer occult lesions and more lesions with calcifications in mass, asymmetry, and architectural distortion (p=0.004). Grouped calcifications were usually associated with DCIS, while regional calcifications were commonly found in DCIS-MI (p<0.05). CONCLUSION Large extent, high nuclear grade, comedo-type and negative PR were found to be independent predictors of DCIS-MI. Lesions with calcifications and regional calcifications were more likely associated with DCIS-MI on mammography.
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Affiliation(s)
- M Zhang
- The Department of Breast Imaging, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao 266100, Shandong province, China
| | - Q Lin
- The Department of Breast Imaging, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao 266100, Shandong province, China.
| | - X H Su
- The Department of Breast Imaging, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao 266100, Shandong province, China
| | - C X Cui
- The Department of Breast Imaging, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao 266100, Shandong province, China
| | - T T Bian
- The Department of Breast Imaging, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao 266100, Shandong province, China
| | - C Q Wang
- The Department of Pathology, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao 266100, Shandong province, China
| | - J Zhao
- The Department of Pathology, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao 266100, Shandong province, China
| | - L L Li
- The Department of Breast Imaging, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao 266100, Shandong province, China
| | - J Z Ma
- The Department of Breast Imaging, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao 266100, Shandong province, China
| | - J L Huang
- The Department of Breast Imaging, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao 266100, Shandong province, China
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12
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Si J, Guo R, Pan H, Lu X, Guo Z, Han C, Xue L, Xing D, Wu W, Chen C. Multiple Microinvasion Foci in Ductal Carcinoma In Situ Is Associated With an Increased Risk of Recurrence and Worse Survival Outcome. Front Oncol 2020; 10:607502. [PMID: 33344258 PMCID: PMC7744719 DOI: 10.3389/fonc.2020.607502] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/05/2020] [Indexed: 12/21/2022] Open
Abstract
Background Ductal carcinoma in situ with microinvasion (DCISM) was defined as one or more foci of invasion beyond the basement membrane within 1 mm. The size of primary lesion is associated with axillary status and prognosis in patients with invasive breast cancer; thus, it is of interest to determine whether multiple foci of microinvasion are associated with a higher risk of positive axillary status or worse long-term outcomes in patients with DCISM. Methods This study identified 359 patients with DCISM who had undergone axillary evaluation at our institute from January 2006 to December 2015. Patients were categorized as one focus or multiple foci (≥2 foci) according to the pathological results. Clinicopathological features, axillary status, and disease-free survival rate were obtained and analyzed. Results Of 359 patients, 233 (64.90%) had one focus of microinvasion and 126 (35.10%) had multiple foci. Overall, 242 (67.41%) and 117 (32.59%) patients underwent sentinel lymph nodes biopsy (SLNB) and axillary lymph nodes dissection (ALND), respectively. Isolated tumor cells were found in four (1.11%) patients and axillary metastasis rate was 2.51%. Neither axillary evaluation methods (P = 0.244) nor axillary metastasis rate (P = 0.559) was significantly different between patients with one focus and multiple foci. In univariate analysis, patients with multiple foci tended to have larger tumor size (P < 0.001), higher nuclear grade (P = 0.001), and higher rate of lymphatic vascular invasion (P = 0.034). Also, the proportion of positive HER2 (P = 0.027) and Ki67 level (P = 0.004) increased in patients with multiple foci, while in multivariate analysis, only tumor size showed significant difference (P = 0.009). Patients with multiple foci were more likely to receive chemotherapy (56.35 vs 40.77%; P = 0.028). At median 5.11 years follow-up, overall survival rate was 99.36%. Patients with multiple microinvasive foci had worse disease-free survival rate compared with one-focus patients (98.29 vs 93.01%, P = 0.032). Conclusion Even though the numbers of microinvasion were different and patients with multiple foci of microinvasion tended to have larger tumor size, there was no higher risk of axillary involvement compared with patients with one focus of microinvasion, while patients with multiple microinvasive foci had worse DFS rate. Thus, DCISM patients with multiple foci of microinvasion may be the criterion for more aggressive local–regional treatment. Optimization of adjuvant therapy in DCISM patients is required.
