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Management of DCIS. KWH Experience. Dr. Carmen Ho. Ductal carcinoma in situ (DCIS ). Breast cancer as most common cancer in women in Hong Kong DCIS as precursor of invasive cancer Heterogeneous group with diverse malignant potential Incidence of DCIS increased with mammographic screening - PowerPoint PPT Presentation
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KWH Experience
Dr. Carmen Ho
Breast cancer as most common cancer in women in Hong Kong
DCIS as precursor of invasive cancer Heterogeneous group with diverse malignant
potential
Incidence of DCIS increased with mammographic screening 3/100,000 to 34/100,000 in 50-69 years old
Steenbergen. Breast Cancer Res Treat.2009.
Best treatment for DCIS remains a controversy
Mastectomy vs. breast conserving treatment + RTRT reduces local recurrence rate
(13.4% vs. 3.9%)NSABP B-17
Similar local recurrence and survivalNSABP B-04
Acceptance of BCT in Chinese (survey)29-49%
Chua et al. Breast J. 2005
BCT rate in HK for breast cancer : 22-30%
Yau et al. Int J Radiat Oncol Biol Phys. 2008
Retrospective study Period : January 2002 – April 2009 Inclusion
Patients diagnosed with DCIS after surgical excision Patients with micro- or invasive features were not
included 212 patients included
Age : 57.2 (37.8 – 87.5)
Median FU : 31.0 months (0.3 - 81.4 months)
Bilateral disease : 22 7 with bilateral disease on presentation
Table 1: Patient Characteristics
Presentation
Mammographic abnormality 130 (62%)
Breast lump 58 (27%)
Nipple discharge 17 (8%)
Nipple abnormality 3 (1%)
Mastalgia 4 (2%)
Average size : 2.02cm (0.1 – 7 cm)
SizeScreen detected group : 1.32cmSymptomatic group : 2.47cm
(P<0.01)
Operation
Mastectomy 80
Mastectomy with immediate reconstruction 28
Breast conserving treatment 104
Wide local excision 27
ROLL 31
Wire guided excision 42
Microdochectomy 4
BCT offered to 175 patients
Unicentric tumor <3cm Appropriate tumor to breast ratioAcceptance of adjuvant radiotherapy
104 patients accepted BCT (59.4%)
75% were screen detected
96.2% (100/104) have adjuvant RT
4 patients with small foci (<0.6cm) and low grade DCIS
1 has IBTR 5 years later as DCIS
32 patients (31.7%) receiving BCT have close margin (<3mm)5 patients underwent re-excision8 required subsequent mastectomy Boost dose of radiotherapy All free of local recurrence
Sentinel LN biopsy was done in 98 patientsPositive sentinel LN noted in 3 patientsAxillary dissection was performed
198 / 212 (93.4%) remained disease free
Screen detected : 95.4% (124/130)
Symptomatic : 90.2% (74/82)
4 patients with BCT have ipsilateral breast tumor recurrence (3.8%)
3 recurred as invasive ductal carcinoma, subsequent mastectomy performed
1 recurred as DCIS with ROLL done
All remained disease free after salvage treatment
1 patient diedPresented with blood stained nipple
dischargeMicrodochectomy performed : DCIS with
involved margin Simple mastectomy performed
DCIS (high grade with comedo necrosis) 6 months after mastectomy, developed
bone metastasis
Emphasize on importance of screening mammogram
Acceptance of BCT + RT as treatment 75% patients receiving BCT were screen detected
69% with clear margin (>3mm)
Positive sentinel LN in 3.0% patients with DCIS
Risk of local recurrence after BCT 3.8% with median FU 31.0 months
Success of salvage treatment after IBTR