Behaviour and characteristics of low-grade ductal carcinoma in situ of the breast: literature review and single-centre retrospective series

Koh, Valerie Cui Yun; Lim, Jeffrey Chun Tatt; Thike, Aye Aye; Cheok, Poh Yian; Thu, Minn Minn Myint; Li, Huihua; Tan, Veronique Kiak Mien; Ong, Kong Wee; Tan, Benita Kiat Tee; Ho, Gay Hui; Thilagaratnam, Shyamala; Wong, Jill Su Lin; Wong, Fuh Yong; Ellis, Ian Ogilvie; Tan, Puay Hoon

Abstract

© 2019 John Wiley & Sons Ltd Aims: Ductal carcinoma in situ (DCIS) of the breast is a heterogeneous disease that has risen to prominence and more recently controversy, with the advent of screening mammography. Debate concerning the true biological potential of low nuclear grade DCIS continues to challenge therapeutic considerations. In this study, we carried out a comprehensive literature review of the behaviour, outcomes and current management trials of low-grade DCIS, as well as a retrospective study of a large single institutional series of low-grade DCIS diagnosed at our hospital. Methods and results: The study cohort comprised 195 cases of low-grade DCIS diagnosed at the Singapore General Hospital from 1994 to 2010. Clinicopathological parameters and follow-up data were retrieved and compared between screen-detected and symptomatic low-grade DCIS. Immunohistochemistry was performed for ER, PR and HER2. Among 195 cases, 123 (63.1%) were screen-detected, while 72 (36.9%) were symptomatic. Screen-detected cases had frequent calcifications (P < 0.001) and were smaller (P = 0.018) than symptomatic cases. All cases were ER-positive and rate of PR expression was high. No HER2 overexpression was observed. Mean and median follow-up periods were 107.8 and 109.6 months, respectively. Six patients recurred ipsilaterally, and one patient developed direct distant metastasis. One breast cancer-related death was recorded. Positive surgical margins (P = 0.023) were significantly associated with a higher risk of ipsilateral recurrences, as well as poorer disease-free survivals (P = 0.010). Conclusion: Our data indicate that low-grade DCIS may be followed by invasive recurrences and even metastatic disease, requiring more study before being regarded as innocuous and indolent.

Citation

Koh, V. C. Y., Lim, J. C. T., Thike, A. A., Cheok, P. Y., Thu, M. M. M., Li, H., …Tan, P. H. (2019). Behaviour and characteristics of low-grade ductal carcinoma in situ of the breast: literature review and single-centre retrospective series. Histopathology, 74(7), 970-987. https://doi.org/10.1111/his.13837

• Journal Article Type: Article
• Acceptance Date: Feb 7, 2019
• Online Publication Date: Mar 28, 2019
• Publication Date: Jun 1, 2019
• Deposit Date: Aug 8, 2019
• Journal: Histopathology
• Print ISSN: 0309-0167
• Electronic ISSN: 1365-2559
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 74
• Issue: 7
• Pages: 970-987
• DOI: https://doi.org/10.1111/his.13837
• Keywords: Pathology and Forensic Medicine; Histology; General Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/2405940
• Publisher URL: https://onlinelibrary.wiley.com/doi/full/10.1111/his.13837