Comparison of local recurrence after simple and skin-sparing mastectomy performed in patients with ductal carcinoma in situ (original) (raw)
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The Breast, 2023
Background. The incidence of ductal carcinoma in situ (DCIS) is increasing with the use of screening mammography, and approximately 30% of all women diagnosed with DCIS are treated by mastectomy. There is increasing use of a skin-sparing mastectomy (SSM) approach to surgically excise DCIS as this facilitates immediate breast reconstruction. The rates of locoregional recurrence (LRR) after simple mastectomy performed for pure DCIS are historically reported as 1%; however, international data suggest that LRR after SSM may be higher. Methods. To determine our rates of LRR and compare the effect of the type of mastectomy performed, we undertook a retrospective review of all patients who underwent a mastectomy for pure DCIS at our institution between 2000 and 2010. Results. In total, 199 patients underwent a mastectomy for pure DCIS (with eight local recurrences), all of which were invasive ductal carcinoma. The recurrences all occurred after SSM, which was associated with a higher 5-year LRR of 5.9% (5/102) compared with 0% in the simple mastectomy group (0/97; p = 0.012), log-rank. Univariate analysis showed the two factors that predicted the risk of recurrence were a young age at mastectomy and close or involved margins. Conclusions. These data highlight the importance of achieving clear margins, especially in young women with Electronic supplementary material The online version of this article (
Recurrence after Mastectomy for Ductal Carcinoma in Situ
The American Surgeon, 2009
Mastectomy has long been a standard option for patients with ductal carcinoma in situ (DCIS). It is preferentially chosen by some women and may be suggested for individuals with recurrent, multifocal, or multicentric disease. We chose to evaluate our recent experience with mastectomy for DCIS. A retrospective review was conducted of 83 patients (87 breasts) from 1995 to 2006 who underwent mastectomy for DCIS. Mastectomy for DCIS was performed in 49 postmenopausal, 33 premenopausal, and one male patient. The average age was 53 years and the mean follow up was 4.5 years. Sentinel lymph node (SLN) biopsy was performed on 44 cases; positive nodes were identified in two. Intraoperative analyses of SLN were all negative. Only one patient had ipsilateral recurrence of the skin (1.1%). DCIS with microinvasion was noted in 32 per cent of the patients; none of these patients had ipsilateral recurrence. Three patients had positive microscopic margins; none have recurred to date. These results ...
Plastic and Reconstructive Surgery, 2003
Skin-sparing mastectomy with immediate breast reconstruction can provide an excellent cosmetic result. Despite its increasing popularity, few studies have assessed the risk of recurrence when the procedure is used for the treatment of ductal carcinoma in situ. To evaluate the oncologic safety of skin-sparing mastectomy used for the treatment of ductal carcinoma in situ, the recurrence rate was analyzed. Patients with ductal carcinoma in situ or invasive carcinoma or both who underwent skin-sparing mastectomy with immediate breast reconstruction between 1985 and 1994 and had a follow-up period of at least 6 years were included in this retrospective analysis. The recurrence rates were determined for invasive carcinoma (with or without foci of ductal carcinoma in situ) and ductal carcinoma in situ alone. A total of 221 patients were included, 177 patients with invasive carcinoma and 44 patients with ductal carcinoma in situ alone. The immediate breast reconstructions were performed with transverse rectus abdominis muscle (TRAM) flaps in 62 percent of patients, implants in 34 percent of patients, and latissimus dorsi myocutaneous flaps (with or without implants) in 4 percent of patients. The local recurrence rate was zero of 44 for patients with ductal carcinoma in situ and 5.6 percent (10 of 177) for patients with invasive carcinoma during a mean follow-up period of 9.8 years. There was a 6.8 percent (12 of 177) metastatic recurrence rate in the invasive carcinoma group. All recurrences were invasive ductal carcinoma. Of the patients with ductal carcinoma in situ alone, none developed metastatic disease. The combined metastatic and local recurrence rates for the invasive carcinoma group (n ϭ 177) with each type of reconstruction were 13 percent (14 of 110), 12 percent (seven of 60), and 14 percent (one of seven) for TRAM flaps, implants, and latissimus dorsi flaps, respectively. The risk of recurrence following skin-sparing mastectomy and immediate breast reconstruction for ductal carcinoma in situ is low during this follow-up period. Therefore, skinsparing mastectomy with immediate breast reconstruction seems to be a safe oncologic treatment option for ductal carcinoma in situ; however, a longer follow-up period is important to determine the long-term risk of recurrence. (Plast. Reconstr. Surg. 111: 706, 2003.) Before the use of mammography for breast cancer screening, ductal carcinoma in situ was believed to have a relatively low incidence. However, it is currently the fastest growing subgroup of breast neoplasia, making the determination of proper management an increasingly important issue. 