nach oben

Erschienen in:

01.04.2012 | Original Article

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

verfasst von: Naoki Hayashi, Hiroko Tsunoda, Eriko Abe, Mari Kikuchi, Katsutoshi Enokido, Koichiro Tsugawa, Koyu Suzuki, Seigo Nakamura

Erschienen in: Breast Cancer | Ausgabe 2/2012

Einloggen, um Zugang zu erhalten

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.

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.

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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

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.PubMedCrossRef

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.

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

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

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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.PubMedCrossRef

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

Titel: Ultrasonography- and/or mammography-guided breast conserving surgery for ductal carcinoma in situ of the breast: experience with 87 lesions
verfasst von: Naoki Hayashi
Hiroko Tsunoda
Eriko Abe
Mari Kikuchi
Katsutoshi Enokido
Koichiro Tsugawa
Koyu Suzuki
Seigo Nakamura
Publikationsdatum: 01.04.2012
Verlag: Springer Japan
Erschienen in: Breast Cancer / Ausgabe 2/2012
Print ISSN: 1340-6868
Elektronische ISSN: 1880-4233
DOI: https://doi.org/10.1007/s12282-010-0218-5

Springer Medizin

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