Cystic hypersecretory carcinoma with invasion: Case series on a rare variant of carcinoma breast

Background: Cystic Hypersecretory Carcinoma (CHC) is a rare subset of breast carcinoma. It is part of a spectrum of cystic hypersecretory lesions which includes cystic hypersecretory hyperplasia (CHH), CHH with atypia, CHC in situ and CHC with invasion. Approximately 65 cases of cystic hypersecretory lesions have been reported; most of them were CHC in situ and only 19 cases of CHC with invasion have been reported so far. Case Presentation: We are reporting 2 cases of 47 and 62 year old women with a palpable breast mass for 6 and 1 month duration respectively. Trucut biopsy was carried out for both which showed high grade ductal carcinoma in situ with microinvasion in the first patient and the latter showed a tiny focus of invasive carcinoma. Simple mastectomy and modified radical mastectomy (MRM) were done for the respective cases; both showed dilated cystic spaces filled with eosinophilic secretions (thyroid colloid-like), lining neoplastic cells that showed variable degrees of proliferation, atypia and in situ carcinoma. There were foci of invasion in both cases and hence a morphological diagnosis of CHC with invasion was made. Conclusion: Owing to a smaller number of reported cases, little is known about the biological behavior, prognosis and molecular profile of cystic hypersecretory carcinoma.

Comparative analysis of clinicopathological and mammographic findings between ductal carcinoma in situ with microinvasion and ductal carcinoma in situ / 中华放射学杂志

Objective:To comparative analyze mammographic and clinicopathological findings of ductal carcinoma in situ (DCIS) and DCIS with microinvasion (DCISM), and to investigate the predictive factors for DCISM.Methods:A total of 626 patients with DCISM and DCIS confirmed by surgery and pathology in the Affiliated Hospital of Qingdao University from January 2016 to July 2020 were collected and underwent preoperative mammography. The X-ray findings of DCISM and DCIS patients were classified and diagnosed according to the Breast Imaging Reporting and Data System (BI-RADS) criteria. The differences in clinicopathological and radiographic findings between DCISM and DCIS patients were analyzed using χ 2 test or Fisher exact test. The risk factors of DCISM were evaluated by using univariate and multivariate binary logistic regression analysis. Results:Among the 626 cases, 171 were diagnosed as DCISM, 455 were diagnosed as DCIS. Large diameter (≥2.7 cm), high nuclear grade, comedo type, axillary lymph node metastasis, high Ki67 proliferation index, negativity of estrogen receptor and progesterone receptor were found to be predictors of DCISM in the univariate analysis (all P<0.05). And large diameter (≥2.7 cm)(OR 2.229,95% CI 1.505-3.301, P<0.001), high nuclear grade(OR 1.711,95%CI 1.018-2.875, P=0.043) and axillary lymph node metastasis(OR 4.140,95% CI 1.342-12.773, P=0.013) were found to be independent predictors of DCISM in the multivariate analysis (all P<0.05). Mammographically, the lesion types, the presence and distribution of calcification were statistically significant between DCIS and DCISM patients (χ 2=17.42, 9.65, 9.10, P<0.05). Up to 17.6% (80/455) of DCIS were occult leisions, and DCISM showed more lesions with calcification in mass, asymmetry, and architectural distortion (49.1%, 84/171). Grouped calcifications were usually associated with DCIS (41.5%, 120/289), while regional calcification were commonly found in DCISM (35.9%, 47/131). Conclusions:Lesions with calcification and regional calcification were more likely associated with DCISM on mammography. Large diameter (≥2.7 cm), high nuclear grade and axillary lymph node metastasis were found to be independent predictors of DCISM.

Analysis of the correlation between MRI features and HER-2 expression inductal carcinoma in situ / 中国辐射卫生

Objective To investigate the correlation between the features of multimodal magnetic resonance imaging (MRI) and the expression of human epidermal growth factor receptor-2 (HER-2) in ductal carcinoma in situ (DCIS). Methods A total of 53 patients with DCIS confirmed by surgery and pathology in Dezhou Second People’s Hospital from September 2018 to June 2021 were analyzed retrospectively. The patients were divided into HER-2 positive group (29 cases) and HER-2 negative group (24 cases). MRI features were compared between the two groups. Results There were significant differences in the internal enhancement characteristics, microvascular sign, and time-intensity curve type between the two groups (P < 0.05). There were no significant differences in lesion morphology, non-mass-like enhancement pattern, and apparent diffusion coefficient value (P > 0.05). The HER-2 positive group showed clumped enhancement (65.5%), type Ⅱ (48.1%) andtype Ⅲ (29.6%) time-intensity curves, and microvascular sign (89.7%). The HER-2 negative group showed clusteredring enhancement (50.0%), type Ⅱ (45.8%) and type I (54.2%) time-intensity curves, and microvascular sign (54.2%). A combination of clumped enhancement, microvascular sign, and type Ⅲ time-intensity curve showed 100% specificity and 100% positive predictive value for the diagnosis of HER-2 positive DCIS. Conclusion Clumped enhancement, microvascular sign, and type Ⅱ or Ⅲ time-intensity curve on MRI can largely reflect the expression of HER-2 in DCIS. The three can be used in combination to improve the diagnostic efficiency of HER-2 positive DCIS.

