Powered by

© May 2005 Lorentz JÄNTSCHI && Sorana Daniela BOLBOACĂ

Up

1. Title
   Clinical practice guidelines for the care and treatment of breast cancer: 5. Management of ductal carcinoma in situ (DCIS)(2001 update)
2. Authors
   Ivo A. Olivotto, Mark Levine
3. Organization
   The Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer, *The Steering Committee is part of Health Canada's Canadian Breast Cancer Initiative.
4. Objective
   To help physicians and patients arrive at the most clinically effective approach to the management of ductal carcinoma in situ (DCIS).
5. Options
   Mastectomy, wide-excision breast-conserving surgery (BCS) plus radiotherapy or BCS alone.
6. Outcomes
   Overall survival, local recurrence, cosmesis, complications of therapy.
7. Evidence
   Review of English-language literature published between 1976 and April 2001, identified through MEDLINE and CANCERLIT. Nonsystematic review continued to June 2001.
8. Validation
   The authors' original text was revised by a writing committee, primary and secondary reviewers, and the Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. The final document reflects a consensus of all these contributors. The current update did not undergo an external review. A writing committee updated the original guideline and then submitted it for further review, revision and approval by the steering committee.
9. Sponsor
   The Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer was convened by Health Canada.
10. Completion date
    July 2001.
11. Method
    This guideline refers to the classification and management of ductal carcinoma in situ (DCIS or intraductal carcinoma) of the breast.[1,2] DCIS is a proliferation of malignant-appearing cells of the ducts and terminal lobular units of the breast that have not breached the ductal basement membrane. DCIS (TNM stage Tis) [3] must be distinguished pathologically from atypical ductal hyperplasia [1,4] and microinvasive breast cancer (TNM stage T1mic). [1–3,5] The occurrence of DCIS has increased over 5-fold since the mid-1980s in association with the increasing use of screening mammography. [6,7]
    This guideline is based on a systematic review of the English-language literature published from 1976 to April 2001, identified primarily through MEDLINE and CANCERLIT. Key words combined in the search were: "breast neoplasms," "carcinoma in situ," and "carcinoma, intraductal, non-infiltrating" as subject headings; and "duct," "dcis" and "ductal carcinoma" as text words. The search was restricted to controlled clinical trials, meta-analyses, practice guidelines and literature reviews on the topic. References in review articles and textbooks were also used. A nonsystematic review of the literature was continued to June 2001. The quality of the evidence on which conclusions were based was categorized into 5 levels (see Levels of Evidence).[8] The iterative process used to develop this guideline has been described previously.[9] A writing committee updated the original guideline and then submitted it for further review, revision and approval by the steering committee.
12. References
    1.Tavassoli F. Pathology of the breast. New York: Elsevier; 1992. p. 248-53.
    2.Lagios MD. Ductal carcinoma in situ. Pathology and treatment. Surg Clin North Am 1990;70:853-71.
    3.Sobin LH, Wittekind CH, editors. TNM classification of malignant tumors. 5th ed. Toronto: J. Wiley; 1997. p. 187-90.
    4.Page DL, Jensen RA, Simpson JF. Premalignant and malignant diseases of the breast: the roles of the pathologist. Mod Pathol 1998;11:120-8.
    5.Lagios MD, Westdahl PR, Margolin FR, Rose MR. Duct carcinoma in situ: relationship of extent of noninvasive disease to the frequency of occult invasion, multicentricity, lymph node metastases, and short-term treatment failures. Cancer 1982;50:1309-14.
    6.Ernster VL, Barclay J. Increases in ductal carcinoma in situ (DCIS) of the breast in relation to mammography: a dilemma. Natl Cancer Inst Monogr 1997;22:151-6.
    7.Winchester DJ, Menck HR, Winchester DP. National treatment trends for ductal carcinoma in situ of the breast. Arch Surg 1997;132:660-5.
    8.Sackett DL. Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest 1989;95(Suppl):2S-4S.
    9.Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. Clinical practice guidelines for the care and treatment of breast cancer. CMAJ 1998;158(3 Suppl):S1-83.
    10.Holland R, Hendriks JH, Vebeek AL, Mravunac M, Schuurmans Stekhoven JH. Extent, distribution, and mammographic/histological correlations of breast carcinoma in situ. Lancet 1990;335:519-22.
