Do Eligibility Criteria for Ductal Carcinoma In Situ (DCIS) Active Surveillance Trials Identify Patients at Low Risk for Upgrade to Invasive Carcinoma?
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
received:
03
01
2020
pubmed:
18
5
2020
medline:
2
4
2021
entrez:
18
5
2020
Statut:
ppublish
Résumé
Clinical trials are currently ongoing to determine the safety and efficacy of active surveillance (AS) versus usual care (surgical and radiation treatment) for women with ductal carcinoma in situ (DCIS). This study aimed to determine upgrade rates of DCIS at needle biopsy to invasive carcinoma at surgery among women who meet the eligibility criteria for AS trials. A retrospective review was performed of consecutive women at an academic medical center with a diagnosis of DCIS at needle biopsy from 2007 to 2016. Medical records were reviewed for mode of presentation, imaging findings, biopsy pathology results, and surgical outcomes. Each patient with DCIS was evaluated for AS trial eligibility based on published criteria for the COMET, LORD, and LORIS trials. During a 10-year period, DCIS was diagnosed in 858 women (mean age 58 years; range 28-89 years). Of the 858 women, 498 (58%) were eligible for the COMET trial, 101 (11.8%) for the LORD trial, and 343 (40%) for the LORIS trial. The rates of upgrade to invasive carcinoma were 12% (60/498) for the COMET trial, 5% (5/101) for the LORD trial, and 11.1% (38/343) for the LORIS trial. The invasive carcinomas ranged from 0.2 to 20 mm, and all were node-negative. Women who meet the eligibility criteria for DCIS AS trials remain at risk for occult invasive carcinoma at presentation, with upgrade rates ranging from 5 to 12%. These findings suggest that more precise criteria are needed to ensure that women with invasive carcinoma are excluded from AS trials.
Sections du résumé
BACKGROUND
BACKGROUND
Clinical trials are currently ongoing to determine the safety and efficacy of active surveillance (AS) versus usual care (surgical and radiation treatment) for women with ductal carcinoma in situ (DCIS). This study aimed to determine upgrade rates of DCIS at needle biopsy to invasive carcinoma at surgery among women who meet the eligibility criteria for AS trials.
METHODS
METHODS
A retrospective review was performed of consecutive women at an academic medical center with a diagnosis of DCIS at needle biopsy from 2007 to 2016. Medical records were reviewed for mode of presentation, imaging findings, biopsy pathology results, and surgical outcomes. Each patient with DCIS was evaluated for AS trial eligibility based on published criteria for the COMET, LORD, and LORIS trials.
RESULTS
RESULTS
During a 10-year period, DCIS was diagnosed in 858 women (mean age 58 years; range 28-89 years). Of the 858 women, 498 (58%) were eligible for the COMET trial, 101 (11.8%) for the LORD trial, and 343 (40%) for the LORIS trial. The rates of upgrade to invasive carcinoma were 12% (60/498) for the COMET trial, 5% (5/101) for the LORD trial, and 11.1% (38/343) for the LORIS trial. The invasive carcinomas ranged from 0.2 to 20 mm, and all were node-negative.
CONCLUSIONS
CONCLUSIONS
Women who meet the eligibility criteria for DCIS AS trials remain at risk for occult invasive carcinoma at presentation, with upgrade rates ranging from 5 to 12%. These findings suggest that more precise criteria are needed to ensure that women with invasive carcinoma are excluded from AS trials.
Identifiants
pubmed: 32418079
doi: 10.1245/s10434-020-08576-6
pii: 10.1245/s10434-020-08576-6
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
4459-4465Subventions
Organisme : Electronic Space Systems Corporation (ESSCO)
ID : ESSCO-MGH Breast Cancer Research Fund
Organisme : Radiological Society of North America
ID : RSNA Research Scholar Grant
Références
Yamada T, Mori N, Watanabe M, et al. Radiologic-pathologic correlation of ductal carcinoma in situ. Radiographics. 2010;30:1183–98. https://doi.org/10.1148/rg.305095073 .
doi: 10.1148/rg.305095073
pubmed: 20833844
Mitchell KB, Kuerer H. Ductal carcinoma in situ: treatment update and current trends. Curr Oncol Rep. 2015;17:48. https://doi.org/10.1007/s11912-015-0473-x .
doi: 10.1007/s11912-015-0473-x
pubmed: 26373411
Pang JM, Gorringe KL, Fox SB. Ductal carcinoma in situ: update on risk assessment and management. Histopathology. 2016;68:96–109. https://doi.org/10.1111/his.12796 .
doi: 10.1111/his.12796
pubmed: 26768032
Rosso KJ, Weiss A, Thompson AM. Are there alternative strategies for the local management of ductal carcinoma in situ? Surg Oncol Clin North Am. 2018;27:69–80. https://doi.org/10.1016/j.soc.2017.08.002 .
doi: 10.1016/j.soc.2017.08.002
Bruce J, Thornton AJ, Scott NW, et al. Chronic preoperative pain and psychological robustness predict acute postoperative pain outcomes after surgery for breast cancer. Br J Cancer. 2012;107:937–46. https://doi.org/10.1038/bjc.2012.341 .
