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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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Shin YD, Kang G, Jang H, Choi YJ. Trends in Axillary Surgery for Treating Ductal Carcinoma In Situ: A Korean Population-based Study. J Breast Cancer 2021; 24:49-62. [PMID: 33634620 PMCID: PMC7920862 DOI: 10.4048/jbc.2021.24.e10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 01/25/2021] [Accepted: 01/25/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Ductal carcinoma in situ (DCIS) is common in South Korea. We evaluated the patterns of axillary surgery among patients with DCIS to highlight the need for compliance with the updated national guidelines. We also evaluated whether sentinel lymph node biopsy (SLNB) was performed in accordance with the national guidelines. Methods The Korean Health Insurance Review and Assessment Service-National Inpatient Sample database was searched for patients with DCIS (2009–2015) to identify axillary surgery patterns by breast surgery type, year of diagnosis, age at diagnosis, and the location and volume of surgeries for DCIS at the hospital. The rates of SLNB and axillary dissection were compared using descriptive statistics and univariate analyses. Analyses were also conducted using the chi-squared test and multiple logistic regression analysis. Results We identified 16,315 Korean women who underwent surgery for DCIS, including 11,292 cases of SLNB (69.2%) and 131 cases of axillary lymph node dissection (0.8%). Breast-conserving surgery (BCS) was performed in 10,323 patients (63.3%) with an SLNB rate of 56.0%, while total mastectomy (TM) was performed in 5,992 patients (36.7%), with an SLNB rate of 92.0%. During 2009–2015, the SLNB rate during TM increased from 88.23% to 92.80%. SLNB was influenced by hospital region and surgical volume, and hospitals performing low volumes of surgeries were significantly more likely to perform SLNB regardless of the surgery type (odds ratio, 1.372; 95% confidence interval, 1.265–1.488). Conclusion Although the Korean guidelines recommend SLNB for all TM procedures and select BCS procedures for DCIS, relatively high rates of SLNB were performed for BCS, and there was inter-hospital variability in performing SLNB. Improved compliance with the guidelines by the surgeons is critical for Korean patients with DCIS.
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Affiliation(s)
- Young Duck Shin
- Department of Anesthesiology and Pain Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Gilwon Kang
- Department of Health Informatics and Management, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Hoyeon Jang
- Department of Health Informatics and Management, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Young Jin Choi
- Department of Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea.
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Pyfer BJ, Jonczyk M, Jean J, Graham RA, Chen L, Chatterjee A. Analysis of Surgical Trends for Axillary Lymph Node Management in Patients with Ductal Carcinoma In Situ Using the NSQIP Database: Are We Following National Guidelines? Ann Surg Oncol 2020; 27:3448-3455. [PMID: 32232706 DOI: 10.1245/s10434-020-08374-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND For patients with ductal carcinoma in situ (DCIS), multiple national cancer organizations recommend that sentinel lymph node biopsy (SLNB) be offered when treated with mastectomy, but not when treated with breast-conserving surgery (BCS). This study analyzes national surgical trends of SLNB and axillary lymph node dissection (ALND) in DCIS patients undergoing breast surgery with the aim to quantify deviations from national guidelines. METHODS A retrospective cohort analysis of the American College of Surgeons' National Surgical Quality Improvement Program (ACS NSQIP) database from 2005 to 2017 identified patients with DCIS. Patients were categorized by their primary method of breast surgery, i.e. mastectomy or BCS, then further categorized by their axillary lymph node (ALN) management, i.e. no intervention, SLNB, or ALND. Data analysis was conducted via linear regression and a non-parametric Mann-Kendall test to assess a temporal trend and Sen's slope. RESULTS Overall, 43,448 patients with DCIS met the inclusion criteria: 20,504 underwent mastectomy and 22,944 underwent BCS. Analysis of DCIS patients from 2005 to 2017 revealed that ALND decreased and SLNB increased in every subgroup, regardless of surgical treatment modality. Evaluation in the mastectomy group increased overall: mastectomy alone increased from 57.1 to 65.8% (p < 0.01) and mastectomy with immediate reconstruction increased from 58.5 to 72.1% (p < 0.01). Increases also occurred in the total BCS population: partial mastectomy increased from 14.0 to 21.1% and oncoplastic surgery increased from 10.5 to 23.0% (both p < 0.01). CONCLUSIONS Despite national guideline recommendations for the management of ALN surgery in DCIS patients, approximately 20-30% of cases continue to not follow these guidelines. This warrants further education for surgeons and patients.
