Nipple-sparing Mastectomy with Immediate Implant-based Reconstruction for Patients with Pure Ductal Carcinoma in Situ / Mastectomia preservadora demamilo com reconstrução imediata baseada em implante para pacientes com carcinoma ductal puro in situ

Abstract Objective The presence of an extensive intraductal component is associated to an increasing risk of relapse in the nipple-areola complex. The aim of the present study was to evaluate the outcomes of patients diagnosed with ductal carcinoma in situ (DCIS) who underwent nipple-sparing mastectomy (NSM) with immediate breast reconstruction using silicone implants. Methods We retrospectively analyzed the postoperative complications and oncological safety of 67 breast cancer patients diagnosed with pure DCIS who underwent NSM with immediate breast reconstruction using silicone implants between 2004 and 2018. Results Among the 127 NSM procedures performed, 2 hematomas (1.5%) and 1 partial nipple necrosis (0.7%) were observed. After a mean follow-up of 60months, the local recurrence rate was of 8.9%, the disease-free survival rate was of 90%, and 1 of the patients died. Conclusion Despite the local recurrence rate, we showed that NSM with immediate breast reconstruction using silicone implants is a feasible surgical approach, with a low rate of complications and high survival rates for patients with a diagnosis of pure DCIS when breast-conserving surgery is not an option.

Resumo Objetivo A presença de componente intraductal extenso é associada ao risco aumentado de recorrência no complexo aréolo-mamilar. O objetivo deste estudo foi avaliar os resultados de pacientes diagnosticados com carcinoma ductal in situ (CDIS)submetidas a adenomastectomia (nipple-sparing mastectomy, NSM, em inglês) com reconstrução mamária imediata utilizando prótese de silicone. Métodos Restrospectivamente, foramanalisadas as complicações pós-operatórias e a segurança oncológica de 67 pacientes com câncer de mama diagnosticadas com CDIS puro, e submetidas a NSM com reconstrução mamária imediata utilizando prótese de silicone, entre 2004 e 2018. Resultados Entre os 127 procedimentos realizados, 2 hematomas (1,5%) e 1 necrose parcial de mamilo (0,7%) foram observados. Após um período médio de 60 meses de seguimento, a taxa de recorrência local foi de 8,9%, a sobrevida livre de doença, de 90%, e apenas 1 paciente foi a óbito. Conclusão Apesar da taxa de recorrência local, demostrou-se que NSM com reconstrução mamária imediata comprótese de silicone é umprocedimento viável, combaixa taxa de complicação e alta sobrevida para pacientes com diagnóstico de CDIS puro quando a cirurgia conservadora da mama não é uma opção.

Solid intracystic papillary carcinoma in male breast: case report

The intracystic papillary carcinoma (IPC) is one of the rarest types of breast cancer, mainly in men, representing less than 1% of the malignant diseases in the male sex. It is frequently associated with the ductal carcinoma in situ (DCIS), but there are also other forms such as the pure and the invasive ones. The male population breast cancer diagnosis is late and, therefore, it has a worse prognosis. The diagnosis is given by imaging tests and anatomopathological studies. The treatment consists of excisional tumor therapy, which can be carried out conservatively or through mastectomy, with or without adjuvant therapy.

Ductal carcinoma in situ of the breast: correlation of architectural, cytological, IHC findings and recurrence analysis / Carcinoma ductal in situ da mama: correlação dos achados arquiteturais, citológicos e IHQ e análise de recorrência

ABSTRACT Objective: This study evaluated the histopathological features of ductal carcinoma in situ (DCIS), including cytological grade, architectural pattern and immunohistochemistry (IHC) in pure DCIS and DCIS associated with invasive carcinoma of no special type (ICNST). Methods: We evaluated a series of 232 cases of pure DCIS and DCIS associated with ICNST from a total of 399 breast carcinomas from a population consisting by women diagnosed with breast cancer and submitted to breast surgery from 2011 to 2015. Results: DCIS presented a mixed architectural pattern in most cases (56%); the solid subtype was the most common morphology (30%). High-grade DCIS was identified in 84/221 cases (38%), and comedonecrosis was present in 106/221 cases (48%). High-grade was more common in the solid subtype (61/155 cases, 39%, p < 0.001). Tumor size was greater in the presence of comedonecrosis than in the absence (mean 27 vs 20 mm, p = 0.009). Estrogen receptor (ER) was positive in 81% of cases with a cribriform pattern (p = 0.013). Greater locoregional recurrence was found in the comedonecrosis (15%) and micropapillary (19%) subtypes in DCIS associated with ICNST. Conclusion: We observed a greater relationship of ER with the low nuclear grade, while Ki-67 was related to the high-grade. DCIS presented a higher nuclear grade compared to ICNST. The less common pure pattern was the micropapillary, and the most common, the solid. Comedonecrosis was more frequent in the solid pattern. Our results showed that high-grade was more common in the solid and comedo subtype, and low-grade was more frequent in the cribriform.