doi: 10.1038/bjc.2012.341
pubmed: 22850552
pmcid: 3464763
Miller ME, Muhsen S, Olcese C, et al. Contralateral breast cancer risk in women with ductal carcinoma in situ: is it high enough to justify bilateral mastectomy? Ann Surg Oncol. 2017;24:2889–97. https://doi.org/10.1245/s10434-017-5931-2 .
doi: 10.1245/s10434-017-5931-2
pubmed: 28766208
pmcid: 5728655
Elshof LE, Tryfonidis K, Slaets L, et al. Feasibility of a prospective, randomised, open-label, international multicentre, phase III, non-inferiority trial to assess the safety of active surveillance for low risk ductal carcinoma in situ: the LORD study. Eur J Cancer. 2015;51:1497–510. https://doi.org/10.1016/j.ejca.2015.05.008 .
doi: 10.1016/j.ejca.2015.05.008
pubmed: 26025767
Francis A, Thomas J, Fallowfield L, et al. Addressing overtreatment of screen detected DCIS; the LORIS trial. Eur J Cancer. 2015;51:2296–303. https://doi.org/10.1016/j.ejca.2015.07.017 .
doi: 10.1016/j.ejca.2015.07.017
pubmed: 26296293
Hwang ES, Hyslop T, Lynch T, et al. The COMET (Comparison of Operative versus Monitoring and Endocrine Therapy) trial: a phase III randomised controlled clinical trial for low-risk ductal carcinoma in situ (DCIS). BMJ Open. 2019;9:e026797. https://doi.org/10.1136/bmjopen-2018-026797 .
doi: 10.1136/bmjopen-2018-026797
pubmed: 30862637
pmcid: 6429899
Grimm LJ, Shelley Hwang E. Active surveillance for DCIS: the importance of selection criteria and monitoring. Ann Surg Oncol. 2016;23:4134–6. https://doi.org/10.1245/s10434-016-5596-2 .
doi: 10.1245/s10434-016-5596-2
pubmed: 27704372
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;260:119–28. https://doi.org/10.1148/radiol.11102368 .
doi: 10.1148/radiol.11102368
pubmed: 21493791
Brem RF, Schoonjans JM, Goodman SN, et al. Nonpalpable breast cancer: percutaneous diagnosis with 11- and 8-gauge stereotactic vacuum-assisted biopsy devices. Radiology. 2001;219:793–6. https://doi.org/10.1148/radiology.219.3.r01jn34793 .
doi: 10.1148/radiology.219.3.r01jn34793
pubmed: 11376271
Jackman RJ, Burbank F, Parker SH, et al. Stereotactic breast biopsy of nonpalpable lesions: determinants of ductal carcinoma in situ underestimation rates. Radiology. 2001;218:497–502. https://doi.org/10.1148/radiology.218.2.r01fe35497 .
doi: 10.1148/radiology.218.2.r01fe35497
pubmed: 11161168
Wahedna Y, Evans AJ, Pinder SE, et al. Mammographic size of ductal carcinoma in situ does not predict the presence of an invasive focus. Eur J Cancer. 2001;37:459–62. https://doi.org/10.1016/s0959-8049(00)00397-x .
doi: 10.1016/s0959-8049(00)00397-x
pubmed: 11267854
Goyal A, Douglas-Jones A, Monypenny I, et al. Is there a role of sentinel lymph node biopsy in ductal carcinoma in situ? Analysis of 587 cases. Breast Cancer Res Treat. 2006;98:311–4. https://doi.org/10.1007/s10549-006-9167-2 .
doi: 10.1007/s10549-006-9167-2
pubmed: 16552627
Houssami N, Ciatto S, Ellis I, Ambrogetti D. Underestimation of malignancy of breast core-needle biopsy: concepts and precise overall and category-specific estimates. Cancer. 2007;109:487–95. https://doi.org/10.1002/cncr.22435 .
doi: 10.1002/cncr.22435
pubmed: 17186530
Houssami N, Ambrogetti D, Marinovich ML, et al. Accuracy of a preoperative model for predicting invasive breast cancer in women with ductal carcinoma in situ on vacuum-assisted core needle biopsy. Ann Surg Oncol. 2011;18:1364–71. https://doi.org/10.1245/s10434-010-1438-9 .
doi: 10.1245/s10434-010-1438-9
pubmed: 21107741
Kim J, Han W, Lee JW, et al. Factors associated with upstaging from ductal carcinoma in situ following core needle biopsy to invasive cancer in subsequent surgical excision. Breast. 2012;21:641–5. https://doi.org/10.1016/j.breast.2012.06.012 .
doi: 10.1016/j.breast.2012.06.012
pubmed: 22749854
Trentin C, Dominelli V, Maisonneuve P, et al. Predictors of invasive breast cancer and lymph node involvement in ductal carcinoma in situ initially diagnosed by vacuum-assisted breast biopsy: experience of 733 cases. Breast. 2012;21:635–40. https://doi.org/10.1016/j.breast.2012.06.009 .
