Predictors and effectiveness of different biopsy techniques in spotting invasion in the clinically diagnosed breast ductal carcinoma in situ / Factores predictivos y efectividad de diferentes técnicas de biopsia en la detección de focos infiltrantes en carcinomas in situ diagnosticados clínicamente

Objectives: To study the management of patients with ductal carcinoma in situ (DCIS) and detect the predictors of recurrence and of missing an invasive component in the preoperative biopsy, aiming at guiding tailored treatment of these cases.Materials and methods: A total of 123 cases of DCIS, pure/with invasion, were retrieved from the database of a tertiary cancer hospital in the period from February 2007 to February 2018. Clinical, radiologic & pathologic characteristics and its impact on the surgical management were analyzed.Results: The mean age of the patients was 50.5±12.4 years. The commonest presentation was a palpable mass in 82.9% of the cases. Conservative breast surgery was successfully performed in 15 cases and mastectomy in 108 cases. Recurrence was reported in 11 cases. The underestimation rate in core needle biopsy was 48.9% missing invasive component within diagnosed malignant lesions and 19.6% missing the diagnosis of malignancy. On the other hand, overtreatment was noted as regard surgical procedure and adjuvant therapies.Conclusions: Mastectomy still the most common surgical treatment of DCIS and unfortunately sentinel lymph node biopsy is still underused. Underestimation of invasive component can occur in at least 1/4 of the patients, complexing the treatment plan. Overtreatment with axillary surgery, chemotherapy or radiotherapy needs governance. (AU)

Objetivos: Estudiar el manejo de pacientes con carcinoma ductal in situ (CDIS) y detectar los predictores de recaída y de ausencia de un componente invasivo en la biopsia preoperatoria, con el objetivo de orientar el tratamiento a medida de estos casos.Materiales y métodos: Se recuperó un total de 123 casos de CDIS, puro/con invasión de la base de datos de un hospital de cáncer terciario en el período de febrero de 2007 a febrero de 2018. Se analizaron las características clínicas, radiológicas y patológicas, así como su impacto en el manejo quirúrgico.Resultados: La edad media fue de 50,5 ± 12,4 años. La presentación más común fue masa palpable en el 82,9% de los casos. Se realizó cirugía de mama conservadora con éxito en 15 casos y mastectomía en 108 casos. Se informó de recaída en 11 casos. La tasa de subestimación en la biopsia con aguja fue de 48,9% sin componente invasivo en lesiones malignas diagnosticadas y 19,6% sin diagnóstico de malignidad. Por otra parte, se observó un exceso de tratamiento con relación al procedimiento quirúrgico y las terapias adyuvantes.Conclusiones: La mastectomía sigue siendo el tratamiento quirúrgico más común del CDIS y desafortunadamente no se utiliza aún la biopsia de ganglio linfático centinela. La subestimación del componente invasivo puede ocurrir en al menos el 25% de los pacientes, complejizando el plan de tratamiento. Debe gestionarse el sobretratamiento con cirugía axilar, quimioterapia o radioterapia. (AU)

Sonomammographic characteristics of invasive lobular carcinoma.

OBJECTIVE: The objective of our study was to identify characteristic features of invasive lobular carcinoma on mammography and ultrasound examinations. MATERIALS AND METHODS: This is a retrospective multicenter study of women with biopsy-proven invasive lobular carcinoma. All patients had undergone diagnostic sonomammography. The imaging findings were identified by experienced breast imagers. Final surgical pathology results were used as the reference standard. RESULTS: Thirty-two women ranging in age from 42 to 63 years old (mean age, 53 years), All had biopsy-proven invasive lobular carcinomas. Common features on mammogram included dense mass followed by architectural distortion; three cases showed breast asymmetry and one case was reported as normal. On ultrasound, common features included solid mass with spiculated margins, posterior shadowing, and perpendicular to the skin. CONCLUSION: Although no specific features could be linked to invasive lobular carcinoma, care should be directed to subtle signs such as architectural distortion and breast asymmetry in order not to miss any lesions. The combination of mammographic and sonographic helps to decrease the relatively high false negative diagnosis of this type of breast cancer.