RESUMEN Objetivo: Este estudio evaluó las características del carcinoma ductal in situ (CDIS), incluyendo grado citológico, patrón arquitectural y inmunohistoquímica en CDIS puro y asociado a carcinoma invasivo tipo no especial (CI-TNE). Métodos: Evaluamos una serie de 232 casos de CDIS puro o asociado a carcinoma mamario invasivo procedentes de una población de mujeres diagnosticadas con cáncer de mama y sometidas a cirugía mamaria, entre 2011 y 2015. Resultados: El CDIS presentó un patrón arquitectural mixto en la mayoría de los casos (56%); el subtipo sólido fue la morfología más común (30%). El CDIS de alto grado fue identificado en 84/221 casos (38%), y comedonecrosis estaba presente en 106/221 casos (48%). El alto grado fue más común en el subtipo sólido (61/155 casos, 39%; p < 0.001). El tamaño del tumor fue más grande en presencia de comedonecrosis de lo que en su ausencia (promedio 27 vs. 20 mm; p = 0.009). El receptor de estrógeno (RE) fue positivo en el 81% de los casos con patrón cribiforme (p = 0.013). Se encontró mayor recidiva locorregional en los subtipos comedonecrosis (15%) y micropapilar (19%) en el CDIS asociado al CI-TNE. Conclusión: Observamos mayor relación del RE con bajo grado nuclear, mientras Ki-67 se relacionó con alto grado. El CDIS presentó grado nuclear más alto de lo que el CI-TNE. El patrón puro menos común fue el micropapilar, y el más común, el sólido. La comedonecrosis fue más frecuente en el patrón sólido. Nuestros resultados mostraron que el alto grado fue más común en los subtipos sólido y comedonecrosis, y el bajo grado, más frecuente en el cribiforme.

RESUMO Objetivo: Este estudo avaliou as características histopatológicas do carcinoma ductal in situ (CDIS), incluindo grau citológico, padrão arquitetural e imuno-histoquímica (IHQ) em CDIS puro e associado a carcinoma invasivo tipo não especial (CI-TNE). Métodos: Avaliamos uma série de 232 casos de CDIS puro ou associado ao carcinoma mamário invasivo de um total de 399 carcinomas mamários provenientes de uma população constituída por mulheres diagnosticadas com câncer de mama e submetidas à cirurgia mamária, entre 2011 e 2015. Resultados: O CDIS apresentou um padrão arquitetural misto na maioria dos casos (56%); o subtipo sólido foi a morfologia mais comum (30%). O CDIS de alto grau foi identificado em 84/221 casos (38%), e comedonecrose estava presente em 106/221 casos (48%). O alto grau foi mais comum no subtipo sólido (61/155 casos, 39%; p < 0,001). O tamanho do tumor foi maior na presença de comedonecrose do que na ausência (média 27 vs. 20 mm; p = 0,009). O receptor de estrogênio (RE) foi positivo em 81% dos casos com padrão cribriforme (p = 0,013). Maior recorrência locorregional foi encontrada nos subtipos comedonecrose (15%) e micropapilar (19%) no CDIS associado ao CI-TNE. Conclusão: Observamos uma maior relação do RE com o baixo grau nuclear, enquanto o Ki-67 relacionou-se com o alto grau. O CDIS apresentou mais alto grau nuclear em comparação com o CI-TNE. O padrão puro menos comum foi o micropapilar, e o mais comum, o sólido. A comedonecrose foi mais frequente no padrão sólido. Nossos resultados mostraram que o alto grau foi mais comum nos subtipos sólido e comedonecrose, e o baixo grau, mais frequente no cribriforme.

MRI manifestations of breast encapsulated papillary carcinoma / 中国医学影像技术

Objective: To explore MRI manifestations of breast encapsulated papillary carcinoma (EPC). Methods: Data of 18 women with EPC confirmed by surgery and pathology were retrospectively analyzed. Pure EPC (n=7) and EPC with invasion or ductal carcinoma in situ (DCIS) (n=11) were compared. Results: All 18 EPC presented as masses, and 5 were accompanied by non-mass enhancement. Totally 11 masses were mixed cystic-solid and 7 purely solid, 10 were round/oval and 8 were irregular, 11 were margins circumscribed and 7 were irregular. The median apparent diffusion coefficient (ADC) value of the solid part of EPC was 1.12×10-3 mm2/s. The time-intensity curve (TIC) of EPC was washout in 13 cases and plateau in 5 cases. Delayed-enhancement capsules were observed in 15 masses, included 13 masses showing hypointense capsules on T2WI. The adjacent vessel sign (AVS) was present in 16 masses. No significant difference of clinical nor MRI features was found between pure EPC and EPC with invasion or DCIS. Conclusion: MRI findings of breast EPC were of certain characteristics, commonly manifested by mixed cystic-solid mass with circumscribed margin, delayed-enhancement capsules presenting hypointense on T2WI, washout TIC type and AVS positive.

