Topic
Ductal carcinoma in situ (DCIS)
About: Ductal carcinoma in situ (DCIS) is a research topic. Over the lifetime, 452 publications have been published within this topic receiving 10362 citations.
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TL;DR: The Van Nuys Prognostic Index (VNPI) was developed to aid in the complex treatment selection process.
Abstract: BACKGROUND
There is controversy and confusion regarding therapy for patients with ductal carcinoma in situ (DCIS) of the breast. The Van Nuys Prognostic Index (VNPI) was developed to aid in the complex treatment selection process.
METHODS
The VNPI combines three significant predictors of local recurrence: tumor size, margin width, and pathologic classification. Scores of 1 (best) to 3 (worst) were assigned for each of the 3 predictors and then totaled to give an overall VNPI score ranging from 3 to 9. Three hundred thirty-three patients with pure DCIS treated with breast preservation (195 by excision only and 138 by excision plus radiation therapy) were studied with detection of local recurrence as the end point.
RESULTS
There was no statistical difference in the 8 year local recurrence free survival in patients with VNPI scores of 3 or 4, regardless of whether or not radiation therapy was used (100% vs. 97%; P = not significant). Patients with VNPI scores of 5, 6, or 7 received a statistically significant 17% local recurrence free survival benefit when treated with radiation therapy (85% vs. 68%; P = 0.017). Patients with scores of 8 or 9, although showing the greatest relative benefit from radiation therapy, experienced local recurrence rates in excess of 60% at 8 years.
CONCLUSIONS
DCIS patients with VNPI scores of 3 or 4 can be considered for treatment with excision only. Patients with intermediate scores (5, 6, or 7) show a 17% decrease in local recurrence rates with radiation therapy. Patients with VNPI scores of 8 or 9 exhibit extremely high local recurrence rates, regardless of irradiation, and should be considered for mastectomy. Cancer 1996;77:2267-74.
680 citations
TL;DR: A new prognostic classification designated the Van Nuys classification for ductal carcinoma-in-situ (DCIS) is presented, which combines high nuclear grade and comedo-type necrosis to predict clinical recurrence.
662 citations
TL;DR: Postoperative radiation therapy did not lower the recurrence rate among patients with ductal carcinoma in situ that was excised with margins of 10 mm or more, but patients in whom the margin width is less than 1 mm can benefit from postoperative radiation Therapy.
Abstract: Background Ductal carcinoma in situ is a noninvasive carcinoma that is unlikely to recur if completely excised. Margin width, the distance between the boundary of the lesion and the edge of the excised specimen, may be an important determinant of local recurrence. Methods Margin widths, determined by direct measurement or ocular micrometry, and standardized evaluation of the tumor for nuclear grade, comedonecrosis, and size were performed on 469 specimens of ductal carcinoma in situ from patients who had been treated with breast-conserving surgery with or without postoperative radiation therapy, according to the choice of the patient or her physician. We analyzed the results in relation to margin width and whether the patient received postoperative radiation therapy. Results The mean (±SE) estimated probability of recurrence at eight years was 0.04±0.02 among 133 patients whose excised lesions had margin widths of 10 mm or more in every direction. Among these patients there was no benefit from postoperati...
653 citations
TL;DR: A mechanistic, agent-based cell model is developed and applied to DCIS that is the first to account for cell calcification and introduces the first patient-specific calibration method to fully constrain the model based upon clinically-accessible histopathology data.
222 citations
Journal Article•
TL;DR: Sentinel lymph nodes biopsy is a valuable tool in the treatment of patients with DCIS and DCISM and is particularly needed in those undergoing mastectomy, and no "high-risk" group of patients can be identified for selective sentinel lymph node biopsy.
Abstract: The appropriateness of sentinel lymph node biopsy in the management of patients with biopsy diagnoses of ductal carcinoma in situ (DCIS) or DCIS with microinvasion (DCISM) has not been established Three hundred forty-one patients presented with a biopsy diagnosis of DCIS or DCISM Two hundred forty (70%) underwent sentinel node biopsy at their definitive procedure All clinical and pathologic data were collected prospectively Of 224 patients with a biopsy diagnosis of DCIS 23 (10%) were upstaged to infiltrating ductal carcinoma (IDC) at their definitive therapy and of 16 patients with a biopsy diagnosis of DCISM seven (44%) were upstaged to IDC Excisional biopsies were no more sensitive for detecting IDC than was core biopsy Lymph node metastases were detected in 26 of 195 (13%) patients with a definitive diagnosis of DCIS, in three of 15 (20%) with a definitive diagnosis of DCISM, and in eight of 30 (27%) with a definitive diagnosis of IDC Sentinel lymph node biopsy is a valuable tool in the treatment of patients with DCIS and DCISM and is particularly needed in those undergoing mastectomy No "high-risk" group of patients can be identified for selective sentinel lymph node biopsy
218 citations