| 1. Pinder SE, Fox S, Schnitt S, van Deurzen C, Weaver D, Wesseling J. Ductal carcinoma in situ. WHO Classification of Tumours—Breast Tumours, 5th ed.; Board, E., Ed; 2019:78. |
Review/Other-Dx |
N/A |
No abstract available. |
No abstract available. |
4 |
| 2. Grimm LJ, Rahbar H, Abdelmalak M, Hall AH, Ryser MD. Ductal Carcinoma in Situ: State-of-the-Art Review. [Review]. Radiology. 302(2):246-255, 2022 02. |
Review/Other-Dx |
N/A |
To provide a multidisciplinary update on DCIS centered on the radiologist and include the many factors that may influence breast imaging practices in the present and near future. |
No results in abstract. |
4 |
| 3. Rauch GM, Kuerer HM, Scoggins ME, et al. Clinicopathologic, mammographic, and sonographic features in 1,187 patients with pure ductal carcinoma in situ of the breast by estrogen receptor status. Breast Cancer Res Treat. 139(3):639-47, 2013 Jun. |
Observational-Dx |
1187 patients with DCIS that had mammography |
To describe the clinicopathologic, mammographic, and sonographic findings in patients with pure DCIS by ER expression. |
Of 1219 patients with pure DCIS and known ER status identified, 1187 with complete data were included. Mammography was performed in all 1187 patients and sonography in 519 (44%). There were 972 (82%) patients with ER-positive and 215 (18%) with ER-negative disease. ER-negative DCIS was more likely to be high grade (93% vs 44%, p<0.0001), associated with comedonecrosis (64% vs 29%, p<0.0001), and multifocal (23% vs 15%, p=0.009). On sonography, ER-negative DCIS was more likely to be visible (61% vs 46%, p=0.004), larger (mean size, 2.3 vs 1.6 cm, p=0.006), and show posterior shadowing (53% vs 28%, p=0.006). Mastectomy was more frequently performed for ER-negative DCIS (47% vs 37%, p=0.008). Palpable DCIS was visible on sonography in 55% of cases and mammography in 81%. Compared with ER-positive palpable DCIS, ER-negative palpable DCIS was larger and more likely to be visible on sonography. Compared with ER-positive noncalcified DCIS, ER-negative noncalcified DCIS was less likely to be visible on mammography. |
3 |
| 4. Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin 2023;73:17-48. |
Review/Other-Dx |
N/A |
Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population-based cancer occurrence and outcomes using incidence data collected by central cancer registries and mortality data collected by the National Center for Health Statistics. |
In 2023, 1,958,310 new cancer cases and 609,820 cancer deaths are projected to occur in the United States. Cancer incidence increased for prostate cancer by 3% annually from 2014 through 2019 after two decades of decline, translating to an additional 99,000 new cases; otherwise, however, incidence trends were more favorable in men compared to women. For example, lung cancer in women decreased at one half the pace of men (1.1% vs. 2.6% annually) from 2015 through 2019, and breast and uterine corpus cancers continued to increase, as did liver cancer and melanoma, both of which stabilized in men aged 50 years and older and declined in younger men. However, a 65% drop in cervical cancer incidence during 2012 through 2019 among women in their early 20s, the first cohort to receive the human papillomavirus vaccine, foreshadows steep reductions in the burden of human papillomavirus-associated cancers, the majority of which occur in women. Despite the pandemic, and in contrast with other leading causes of death, the cancer death rate continued to decline from 2019 to 2020 (by 1.5%), contributing to a 33% overall reduction since 1991 and an estimated 3.8 million deaths averted. This progress increasingly reflects advances in treatment, which are particularly evident in the rapid declines in mortality (approximately 2% annually during 2016 through 2020) for leukemia, melanoma, and kidney cancer, despite stable/increasing incidence, and accelerated declines for lung cancer. In summary, although cancer mortality rates continue to decline, future progress may be attenuated by rising incidence for breast, prostate, and uterine corpus cancers, which also happen to have the largest racial disparities in mortality. |
4 |
| 5. Wapnir IL, Dignam JJ, Fisher B, et al. Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst. 2011;103(6):478-488. |
Experimental-Tx |
B-17 trial; 813 patients: B-24 trial; 1,799 patients |
To evaluate I-IBTR and its influence on survival among participants in 2 NSABP randomized trials for DCIS. |
Of 490 IBTR events, 263 (53.7%) were invasive. Radiation reduced I-IBTR by 52% in the LRT group compared with lumpectomy only (B-17, HR of risk of I-IBTR = 0.48, 95% CI = 0.33 to 0.69, P<.001). Lumpectomy followed by RT + tamoxifen reduced I-IBTR by 32% compared with lumpectomy followed by RT + placebo (B-24, HR of risk of I-IBTR = 0.68, 95% CI = 0.49 to 0.95, P= .025). The 15-year cumulative incidence of I-IBTR was 19.4% for lumpectomy only, 8.9% for lumpectomy followed by RT (B-17), 10.0% for lumpectomy followed by RT + placebo (B-24), and 8.5% for lumpectomy followed by RT + tamoxifen. The 15-year cumulative incidence of all contralateral breast cancers was 10.3% for lumpectomy only, 10.2% for lumpectomy followed by RT (B-17), 10.8% for lumpectomy followed by RT + placebo (B-24), and 7.3% for lumpectomy followed by RT + tamoxifen. I-IBTR was associated with increased mortality risk (HR of death = 1.75, 95% CI = 1.45 to 2.96, P<.001), whereas recurrence of DCIS was not. 22/39 deaths after I-IBTR were attributed to breast cancer. Among all patients (with or without I-IBTR), the 15-year cumulative incidence of breast cancer death was 3.1% for lumpectomy only, 4.7% for lumpectomy followed by RT (B-17), 2.7% for lumpectomy followed by RT + placebo (B-24), and 2.3% for lumpectomy followed by RT + tamoxifen. |
1 |
| 6. Worni M, Akushevich I, Greenup R, et al. Trends in Treatment Patterns and Outcomes for Ductal Carcinoma In Situ. J Natl Cancer Inst. 107(12):djv263, 2015 Dec. |
Observational-Tx |
121,080 DCIS patients |
To evaluate national treatment trends for DCIS and to determine their impact on disease-specific (DSS) and overall survival (OS). |
