Abstract
Background
Prospective cohort studies are being conducted worldwide to identify a low-grade group of ductal carcinoma in situ (DCIS) that does not require surgery. However, to do this, it is necessary to predict which cases, diagnosed with preoperative DCIS, will be upgraded to invasive ductal carcinoma (IDC) after surgery.
Methods
In this study, we evaluated the frequency of IDC upgrades in patients who were preoperatively diagnosed with DCIS at Showa University using the criteria of ongoing clinical trials. We divided our cases into those that could be enrolled in the ongoing trial and those that could not. Moreover, we evaluated whether CNB, which is allowed only in Japanese clinical trials, is related to the IDC mixture.
Results
There were 211 (52.1%) cases that matched the criteria of the U.K. and Netherlands trials, of which 62 (29.4%) were upgraded to IDC. A total of 113 (27.9%) cases met the criteria for clinical trials in Japan and the U.S., 25 (22.1%) of which were upgraded to IDC and 47 (34.6%) which matched when considering biopsy methods. The number of cases upgraded to IDC decreased to four (8.5%).
Conclusions
This study demonstrated that there were a certain number of mixed IDC. We will pay attention to the results of ongoing clinical trials regarding how the presence of this mixed IDC affects the prognosis in non-surgery cases. Careful follow-up is recommended for non-surgical treatment.
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References
Virnig BA, Tuttle TM, Shamliyan T, Kane RL. Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes. J Natl Cancer Inst. 2010;102:170–8.
Ernster VL, Ballard-Barbash R, Barlow WE, Zheng Y, Weaver DL, Cutter G, et al. Detection of ductal carcinoma in situ in women undergoing screening mammography. J Natl Cancer Inst. 2002;94:1546–54.
Ernster VL, Barclay J. Increases in ductal carcinoma in situ (DCIS) of the breast in relation to mammography: a dilemma. JNCI Monogr. 1997;1997:151–6.
Kurebayashi J, Miyoshi Y, Ishikawa T, Saji S, Sugie T, Suzuki T, et al. Clinicopathological characteristics of breast cancer and trends in the management of breast cancer patients in Japan: based on the breast cancer registry of the Japanese breast cancer society between 2004 and 2011. Breast Cancer. 2015;22:235–44.
Welch HG, Prorok PC, O’Malley AJ, Kramer BS. Breast-cancer tumor size, overdiagnosis, and mammography screening effectiveness. N Engl J Med. 2016;375:1438–47.
Bleyer A, Welch H. Effect of three decades of screening mammography on breast-cancer incidence. N Engl J Med. 2012;367(21):1998–2005.
Kanbayashi C, Iwata H. Current approach and future perspective for ductal carcinoma in situ of the breast. Jpn J Clin Oncol. 2017;47:671–7.
Erbas B, Provenzano E, Armes J, Gertig D. The natural history of ductal carcinoma in situ of the breast: a review. Breast Cancer Res Treat. 2005;97:135–44.
Lakhani SR. The transition from hyperplasia to invasive carcinoma of the breast. J Pathol. 1999;187:272–8.
Eusebi V, Feudale E, Foschini MP, Micheli A, Conti A, Riva C, et al. Long-term follow-up of in situ carcinoma of the breast. Semin Diagn Pathol. 1994;11:223–35.
Welch HG, Black WC. Using autopsy series to estimate the disease “reservoir” for ductal carcinoma in situ of the breast: how much more breast cancer can we find? Ann Intern Med. 1997;127:1023–8.
Narod SA, Iqbal J, Giannakeas V, Sopik V, Sun P. Breast cancer mortality after a diagnosis of ductal carcinoma in situ. JAMA Oncol. 2015;1:888–96.
Sagara Y, Mallory MA, Wong S, Aydogan F, DeSantis S, Barry WT, et al. Survival benefit of breast surgery for low-grade ductal carcinoma in situ: a population-based cohort study. JAMA Surg. 2015;150:739–45.
Elshof LE, Tryfonidis K, Slaets L, van Leeuwen-Stok AE, Skinner VP, Dif N, et al. Feasibility of a prospective, randomised, open-label, international multicentre, phase III, non-inferiority trial to assess the safety of active surveillance for low-risk ductal carcinoma in situ—the LORD study. Eur J Cancer. 2015;51:1497–510.
Francis A, Thomas J, Fallowfield L, Wallis M, Bartlett JM, Brookes C, et al. Addressing overtreatment of screen-detected DCIS; the LORIS trial. Eur J Cancer. 2015;51:2296–303.
