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There are few established indications for sentinel lymph node biopsy (SLNB) in breast ductal carcinoma in situ (DCIS). This study examines factors contributing to the high rate of SLNB in DCIS in Alberta, Canada.
Patients who underwent definitive surgery from January 2009 to July 2011 for DCIS diagnosed on preoperative core-needle biopsy were ident...
Context in source publication
Context 1
... was the initial treatment in 37.6 % of patients overall (Table 2). Tumor size [odds ratio (OR), 1.92 per 1-cm increase in preoperative tumor size; 95 % CI 1.65- 2.24; i.e., a 2-cm tumor is 1.92 times more likely than a 1-cm tumor to be treated with TM] and operating surgeon were significantly related to the treatment with TM. ...
Similar publications
Breast cancer guidelines advise sentinel lymph node biopsy (SLNB) in patients with ductal carcinoma in situ (DCIS) on core biopsy at high risk of invasive cancer or in case of mastectomy. This study investigates the incidence of SLNB and SLN metastases and the relevance of indications in guidelines and literature to perform SLNB in order to validat...
Comparing diagnostic accuracy study between ultrasonography (US) guided fine-needle aspiration biopsy (FNAB) and core-needle biopsy (CNB) of the Sentinel lymph nodes (SLNs) in newly diagnosed invasive breast cancer patients. We selected 289 newly diagnosed invasive breast cancer patients from June 2015 to July 2017. Ultrasound (US) guided fine-need...
Citations
... Axillary surgery for DCIS is considered due to the possibility of diagnostic upgrade and subsequent risk of axillary lymph node metastasis after surgery. The rates of diagnostic upgrading based on breast surgical methods have been reported to be similar in various studies, ranging from 10.9% to 24.0% for BCS and 13.7% to 30.4% for TM [11,30]. However, Shin et al. [9] reported that, among patients diagnosed with DCIS who underwent TM, 2.7% (4/148) had sentinel lymph node (SLN) metastases, all of which were diagnostic upgrades. ...
Purpose
In total mastectomy (TM), sentinel lymph node biopsy (SLNB) is recommended but can be omitted for breast-conserving surgery (BCS) in patients with ductal carcinoma in situ (DCIS). However, concerns regarding SLNB-related complications and their impact on quality of life exist. Consequently, further research is required to evaluate the role of axillary surgeries, including SLNB, in the treatment of TM. We aimed to explore the clinicopathological factors and outcomes associated with axillary surgery in patients with a final diagnosis of pure DCIS who underwent BCS or TM.
Methods
We retrospectively analyzed large-scale data from the Korean Breast Cancer Society registration database, highlighting on patients diagnosed with pure DCIS who underwent surgery and were categorized into two groups: BCS and TM. Patients were further categorized into surgery and non-surgery groups according to their axillary surgery status. The analysis compared clinicopathological factors and outcomes according to axillary surgery status between the BCS and TM groups.
Results
Among 18,196 patients who underwent surgery for DCIS between 1981 and 2022, 11,872 underwent BCS and 6,324 underwent TM. Both groups leaned towards axillary surgery more frequently for large tumors. In the BCS group, clinical lymph node status was associated with axillary surgery (odds ratio, 11.101; p = 0.003). However, in the TM group, no significant differences in these factors were observed. Survival rates did not vary between groups according to axillary surgery performance.
Conclusion
The decision to perform axillary surgery in patients with a final diagnosis of pure DCIS does not affect the prognosis, regardless of the breast surgical method. Furthermore, regardless of the breast surgical method, axillary surgery, including SLNB, should be considered for high-risk patients, such as those with large tumors. This may reduce unnecessary axillary surgery and enhance the patients’ quality of life.
... This is more common if the diagnosis of the disease is made by core biopsy of the breast. [5] The potential of DCIS to harbor malignancy was found to be associated with lesion diameter and nuclear grade in the study by Chin-Lenn et al. [6] There are many studies in the literature investigating lymph node metastasis in patients with DCIS, but which patients should undergo lymph node biopsy in practice is still controversial. In patients undergoing mastectomy, if the final pathology shows an invasive component, SLNB is recommended because SLNB cannot be performed with a second operation, but the recommendations are not clear in patients undergoing BCS. ...
