Predicting Residual Disease and Local Recurrence in Patients With Ductal Carcinoma In Situ

Extract

There is an old real estate joke that goes like this. Question: What are the three most important factors to consider when buying a house? Answer: “Location, location, location!”

A form of this question might well be asked about patients with ductal carcinoma in situ (DCIS) of the breast. For example, what are the three most important factors for predicting local recurrence in patients with conservatively treated DCIS? Read on and I will give my answer.

The examination of serial tissue sections by Faverly et al. ( 1 ) and Holland et al. ( 2 , 3 ) revealed that DCIS is usually unicentric but commonly multifocal. In other words, it is generally confined to a single segment of the breast. It is often larger than expected, extending beyond mammographic microcalcifications, and skip areas (i.e., areas of DCIS with intervening normal breast epithelial tissue) are common. In spite of its extent, however, DCIS is a local disease, lacking the following two important components of the fully expressed malignant phenotype: invasion and metastasis. Therefore, complete excision will likely cure most patients. If complete excision cures the disease, how then does one accomplish this within the confines of obtaining an acceptable cosmetic result? Although there is no perfect tool, current data suggest that margin width is the best judge of complete excision.