Kanbayashi C, Thompson AM, Hwang SS, Partridge AH, Rea DW, Wesseling J, et al. The international collaboration of active surveillance trials for low-risk DCIS (LORIS, LORD, COMET, LORETTA). J Clin Oncol. 2019. https://doi.org/10.1200/JCO.2019.37.15_suppl.TPS603.
Hwang ES, Hyslop T, Lynch T, Frank E, Pinto D, Basila D, et al. The COMET (comparison of operative versus monitoring and endocrine therapy) trial: a phase III randomised controlled clinical trial for low-risk ductal carcinoma in situ (DCIS). BMJ Open. 2019;9:e026797.
Jackman RJ, Burbank F, Parker SH, Phil Evans W, Lechner MC, Richardson TR, et al. Stereotactic breast biopsy of nonpalpable lesions: determinants of ductal carcinoma in situ underestimation rates. Radiology. 2001;218:497–502.
Mittendorf EA, Arciero CA, Gutchell V, Hooke J, Shriver CD. Core biopsy diagnosis of ductal carcinoma in situ: an indication for sentinel lymph node biopsy. Curr Surg. 2005;62:253–7.
Deurloo EE, Sriram JD, Teertstra HJ, Loo CE, Wesseling J, Rutgers EJ, et al. MRI of the breast in patients with DCIS to exclude the presence of invasive disease. Eur Radiol. 2012;22:1504–11.
Park AY, Gweon HM, Son EJ, Yoo M, Kim JA, Youk JH. Ductal carcinoma in situ diagnosed at US-guided 14-gauge core-needle biopsy for breast mass: preoperative predictors of invasive breast cancer. Eur J Radiol. 2014;83:654–9.
Rakovitch E, Nofech-Mozes S, Hanna W, Narod S, Thiruchelvam D, Saskin R, et al. HER2/neu and Ki-67 expression predict non-invasive recurrence following breast-conserving therapy for ductal carcinoma in situ. Br J Cancer. 2012;106:1160–5.
Poulakaki N, Makris G-M, Papanota A-M, Marineli F, Marinelis A, Battista M-J, et al. Ki-67 expression as a factor predicting recurrence of ductal carcinoma in situ of the breast: a systematic review and meta-analysis. Clin Breast Cancer. 2018;18:157-67.e6.
Goyal A, Douglas-Jones A, Monypenny I, Sweetland H, Stevens G, Mansel RE. Is there a role of sentinel lymph node biopsy in ductal carcinoma in situ?: analysis of 587 cases. Breast Cancer Res Treat. 2006;98:311–4.
Lee JW, Han W, Ko E, Cho J, Kim EK, Jung SY, et al. Sonographic lesion size of ductal carcinoma in situ as a preoperative predictor for the presence of an invasive focus. J Surg Oncol. 2008;98:15–20.
Meijnen P, Oldenburg HS, Loo CE, Nieweg OE, Peterse JL, Rutgers EJ. Risk of invasion and axillary lymph node metastasis in ductal carcinoma in situ diagnosed by core-needle biopsy. Br J Surg. 2007;94:952–6.
Yen TWF, Hunt KK, Ross MI, Mirza NQ, Babiera GV, Meric-Bernstam F, et al. Predictors of invasive breast cancer in patients with an initial diagnosis of ductal carcinoma in situ: a guide to selective use of sentinel lymph node biopsy in management of ductal carcinoma in situ. J Am Coll Surg. 2005;200:516–26.
Curigliano G, Burstein HJ, Winer EP, Gnant M, Dubsky P, Loibl S, et al. De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen international expert consensus conference on the primary therapy of early breast cancer. Ann Oncol. 2017;28:1700–12.
Brennan ME, Turner RM, Ciatto S, Marinovich ML, French JR, Macaskill P, et al. Ductal carcinoma in situ at core-needle biopsy: meta-analysis of underestimation and predictors of invasive breast cancer. Radiology. 2011;260:119–28.
Osako T, Iwase T, Ushijima M, Horii R, Fukami Y, Kimura K, et al. Incidence and prediction of invasive disease and nodal metastasis in preoperatively diagnosed ductal carcinoma in situ. Cancer Sci. 2014;105:576–82.
Wang SY, Shamliyan T, Virnig BA, Kane R. Tumor characteristics as predictors of local recurrence after treatment of ductal carcinoma in situ: a meta-analysis. Breast Cancer Res Treat. 2011;127:1–14.
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Nakayama, S., Masuda, H., Miura, S. et al. Identifying ductal carcinoma in situ cases not requiring surgery to exclude postoperative upgrade to invasive ductal carcinoma. Breast Cancer 29, 610–617 (2022). https://doi.org/10.1007/s12282-022-01338-0
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DOI: https://doi.org/10.1007/s12282-022-01338-0