    11.Caines J, Cantin J, Hugi MR, Bowman DM, McGregor M. Clinical practice guidelines for the care and treatment of breast cancer: 2. Investigation of lesions detected by mammography. CMAJ 1998;158(3 Suppl):S9-S14.
    12.Caines JS, Chantziantoniou K, Wright BA, Konok GP, Iles SE, Bodurtha A, et al. Nova Scotia Breast Screening Program experience: use of needle core biopsy in the diagnosis of screening-detected abnormalities. Radiology 1996;198:125-30.
    13.Ikeda DM, Andersson I. Ductal carcinoma in situ: atypical mammographic appearances. Radiology 1989;172:661-6.
    14.Kinkel K, Gilles R, Feger C, Guinebretiere JM, Tardivon AA, Masselot J, et al. Focal areas of increased opacity in ductal carcinoma in situ of the comedo type: mammographic–pathologic correlation. Radiology 1994;192:443-6.
    15.Parker SH, Burbank F, Jackman RJ, Aucreman CJ, Cardenosa G, Cink TM, et al. Percutaneous large-core breast biopsy: a multi-institutional study. Radiology 1994;193:359-64.
    16.Morrow M, Schnitt S, Harris JR. Ductal carcinoma in situ. In: Harris JR, Lippman M, Morrow M, Osborne CK, editors. Diseases of the breast. 2nd ed. Philadelphia: Lippincot Williams & Wilkins; 2000. p. 383-401.
    17.Consensus conference on the classification of ductal carcinoma in situ. The Consensus Conference Committee. Cancer 1997;80:1798-802.
    18.Wolf CJM, Pery NM, editors. Macroscopic examination of biopsy and resection specimens. European guidelines for quality assurance in mammography screening. European Commission; 1996.
    19.Silverstein MJ, Waisman JR, Colburn WJ, Furmanski M, Lewinsky BS, Cohlan BF, et al. Intraductal breast carcinoma (DCIS) with and without microinvasion: Is there a difference in outcome? [abstract] Proc Annu Meet Am Soc Clin Oncol 1993;12:A24.
    20.Frykberg E, Bland KI. Overview of the biology and management of ductal carcinoma in situ. Cancer 1994;74:350-62.
    21.McCormick B, Rosen PP, Kinne D, Cox L, Yaholam J. Ductal carcinoma in situ of the breast: an analysis of local control after conservative surgery and radiotherapy. Int J Radiat Oncol Biol Phys 1991;21:289-92.
    22.Silverstein MJ, Waisman JR, Gamagami P, Gierson ED, Colburn WJ, Rosser RJ, et al. Intraductal carcinoma of the breast (208 cases): clinical factors influencing treatment choice. Cancer 1990;66:102-8.
    23.Cataliotti L, Distante V, Ciatto S, Bianchi S, Pacini P, Simoncini R, et al. Intraductal breast cancer: review of 183 consecutive cases. Eur J Cancer 1992;28A:917-20.
    24.Lilleng R, Hagmar B. The comedo subtype of intraductal carcinoma: cytologic characteristics. Acta Cytol 1992;36:345-52.
    25.Malamud YR, Ducatman BS, Wang HH. Comparative features of comedo and non-comedo ductal carcinoma in situ of the breast on fine needle aspiration biopsy. Diag Cytopathol 1992;8:571-6.
    26.Venegas R, Rutgers JL, Cameron BL, Vargas H, Butler JA. Fine needle aspiration cytology of breast ductal carcinoma in situ. Acta Cytol 1994;38:136-43.
    27.Poller DN, Snead DR, Roberts EC, Galea M, Bell JA, Gilmour A, et al. Oestrogen receptor expression in ductal carcinoma in situ of the breast: relationship to flow cytometry analysis of DNA and expression of c-erb B2 oncoprotein. Br J Cancer 1993;68:156-61.
    28.Silverstein MJ, Poller D, Waisman J, Colburn W, Barth A, Gierson E, et al. Prognostic classification of breast ductal carcinoma in situ. Lancet 1995;345:1154-7.
    29.Bellamy CO, McDonald D, Salter DM, Chetty U, Anderson TJ. Noninvasive ductal carcinoma of the breast: the relevance of histologic categorization. Hum Pathol 1993;24:16-23.
    30.Kuske RR, Bean JM, Garcia DM, Perez CA, Andriole D, Philpott G, et al. Breast conservation therapy for intraductal carcinoma of the breast. Int J Radiat Oncol Biol Phys 1993;26:391-6.