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Affiliation(s)
| | | | - Jolie Jean
- Tufts University Medical School, Boston, MA, USA
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Kim S, Kim J, Park HS, Kim HY, Lee K, Lee J, Lee H, Kim JY, Kim SI, Cho YU, Park BW. An Updated Nomogram for Predicting Invasiveness in Preoperative Ductal Carcinoma In Situ of the Breast. Yonsei Med J 2019; 60:1028-1035. [PMID: 31637884 PMCID: PMC6813145 DOI: 10.3349/ymj.2019.60.11.1028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/26/2019] [Accepted: 09/06/2019] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To validate and update a nomogram for predicting ductal carcinoma in situ (DCIS) upstaging in preoperative biopsy. MATERIALS AND METHODS Medical records of 444 preoperative DCIS patients were evaluated and used to validate a previous version of the Severance nomogram for predicting DCIS upstaging in preoperative biopsy. Patients were divided into two groups according to the final postoperative pathology. Univariate and multivariate analyses with the chi-square test, Student's t-test, and binary logistic regression method identified new significant variables. The updated nomogram was evaluated with the C-index and Hosmer-Lemeshow goodness of fit test. RESULTS The area under a receiver operating characteristic curve for comparison with the previous nomogram was 0.48. In postoperative pathology, the pure DCIS and invasive cancer groups comprised 345 and 99 cases, respectively. Approximately 22.3% of patients preoperatively diagnosed with DCIS were upstaged to invasive cancer. Significant variables in the univariate analysis were operation type, human epidermal growth factor receptor 2 overexpression, comedo necrosis, sonographic mass, mammographic mass, preoperative biopsy method, and suspicious microinvasion in preoperative biopsy. In multivariate analysis, operation type, sonographic mass, mammographic mass, and suspicious microinvasion were risk factors for upstaging. The updated model with these variables showed moderate discrimination and was appropriate in the calibration test. CONCLUSION The previous nomogram did not effectively discriminate upstaging of preoperative DCIS in an independent cohort. An updated version of the nomogram appears to provide more accurate information for predicting preoperative DCIS upstaging.
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Affiliation(s)
- Sanghwa Kim
- Department of Breast and Endocrine Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Jihong Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Seok Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
| | - Ha Yan Kim
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
| | - Kwanbum Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jeea Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Haemin Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jee Ye Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Young Up Cho
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Byeong Woo Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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Hotton J, Salleron J, Rauch P, Buhler J, Pierret M, Baumard F, Leufflen L, Marchal F. Predictive factors of axillary positive sentinel lymph node biopsy in extended ductal carcinoma in situ treated by simple mastectomy at once. J Gynecol Obstet Hum Reprod 2019; 49:101641. [PMID: 31562936 DOI: 10.1016/j.jogoh.2019.101641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/30/2019] [Accepted: 09/24/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The incidence of positive sentinel lymph node biopsy (SLNB) in ductal carcinoma in situ (DCIS) ranged from 0 to 14%. The main hypothesis would be the presence of an invasive contingent on the final histology. The objective was to identify predictive factors of sentinel lymph node positivity in the management of extended ductal carcinoma in situ treated by simple mastectomy. METHODS This was a retrospective study carried out at the Lorraine Cancer Institute from January 2003 to December 2017. Women with DCIS on core-needle biopsy whose management consisted of simple mastectomy and SLNB procedure were included. RESULTS 188 patients were analyzed. Preoperatively, 18 patients (9.6%) had DCIS with microinvasion, while the others had pure DCIS. Eight patients (4.2%) had positive sentinel lymph node biopsy, the majority of which were single micrometastases. Predictive factor of node invasion was microinvasion on biopsy (p<0.01). Only in cases of pure DCIS, the percentage of positive SLNB was reduced to 2.9%. Invasive carcinoma was found in the majority of patients with positive axillary SLNB procedure (75%, n=6), compared to 16.7% (n=30) without SLNB involvement (p<0.01). CONCLUSIONS The low rate of positive sentinel node biopsy in pure ductal carcinoma in situ suggests that in the absence of microinvasion, the sentinel procedure would seem less appropriate. New techniques for identifying sentinel lymph node biopsy could report axillary staging after definitive histologic results.
