Classification of Ductal Carcinoma In Situ (DCIS)

  • DCIS is generally classified as one of five subtypes:
    • Based on differences in the architectural pattern of the cancer cells and nuclear features:
      • Comedo
      • Solid
      • Cribriform
      • Micropapillary
      • Papillary
    • Cribriform, comedo, and micropapillary:
      • Are the most common subtypes:
        • Although two or more patterns coexist:
          • In up to 50% of cases
  • The classification of noninvasive breast cancer:
    • Stratifies lesions based on their:
      • Likelihood of recurrence and incorporates prognostic factors
  • Lagios et al. (1989):
    • Identified high nuclear grade and comedonecrosis:
      • As factors predictive of local recurrence
    • Patients whose tumors had a high nuclear grade and comedonecrosis:
      • Had a 19% local recurrence rate after lumpectomy alone at an average interval of 26 months:
        • Compared with 5% for those patients:
          • Whose tumors did not have necrosis and were a lower nuclear grade
  • Silverstein et al. (1995):
    • Developed the Van Nuys algorithm:
      • To stratify patients into three risk groups using three established predictors of local recurrence:
        • Tumor size
        • Margin width
        • Pathologic classification:
          • The presence or absence of comedonecrosis and / or high tumor grade
      • Now updated to include:
        • Age
  • The University of Southern California / Van Nuys Prognostic Index Scoring System:
    • Can be used to determine which patients with DCIS are at greatest risk for recurrence:
      • And would therefore benefit from particular forms of locoregional therapy
    • With the goal being a local recurrence rate:
      • Of less than 20% at 12 years
    • Surgical excision alone:
      • Is recommended for a patient with a:
        • Score of 4 to 6
        • Score of 7:
          • But have margins ≥ 3 mm
    • Excision plus radiation therapy:
      • Is recommended for patients with a:
        • Score of 7 and margins < 3 mm
        • Score of 8 and margins ≥ 3 mm
        • Score of 9 and margins ≥ 5 mm
    • Mastectomy:
      • Is recommended for a:
        • Score of 8 and margins < 3 mm
        • Score of 9 and margins < 5 mm
        • Score of 10 to 12
    • The USC/VNPI score may be a useful adjunct in therapeutic decision making:
      • But multiple attempts at independently validating the utility of this risk stratification scheme have not been consistent
  • Currently, there is no universally accepted classification system for DCIS

#Arrangoiz #CancerSurgeon #BreastSurgeon #SurgicalOncologist #BreastCancer #LCIS #DCIS #DuctalCarcinomaInsitu #LobularNeoplasia #LobularCarcinomaInsitu #Surgeon #Teacher #Miami #Mexico #MSMC #MountSinaiMedicalCenter

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