Ductal Carcinoma In Situ with Microinvasive Disease

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • The eighth edition of the American Joint Committee on Cancer (AJCC) staging system:
    • Defines microinvasion as invasion of breast cancer cells through the basement membrane:
      • At one or more foci:
        • None of which exceeds a dimension of 1 mm
  • DCIS:
    • Is a Tis lesion:
      • It is classified as stage 0 cancer
  • DCIS with microinvasion:
    • Is considered T1mi:
      • It upstages DCIS from stage 0 to stage I disease
  • By definition, DCIS without microinvasion:
    • Does not have the ability to metastasize to axillary lymph nodes or distant sites:
      • Whereas DCIS with microinvasion does
  • Axillary metastases:
    • Have been reported in 0% to 20% of patients:
      • With DCIS with microinvasion
  • The incidence of microinvasion in DCIS:
    • Varies according to the size and extent of the index lesion
  • Lagios et al. reported:
    • A 2% incidence of microinvasion in patients with DCIS measuring less than 25 mm in diameter:
      • Compared with a 29% incidence of microinvasion in those with lesions larger than 26 mm
  • The incidence of microinvasion is also higher:
    • In patients with high-grade or comedo-type DCIS with necrosis
    • In patients with DCIS who present with a palpable mass or nipple discharge
  • There is conflicting data in the literature on the prognosis of DCIS with microinvasion compared to DCIS without microinvasion:
    • Historically, studies have shown that patients with DCIS with microinvasion have a worse prognosis compared with those who have DCIS alone
    • In a retrospective study of 1,248 serially sectioned DCIS tumors, de Mascarel et al:
      • Reported a 10.1% incidence of axillary metastases in cases of DCIS with microinvasion
      • Patients with DCIS alone had a better 10-year distant metastasis-free survival rate than patients with DCIS with microinvasion:
        • 98% and 91%, respectively
      • The overall survival rate was also better in patients with DCIS alone:
        • 96.5% vs. 88.4%
      • However, the metastasis-free and overall survival rates were worse:
        • In patients with invasive ductal carcinoma compared with those with DCIS with microinvasion
    • In a retrospective review of the SEER database from Champion et al., 134,569 women with DCIS alone, DCIS with microinvasion, and T1a intraductal carcinoma were compared:
      • They found that the disease-specific survival of DCIS with microinvasion was significantly different from the other two groups (DCIS alone: hazard ratio [HR] 0.59, confidence interval [CI] 0.43–0.80; invasive: HR 1.43, CI 1.04–1.96) but the overall survival of DCIS with microinvasion was similar to early invasive disease
      • Patients with DCIS alone had an improved overall survival compared to DCIS with microinvasion (HR 0.83, CI 0.75–0.93)
      • These results suggest that DCIS with microinvasion should be characterized as an early invasive tumor with a good outcome and that the therapeutic approach for these patients should be similar to that for patients with invasive cancer
    • However, some studies have pointed toward DCIS with microinvasion as having a more similar natural history to DCIS alone than to early-stage invasive disease:
      • In a review of 393 patients treated at Yale between 1973 and 2004, there was no significant difference between patients with DCIS alone and those with DCIS with microinvasion with regard to the presence of axillary metastases (in those who had axillary staging) or the likelihood of recurrence (locoregional and distant) or overall survival
    • In a more recent study from Zheng et al., 308 cases of DCIS alone were compared to 92 cases of DCIS with microinvasion and 111 cases of T1a tumors:
      • With a 25-month median follow-up, their analysis demonstrated no difference in disease-free survival and overall survival among the three groups
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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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