Extensive intraductal component positive carcinoma of breast: two year study with special reference to ER/PR/HER2NEU/Ki67 in a tertiary care centre of Barak Valley

Background: Extensive intraductal component positive carcinoma (EICPC) of breast is defined by Schnitt et al as-A. 25% or more of Ductal carcinoma in situ (DCIS) is present along the invasive lesion and DCIS is also present outside the area of invasive carcinoma. B. EICPC also include carcinomas in which DCIS is associated with a “small” (approximately 10 mm or less) invasive carcinoma or carcinomas. In Extensive Intraductal Carcinoma (EIDC) most of the cases were associated with recurrence when surgical margin status is not evaluated or focally involved. Our objective was to study the prevalence of EIDC and expression of estrogen receptor (ER)/progesterone receptor (PR)/human epidermal growth factor (HER2NEU)/Ki67(antigen identified by monoclonal antibody KI67) in those cases.Methods: It was a retrospective cross sectional study conducted over a period of 2017 to August 2019.All the histologically confirmed cases of EIDC was retrieved from the institute.Results: Out of 65 cases of invasive carcinoma 17 (26.1%) cases were positive for EICPC. Age of patients ranged from 27 to 73years with mean age of 43 years and 5 patients (29.4%) were postmenopausal. Most of the cases  i.e. 6(35.2%) had a ER+/PR+/HER2NEU- status with most of the cases having high 6(47%)Ki-67 index. According to the BLOOM RICHARDSON GRADING 14 cases were grade II (82.3%) and 3 cases were grade I (17.7%) and in pT and pN staging majority were stage pT1 - 7 (41.1%). Most of the cases were mastectomy cases 11 (64.4%) with a base free status except in one lumpectomy case where margin was involved.Conclusions: In this study majority of the cases were ER+//PR+/HER2NEU- with most of the cases having high Ki67 index. Evaluation of EIDC, along with the negative margin status is important to prevent recurrence.

Clinical comparison between ductal carcinoma in situ and ductal carcinoma in situ with microinvasion / 中华放射肿瘤学杂志

Objective To analyze the differences in the treatment patterns,clinical characteristics,treatment outcomes and prognostic factors between breast cancer patients with ductal carcinoma in situ (DCIS) and ductal carcinoma in situ with microinvasion (DCIS-MI).Methods Clinical data of 866 female patients including 631 DCIS cases and 235 DCIS-MI cases treated in our institution between 1999 and 2013 were retrospectively analyzed.The local control (LC),disease-free survival (DFS) and overall survival (OS) rates were calculated by Kaplan-Meier survival analysis.The prognostic factors were identified by Log-rank test.Results Similar LC,DFS and OS rates were obtained between two groups (all P＞ O.05).The univariate analysis demonstrated that Her-2-positive patients had worse OS and DFS than Her-2-negative counterparts.Patients undergoing breast-conserving surgery without radiotherapy had lower LC and DFS rates compared with those receiving radical mastectomy.Conclusions DCIS and DCIS-MI patients have similar clinical prognosis in terms of OS,LC and DFS.Her-2 positive is an unfavorable prognostic factor for DFS and OS.The LC and DFS rates in the breast-conserving surgery alone group are worse than those in the mastectomy group.

Adherencia a hormonoterapia en pacientes con carcinoma ductal in situ de mama / Adherence to hormonal therapy in patients with ductal carcinoma in situ of the breast

Introducción Las pacientes con Carcinoma Ductal in Situ de mama (cdis) tienen mayor riesgo de desarrollar carcinoma invasor. Aquellas con receptores hormonales positivos se beneficiarían con hormonoterapia. El largo período de tratamiento y los efectos adversos asociados al mismo hacen dificultosa la adherencia. Objetivos El objetivo del presente trabajo es analizar la adherencia a la hormonoterapia en pacientes operadas por Carcinoma Ductal in Situ en el Hospital Universitario Austral. Material y método Es un estudio observacional, analítico, de corte transversal. Se incluyeron pacientes con diagnóstico de Carcinoma Ductal in Situ que fueron intervenidas quirúrgicamente en el Hospital Universitario Austral en el período comprendido entre el 24 de julio de 2000 y el 5 de julio de 2017. Los datos fueron recopilados a través de una encuesta. Resultados Se obtuvieron 100 encuestas. La adherencia fue del 82%. La misma no se modificó según edad, conocimiento de riesgos y beneficios del tratamiento, tipo y número de cirugías, radioterapia y número de consultas. Las reacciones adversas a la medicación fueron la causa más frecuente de abandono al tratamiento. Conclusiones El tratamiento multidisciplinario podría asegurar un óptimo nivel de adherencia

