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Ultrasonography- and/or mammography-guided breast conserving surgery for ductal carcinoma in situ of the breast: experience with 87 lesions

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Abstract

Background

It is very important to excise ductal carcinoma in situ (DCIS) with sufficient margins to prevent local recurrence. We describe the experience of ultrasonography (US)-guided and/or mammography (MMG)-guided breast conserving surgery (BCS) for DCIS.

Methods

In this retrospective study, we considered 87 consecutive lesions of 86 patients treated with US- and/or MMG-guided BCS between January and December 2006.

Results

The mean age of the 86 patients was 50.0 years (range 28–80 years). Preoperative mapping was performed using US alone for 49 lesions without microcalcifications and using US and MMG for 38 lesions with microcalcifications. Eighty-one (93.1%) of the 87 lesions were diagnosed as non-comedo type or mixed type, and 6 lesions (6.9%) were diagnosed as comedo type of DCIS. Sixty-five lesions (74.8%) were diagnosed as negative margins, 15 lesions (17.2%) as close margins, and 7 lesions (8.0%) as positive margins. Three lesions (3.4%) without microcalcifications that were mapped using US alone underwent additional resection in a second operation. The maximum tumor size was correlated with margin status (p = 0.043).

Conclusion

Thus US- and/or MMG-guided BCS is a reliable method for treating patients with DCIS regardless of histopathological type and offers the advantage of being noninvasive and nonstressful for patients.

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References

  1. Nakamura S. The results of a questionnaire survey for current diagnosis and treatment of ductal carcinoma in situ (DCIS) in Japan (in Japanese). Jpn J Breast Cancer. 2007;22:95–100.

    Google Scholar 

  2. Fisher ER, Costantino J, Fisher B, Palekar AS, Redmond C, Mamounas E. Pathologic findings 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. 1995;75:1310–9.

    Article  PubMed  CAS  Google Scholar 

  3. Di Saverio S, Catena F, Santini D, Ansaloni L, Fogacci T, Mignani S, et al. 259 Patients with DCIS of the breast applying USC/Van Nuys prognostic index: a retrospective review with long term follow up. Breast Cancer Res Treat. 2008;109:405–16.

    Article  PubMed  Google Scholar 

  4. Bijker N, Meijnen P, Peterse JL, Bogaerts J, Van Hoorebeeck I, Julien JP, et al. Breast-conserving treatment with or without radiotherapy in ductal carcinoma-in situ: ten-year results of European Organisation for Research and Treatment of Cancer randomized phase III trial 10853—a study by the EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group. J Clin Oncol. 2006;24:3381–7.

    Article  PubMed  Google Scholar 

  5. Silverstein MJ, Lagios MD, Groshen S, Waisman JR, Lewinsky BS, Martino S, et al. The influence of margin width on local control of ductal carcinoma in situ of the breast. N Engl J Med. 1999;340:1455–61.

    Article  PubMed  CAS  Google Scholar 

  6. Solin LJ, Fourquet A, Vicini FA, Taylor M, Olivotto IA, Haffty B, et al. Long-term outcome after breast-conservation treatment with radiation for mammographically detected ductal carcinoma in situ of the breast. Cancer. 2005;103:1137–46.

    Article  PubMed  Google Scholar 

  7. Nixon AJ, Neuberg D, Hayes DF, Gelman R, Connolly JL, Schnitt S, et al. Relationship of patient age to pathologic features of the tumor and prognosis for patients with stage I or II breast cancer. J Clin Oncol. 1994;12:888–94.

    PubMed  CAS  Google Scholar 

  8. Vrieling C, Collette L, Fourquet A, Hoogenraad WJ, Horiot JC, Jager JJ, et al. Can patient-, treatment- and pathology-related characteristics explain the high local recurrence rate following breast-conserving therapy in young patients? Eur J Cancer. 2003;39:932–44.

    Article  PubMed  CAS  Google Scholar 

  9. Van Zee KJ, Liberman L, Samli B, Tran KN, McCormick B, Petrek JA, et al. Long term follow-up of women with ductal carcinoma in situ treated with breast-conserving surgery: the effect of age. Cancer. 1999;86:1757–67.

    Article  PubMed  Google Scholar 

  10. Rahusen FD, Bremers AJ, Fabry HF, van Amerongen AH, Boom RP, Meijer S. Ultrasound-guided lumpectomy of nonpalpable breast cancer versus wire-guided resection: a randomized clinical trial. Ann Surg Oncol. 2002;9:994–8.