One hundred twenty-one thousand and eighty DCIS patients were identified. The greatest proportion of patients was treated with lumpectomy and radiation therapy (43.0%), followed by lumpectomy alone (26.5%) and unilateral (23.8%) or bilateral mastectomy (4.5%) with significant shifts over time. The rate of sentinel lymph node biopsy increased from 9.7% to 67.1% for mastectomy and from 1.4% to 17.8% for lumpectomy. Compared with mastectomy, OS was higher for lumpectomy with radiation (hazard ratio [HR] = 0.79, 95% confidence interval [CI] = 0.76 to 0.83, P < .001) and lower for lumpectomy alone (HR = 1.17, 95% CI = 1.13 to 1.23, P < .001). IPW-adjusted ten-year DSS was highest in lumpectomy with XRT (98.9%), followed by mastectomy (98.5%), and lumpectomy alone (98.4%). |
2 |
| 7. 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. |
Meta-analysis |
52 studies (7350 cases of DCIS) |
To perform a meta-analysis to report pooled estimates for underestimation of invasive breast cancer (where core-needle biopsy [CNB] shows ductal carcinoma in situ [DCIS] and excision histologic examination shows invasive breast cancer) and to identify preoperative variables that predict invasive breast cancer. |
Fifty-two studies that included 7350 cases of DCIS with findings at excision histologic examination as the reference standard met the eligibility criteria and were included. There were 1736 underestimates (invasive breast cancer at excision); the random-effects pooled estimate was 25.9% (95% confidence interval: 22.5%, 29.5%). Preoperative variables that showed significant univariate association with higher underestimation included the use of a 14-gauge automated device (vs 11-gauge vacuum-assisted biopsy, P = .006), high-grade lesion at CNB (vs non-high grade lesion, P < .001), lesion size larger than 20 mm at imaging (vs lesions = 20 mm, P < .001), Breast Imaging Reporting and Data System (BI-RADS) score of 4 or 5 (vs BI-RADS score of 3, P for trend = .005), mammographic mass (vs calcification only, P < .001), and palpability (P < .001). |
Good |
| 8. Han JS, Molberg KH, Sarode V. Predictors of invasion and axillary lymph node metastasis in patients with a core biopsy diagnosis of ductal carcinoma in situ: an analysis of 255 cases. Breast J 2011;17:223-9. |
Observational-Dx |
255 patients with DCIS |
To perform a retrospective analysis of 255 patients with DCIS who had subsequent excision. |
Clinical, radiologic, and pathologic findings were correlated with risk of invasion and sentinel lymph node (SLN) metastasis. Of 255 patients with DCIS, 199 had definitive surgery and 52 (26%) had invasive ductal carcinoma (IDC) on final excision. Extent of abnormal microcalcification on mammography, and presence of a radiologic/palpable mass and solid type of DCIS were significantly associated with invasion on final excision. Sentinel lymph node biopsy was performed in 131 (65.8%) patients of whom 18 (13.4%) had metastasis. Size of IDC and extent of DCIS on final pathology were significantly associated with positive SLN. Micrometastasis and isolated tumor cells comprised majority (71.4%) of the metastases in DCIS. SLN biopsy should be considered in those with high risk DCIS. |
3 |
| 9. Heymans C, van Bastelaar J, Visschers RGJ, Vissers YLJ. Sentinel Node Procedure Obsolete in Lumpectomy for Ductal Carcinoma In Situ. Clin Breast Cancer. 17(3):e87-e93, 2017 06. |
Review/Other-Dx |
240 patients with needle-biopsy diagnosis of DCIS |
To investigate how often a positive sentinel node and invasive carcinoma occurred in patients with a preoperative diagnosis of DCIS and whether this influenced the adjuvant regime. |
A total of 160 of 240 patients underwent a sentinel node biopsy. Sixteen of 85 patients undergoing lumpectomy had occult invasive cancer. One patient had a micrometastasis. In patients undergoing mastectomy, 30 of 155 patients had occult invasive cancer. One patient had a micrometastasis, and 3 had a macrometastases. Eleven patients received adjuvant treatment as a result of invasive cancer. Three patients received adjuvant treatment (radiotherapy of the axilla or axillary dissection) because of node positivity. These patients underwent a primary mastectomy. |
4 |
| 10. James TA, Palis B, McCabe R, et al. Evaluating the role of sentinel lymph node biopsy in patients with DCIS treated with breast conserving surgery. Am J Surg 2020;220:654-59. |
Review/Other-Tx |
15,422 patients with DCIS undergoing BCS |
To assess national surgical practice patterns and clinical outcomes with respect to the use of SLNB for DCIS in patients undergoing breast conserving surgery (BCS). |
We identified 15,422 patients with DCIS undergoing BCS in 2015, of which 2,698 (18%) underwent SLNB. A multivariate analysis demonstrated a significant association between greater frequency of SLNB in patients age range of 60-69, receipt of care at a community facility, and higher nuclear grade DCIS. Positive sentinel nodes metastasis was identified in 0.9% patients undergoing BCS and SLNB for DCIS. |
4 |
| 11. Kotani H, Yoshimura A, Adachi Y, et al. Sentinel lymph node biopsy is not necessary in patients diagnosed with ductal carcinoma in situ of the breast by stereotactic vacuum-assisted biopsy. Breast Cancer. 23(2):190-4, 2016 Mar. |
Observational-Dx |
1,458 patients who underwent stereotactic VAB |
To evaluate the role and need of a sentinel lymph node biopsy (SLNB) in patients with an initial diagnosis of ductal carcinoma in situ (DCIS) made by stereotactic vacuum-assisted biopsy (VAB). |
Of the 1,458 patients who underwent stereotactic VAB, 199 had a preoperative diagnosis of DCIS and underwent surgery. In these patients, 20 % (39/199) were upstaged to IDC or at least microinvasion in final pathology. Axillary lymph node status was investigated in 81 % (161/199) of initially diagnosed DCIS patients, and resulted in finding lymph node metastasis in 0.62 % (1/161) patients. To assess the potential preoperative predictors of invasiveness, the value of DCIS histological grade on biopsy samples, the distribution of calcifications on mammograms, and the combination of these factors were studied. The underestimation rate was higher (30 %) in the combination of high DCIS histological grade and extensive calcification although there was no significant association (p = 0.23). |
4 |
| 12. Magnoni F, Massari G, Santomauro G, et al. Sentinel lymph node biopsy in microinvasive ductal carcinoma in situ. Br J Surg. 106(4):375-383, 2019 03. |
Observational-Tx |
257 women with microinvasive breast cancer |
