학술논문
The presentation, management and outcome of patients with ductal carcinoma in situ (DCIS) with microinvasion (invasion ≤1 mm in size)—results from the UK Sloane Project.
Document Type
Article
Author
Shaaban, Abeer M.; Hilton, Bridget; Clements, Karen; Dodwell, David; Sharma, Nisha; Kirwan, Cliona; Sawyer, Elinor; Maxwell, Anthony; Wallis, Matthew; Stobart, Hilary; Mylvaganam, Senthurun; Litherland, Janet; Brace-McDonnell, Samantha; Dulson-Cox, Joanne; Kearins, Olive; Provenzano, Elena; Ellis, Ian O.; Pinder, Sarah E.; Thompson, Alastair M.
Source
Subject
Language
ISSN
0007-0920
Abstract
Background: The diagnosis, management and prognosis of microinvasive breast carcinoma remain controversial. Methods: We analysed the outcomes of patients with DCIS with and without microinvasion diagnosed between 2003 and 2012 within the Sloane project. Results: Microinvasion was recorded in 521 of 11,285 patients (4.6%), with considerable variation in reported incidence among screening units (0–25%). Microinvasion was associated with high-grade DCIS, larger DCIS size, comedo necrosis and solid, cribriform architecture (all P < 0.001). Microinvasion was more frequent in patients who underwent mastectomy compared with breast-conserving surgery (BCS) (6.9% vs 3.6%, P < 0.001), and in those undergoing axillary nodal surgery (60.4% vs 30.3%, P < 0.001) including the subset undergoing BCS (43.4% vs 8.5%, P < 0.001). Nodal metastasis rate was low and not statistically significant difference from the DCIS only group (P = 0.68). Following median follow-up of 110 months, 3% of patients had recurrent ipsilateral high-grade DCIS, and 4.2% developed invasive carcinoma. The subsequent ipsilateral invasion was of Grade 3 in 71.4% of patients with microinvasion vs 30.4% in DCIS without microinvasion (P = 0.02). Distant metastasis and breast cancer mortality were higher with microinvasion compared with DCIS only (1.2% vs 0.3%, P = 0.01 and 2.1% vs 0.8%; P = 0.005). Conclusions: The higher breast cancer mortality with microinvasion indicates a more aggressive disease. [ABSTRACT FROM AUTHOR]