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Prognostische Faktoren beim duktalen Carcinoma in situ

Prognostic factors in ductal carcinoma in situ

  • Schwerpunkt: Mammapathologie
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Zusammenfassung

Das duktale Carcinoma in situ (DCIS) ist eine heterogene Erkrankung mit einem Progressionsrisiko von etwa 30–50%. Unsere Kenntnisse über den natürlichen Verlauf der Erkrankung sind begrenzt, sodass es derzeit nicht möglich ist, individuell vorherzusagen, ob ein DCIS zu einem invasiven Karzinom fortschreiten wird oder nicht. Trotz dieser Einschränkung bilden heute pathomorphologische Parameter die wesentliche Grundlage für die Abschätzung der Prognose und Therapieplanung. Der Ausschluss eines invasiven Mammakarzinoms, die Bestimmung von Kerngrad, Architektur, Größe und Verteilungsmuster des DCIS sowie der Nachweis von Nekrosen und die Erhebung des Resektionsrandstatus einschließlich der Sicherheitsabstände sind entscheidend für das lokale Vorgehen. Die Bestimmung des Hormonrezeptorstatus ist bei Patientinnen angezeigt, bei denen eine Tamoxifenbehandlung nach brusterhaltender Therapie erwogen wird. Dabei empfiehlt sich die sorgfältige Beurteilung der genannten Parameter in Anlehnung an international akzeptierte Vorgaben, deren prognostische Relevanz und diagnostische Reproduzierbarkeit belegt ist. Dennoch sind bessere Prognosemarker erforderlich, um Patientinnen mit dieser zunehmend häufiger diagnostizierten Erkrankung zukünftig eine individuell angepasste Behandlung anbieten zu können.

Abstract

Ductal carcinoma in situ (DCIS) is a heterogeneous disease that progresses to invasive cancer in 30–50% of the patients. Its natural history is poorly defined so that we are unable to identify cases of DCIS that do not progress to invasive carcinoma during an individual’s lifetime. However, pathologic features of DCIS are nowadays the basis for the estimation of the prognosis and planning of therapy. Exclusion of microinvasion, characterization of nuclear grade, architecture, size and distribution of the DCIS, presence or absence of comedonecrosis as well as the assessment of surgical margins are relevant factors for local treatment. The determination of steroid hormone receptor status is indicated in patients considering tamoxifen therapy after breast conservation. It is advisable to evaluate the features according to internationally accepted guidelines with proven prognostic relevance and reproducibility. Nevertheless, better prognostic factors are needed to adapt the management of this increasingly diagnosed disease to the individual patient.

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    A. Lebeau

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Lebeau, A. Prognostische Faktoren beim duktalen Carcinoma in situ. Pathologe 27, 326–336 (2006). https://doi.org/10.1007/s00292-006-0853-y

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