INTRODUCTION: The number of patients diagnosed with ductal carcinoma in situ (DCIS) has increased in the past 20 years with the widespread use of mammography screening. This study aims to investigate which patients with DCIS should undergo sentinel lymph node biopsy (SLNB).
METHODS: Between 2008 and 2023, patients diagnosed with DCIS in the General Surgery Clinic were evaluated retrospectively. Age, clinical features, tumor nuclear grade, presence of comedonecrosis, tumor diameter, hormone receptor, presence of microinvasive components, axillary pathology, surgical interventions, locoregional recürrences, overall and disease-free survival information of the patients were evaluated.
RESULTS: Forty-eight patients with a mean age of 52.2+12.4 years (25–76) were included in the study. Mastectomy was performed in 16, breast-conserving surgery in 32, SLNB in 21, axillary dissection in three, and no axillary-directed intervention was performed in 24 patients. Pure DCIS was detected in 44 patients and microinvasive com-ponent was detected in four patients (8.3%). No metastasis was detected after axillary sampling. It was statistically significant that a higher proportion of patients who underwent axillary intervention were in the mastectomy group and had diffuse microcalcifications in their mammograms (p<0.001 and p=0.009). Patients were followed up for a mean of 82.5 months, and locoregional recurrence was detected in 3 (6.25%) patients. One of the recurrences was due to DCIS, and the others were due to invasive cancer. The tumor sizes in these cases were above the average tumor size in the study.
DISCUSSION AND CONCLUSION: Although the absence of axillary metastasis in our study is attributed to the low number of patients and small mean tumor size, routine SLNB might not be performed in patients with DCIS due to the low rate of axillary metastasis. SLNB may be preferred only in cases where mastectomy will be performed.
... Out of 297 DCIS patients diagnosed by core needle biopsy who also underwent sentinel lymph node biopsy, only 10 patients were found to be sentinel lymph node positive [10]. In our case, a definite diagnosis of pure DCIS was made after postoperative histopathological examination and no evidence of invasion was found. ...
Introduction
and importance: Male breast cancer is a rare entity. Ductal carcinoma in situ (DCIS), constituting 10% of all male breast cancer, is confined within the breast ducts and lobules, rarely metastasizing and even less so after mastectomy.
Case presentation
A 71 years old male with no history of trauma presented with pain, swelling, and deformity of the left arm. He had continuous back pain for 6 months and a history of mastectomy of the right breast. Fracture of shaft of the left humerus was detected on X-ray. Computed tomography (CT) showed multiple vertebral metastases later confirmed to be metastasized from the breast by biopsy. Tumor cells were progesterone receptor (PR) positive, estrogen receptor (ER) negative, and human epidermal growth factor receptor 2 (HER2) negative. The fracture was treated and the patient was kept on Tamoxifen. On follow-up after four months, the patient is doing well with relief of back pain.
Clinical discussion
Despite mastectomy and the histopathological diagnosis of pure DCIS, distant metastases can occur even in absence of locoregional recurrence. Therefore, the aggressive phenotype of DCIS rather than diagnostic or treatment variables can be thought to bring worse outcome in the form of metastases. Early hormonal status identification and hormone therapy could result in a better outcome.
Conclusion
Skeletal metastases should be strongly suspected in patients presenting with bone pain and having a history of DCIS of the breast, even after mastectomy. Even though distant metastasis after mastectomy is rare, regular follow-up and surveillance is necessary.
... In theory, ductal carcinoma in situ (DCIS) does not metastasize to adjacent lymph nodes, and axillary lymph node evaluation or surgery had limited role. DCIS as determined by pathologic analysis of biopsy specimens, however, does not preclude invasive disease in excised specimens, and up to 50% (range, 3.5-56%) of core needle biopsy (CNB) or vacuum-assisted core biopsy (VACB) diagnosed DCIS would upgrade to have an invasive component (IC) [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Indication and adequacy of application of SLNB in lymph node evaluation of patients with pre-operative (pre-OP) DCIS diagnosed by biopsy remained a debated issue as SLNB remains an invasive procedure and not morbidity free [18][19][20]. ...
... In the current study, we enrolled 682 pre-OP DCIS patients and compared ALN metastasis pattern with another cohort of 2268 pre-OP diagnosed invasive cancer. We found 34.2% of these pre-OP DCIS patients upgraded to DCIS-IC in final pathology, and this upgrade rate was consistent with literate reported range (3.5-56%) [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. The risk of ALN metastasis rate varied widely depends on the pre-operative pathology, and in our current study, the ALN metastasis rate is 7.6% in pre-OP DCIS patients, and up to 39% in pre-OP invasive cancer group (Table 2). ...