Introduction Patients with Ductal Carcinoma in Situ of the breast (dcis) have a higher risk of developing invasive carcinoma. Those with hormone receptor-positive would benefit from hormonal therapy. The long period of treatment and the associated adverse events make adherence difficult. Objectives The aim of this study is to analyze the adherence of hormonal therapy in operated patients with Ductal Carcinoma in Situ at Hospital Universitario Austral. Materials and method It is an observational, analytical and cross-sectional study. Patients diagnosed with Ductal Carcinoma in Situ who underwent surgery at Hospital Universitario Austral in the period between 07/24/2000 and 07/05/2017 were included. The data was collected through a survey. Results 100 surveys were obtained. The adherence was 82%. It was not modified according to age, knowledge of risks and benefits of the treatment, type and number of surgeries, radiotherapy and number of consultations. Adverse events were the most frequent cause of discontinue of treatment. Conclusions Multidisciplinary treatment could ensure an optimal level of adherence

Patrón de recurrencia local en el carcinoma ductal in situ de mama según su inmunofenotipo / Pattern of local recurrence in ductal carcinoma in situ according to the inmunophenotype

Introducción En el carcinoma intraductal o carcinoma ductal in situ (cdis), la sobreexpresión del her2 neu (her2 neu+), alcanza un 60 a 70% de los casos y se asocia con la presencia de alto grado nuclear, comedo-necrosis y baja expresión de receptores hormonales. La asociación entre la sobreexpresión de her2 neu, receptor de estrógeno negativo (re) y alta expresión de factor de proliferación Ki67 (>14%) en pacientes con cdis tendría mayor riesgo de recurrencia local. Objetivos Determinar la frecuencia de sobreexpresión del factor de membrana epidérmico her2 neu en los carcinomas ductales in situ de mama y su relación con la recurrencia local de la enfermedad. Asimismo, determinar la relación entre la sobreexpresión del her2 neu y la supervivencia libre de enfermedad (sle), la supervivencia global (sg), los receptores hormonales y Ki67, y el tipo de recurrencia. Material y método Estudio retrospectivo que incluye pacientes con diagnóstico de cdis de mama en el Servicio de Mastología del Hospital Británico de Buenos Aires operadas entre enero de 2006 y diciembre de 2014. Las variables analizadas fueron la edad, el estado menopáusico, la forma de presentación, el tratamiento quirúrgico y adyuvante, el diagnóstico anátomo-patológico y la inmunohistoquímica, la supervivencia libre de enfermedad y la supervivencia global. Resultados Se incluyeron en el estudio 252 pacientes que cumplían con los criterios de inclusión, agrupándolas según la sobreexpresión o no del receptor de membrana her2 neu en el resultado anátomo-patológico de la pieza operatoria. Sobreexpresaron el receptor de membrana her2 neu (her2 neu+) 86 pacientes (34,1%), mientras que 166 pacientes (65,9%) fueron her2 neu negativo (her2 neu­). Se observó menor número de re negativo en el grupo her2 neu­ (8,4%) vs las pacientes del grupo her2 neu+ (39,5%) (p<0,001). Se registraron 24 recurrencias locales (9,52%), 8 de ellas del grupo her2 neu­ (4,8%) y las 16 restantes del grupo her2 neu+ (18,6%). Se halló una asociación estadísticamente significativa entre la recurrencia local y la sobreexpresión de her2 neu: p=0,04. Conclusiones Se encontró que la sobreexpresión del her2 neu se asoció a una mayor tasa de recurrencia local del carcinoma ductal in situ, con una menor sle en este grupo. También hubo un mayor número de tumores con receptores hormonales negativos en el grupo her2 neu+. En cuanto a la sg, no encontramos diferencias entre ambos grupos

Introduction The incidence of human epidermal growth factor 2 (her2 neu) overexpression or amplification in ductal carcinoma in situ (dcis) is between 60 to 70%, and is associated with the presence of high nuclear grade, comedonecrosis, and low expression of hormonal receptors. There is a higher risk of local recurrence in patients with dcis that overexpress her2 neu, have negative estrogen receptor and high Ki67 (>14%). Objectives Identify patients diagnosed with dcis that overexpressed her2 neu, and its association with local recurrence. Likewise, determine the relationship between her2 neu amplification and disease free survival (dfs), overall survival (os), and expression of hormonal receptors, Ki67 and the type of recurrence. Materials and method Retrospective study, that included patients with dcis diagnosed and surgically treated in the Breast Service of Hospital Britanico de Buenos Aires between January 2006 and December 2014. Demographic information analyzed included age, menopausal status, type of presentation, surgery and adjuvant therapy, histopathological analysis and immunohistochemistry (ihc), dfs and os. Results 252 patients were included and divided in two groups according to the her2 neu expression in the histopathologic result after surgery. The overexpression of her2 neu (her2 neu positive/her2 neu+) was found in 86 patients (34.1%) and 166 patients (65,9%) were her2 neu negative (her2 neu­). In the her2 neu­ group we found less negative estrogen receptor (8.4%) than in the her2 neu+ group (39.5%) (p<0.001). There were 24 local recurrence (9.52%): 8 were her2 neu­ (4.8%) and 16 were her2 neu+ (18.6%). The association between local recurrence and her2 neu overexpression was statistically significant in our analysis: p=0.04. Conclusions The her2 neu overexpression was related with a higher recurrence rate, less dfs. There was also a higher number of tumors with negative estrogen receptor that overexpressed her2 neu. No difference was found in the os between groups