DIFFICULTIES IN COLLECTING DATA ON DUCTAL CARCINOMA IN SITU AT A POPULATION-BASED CANCER REGISTRY / Dificuldades na coleta de dados de carcinoma ductal in situ em um Registro de Câncer de Base Populacional

Objective: To verify data-coding accuracy for ductal carcinoma in situ at the Goiânia population-based cancer registry in the Brazilian state of Goiás. Methods: Ecological time series analysis of cases coded as ductal carcinoma in situ in the state cancer database (ONCOSIS), considering data from the Goiânia population-based cancer registry, from 1994 to 2010. Results: Of 376 cases originally coded as ductal carcinoma in situ, 115 were excluded following a review of the pathology reports. These exclusions referred to cases of lobular carcinoma in situ (n=21), Paget's disease (n=4), invasive carcinoma (n=08), ductal carcinoma in situ associated with invasive carcinoma (n=14), microinvasive carcinoma (n=21), records on non-residents in Goiânia, and duplicated data (n=46). Conclusion: Many cases needed recoding and, as a consequence, altered the initial database. Standardizing pathology reports and training data collection staff are crucial steps to avoid omissions and errors when transcribing cases of ductal carcinoma in situ in a population-based cancer registry database.

Objetivo: Verificar a acurácia da codificação dos dados de carcinoma ductal in situ dentro do Registro de Câncer de Base Populacional de Goiânia, Goiás - Brasil. Métodos: Estudo ecológico de série temporal de casos codificados como carcinoma in situ da mama, pelo programa (ONCOSIS) do Registro de Câncer de Base Populacional de Goiânia, entre 1994 e 2010. Posteriormente realizou­se busca individual dos laudos histopatológicos de CDIS. Resultados: De 376 casos de CDIS, foram excluídos 115 casos após a revisão dos laudos anatomopatológicosas. As exclusões referem-se a carcinoma lobular in situ (21), Doença de Paget (4), carcinoma invasor (08); CDIS associado a carcinoma invasor (14); microinvasor (21), pacientes com endereço fora de Goiânia e dados duplicados (46). Conclusão: Há um grande número de casos que precisam ser recodificados, alterando o banco inicial. A padronização de laudos e o treinamento dos coletadores são etapas importantes para que não haja informações desconhecidas ao transcrever o CDIS para as fichas do RCBP.

Magnetic resonance imaging of the breast: role in the evaluation of ductal carcinoma in situ / Papel da ressonância magnética das mamas na avaliação do carcinoma ductal in situ

Abstract Ductal carcinoma in situ (DCIS) is a precursor mammary lesion whose malignant cells do not extend beyond the basement membrane and presents a risk of progression to malignant disease. Its early detection increased with screening mammography. The objective of this study was to review the literature on the main presentations of DCIS on magnetic resonance imaging (MRI), through searches of the Medline/PubMed, Latin-American and Caribbean Center on Health Sciences Information (Lilacs), and Scientific Electronic Library Online (SciELO) databases. DCIS can occur in its pure form or in conjunction with invasive disease, in the same lesion, in different foci, or in the contralateral breast. MRI has a high sensitivity for the detection of pure DCIS, being able to identify the non-calcified component, and its accuracy increases with the nuclear grade of the lesion. The most common pattern of presentation is non-nodular enhancement; heterogeneous internal structures; a kinetic curve showing washout or plateau enhancement; segmental distribution; and restricted diffusion. MRI plays an important role in the detection of DCIS, especially in the evaluation of its extent, contributing to more reliable surgical excision and reducing local recurrence.

Resumo O carcinoma ductal in situ (CDIS) é uma lesão mamária precursora cujas células malignas não ultrapassam a membrana basal e possui risco de evolução para doença maligna. Sua detecção precoce aumentou com a mamografia de rastreamento. O objetivo deste estudo foi realizar uma revisão da literatura sobre as principais apresentações do CDIS na ressonância magnética (RM), utilizando mecanismos de busca na base de dados Medline/PubMed, Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde (Lilacs) e Scientific Electronic Library Online (SciELO). O CDIS pode ocorrer de forma pura ou associado a doença invasiva, na mesma lesão, em focos diferentes e na mama contralateral. A RM possui alta sensibilidade para a detecção do CDIS puro, sendo capaz de identificar o componente não calcificado da doença e sua precisão aumenta com o seu grau nuclear. O padrão de apresentação mais comum é o realce não nodular com padrão interno heterogêneo, curva cinética de lavagem rápida (washout) ou platô, de distribuição segmentar e com restrição na difusão. A RM tem importante papel na detecção do CDIS e, principalmente, na avaliação da sua extensão, contribuindo para uma exérese cirúrgica mais confiável e reduzindo as recidivas locais.

The value of preoperative CA19-9 combined with platelet-to-lymphocyte ratio in predicting invasive malignancy in intraductal papillary mucinous neoplasms / 中华外科杂志