To examine patients with microinvasive breast cancer who underwent axillary staging via SLNB. |
Of 257 women with microinvasive breast cancer who underwent sentinel lymph node biopsy (SLNB), 226 (87·9 per cent) had negative sentinel lymph nodes (SLNs) and 31 had metastatic SLNs. Twelve patients had isolated tumour cells (ITCs), 14 had micrometastases and five had macrometastases in sentinel nodes. Axillary lymph node dissection was performed in 16 of the 31 patients with positive SLNs. After a median follow-up of 11 years, only one regional first event was observed in the 15 patients with positive SLNs who did not undergo axillary lymph node dissection. There were no regional first events in the 16 patients with positive SLNs who had axillary dissection. |
2 |
| 13. Prendeville S, Ryan C, Feeley L, et al. Sentinel lymph node biopsy is not warranted following a core needle biopsy diagnosis of ductal carcinoma in situ (DCIS) of the breast. BREAST. 24(3):197-200, 2015 Jun. |
Review/Other-Dx |
296 patients with a CNB diagnosis DCIS |
To evaluate the risk of clinically relevant SLN metastasis following a core needle biopsy (CNB) diagnosis of pure DCIS. |
Of 296 patients with a CNB diagnosis DCIS, 181 had SLNB (62%). The rate of invasion at excision in those undergoing SLNB was 30% (54/181). SLN metastasis was detected in 7/181 cases (4%), including 6 cases with isolated tumour cells only (3.5%) and only 1 case with a macro-metastatic deposit (0.5%). |
4 |
| 14. Sorrentino L, Sartani A, Bossi D, et al. Sentinel node biopsy in ductal carcinoma in situ of the breast: Never justified?. Breast Journal. 24(3):325-333, 2018 05. |
Observational-Dx |
175 patients with a preoperative diagnosis of DCIS following a vacuum-assisted breast biopsy, and undergoing surgery with sentinel node biopsy |
To identify preoperative features predictive of nodal involvement in DCIS patients. |
Lymph node biopsy was positive in 13 (7.4%) patients, with 8 (61.5%) macrometastases and 5 (38.5%) micrometastases. In these patients, Breast Imaging Reporting and Data System (BI-RADS) index >4 (OR 4.69, 95% CI 1.282-17.224, P = .02), lesion extension =20 mm (OR 4.25, 95% CI 1.255-14.447, P = .02), multifocal disease (OR 4.12, 95% CI 0.987-17.174, P = .05), comedo type (OR 3.54, 95% CI 1.044-11.969, P = .04), and upstaging (OR 4.56, 95% CI 1.080-19.249, P = .04) were all predictive of nodal involvement, although upstaging could not be predicted preoperatively. By multivariate analysis, the only independent factor predictive for positive sentinel node was multifocal disease (OR 5.14, 95% CI 1.015-26.066, P < .05). |
4 |
| 15. van Roozendaal LM, Goorts B, Klinkert M, et al. Sentinel lymph node biopsy can be omitted in DCIS patients treated with breast conserving therapy. Breast Cancer Res Treat. 156(3):517-525, 2016 Apr. |
Observational-Dx |
910 clinically node negative patients |
To investigate the incidence of SLNB and SLN metastases and the relevance of indications in guidelines and literature to perform SLNB in order to validate whether SLNB is justified in patients with DCIS on core biopsy in current era. |
SLNB was performed in 471 patients (51.8 %): 94.5 % had pN0, 3.0 % pN1mi and 2.5 % pN1. Patients undergoing mastectomy had 7 % SLN metastases versus 3.5 % for breast conserving surgery (BCS) (p = 0.107). The only factors correlating to SLN metastases were smaller core needle size (p = 0.01) and invasive cancer (p < 0.001). Invasive cancer was detected in 16.7 % by histopathology with 15.6 % SLN metastases versus only 2 % in pure DCIS. SLNB showed metastases in 5.5 % of patients; 3.5 % in case of BCS (any histopathology) and 2 % when pure DCIS was found at definitive histopathology (BCS and mastectomy). |
3 |
| 16. Watanabe Y, Anan K, Saimura M, et al. Upstaging to invasive ductal carcinoma after mastectomy for ductal carcinoma in situ: predictive factors and role of sentinel lymph node biopsy. Breast Cancer. 25(6):663-670, 2018 Nov. |
Observational-Dx |
220 patients who underwent mastectomy for a preoperative diagnosis of DCIS |
to investigate preoperative factors associated with ductal carcinoma in situ (DCIS) upstaged to invasive ductal carcinoma (IDC) and sentinel lymph node (SLN) status in patients who underwent mastectomy for a preoperative diagnosis of DCIS. |
Fifty-one (22.6%) of 226 lesions were upgraded to IDC after mastectomy. Preoperative factors associated with upstaging to IDC included patient-reported signs and symptoms, a clinically palpable mass, ultrasound findings classified as category 4 or 5, the ultrasound appearance of a mass or widely distributed non-mass abnormality (NMA), and a high Ki67 index. The prevalence of SLN macrometastasis was 0.9%. IDC was diagnosed for 10.9% of lesions of a preoperative ultrasound category of 0-3, 13.0% of those with no mass or NMA detected by ultrasonography, and 14.1% of lesions preoperatively diagnosed by methods other than core needle biopsy (CNB). Of those lesions, none was associated with SLN metastasis. |
4 |
| 17. Zhang K, Qian L, Zhu Q, Chang C. Prediction of Sentinel Lymph Node Metastasis in Breast Ductal Carcinoma In Situ Diagnosed by Preoperative Core Needle Biopsy. Front. oncol.. 10:590686, 2020. |
Observational-Dx |
407 patients with a preoperative diagnosis of DCIS |
To investigate factors associated with SLN metastasis and build a model to predict the potential risk of SLN metastasis in patients with a preoperative diagnosis of DCIS. |
Upstaging to invasive/microinvasive cancer occurred in 225 patients after surgery. SLN metastasis was found in 42 patients, including 32 patients upstaging to invasive disease, 8 to microinvasive disease, and 2 pure DCIS. Tumor size based on US examination, axillary ultrasound finding, multifocality, surgery, upstaging, and Ki-67 expression were significantly related to SLN metastasis. The model incorporating tumor size, axillary ultrasound finding and multifocality yielded an AUC of 0.805 (95% CI: 0.715-0.895, p<0.001) in the training set, and 0.729 (95% CI: 0.547-0.911, p=0.013) in the testing set. |
4 |
| 18. Lara JF, Young SM, Velilla RE, Santoro EJ, Templeton SF. The relevance of occult axillary micrometastasis in ductal carcinoma in situ: a clinicopathologic study with long-term follow-up. Cancer. 2003;98(10):2105-2113. |
Review/Other-Dx |
102 patients |