Background
The optimal axillary lymph node (ALN) management strategy in patients diagnosed with ductal carcinoma in situ (DCIS) preoperatively remains controversial. The value of breast magnetic resonance imaging (MRI) to predict ALN metastasis pre-operative DCIS patients was evaluated.
Methods
Patients with primary DCIS with or without pre-operative breast MRI evaluation and underwent breast surgery were recruited from single institution. The value of breast MRI for ALN evaluation, predictors of breast and ALN surgeries, upgrade from DCIS to invasive cancer, and ALN metastasis were analyzed.
Results
A total of 682 cases with pre-operative diagnosis of DCIS were enrolled in current study. The rate of upgrade to invasive cancer were found in 34.2% of specimen, and this upgrade rate is 23% for patients who received breast conserving surgery and 40.7% for mastectomy ( p < 0.01). Large pre-operative imaging tumor size and post-operative invasive component were risk factors to ALN metastasis. Breast MRI had 53.8% sensitivity, 77.8% specificity, 14.9% positive predictive value, 95.9% negative predictive value (NPV), and 76.2% accuracy to predict ALN metastasis in pre-OP DCIS patients. In MRI node-negative breast cancer patients with MRI tumor size < 3 cm, the NPV was 96.4%, and all these false-negative cases were N1. Pre-OP diagnosed DCIS patients with MRI tumor size < 3 cm and node negative suitable for BCS could safely omit SLNB if whole breast radiotherapy is to be performed.
Conclusion
Breast MRI had high NPV to predict ALN metastasis in pre-OP DCIS patients, which is useful and could be provided as shared decision-making reference.
... Although the non-surgery arm is conducting active monitoring only in LORIS and LORD, endocrine therapy is mandatory in the non-surgery arm trial of LORETTA, and is an option in COMET (6). Despite a preoperative diagnosis of DCIS, 14-38% of patients were found to have invasive disease in the final pathological analysis (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). The active surveillance trials exclude patients with risk factors associated with upstaging to invasive cancer, such as high-grade DCIS and/or a palpable mass (2)(3)(4)(5). ...
Purpose
Four clinical active surveillance trials including LORIS, COMET, LORD and LORETTA, are being conducted to assess whether women with low-risk ductal carcinoma in situ can safely avoid surgery. The present study aimed to determine the rate of upstaging to invasive cancer among patients with a preoperative diagnosis of ductal carcinoma in situ and to evaluate the incidence of upstaging in patients meeting the eligibility criteria for four active surveillance clinical trials.
Methods
The present study initially enrolled 180 patients with 183 calcifications who received the diagnosis of ductal carcinoma in situ by biopsy. Patients were classified as eligible for four clinical trials according to the respective inclusion criteria.
Results
In total, 152 patients with 155 calcifications were analyzed. Of these, 32 (21%) were upstaged to invasive disease based on the final pathological analysis of surgical specimens. Of the 152 patients, 53 (35%), 90 (59%), 24 (16%) and 34 (22%) met the eligibility criteria for the LORIS, COMET, LORD and LORETTA trial, respectively. Among patients with low-risk ductal carcinoma in situ, 10 (19%), 14 (16%), 6 (25%) and 4 (12%) patients were upstaged to invasive disease in LORIS, COMET, LORD and LORETTA, respectively. The upstaging to pT1b or higher rates were 2% (1/53), 3% (3/90), 0% (0/24) and 3% (1/34) in LORIS, COMET, LORD and LORETTA, respectively.
Conclusions
The upstaging rate in patients eligible for the clinical active surveillance trials was 12–25%. Although the rate of upstaging to pT1b or higher was low, further studies are required to determine the rates of upstaging to invasive cancer and the risk factors among patients with low-risk ductal carcinoma in situ.
... Furthermore, the frequency of axillary node-positive among patients preoperatively diagnosed with DCIS is 2.5-6.8% [15][16][17]. Thus, better preoperative information is important to predict DCIS in the final pathological diagnosis so as not to administer overly intensive treatment to patients. ...