1 More than 60 percent of cases are discovered solely by mammography. 2 Usually, high-quality mammography can detect small, nonpalpable lesions by visualizing calcium deposits that form as a result of tumor cell necrosis. Ductal carcinoma in situ is defined as proliferating malignant ductal cells limited to existing ductal units, without invasion through the basement membrane. 3 Hypothesized to be the primary stage of carcinoma in a multistep process of carcinogenesis, ductal carcinoma in situ includes a heterogeneous group of lesions with various morphologic and biological attributes. Patients who have multifocal ductal carcinoma in situ with microinvasion have a 5-year disease-free survival rate of 78 percent, compared with 98 percent in patients with simple ductal carcinoma in situ. For breast cancer patients undergoing immediate reconstruction, skin-sparing mastectomy has become increasingly popular because
Outcomes and factors impacting local recurrence of ductal carcinoma in situ
Cancer, 2000
BACKGROUND. The optimal management of ductal carcinoma in situ (DCIS) remains controversial. Investigators have focused on identifying patients who are eligible for treatment by excision alone. A retrospective analysis of patients with DCIS treated by various modalities was conducted to compare outcomes and determine factors significant for local recurrence (LR). Between 1985Between -1992 consecutive diagnoses of DCIS were identified in 85 patients. Seventy-four percent were detected mammographically. The most common histologic subtypes were comedo (54%) and cribriform (23%). Tumor sizes were Ͻ 2.5 cm (49%), Ͼ 2.5-5 cm (26%), Ͼ 5 cm (23%), and unknown (2%).
The American Journal of Surgery, 2007
Background: Local recurrence rates after skin-sparing mastectomy and immediate reconstruction are similar to recurrence rates after conventional mastectomy. We investigated the pattern of local recurrences and risk factors associated with them. Methods: We identified 206 patients who underwent 210 skin-sparing mastectomies with immediate reconstruction from 1998 to 2006 in our database. Results: Eleven patients had local recurrences (5.3%). Nine developed in the quadrant of the corresponding primary tumor. There were no significant differences between patients who recurred and those who did not with respect to tumor size/stage, margin status, estrogen receptor/progesterone receptor/Her2neu status, lymph node metastases, or radiation therapy (P Ͼ .05). Patients with grade 3 invasive tumors or high-grade ductal carcinoma in situ were more likely to recur than patients with grade 1 or 2 invasive tumors or low-or intermediate-grade ductal carcinoma in situ (P ϭ .0035). Those patients who recurred had a significantly decreased overall survival compared to patients who did not recur (P ϭ .0006). Conclusions: Skin-sparing mastectomy and immediate reconstruction has a low local recurrence rate. Recurrences occur most commonly in the same quadrant as the primary tumor and treatment approaches include surgery, chemotherapy, and radiation therapy. Local recurrence portends a poorer overall survival.
International Journal of Radiation Oncology*Biology*Physics, 2007
Purpose: Outcomes after different treatment strategies for ductal carcinoma in situ (DCIS) of the breast were analyzed for a geographically defined population in the East Netherlands. Methods and Materials: A total of 798 patients with a first diagnosis of DCIS between January 1989 and December 2003 were included and their medical records were reviewed. Survival rates for ipsilateral recurrences were calculated by the Kaplan-Meier method and a multivariate Cox proportional hazards regression model was used to evaluate the prognostic significance of different variables. Results: The 5-year recurrence-free survival was 75% for breast conserving surgery (BCS) alone (237 patients) compared with 91% for BCS followed by radiation therapy (RT; 153 patients) and 99% for mastectomy (408 patients, p < 0.01). Independent risk factors for local recurrences were treatment strategy, symptomatically detected DCIS, and presence of comedo necrosis. Margin status reached statistical significance only for patients treated by BCS (hazard ratio, 2.0; 95% confidence interval, 1.1-4.0) whereas significance of other prognostic variables did not change. Conclusions: In a defined population outside a trial setting, RT after BCS for DCIS lowered recurrence rates. Besides the use of RT, a microscopically complete excision of DCIS is essential. This is especially true for patients with symptomatically detected DCIS and with tumors that contain comedo necrosis, as these groups are at particular high risk for recurrent disease. Ó 2007 Elsevier Inc.
