Surgical management of ductal carcinoma in situ of the breast: A large retrospective study from a single institution

Miligy, Islam M.; Toss, Michael S.; Khout, Hazem; Hc, Burrell; Ellis, Ian O.; Green, Andrew R.; Macmillan, R. Douglas; Rakha, Emad

Abstract

Background: Management of breast ductal carcinoma in situ (DCIS) has various approaches with distinct institutional specific practice. Here, we review DCIS management in a single institution with emphasise on re-operation rates and outcome. Methods: DCIS cases diagnosed at the Nottingham Breast Institute between 1987 and 2017 were identified (n=1,249). Clinicopathological data was collected. Cases were histologically reviewed, and different factors associated with primary operation selection, re-excision, presence of residual tumour in the re-excision specimens, use of radiotherapy and ipsilateral recurrences were analysed. Results: 34% of DCIS patients were initially treated by mastectomy and were more frequently symptomatic, of high nuclear tumour grade, size >40mm, and associated with comedo necrosis and Paget’s disease of the nipple. Further surgery was due to involved or narrow surgical margins. Residual tumour tissue was detected in 53% of the re-excision specimens. Re-excision rates of patients treated with breast conserving surgery (BCS) were reduced from approximately 70% to 23% and the final mastectomy rates decreased from 60% to 20%. Changes in surgical practice with acceptance of smaller excision margins and more frequent use of local radiotherapy have led to a significant decrease not only in the re-excision rate but also in the final mastectomy rate together with non-significant reduction in 5- and 10-year local recurrence rates. Conclusion: Although BCS is increasingly the preferred primary surgical option for DCIS management, a proportion of low-risk DCIS patients continue to undergo re-excision surgery or completion mastectomy. Despite acceptance of smaller margins, recurrence rate is decreasing.

Citation

Miligy, I. M., Toss, M. S., Khout, H., Hc, B., Ellis, I. O., Green, A. R., …Rakha, E. (2019). Surgical management of ductal carcinoma in situ of the breast: A large retrospective study from a single institution. Breast Journal, 25(6), 1143-1153. https://doi.org/10.1111/tbj.13425

• Journal Article Type: Article
• Acceptance Date: Feb 20, 2019
• Online Publication Date: Jul 18, 2019
• Publication Date: 2019-11
• Deposit Date: Feb 22, 2019
• Publicly Available Date: Jul 19, 2020
• Journal: The Breast Journal
• Print ISSN: 1075-122X
• Electronic ISSN: 1524-4741
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 25
• Issue: 6
• Pages: 1143-1153
• DOI: https://doi.org/10.1111/tbj.13425
• Keywords: DCIS, management, mastectomy, BCS, re-excision; Running title: Management of DCIS; 1
• Public URL: https://nottingham-repository.worktribe.com/output/1577823
• Publisher URL: https://onlinelibrary.wiley.com/doi/full/10.1111/tbj.13425
• Additional Information: This is the peer reviewed version of the following article: Miligy, IM, Toss, MS, Khout, H, et al. Surgical management of ductal carcinoma in situ of the breast: A large retrospective study from a single institution. Breast J. 2019; 00: 1– 11, which has been published in final form at https://doi.org/10.1111/tbj.13425. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.