Outcome after invasive local recurrence in patients with ductal carcinoma in situ of the breast.

PURPOSE: To detail the outcome, in terms of local recurrence, local invasive recurrence, distant recurrence, and breast cancer mortality for patients previously treated for ductal carcinoma in situ (DCIS). PATIENTS AND METHODS: Clinical, pathologic, and outcome data were collected prospectively for 707 patients with DCIS accrued from 1972 through June 1997. RESULTS: There were 74 local recurrences; 39 were noninvasive (DCIS) and 35 were invasive. Fifty-one percent of patients with invasive recurrences presented with stage 1 disease; the remainder presented with more advanced disease. Invasive local recurrence after mastectomy was a rare event that occurred in 0.8% of patients. Invasive recurrence after breast preservation was more common and occurred in 7.4% of patients. The 8-year probability of breast cancer mortality after breast preservation was 2.1%, a number that is likely to increase with longer follow-up. The 8-year breast cancer-specific mortality and distant-disease probability for the subgroup of 74 patients with locally recurrent disease was 8.8% and 20.8%, respectively. If only the 35 invasive recurrences are considered as events, the 8-year breast cancer-specific mortality and distant-disease probability was 14.4% and 27.1%, respectively. CONCLUSION: Invasive local recurrence after breast-preservation treatment for patients with DCIS is a serious event that converts patients with previous stage 0 disease to patients with disease that ranges from stage I to stage IV. These results, however, indicate that most DCIS patients with local recurrence can be salvaged.

Pathologic and mammographic findings predicting the adequacy of tumor excision before breast-conserving therapy.

OBJECTIVE: We performed a retrospective review to determine the need for reexcision after excisional biopsy in patients with breast cancer who were treated with breast-conserving therapy. MATERIALS AND METHODS: Eighty-seven patients with infiltrating ductal carcinoma of the breast underwent excisional biopsy followed by reexcision of the tumor site. Reexcision specimens were evaluated for residual disease and correlated with initial mammographic and pathologic findings. RESULTS: Tumors with an extensive intraductal component (EIC) were more likely to have residual disease at reexcision than those without an EIC (65% versus 6%, p < .01). Initially positive margins did not predict residual disease at reexcision significantly better than did initially negative margins (29% versus 13%, p = .08). Suspicious mammographic calcifications, absence of a discernible mass detected mammographically, or both were associated with a significantly increased risk of residual disease at reexcision. By combining all features (EIC, margin status, and mammography), we found that subsets of patients had significantly different risks of residual disease, which ranged from 6% to 83% (p < .01). CONCLUSION: Mammographic and pathologic findings are useful in predicting the adequacy of breast resection before radiation therapy in patients treated with breast-conserving therapy. An EIC is the most useful predictor of residual disease at reexcision. When combined, EIC, margin status, and mammographic findings form a powerful tool to judge the need for reexcision before radiation therapy.