Skip to main content

Advertisement

Log in

Is expert breast pathology assessment necessary for the management of ductal carcinoma in situ?

  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Background.Current guidelines include a recommendation that a pathologist with expertise in breast disease review all ductal carcinoma in situ (DCIS) specimens due to the presence of significant variability in pathologic reporting of DCIS. The objective of this study was to evaluate the completeness and accuracy of pathologic reporting of DCIS over the past decade and to determine the current impact of expert breast pathology assessment on the management of DCIS.

Methods.All patients with a diagnosis of DCIS referred to a single regional cancer centre between 1982 and 2000 have been reviewed. Inter-observer variability between initial and secondary reports has been evaluated using kappa statistics. For each case, the Van Nuys Prognostic Index (VNPI) using pathologic data obtained from the initial and reviewed pathology reports were compared. The impact of expert breast pathology on risk assessment and treatment was determined.

Results.481 individuals with DCIS were referred and pathology review was performed on 350 patients (73%). Inter-observer agreement was high for the main pathologic features of DCIS. From 1996 to 2000, secondary pathology assessments lead to a change in the assessment of local recurrence risk in 100 cases (29%) and contributed to a change in treatment recommendation in 93 (43%) cases.

ConclusionExpert breast pathology assessments continue to be necessary in the management of DCIS

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Ernster VL, Barclay J, Kerlikowske K, Grady D, Henderson C: Incidence of and treatment for ductal carcinoma in situ of the breast. JAMA 275: 913–918, 1996

    Google Scholar 

  2. Ernster VL, Barclay J: Increases in ductal carcinoma in situ (DCIS)of the breast in relation to mammography: a dilemma.[Review ][34 refs ]. J Natl Cancer Inst Monogr: 151–156, 1997

  3. Fisher B, Dignam J, Wolmark N, Mamounas E, Costantino J, Poller W, Fisher ER, Wickerham DL, Deutsch M, Margolese R, Dimitrov N, Kavanah M: Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: ndings from National Surgical Adjuvant Breast and Bowel Project B-17. J Clin Oncol 16: 441–452, 1998

    Google Scholar 

  4. Fourquet A, Zafrani B, Campana F, Clough KB: Institute Curie experience. In: Silverstein MJ (ed) Ductal Carcinoma In situ. Williams & Wilkins, Baltimore, 1997, pp 385–390

    Google Scholar 

  5. Silverstein MJ: Van Nuys Experience by Treatment. In: Silverstein MJ (ed) Ductal Carcinoma In Situ. Williams & Wilkins, Baltimore, 1997, pp 443–447

    Google Scholar 

  6. Solin LJ, Kurtz J, Fourquet A, Amalric R, Recht A, Bornstein BA, Kuske R, Taylor M, Barrett W, Fowble B, Haffty B, Schultz DJ, Yeh IT, McCormick B, McNeese M: Fifteen-year results of breast-conserving surgery and defin-itive breast irradiation for the treatment of ductal carci-noma in situ of the breast. J Clin Oncol 14: 754–763, 1996

    Google Scholar 

  7. Bijker N, Peterse JL, Duchateau L, Julien JP, Fentiman IS, Duval C, Di Palma S, Simony-Lafontaine J, de Mascard I, van de Vijver, MJ: Risk factors for recurrence and metastasis after breast-conserving therapy for ductal carci-noma-in-situ: analysis of European Organization for Research and Treatment of Cancer Trial 10853. J Clin Oncol 19: 2263–2271, 2001

    Google Scholar 

  8. Fisher ER, Dignam J, Tan-Chiu E, Costantino J, Fisher B, Paik S, Olmark N: Pathologic Findings from the National Surgical Adjuvant Breast Project (NSABP)Eight-Year Update of Protocol B-17. Cancer 86: 429–438, 1999

    Google Scholar 

  9. Julien JP, Bijker N, Fentiman IS, Peterse JL, Delledonne V, Rouanet P, Avril A, Sylvester R, Mignolet F, Bartelink H, van Dongen JA: Radiotherapy in breast-conserving treat-ment for ductal carcinoma in situ: rst results of the EORTC randomised phase III trial 10853. EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group. Lancet 355: 528–533, 2000

    Google Scholar 

  10. Silverstein MJ, Lagios MD, Groshen S, Waisman JR, Lewinsky BS, Martino S, Gamagami P, Colburn WJ: The influence of margin width on local control of ductal carcinoma in situ of the breast. New England J Med 340: 1455–1461, 1999

    Google Scholar 

  11. Schwartz GF, Solin LJ, Olivotto IA, Ernster VL, Pressman PI: Consensus conference on the treatment of in situ ductal carcinoma of the breast, April 22–25, 1999.[Review ][3 refs ]. Cancer 2000. Feb.15, 946–954, 1988

    Google Scholar 

  12. Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer: The management of ductal carcinoma in situ (DCIS). Can Med Assoc J 158(3 Suppl): S27–S34, 1998

