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Query: UMLS:C0007124 (ductal carcinoma in situ)
 3,833 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To evaluate the impact of mammography on the patterns of patients referred for definitive breast irradiation, the records of 1507 cases of carcinoma of the breast in 1468 women treated between 1977 and 1988 with breast-conserving surgery and definitive irradiation were reviewed. All patients had undergone complete excision of the primary tumor with or without axillary staging. All patients had either noninvasive, intraductal carcinoma (American Joint Committee [AJC] Stage Tis, N0) or invasive carcinoma (AJC Stage T1 or T2, N0 or N1). The use of a mammographic needle localization breast biopsy for diagnosis of a nonpalpable carcinoma steadily increased over time from 3% (one of 32) in in 1977-78 to 26% (111/421) in 1987-88 (P less than 0.0001). The percentage of intraductal carcinomas was significantly increased for the cases in which a mammographic needle localization was used for biopsy of a nonpalpable carcinoma (P less than 0.0001). There was an increase in the incidence of intraductal carcinomas in patients referred for definitive breast irradiation over time from 6% (two of 32) in 1977-78 to 13% (53/421) in 1987-88 (P = 0.0004). These results demonstrate that the use of mammography has had a significant impact on the patterns of patients referred for breast conservation and definitive irradiation with an increase in the percentage of nonpalpable cancers diagnosed using mammographic needle localization and with an increase in the percentage of intraductal carcinomas referred over time.
Cancer 1990 Mar 01
PMID:The impact of mammography on the patterns of patients referred for definitive breast irradiation. 215 19

With the introduction of population screening for mammary carcinoma, in the initial phase an increase of malignancies has to be expected. Later on in the program the type of lesions will change. In the case of nonpalpable lesions close cooperation between surgeon, radiologist and pathologist is mandatory. The treatment of patients with ductal carcinoma in situ needs special attention because of the complexity of the problem, and requires careful preparation of the disciplines involved.
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PMID:Surgical implications of population screening for mammary carcinoma. 215 38

One hundred four sequential pretherapy and posttherapy breast tissue specimens from 57 patients with locally advanced and metastatic breast cancer were evaluated in an attempt to define the effects of systemic chemotherapeutic agents on the tumors and residual nonneoplastic breast tissue. The patients were treated uniformly at the National Cancer Institute on an experimental protocol combining systemic chemotherapy with attempted hormonal synchronization. Tumors were sampled prior to and following several cycles of chemotherapy to a maximum objective clinical response (average number of cycles, 7). In 38 cases, the posttreatment biopsy was positive for tumor. The most striking histologic change was extreme vacuolization of tumor cells that often resembled histiocytes. Atrophy of the terminal duct lobular unit (TDLU) and atypia of epithelial cells in TDLU and large ducts were also seen. Severe degrees of epithelial atypia occasionally proved to be difficult to distinguish from residual intraductal carcinoma. Breast biopsies were stained with antibodies to cytokeratin, epithelial membrane antigen (EMA), B72.3, lactalbumin, and SP1 using immunoperoxidase techniques. The number of cases showing immunoreactivity with antibodies to cytokeratin, EMA, and B72.3 remained approximately the same before and after therapy, while SP1 expression decreased and lactalbumin expression increased after therapy. Recognition of chemotherapeutic changes in breast tissue is important since systemic chemotherapy plays an important role in the management of breast cancer.
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PMID:The effects of hormonal and chemotherapy on tumoral and nonneoplastic breast tissue. 215 74

