Not All Ductal Carcinomas In Situ Are Created IDLE (Indolent Lesions of Epithelial Origin).
* Context.--Mammographic screening has increased the incidence of ductal carcinoma in situ (DCIS), but this has not been accompanied by a decline in the incidence of invasive carcinoma (IC). Consequently, the surgical treatment of DCIS has recently been questioned, with some advocating only surveill...
| Publicado en: | Archives of Pathology & Laboratory Medicine Vol. 143; no. 1; pp. 99 - 105 |
|---|---|
| Autores principales: | , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
College of American Pathologists
Jan2019
|
| 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=133748688&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 133748688 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00039985 1FS jtl: Archives of Pathology & Laboratory Medicine issn: 00039985 maglogo: N pubinfo: dt: Jan2019 vid: 143 iid: 1 pid: 2550 pub: College of American Pathologists place: Northfield, Illinois artinfo: ui: 133748688 133748688 133748688 10.5858/arpa.2017-0366-OA 133748688 ppf: 99 ppct: 6 formats: fmt: @attributes: type: P tig: atl: Not All Ductal Carcinomas In Situ Are Created IDLE (Indolent Lesions of Epithelial Origin). aug: au: Alexander, Melissa Beyda, Jessica Nayak, Anupma Jaffer, Shabnam affil: Department of Pathology, New York University, Winthrop University Hospital, Mineola, New York sug: subj: Carcinoma, Ductal Diagnosis Carcinoma in Situ Diagnosis Biopsy Methods Predictive Value of Tests Human Adult Middle Age Aged Aged, 80 and Over Magnetic Resonance Imaging Methods Neoplasm Grading Necrosis Neoplasm Staging Carcinoma, Ductal Pathology Carcinoma in Situ Pathology Neoplasm Metastasis Lymph Nodes Pathology Carcinoma, Ductal Therapy Carcinoma in Situ Therapy Neoadjuvant Therapy Methods Adult: 19-44 years Middle Aged: 45-64 years Aged: 65+ years Aged, 80 & over ab: * Context.--Mammographic screening has increased the incidence of ductal carcinoma in situ (DCIS), but this has not been accompanied by a decline in the incidence of invasive carcinoma (IC). Consequently, the surgical treatment of DCIS has recently been questioned, with some advocating only surveillance (with or without neoadjuvant endocrine therapy) after a core biopsy diagnosis of DCIS. Objectives.--To examine the predictive value of a core biopsy diagnosis of DCIS, particularly the upgrade rate to IC, and to identify associated factors. Design.--Using the pathology database, we identified 2943 cases of DCIS diagnosed on core biopsy from 2000 to 2015, of which 229 cases (8%) later had the stage upgraded to IC. Results.--Ages ranged from 25 to 90 years (mean, 59 years). The DCIS presented with calcifications in 151 of 229 cases (65.9%), was widespread in 26 of 151 cases (17%), had a mass or density present in 70 of 229 cases (31%), with heterogeneous echogenic features in 44 of those 70 cases (63%), and an enhancement upon magnetic resonance imaging in 8 of 229 cases (3.5%). Of the 229 cases, the DCIS grades were as follows: low in 29 cases (13%), intermediate in 79 cases (36%), and high in 121 cases (53%). Of the 229 cases, necrosis was present in 152 (66.4%) and was comedo necrosis in 99 cases (43%). Of the 229 cases of IC, the tumor stage was as follows: microIC in 36 (16%), T1a in 119 (52%), T1b in 35 (15%), T1c in 28 (12%), T2 in 8 (3%), and T3 in 3 cases (1%). Axillary lymph nodes were staged in 167 patients as follows: N0, 141 cases (84%); N0(i+), 14 cases (8%); and N1, 12 cases (7%). The 12 N1 cases were subclassified by T stage as follows: T1a, 1 case (8%); T1b, 4 cases (33%); T1c, 2 cases (17%); T2, 4 cases (33%); and T3, 1 case (8%). The IC cases of stage upgrading were predominantly smaller than 2 cm (218 of 229; 95%), and more than twothirds were smaller than 0.5 cm (155 of 229; 95%), most of which were accompanied by extensive DCIS. Conclusions.--Approximately one-half of the upgrades were associated with high-grade DCIS, especially with comedo necrosis; nevertheless, the other one-half of the upgrades were due to low- and intermediate-grade DCIS and should not be underestimated. There were few positive results from axillary lymph node biopsies, but they occurred in 3% (7 of 218) of the carcinomas smaller than 2 cm. Our findings indicate that caution is needed when DCIS cases diagnosed by core biopsy are treated nonsurgically with surveillance (with or without neoadjuvant endocrine therapy), given the number of cases (229 of 2943; 8%) that are upgraded to IC and those with axillary lymph node metastases (12 of 167; 7%). pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|