Objective@#To explore preoperative predictive markers for invasive malignancy in intraductal papillary mucinous neoplasm(IPMN).@*Methods@#The retrospective case-controlled study was adopted.Seventy-nine patients who underwent surgery and with pathologically confirmed IPMN from January 2005 to December 2014 at Department of Pancreatic Surgery, Zhongshan Hospital Fudan University were enrolled.Forty-six patients were male and 33 were female,with an average age of (62.9±8.9)years (range:37-82 years).Tumor sites:56 tumors were located at the head of the pancreas,22 were located at the body and tail of the pancreas,and 1 was located across the whole pancreas.Surgical procedures: 51 patients underwent pancreaticoduodenectomy, 22 patients underwent distal pancreatectomy, 4 patients underwent segmental pancreatectomy and 2 patients underwent total pancreatectomy.IPMNs were classified into non-invasive lesions and invasive carcinomas according to the histopathological findings of the tumor.Thirty-two tumors were non-invasive lesions and 47 were invasive carcinomas.The preoperative findings were compared between patients with non-invasive IPMN and patients with invasive carcinoma by univariate analysis using t test and χ2 test accordingly,and factors with statistically significance were subsequently submitted to multivariate analysis.@*Results@#Univariate analysis showed that tumor size(P=0.022), carcinoembryonic antigen(P=0.012), CA19-9(P=0.011), lymphocytes(P=0.034), neutrophil-to-lymphocyte ratio(P=0.010)and platelet-to-lymphocyte ratio(PLR)(P=0.004)were predictive markers with statistical significance.Multivariate analysis showed that CA19-9(P=0.012)and PLR(P=0.025) were independent predictive markers for invasive malignancy in IPMN.The area under curve of the combination factor of CA19-9 and PLR(0.864) was larger than that of CA19-9(0.806) or PLR(0.685) alone, and all the authentic indicators of the combination factor were better than those of each alone.@*Conclusions@#CA19-9 and PLR are independent predictive markers for invasive malignancy in IPMN.The combination of CA19-9 and PLR has improved efficacy than each alone.

Ultrasonographic features of calcified and non-calcified ductal carcinoma in situ of breast and their expression of estrogen receptor and human epidermal growth factor receptor-2 / 中国医学影像技术

Objective: To compare the ultrasonographic features of calcified and non-calcified ductal carcinoma in situ (DCIS) of breast, and to explore the difference of the expression of estrogen receptor (ER) and human epidermal growth factor receptor-2 (Her-2). Methods A total of 148 patients with pathologically confirmed DCIS were retrospectively analyzed and divided into calcified DCIS group (n=66) and non-calcified DCIS group (n=82) according to the presence of microcalcification in ultrasonography. The differences of the ultrasonographic features, ER and Her-2 positive expression were analyzed. Results The signs of mass, ductal ectasia and elastographic scores showed statistically significant differences between the 2 groups (all P0.05). ER positive rate was 42.42% (28/66) in calcified DCIS group and 69.51% (57/82) in non-calcified DCIS group. The difference of ER positive rate between the two groups was statistically significant (P<0.01). Her-2 positive in calcified DCIS group was 30.30% (20/66), while in the non-calcified DCIS group was 14.63% (12/82; P=0.02). Conclusion The ultrasonographic features are different between calcified breast DCIS and non-calcified DCIS. Positive ER is more common in non-calcified DCIS, while high Her-2 expression is more common in calcified DCIS, indicating that calcified DCIS may have rather aggressive histological features.

Natural history of ductal carcinoma in situ / História natural do carcinoma ductal in situ

Ductal carcinoma in situ (DCIS) has been detected more frequently in the last decades using the mammographic screening. The objective of the present study was to review the epidemiological aspects of DCIS. A bibliographic narrative review was carried out focusing on the following aspects: the epidemiology of DCIS to discuss subtypes; natural history; screening; and survival. It was possible to verify that the DCIS is currently considered a precursor lesion of breast cancer, presenting a considerable and uneven increased incidence between developed and developing countries, probably due to the inclusion of mammographic screening programs. There are controversies regarding the benefit or not of its detection, diagnosis, treatment and survival of patients with DCIS. It is concluded that the considerable increase in the incidence of DCIS raises an important discussion about the real need for its diagnosis as well as its real biological significance

carcinoma ductal in situ (CDIS) tem sido detectado com maior frequência nas últimas décadas a partir do rastreamento mamográfico. O objetivo do presente estudo foi revisar os aspectos epidemiológicos do CDIS. Foi realizada uma revisão bibliográfica narrativa enfocando os aspectos do CDIS: epidemiologia, para discussão a respeito dos subtipos; história natural; rastreamento; e sobrevida. Foi possível verificar que o CDIS é atualmente considerado como uma lesão precursora do câncer de mama e apresenta aumento considerável e desigual em sua incidência entre países desenvolvidos e em desenvolvimento, devido, provavelmente, à inclusão dos programas de rastreamento mamográfico. Há controversas quanto ao benefício ou não da detecção, do diagnóstico, do tratamento e da sobrevida de pacientes que apresentam o CDIS. Conclui-se que o aumento considerável da incidência do CDIS levanta importante discussão sobre a necessidade real de seu diagnóstico, bem como do seu real significado biológico

Evaluation of survivin immunoexpression in the differentiation of high- and low-grade breast ductal carcinoma in situ / Expressão da proteína survivina em carcinoma ductal in situ de mama de alto e de baixo grau

ABSTRACT Objective To evaluate the expression of survivin protein in low- and high-grade ductal carcinoma in situ. Methods Breast tissue fragments obtained by incisional biopsy and surgical procedures of 37 women with ductal carcinoma in situ of the breast were subdivided into two groups: Group A, composed of women with low-grade ductal carcinoma in situ, and Group B, women with high-grade ductal carcinoma in situ. Survivin protein expression test was performed by immunohistochemistry, using a monoclonal antibody clone I2C4. The criterion to evaluate survivin immunoexpression was based on the percentage of neoplastic cells that presented brown-gold staining. This criterion was positive when the percentage of stained cells was ≥10%. Results The survivin protein was expressed in 22 out of 24 cases of high-grade ductal carcinoma in situ (78%), whereas, in Group A, of low-grade ductal carcinoma in situ (n=13), it was positive in only 6 cases (21.40%; p=0.004). Conclusion The frequency of expression of survivin was significantly higher in the group of patients with high-grade ductal carcinoma in situ compared to those in the low-grade ductal carcinoma in situ group.