Single Circulating Blast in the Peripheral Blood Film in Normal Individuals and Patients of Non-neoplastic Haematological Disorders and Non-hematological Neoplasms/Disorders- A Study at a Tertiary Care Centre

Introduction: The blasts in the peripheral blood is usuallyassociated with a haematological disorder. Study aimed tosee if a single blast seen in a peripheral blood film of healthyindividuals and patients of non-neoplastic haematologicaldisorders and non-hematological neoplasms/disorders didhave any clinical significance.Material and Methods: The period of study was from 2014to 2018 conducted at a tertiary care hospital. The study wasdone exclusively on Peripheral Blood Films. The films werestained with Leishman stain. An occasional blast was detectedin some healthy subjects and patients of non-neoplastichaematological disorders and non-hematological neoplasms/disorders.Result: The routine smears were analyzed with caution afterthe first case of a patient of Iron Deficiency Anemia revealeda clear-cut Blast. In the period of 4 years from 2014 to 2018,a total of 23 cases of apparently normal individuals or patientswith non neoplastic haematological disorders and nonhematological neoplasms/disorders showed at least 1% on oneseparate occasion.Conclusion: A careful morphological examination in theperipheral smears of few normal individuals and individualswith non neoplastic haematological disorders and nonhematological neoplasms/disorders showed at least 1%Blast on one separate occasion. The cells were clear cutblasts with a large size, fine nuclear chromatin, one to twonucleoli with round to slightly irregular nuclear contours anda mild amount of pale agranular cytoplasm. On thoroughinvestigations of these individuals there was no evidence ofa neoplastic haematological disorder. Therefore a single blastin a peripheral blood seen in a healthy individuals or patientswith benign haematological disorder and non-neoplasticneoplasms/disorders may not always indicate a neoplasticprocess.

An Updated Nomogram for Predicting Invasiveness in Preoperative Ductal Carcinoma In Situ of the Breast

PURPOSE: To validate and update a nomogram for predicting ductal carcinoma in situ (DCIS) upstaging in preoperative biopsy. MATERIALS AND METHODS: Medical records of 444 preoperative DCIS patients were evaluated and used to validate a previous version of the Severance nomogram for predicting DCIS upstaging in preoperative biopsy. Patients were divided into two groups according to the final postoperative pathology. Univariate and multivariate analyses with the chi-square test, Student's t-test, and binary logistic regression method identified new significant variables. The updated nomogram was evaluated with the C-index and Hosmer—Lemeshow goodness of fit test. RESULTS: The area under a receiver operating characteristic curve for comparison with the previous nomogram was 0.48. In postoperative pathology, the pure DCIS and invasive cancer groups comprised 345 and 99 cases, respectively. Approximately 22.3% of patients preoperatively diagnosed with DCIS were upstaged to invasive cancer. Significant variables in the univariate analysis were operation type, human epidermal growth factor receptor 2 overexpression, comedo necrosis, sonographic mass, mammographic mass, preoperative biopsy method, and suspicious microinvasion in preoperative biopsy. In multivariate analysis, operation type, sonographic mass, mammographic mass, and suspicious microinvasion were risk factors for upstaging. The updated model with these variables showed moderate discrimination and was appropriate in the calibration test. CONCLUSION: The previous nomogram did not effectively discriminate upstaging of preoperative DCIS in an independent cohort. An updated version of the nomogram appears to provide more accurate information for predicting preoperative DCIS upstaging.

ADCMin ,ADCDR and DCE-MRI in the differential diagnosis of breast ductal carcinoma in situ and breast ductal carcinoma in situ with microinvasion / 实用放射学杂志