To evaluate how SLN evaluation underscores the need to reevaluate the significance of occult micrometastases in DCIS. |
IHC detected micrometastasis has no apparent clinical significance in DCIS. Serial IHC evaluation of lymph nodes dramatically increased the identification of occult micrometastasis. However, IHC detected micrometastasis has no apparent clinical significance in DCIS, based on the current long-term clinicopathologic study. Therefore, the authors questioned the significance of occult micrometastasis, identified by IHC, in DCIS of any type and extent. |
4 |
| 19. Matsen CB, Hirsch A, Eaton A, et al. Extent of microinvasion in ductal carcinoma in situ is not associated with sentinel lymph node metastases. Ann Surg Oncol. 21(10):3330-5, 2014 Oct. |
Observational-Tx |
414 patients with DCISM who underwent SLNB |
To hypothesize that in a large cohort of patients with ductal carcinoma in situ with microinvasion (DCISM), multiple foci of microinvasion might be associated with a higher risk of positive sentinel lymph node biopsy (SLNB). |
Of 414 patients, 235 (57 %) had 1 focus of microinvasion and 179 (43 %) had =2 foci. SLNB macrometastases were found in 1.4 %, and micrometastases were found in 6.3 %; neither were significantly different between patients with 1 focus versus =2 foci (p = 1.0). Patients with positive SLNB or =2 foci of microinvasion were more likely to receive chemotherapy. At median 4.9 years (range 0-16.2 years) follow-up, 18 patients, all in the SLNB negative group, had recurred for an overall 5-year recurrence-free proportion of 95.9 %. |
2 |
| 20. Pimiento JM, Lee MC, Esposito NN, et al. Role of axillary staging in women diagnosed with ductal carcinoma in situ with microinvasion. J Oncol Pract 2011;7:309-13. |
Review/Other-Dx |
90 patients with diagnosis of DCISM (invasive tumor ≤ 0.1 cm) |
To redefine the incidence of true lymph node positivity associated with DCISM.To examine clinical and pathologic features at a single high-volume cancer center for an association with sentinel lymph node– positive disease, thereby guiding patient selection for sentinel lymph node biopsy in patients with this uncommon disease entity. |
Of 90 patients, 33% were diagnosed by core needle biopsy (CNB), 37% by excisional biopsy, and 29% were upstaged from DCIS on CNB to DCISM at final operation. Three (10%) of 30 patients with DCISM on CNB were upstaged to invasive cancer on final pathology. Median age at diagnosis was 58.9 years (range: 30-89). Lumpectomy was performed in 45% of patients and mastectomy in 55%. Mean number of sentinel nodes was 2.59 (SE 0.17). Six (6.9%) of 87 patients with DCISM as final diagnosis had a positive SLNB (four lumpectomies, two mastectomies). There was no correlation with any clinicopathologic features, including palpable DCIS, DCIS grade/necrosis, or age at diagnosis. All six SLNB-positive patients had a complete axillary dissection; two had additional disease. Median follow-up time was 74.2 months (range: 2-169). In-breast recurrence was seen in three patients (5%), regardless of SLN status, DCIS grade, or necrosis. Two patients developed distant metastasis. Overall survival was 94.19% at 5 years for DCISM and 100% for DCISM with nodal disease. |
4 |
| 21. Vieira CC, Mercado CL, Cangiarella JF, Moy L, Toth HK, Guth AA. Microinvasive ductal carcinoma in situ: clinical presentation, imaging features, pathologic findings, and outcome. Eur J Radiol. 73(1):102-7, 2010 Jan. |
Review/Other-Tx |
21 patients |
To describe the clinical features, imaging characteristics, pathologic findings and outcome of DCISM. |
The clinical presentation and radiologic appearance of a mass are commonly encountered in DCISM lesions (48% and 57%, respectively), irrespective of lesion size, mimicking findings seen in invasive carcinoma. Despite its potential for nodal metastasis (5% in our series), mean follow-up at 36 months was good with no evidence of local or systemic recurrence at follow-up. Knowledge of these clinical and imaging findings in DCISM lesions may alert the clinician to the possibility of microinvasion and guide appropriate management. |
4 |
| 22. Bijker N, Meijnen P, Peterse JL, et al. Breast-conserving treatment with or without radiotherapy in ductal carcinoma-in-situ: ten-year results of European Organisation for Research and Treatment of Cancer randomized phase III trial 10853--a study by the EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group. J Clin Oncol 2006;24:3381-7. |
Experimental-Tx |
1,010 women with mostly (71%) mammographically detected DCIS |
To conduct a randomized trial investigating the role of radiotherapy (RT) after local excision (LE) of ductal carcinoma-in-situ (DCIS) of the breast.To analyze the efficacy of radiotherapy (RT) with 10 years follow-up on both the overall risk of local recurrence (LR) and related to clinical, histologic, and treatment factors. |
The 10-year LR-free rate was 74% in the group treated with LE alone compared with 85% in the women treated by LE plus RT (log-rank P < .0001; hazard ratio [HR] = 0.53). The risk of DCIS and invasive LR was reduced by 48% (P = .0011) and 42% (P = .0065) respectively. Both groups had similar low risks of metastases and death. At multivariate analysis, factors significantly associated with an increased LR risk were young age (< or = 40 years; HR = 1.89), symptomatic detection (HR = 1.55), intermediately or poorly differentiated DCIS (as opposed to well-differentiated DCIS; HR = 1.85 and HR = 1.61 respectively), cribriform or solid growth pattern (as opposed to clinging/micropapillary subtypes; HR = 2.39 and HR = 2.25 respectively), doubtful margins (HR = 1.84), and treatment by LE alone (HR = 1.82). The effect of RT was homogeneous across all assessed risk factors. |
1 |
| 23. Houghton J, George WD, Cuzick J, et al. Radiotherapy and tamoxifen in women with completely excised ductal carcinoma in situ of the breast in the UK, Australia, and New Zealand: randomised controlled trial. Lancet 2003;362:95-102. |
Experimental-Tx |
1694 patients (544 patients = no adjuvant treatment, 567 = tamoxifen alone, 267 = radiotherapy alone, 316 = radiotherapy and tamoxifen) |
