Feasibility of the Less Is More Approach in Treating Low-Risk Ductal Carcinoma In Situ Diagnosed on Core Needle Biopsy: Ten-Year Review of Ductal Carcinoma In Situ Upgraded to Invasion at Surgery.
Context.--Ductal carcinoma in situ (DCIS) represents 20% of screen-detected breast cancers. The likelihood that certain types of DCIS are slow growing and may never progress to invasion suggests that our current standards of treating DCIS could result in overtreatment. The LORIS (LOw RISk DCIS) and...
| Publicado en: | Archives of Pathology & Laboratory Medicine Vol. 142; no. 9; pp. 1120 - 1127 |
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| Autores principales: | , , , , , |
| Formato: | pictorial research tables/charts Journal Article |
| Publicado: |
College of American Pathologists
Sep2018
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=131492914&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 131492914 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00039985 1FS jtl: Archives of Pathology & Laboratory Medicine issn: 00039985 maglogo: N pubinfo: dt: Sep2018 vid: 142 iid: 9 pid: 2550 pub: College of American Pathologists place: Northfield, Illinois artinfo: ui: 131492914 131492914 131492914 10.5858/arpa.2017-0268-OA 131492914 ppf: 1120 ppct: 7 formats: fmt: @attributes: type: P tig: atl: Feasibility of the Less Is More Approach in Treating Low-Risk Ductal Carcinoma In Situ Diagnosed on Core Needle Biopsy: Ten-Year Review of Ductal Carcinoma In Situ Upgraded to Invasion at Surgery. aug: au: Podoll, Mirna B. Reisenbichler, Emily S. Roland, Lania Bruner, Andrew Mizuguchi, Sarah Sanders, Mary Ann G. affil: Department of Pathology, Microbiology and Immunology, Vanderbilt University, Nashville, Tennessee sug: subj: Biopsy, Needle Methods Carcinoma, Ductal Diagnosis Carcinoma, Ductal Risk Factors Carcinoma, Ductal Surgery Neoplasm Invasiveness Disease Surveillance Treatment Outcomes Retrospective Design Human Lymph Nodes Neoplasm Grading Carcinoma, Ductal Pathology Patient Safety Disease Management ab: Context.--Ductal carcinoma in situ (DCIS) represents 20% of screen-detected breast cancers. The likelihood that certain types of DCIS are slow growing and may never progress to invasion suggests that our current standards of treating DCIS could result in overtreatment. The LORIS (LOw RISk DCIS) and LORD (LOw Risk DCIS) trials address these concerns by randomizing patients with low-risk DCIS to either active surveillance or conventional treatment. Objective.--To determine the upgrade rate of DCIS diagnosed on core needle biopsy to invasive carcinoma at surgery and to evaluate the safety of managing low-risk DCIS with surveillance alone, by characterizing the pathologic and clinical features of upgraded cases and applying criteria of the LORD and LORIS trials to these cases. Design.--A 10-year retrospective analysis of DCIS on core needle biopsy with subsequent surgery. Results.--We identified 1271 cases of DCIS on core needle biopsy: 200 (16%) low grade, 649 (51%) intermediate grade, and 422 (33%) high grade. Of the 1271 cases, we found an 8% upgrade rate to invasive carcinoma (n ¼ 105). Nineteen of the 105 upgraded cases (18%) had positive lymph nodes. Low-grade DCIS was least likely to upgrade to invasion, comprising 10% (10 of 105) of upgraded cases. Three of the 105 upgraded cases (3%) met criteria for the LORD trial, and all were low-grade DCIS on core needle biopsy with favorable biology on follow-up. Conclusions.--There is a clear risk of upgrade to invasion on follow-up excision; however, applying strict criteria of the LORD trial effectively decreases the likelihood of a missed invasive component or missed aggressive pathologic features. pubtype: Academic Journal doctype: pictorial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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