    Article  PubMed  Google Scholar 

  11. Ngo C, Pollet AG, Laperrelle J, Ackerman G, Gomme S, Thibault F, et al. Intraoperative ultrasound localization of nonpalpable breast cancers. Ann Surg Oncol. 2007;14:2485–9.

    Article  PubMed  Google Scholar 

  12. Fornage BD, Ross MI, Singletary SE, Paulus DD. Localization of impalpable breast masses: value of sonography in the operating room and scanning of excised specimens. AJR Am J Roentgenol. 1994;163:569–73.

    PubMed  CAS  Google Scholar 

  13. Harlow SP, Krag DN, Ames SE, Weaver DL. Intraoperative ultrasound localization to guide surgical excision of nonpalpable breast carcinoma. J Am Coll Surg. 1999;189:241–6.

    Article  PubMed  CAS  Google Scholar 

  14. Rahusen FD, Taets van Amerongen AH, van Diest PJ, Borgstein PJ, Bleichrodt RP, Meijer S. Ultrasound-guided lumpectomy of nonpalpable breast cancers: a feasibility study looking at the accuracy of obtained margins. J Surg Oncol. 1999;72:72–6.

    Article  PubMed  CAS  Google Scholar 

  15. Nagashima T, Hashimoto H, Oshida K, Nakano S, Tanabe N, Nikaido T, et al. Ultrasound demonstration of mammographically detected microcalcifications in patients with ductal carcinoma in situ of the breast. Breast Cancer. 2005;12:216–20.

    Article  PubMed  Google Scholar 

  16. Satake H, Shimamoto K, Sawaki A, Niimi R, Ando Y, Ishiguchi T, et al. Role of ultrasonography in the detection of intraductal spread of breast cancer: correlation with pathologic findings, mammography and MR imaging. Eur Radiol. 2000;10:1726–32.

    Article  PubMed  CAS  Google Scholar 

  17. Chen SC, Cheung YC, Lo YF, Chen MF, Hwang TL, Su CH, et al. Sonographic differentiation of invasive and intraductal carcinomas of the breast. Br J Radiol. 2003;76:600–4.

    Article  PubMed  Google Scholar 

  18. Allen LR, Lago-Toro CE, Hughes JH, Careaga E, Brown AT, Chernick M, et al. Is there a role for MRI in the preoperative assessment of patients with DCIS? Ann Surg Oncol. 2010. doi:10.1245/s10434-010-1000-9.

  19. Berg WA, Gutierrez L, NessAiver MS, Carter WB, Bhargavan M, Lewis RS, et al. Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology. 2004;233:830–49.

    Article  PubMed  Google Scholar 

  20. Marcotte-Bloch C, Balu-Maestro C, Chamorey E, Ettore F, Raoust I, Flipo B, et al. MRI for the size assessment of pure ductal carcinoma in situ (DCIS): a prospective study of 33 patients. Eur J Radiol. 2009. doi:10.1016/j.ejrad.2009.09.003

  21. Soderstrom CE, Harms SE, Copit DS, Evans WP, Savino DA, Krakos PA, et al. Three-dimensional RODEO breast MR imaging of lesions containing ductal carcinoma in situ. Radiology. 1996;201:427–32.

    PubMed  CAS  Google Scholar 

  22. Notani M, Uchida N, Kitagaki H. Role of 10-Gy boost radiation after breast-conserving surgery for stage I-II breast cancer with a 5-mm negative margin. Int J Clin Oncol. 2007;12:261–7.

    Article  PubMed  Google Scholar 

  23. Early Breast Cancer Trialists’ Collaborative Group. Effects of radiotherapy and surgery in early breast cancer. An overview of the randomized trials. N Engl J Med. 1995;333:1444–55.

    Google Scholar 

  24. Arriagada R, Le MG, Rochard F, Contesso G. Conservative treatment versus mastectomy in early breast cancer: patterns of failure with 15 years of follow-up data. Institut Gustave-Roussy Breast Cancer Group. J Clin Oncol. 1996;14:1558–64.

    PubMed  CAS  Google Scholar 

  25. Blichert-Toft M, Rose C, Andersen JA, Overgaard M, Axelsson CK, Andersen KW, et al. Danish randomized trial comparing breast conservation therapy with mastectomy: six years of life-table analysis. Danish Breast Cancer Cooperative Group. J Natl Cancer Inst Monogr. 1992;11:19–25.

    PubMed  Google Scholar 

  26. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41.

    Article  PubMed  Google Scholar 

  27. Jacobson JA, Danforth DN, Cowan KH, d’Angelo T, Steinberg SM, Pierce L, et al. Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. N Engl J Med. 1995;332:907–11.