... Regarding the rate of LN metastasis in patients with preoperatively diagnosed DCIS, our results (4.2%) were consistent with those of previous studies (2.5-6.8%) [15][16][17]. The small rate of lymph node (LN) metastasis may support omission of upfront SLNB for patients with preoperatively diagnosed DCIS. ...
... However, our results showed that 86 (12.9%) of [2 or 3], and the presence of comedo necrosis) were associated with the presence of IDC in patients who were preoperatively diagnosed with DCIS. These clinicopathological predictors were the same as those described in previous reports [9][10][11][12][13][14][15][16][17][21][22][23][24]. Some previous studies [13] described that the type of biopsy device (14-gauge automated device versus 11-gauge vacuum) was significantly associated with under-staging. ...
Background
We conducted a prospective study with the intention to omit surgery for patients with ductal carcinoma in situ (DCIS) of the breast. We aimed to identify clinicopathological predictors of postoperative upstaging to invasive ductal carcinoma (IDC) in patients preoperatively diagnosed with DCIS.
Patients and methods
We retrospectively analyzed patients with DCIS diagnosed through biopsy between April 1, 2010 and December 31, 2014, from 16 institutions. Clinical, radiological, and histological variables were collected from medical records.
Results
We identified 2,293 patients diagnosed with DCIS through biopsy, including 1,663 DCIS (72.5%) cases and 630 IDC (27.5%) cases. In multivariate analysis, the presence of a palpable mass (odds ratio [OR] 1.8; 95% confidence interval [CI] 1.2–2.6), mammography findings (≥ category 4; OR 1.8; 95% CI 1.2–2.6), mass formations on ultrasonography (OR 1.8; 95% CI 1.2–2.5), and tumor size on MRI (> 20 mm; OR 1.7; 95% CI 1.2–2.4) were independent predictors of IDC. Among patients with a tumor size on MRI of ≤ 20 mm, the possibility of postoperative upstaging to IDC was 22.1%. Among the 258 patients with non-palpable mass, nuclear grade 1/2, and positive for estrogen receptor, the possibility was 18.1%, even if the upper limit of the tumor size on MRI was raised to ≤ 40 mm.
Conclusion
We identified four independent predictive factors of upstaging to IDC after surgery among patients with DCIS diagnosed by biopsy. The combined use of various predictors of IDC reduces the possibility of postoperative upstaging to IDC, even if the tumor size on MRI is larger than 20 mm.
... In theory, ductal carcinoma in situ (DCIS) does not metastasize to adjacent lymph nodes, and axillary lymph node evaluation or surgery had limited role. DCIS as determined by pathologic analysis of biopsy specimens, however, does not preclude invasive disease in excised specimens, and up to 50% (range, 3.5-56%) of core needle biopsy (CNB) or vacuum-assisted core biopsy (VACB) diagnosed DCIS would upgrade to have an invasive component (IC) [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Indication and adequacy of application of SLNB in lymph node evaluation of patients with pre-operative (pre-OP) DCIS diagnosed by biopsy remained a debated issue as SLNB remains an invasive procedure and not morbidity free [18][19][20]. ...
... In the current study, we enrolled 682 pre-OP DCIS patients and compared ALN metastasis pattern with another cohort of 2268 pre-OP diagnosed invasive cancer. We found 34.2% of these pre-OP DCIS patients upgraded to DCIS-IC in nal pathology, and this upgrade rate was consistent with literate reported range (3.5-56%) [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. The risk of ALN metastasis rate varied widely depends on the pre-operative pathology, and in our current study, the ALN metastasis rate is 7.6% in pre-OP DCIS patients, and up to 39% in pre-OP invasive cancer group (Table 2). ...
Background: The optimal axillary lymph node (ALN) management strategy in patients diagnosed with ductal carcinoma in situ (DCIS) preoperatively remains controversial. The value of breast magnetic resonance imaging (MRI) to predict ALN metastasis pre-operative DCIS patients were evaluated.
Methods: Patients with primary DCIS with or without pre-operative breast MRI evaluation and underwent breast surgery were recruited from single institution. The value of breast MRI for ALN evaluation, predictors of breast & ALN surgeries, upgrade from DCIS to invasive cancer, and ALN metastasis were analyzed.