From January 1, 1987, to December 31, 1988, roentgenographically guided biopsies of 1261 occult breast abnormalities were performed. There were 626 (49.6%) masses and 635 (50.4%) lesions with calcification as the dominant feature. Of the total, 237 (18.8%) were found to be malignant, including 85 cases of ductal carcinoma in situ. Biopsies performed for a mass yielded a 20.8% (130/626) incidence of cancer; and for calcification, 16.9% (107/635). The biopsy results were supported by the interpretations of four radiologists (J.E.M., P.C.S., and M.R.S.) who were practicing at Brigham and Women's Hospital in 22.2% of the total (280), whereas the remaining 981 lesions were discovered on mammograms that were performed and interpreted elsewhere and were referred to our hospital for surgical consultation. The biopsy results of the mammograms from other facilities yielded a positive predictive value of 16.7% (164/981) vs 26.1% (73/280) for the Brigham and Women's Hospital group. This statistically significant difference lends support to the value of a second opinion in patients with biopsy recommendations for occult breast lesions, especially when findings are inconclusive.
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PMID:Biopsy of occult breast lesions. Analysis of 1261 abnormalities. 221 60

As mammography is increasingly prescribed systematically and mammography films are of better quality, diagnostic biopsies are performed in growing numbers, leading to the discovery of "borderline" histological lesions which were relatively rare a few years ago. The authors have studied the frequency and clinical presentation of these lesions. In patients with atypical hyperplasia simple monitoring is the rule since the short- and long-term effects of medical treatments are too uncertain for these to be recommended routinely. The finding at histology of lobular carcinoma in situ is regarded as indicating a high risk of cancer infiltrating both breasts, and in all but some special cases close supervision with 6-monthly clinical examination and annual mammography is advocated. Whether or not endocrine treatments reduce the incidence of infiltrating carcinoma is unknown. In patients with intraductal carcinoma mastectomy gives excellent results at the cost of a considerable loss of tissue. In view of the N.S.A.B.P. and Curie Institute experience, tumorectomy alone is not recommended because of the high risk of recurrence, but a conservative treatment (limited surgery followed by radiation) is permitted. Conservative treatment may also be attempted in Paget's disease without palpable tumour.
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PMID:[Treatment of borderline lesions and non-infiltrating carcinoma]. 215 43

Two hundred eight cases of intraductal breast carcinoma (DCIS) were selectively treated; 97 with mastectomy, 96 with radiation therapy, and 15 using excisional biopsy only. Mastectomy patients tended to have larger tumors, involved biopsy margins, palpable and often multifocal tumors. Breast preservation patients tended to have smaller, often occult, tumors with clear surgical margins. Before 1983, mastectomy was more common; during and after 1983, breast preservation was more common. Comedocarcinomas were the most frequent tumors. They were the largest, had the highest percentage of microinvasion (20%), and had the highest recurrence rate (8%). Noncomedo DCIS had a recurrence rate of 1%, one of 103 tumors. The recurrence rate for comedocarcinomas treated with radiation therapy was nearly three times higher than for those treated with mastectomy (11% versus 4%). One of 164 (0.6%) axillary lymph node dissections yielded positive nodes. Nine patients have recurred: two in the mastectomy group and seven in the breast conservation group (P less than 0.1). Eight of nine recurrences were the comedo subtype (P less than 0.05). Three patients developed metastatic disease, two of whom have died. Axillary dissection for intraductal carcinoma of the breast is unlikely to yield involved nodes and is not indicated for most cases. It should be reserved for lesions revealing microinvasion. Conservative therapy for comedocarcinoma must be viewed with caution.
Cancer 1990 Jul 01
PMID:Intraductal carcinoma of the breast (208 cases). Clinical factors influencing treatment choice. 216 38

The mammographic features of carcinoma originating within a fibroadenoma in 24 patients were studied by means of retrospective review of pathologic slides. Histologic examination showed that the lesions were lobular carcinoma in situ (LCIS) (seven patients), ductal carcinoma in situ (DCIS) (13 patients), synchronous LCIS and invasive lobular carcinoma (one patient), and synchronous LCIS and DCIS (three patients). In all patients the mammographic manifestation was a mass 1.0 cm or greater in diameter; 14 masses were 1-2 cm in diameter, and the remainder were more than 2 cm in diameter. Features that were considered suspect included large size, indistinct margins, and clustered microcalcifications. In three patients, microcalcifications within the mass raised suspicion of malignancy. At histologic examination these microcalcifications were associated with the intraductal carcinoma harbored in the fibroadenoma in only one of these patients. Fibroadenomas that harbor carcinoma may be indistinguishable from common benign fibroadenomas, but their occurrence is rare. In this study, a single patient had invasive lobular carcinoma; all the other lesions were in situ lesions.
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PMID:Carcinoma within fibroadenomas: mammographic features. 216 33

