Treatment for Ductal Carcinoma In Situ (DCIS)

Local treatment for ductal carcinoma in situ (DCIS) involves:
- Mastectomy or breast-conserving therapy, which consists of partial mastectomy followed in most cases by adjuvant radiation therapy
Sentinel lymph node biopsy (SLNB):
- Is not indicated for most patients undergoing breast-conserving therapy for DCIS:
  - Because DCIS is a preinvasive lesion:
    - Axillary nodes are rarely involved:
      - Even in cases of extensive multifocal high-grade disease
If invasive breast cancer is identified after a breast-conserving surgery is performed for DCIS:
- SLNB can be performed as a second procedure
If a mastectomy is performed as the initial procedure:
- A sentinel node biopsy should be performed in the event of an occult invasive cancer
Radiation therapy alone is not given for DCIS:
- Although there are ongoing clinical trials comparing active surveillance to surgery with or without endocrine therapy:
  - These are reserved for low- and intermediate-grade DCIS and are not yet considered standard of care
References
Virnig BA, Tuttle TM, Shamliyan T, Kane RL. Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes. J Natl Cancer Inst 2010; 102:170.
Lyman GH, Giuliano AE, Somerfield MR, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol. 2005;23(30):7703-7720.
Intra M, Rotmensz N, Veronesi P, et al. Sentinel node biopsy is not a standard procedure in ductal carcinoma in situ of the breast: the experience of the European Institute of Oncology on 854 patients in 10 years. Ann Surg. 2008;247(2):315-319.
Brennan ME, Turner RM, Ciatto S, et al. Ductal carcinoma in situ at core-needle biopsy: meta-analysis of underestimation and predictors of invasive breast cancer. Radiology. 2011;260(1):119-128.
Youngwirth LM, Boughey JC, Hwang ES. Surgery versus monitoring and endocrine therapy for low-risk DCIS: The COMET Trial. Bull Am Coll Surg. 2017;102(1):62-63.