    31.Lagios MD, Margolin FR, Westdahl PR, Rose MR. Mammographically detected ductal carcinoma in situ: frequency of local recurrence following tylectomy and prognostic effect of nuclear grade on local recurrence. Cancer 1989;63:618-24.
    32.Schwartz GF, Patchefsky AS, Finklestein SD, Sohn SH, Prestipino A, Feig SA, et al. Nonpalpable in situ ductal carcinoma of the breast. Predictors of multicentricity and microinvasion and implications for treatment. Arch Surg 1989;124:29-32.
    33.Solin LJ, Kurtz J, Fourquet A, Amalric R, Recht A, Barnstein BA, et al. Fifteen-year results of breast-conserving surgery and definitive breast irradiation for the treatment of ductal carcinoma in situ of the breast. J Clin Oncol 1996;14:754-63.
    34.Hardman PDJ, Worth A, Lee U, Baird RM. The risk of occult invasive breast cancer after excisional biopsy showing in situ ductal carcinoma of comedo pattern. Can J Surg 1989;32:56-60.
    35.Ringberg A, Palmer BV, Linell F, Rychterova V, Ljungberg O. Bilateral and multifocal breast carcinoma: a clinical and autopsy study with special emphasis on carcinoma in situ. Eur J Surg Oncol 1991;17:20-9.
    36.Fisher ER, Costantino J, Fisher B, Palekar AS, Redmond C, Mamounas E. Pathologic findings from the National Surgical Adjuvant Breast Project (NSABP) protocol B-17. Intraductal carcinoma (ductal carcinoma in situ). The National Surgical Adjuvant Breast and Bowel Project Collaborating Investigators. Cancer 1995;75:1310-9.
    37.Fisher B, Dignam J, Wolmark N, Mamounas E, Costantino J, Poller W, et al. Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-17. J Clin Oncol 1998;16:441-52.
    38.Solin LJ, Yeh IT, Kurtz J, Fourquet A, Recht A, Kuske R, et al. Ductal carcinoma in situ (intraductal carcinoma) of the breast treated with breast-conserving surgery and definitive irradiation: correlation of pathologic parameters with outcome of treatment. Cancer 1993;71:2532-42.
    39.Zafrani B, Fourquet A, Vilcoq JR, Legal M, Calle R. Conservative management of intraductal breast carcinoma with tumorectomy and radiation therapy. Cancer 1986;57:1299-301.
    40.Fisher B, Costantino J, Redmond C, Fisher E, Margolese R, Dimitrov N, et al. Lumpectomy compared with lumpectomy and radiation therapy for the treatment of intraductal breast cancer. N Engl J Med 1993;328:1581-6.
    41.Schwartz GF, Finkel GC, Garcia JC, Pathefsky AS. Subclinical ductal carcinoma of the breast. Treatment by local excision and surveillance alone. Cancer 1992;70:2468-74.
    42.Holland R, Peterse JL, Millis RR, Eusebi V, Faversly D, Van de Vijver MJ, et al. Ductal carcinoma in situ: a proposal for a new classification. Semin Diagn Pathol 1994;11:167-80.
    43.Recht A, Rutgers EJ, Fentiman IS, Kurtz JM, Mansel RE, Sloane JP. The fourth EORTC DCIS Consensus meeting (Chateau Marquette, Heemskerk, The Netherlands, 23-24 January 1998) — conference report. Eur J Cancer 1998;34:1664-9.
    44.Schnitt SJ, Harris JR, Smith BL. Developing a prognostic index for ductal carcinoma in situ of the breast. Are we there yet? Cancer 1996;77:2189-92.
    45.Silverstein MJ, Lagios MD, Groshen S, Waisman JR, Lewinsky BS, Martino S, et al. The influence of margin width on local control of ductal carcinoma in situ of the breast. N Engl J Med 1999;340:1455-61.
    46.Ellis IO, Pinder SE, Lee AH, Elston CW. A critical appraisal of existing classification systems of epithelial hyperplasia and in situ neoplasia of the breast with proposals for future methods of categorization: Where are we going? Sem Diagnostic Path 1999;16:202-8.
    47.Silverstein MJ, Lagios MD, Craig PH, Waisman JR, Lewinsky BS, Colburn WJ, et al. A prognostic index for ductal carcinoma of the breast in situ. Cancer 1996;77:2267-74.
    48.Scott MA, Lagios MD, Axelsson K, Rogers LW, Anderson TJ, Page DL. Ductal carcinoma in situ of the breast: reproducibility of histological subtype analysis. Hum Pathol 1997;28:967-73.
