Local Treatment for Ductal Carcinoma In Situ

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • 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.
#Arrangoiz #BreastSurgeon #BreastCancer #CancerSurgeon #SurgicalOncology #MountSinaiMedicalCenter #MSMC #Miami #Mexico
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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