Objective To explore the differential diagnosis of breast ductal carcinoma in situ (DCIS)and breast ductal carcinoma in situ with microinvasion (DCIS-Mi)by ADCMin ,ADCDR and DCE-MRI,and to analyze the correlation between DCIS-Mi and biological factors. Methods Preoperative breast MRI examinations were performed in 41 patients with DCIS-Mi and 3 7 patients with DCIS.DCIS-Mi and DCIS patients were compared in terms of ADCMin ,ADCMax ,ADCDR ,early enhancement rate (EER)and the morphological characteristics of DCE-MRI.The optimal diagnostic variables were determined by binary Logistic regression,the threshold value of the optimal diagnostic variables was ensured by ROC,and the correlation between DCIS-Mi and biological factors was analyzed by Spearman.Results ADCMin of DCIS-Mi patients was lower than that of DCIS (t＝6.294,P＝0.033),and ADCDR was higher than that of DCIS (t＝9.246,P＝0.020).70.7 3% DCIS-Mi showed non-tumor-like enhancement,inclined to segmental distribution,and internal heterogeneous or cluster ring enhancement;29.27% manifested tumor-like enhancement,internal heterogeneous or ring enhancement,and unclear margin.64.86% DCIS showed non-tumor-like enhancement,inclined to linear distribution,internal homogeneous/heterogeneous enhancement;35.14% expressed tumor-like enhancement,internal homogeneous enhancement,and clear margin.The accuracy,sensitivity and specificity of ADCMin , ADCDR ,tumor or non-tumor internal enhancement features in the diagnosis of DCIS-Mi were higher (84.0%,9 5.3%,9 2.4%;89.3%, 9 5.3%,9 2.4%;85.1%,9 2.5%,9 3.8%;87.4%,9 6.8%,84.7%, respectively).ADCMin and ADCDR threshold value were 1.1 1× 10－3 mm2/s and 0.35×10－3 mm2/s,respectively.ADCMin of patients with DCIS-Mi was positive correlation with ER(－)and PR(－), and negative correlation with HER-2(+)(P＜0.05).ADCDR ,non-tumor distribution,and non-tumor internal enhancement characteristics,the tumor edge and internal enhancement characteristics were negative correlation with ER(－)and PR(－),and positive correlation with HER-2 (+)(P＜0.05).Conclusion ADCMin ,ADCDR and DCE-MRI can be used for the differential diagnosis of DCIS-Mi and DCIS, and provided evidence for clinical treatment plan.

A single-center retrospective study on influence factors on surgical methods in DCIS patients / 中华内分泌外科杂志

Objective To evaluate the influence factors on surgical methods in DCIS (Ductal carcinoma in situ) patients,and the prognosis of different surgical methods in a 10-year single-center retrospective study.Methods We retrospectively included 1557 DCIS patients who received treatments in our center from Jan.2006 to Nov.2016.T tests,Chi-square analysis and logistic regression analysis were used to analyze influence factors on surgical methods.Kaplan-Meier and Log-rank analysis were used to evaluate recurrence-free survival(RFS) and loco-regional recurrence-free survival (LRRFS) in patients with different surgical methods.Results Of the enrolled 1557 DCIS patients,surgical methods included modified radical mastectomy,simple mastectomy (with or without axillary evaluation) and breast conservation surgery (with or without axillary evaluation).The number of DCIS cases in our center increased (P＜0.001),so did the percentage of DCIS in annual malignant surgery cases (P=-0.026).Significant decrease was found in modified radical mastectomy (P=0.012).More than half of the patients received simple mastectomy after 2010,and more than one fifth of the patients received breast conservation surgery after 2008.About 13.99％ patients who received mastectomy had breast reconstruction.The independent influence factors of refusing breast conservation surgery were age ≥ 50(P＜0.001),medium nuclear grade (P=0.044),tumor size ＞ 15mm (P＜0.001) and spontaneous discharge (P＜0.001).Patients with smaller tumor size (≤ 15mm) and no spontaneous discharge had 4.18-fold and 7.04-fold greater preference for breast conservation surgery,respectively(OR=0.232,P＜0.001;OR=0.144,P＜0.001).There were no significant differences in RFS and LRRFS in patients with different surgical methods.Conclusion The evaluation in trends and influence factors of different surgical methods provides basis on surgical precision medicine in DCIS patients.

Treatment trends and prognosis of breast ductal carcinoma in situ: a single center analysis / 中华放射肿瘤学杂志

Objective To analyze the changes in treatment patterns,clinical characteristics,treatment outcomes and prognostic factors of ductal carcinoma in situ (DCIS).Methods Clinical data of 617 female patients admitted to our institution between 2000 and 2013 were retrospectively analyzed.KaplanMeier survival analysis was adopted to calculate the local control (LC),disease-free survival (DFS) and overall survival (OS) rates.Log-rank test was utilized to identify the prognostic factors.Results Along the number of DCIS patients was gradually increased year by year,the proportion of breast conservative surgery was also elevated.However,mastectomy remained the primary surgical method.A total of 374 patients underwent mastectomy,160 cases received breast conservative surgery plus radiotherapy and 83 underwent breast conservative surgery alone.Postoperatively,366 patients (83.6％) with positive hormone receptor received hormone therapy and 45 patients (7.3％) underwent chemotherapy.The median follow-up time was 47 months.The 5-year LC,DFS and OS rates were 98.4％,97.5％ and 98.9％,respectively.Univariate analysis demonstrated that Her-2-positive patients obtained worse OS (P=0.019).Although mastectomy group had more adverse factors compared with breast conservative surgery with or without radiotherapy groups,similar survival results were obtained among three groups.Mastectomy yielded better LC and DFS compared with breast conservative surgery alone.Conclusions DCIS patients obtain favorable clinical prognosis between the breast conservative surgery and mastectomy groups.The LC rate in the mastectomy group is better than that in the breast conservative surgery group.