To compare the efficacy of complete local excision alone with excision followed by radiotherapy to the residual ipsilateral breast, or excision followed by tamoxifen for 5 years, or both, in reducing the incidence of subsequent ipsilateral invasive breast carcinoma in patients with ductal carcinoma in situ.To determine the incidence of subsequent ductal carcinoma in situ in the ipsilateral and contralateral breasts of patients treated by complete local excision alone with complete local excision followed by radiotherapy or tamoxifen. |
Ipsilateral invasive disease was not reduced by tamoxifen but recurrence of overall ductal carcinoma in situ was decreased (hazard ratio 0.68 [0.49-0.96]; p=0.03). Radiotherapy reduced the incidence of ipsilateral invasive disease (0.45 [0.24-0.85]; p=0.01) and ipsilateral ductal carcinoma in situ (0.36 [0.19-0.66]; p=0.0004), but there was no effect on the occurrence of contralateral disease. There was no evidence of interaction between radiotherapy and tamoxifen. |
1 |
| 24. McCormick B, Winter K, Hudis C, et al. RTOG 9804: a prospective randomized trial for good-risk ductal carcinoma in situ comparing radiotherapy with observation. J Clin Oncol. 33(7):709-15, 2015 Mar 01. |
Experimental-Tx |
636 patients (322 in observation with or without tamoxifen, 314 with radiation therapy to the whole breast with or without tamoxifen) |
To test the benefit of radiotherapy (RT) after breast-conserving surgery compared with observation. |
Median follow-up time was 7.17 years (range, 0.01 to 11.33 years). Two LFs occurred in the RT arm, and 19 occurred in the observation arm. At 7 years, the LF rate was 0.9% (95% CI, 0.0% to 2.2%) in the RT arm versus 6.7% (95% CI, 3.2% to 9.6%) in the observation arm (hazard ratio, 0.11; 95% CI, 0.03 to 0.47; P < .001). Grade 1 to 2 acute toxicities occurred in 30% and 76% of patients in the observation and RT arms, respectively; grade 3 or 4 toxicities occurred in 4.0% and 4.2% of patients, respectively. Late RT toxicity was grade 1 in 30%, grade 2 in 4.6%, and grade 3 in 0.7% of patients. |
1 |
| 25. Allred DC, Anderson SJ, Paik S, et al. Adjuvant tamoxifen reduces subsequent breast cancer in women with estrogen receptor-positive ductal carcinoma in situ: a study based on NSABP protocol B-24. J Clin Oncol. 2012;30(12):1268-1273. |
Observational-Tx |
732 patients |
To evaluate retrospectively ER and progesterone receptors and their relationships to response to adjuvant tamoxifen in the B-24 trial. The NSABP B-24 study demonstrated significant benefit with adjuvant tamoxifen in patients with DFS after lumpectomy and radiation. |
ER was positive in 76% of patients. Patients with ER-positive DCIS treated with tamoxifen (vs placebo) showed significant decreases in subsequent breast cancer at 10 years (HR, 0.49; P<.001) and overall follow-up (HR, 0.60; P=.003), which remained significant in multivariable analysis (overall HR, 0.64; P=.003). Results were similar, but less significant, when subsequent ipsilateral and contralateral, invasive and noninvasive, breast cancers were considered separately. No significant benefit was observed in ER-negative DCIS. Progesterone receptors and either receptor were positive in 66% and 79% of patients, respectively, and in general, neither was more predictive than ER alone. |
2 |
| 26. Margolese RG, Cecchini RS, Julian TB, et al. Anastrozole versus tamoxifen in postmenopausal women with ductal carcinoma in situ undergoing lumpectomy plus radiotherapy (NSABP B-35): a randomised, double-blind, phase 3 clinical trial. Lancet 2016;387:849-56. |
Experimental-Tx |
3,104 patients (1552 to tamoxifen and 1552 to anastrozole) |
To compare anastrozole versus tamoxifen in postmenopausal women with ductal carcinoma in situ undergoing lumpectomy plus radiotherapy. |
Between Jan 1, 2003, and June 15, 2006, 3104 eligible patients were enrolled and randomly assigned to the two treatment groups (1552 to tamoxifen and 1552 to anastrozole). As of Feb 28, 2015, follow-up information was available for 3083 patients for overall survival and 3077 for all other disease-free endpoints, with median follow-up of 9·0 years (IQR 8·2-10·0). In total, 212 breast cancer-free interval events occurred: 122 in the tamoxifen group and 90 in the anastrozole group (HR 0·73 [95% CI 0·56-0·96], p=0·0234). A significant time-by-treatment interaction (p=0·0410) became evident later in the study. There was also a significant interaction between treatment and age group (p=0·0379), showing that anastrozole is superior only in women younger than 60 years of age. Adverse events did not differ between the groups, except for thrombosis or embolism--a known side-effect of tamoxifen-for which there were 17 grade 4 or worse events in the tamoxifen group versus four in the anastrozole group. |
1 |
| 27. NCCN Clinical Practice Guidelines in Oncology. Breast Cancer. Version 4.2023. Available at: https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. |
Observational-Dx |
407 patients with a preoperative diagnosis of DCIS |
To investigate factors associated with sentinel lymph node (SLN) metastasis and build a model to predict the potential risk of SLN metastasis in patients with a preoperative diagnosis of DCIS. |
A total of 407 patients with a preoperative diagnosis of DCIS were included. Upstaging to invasive/microinvasive cancer occurred in 225 patients after surgery. SLN metastasis was found in 42 patients, including 32 patients upstaging to invasive disease, 8 to microinvasive disease, and 2 pure DCIS. Tumor size based on US examination, axillary ultrasound finding, multifocality, surgery, upstaging, and Ki-67 expression were significantly related to SLN metastasis. The model incorporating tumor size, axillary ultrasound finding and multifocality yielded an AUC of 0.805 (95% CI: 0.715-0.895, p<0.001) in the training set, and 0.729 (95% CI: 0.547-0.911, p=0.013) in the testing set. |
4 |
| 28. 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. 51(12):1497-510, 2015 Aug. |
Experimental-Tx |
1240 women aged ⩾ 45 years with asymptomatic, screen-detected, pure low-grade DCIS based on vacuum-assisted biopsies of microcalcifications only |
To evaluate the safety of active surveillance in women with low-risk DCIS. |
No results provided in abstract. |
1 |
| 29. Francis A, Thomas J, Fallowfield L, et al. Addressing overtreatment of screen detected DCIS; the LORIS trial. Eur J Cancer. 51(16):2296-303, 2015 Nov. |
Review/Other-Tx |
Not reported |
To describe the background and development of 'The low risk' DCIS trial (LORIS), a phase III trial of surgery versus active monitoring |