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Affiliation(s)
- Jing Si
- Department of Breast Disease, The First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing University, Jiaxing, China.,Cancer Research Center, The First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Rong Guo
- Department of Breast Surgery, Breast Cancer Center of the Third Affiliated Hospital of Kunming Medical University, Cancer Hospital of Yunnan Province, Kunming, China
| | - Huan Pan
- Department of Central Laboratory, The First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Xiang Lu
- Department of Breast Disease, The First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Zhiqin Guo
- Department of Pathology, The First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Chao Han
- Department of Breast Disease, The First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Li Xue
- Department of Breast Disease, The First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Dan Xing
- Department of Breast Disease, The First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Wanxin Wu
- Department of Pathology, The First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Caiping Chen
- Department of Breast Disease, The First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing University, Jiaxing, China.,Cancer Research Center, The First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing University, Jiaxing, China
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13
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Zheng J, Yu J, Zhou T. Clinical characteristics of breast ductal carcinoma in situ with microinvasion: a narrative review. J Int Med Res 2020; 48:300060520969304. [PMID: 33179556 PMCID: PMC7673047 DOI: 10.1177/0300060520969304] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/05/2020] [Indexed: 11/16/2022] Open
Abstract
Ductal carcinoma in situ (DCIS) with microinvasion (DCIS-MI) is defined as the extension of cancer cells beyond the basement membrane into adjacent tissue with no focus larger than 1 mm or a maximum diameter of less than 1 mm for multiple invasive foci. DCIS-MI constitutes approximately 1% of all breast cancer cases and 5% to 10% of cases of DCIS. The current literature is controversial concerning the clinical prognostic features and management of DCIS-MI. This narrative review described recently reported literature regarding the characteristics, diagnosis, treatment, and prognosis of DCIS-MI.
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Affiliation(s)
- Jie Zheng
- Department of Breast Cancer Center, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jingjing Yu
- Division of Gland Sugery, The Third Hospital of Xingtai, Xingtai, China
| | - Tao Zhou
- Department of Breast Cancer Center, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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14
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Fan B, Pardo JA, Serres S, Alapati AC, Szewczyk J, Mele A, James TA. Role of Sentinel Lymph Node Biopsy in Microinvasive Breast Cancer. Ann Surg Oncol 2020; 27:4468-4473. [PMID: 32430750 DOI: 10.1245/s10434-020-08606-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Microinvasive ductal carcinoma (DCISM), defined as DCIS with a focus of invasive carcinoma ≤ 1 mm, can be managed similarly to pure DCIS; however, management of the axilla in DCISM has been a subject of debate. Reports in the literature differ on the utility and necessity of sentinel lymph node biopsy (SLNB) for DCISM. The aim of the present study was to identify risk factors for nodal disease in patients with DCISM, which can help develop a selective approach to SLNB in this patient population. METHODS The National Cancer Database was used to select patients with DCISM (pT1mi), diagnosed from 2012 to 2015, who underwent SLNB. Multivariable regression analysis was performed to determine associations between sentinel lymph node metastasis and relevant clinical variables. RESULTS Our cohort comprised of 2609 patients with pT1mi who underwent SLNB. Of these, 76 (2.9%) were found to have sentinel lymph node metastases on final pathology. Low/intermediate grade tumors were associated with decreased SLN metastasis (OR 0.50, CI 0.28-0.92). Age and receptor status of the tumor did not have a clear association in predicting SLN metastases. CONCLUSIONS The rate of sentinel node metastases in DCISM is low at only 2.9% in this national study. Tumor grade was identified as influencing the risk of SLN metastases. This information can factor into shared decision-making for SLNB in patients with DCISM.
