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

Authors
  • Miligy, Islam M1
  • Toss, Michael S1
  • Khout, Hazem2
  • Whisker, Lisa2
  • Burrell, Helen C2
  • Ellis, Ian O1, 2, 3
  • Green, Andrew R1
  • Macmillan, Douglas2
  • Rakha, Emad A1, 2, 3
  • 1 Division of Cancer and Stem Cells, Nottingham Breast Cancer Research Centre, School of Medicine, Nottingham City Hospital, The University of Nottingham, Nottingham, UK.
  • 2 Nottingham Breast Institute, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK.
  • 3 Department of Histopathology, School of Medicine, Nottingham City Hospital, The University of Nottingham, Nottingham, UK.
Type
Published Article
Journal
The Breast Journal
Publisher
Wiley (Blackwell Publishing)
Publication Date
Nov 01, 2019
Volume
25
Issue
6
Pages
1143–1153
Identifiers
DOI: 10.1111/tbj.13425
PMID: 31318120
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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 emphasize on re-operation rates and outcome. Breast ductal carcinoma in situ cases diagnosed at the Nottingham Breast Institute between 1987 and 2017 were identified (n = 1249). Clinicopathological data were collected. Cases were histologically reviewed, and different factors associated with primary operation selection, re-excision, presence of residual tumor in the re-excision specimens, use of radiotherapy and ipsilateral recurrences were analyzed. 34% of DCIS patients were initially treated by mastectomy and were more frequently symptomatic, of high nuclear tumor grade, size >40 mm, and associated with comedo necrosis and Paget's disease of the nipple. Further surgery was due to involved or narrow surgical margins. Residual tumor 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. 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. © 2019 Wiley Periodicals, Inc.

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