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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

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


Authors

Islam M. Miligy

Michael S. Toss

Hazem Khout

Burrell Hc

R. Douglas Macmillan

EMAD RAKHA Emad.Rakha@nottingham.ac.uk
Professor of Breast Cancer Pathology



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.

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