Term
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Definition
| 182 patients with LCIS who were inadvertently enrolled on the (NSABP) B-17 trial for DCIS and treated with lumpectomy only, there was a 14.4% in-breast tumor recurrence (IBTR) rate and a 7.8% contralateral breast tumor recurrence rate after a median follow-up of 12 years (44). Nine IBTR (5% of the total cohort) were invasive carcinoma and 17 (9% of the total cohort) were DCIS. Although the frequency of contralateral breast tumor recurrence rate was less than that of IBTR, the frequency of invasive contralateral breast tumor recurrence rate (5.6% of total cohort) was similar to invasive IBTR (5% of total cohort). Of note, all of the IBTR were documented to be at the site of the index lesion except for one, characterized as pure LCIS, that was found at a remote site. |
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Term
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Definition
| The most widely accepted treatment approach is to manage the breast according to the dominant malignant histology (DCIS or invasive carcinoma) and disregard the presence of LCIS. In such circumstances, it is not necessary to pursue additional surgery to obtain clear margins for LC |
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Term
| What trials support doing RT after lumpectomy vs doing lumpectomy alone? |
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Definition
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Term
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Definition
| Axillary-node involvement is rare (0% to 5%) and most likely is associated with an undetected focus of invasive carcinoma |
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Term
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Definition
| (two or more areas separated by <4 cm) |
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Term
| a multicentric growth pattern was rare (less than 2%), with most cases showing an even distribution between discontinuous and continuous growth patterns |
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Definition
| 1-cm margin of normal tissue around the lesion would lead to complete surgical clearance of histologically evident DCIS in 90% of cases. |
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Term
| Women with DCIS in one breast are at risk for a second tumor (either invasive or in situ) in the contralateral breast (56); the rate at which such tumors develop is similar to that among women with primary invasive breast cancer, approximately 0.5% to 1% per year. |
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Definition
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Term
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Definition
| No randomized study has compared mastectomy with breast-conservation treatment for DCIS. Therefore, the relative outcomes for mastectomy and breast-conservation treatment can be estimated only by reviewing nonrandomized, retrospective studies. |
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Term
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Definition
818 patients who were stratified by age (49 years of age or younger vs. older than 49 years), DCIS versus DCIS plus LCIS, method of detection, and whether an axillary dissection was performed. Tumor size was determined by mammogram, gross pathologic measurement, or clinical examination. Of the patients enrolled, 83% had nonpalpable tumors. The 12-year rate of local recurrence was 15.7% with radiation and 31.7% without radiation (p <.000005) (Fig. 52.6). The average annual incidence rates of all ipsilateral breast tumor recurrences, ipsilateral noninvasive recurrences, and ipsilateral invasive recurrences were reduced with breast irradiation by 59%, 47%, and 71%, respectively. An analysis of clinical
variables showed that microcalcifications extending beyond a maximum dimension of >1 cm were associated with an elevated risk of breast recurrence. A central pathology review was performed, including a multivariate analysis of histopathologic variables (Table 52.2), that revealed only moderate/marked comedonecrosis as being significantly associated with local failure risk. Margin status (free vs. unknown/involved) was of borderline significance. |
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Term
| fOLLOW UP FOR DCIS AFTER SURGERY: |
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Definition
| baseline mammogram 6 to 12 months after initial therapy and at least annually thereafter. Distant |
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Term
Recurrence after DCIS,
What is the prognosis? |
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Definition
| Patients with recurrent DCIS have an excellent prognosis, with less than a 1% risk of further recurrence after salvage mastectomy. Patients with invasive recurrence after breast-conserving surgery for DCIS have a prognosis similar to those with early-stage breast cancer, with a 15% to 20% risk of metastatic recurrence at 8 years |
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Term
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Definition
| There is no role for postmastectomy or nodal irradiation in the treatment of DCIS. |
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Term
| the optimal margin width for the management of DCIS is not known. At a minimum, there should be no tumor at the margin. |
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Definition
| Three to 13% of patients with DCIS, and a slightly greater percentage with DCIS and microinvasion, have isolated tumor cells in sentinel axillary lymph nodes |
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Term
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Definition
50Gy +/- boost to surgical scar.
boost better employed for close margins.
no role for axillary radiation (or dissection). |
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