RESUMO Objetivo Avaliar a imunoexpressão da proteína survivina nos carcinomas ductais in situ de mama de baixo e de alto graus. Métodos Fragmentos de tecido mamários obtidos por biópsia incisional e procedimentos cirúrgicos de 37 mulheres acometidas por carcinoma ductal in situ de mama foram subdivididos em dois grupos: Grupo A, formado por mulheres com carcinoma ductal in situ de baixo grau; e Grupo B, por mulheres com carcinoma ductal in situ de alto grau. A pesquisa de expressão da proteína survivina foi realizada pela técnica de imuno-histoquímica, utilizando-se anticorpo monoclonal clone I2C4. O critério de avaliação da imunoexpressão da survivina baseou-se na percentagem de células neoplásicas que apresentava coloração castanho-dourada. Considerouse tal critério positivo quando a percentagem de células apresentasse marcação ≥10%. Resultados A proteína survivina apresentou-se expressa em 22 dos 24 casos de carcinoma ductal in situ de alto grau (78%), enquanto no Grupo A, de carcinoma ductal in situ de baixo grau (n=13), apresentou-se positiva em apenas 6 casos (21,40%; p=0,004). Conclusão O índice de frequência de expressão da survivina foi significativamente mais elevado no grupo de pacientes com carcinoma ductal in situ de alto grau, quando comparado às do grupo com carcinoma ductal in situ de baixo grau.

Mechanism of ductal carcinoma in situ to invasive breast cancer / 国际肿瘤学杂志

Ductal carcinoma in situ (DCIS) is a precursor of invasive ductal breast cancer,and up to 40％ of these lesions will progress to invasive disease if untreated.The micro-environment,genetic aberrations,signal pathways and epigenetics play important roles during the infiltration and transformation of DCIS.Further studies of the infiltration and transformation of DCIS will promote the accurate assessment and prognosis prediction of the patients with DCIS,for finding a comprehensive evaluation standard and the balance between the over and low treatment.

Microinvasive Carcinoma versus Ductal Carcinoma In Situ: A Comparison of Clinicopathological Features and Clinical Outcomes / 한국유방암학회지

PURPOSE: Although microinvasive carcinoma is distinct from ductal carcinoma in situ (DCIS), the clinical significance of microinvasion in DCIS remains elusive. The purpose of this study is to evaluate the clinicopathological features and clinical outcomes of microinvasive carcinoma compared with pure DCIS. METHODS: We assessed 613 cases of DCIS and microinvasive carcinoma that were consecutively resected from 2003 to 2014 and analyzed clinicopathological variables, expression of standard biomarkers such as the estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), p53, and Ki-67, and tumor recurrence. RESULTS: Among the 613 cases, 136 (22.2%) were classified as microinvasive carcinoma. Microinvasive carcinoma was significantly associated with DCIS with a large extent, high nuclear grade, necrosis, and comedotype architectural pattern. ER and PR expressions were dominantly observed in pure DCIS, whereas positive HER2 status, p53 overexpression, and high Ki-67 proliferation indices were more frequently observed in microinvasive carcinoma. Lymph node metastasis was found in only four cases of microinvasive carcinoma with multifocal microinvasion. In the multivariate analysis, DCIS with a large extent, comedo-type architectural pattern, and negative ER status were found to be independent predictors of microinvasion. During follow-up, 12 patients had ipsilateral breast recurrence, and no differences in recurrence rates were observed between patients with DCIS and those with microinvasive carcinoma. The triple-negative subtype was the only factor that was associated with tumor recurrence. CONCLUSION: Microinvasive carcinomas are distinct from DCIS in terms of clinicopathological features and biomarker expressions but are similar to DCIS in terms of clinical outcomes. Our results suggest that microinvasive carcinoma can be treated and followed up as pure DCIS.