    49.Bijker N, Peterse JL, Duchateau L, Julien JP, Fentiman IS, Duval C, et al. Risk factors for recurrence and metastasis after breast-conserving therapy for ductal carcinoma-in-situ: analysis of European Organization for Research and Treatment of Cancer Trial 10853. J Clin Oncol 2001;19:2263-71.
    50.Noguchi S, Aihara T, Koyama H, Motomura K, Inaji H, Imaoka S. Discrimination between multicentric and multifocal carcinomas of the breast through clonal analysis. Cancer 1994;74:872-7.
    51.Silverstein MJ, Gierson ED, Colburn WJ, Cope LM, Furmanski M, Senofsky GM, et al. Can intraductal breast carcinoma be excised completely by local excision? Cancer 1994;73:2985-9.
    52.De Mascarel I, Bonichon F, MacGrogan G, Tunon de Lara C, Avril A, Picot V, et al. Application of the Van Nuys prognostic index in a retrospective series of 367 ductal carcinomas in situ of the breast examined by serial macroscopic sectioning: practical considerations. Breast Cancer Res Treat 2000;61:151-9.
    53.Bellamy COC, McDonald C, Salter DM, et al. Non-invasive ductal carcinoma of the breast: the relevance of histologic categorization. Hum Pathol 1993;24:16-23.
    54.Noguchi S, Aihara T, Koyama H, Motomura K, Inaji H, Imaoka S. Discrimination between multicentric and multifocal carcinomas of the breast through clonal analysis. Cancer 1994;74:872-7.
    55.Simpson T, Thirlby RC, Dail DH. Surgical treatment of ductal carcinoma in situ of the breast. 10- to 20-year follow up [review]. Arch Surg 1992;127:468-72.
    56.Gump F. Multicentricity in early breast cancer. Semin Surg Oncol 1992;8:117-21.
    57.Nielsen M, Jensen J, Andersen J. Precancerous and cancerous breast lesions during lifetime and at autopsy: a study of 83 women. Cancer 1984;54:612-5.
    58.Harris JR, Recht A, Bornstein B, Schnitt S, Shulman L, Saderosky N. Ductal carcinoma in situ treated by excision plus radiotherapy: the influence of magnification views of mammography. Proceedings of the Breast Cancer Symposium, San Antonio, Tex., November 1994.
    59.White J, Levine A, Gustafson G, Wimbish K, Ingold J, Pettinga J, et al. Outcome and prognostic factors for local recurrence in mammographically detected DCIS of the breast treated by surgery and radiation therapy. Int J Radiat Oncol Biol Phys 1995;31:791-7.
    60.Ray GR, Adelson J, Hayhurst E, Marzoni A, Gregg D, Bronk M, et al. Ductal carcinoma in situ of the breast: results of treatment by conservative surgery and definitive irradiation. Int J Radiat Oncol Biol Phys 1994;28:105-11.
    61.Silverstein MJ, Barth A, Poller DN, Gierson ED, Colburn WJ, Waisman JR, et al. Ten-year results comparing mastectomy to excision and radiation therapy for ductal carcinoma in situ of the breast. Eur J Cancer 1995;31A:1425-7.
    62.Boyages J, Delaney G, Taylor R. Predictors of local recurrence after treatment of ductal carcinoma in situ: a meta-analysis. Cancer 1999;85:616-28.
    63.Julien JP, Bijker N, Fentiman IS, Peterse JL, Delledonne V, Rouanet P, et al. Radiotherapy in breast-conserving treatment for ductal carcinoma in situ: first results of the EORTC randomised phase III trial 10853. EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group. Lancet 2000;355:528-33.
    64.Moore MM. Treatment of ductal carcinoma in situ of the breast. Semin Surg Oncol 1991;7:267-70.
    65.Silverstein MJ, Waisman JR, Gierson ED, Colburn W, Gamagami P, Lewinsky BS. Radiation therapy for intraductal carcinoma: Is it an equal alternative? Arch Surg 1991;126:424-8.
    66.DeHaes JC, van Oostrom MA, Welvaart K. The effect of radical conserving surgery on the quality of life of early breast cancer patients. Eur J Surg Oncol 1986;12:337-42.
    67.Fallowfield LJ, Baum M, Maguire GP. Effects of breast conservation on psychological morbidity associated with diagnosis and treatment of early breast cancer. BMJ 1986;293:1331-4.