No results reported. |
4 |
| 30. Hiroji I. Single-arm confirmatory trial of endocrine therapy alone for estrogen receptor-positive, low-risk ductal carcinoma in situ of the breast (JCOG1505, LORETTA trial). Available at: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000032260. |
Observational-Tx |
340 patients |
To confirm whether endocrine therapy alone for estrogen receptor-positive low-risk DCIS is safe and effective compared with the current standard treatment. |
No results included. |
2 |
| 31. 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. 9(3):e026797, 2019 03 12. |
Experimental-Tx |
1200 patients (600 patients with GCC plus or minus endocrine therapy and 600 patients with AS plus or minus endocrine therapy) |
To compare ipsilateral invasive breast cancer rate in women undergoing guideline concordant care (GCC) with active surveillance (AS).To compare surgical, oncological and patient-reported outcomes. |
No results reported. |
1 |
| 32. Kanbayashi C, Iwata H. Current approach and future perspective for ductal carcinoma in situ of the breast. [Review]. Jpn J Clin Oncol. 47(8):671-677, 2017 Aug 01. |
Review/Other-Dx |
N/A |
To present an overview of the current treatment approaches, problems with overdiagnosis and potential future management strategies for ductal carcinoma in situ of the breast. |
No results in abstract. |
4 |
| 33. Duffy SW, Dibden A, Michalopoulos D, et al. Screen detection of ductal carcinoma in situ and subsequent incidence of invasive interval breast cancers: a retrospective population-based study. Lancet Oncol. 17(1):109-14, 2016 Jan. |
Observational-Dx |
5,243,658 women |
To estimate the association between detection of DCIS at screening and invasive interval cancers subsequent to the relevant screen. |
We analysed data for 5,243,658 women and on interval cancers occurring in the 36 months after the relevant screen. The average frequency of DCIS detected at screening was 1·60 per 1000 women screened (median 1·50 [unit range 0·54-3·56] [corrected to] per 1000 women). There was a significant negative association of screen-detected DCIS cases with the rate of invasive interval cancers (Poisson regression coefficient -0·084 [95% CI -0·13 to -0·03]; p=0·002). 90% of units had a DCIS detection frequency within the range of 1·00 to 2·22 per 1000 women; in these units, for every three screen-detected cases of DCIS, there was one fewer invasive interval cancer in the next 3 years. This association remained after adjustment for numbers of small screen-detected invasive cancers and for numbers of grade 3 invasive screen-detected cancers. |
4 |
| 34. American Society of Clinical Oncology Choosing Wisely; Last Reviewed 2021 Available at: https://old-prod.asco.org/news-initiatives/current-initiatives/cancer-care-initiatives/value-cancer-care/choosing-wisely |
Review/Other-Dx |
N/A |
To highlight ten categories of tests, procedures, and/or treatments whose common use and clinical value are not supported by available evidence. |
No results. |
4 |
| 35. Dershaw DD, Abramson A, Kinne DW. Ductal carcinoma in situ: mammographic findings and clinical implications. Radiology 1989;170:411-5. |
Review/Other-Dx |
51 women with DCIS in 54 breasts |
To identify the women in whom pure DCIS was diagnosed and to evaluate the mammographic patterns with which they presented, as well as to evaluate the ability of mammography to demonstrate the extent and multicentricity of disease within the breast. |
Mammographic patterns of DCIS were microcalcifications in 37 of 54 (68%) lesions and calcifications within a mass in 16 (30%). Multifocal DCIS, evidenced radiographically by patterns of more than one mass, more than one cluster of microcalcifications, or parallel linear, irregular intraductal calcifications, was seen in 35 of 54 (65%) breasts but only on specimen radiographs in four of these. In 22 (41%) lesions maximum tumor expanse was greater than 2.5 cm, and all were multicentric. Multicentricity of tumor and tumor size greater than 2.5 cm may indicate need for therapies more radical than simple excision. |
4 |
| 36. Gruber IV, Rueckert M, Kagan KO, et al. Measurement of tumour size with mammography, sonography and magnetic resonance imaging as compared to histological tumour size in primary breast cancer. BMC Cancer. 13:328, 2013 Jul 05. |
Observational-Dx |
121 patients with primary breast cancer |
To evaluate sizing of primary breast cancer using mammography, sonography and magnetic resonance imaging (MRI) and thereby establish which imaging method most accurately corresponds with the size of the histological result. |
Tumour size was found to be significantly underestimated with sonography, especially for the tumour groups IDC + DCIS, IDC and ILC. The greatest difference between sonographic sizing and actual histological tumour size was found with invasive lobular breast cancer. There was no significant difference between mammographic and histological sizing. MRI overestimated non-significantly the tumour size and is superior to the other imaging techniques in sizing of IDC + DCIS and ILC. |
3 |
| 37. Ikeda DM, Andersson I. Ductal carcinoma in situ: atypical mammographic appearances. Radiology 1989;172:661-6. |
Review/Other-Dx |
190 women with biopsy-proved DCIS and that had mammograms |
To examine the mammographic presentations of DCIS that are not predominantly characterized by the presence of calcifications. |
Excluded from the current study were 117 (62%) women whose radiographs showed suspicious clustered microcalcifications, a well-known finding in DCIS. Of the remaining 73 (38%) women, 30 (16%) had negative mammograms, and 43 (23%) had mammographic manifestations of breast malignancy other than microcalcifications. Of the latter 43, 15 had circumscribed masses, and 12 had various focal nodular patterns. The remaining 16 patients showed other mammographic signs of malignancy, including asymmetry (n = 1); dilated retroareolar ducts (n = 2); ill-defined, rounded tumor (n = 2); focal architectural distortion (n = 4); subareolar mass (n = 3); and developing density (n = 4). Of the 73 women in the study, 60 presented with clinical findings related to the tumor. |
4 |
| 38. Stomper PC, Margolin FR. Ductal carcinoma in situ: the mammographer's perspective. AJR Am J Roentgenol 1994;162:585-91. |
Review/Other-Dx |