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Affiliation(s)
- Betty Fan
- Department of Surgery, Breast Care Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jaime A Pardo
- Department of Surgery, Breast Care Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stephanie Serres
- Department of Surgery, Breast Care Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Amulya C Alapati
- Department of Surgery, Breast Care Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Joanne Szewczyk
- Department of Surgery, Breast Care Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Alessandra Mele
- Department of Surgery, Breast Care Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ted A James
- Department of Surgery, Breast Care Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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15
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Zheng J, Zhou T, Li F, Shi J, Zhang L. Clinic-Pathological Features of Breast Ductal Carcinoma in Situ with Micro-Invasion. Cancer Invest 2020; 38:113-121. [PMID: 31939679 DOI: 10.1080/07357907.2020.1715422] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background: To investigate the differences of clinic-pathological features among ductal carcinoma in situ (DCIS), ductal carcinoma in situ with micro-invasion (DCIS-MI) and early invasive carcinoma (IDC) in stage T1.Methods: From January 2014 to December 2018, 308 cases DCIS, DCIS-MI 92 cases and 111 cases of T1a, 343 cases of T1b, and 1032 cases of T1c were investigated in a retrospective analysis. The population and clinic-pathological characteristics including age, menstrual status, surgical mode, lymph node status and molecular markers were compared in each group. Survival rate of all patients were followed-up for 5 years.Results: Compared with DCIS-MI group, the higher breast-conserving rate and lower lymph node metastasis rate in the DCIS group were shown in the DCIS-MI group (p < .05). There were no significant differences in tumor diameter, number of tumors, ER, PR, HER2 and Ki67 expression, molecular typing, (p > .05). The expression of Ki67 in T1a, T1b and T1c groups increased gradually with elevated grades (p < .05). The proportion of HER2-positive patients in DCIS-MI group was significantly higher than that in T1a-b-c (p < .05). There were no significant differences in DFS and OS between the 3 groups (p > .05).Conclusions: The clinic-pathological features of DCIS-MI are similar to those of DCIS and T1a, but significantly different from T1c.
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Affiliation(s)
- Jie Zheng
- First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Tao Zhou
- Department of Breast Cancer Center, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Fang Li
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jiajie Shi
- Department of Breast Cancer Center, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lina Zhang
- Department of Breast Cancer Center, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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16
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Gooch JC, Schnabel F, Chun J, Pirraglia E, Troxel AB, Guth A, Shapiro R, Axelrod D, Roses D. A Nomogram to Predict Factors Associated with Lymph Node Metastasis in Ductal Carcinoma In Situ with Microinvasion. Ann Surg Oncol 2019; 26:4302-4309. [PMID: 31529311 DOI: 10.1245/s10434-019-07750-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Ductal carcinoma in situ (DCIS) with foci of invasion measuring ≤ 1 mm (DCISM), represents < 1% of all invasive breast cancers. Sentinel lymph node biopsy (SLNB) has been a standard component of surgery for patients with invasive carcinoma or extensive DCIS. We hypothesize that selective performance of SLNB may be appropriate given the low incidence of sentinel node (SN) metastasis for DCISM. We investigated the clinicopathologic predictors for SN positivity in DCISM, to identify which patients might benefit from SLNB. METHODS A retrospective review of the National Cancer Database was performed for cases from 2012 to 2015. Clinical and tumor characteristics, including SN results, were evaluated, and Pearson's Chi square tests and logistic regression were performed. RESULTS Of 7803 patients with DCISM, 306 (4%) had at least one positive SN. Patients with positive SNs were younger, more often of Black race, had higher-grade histology and larger tumor size, and were more likely to have lymphovascular invasion (LVI; all p < 0.001). In an adjusted model, the presence of LVI was associated with the highest odds ratio (OR) for node positivity (OR 8.80, 95% confidence interval 4.56-16.96). CONCLUSIONS Among women with DCISM, only 4% had a positive SN. Node positivity was associated with more extensive and higher-grade DCIS, and the presence of LVI was strongly correlated with node positivity. Our data suggest that LVI is the most important factor in determining which patients with DCISM will benefit from SN biopsy.