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Affiliation(s)
- Judicael Hotton
- Institut de Cancérologie de Lorraine, Department of Surgical Oncology, Université de Lorraine, F-54519 Vandoeuvre-lès-Nancy, France.
| | - Julia Salleron
- Institut de Cancérologie de Lorraine, Biostatistics Unit, Université de Lorraine, F-54519 Vandoeuvre-lès-Nancy, France
| | - Philippe Rauch
- Institut de Cancérologie de Lorraine, Department of Surgical Oncology, Université de Lorraine, F-54519 Vandoeuvre-lès-Nancy, France
| | - Julie Buhler
- Institut de Cancérologie de Lorraine, Department of Surgical Oncology, Université de Lorraine, F-54519 Vandoeuvre-lès-Nancy, France
| | - Marion Pierret
- Institut de Cancérologie de Lorraine, Department of Surgical Oncology, Université de Lorraine, F-54519 Vandoeuvre-lès-Nancy, France
| | - Florian Baumard
- Institut de Cancérologie de Lorraine, Biostatistics Unit, Université de Lorraine, F-54519 Vandoeuvre-lès-Nancy, France
| | - Lea Leufflen
- Institut de Cancérologie de Lorraine, Department of Surgical Oncology, Université de Lorraine, F-54519 Vandoeuvre-lès-Nancy, France
| | - Frederic Marchal
- Institut de Cancérologie de Lorraine, Department of Surgical Oncology, Université de Lorraine, F-54519 Vandoeuvre-lès-Nancy, France; Université de Lorraine, CNRS UMR7039, CRAN, F-54000 Nancy, France
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Bertozzi S, Cedolini C, Londero AP, Baita B, Giacomuzzi F, Capobianco D, Tortelli M, Uzzau A, Mariuzzi L, Risaliti A. Sentinel lymph node biopsy in patients affected by breast ductal carcinoma in situ with and without microinvasion: Retrospective observational study. Medicine (Baltimore) 2019; 98:e13831. [PMID: 30608397 PMCID: PMC6344146 DOI: 10.1097/md.0000000000013831] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
With the introduction of an organized mammographic screening, the incidence of ductal carcinoma in situ (DCIS) has experienced an important increase. Our experience with sentinel lymph node biopsy (SLNB) among patients with DCIS is reviewed.We collected retrospective data on patients operated on their breasts for DCIS (pTis), DCIS with microinvasion (DCISM) (pT1mi) and invasive ductal carcinoma (IDC) sized ≤2 cm (pT1) between January 2002 and June 2016, focusing on the result of SLNB.543 DCIS, 84 DCISM, and 2111 IDC were included. In cases of DCIS and DCISM, SLNB resulted micrometastatic respectively in 1.7% and 6.0% of cases and macrometastatic respectively in 0.9% and 3.6% of cases. 5-year disease-free survival and overall survival in DCISM and IDC were similar, while significantly longer in DCIS. 5-year local recurrence rate of DCIS and DCISM were respectively 2.5% and 7.9%, and their 5-year distant recurrence rate respectively 0% and 4%. IDC, tumor grading ≥2 and lymph node (LN) macrometastasis were significant predictors for decreased overall survival. Significant predictors for distant metastases were DCISM, IDC, macroscopic nodal metastasis, and tumor grading ≥2. Predictors for the microinvasive component in DCIS were tumor multifocality/multicentricity, grading ≥2, ITCs and micrometastases.Our study suggests that despite its rarity, sentinel node metastasis may also occur in case of DCIS, which in most cases are micrometastases. Even in the absence of an evident invasive component, microinvasion should always be suspected in these cases, and their management should be the same as for IDC.