Fatores preditivos de margens cirúrgicas comprometidas no tratamento do carcinoma ductal in situ da mama / Predictive factors of positive margins in the treatment of ductal carcinoma in situ

O objetivo deste estudo foi determinar, através de revisão da literatura, possíveis fatores que possam estar associados com margens cirúrgicas comprometidas em portadoras de carcinoma ductal in situ (CDIS). Foi empregado o banco de dados do Medical Literature Analysis and Retrieval System Online (MEDLINE®), utilizando as expressões: "Ductal carcinoma in situ", "in situ breast cancer" e "DCIS". Os termos adicionais incluídos foram "surgery" e "margin". O período de referência desses estudos foi de fevereiro de 2000 a fevereiro de 2015. Dos 438 artigos encontrados, 6 foram incluí- dos nessa revisão, com um total de 1.222 pacientes. A taxa de margens comprometidas nos estudos variou de 29 a 72%. As principais variáveis relacionadas com margem comprometida foram o grau histológico e o tamanho nal da lesão na para na (três estudos), multifocalidade (um estudo) e volume da peça cirúrgica ressecada (um estudo). Margens cirúrgicas representam, indubitavelmen- te, um dos mais importantes fatores de recorrência local no tratamento do CDIS. São necessários estudos mais amplos e com metodologias adequadas para se estrati car, com segurança, os fatores de risco associados ao comprometimento das margens cirúrgicas.

e purpose of this study was to determinate, through a literature review, possible factors related to positive margins in patients treated with surgery for ductal carcinoma in situ (DCIS). e Medical Literature Analysis and Retrieval System Online (MEDLINE®) database were used to search the articles, with the expressions: "Ductal carcinoma in situ" "in situ breast cancer" and "DCIS". Ad- ditional terms included were "surgery" and "margin". e reference period of these studies was from February 2000 to February 2015. A total of 438 articles were found, and six of them were included in this review, with a total of 1,222 patients. e rate of positive margins studies varied from 29 to 72%. e main variables related to positive margins were the histological grade and the nal size of the lesion in para n (three studies), multifocality (one study) and volume of the resected specimen (one study). Surgical margins represent, undoubtedly, one of the most important factors of local recurrence in the treatment of DCIS. Larger studies are needed, with adequate methodology, to safely stratify the risk factors associated with surgical margins involvement.

Sonographic findings and pathological features of ductal carcinoma in situ without microcalcifications on mammography / 中华医学超声杂志（电子版）

Objective To investigate the characteristic sonographic and pathological features of breast ductal carcinoma in situ (DCIS) without microcalcifications on mammography (MG).Methods Forty cases of DCIS without microcalcifications on MG were retrospectively reviewed.The 40 lesions were classified into mass and non-mass groups according to their sonographic findings.The pathological subtypes and nuclear grades of these cases were also analyzed.Fisher exact test was used to compare the differences of the sonographic accuracy rate,sonographic microcalcification rate,pathological nuclear grade and subtype rate between mass and non-mass groups.Results No abnormal finding was found in sixteen cases (40.0％)on MG and only one case (2.5％) on ultrasonography (US),respectively.The most common sonographic feature of DCIS without microcalcifications on MG were masses (75.0％,30/40),and other sonographic findings were round/oval and irregular shape,microlobulated margin,heterogeneous hypoechogenicity and isoechogenicity,and posterior acoustic feature.Ductal dilatations and heterogeneous isoechogenicity were present in most non-mass lesions of DCIS without microcalcifications on MG (22.5％,9/40).The ultrasonographic microcalcifications were found in 5 cases of DCIS without microcalcifications on MG.The common pathological features of DCIS without microcalcifications on MG were medium-low nuclear grade (85.0％,34/40) and noncomedo (87.5％,35/40).The difference of US accuracy rate in mass and non-mass groups was statistically significant [73.3％ (22/30) vs 33.3％ (3/9),P=0.047].The differences of US microcalcification rate,pathological subtype and nuclear grade were not significant (P=1.000,0.070).Conclusions The mass appearance and medium-low nuclear grade were most common sonographic findings and pathological features of DCIS without microcalcifications on MG.Ultrasonography should be an helpful tool for improving the diagnostic sensitivity ofmammography in breast DCIS.

Comparison of laparoscopic distal pancreatectomy and open distal pancreatectomy in pancreatic ductal adenocarcinoma / 中华肿瘤杂志

Objective@#To compare and evaluate the curative effect of laparoscopic distal pancreatectomy(LDP) and traditional open distal pancreatectomy(ODP) in pancreatic ductal adenocarcinoma.@*Methods@#The clinical data of 15 patients treated by LDP and 87 contemporaneous cases treated by ODP from January 2010 to November 2015 was collected, and the curative effect and prognosis of these patients were retrospectively analyzed.@*Results@#The operation time of LDP group was (286.5±48.1) min, significantly longer than that of OPD group(226.6±56.8) min (P<0.05). The operative hemorrhage, postoperative exhaust time, recovery eating time, the whole and postoperative hospitalization time of LDP group were (188.7±108.9) ml, (2.2±1.3) d, (2.9±1.1) d, (13.2±10.4) d and (9.3±8.1) d, respectively, dramatically shorter than those of ODP group (625.2±982.1) ml, (4.3±1.7) d, (5.2±1.8) d, (20.7±8.7) d and (14.9±7.8) d, respectively (all of P<0.05). There were no intraoperative blood transfusion case in LDP group, however, 13 patients in ODP group received intraoperative blood transfusion, without significant difference (P=0.207). Alternatively, 6 cases occurred pancreatic fistula in LDP group, among them, 5 cases were grade A and 1 case was grade B; In ODP group, 17 cases occurred pancreatic fistula, among them 13 cases were grade A, 1 case was grade B and 3 cases were grade C, without significant differences (P=0.130). There were 2 cases of delayed gastric empty, 1 case of pulmonary infection in LDP group. In ODP group, there were 5 cases of postoperative delayed gastric empty, 3 cases of pulmonary infection and 6 cases of intra-abdominal infection, without significant differences (P>0.05). In both LDP group and ODP group, none occurred percutaneous drainage, re-admissions, second operation or perioperative death.@*Conclusions@#Compared to ODP, LDP is much safer and more steady in perioperative periodand operation. Patients of pancreatic ductal adenocarcinoma received LDP can acquire more benefit and recovery sooner, and LDP is a safe and effective operative method.

