Ipsilateral local recurrence in relation to therapy and morphological characteristics in patients with ductal carcinoma in situ of the breast.
RESULTS
A standardized histopathological protocol has been designed, in which different histological characteristics of ductal carcinoma in situ (DCIS) are reported: nuclear grade (ng), growth pattern according to Andersen et al., necrosis, size of the lesion, resection margins and focality. Using this protocol a re-evaluation of a population-based consecutive series of 306 cases of DCIS has been done as well as a thorough clinical follow-up. After a median follow-up of 63 months, 13% have developed ipsilateral local recurrences, invasive and/or in situ. Ipsilateral local recurrence-free survival (IL-RFS) was significantly better for patients operated with mastectomy (ME) or breast conserving therapy (BCT) with radiotherapy (RT) than for patients operated with BCT without RT (5-year IL-RFS 96% vs 94% vs 79%, P<0.001). In the subgroup of BCT without RT there were significant differences in IL-RFS between histopathological subgroups: ng 1 + 2 (non-high grade) vs ng 3 (high grade; P=0.014), non-high-grade without comedo-type necrosis vs non-high-grade with comedo-type necrosis vs high-grade (the Van Nuys classification system; P=0.025). Growth pattern (not diffuse vs diffuse) and margins (free vs involved or not evaluated) showed a tendency (P=0.07 and 0.05, respectively) to be associated to IL-RFS. In contrast, no significant differences in IL-RFS were found in subgroups based on mode of detection, focality or size. Ninety-four per cent of the local recurrences after BCT appeared at the previous operation site.


CONCLUSIONS
In the BCT without RT group, combinations of either non-high grade and not a diffuse growth pattern or non-high grade and free margins identified groups (constituting approximately 30% of the patients) were at low risk of developing ipsilateral recurrences (6-10%), compared to a 31-37% recurrence risk in the remaining groups during the observed follow-up time. The beneficial effect of post-operative RT for these low-risk groups can be questioned, and should be studied further.
Ringberg
A
A
Department of Plastic and Reconstructive Surgery, Malmö University Hospital, Sweden.
Idvall
I
I
Fernö
M
M
Anderson
H
H
Anagnostaki
L
L
Boiesen
P
P
Bondesson
L
L
Holm
E
E
Johansson
S
S
Lindholm
K
K
Ljungberg
O
O
Ostberg
G
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000517:prevention & control / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D002114:Calcinosis; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000401:mortality / Q000473:pathology* / Q000517:prevention & control / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005568:Forms and Records Control / Q000592:standards; D006801:Humans; D015412:Mastectomy, Segmental; D008499:Medical Records / Q000592:standards; D008875:Middle Aged; D009336:Necrosis; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D018714:Radiotherapy, Adjuvant; D012306:Risk; D016019:Survival Analysis; D016896:Treatment Outcome