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Affiliation(s)
- Serena Bertozzi
- Breast Unit
- Clinic of Surgery, University Hospital of Udine
- Department of Medical Area (DAME), University of Udine
| | - Carla Cedolini
- Breast Unit
- Clinic of Surgery, University Hospital of Udine
| | | | - Barbara Baita
- Breast Unit
- Clinic of Surgery, University Hospital of Udine
| | | | | | - Marta Tortelli
- Breast Unit
- Clinic of Surgery, University Hospital of Udine
| | | | - Laura Mariuzzi
- Department of Medical Area (DAME), University of Udine
- Institute of pathology, University Hospital of Udine, Udine (UD), Italy
| | - Andrea Risaliti
- Clinic of Surgery, University Hospital of Udine
- Department of Medical Area (DAME), University of Udine
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8
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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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D'eredità G, Giardina C, Napoli A, Ingravallo G, Leopoldo Troilo V, Fischetti F, Berardi T. Sentinel Lymph Node Biopsy in Patients with Pure and High-Risk Ductal Carcinoma in Situ of the Breast. TUMORI JOURNAL 2018; 95:706-11. [DOI: 10.1177/030089160909500612] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Aims and Background The role of sentinel lymph node biopsy in patients initially diagnosed with ductal carcinoma in situ resides in determining the predictors of invasive disease. The aim of the present study was to examine the incidence of sentinel lymph node metastases in a selected group of patients, with characteristics of high-risk ductal carcinoma in situ, in order to determine the clinical usefulness of sentinel lymph node biopsy. Methods A total of 90 patients with a biopsy diagnosis of ductal carcinoma in situ were treated. Fifty-two patients with high-risk ductal carcinoma in situ had sentinel lymph node biopsy. The following characteristics of the primary tumor were considered as indicative of a risk of invasive disease: presence of palpable mass, mammographic mass, multicentric disease that required mastectomy, and histologically high nuclear grade or non-high nuclear grade with necrosis. Subdermal injections of 99mTc-labeled human albumin and subareolar injection ofblue dye were used for sentinel lymph node identification. All sentinel nodes were sectioned serially and stained with hematoxylin and eosin. Immunohistochemical analysis was performed using a cytokeratin monoclonal antibody. Results A positive sentinel lymph node was found in only one patient (1.9%). The patient had a double lesion, and core-needle biopsy showed an atypical ductal hyperplasia and a intermediate degree of ductal carcinoma in situ. At pathologic review of the specimen, no invasive aspect was detected. Conclusions The results of our study indicate that sentinel lymph node metastasis in pure ductal carcinoma in situ is extremely uncommon. We therefore suggest that sentinel lymph node biopsy might be indicated for patients with ductal carcinoma in situ detected as a palpable mass or as large extensive microcalcifications, as well as for patients who are undergoing mastectomy, especially with immediate reconstruction.
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Affiliation(s)
| | | | - Anna Napoli
- Department of Pathology, University of Bari, Bari, Italy
| | | | | | | | - Tommaso Berardi
- Department of Clinical Methodology and Medical-Surgical Technologies
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Al-Ameer AY, Al Nefaie S, Al Johani B, Anwar I, Al Tweigeri T, Tulbah A, Alshabanah M, Al Malik O. Sentinel lymph node biopsy in clinically detected ductal carcinoma in situ. World J Clin Oncol 2016; 7:258-264. [PMID: 27081649 PMCID: PMC4826972 DOI: 10.5306/wjco.v7.i2.258] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/15/2015] [Accepted: 01/29/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the indications for sentinel lymph node biopsy (SLNB) in clinically-detected ductal carcinoma in situ (CD-DCIS).
METHODS: A retrospective analysis of 20 patients with an initial diagnosis of pure DCIS by an image-guided core needle biopsy (CNB) between June 2006 and June 2012 was conducted at King Faisal Specialist Hospital. The accuracy of performing SLNB in CD-DCIS, the rate of sentinel and non-sentinel nodal metastasis, and the histologic underestimation rate of invasive cancer at initial diagnosis were analyzed. The inclusion criteria were a preoperative diagnosis of pure DCIS with no evidence of invasion. We excluded any patient with evidence of microinvasion or invasion. There were two cases of mammographically detected DCIS and 18 cases of CD-DCIS. All our patients were diagnosed by an image-guided CNB except two patients who were diagnosed by fine needle aspiration (FNA). All patients underwent breast surgery, SLNB, and axillary lymph node dissection (ALND) if the SLN was positive.