Surgical treatment and prognosis of ductal carcinoma in situ: 526 cases analysis / 中华外科杂志

Objective@#To evaluate the choice of surgical treatment of ductal carcinoma in situ (DCIS) and its impact on long-term outcomes.@*Methods@#A retrospective analysis of the clinicopathological features and treatment protocol of DCIS patients who underwent surgical treatment in Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine from January 2009 to August 2016 was done. The factors which could affect surgical treatment were analyzed by χ2 test and Logistic regression. Survival analysis were performed between different surgical approaches. Kaplan-Meier survival curves and Log-rank tests demonstrated the distribution of disease free survival and overall survival.@*Results@#A total of 526 patients were enrolled in this study, 405 cases (77.0%) underwent mastectomy, 121 cases (23.0%) underwent breast-conserving surgery, of which 88 cases received radiotherapy after breast-conserving surgery. It was shown by univariate and multivariate analysis that age>50 years (OR=0.631, 95% CI: 0.413 to 0.965, P=0.034), first symptom of nipple discharge (OR=0.316, 95% CI: 0.120 to 0.834, P=0.020), excision biopsy (OR=1.831, 95% CI: 1.182 to 2.835, P=0.007) and tumor size >3 cm (OR=0.422, 95% CI: 0.206 to 0.864, P=0.018) were significantly correlated with choice of surgical treatment for breast lesions. Axillary lymph node dissection was performed for 118 cases (22.4%), with sentinel lymph node biopsy for 327 cases (62.2%), and none for 81 cases (15.4%). There was significant statistical difference in the choice of axillary lymph node management in patients of different age (χ2=8.124, P=0.017), biopsy type (χ2=35.567, P=0.000), breast operation type (χ2=149.118, P=0.000) and tumor size (χ2=13.394, P=0.010). The 5-year disease free survival rates was 95.7%, 89.6% and 100%, respectively, for mastectomy group, breast-conserving surgery group and breast-conserving surgery plus radiotherapy group. And the 5-year overall survival rates for three groups were 99.0%, 100% and 100%. The differences were not statistically significant (P=0.427, 0.777).@*Conclusions@#For DCIS patients, age, first symptom and tumor size are independent predictors of breast surgery. The choice of axillary lymph node surgery is influenced by age, biopsy, operation type, and tumor size. Different surgical treatment options has no significant effect on disease-free survival and overall survival in DCIS patients.

Relationships of ductal carcinoma in situ calcification feature and ER, PR and HER2 expression / 国际肿瘤学杂志

Objective To discuss the relationships of ductal carcinoma in situ calcification feature and estrogen receptor (ER),progesterone receptor (PR),human epidermal growth factor receptor 2 (HER2) expression.Methods The mammary gland molybdenum target X-ray results of 226 patients with ductal carcinoma in situ were retrospectively analyzed in our hospital during January 2013 to December 2016.All patients were divided into calcification group (n =110) and no calcium group (n =116).Immunohistochemical method was used to detect the expressions of ER,PR and HER2,and their relationships with calcification feature were analyzed.Results The positive expression rates of ER and PR in calcification group were 72.73％ and 54.55％ significantly higher than those in no calcium group (39.66％ and 38.79％;x2=25.033,P ＜0.001;x2 =5.632,P =0.036).The positive expression rate of HER2 in calcification group was 45.45％,significantly lower than that of the no calcium group (82.76％,x2 =34.358,P ＜ 0.001).According to the single factor analysis,the calcified form (x2 =31.098,P ＜ 0.001;x2 =24.117,P =0.003),distribution (x2=30.272 P＜0.001;x2=11.811,P=0.008),number (x2 =15.533 P＜0.001;x2 =7.875,P=0.019) and concomitant situation (x2 =27.915,P ＜0.001;x2 =7.229,P =0.027) were associated with ER and PR expressions,and the calcified distribution (x2 =8.068,P =0.035),number (x2 =60.768,P ＜0.001) and concomitant situation (x2 =24.915,P ＜ 0.001) were associated with HER2 expression.Logistic regression analysis shows that the small polymorphic form,cluster distribution,number ＞ 30,with mass were the independent prediction factors of ER,PR and HER2 expressions (all P ＜ 0.001).Conclusion The mammary gland molybdenum target calcification features of ductal carcinoma in situ are associated with ER,PR and HER2 expressions,the small polymorphic form,cluster distribution,number ＞ 30,with mass can be used as important reference indexes to preliminarily predict biological therapy and expressions of prognostic factors.