N/A |
To review the natural history of this disorder, its mammographic and pathologic features, and current considerations in patient management, including the role of mammography. To summarize the results of recent clinical trials. |
No results in abstract |
4 |
| 39. Holmberg L, Wong YN, Tabar L, et al. Mammography casting-type calcification and risk of local recurrence in DCIS: analyses from a randomised study. Br J Cancer. 108(4):812-9, 2013 Mar 05. |
Observational-Dx |
387 women in subcohort (148 randomized to RT and 139 randomized to Control Group); 151 cases outside subcohort (44 to RT and 107 to Control Group) |
To study the association between mammographic calcifications and local recurrence in the ipsilateral breast. |
Calcifications representing necrosis were found predominantly in younger women. Women with crushed stone or casting-type microcalcifications had higher histopathological grade and more extensive disease. The relative risk (RR) of a new IBE comparing those with casting-type calcifications to those without calcifications was 2.10 (95% confidence interval (CI) 0.92-4.80). This risk was confined to in situ recurrences; the RR of an IBE associated with casting-type calcifications on the mammogram adjusted for age and disease extent was 16.4 (95% CI 2.20-140). |
3 |
| 40. Barreau B, de Mascarel I, Feuga C, et al. Mammography of ductal carcinoma in situ of the breast: review of 909 cases with radiographic-pathologic correlations. Eur J Radiol 2005;54:55-61. |
Observational-Dx |
909 cases |
To analyse radiologic signs of ductal carcinoma in situ (DCIS) to appreciate the extension and there possible "agressivity". |
We retrospectively analysed mammographies of 909 ductal carcinoma in situ (DCIS) (1980–1999) and compared our results to those of literature. Microcalcifications were present in 75% of the cases, and soft-tissue abnormalities in 27% cases with association with calcifications in 14% of cases. Palpable masses were found in 12% of the cases and nipple discharge was present in 12% of the cases. The radiographic–pathologic correlation allowed to suspect the DCIS “aggressiveness” on radiologic signs. Granular, linear, branching and/or galactophoric topography of the microcalcifications were correlated with necrosis, grade 3, comedocarcinoma type. A number of microcalcifications higher than 20 was correlated with necrosis and grade 3. Mammographic size was correlated to histologic size. Masses were correlated with grade 1. A diagnosis strategy can be proposed with a multidisciplinar approach. |
4 |
| 41. Evans A, Pinder S, Wilson R, et al. Ductal carcinoma in situ of the breast: correlation between mammographic and pathologic findings. AJR Am J Roentgenol 1994;162:1307-11. |
Observational-Dx |
128 patients with DCIS |
To correlate the radiologic and pathologic features of ductal carcinoma in situ of the breast. |
Patients with small-cell ductal carcinoma in situ more commonly have a normal mammogram (28% vs 6%, respectively, p < .001) or an abnormal mammogram without calcification (42% vs 5%, respectively, p < .001) than do patients with large-cell ductal carcinoma in situ. Among patients with abnormal mammographic findings, calcification is present in 58% of those with small-cell ductal carcinoma in situ, compared with 95% of those with large-cell ductal carcinoma in situ (p < .001). No significant differences were found in the calcification morphology of small- and large-cell ductal carcinoma in situ. These features were seen more commonly in ductal carcinoma in situ with necrosis than in ductal carcinoma in situ without necrosis, respectively: abnormal mammographic findings (95% vs 73%, p < .001), calcification (96% vs 61%, p < .001), calcification with a ductal distribution (80% vs 45%, p < .005), and rod-shaped calcification (83% vs 45%, p < .001). An abnormal mammogram without calcification (39% vs 4%, p < .001) or predominantly punctate calcification (36% vs 13%, p < .05) was seen more commonly in ductal carcinoma in situ without necrosis than in ductal carcinoma in situ with necrosis, respectively. |
3 |
| 42. Yang WT, Tse GM. Sonographic, mammographic, and histopathologic correlation of symptomatic ductal carcinoma in situ. AJR Am J Roentgenol 2004;182:101-10. |
Review/Other-Dx |
60 DCIS lesions from 55 symptomatic women |
To describe the features of symptomatic ductal carcinoma in situ (DCIS) of the breast shown on high-resolution sonography and to correlate them with findings from mammography and histopathology to evaluate the prognostic ability of sonographic findings. |
Of the 60 lesions, 33 were classified as Van Nuys group 1, 19 as Van Nuys group 2, and eight as Van Nuys group 3. Six (10%) of the 60 lesions were not visible on sonography, and 12 lesions (20%) were not visible on mammography. Sonography revealed a mass in 43 cases (72%), ductal changes in 14 cases (23%), and architectural distortion in four cases (7%). Eight lesions had more than one of these features. A sonographically visualized, irregularly shaped mass with indistinct or angular margins and no posterior acoustic shadowing or enhancement was associated with a high Van Nuys classification (p < 0.05). Microcalcifications were visible on sonography in 13 (22%) of the 60 lesions or on mammography in 25 lesions (42%). Both findings were associated with a high Van Nuys classification (p < 0.05). |
4 |
| 43. Stein RG, Wollschlager D, Kreienberg R, et al. The impact of breast cancer biological subtyping on tumor size assessment by ultrasound and mammography - a retrospective multicenter cohort study of 6543 primary breast cancer patients. BMC Cancer. 16:459, 2016 07 13. |
Observational-Dx |
6543 patients |
To assess the accuracy of tumor size measurement by ultrasound and mammography in a multicentered health services research study. |
Overall, the correlation with histology was 0.61 for mammography and 0.60 for ultrasound. Both correlations were higher in pT2 cancers than in pT1 and pT3. Ultrasound as well as mammography revealed a significantly higher correlation with histology in invasive ductal compared to lobular cancers (p < 0.01). For invasive lobular cancers, the mammography showed better correlation with histology than ultrasound (p = 0.01), whereas there was no such advantage for invasive ductal cancers. Ultrasound was significantly superior for HR negative cancers (p < 0.001). HER2/neu positive cancers were also more precisely assessed by ultrasound (p < 0.001). The size of HER2/neu negative cancers could be more accurately predicted by mammography (p < 0.001). |