RESULTS: Twenty patients with an initial diagnosis of pure DCIS underwent SLNB, 2 of whom had an ALND. The mean age of the patients was 49.7 years (range, 35-70). Twelve patients (60%) were premenopausal and 8 (40%) were postmenopausal. CNB was the diagnostic procedure for 18 patients, and 2 who were diagnosed by FNA were excluded from the calculation of the underestimation rate. Two out of 20 had a positive SLNB and underwent an ALND and neither had additional non sentinel lymph node metastasis. Both the sentinel visualization rate and the intraoperative sentinel identification rate were 100%. The false negative rate was 0%. Only 2 patients had a positive SLNB (10%) and neither had additional metastasis following an ALND. After definitive surgery, 3 patients were upstaged to invasive ductal carcinoma (3/18 = 16.6%) and 3 other patients were upstaged to DCIS with microinvasion (3/18 = 16.6%). Therefore the histologic underestimation rate of invasive disease was 33%.
CONCLUSION: SLNB in CD-DCIS is technically feasible and highly accurate. We recommend limiting SLNB to patients undergoing a mastectomy.
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Li Y, Zhang S, Wei X, Zhang J. The clinical features and management of women with ductal carcinoma in situ with microinvasion: A retrospective Cohort study. Int J Surg 2015; 19:91-4. [PMID: 26013173 DOI: 10.1016/j.ijsu.2015.05.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 04/22/2015] [Accepted: 05/06/2015] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The purpose of our study is to demonstrate the clinical features and management of patients with Ductal Carcinoma in situ with microinvasion (DCISM) in a single Chinese cancer center. METHODS Retrospectively analysis of cases between 2003 and 2009 was performed in our institution. The type of treatments, pathological results, and axillary lymph nodes status, hormonal receptor statues (estrogen receptor (ER), progesterone receptor (PR) and Her2) were collected. The disease-free survival rate was calculated from the date of initial diagnosis using the Kaplan-Meier method. RESULTS Five hundred and sixty-seven cases were enrolled in our study, 474 pure Ductal Carcinoma in situ (DCIS) and 93 DCISM were included. Among these, 168 (35.4%) was diagnosed with the grade I and 26(5.5%) with grade III in pure DCIS group, compared with 3 (3.2%) and 11(11.8%) with grade I and III in DCISM (p < .0001). We also found that DCISM was associated with comadonecrosis histologic subtype (p < .0001) and presence of luminal B type (ER/PR positive and Her-2 positive) (p < .0032). There were more positive axillary lymph nodes involvement in patients with DCISM than those with DCIS after performing ALND(p = .0284). Patients with DCISM underwent more axillary lymph node dissection (ALND) in Chinese cancer center than those did in US centers (1.1% VS 47.8-68% and 86.1% VS 3.6-6.9%, respectively). No significantly difference was found in the overall survival rate between patients with DCIS and DCISM during median 100 months follow-up. CONCLUSIONS In a Chinese cancer hospital, the majority of cases underwent mastectomy and ALDN after the diagnosis of DCISM.The optimal treatments of patients with DCISM should be further investigated.
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Affiliation(s)
- Ying Li
- The Third Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.
| | - Sheng Zhang
- The Third Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Xi Wei
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.
| | - Jin Zhang
- The Third Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.
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13
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Walters LL, Pang JC, Zhao L, Jorns JM. Ductal carcinomain situwith distorting sclerosis on core biopsy may be predictive of upstaging on excision. Histopathology 2015; 66:577-86. [DOI: 10.1111/his.12550] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 09/15/2014] [Indexed: 12/18/2022]
Affiliation(s)
- Laura L Walters
- Department of Pathology; University of Michigan; Ann Arbor MI USA
| | - Judy C Pang
- Department of Pathology; University of Michigan; Ann Arbor MI USA
| | - Lili Zhao
- Department of Biostatistics; University of Michigan; Ann Arbor MI USA
| | - Julie M Jorns
- Department of Pathology; University of Michigan; Ann Arbor MI USA
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Sentinel Lymph Node Biopsy Should Be Included with the Initial Surgery for High-Risk Ductal Carcinoma-In-Situ. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:624185. [PMID: 27379334 PMCID: PMC4897395 DOI: 10.1155/2014/624185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 08/30/2014] [Accepted: 09/02/2014] [Indexed: 12/02/2022]
Abstract
Background. A proportion of those diagnosed preoperatively with ductal carcinoma-in-situ (DCIS) will be histologically upgraded to invasive carcinoma. Repeat surgery for sentinel lymph node (SLN) biopsy will be required if it had not been included with the initial surgery. We reviewed the outcome of SLN biopsy performed with the initial surgery based on a preoperative diagnosis of DCIS and aimed to identify patients at risk of histological upgrade. Methods. Retrospective review of 294 consecutive female patients diagnosed with DCIS was performed at our institute from January 1, 2001, to December 31, 2008. Results. Of the 294 patients, 132 (44.9%) underwent SLN biopsy together with the initial surgery. The SLN was positive for metastases in 5 patients, all of whom had tumours that were histologically upgraded. Histological upgrade also occurred in 43 of the 127 patients (33.9%) in whom the SLN was negative for metastases. On multivariate analysis, histological upgrade was more likely if a mass was detected on mammogram, if the preoperative diagnosis was obtained with core biopsy and if microinvasion was reported in the biopsy. Conclusion. Patients in whom a preoperative diagnosis of DCIS is likely to be upgraded to invasive carcinoma will benefit from SLN biopsy being performed with the initial surgery.