Ductal carcinoma in situ of the breast: Evaluation of main presentations on magnetic resonance imaging compared with findings on mammogram and histology / Carcinoma ductal in situ mamário: avaliação das principais apresentações à ressonância magnética em correlação com os achados da mamografia e histologia

SUMMARY Objective: The purpose of this study was to evaluate the various morphologies and kinetic characteristics of the ductal carcinoma in situ (DCIS) on breast magnetic resonance imaging (MRI) exam, to establish which are the most prevalent and to determine the effectiveness of the method in the detection of DCIS. Method: A prospective observational study, starting in May 2014. We evaluated 25 consecutive patients with suspicious or highly suspicious microcalcifications on mammography screening, BI-RADS categories 4 and 5, who underwent breast MRI and then surgery with proven diagnosis of pure DCIS. Surgery was considered the gold standard for correlation between histologic findings and radiological findings obtained on MRI. Results: The most frequent morphological characteristic of DCIS on MRI was non-mass-like enhancement (NMLE), p<0.001, observed in 22/25 (88%) patients (95CI 72.5-100). Of these, segmental distribution was the most prevalent, represented by 9/22 (40.91%) cases (95CI 17.4-64.4), p=0.306, and a clumped internal enhancement pattern was most commonly characterized in DCIS, observed in 13/22 (50.09%) cases. Conclusion: DCIS has a wide variety of imaging features on MRI and being able to recognize these lesions is crucial. Its most common morphological presentation is non-mass-like enhancement, while segmental distribution and a clumped internal enhancement pattern are the most common presentations. Faced with the combined analysis of these findings, percutaneous core needle biopsy (core biopsy) or vacuum-assisted biopsy (VAB) should be encouraged.

RESUMO Objetivo: avaliar as várias morfologias e características cinéticas do carcinoma ductal in situ (CDIS) ao exame de ressonância magnética (RM) de mama, estabelecer as mais prevalentes e determinar a eficácia do método na detecção do CDIS. Método: estudo prospectivo e observacional, com início em 2011 e duração de 24 meses. Foram avaliadas 25 pacientes consecutivas que apresentaram microcalcificações suspeitas ou altamente suspeitas ao exame mamográfico de rastreamento, categorias 4 e 5 de BI-RADS, que realizaram RM mamária e, posteriormente, foram submetidas à cirurgia com resultado comprovado de CDIS puro. A cirurgia foi considerada padrão-ouro para correlação entre os resultados histológicos e os achados radiológicos obtidos à RM. Resultados: a característica morfológica do CDIS mais frequente à RM foi o realce não nodular (p<0,001), observada em 22/25 (88%) casos (IC 95% 72,5-100). Dentre estes, a distribuição segmentar foi a mais prevalente, representada por 9/22 (40,91%) casos (IC 95% 17,4-64,4), p=0,306, e o realce interno tipo clumped foi o padrão mais frequentemente caracterizado no CDIS, observado em 13/22 (50,09%) casos. Conclusão: o CDIS tem uma grande variedade de características imaginológicas à RM e é fundamental reconhecê-las. A apresentação morfológica mais comum é o realce não nodular, sendo a distribuição segmentar e o padrão interno de realce tipo clumped as apresentações mais frequentes. Diante da análise combinada desses achados, a biópsia percutânea por agulha grossa (core biopsy) ou assistida a vácuo (mamotomia) deve ser encorajada.

Predictors for the Transition from Ductal Carcinoma In Situ to Invasive Breast Cancer in Korean Patients

PURPOSE: To identify predictive factors of upstaging from diagnosed ductal carcinoma in situ (DCIS) to invasive cancer after surgical excision. METHODS: One hundred seventy-four patients diagnosed with DCIS based on biopsies between January 2009 and December 2014 were evaluated. Patients' clinicopathological variables were assessed to identify predictive factors of invasive carcinoma from final pathology. RESULTS: One hundred seventy-four cases of DCIS were included. Of these, 42 were upstaged to invasive carcinoma on the final excision. Preoperative features such as age 40 years or younger at diagnosis, presence of a palpable mass, ultrasonography (USG)-guided core needle biopsy, tumor size ≥20 mm on USG, high grade DCIS, cribriform DCIS, comedo necrosis, presence of intraluminal calcification, estrogen receptor negativity, progesterone receptor negativity and triple-negative subtype were significantly associated with the risk of invasive carcinoma. Multivariate analysis showed that a tumor size ≥20 mm on USG and triple negative subtype were independently associated with upstaging. CONCLUSION: Tumor size ≥20 mm on USG and triple-negative subtype were independently associated with the upstaging of DCIS to invasive cancer.

The diagnosis and treatment of breast ductal carcinoma in situ / 国际肿瘤学杂志

Accurate knowledge,diagnosis and treatment of breast ductal carcinoma in situ(DCIS),are crucial in controlling the development of breast cancer.In the diagnosis phase,breast ultrasound is commonly used as a screening tool,and a clear diagnosis can be made by mammography.Meanwhile,serological tests contribute to the detection of DCIS in early stages.In the treatment,the optimal surgical operation method remains debatable.It is widely acknowledged that the radiotherapy of postoperative patients should become more individualized.In addition,corresponding endocrine therapy helps those ER positive patients to reduce the recurrence.In the development of DCIS to invasive cancer,there are changes in gene and protein expressions,which may be a potential direction for further research.