    Google Scholar 

  13. Houghton J, George WD, Cuzick J, Duggan C, Fentiman IS, Spittle M: UK Coordinating Committee on Cancer Research, Ductal Carcinoma in situ Working Party, and DCIS trialists in the UK, A.a.N.Z. Radiotherapy and tamoxifen in women with completely excised ductal carci-noma in situ of the breast in the UK, Australia, and New Zealand: randomised controlled trial. Lancet 12(362): 95–102, 2003

    Google Scholar 

  14. Olivotto I, Levine M: Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer Clinical practice guidelines for the care and treat-ment of breast cancer: the management of ductal carcinoma in situ (summary of the 2001 update).[Review ][8 refs ]. CMAJ Can Med Association J 165: 912–913, 2001

    Google Scholar 

  15. Recht A, Rutgers EJ, Fentiman IS, Kurtz JM, Mansel RE, Sloane JP: The fourth EORTC DCIS Consensus meeting (Chateau Marquette, Heemskerk, The Netherlands, 23–24 January 1998)–conference report.[Review ][42 refs ]. European J Cancer 34: 1664–1669, 1998

    Google Scholar 

  16. Silverstein MJ: Predicting local recurrences in patients with ductal carcinoma in situ. In: Silverstein MJ (ed), Ductal Carcinoma In Situ. Williams and Wilkins, Balimore, 1997, PP 271–283

    Google Scholar 

  17. Sloane JP, Amendoeira I, Apostolikas N, Bellocq JP, Bianchi S, Boecker W, Bussolati G, Coleman D, Connolly CE, Dervan P, Eusebi V, De Miguel C, Drijkoningen M, Elston CW, Faverley D, Gad A, Jacquemier J, Lacerda M, Martinez-Penuela J, Munt C, Peterse JL, Rank F, Sylvan M, Tsakraklides V, Zafrani B: Consistency achieved by 23 European pathologists in categorizing ductal carcinoma in situ of the breast using ve classi cations. European Commission Working Group on Breast Screening Pathol-ogy. Hum Pathol 29: 1056–1062, 1998

    Google Scholar 

  18. Douglas-Jones AG, Morgan JM, Appleton MA, Attanoos R, Caslin A, Champ CS, Cotter M, Dallimore NS, Dawson A, Fortt RW, Griffiths AP, Hughes M, Kitching PA, O' Brien C, Rashid AM, Stock D, Verghese A, Williams DW, Williams NW, Williams S: Consistency in the obser-vation of features used to classify duct carcinoma in situ (DCIS)of the breast. J Clin Pathol 53: 596–602, 2000

    Google Scholar 

  19. Fisher ER, Costantino J, Fisher B, Palekar AS, Redmond C, Mamounas E: Pathologic ndings from the National Surgical Adjuvant Breast Project (NSABP)Protocol B-17. Intraductal carcinoma (ductal carcinoma in situ).The National Surgical Adjuvant Breast and Bowel Project Collaborating Investigators. Cancer 75: 1310–1319, 1995

    Google Scholar 

  20. Silverstein MJ, Lagios MD, Craig PH, Waisman JR, Lewinsky BS, Colburn WJ, Poller DN: A prognostic index for ductal carcinoma in situ of the breast. Cancer 77: 2267–2274, 1996

    Google Scholar 

  21. Elwood M: Critical Appraisal of Epidemiological Studies and Clinical Trials. Oxford, 1998

  22. Standards for the management of ductal carcinoma in situ of the breast (DCIS).2004. Ref Type: Internet Communi-cation

  23. Staradub VL, Messenger KA, Hao N, Wiley EL, Morrow M: Changes in breast cancer therapy because of pathology second opinions. Ann Surg Oncol 9: 982–987, 2002

    Google Scholar 

  24. Fisher B, Costantino J, Redmond C, Fisher E, Margolese R, Dimitrov N, Wolmark N, Wickerham DL, Deutsch M, Ore L: Lumpectomy compared with lumpectomy and radiation therapy for the treatment of intraductal breast cancer. New England J Med 328: 1581–1586, 1993

    Google Scholar 

  25. Lagios MD, Margolin FR, Westdahl PR, Rose MR: Mammographically detected duct carcinoma in situ. Fre-quency of local recurrence following tylectomy and prog-nostic effect of nuclear grade on local recurrence. Cancer 63: 618–624, 1989

    Google Scholar 

  26. Schwartz GF: The role of excision and surveillance alone in subclinical DCIS of the breast. Oncology (Huntingt) 8: 21–26 discussion, 1994

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rakovitch, E., Mihai, A., Pignol, JP. et al. Is expert breast pathology assessment necessary for the management of ductal carcinoma in situ?. Breast Cancer Res Treat 87, 265–272 (2004). https://doi.org/10.1007/s10549-004-9454-8

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-004-9454-8

Navigation