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Sentinel lymph node biopsy in patients with microinvasive breast cancer: A systematic review and meta-analysis. Eur J Surg Oncol 2014; 40:5-11. [DOI: 10.1016/j.ejso.2013.10.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 10/26/2013] [Accepted: 10/28/2013] [Indexed: 11/20/2022] Open
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Bayraktar S, Arun B, Glück S. Ductal carcinoma in situ: how should we treat it? BREAST CANCER MANAGEMENT 2013. [DOI: 10.2217/bmt.13.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY The observed incidence of ductal carcinoma in situ (DCIS) has increased because of the increasing use of sensitive imaging modalities. While the clinical course of DCIS is quite variable, it is considered a precursor lesion to invasive breast cancer. The current focus of DCIS treatment is on the prevention of progression to invasive disease. However, at present, validated diagnostic tests to predict progression accurately are lacking. Additionally, important clinical questions arise during DCIS management. For example, optimal margins of excision or axillary lymph node sampling have not been addressed in randomized clinical trials. May whole-breast radiation after lumpectomy be omitted in selected patients? What is the role of adjuvant tamoxifen if it does not impact overall survival rates? This review aims to describe the natural history of DCIS and highlights the current therapeutic options and challenges in patient management.
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Affiliation(s)
- Soley Bayraktar
- Department of Medical Oncology, Mercy Cancer Center, Ardmore, OK, USA
| | - Banu Arun
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stefan Glück
- Department of Medicine, Division of Hematology/Medical Oncology, University of Miami & Sylvester Comprehensive Cancer Center, Miami, FL, USA
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Factors associated with upstaging from ductal carcinoma in situ following core needle biopsy to invasive cancer in subsequent surgical excision. Breast 2012; 21:641-5. [DOI: 10.1016/j.breast.2012.06.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 04/09/2012] [Accepted: 06/20/2012] [Indexed: 11/19/2022] Open
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Kósa C, Garami Z, Dinya T, Fülöp B. [Predictive factors of invasion with initial diagnosis of ductal carcinoma in situ based on core biopsy]. Magy Seb 2012; 65:218-21. [PMID: 22940391 DOI: 10.1556/maseb.65.2012.4.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Previous studies suggest that sentinel lymph node biopsy (SLNB) should not be performed in case of pure ductal carcinoma in situ (DCIS) routinely. In order to avoid a second operation for invasive cancer detected postoperatively the chance of invasion need to be determined preoperatively. The purpose of our retrospective study was to evaluate the sensitivity of core biopsy and determine the predictive value of clinical and histological factors of invasion in cases when DCIS diagnosed preoperatively. MATERIAL AND METHODS Between January 2006 and December 2011, 1311 patients were treated for breast cancer in our institute, of whom preoperative core biopsy showed DCIS in 50 cases. Wide excision or quadrantectomy was performed in 41 cases, re-excision was necessary in 6 cases for positive surgical margins and mastectomy was carried out in four patients for multicentricity. In further 9 cases extensive tumour size indicated mastectomy straight away. SLNB was carried out in 31 patients, axillary block dissection (ABD) in 8 patients, while ABD for positive sentinel nodes in another two cases. Pathology showed invasion in 17 (34,7 %) cases. RESULTS Multivariate analysis showed that tumour grade, symptomatic disease, patients' age were significant predictors of invasion. Although preoperative tumour size also showed correlation with invasiveness, this was statistically not significant. CONCLUSION Evaluation of a larger patient population might be helpful to identify women who should undergo tumour excision and SLNB as a single step operation due to increased risk of invasive disease despite the preoperative diagnosis of DCIS.