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Affiliation(s)
- Jessica C Gooch
- Division of Breast Surgery, Department of Surgery, Perlmutter Comprehensive Cancer Center, New York University Langone Health, 160 East 34th St, New York, NY, 10016, USA.,Division of Surgical Oncology, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Freya Schnabel
- Division of Breast Surgery, Department of Surgery, Perlmutter Comprehensive Cancer Center, New York University Langone Health, 160 East 34th St, New York, NY, 10016, USA
| | - Jennifer Chun
- Division of Breast Surgery, Department of Surgery, Perlmutter Comprehensive Cancer Center, New York University Langone Health, 160 East 34th St, New York, NY, 10016, USA
| | - Elizabeth Pirraglia
- Department of Population Health, Division of Biostatistics, New York University Langone Health, New York, NY, USA
| | - Andrea B Troxel
- Department of Population Health, Division of Biostatistics, New York University Langone Health, New York, NY, USA
| | - Amber Guth
- Division of Breast Surgery, Department of Surgery, Perlmutter Comprehensive Cancer Center, New York University Langone Health, 160 East 34th St, New York, NY, 10016, USA
| | - Richard Shapiro
- Division of Breast Surgery, Department of Surgery, Perlmutter Comprehensive Cancer Center, New York University Langone Health, 160 East 34th St, New York, NY, 10016, USA
| | - Deborah Axelrod
- Division of Breast Surgery, Department of Surgery, Perlmutter Comprehensive Cancer Center, New York University Langone Health, 160 East 34th St, New York, NY, 10016, USA
| | - Daniel Roses
- Division of Breast Surgery, Department of Surgery, Perlmutter Comprehensive Cancer Center, New York University Langone Health, 160 East 34th St, New York, NY, 10016, USA.
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17
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Flanagan MR, Cody HS. ASO Author Reflections: Sentinel Lymph Node Biopsy for Ductal Carcinoma In Situ with Suspicion for Microinvasion on Core Needle Biopsy. Ann Surg Oncol 2019; 26:704. [PMID: 31444603 DOI: 10.1245/s10434-019-07747-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Meghan R Flanagan
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hiram S Cody
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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18
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Flanagan MR, Stempel M, Brogi E, Morrow M, Cody HS. Is Sentinel Lymph Node Biopsy Required for a Core Biopsy Diagnosis of Ductal Carcinoma In Situ with Microinvasion? Ann Surg Oncol 2019; 26:2738-2746. [PMID: 31147995 DOI: 10.1245/s10434-019-07475-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Among patients with a core biopsy diagnosis of ductal carcinoma in situ (DCIS), approximately 10% have microinvasion (DCISM), which, like DCIS, is subject to upstaging by surgical excision, but for which the rates of T and N upstaging are unknown, as is the role of sentinel lymph node biopsy (SLNB), since current studies of SLNB for DCISM are based on the final pathologic report, not the core needle biopsy. In this study, we identified the rates of T and N upstaging following surgical excision in patients with a suspected versus definite core needle biopsy diagnosis of DCISM. METHODS Overall, 369 consecutive patients (2007-2017) with a core biopsy diagnosis of suspected versus definite DCISM and surgical excision were stratified by extent of DCISM on core biopsy: suspicious focus, single focus, multiple foci/single biopsy, and multiple foci/multiple biopsies. Within strata, we identified clinicopathologic features associated with T and N upstaging. RESULTS Across core biopsy strata, there were no clear differences in imaging characteristics or median invasive tumor size (0.2 cm). Among 105 patients with a core biopsy suspicious for DCISM versus 264 with definite DCISM, 28% and 37%, respectively, were upstaged to at least pT1a, but only 1% and 6%, respectively, to pN1. CONCLUSIONS Although 28% of patients with suspected DCISM on core biopsy were surgically upstaged to invasive cancer, the frequency of pN1 SLN metastasis (1%) was comparable with that of DCIS, and was insufficient to recommend SLNB at initial surgery. SLNB remains reasonable for patients with definite DCISM on core biopsy.