Values of Minimal Apparent Diffusion Coefficient,Difference between Ratios of Apparent Diffusion Coefficients,and Dynamic Contrast-enhanced Magnetic Resonance Imaging Features in Diagnosing Breast Ductal Carcinoma In Situ with Microinvasion / 中国医学科学院学报

To explore the values of minimal apparent diffusion coefficient(ADC),difference between ratios of apparent diffusion coefficients(ADC),and dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)in the treatment of breast ductal carcinoma in situ with microinvasion(DCIS-Mi). Totally 27 patients with DCIS-Mi and 31 patients with breast ductal carcinoma in situ(DCIS)were collected in our hospital from October,2016 to June,2018.Philips Ingenia 3.0T superconducting magnetic resonance scanner and dedicated phase-controlled array surface coil were used for breast examinations.ADC and maximum apparent diffusion coefficient(ADC)were selected from multiple regions of interest(ROI)in the apparent diffusion coefficients(ADC)figure,and ADC was calculated.In addition,DCE-MRI characteristics were analyzed. The ADC of DCIS-Mi was significantly lower than that of DCIS[(1.15±0.03)×10 mm /s .(1.34±0.04)×10 mm /s,=-7.192,=0.002],the ADC was significantly higher than that of DCIS[(0.32±0.03)×10 mm /s .(0.18±0.08)×10 mm /s,=-10.228,<0.001],and the early enhancement rate of DCIS-Mi was higher than that of DCIS[159.71(157.82,162.49)% .147.29(143.59,160.22)%,=-3.578,=0.007].The background parenchymal enhancement of DCIS-Mi was moderate,severe,and non-lump-like,mainly segmental,and the internal enhancement was heterogeneous or clustered circular.Multivariate Logistic regression analysis showed that non-internal characteristics of the mass,the edge of the mass,internal enhancement characteristics of the mass,time-intensity curve,early enhancement rate,ADC and ADC were the optimal variables for the diagnosis of DCIS-Mi,and the optimal variables were shown by receiver operating characteristic(ROC)curve analysis:the area under curve,sensitivity and specificity of ADC,ADC,non-tumor internal enhancement,and tumor internal enhancement were higher,with the critical values being 1.12×10 mm /s,0.31×10 mm /s,1.50,and 1.50,respectively. DCE-MRI combined with ADC value(especially ADC,ADC,non-mass internal enhancement,and mass internal enhancement)is helpful in differentiating breast DCIS-Mi and DCIS.

Radiotherapy in breast ductal carcinoma in situ / Radioterapia em carcinoma ductal in situ de mama

Breast ductal carcinoma in situ (DCIS) comprises a heterogeneous group of lesions with different forms of clinical and pathological presentation. Postoperative radiotherapy is usually performed in DCIS patients who underwent conservative breast surgery. The objective of the present study was to describe indications and clinical evidences of radiotherapy for breast DCIS patients

O carcinoma ductal in situ (CDIS) de mama compreende um grupo heterogêneo de lesões com diferentes formas de apresentação clínica e patológica. A radioterapia pós-operatória é normalmente realizada nas pacientes com CDIS submetidas à cirurgia conservadora de mama. O presente estudo teve o objetivo de apresentar as indicações e as evidências para a utilização da radioterapia na abordagem do CDIS de mama.

Clinicopathological markers associated with recurrence in ductal carcinoma in situ of breast by age group

PURPOSE: In the present study, factors related to the recurrence of breast ductal carcinoma in situ (DCIS) in Korean patients were identified, and the prognostic factors for each age group were explored.METHODS: The subjects were 226 patients who were diagnosed with DCIS by histopathologic examination, and the effect of representative prognostic factors that are known already, including estrogen receptor (ER), progesterone receptor (PR) and the human epidermal growth factor receptor 2 (HER2) status, Ki-67 levels, and adjuvant therapy on the recurrence of DCIS was analyzed by using the Cox proportional hazard model.RESULTS: Among the 226 subjects, 11 patients underwent the recurrence of breast cancer. The average follow-up period was 52.7±23.5 months. The average age of the subjects was 50.6±9.3 years. Among the DCIS patients, the recurrence of breast cancer was significantly higher in the ER negative patients and those who have a Ki-67 level over 20%. However, the PR and HER2 status did not significantly affect breast cancer recurrence. The result also showed that only ER negative was a significant factor before the age of 50 years and that only the Ki-67 level over 20% was a significant factor to the patients 50 years of age or older.CONCLUSION: DCIS patients should be appropriately treated and managed depending on their age and clinicopathological factors to prevent the recurrence of DCIS.