The influence of extensive intraductal component (EIC) on local recurrence risk was studied for 496 patients with stage I-II infiltrating ductal cancers treated by conservative surgery and irradiation. EIC was diagnosed in 65 of 231 (28%) premenopausal and 41 of 265 (15.5%) post-menopausal patients. Local recurrence risk was markedly increased in EIC+ patients (5-year actuarial risk 18% versus 8% without EIC, P less than 0.001), but this effect appeared limited to premenopausal patients. Local recurrence risk increased with increasing degree of EIC. EIC with more than 50% intraductal carcinoma was more prevalent in patients younger than 40, perhaps accounting to some degree for the higher local recurrence rates observed in younger patients. The presence of EIC had no influence on overall survival, on median time to local recurrence, or on short-term survival after local failure. The usefulness of EIC as a risk factor for local recurrence is discussed.
Br J Cancer 1990 Jun
PMID:An assessment of extensive intraductal component as a risk factor for local recurrence after breast-conserving therapy. 216 36

The application of fine-needle aspiration biopsy (FNAB) to the diagnosis of nonpalpable breast lesions was evaluated with a new method which uses standard needle localization under mammographic guidance to assure accurate sampling by FNAB. This method was prospectively applied to 100 mammographically detected breast lesions in 100 women (mean age, 53 years). All 100 patients underwent surgical excision of these nonpalpable lesions after cytologic aspiration. Sufficient aspirated material was obtained for cytologic diagnosis from 91 patients (91%). The histologic and cytologic interpretations were then compared. Twenty malignancies were ultimately diagnosed by histology (12 invasive ductal carcinoma, six ductal carcinoma in situ, and two lobular carcinoma in situ), of which 17 had been cytologically diagnosed. There were no false-positive diagnoses of malignancy by FNAB. False-negative readings (3.3%) included two cases of lobular carcinoma in situ and one case of ductal carcinoma in situ. This technique thus demonstrated a sensitivity of 85%, specificity of 100%, and overall diagnostic accuracy of 96.7% for the nonsurgical detection of malignancy in nonpalpable breast lesions. These results suggest that the established safety, reliability, and cost-effectiveness of FNAB can be maintained in this clinical setting. This procedure may obviate the need for open surgical biopsy in those patients with an unequivocal diagnosis of malignancy. It can also be done using standard techniques and equipment available in many community hospitals.
Cancer 1990 Oct 01
PMID:Prospective evaluation of radiologically directed fine-needle aspiration biopsy of nonpalpable breast lesions. 216 89

The optimal treatment for ductal carcinoma in situ (DCIS) of the breast is undefined. At three Connecticut hospitals 1) Yale-New Haven Hospital, New Haven; 2) Uncas-on-Thames Hospital, Norwich; 3) Norwalk Hospital, Norwalk, breast conservation therapy with lumpectomy followed by radiation therapy (RT) has been offered to women with DCIS as an alternative to mastectomy. From 1974 through 1987, 60 women with DCIS have been treated with RT. With a minimum evaluable follow-up of two years, a maximum follow-up of 15 years, and a median follow-up of 3.6 years, there have been no cancer-related deaths in the 60 patients. Four of the 60 patients (6.7%) developed a local breast recurrence but were salvaged with further surgical therapy (three patients with mastectomies and one patient with repeat lumpectomy). Only one patient (2%) has died of nonmalignant disease and the remaining 59 patients (98%) survived cancer-free. The five-year actuarial breast recurrence-free rate was 95%. These results suggest that breast conservation therapy with RT is a viable treatment option for women with DCIS.
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PMID:Radiation therapy for ductal carcinoma in situ of the breast. 217 69


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