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Affiliation(s)
- Meghan R Flanagan
- Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Michelle Stempel
- Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Edi Brogi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Hiram S Cody
- Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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19
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Sentinel and non-sentinel lymph node metastases in patients with microinvasive breast cancer: a nationwide study. Breast Cancer Res Treat 2019; 175:713-719. [DOI: 10.1007/s10549-019-05200-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 03/07/2019] [Indexed: 10/27/2022]
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20
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Magnoni F, Massari G, Santomauro G, Bagnardi V, Pagan E, Peruzzotti G, Galimberti V, Veronesi P, Sacchini VS. Sentinel lymph node biopsy in microinvasive ductal carcinoma in situ. Br J Surg 2019; 106:375-383. [PMID: 30791092 DOI: 10.1002/bjs.11079] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/25/2018] [Accepted: 11/12/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND Microinvasive breast cancer is an uncommon pathological entity. Owing to the rarity of this condition, its surgical axillary management and overall prognosis remain controversial. METHODS A database was analysed to identify patients with microinvasive ductal carcinoma in situ (DCIS) who had surgery for invasive breast cancer at the European Institute of Oncology, Milan, between 1998 and 2010. Women who had undergone axillary staging by sentinel lymph node biopsy were included in the study. RESULTS Of 257 women with microinvasive breast cancer who underwent sentinel lymph node biopsy (SLNB), 226 (87·9 per cent) had negative sentinel lymph nodes (SLNs) and 31 had metastatic SLNs. Twelve patients had isolated tumour cells (ITCs), 14 had micrometastases and five had macrometastases in sentinel nodes. Axillary lymph node dissection was performed in 16 of the 31 patients with positive SLNs. After a median follow-up of 11 years, only one regional first event was observed in the 15 patients with positive SLNs who did not undergo axillary lymph node dissection. There were no regional first events in the 16 patients with positive SLNs who had axillary dissection. CONCLUSION Good disease-free and overall survival were found in women with positive SLNs and microinvasive DCIS. This study is in line with studies showing that SLNB in microinvasive DCIS may not be useful, and supports the evidence that less surgery can provide the same level of overall survival with better quality of life.
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Affiliation(s)
- F Magnoni
- European Institute of Oncology, University of Milan-Bicocca, Milan, Italy
| | - G Massari
- European Institute of Oncology, University of Milan-Bicocca, Milan, Italy
| | - G Santomauro
- European Institute of Oncology, University of Milan-Bicocca, Milan, Italy
| | - V Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - E Pagan
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - G Peruzzotti
- European Institute of Oncology, University of Milan-Bicocca, Milan, Italy
| | - V Galimberti
- European Institute of Oncology, University of Milan-Bicocca, Milan, Italy
| | - P Veronesi
- European Institute of Oncology, University of Milan-Bicocca, Milan, Italy
| | - V S Sacchini
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
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21
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Chen C, Huang S, Huang A, Jia Y, Wang J, Zhang Z, Mao M, Wang L, Zhou J. Risk factors for lymph node metastasis and the impact of adjuvant chemotherapy on ductal carcinoma in situ with microinvasion: a population-based study. Onco Targets Ther 2018; 11:9071-9080. [PMID: 30588019 PMCID: PMC6300372 DOI: 10.2147/ott.s186228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Ductal carcinoma in situ with microinvasion (DCISM) represents ~1% of all breast cancer cases. Risk factors for lymph node (LN) metastasis and appropriate adjuvant therapy for DCISM are still widely debated. METHODS We retrieved DCISM data from the National Cancer Institute's Surveillance, Epidemiology, and End Results registry database (1998-2013). Chi-squared tests and logistic regression models were applied to investigate the potential risks of LN metastasis. Univariate and multivariate Cox proportional hazards regressions were performed to estimate the prognostic factors of DCISM. Survival outcomes were estimated using the Kaplan-Meier method. A 1:1 propensity score matching was used to minimize potential bias. RESULTS Overall, 6,219 patients with DCISM met our inclusion criteria. Younger age and higher grade disease were identified as risk factors for LN metastasis. In the multivariable analysis, LN metastasis and chemotherapy were prognostic factors for worse overall survival and breast cancer-specific survival. Furthermore, propensity score matching and subgroup analysis showed that chemotherapy may not be effective for DCISM patients. CONCLUSION Younger patients with high-grade disease tend to have LN involved in DCISM. Adjuvant chemotherapy might not be necessary for patients with DCISM.