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Affiliation(s)
- Csaba Kósa
- Debreceni Egyetem Orvos- és Egészségtudományi Centrum Sebészeti Intézet 4012 Debrecen Móricz Zsigmond krt. 22.
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Tang Y, Xu F, Tao K, Qian N, Toi M. Clinical applications of sentinel lymph node biopsy in ductal carcinoma in situ of the breast: a dilemma. TOHOKU J EXP MED 2011; 224:1-5. [PMID: 21502730 DOI: 10.1620/tjem.224.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Breast cancer is the fifth most common cause of cancer deaths in the world, which often spreads first to the axillary lymph nodes (ALN) from the primary tumor. ALN helps clinician stage breast cancer. In addition, it is one of the key prognostic factors for patients with invasive breast cancer. The sentinel lymph node (SLN) is defined as the first regional lymph node to receive lymphatic fluid from a malignant tumor. As a result, it seems possible to assess the complete nodal status with sentinel lymph node biopsy (SLNB), which is attractive and reliable approach for identifying lymph node metastasis. Ductal carcinoma in situ (DCIS) is the most common type of non-invasive breast cancer. However, the role of SLNB in DCIS is controversial because DCIS does not cause invasion and metastasis theoretically. In this review, clinical applications of SLNB in DCIS will be discussed. The potential benefit of accurately upstaging patients with DCIS and the minimal invasiveness of SLNB justify use of SLNB in selected high-risk DCIS patients. At least DSIS with microinvasion, have DCIS of sufficient extent on mammography or MRI, or indicated invasive or microinvasive focus by final histological examination, are recommended for SLNB. Moreover, large randomized trials to evaluate the usefulness of SLNB in DCIS patients after long-term follow-up on local control and survival are required for further evaluation.
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Affiliation(s)
- Yu Tang
- Departmentof Ultrasound, PLA 302 Hospital, China
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Schmale I, Liu S, Rayhanabad J, Russell CA, Sener SF. Ductal carcinoma in situ (DCIS) of the breast: perspectives on biology and controversies in current management. J Surg Oncol 2011; 105:212-20. [PMID: 21751217 DOI: 10.1002/jso.22020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 06/15/2011] [Indexed: 12/23/2022]
Abstract
The incidence of ductal carcinoma in situ (DCIS) has increased because of increasing use of sensitive imaging modalities. MRI is commonly used for the detection of breast cancer but has not yet been validated in randomized trials. There have not been randomized trials addressing optimal margins of excision or axillary sampling. Whole breast radiation after lumpectomy decreases the risk of recurrence but may be omitted in selected patients. Adjuvant Tamoxifen reduces the risk of recurrence but has no impact on overall survival rates.
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Affiliation(s)
- Isaac Schmale
- Division of Breast and Soft Tissue Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Cheng G, Kurita S, Torigian DA, Alavi A. Current status of sentinel lymph-node biopsy in patients with breast cancer. Eur J Nucl Med Mol Imaging 2010; 38:562-75. [PMID: 20700739 DOI: 10.1007/s00259-010-1577-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Accepted: 07/18/2010] [Indexed: 12/17/2022]
Abstract
Axillary node status is the most important prognostic indicator for patients with invasive breast cancer. Sentinel lymph-node biopsy (SLNB) is widely accepted and the preferred procedure for identifying lymph-node metastasis. SLNB allows focused excision and pathological examination of the most likely axillary lymph nodes to receive tumor metastases while avoiding morbidities associated with complete axillary nodal dissection. Since its introduction in the early 1990s, the process of SLNB has undergone continual modification and refinement; however, the procedure varies between institutions and controversies remain. In this review, we examine the technical issues that influence the success of lymph node mapping, discuss the controversies, and summarize the indications and contraindications for axillary node mapping and biopsy in clinical practice.
