Extensive intraductal component (EIC) and estrogen receptor (ER) status in breast cancer

Assessment of the extent of microcalcifications to predict the size of a ductal carcinoma in situ: comparison between tomosynthesis and conventional mammography

OBJECTIVES

The objective was to determine if digital tomosynthesis of the breast (DBT) assesses the extension of ductal carcinoma in situ (DCIS) with higher precision than mammography (MG).

MATERIAL AND METHODS

The local ethics committee approved this retrospective study including 26 patients with DCIS, which were rated by three radiologists. Statistics were performed using intraclass correlation (ICC) for interreader agreement and the Pearson correlation for correlation of MG and DBT. Standard of reference was the histologic extension.

RESULTS

The ICC was excellent. Correlation between MG and histology was 0.879 (P<.01) and for DBT and histology was 0.914 (P<.01).

CONCLUSION

DBT provides a slightly better estimation of the size of a DCIS than MG.

MARGINS AND OUTCOME OF SCREEN-DETECTED BREAST CANCER WITH EXTENSIVE IN SITU COMPONENT

BACKGROUND

In situ disease surrounding invasive tumours is an important consideration in the management of patients with early breast cancer. This study of screen-detected breast cancers assessed the influence of in situ disease including an extensive in situ component (defined as ductal carcinoma in situ involving more than 25% of the area within the invasive tumour) on surgical management, local recurrence and survival of a group of patients.

METHODS

A total of 595 cases of invasive breast cancer detected at St Vincent's BreastScreen were retrospectively reviewed to determine presence and extent of in situ disease, the surgical procedure and adequacy of excision. Outcome was examined in a cohort of 126 cases.

RESULTS

A total of 438 (74%) patients had in situ foci in or around the invasive tumour and 107 (18%) were defined as extensive in situ component (EIC)-positive. The initial procedure was mastectomy in 20% of the cases and breast-conserving surgery in 80% including 18% who underwent further surgery. Re-excision (P = 0.02) or mastectomy (P = 0.01) was more often required in patients with EIC. After definitive local excision, margins were close or involved with invasive disease in 3% but the patients with EIC were more likely to have margins close or involved with in situ disease (16 vs 2%; P = 0.001). There were seven deaths and one local invasive recurrence in the follow-up group and none of the deaths were in patients who were EIC-positive.

CONCLUSIONS

EIC predicts for a higher rate of re-excision and/or mastectomy. For patients with EIC, there is an acceptably low risk of local recurrence if margins are clear.