Risk factors of underestimating diagnosis with ductal carcinoma in situ following core needle biopsy / 复旦学报（医学版）

Objective To analyze the risk factors of underestimation from core needle biopsy (CNB) diagnosed ductal carcinoma in situ (DCIS) to invasive cancer after surgical excision.Methods One hundred and fifteen cases of CNB diagnosed DCIS treated in Obstetrics and Gynecology Hospital,Fudan University from Jan.,2010 to Dec.,2016 were analyzed retrospectively.According to postoperative pathological conditions,the cases were divided into underestimation group and non underestimation group.The clinicopathological characteristics of two groups were compared,including age,palpability,tumor diameter,microcalcification,BI-RADS classification and CNB method.Results The overall underestimating rate was 27.0％ (31/115).Univariate analysis found correlation between a palpable lesion,diameter of tumor ＞20 mm,microcalcification,a high BI-RADS classification,use of the 14/16-gauge needle method and underestimation from CNB diagnosed DCIS.Multivariate analysis by Logistic regression showed that diameter of tumor ＞20 mm (OR =0.186,95％CI:0.043-0.810,P =0.025),microcalcification (OR=0.229,95％CI:0.070-0.749,P =0.015),use of the 14/16 gauge needle method (OR =0.171,95 ％ CI:0.043-0.679,P =0.012) were independent risk factors of underestimation from CNB diagnosed DCIS.Conclusions Size of lesion ＞20 mm,microcalcification,use of the 14/16-gauge needle method were independent risk factors of underestimation from CNB diagnosed DCIS.

Diagnostic value of mammographic calcification for ductal carcinoma in situ without palpable lumps / 中华内分泌外科杂志

Objective To explore the diagnostic value of calcification by full field digital mammography in cases without breast palpable lumps or nodules in ductal carcinoma in situ(DC1S).Methods Based on breast imaging-reporting and data system (BI-RADS)proposed by the American College of Radiology (ACR),the cases without palpable lumps or nodules,but with calcification (over Category 4a)found by full field digital mammography admitted from Oct.2014 to Oct.2016 were analyzed.They underwent excisional biopsy after three-dimensional guide wire positioning or three-dimensional vacuum rotary cutting.After being filmed again to make sure the resection was complete,the isolated specimen were sent to pathological examination.The pathology and calcification were analyzed and summarized.Results Among 126 cases,71 (56.3％)were breast adenosis,41 (32.5％) were DCIS,6(4.8％) were infiltrating ductal carcinoma (IDC),and 8 (6.3％)were other types.The detection rate of DCIS in younger group was higher.The calcifications in DCIS were mostly linear-branching,segmental calcification,and those in IDC were mostly pleomorphic,clustering or regional calcification.Conclusion Full field digital mammography has great diagnostic value for DCIS in cases with calcification but without palpable breast lumps or nodules.

Ultrasonographic features of pure ductal carcinoma in situ of the breast: correlations with pathologic features and biological markers

PURPOSE: The purpose of this study was to evaluate the ultrasonographic features of pure ductal carcinoma in situ (DCIS) of the breast and to evaluate the correlations of ultrasonographic features with pathologic and biological features. METHODS: A total of 141 lesions in 138 women with pure DCIS who underwent preoperative breast ultrasonography were retrospectively reviewed. Ultrasonographic features were analyzed using the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) ultrasonography lexicon and the diagnostic criteria of the Japan Society of Ultrasonics in Medicine. Pathologic features including the nuclear grade and presence of comedonecrosis were evaluated. Biological markers including estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) status, as well as the Ki-67 index, were recorded. Ultrasonographic features were compared with pathologic findings and biological markers using the chi-square test. P-values of < 0.05 were considered to indicate statistical significance. RESULTS: Of the 141 lesions, 75 (53.2%) were mass lesions, 56 (39.7%) were non-mass lesions, and 10 (7.1%) were not visible. The most common feature of the mass pattern was a mass with irregular shape (32.6%), an indistinct margin (27.7%), and hypoechogenicity (37.6%). Microcalcifications were observed in 48 cases (36.6%) as an associated feature. Calcifications outside of a mass were more common than calcifications within a mass. Ultrasonographic microcalcifications and ductal changes were frequently observed in non-mass lesions. Ultrasonographic non-mass lesions were associated with high-grade DCIS (P=0.004) and the presence of comedonecrosis (P=0.006). Microcalcifications were significantly associated with high-grade DCIS (P < 0.001), the presence of comedonecrosis (P < 0.001), an elevated Ki-67 (P < 0.001), and HER2 positivity (P=0.003). CONCLUSION: The most common ultrasonographic feature of pure DCIS was an irregular, hypoechoic mass with an indistinct margin. Ultrasonographic microcalcifications and ductal changes were more frequent in non-mass lesions, which were correlated with poor prognostic factors, such as a high nuclear grade, comedonecrosis, HER2 positivity, and an elevated Ki-67 index.