Management of Ductal Carcinoma in Situ of the Breast: A Clinical Practice Guideline
2006
What is the optimal surgical management of ductal carcinoma in situ (DCIS) of the breast? Should breast irradiation be offered to women with DCIS, following breast-conserving surgery (defined as excision of the tumour with microscopically clear resection margins)? Are there patients who could be spared breast irradiation post-breast-conserving surgery for DCIS? What is the role of tamoxifen in the management of DCIS?
in Vivo, 2020
Background/Aim: Surgical margin status remains an important determinant for recurrence of invasive breast cancer and ductal carcinoma in situ. We compared the number of positive margins in initial histology with rates of residual tumor in re-excision specimens. Furthermore, we analysed cost-effectiveness of re-excisions. Patients and Methods: 101 patients treated with secondary surgery were included. The first group underwent breast conserving surgery and secondary mastectomy. The second group was primarily treated with subcutaneous mastectomy followed by secondary surgery. Results: Within the first group, 22.7% did not show residual tumor in the re-excision specimen. Of the second group, 54.3% had no residual tumor. Consequentially 45.7% needed a re-excision to achieve R0 status. Costeffectiveness was determined as secondary endpoint. If a patient needs a secondary mastectomy the hospital gains 602,65€ in comparison to a primary breast conserving operation. Conclusion: In every second patient who had first received a subcutaneous mastectomy, no tumor could be detected in the secondary operation despite a previous R1 status. Surgical margin status ("no ink on tumor") remains an important determinant for local recurrence of ductal carcinoma in situ (DCIS) and invasive breast cancer (IBC) (1, 2). Whether breast conserving surgery (BCS) or mastectomy is performed, depends on tumor size, size of the breast, patient consent and tumor biology. Positive margins after BCS or mastectomy subsequently leads to secondary surgeries (1, 3). Those are unavoidable to lower the risk of local recurrence (4-6). Of the 66,970 patients treated with surgery for DCIS or IBC in 2018, 10,070 patients underwent re-excision in Germany (7). Literature shows residual tumor rates of 33-73% within re-excision (Table I). Some studies differentiate between DCIS and IBC, but often don't distinguish between type of primary operative strategy. The primary endpoint in this study was re-excision-rates for DCIS and IBC depending on the operative strategy. We provide data regarding the significance of residual tumor within re-excisions after primary surgery with positive margins. The "diagnosis related group"-system (DRG) in Germany stipulates that even in the case of a re-operation only the costliest procedure is invoiced. The secondary endpoint in this study was the cost-effectiveness of the secondary surgery. Patients and Methods Patients treated with secondary surgery between June 2017 and March 2019 in the municipal Hospital of Cologne, Holweide, due to positive or close margins within the initial surgery were included in this study. Tumor conference protocols provided information on tumor biology, tumor size, neoadjuvant chemotherapy, primary surgery, pathology results and planned procedures. Regarding the financial implications, the "Webgrouper" of the DRG-Research-Group provides the possibility of classifying the complete hospital stay of breast cancer patients with surgery into diagnosis-related flat rates per case. This results in a total charge for the medical service within one case. The "Webgrouper" is an open source and can be used free of charge, while hospitals use certain certified software programs as groupers. The algorithms of the groupers are nevertheless the same. Within this "Webgrouper", patient related data as age, date of hospitalization and date of 2015 This article is freely accessible online.
European Journal of Cancer, 1995
The lo-year results of 3'00 patients with ductal carcinoma in situ (DCIS) without microinvasion are reported; 167 treated with mastectomiy and 133 treated with excision and radiation therapy. There was a significant difference in disease-free survival at 10 years, in favour of those treated with mastectomy, 98% versus 81% (P = 0.0004). Multivariate analysis confirmed nuclear grade as the only significant predictor of local recurrence (P = 0.02) or invasive local recurrence (P = 0.03) in patients with DCIS treated with excision and radiation therapy. There was no difference in breast cancer-specific survival or overail survival between the two treatment groups.