    68.McArdle JM, Hughson AVM, McArdle CS. Reduced psychological morbidity after breast conservation. Br J Surg 1990;77:1221-3.
    69.Steinberg MD, Juliano MA, Wise L. Psychological outcome of lumpectomy versus mastectomy in the treatment of breast cancer. Am J Psychiatry 1985;142:34-9.
    70.Al-Ghazal SK, Fallowfield L, Blamey RW. Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction. Eur J Cancer 2000;36:1938- 43.
    71.Tate PS, McGee E, Hopkins S, Rogers E, Page G. Breast conservation versus mastectomy: patient preferences in a community practice in Kentucky. J Surg Oncol 1993;52:213-6.
    72.Wobbes T, Tinnemans JG, van der Sluis RF. Residual tumour after biopsy for non-palpable ductal carcinoma in situ of the breast. Br J Surg 1989;76:185-6.
    73.Gluck BS, Dershaw DD, Liberman L, Deutch BM. Microcalcifications on postoperative mammograms as an indicator of adequacy of tumor excision. Radiology 1993;188:469-72.
    74.De Jong E, Peterse JL, van Dongen JA. Recurrence after breast ablation for ductal carcinoma in situ. Eur J Surg Oncol 1992;18:64-6.
    75.Fisher DE, Schnitt SJ, Chistian R, Harris JR, Henderson IC. Chest wall recurrence of ductal carcinoma in situ of the breast after mastectomy. Cancer 1993;71:3025-8.
    76.Montgomery RC, Fowble BL, Goldstein LJ, May DP, Hoffman JP, Sigurdson ER, et al. Local recurrence after mastectomy for ductal carcinoma in situ. Breast J 1998;4:430-6.
    77.Fisher B, Dignam J, Wolmark N, Wickerham DL, Fisher ER, Mamounas E, et al. Tamoxifen in treatment of intraductal breast cancer: National Surgical Adjuvant Breast and Bowel Project B-24 randomised controlled trial. Lancet 1999;353:1993-2000.
    78.Fisher ER, Dignam J, Tan-Chiu E, Costantino J, Fisher B, Paik S, et al. Pathologic findings from the National Surgical Adjuvant Breast Project (NSABP) eight-year update of Protocol B-17: intraductal carcinoma. Cancer 1999;86:429-38.
    79.Fowble B, Yeh IT, Schultz DJ, Solin LJ, Rosato EF, Jardines L, et al. The role of mastectomy in patients with stage I-II breast cancer presenting with gross multifocal or multicentric disease or diffuse microcalcifications. Int J Radiat Oncol Biol Phys 1993;27:567-73.
    80.Palmer BV, Mannur KR, Ross WB. Subcutaneous mastectomy with immediate reconstruction for early breast cancer. Br J Surg 1992;79:1309-11.
    81.Price P, Sinnett HD, Gusterson B, Walsh G, A'Hern RP, McKinna JA. Duct carcinoma in situ: predictors of local recurrence and progression in patients treated by surgery alone. Br J Cancer 1990;61:869-72.
    82.Fisher B, Costantino JP, Wickerham DL, Redmond CK, Kavanah M, Cronin WM, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst 1998;90:1371-88.
    83.Tamoxifen for early breast cancer: an overview of the randomised trials. Early Breast Cancer Trialists' Collaborative Group. Lancet 1998;351:1451-67.
    84.Silverstein MJ, Gierson ED, Colburn WJ, Rosser RJ, Waisman JR, Gamagami P. Axillary lymphadenectomy for intraductal carcinoma of the breast. Surg Gynecol Obstet 1991;172:211-4.
    85.Olivotto I, Jackson J, Mates D, Andersen S, Davidson W, Bryce C, et al. Prediction of axillary lymph node involvement of women with invasive breast carcinoma. Cancer 1998;83:948-55.
    86.Fisher B, Dignam J, Bryant J, DeCillis A, Wickerham DL, Wolmark N, et al. Five versus more than five years of tamoxifen therapy for breast cancer patients with negative lymph nodes and estrogen receptor-positive tumor. J Natl Cancer Inst 1996;88:1529-42.
    87.Schwartz GF, Solin LJ, Olivotto IA, Ernster VL, Pressman PI. Consensus conference on the treatment of in situ ductal carcinoma of the breast, April 22-25, 1999. Cancer 2000;88:946-54.