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Affiliation(s)
- Cong Chen
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China, ;
- Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Hangzhou, China, ;
| | - Shumin Huang
- The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Aihua Huang
- Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Hangzhou, China, ;
- Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yunlu Jia
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China, ;
- Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Hangzhou, China, ;
| | - Ji Wang
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China, ;
- Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Hangzhou, China, ;
| | - Zeqin Zhang
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China, ;
- Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Hangzhou, China, ;
| | - Misha Mao
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China, ;
- Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Hangzhou, China, ;
| | - Linbo Wang
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China, ;
- Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Hangzhou, China, ;
| | - Jichun Zhou
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China, ;
- Biomedical Research Center and Key Laboratory of Biotherapy of Zhejiang Province, Hangzhou, China, ;
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22
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Lillemoe TJ, Tsai ML, Swenson KK, Susnik B, Krueger J, Harris K, Rueth N, Grimm E, Leach JW. Clinicopathologic analysis of a large series of microinvasive breast cancers. Breast J 2018; 24:574-579. [DOI: 10.1111/tbj.13001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/24/2017] [Accepted: 07/27/2017] [Indexed: 12/23/2022]
Affiliation(s)
| | - Michaela L. Tsai
- Allina Health System; Virginia Piper Cancer Institute; Minneapolis MN USA
| | - Karen K. Swenson
- Allina Health System; Virginia Piper Cancer Institute; Minneapolis MN USA
| | | | - Janet Krueger
- Allina Health System; Virginia Piper Cancer Institute; Minneapolis MN USA
| | - Kendra Harris
- Allina Health System; Virginia Piper Cancer Institute; Minneapolis MN USA
| | - Natasha Rueth
- Allina Health System; Virginia Piper Cancer Institute; Minneapolis MN USA
| | - Erin Grimm
- Allina Health Laboratories; Minneapolis MN USA
| | - Joseph W. Leach
- Allina Health System; Virginia Piper Cancer Institute; Minneapolis MN USA
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23
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Fang Y, Wu J, Wang W, Fei X, Zong Y, Chen X, Huang O, He J, Chen W, Li Y, Shen K, Zhu L. Biologic behavior and long-term outcomes of breast ductal carcinoma in situ with microinvasion. Oncotarget 2018; 7:64182-64190. [PMID: 27577080 PMCID: PMC5325434 DOI: 10.18632/oncotarget.11639] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 08/13/2016] [Indexed: 11/25/2022] Open
Abstract
Background Ductal carcinoma in situ with microinvasion (DCIS-Mi) generally has favorable prognosis, but the long-term outcomes of DCIS-Mi and the biologic evolution from ductal carcinoma in situ (DCIS), DCIS-Mi, to DCIS with T1a breast cancer (DCIS-T1a) has not been specified. The aim of our study was to explore the biological and prognostic features of DCIS-Mi, compared with pure DCIS and DCIS-T1a. Results After a median follow-up of 31 months, the 3-year estimated disease free survival(DFS) rate of DCIS-Mi patients was significantly lower than that of pure DCIS patients (89.5% vs 97.1%, P=0.009). Patients with DCIS-Mi or DCIS-T1a tumors had comparable 3-year estimated DFS rates (89.5% vs 94.3%, P=0.13). No significant difference in overall survival (OS) was found among different groups (99.6%, 100% and 99.1% for DCIS, DCIS-Mi and DCIS-T1a, P=0.797). In chemotherapy and trastuzumab-naive DCIS-Mi patients, human epidermal growth factor receptor2 (HER2) positivity (HR=21.8, 95%CI, 1.7-286.8, P=0.019) were independent predictor of worse DFS on multivariate analysis. Methods During September 2002 and December 2014, 602 breast cancer patients who underwent radical surgery were retrospectively reviewed. Three hundred and fifty-nine patients (59.6%) had pure DCIS, 84(14.0%) and 159(26.4%) were diagnosed as DCIS-Mi and DCIS-T1a. Clinico-pathological features were compared between different subgroups. Conclusions DCIS-Mi displayed a comparable survival to that of DCIS-T1a and a more aggressive biological nature than pure DCIS. Patients with HER2-positive DCIS-Mi had a worse survival and adjuvant chemotherapy plus target therapy needs to be further optimized in those patients.
