The influence of clinicopathological features on the predictive accuracy of conventional breast imaging in determining the extent of screen-detected high-grade pure ductal carcinoma in situ

The extent of calcified ductal carcinoma in situ (DCIS) detected by screening mammography is a determinant for treatment with breast conserving surgery (BCS). However, DCIS may be uncalcified and almost a quarter of patients with DCIS treated initially by BCS either require a second operation or are...

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Bibliographic Details
Published in:Annals of the Royal College of Surgeons of England 2011-07, Vol.93 (5), p.385-390
Main Authors: Hayward, L, Oeppen, R S, Grima, A V, Royle, G T, Rubin, C M, Cutress, R I
Format: Article
Language:English
Subjects:
Aged
Biopsy
Breast cancer
Breast Neoplasms - diagnostic imaging
Breast Neoplasms - pathology
Breast Neoplasms - surgery
Breast Surgery
Calcification
Calcinosis - diagnostic imaging
Calcinosis - pathology
Calcinosis - surgery
Carcinoma, Ductal, Breast - diagnostic imaging
Carcinoma, Ductal, Breast - pathology
Carcinoma, Ductal, Breast - surgery
Carcinoma, Intraductal, Noninfiltrating - diagnostic imaging
Carcinoma, Intraductal, Noninfiltrating - pathology
Carcinoma, Intraductal, Noninfiltrating - surgery
Classification
Female
Humans
Incidental Findings
Lymphatic system
Mammography
Mammography - standards
Mastectomy - methods
Metastasis
Middle Aged
Preoperative Care
Reoperation
Retrospective Studies
Statistical analysis
Surgery
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Summary:The extent of calcified ductal carcinoma in situ (DCIS) detected by screening mammography is a determinant for treatment with breast conserving surgery (BCS). However, DCIS may be uncalcified and almost a quarter of patients with DCIS treated initially by BCS either require a second operation or are found to have unexpected invasive disease following surgery. Identification of these cases might guide selective implementation of additional diagnostic procedures. A retrospective review of patients with a preoperative diagnosis of pure high-grade DCIS at the Southampton and Salisbury Breast Screening Unit over a ten-year period was carried out. Mammograms were reviewed independently by a consultant radiologist and additional factors including the Breast Imaging Reporting and Data System (BI-RADS(®)) breast density score, DCIS extent and disease location within the breast recorded. Unexpected invasive disease was found in 35 of 144 patients (24%). Within our unit the re-excision rate for all screen-detected DCIS is currently 23% but for patients included in this study with high-grade DCIS the re-excision rate was 39% (34/87). The extent of DCIS (p=0.008) and lack of expression of the oestrogen receptor (ER) predicted the requirement for re-excision in both univariate (p=0.004) and multivariate analysis (p=0.005). High-grade DCIS may be focally uncalcified, leading to underestimation of disease extent, which might be related to ER status. Invasive foci associated with high-grade DCIS are often mammographically occult. Exploration of additional biomarkers and targeted use of further diagnostic techniques may improve the preoperative staging of DCIS.
ISSN:0035-8843
1478-7083
DOI:10.1308/003588411X579829