Results: A total of 682 cases with pre-operative diagnosis of DCIS were enrolled in current study. The rate of upgrade to invasive cancer were found in 34.2% of specimen, and this upgrade rate is 23% for patients received breast conserving surgery and 40.7% for mastectomy (p<0.01). Large pre-operative imaging tumor size and post-operative invasive component were risk factors to ALN metastasis. Breast MRI had 53.8% sensitivity, 77.8% specificity, 14.9% positive predictive value, 95.9% negative predictive value (NPV), and 76.2% accuracy to predict ALN metastasis in pre-OP DCIS patients. In MRI node negative breast cancer patients with MRI tumor size < 3cm, the NPV was 96.4%, and all these false negative cases were N1. Pre-OP diagnosed DCIS patients with MRI tumor size <3 cm and node negative suitable for BCS could safety omit SLNB if whole breast radiotherapy is to be performed.
Conclusion: Breast MRI had high NPV to predict ALN metastasis in pre-OP DCIS patients, which is useful and could be provided as shared decision-making reference.
... Some previous studies have reported rates of SLN metastasis of 2.5-15% in patients with DCIS diagnosed by preoperative biopsy, and rates of upstaging to invasive cancer on pathological examination of surgical specimens of 20-40% (7,8,(18)(19)(20)(21)(22)(23). Our findings are consistent with these results. ...
... Clinicopathological factors that reportedly correlate with invasive cancer on pathological examination of surgical specimens are high DCIS histological grade (8,20), comedo necrosis (22,25), large preoperative size of DCIS lesion (9,18,22), widely distributed nonmass abnormalities in ultrasonographic imaging (26) and extensive calcification on mammography (27). In our study, we found that lesion size on preoperative diagnostic imaging predicts invasive cancer on pathological examination of surgical specimens. ...
... Our findings are concordant with those of other studies that have shown that larger DCIS lesions have a higher risk of upstaging to invasive cancer by pathological diagnosis at surgery (8,9,18,26,27). However, the precise size of DCIS lesion that predicts pathological diagnosis at surgery has not been reported. ...
Background:
Current guidelines do not recommend that sentinel lymph node biopsy is routinely performed for ductal carcinoma in situ; thus, indications for sentinel lymph node biopsy in patients with ductal carcinoma in situ remain controversial. In this study, we investigated whether sentinel lymph node biopsy can be safely omitted when ductal carcinoma in situ has been diagnosed by preoperative biopsy.
Methods:
We retrospectively analysed sentinel lymph node metastasis rates and upstaging to invasive cancer in surgical specimens, performed receiver operating characteristic analysis for ductal carcinoma in situ lesion size and assessed correlations with preoperative clinicopathological factors of 277 patients with ductal carcinoma in situ diagnosed by preoperative biopsy at our institution.
Results:
Among 277 patients with sentinel lymph node biopsy, six (2.2%) had sentinel lymph node metastasis. All six were upstaged to invasive cancer by pathological examination of surgical specimens. In total, 69 patients (24.9%) were upstaged to invasive cancer. The mean size of ductal carcinoma in situ lesions on preoperative imaging was significantly larger for the 69 upstaged patients (50.0 mm) than for the non-upstaged patients (34.4 mm; P < 0.0001). Of the 277 patients with sentinel lymph node biopsy, 117 (42.2%) had preoperative ductal carcinoma in situ lesions <31.8 mm, which was identified as the optimal cut-off size by receiver operating characteristic analysis. Of these 117 patients, 96 (82.1%, 95% confidence interval: 73.9-88.5%) could be safely omitted from sentinel lymph node biopsy because all of them remained as ductal carcinoma in situ and had negative sentinel lymph nodes at surgery.
Conclusions:
Size of ductal carcinoma in situ lesions on preoperative diagnostic imaging is a predictor of diagnosis of invasive cancer on pathological examination of surgical specimens. Sentinel lymph node biopsy may be unnecessary in ductal carcinoma in situ diagnosed by preoperative biopsy in patients with small lesions.
... 18 In numerous previous studies, large tumor size, palpable lump, and number of lesions were associated with the risk of upstaging. 2,8,15,[18][19][20][21] Other factors, such as nuclear grade, comedo necrosis, sclerosing adenosis, and CNB method, were also correlated with upstaging. 2,8,[18][19][20] Studies on molecular subtype as a predictor of upstaging are rare. ...