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Affiliation(s)
- Yan Fang
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China
| | - Jiayi Wu
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China
| | - Wei Wang
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China
| | - Xiaochun Fei
- Department of Pathology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China
| | - Yu Zong
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China
| | - Xiaosong Chen
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China
| | - Ou Huang
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China
| | - Jianrong He
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China
| | - Weiguo Chen
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China
| | - Yafen Li
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China
| | - Kunwei Shen
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China
| | - Li Zhu
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China
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24
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Szynglarewicz B, Kasprzak P, Donizy P, Biecek P, Halon A, Matkowski R. Epithelial-mesenchymal transition inducer Snail1 and invasive potential of intraductal breast cancer. J Surg Oncol 2017; 116:696-705. [PMID: 28570750 DOI: 10.1002/jso.24708] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/08/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Transcription factor Snail1 is a key inducer of epithelial-mesenchymal transition (EMT), a biological process implicated in the cancer progression and metastasis. The aim of the study was to investigate Snail1 expression in DCIS found on breast biopsy and assess its predictive value for the final invasion. METHODS A total of 209 patients with histologically diagnosed pure DCIS entered the study. Snail1 reactivity was evaluated with immunohistochemistry in tumor tissue from stereotactic vacuum-assisted biopsy of suspicious microcalcifications. RESULTS Snail1 staining was observed in 62% of tumors: weak, intermediate, and strong in 27%, 21%, and 14% of lesions, respectively. Positive Snail1 expression was significantly rarer in DCIS presenting as powdery microcalcifications, when compared with crushed stone-like and casting-type and was more common in DCIS with comedonecrosis. Correlation with other features was not significant. None of standard parameters significantly influenced the upgrading rate. In contrast, in uni- and multivariate analysis the risk of postoperative invasion was significantly associated with positive Snail1 immunoreactivity. Moreover, there was a significant stepwise increase of upgrading rate according to Snail1 expression in DCIS cells: weak 9%, intermediate 26%, and strong 55%, respectively. CONCLUSIONS Snail1 can reflect the invasive potential of DCIS and help identify its more aggressive subtypes.
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Affiliation(s)
- Bartlomiej Szynglarewicz
- Breast Unit, Department of Surgical Oncology, Lower Silesia Oncology Center, Wroclaw, Poland.,Department of Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Piotr Kasprzak
- Department of Breast Imaging, Lower Silesia Oncology Center, Wroclaw, Poland
| | - Piotr Donizy
- Department of Pathomorphology and Oncological Cytology, Wroclaw Medical University, Wroclaw, Poland
| | - Przemyslaw Biecek
- Faculty of Mathematics, Informatics and Mechanics, University of Warsaw, Warsaw, Poland
| | - Agnieszka Halon
- Department of Pathomorphology and Oncological Cytology, Wroclaw Medical University, Wroclaw, Poland
| | - Rafal Matkowski
- Breast Unit, Department of Surgical Oncology, Lower Silesia Oncology Center, Wroclaw, Poland.,Department of Oncology, Wroclaw Medical University, Wroclaw, Poland
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25
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Lung Adenocarcinoma Staging Using the 2011 IASLC/ATS/ERS Classification: A Pooled Analysis of Adenocarcinoma In Situ and Minimally Invasive Adenocarcinoma. Clin Lung Cancer 2016; 17:e57-e64. [DOI: 10.1016/j.cllc.2016.03.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/22/2016] [Accepted: 03/22/2016] [Indexed: 11/20/2022]
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26
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Cserni G, Wells CA, Kaya H, Regitnig P, Sapino A, Floris G, Decker T, Foschini MP, van Diest PJ, Grabau D, Reiner A, DeGaetano J, Chmielik E, Cordoba A, Andreu X, Zolota V, Charafe-Jauffret E, Ryska A, Varga Z, Weingertner N, Bellocq JP, Liepniece-Karele I, Callagy G, Kulka J, Bürger H, Figueiredo P, Wesseling J, Amendoeira I, Faverly D, Quinn CM, Bianchi S. Consistency in recognizing microinvasion in breast carcinomas is improved by immunohistochemistry for myoepithelial markers. Virchows Arch 2016; 468:473-81. [DOI: 10.1007/s00428-016-1909-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 08/24/2015] [Accepted: 01/14/2016] [Indexed: 11/29/2022]
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27
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Orzalesi L, Casella D, Criscenti V, Gjondedaj U, Bianchi S, Vezzosi V, Nori J, Cecconi L, Meattini I, Livi L, Bernini M. Microinvasive breast cancer: pathological parameters, cancer subtypes distribution, and correlation with axillary lymph nodes invasion. Results of a large single-institution series. Breast Cancer 2015; 23:640-8. [DOI: 10.1007/s12282-015-0616-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 05/05/2015] [Indexed: 01/04/2023]
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