Responses

Extract

We do not view Dr. Silverstein's editorial comment as criticism of our data. Dr. Atkins' misinterpretation of some of our data, as reflected in his statement, “There were 30 patients in this study who were found to have residual disease,” probably contributed to his confusion.

Residual disease was actually observed in the re-excision/mastectomy specimens of 66 patients. Although residual disease is defined as “persistence of DCIS [ductal carcinoma in situ] in the re-excision and/or mastectomy specimens,” recurrence of disease at the site of a previous lumpectomy is considered in our study to be an indication of local failure in patients without subsequent re-excision or mastectomy. We assume that residual disease is a marker of the potential for local failure. Hence, the prospective value of residual disease is equivalent to the retrospective value of disease recurrence in determining local failure. As reports of studies of the true “focality” of DCIS emerge, it is evident that many DCIS lesions, especially the high nuclear grade “comedo” types, are unifocal rather than multifocal, but rather extensive.