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Affiliation(s)
- Gang Cheng
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
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Laronga C, Lee MC, McGuire KP, Meade T, Carter WB, Hoover S, Cox CE. Indications for sentinel lymph node biopsy in the setting of prophylactic mastectomy. J Am Coll Surg 2009; 209:746-52; quiz 800-1. [PMID: 19959044 DOI: 10.1016/j.jamcollsurg.2009.08.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 08/12/2009] [Accepted: 08/12/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Bilateral/contralateral prophylactic mastectomy (PM) is offered to high-risk women to decrease their actual or perceived breast cancer risk. When an invasive occult cancer is identified, prevailing wisdom suggests that an axillary dissection be performed. This single-institution study aims to identify patients who may benefit from sentinel node biopsy (SLNB) at the time of prophylactic mastectomy. STUDY DESIGN We performed a retrospective review of a prospective database of patients treated at our institution with bilateral/contralateral PM between 1995 and 2006. We examined patients' clinicopathologic characteristics in comparison with their incidence of occult cancer in the contralateral breast or axilla. RESULTS There were 449 patients who underwent PM and SLNB. Twenty-eight underwent bilateral PM. Of the 28, no occult cancers were identified. Occult cancers were identified in 18 of 420 (4.3%) contralateral prophylactic specimens; they were invasive in 6 (1.4%). In cases of occult carcinoma, the primary established tumor was more likely to be of invasive lobular histology. Eight of 420 (2%) patients had a positive contralateral sentinel node, and within this subset of 8 patients the majority had locally advanced disease on the known tumor side. Other features associated with a positive contralateral sentinel node included the presence of lymphovascular involvement or skin or nipple involvement and grade 2 to 3 invasive primary established tumors. CONCLUSIONS Overall, SLNB in patients undergoing bilateral PM or contralateral PM associated with early-stage disease is not indicated. But patients with locally advanced primary breast cancers have a significantly increased risk of occult cancer in the contralateral axilla, likely due to crossover metastasis; this select group of patients may benefit from SLNB at the time of surgery.
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Affiliation(s)
- Christine Laronga
- Don & Erika Wallace Comprehensive Breast Program, H Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Dr, MCC-BRPROG, Tampa, FL 33612, USA
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Fentiman IS. Which patients with ductal carcinoma in situ will benefit from sentinel node biopsy? Int J Clin Pract 2008; 62:1638-9. [PMID: 19143849 DOI: 10.1111/j.1742-1241.2008.01882.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Partridge A, Winer JP, Golshan M, Bellon JR, Blood E, Dees EC, Sampson E, Emmons KM, Winer E. Perceptions and management approaches of physicians who care for women with ductal carcinoma in situ. Clin Breast Cancer 2008; 8:275-80. [PMID: 18650159 DOI: 10.3816/cbc.2008.n.032] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Limited previous data suggest that heterogeneity exists in the treatment approaches for women with ductal carcinoma in situ (DCIS). We sought in a longitudinal cohort study of women with DCIS to assess the attitudes and management approaches toward DCIS among physicians who provide care to women. MATERIALS AND METHODS Eligible physicians were invited to participate in a 1-time mailed survey. A financial incentive and reminders were used to enhance the response rate. Physician perception of risks associated with DCIS for patients and management approaches were evaluated. RESULTS Two hundred and eight physicians were identified, and 151 (73%) completed the survey. Respondents had a median age of 49 years (range, 32-75 years), and most were surgeons or medical oncologists (66%). Eighty-eight percent reported seeing an average of >or= 1 new patient with DCIS per month. In a multivariable model, physicians who cared for proportionately fewer patients with breast cancer were more likely to view DCIS as a riskier disease to a patient's overall health compared with physicians who cared for more women with breast cancer (odds ratio, 2.2; 95% CI, 1.1-4.6; P = .036). Physicians exhibited differences in management approaches when considering theoretical patients with DCIS and did not use consistent terms when speaking with patients with DCIS. CONCLUSION Substantial variation exists among physicians regarding perceptions and management approaches for women with DCIS. In some settings, risks of physician-recommended therapy might outweigh benefits. Further evaluation of the effects of physician management approaches and attitudes about DCIS on patient outcomes is warranted.
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Affiliation(s)
- Ann Partridge
- Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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