... 2,8,15,[18][19][20][21] Other factors, such as nuclear grade, comedo necrosis, sclerosing adenosis, and CNB method, were also correlated with upstaging. 2,8,[18][19][20] Studies on molecular subtype as a predictor of upstaging are rare. 8,19,21,22 Some studies showed a correlation between negative hormone receptor (HR) and invasion of DCIS, 8,21 and others showed that positive HER2 status was associated with upstaging. ...
Background:
Patients diagnosed with ductal carcinoma in situ (DCIS) by core needle biopsy (CNB) have a great chance of upstaging to invasive cancer. Positive axillary status can be found in these patients. This study sought to identify clinicopathological factors associated with upstaging and axillary metastasis in patients preoperatively diagnosed with DCIS by CNB.
Materials and methods:
This study identified 604 patients (cT1-3N0M0) with preoperative diagnosis of pure DCIS by CNB who had undergone axillary evaluation from August 2006 to December 2015 at Fudan University Shanghai Cancer Center (FUSCC). Predictors of upstaging and axillary lymph nodes metastasis were analyzed, respectively.
Results:
Of all 604 patients, 121 (20.03%) and 193 (31.95%) patients were upstaged to DCIS with microinvasion (DCISM) and invasive breast cancer (IBC). Positive axillary lymph nodes were identified in 41 (6.79%) patients. Predictors of upstaging included tumor size on ultrasonography (>2 cm) (OR 1.786, P = .002) and ER+HER2+ status (OR 1.874, P = .022) in multivariate analysis. Factors associated with axillary lymph nodes metastasis included tumor size on pathology (OR 2.336, P = .038) and number of lesions (OR 3.354, P = .039) in multivariate analysis. In addition, upstaging on final pathology had a significant influence on axillary lymph nodes status (P < .001).
Conclusion:
Axillary evaluation was recommended in patients with larger tumor size (>2 cm), multifocal lesions or ER+HER2+ status. Despite of a 51.98% upstaging rate, the rate of axillary metastasis in these patients was relatively low, supporting the omission of axillary evaluation in selected patients with low risk of upstaging or axillary metastasis.
... Furthermore, previous studies have shown that DCIS on core needle biopsy is upstaged to invasive disease at the time of surgical excision in 15-20% of cases, and this may be related to the extent of disease on preoperative imaging. [14][15][16][17] For example, women with large or multifocal areas of disease on imaging may have been more likely to undergo mastectomy, and these same women may have only had one or two biopsies of these large areas, which may or may not have been truly representative of the disease process. In other words, the true extent of disease may have been undersampled at the time of biopsy, and we assume that microinvasive disease is more likely to be present in a larger background of DCIS than a small area. ...
Background
Ductal carcinoma in situ (DCIS) with microinvasion (DCISM) can be challenging in balancing the risks of overtreatment versus undertreatment. We compared DCISM, pure DCIS, and small volume (T1a) invasive ductal carcinoma (IDC) as related to histopathology, treatment patterns, and survival outcomes.
Methods
Women ages 18–90 years who underwent breast surgery for DCIS, DCISM, or T1a IDC were selected from the SEER Database (2004–2015). Multivariate logistic regression and Cox proportional hazards models were used to estimate the association of diagnosis with treatment and survival, respectively.
Results
A total of 134,569 women were identified: 3.2% DCISM, 70.9% DCIS, and 25.9% with T1a IDC. Compared with invasive disease, DCISM was less likely to be ER+ or PR+ and more likely to be HER2+. After adjustment, DCIS and invasive patients were less likely to undergo mastectomy than DCISM patients (DCIS: OR 0.53, 95% CI 0.49–0.56; invasive: OR 0.86, CI 0.81–0.92). For those undergoing lumpectomy, the likelihood of receiving radiation was similar for DCISM and invasive patients but lower for DCIS patients (OR 0.57, CI 0.52–0.63). After adjustment, breast-cancer-specific survival was significantly different between DCISM and the other two groups (DCIS: HR 0.59, CI 0.43–0.8; invasive: HR 1.43, CI 1.04–1.96). However, overall survival was not significantly different between DCISM and invasive disease, whereas patients with DCIS had improved OS (HR 0.83, CI 0.75–0.93).
Conclusions
Although DCISM is a distinct entity, current treatment patterns and prognosis are comparable to those with small volume IDC. These findings may help providers counsel patients and determine appropriate treatment plans.