Actualidad para el diagnóstico del carcinoma ductal in situ: correlación radiopatológica / Current issues in the diagnosis of ductal carcinoma in situ: a radiopathological correlation

El carcinoma ductal in situ (CDIS) se encuentra en un grupo heterogéneo de tumores, cuyo diagnóstico se ha visto incrementado con el uso de la mamografía como método de cribado. El sistema de clasificación de Van Nuys, que se basa principalmente en el grado nuclear histológico y la presencia de necrosis, es el sistema más reproducible para la clasificación histopatológica. La anomalía más común que se observa en la mamografía son las microcalcificaciones, coexistiendo con otras lesiones como masas y distorsión arquitectural, que representan lesiones de bajo grado. El diagnóstico inicial debe realizarse mediante anamnesis y examen físico detallado que permita realizar una aproximación a las características morfoestructurales de la lesión, para posteriormente llegar a un acercamiento imagenológico y dinámico mediante resonancia magnética (RM), complementada con técnicas de inmunohistoquímica que caractericen el tumor. La presencia de distribución segmentaria morfológica es típico de malignidad (CDIS). La cinética de las lesiones en el estudio dinámico de la RM varía, siendo patognomónico de CDIS el patrón de washout en la fase de reforzamiento tardío. Sin embargo, el patrón dinámico parece estar correlacionado con los hallazgos mamográficos. Los hallazgos de RM y TC multidetector pueden ser útiles en combinación con la RM de mama para el mapeo preoperatorio. Sin embargo, existen técnicas complementarias como la espectroscopía y la difusión ponderada que mejoran la especificidad de la RM y tienen utilidad en la predicción de respuesta a la quimioterapia adyuvante. Estas aplicaciones futuras podrán mejorar la capacidad de diagnóstico oportuno y opciones de tratamiento.

Ductal carcinoma in situ (DCIS) falls into a heterogeneous group of tumors, whose diagnosis has increased with the use of mammography as screening method. The Van Nuys Prognostic Index, mainly based on histological nuclear grade and presence of necrosis, is the most reproducible histopathological classification system. The most common abnormality observed during a mammography are microcalcifications, which coexist with other lesions such as masses and architectural distortion, and represent low-grade lesions. The initial diagnosis should be performed by anamnesis and a detailed physical examination to help determine the morphostructural characteristics of the lesion. Then an imaging and dynamic approach should be achieved by magnetic resonance imaging (MRI) complemented by immunohistochemistry to characterize the tumor. The presence of morphological segmental distribution is typical of malignancy (DCIS). The kinetics of the lesions using a dynamic MRI varies, with the washout and late enhancement pattern being pathognomonic for DCIS. However, the dynamic pattern seems to be correlated with mammographic findings. Multidetector CT and MRI findings may be useful in combination with breast MRI for preoperative mapping. Nevertheless, there are complementary techniques such as spectroscopy and weighted diffusion that improve the specificity of the MRI and are useful in predicting response to adjuvant chemotherapy. These future applications will improve the ability for early diagnosis and treatment options.

Selective Radiation Therapy for Ductal Carcinoma In Situ Following Breast-Conserving Surgery According to Age and Margin Width: Korean Radiation Oncology Group 11-04 and 16-02 Studies / 한국유방암학회지

PURPOSE: The optimal indications for omitting adjuvant radiation therapy (RT) after breast-conserving surgery are still controversial in ductal carcinoma in situ (DCIS) of the breast. The purpose of this study was to validate the role of postoperative RT in DCIS patients aged ≤50 years and with tumor margin widths of <1 cm, both of which have been proven to be high-risk features for recurrence in cohorts not receiving RT. METHODS: Using two multicenter retrospective studies on DCIS, a pooled analysis was performed among patients aged ≤50 years and with margin widths < 1 cm. All patients underwent breast-conserving surgery. Two hundred thirty-two patients received postoperative RT, while 54 did not. The median follow-up period was 77 months (range, 2–190 months) and 70 months (range, 5–166 months) in the patients who received RT and those who did not, respectively. RESULTS: The patients who received RT had larger tumors (p < 0.001), higher nuclear grade (p < 0.001), closer margin width (p < 0.001), and negative estrogen receptor expression (p=0.010) compared with those who did not receive RT. During the follow-up period, there were 17 ipsilateral breast tumor recurrences (IBTRs) as follows: invasive carcinoma in 10 patients and DCIS in seven. In the univariate analysis, the treatment with RT and human epidermal growth factor receptor 2 (HER2) status were significant risk factors for IBTR. The 7-year IBTR rates with and without postoperative RT were 3.6% and 13.1%, respectively (p=0.008). HER2-positive tumors had a higher IBTR rate than the HER2-negative tumors (7-year rate, 13.6% vs. 3.9%; p=0.003). CONCLUSION: Postoperative RT following breast-conserving surgery significantly reduced the 7-year IBTR rate in the DCIS patients aged ≤50 years and with margin widths < 1 cm. HER2 positivity was associated with increased IBTR in these patients.