The presentation, management and outcome of patients with ductal carcinoma in situ (DCIS) with microinvasion (invasion ≤1 mm in size)-results from the UK Sloane Project.
Abstract
Background: The diagnosis, management and prognosis of microinvasive breast carcinoma remain controversial.
Methods: We analysed the outcomes of patients with DCIS with and without microinvasion diagnosed between 2003 and 2012 within the Sloane project.
Results: Microinvasion was recorded in 521 of 11,285 patients (4.6%), with considerable variation in reported incidence among screening units (0-25%). Microinvasion was associated with high-grade DCIS, larger DCIS size, comedo necrosis and solid, cribriform architecture (all P < 0.001). Microinvasion was more frequent in patients who underwent mastectomy compared with breast-conserving surgery (BCS) (6.9% vs 3.6%, P < 0.001), and in those undergoing axillary nodal surgery (60.4% vs 30.3%, P < 0.001) including the subset undergoing BCS (43.4% vs 8.5%, P < 0.001). Nodal metastasis rate was low and not statistically significant difference from the DCIS only group (P = 0.68). Following median follow-up of 110 months, 3% of patients had recurrent ipsilateral high-grade DCIS, and 4.2% developed invasive carcinoma. The subsequent ipsilateral invasion was of Grade 3 in 71.4% of patients with microinvasion vs 30.4% in DCIS without microinvasion (P = 0.02). Distant metastasis and breast cancer mortality were higher with microinvasion compared with DCIS only (1.2% vs 0.3%, P = 0.01 and 2.1% vs 0.8%; P = 0.005).
Conclusions: The higher breast cancer mortality with microinvasion indicates a more aggressive disease.
Author
Shaaban, Abeer M
Hilton, Bridget
Clements, Karen
Dodwell, David
Sharma, Nisha
Kirwan, Cliona
Sawyer, Elinor
Maxwell, Anthony
Wallis, Matthew
Stobart, Hilary
Mylvaganam, Senthurun
Litherland, Janet
Brace-McDonnell, Samantha
Dulson-Cox, Joanne
Kearins, Olive
Provenzano, Elena
Ellis, Ian O
Pinder, Sarah E
Thompson, Alastair M
Hilton, Bridget
Clements, Karen
Dodwell, David
Sharma, Nisha
Kirwan, Cliona
Sawyer, Elinor
Maxwell, Anthony
Wallis, Matthew
Stobart, Hilary
Mylvaganam, Senthurun
Litherland, Janet
Brace-McDonnell, Samantha
Dulson-Cox, Joanne
Kearins, Olive
Provenzano, Elena
Ellis, Ian O
Pinder, Sarah E
Thompson, Alastair M
Citations
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Date
2022-10-12
Type
Article
Subject
Oncology. Pathology.
Collections
Citation
Shaaban AM, Hilton B, Clements K, Dodwell D, Sharma N, Kirwan C, Sawyer E, Maxwell A, Wallis M, Stobart H, Mylvaganam S, Litherland J, Brace-McDonnell S, Dulson-Cox J, Kearins O, Provenzano E, Ellis IO, Pinder SE, Thompson AM. The presentation, management and outcome of patients with ductal carcinoma in situ (DCIS) with microinvasion (invasion ≤1 mm in size)-results from the UK Sloane Project. Br J Cancer. 2022 Dec;127(12):2125-2132. doi: 10.1038/s41416-022-01983-4. Epub 2022 Oct 12
Journal / Source Title
British Journal of Cancer
DOI
10.1038/s41416-022-01983-4
PMID
36224403
Publisher
Nature Publishing Group
Publisher’s URL
http://www.nature.com/bjc