    Article  PubMed  CAS  Google Scholar 

  28. Poggi MM, Danforth DN, Sciuto LC, Smith SL, Steinberg SM, Liewehr DJ, et al. Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy: the National Cancer Institute Randomized Trial. Cancer. 2003;98:697–702.

    Article  PubMed  Google Scholar 

  29. van Dongen JA, Voogd AC, Fentiman IS, Legrand C, Sylvester RJ, Tong D, et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst. 2000;92:1143–50.

    Article  PubMed  Google Scholar 

  30. Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227–32.

    Article  PubMed  Google Scholar 

  31. Veronesi U, Salvadori B, Luini A, Greco M, Saccozzi R, del Vecchio M, et al. Breast conservation is a safe method in patients with small cancer of the breast. Long-term results of three randomised trials on 1,973 patients. Eur J Cancer. 1995;31A:1574–9.

    Article  PubMed  CAS  Google Scholar 

  32. Fisher B, Land S, Mamounas E, Dignam J, Fisher ER, Wolmark N. Prevention of invasive breast cancer in women with ductal carcinoma in situ: an update of the National Surgical Adjuvant Breast and Bowel Project experience. Semin Oncol. 2001;28:400–18.

    Article  PubMed  CAS  Google Scholar 

  33. Houghton J, George WD, Cuzick J, Duggan C, Fentiman IS, Spittle M. Radiotherapy and tamoxifen in women with completely excised ductal carcinoma in situ of the breast in the UK, Australia, and New Zealand: randomised controlled trial. Lancet. 2003;362:95–102.

    Article  PubMed  Google Scholar 

  34. Silverstein MJ, Barth A, Poller DN, Gierson ED, Colburn WJ, Waisman JR, et al. Ten-year results comparing mastectomy to excision and radiation therapy for ductal carcinoma in situ of the breast. Eur J Cancer. 1995;31A:1425–7.

    Article  PubMed  CAS  Google Scholar 

  35. Silverstein MJ, Lagios MD, Craig PH, Waisman JR, Lewinsky BS, Colburn WJ, et al. A prognostic index for ductal carcinoma in situ of the breast. Cancer. 1996;77:2267–74.

    Article  PubMed  CAS  Google Scholar 

  36. Solin LJ, Yeh IT, Kurtz J, Fourquet A, Recht A, Kuske R, et al. Ductal carcinoma in situ (intraductal carcinoma) of the breast treated with breast-conserving surgery and definitive irradiation. Correlation of pathologic parameters with outcome of treatment. Cancer. 1993;71:2532–42.

    Article  PubMed  CAS  Google Scholar 

  37. Fisher ER, Dignam J, Tan-Chiu E, Costantino J, Fisher B, Paik S, et al. Pathologic findings from the National Surgical Adjuvant Breast Project (NSABP) eight-year update of Protocol B-17: intraductal carcinoma. Cancer. 1999;86:429–38.

    Article  PubMed  CAS  Google Scholar 

  38. Chinyama CN, Davies JD, Rayter Z, Farndon JR. Factors affecting surgical margin clearance in screen-detected breast cancer and the effect of cavity biopsies on residual disease. Eur J Surg Oncol. 1997;23:123–7.

    Article  PubMed  CAS  Google Scholar 

  39. Kelly P, Winslow EH. Needle wire localization for nonpalpable breast lesions: sensations, anxiety levels, and informational needs. Oncol Nurs Forum. 1996;23:639–45.

    PubMed  CAS  Google Scholar 

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Acknowledgments

We thank all the residents, staff physicians, nurses, and co-medical staff in our hospital for providing the breast cancer patients with excellent care and all staff in St. Luke’s Life Science Institute for data analysis.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Breast Surgical Oncology, St. Luke’s International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan

    Naoki Hayashi, Eriko Abe, Katsutoshi Enokido, Koichiro Tsugawa & Seigo Nakamura

  2. Department of Radiology, St. Luke’s International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan

    Hiroko Tsunoda & Mari Kikuchi

  3. Department of Pathology, St. Luke’s International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan

    Koyu Suzuki

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  1. Naoki Hayashi
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Correspondence to Hiroko Tsunoda.

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Hayashi, N., Tsunoda, H., Abe, E. et al. Ultrasonography- and/or mammography-guided breast conserving surgery for ductal carcinoma in situ of the breast: experience with 87 lesions. Breast Cancer 19, 131–137 (2012). https://doi.org/10.1007/s12282-010-0218-5

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  • DOI: https://doi.org/10.1007/s12282-010-0218-5

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