doi: 10.1016/j.breast.2012.06.009
pubmed: 22795363
Schulz S, Sinn P, Golatta M, et al. Prediction of underestimated invasiveness in patients with ductal carcinoma in situ of the breast on percutaneous biopsy as rationale for recommending concurrent sentinel lymph node biopsy. Breast. 2013;22:537–42. https://doi.org/10.1016/j.breast.2012.11.002 .
doi: 10.1016/j.breast.2012.11.002
pubmed: 23237921
Parikh U, Chhor CM, Mercado CL. Ductal carcinoma in situ: the whole truth. AJR Am J Roentgenol. 2018;210:246–55. https://doi.org/10.2214/ajr.17.18778 .
doi: 10.2214/AJR.17.18778
pubmed: 29045181
Lamb LR, Lehman CD, Oseni TO, Bahl M. Ductal carcinoma in situ (DCIS) at breast MRI: predictors of upgrade to invasive carcinoma. Acad Radiol. 2019. Epub ahead of print. https://doi.org/10.1016/j.acra.2019.09.025 .
Grimm LJ, Ryser MD, Partridge AH, et al. Surgical upstaging rates for vacuum-assisted biopsy-proven DCIS: implications for active surveillance trials. Ann Surg Oncol. 2017;24:3534–40. https://doi.org/10.1245/s10434-017-6018-9 .
doi: 10.1245/s10434-017-6018-9
pubmed: 28795370
pmcid: 6414216
Elmore JG, Longton GM, Carney PA, et al. Diagnostic concordance among pathologists interpreting breast biopsy specimens. JAMA. 2015;313:1122–32. https://doi.org/10.1001/jama.2015.1405 .
doi: 10.1001/jama.2015.1405
pubmed: 25781441
pmcid: 4516388
Pilewskie M, Stempel M, Rosenfeld H, et al. Do LORIS trial eligibility criteria identify a ductal carcinoma in situ patient population at low risk of upgrade to invasive carcinoma? Ann Surg Oncol. 2016;23:3487–93. https://doi.org/10.1245/s10434-016-5268-2 .
doi: 10.1245/s10434-016-5268-2
pubmed: 27172775
pmcid: 5070657
Soumian S, Verghese ET, Booth M, et al. Concordance between vacuum-assisted biopsy and postoperative histology: implications for the proposed Low-Risk DCIS Trial (LORIS). Eur J Surg Oncol. 2013;39:1337–40. https://doi.org/10.1016/j.ejso.2013.09.028 .
doi: 10.1016/j.ejso.2013.09.028
pubmed: 24209431
Podoll MB, Reisenbichler ES, Roland L, et al. Feasibility of the less-is-more approach in treating low-risk ductal carcinoma in situ diagnosed on core needle biopsy: ten-year review of ductal carcinoma in situ upgraded to invasion at surgery. Arch Pathol Lab Med. 2018;142:1120–6. https://doi.org/10.5858/arpa.2017-0268-oa .
doi: 10.5858/arpa.2017-0268-OA
pubmed: 29582675
Ryser MD, Worni M, Turner EL, et al. Outcomes of active surveillance for ductal carcinoma in situ: a computational risk analysis. J Natl Cancer Inst. 2015;108. https://doi.org/10.1093/jnci/djv372 .
Shi B, Grimm LJ, Mazurowski MA, et al. Can occult invasive disease in ductal carcinoma in situ be predicted using computer-extracted mammographic features? Acad Radiol. 2017;24:1139–47. https://doi.org/10.1016/j.acra.2017.03.013 .
doi: 10.1016/j.acra.2017.03.013
pubmed: 28506510
pmcid: 5557686
Lin CY, Mooney K, Choy W, et al. Will oncotype DX DCIS testing guide therapy? A single-institution correlation of oncotype DX DCIS results with histopathologic findings and clinical management decisions. Mod Pathol. 2018;31:562–8. https://doi.org/10.1038/modpathol.2017.172 .
doi: 10.1038/modpathol.2017.172
pubmed: 29243740
Shi B, Grimm LJ, Mazurowski MA, et al. Prediction of occult invasive disease in ductal carcinoma in situ using deep learning features. J Am Coll Radiol. 2018;15(3 Pt B):527–34. https://doi.org/10.1016/j.jacr.2017.11.036 .
Lehman CD, Gatsonis C, Romanoff J, et al. Association of magnetic resonance imaging and a 12-gene expression assay with breast ductal carcinoma in situ treatment. JAMA Oncol. 2019;5:1036–42. https://doi.org/10.1001/jamaoncol.2018.6269 .
doi: 10.1001/jamaoncol.2018.6269
pubmed: 30653209
pmcid: 6583020
Zhu Z, Harowicz M, Zhang J, et al. Deep learning analysis of breast MRIs for prediction of occult invasive disease in ductal carcinoma in situ. Comput Biol Med. 2019;115:103498. https://doi.org/10.1016/j.compbiomed.2019.103498 .
doi: 10.1016/j.compbiomed.2019.103498
pubmed: 31698241