3 |
| 44. Marinovich ML, Bernardi D, Macaskill P, Ventriglia A, Sabatino V, Houssami N. Agreement between digital breast tomosynthesis and pathologic tumour size for staging breast cancer, and comparison with standard mammography. BREAST. 43:59-66, 2019 Feb. |
Observational-Dx |
85 women |
To compare tomosynthesis and mammography in estimating the size of newly-diagnosed breast cancers. |
Where cancers were detected and hence measured by both tests, tomosynthesis overestimated pathologic size relative to mammography (Analysis 1: MD 5% versus 1%, Analysis 2: 7% versus 3%; P ¼ 0.10 both analyses). There was similar, large measurement variability for both tests (LOA range: 60% to þ166%). Overestimation by tomosynthesis was attributable to the subgroup with dense breasts (MDs ¼ 12e13% versus 4% for mammography). There was low average bias for both tests in the lowdensity subgroup (MDs ¼ 0e4%). LOA were larger in dense breasts for both tomosynthesis and mammography (P 0.02 all comparisons). Cancers detected only by tomosynthesis were more frequently in dense breasts (60e68%): for those tumours size was estimated with increased measurement variability (LOA ranging from 75% to þ293%). |
3 |
| 45. Marinovich ML, Macaskill P, Irwig L, et al. Meta-analysis of agreement between MRI and pathologic breast tumour size after neoadjuvant chemotherapy. Br J Cancer 2013;109:1528-36. |
Meta-analysis |
19 studies (958 patients) |
To examine MRI's agreement with pathology, compare MRI with alternative tests, and investigate consistency between different measures of agreement. |
Data were extracted from 19 studies (958 patients). The pooled MD between MRI and pathology from six studies was 0.1 cm (95% LOA: -4.2 to 4.4 cm). Similar overestimation for MRI (MD: 0.1 cm) and ultrasound (US) (MD: 0.1 cm) was observed, with comparable LOA (two studies). Overestimation was lower for MRI (MD: 0.1 cm) than mammography (MD: 0.4 cm; two studies). Overestimation by MRI (MD: 0.1 cm) was smaller than underestimation by clinical examination (MD: -0.3 cm). The LOA for mammography and clinical examination were wider than that for MRI. Percentage agreement between MRI and pathology was greater than that of comparator tests (six studies). The range of Pearson's/Spearman's correlations was wide (0.21-0.92; 16 studies). Inconsistencies between MDs, percentage agreement and correlations were common. |
Good |
| 46. Gilbert FJ, Tucker L, Gillan MG, et al. The TOMMY trial: a comparison of TOMosynthesis with digital MammographY in the UK NHS Breast Screening Programme--a multicentre retrospective reading study comparing the diagnostic performance of digital breast tomosynthesis and digital mammography with digital mammography alone. Health Technology Assessment (Winchester, England). 19(4):i-xxv, 1-136, 2015 Jan. |
Observational-Dx |
7060 women |
To compare the diagnostic accuracy of digital breast tomosynthesis (DBT) in conjunction with two-dimensional (2D) mammography or synthetic 2D mammography, against standard 2D mammography and to determine if DBT improves the accuracy of detection of different types of lesions. |
Data were available for 7060 subjects comprising 6020 (1158 cancers) assessment cases and 1040 (two cancers) family history screening cases. Overall sensitivity was 87% [95% confidence interval (CI) 85% to 89%] for 2D only, 89% (95% CI 87% to 91%) for 2D?+?DBT and 88% (95% CI 86% to 90%) for synthetic 2D?+?DBT. The difference in sensitivity between 2D and 2D?+?DBT was of borderline significance (p?=?0.07) and for synthetic 2D?+?DBT there was no significant difference (p?=?0.6). Specificity was 58% (95% CI 56% to 60%) for 2D, 69% (95% CI 67% to 71%) for 2D?+?DBT and 71% (95% CI 69% to 73%) for synthetic 2D?+?DBT. Specificity was significantly higher in both DBT reading arms for all subgroups of age, density and dominant radiological feature (p?<?0.001 all cases). In all reading arms, specificity tended to be lower for microcalcifications and higher for distortion/asymmetry. Comparing 2D?+?DBT to 2D alone, sensitivity was significantly higher: 93% versus 86% (p?<?0.001) for invasive tumours of size 11-20?mm. Similarly, for breast density 50% or more, sensitivities were 93% versus 86% (p?=?0.03); for grade 2 invasive tumours, sensitivities were 91% versus 87% (p?=?0.01); where the dominant radiological feature was a mass, sensitivities were 92% and 89% (p?=?0.04) For synthetic 2D?+?DBT, there was significantly (p?=?0.006) higher sensitivity than 2D alone in invasive cancers of size 11-20?mm, with a sensitivity of 91%. |
2 |
| 47. Sudhir R, Sannapareddy K, Potlapalli A, Krishnamurthy PB, Buddha S, Koppula V. Diagnostic accuracy of contrast-enhanced digital mammography in breast cancer detection in comparison to tomosynthesis, synthetic 2D mammography and tomosynthesis combined with ultrasound in women with dense breast. British Journal of Radiology. 94(1118):20201046, 2021 Feb 01. |
Observational-Dx |
166 breast lesions in130 patients |
To assess the diagnostic efficacy of contrast-enhanced digital mammography (CEDM) in breast cancer detection in comparison to synthetic two-dimensional mammography (s2D MG), digital breast tomosynthesis (DBT) alone and DBT supplemented with ultrasound examination in females with dense breast with histopathology as the gold-standard. |
This study included 166 breast lesions in130 patients with mean age of 45 ± 12 years (age range 24-72 years). There were 87 (52.4%) malignant and 79 (47.6%) benign lesions. The sensitivity of CEDM was 96.5%, significantly higher than synthetic 2D MG (75.6%, p < 0.0001), DBT alone (82.8%, p < 0.0001) and DBT + ultrasound (88.5%, p = 0.0057); specificity of CEDM was 81%, significantly higher than s2D MG (63.3%, p = 0.0002) and comparable to DBT alone (84.4%, p = 0.3586) and DBT + ultrasound (79.7%, p = 0.4135). In receiver operating characteristic curve analysis, the area under the curve was of 0.896 for CEDM, 0.841 for DBT + ultrasound, 0.769 for DBT alone and 0.729 for s2D MG. |
1 |
| 48. Kuhl CK, Schrading S, Bieling HB, et al. MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational study. Lancet. 2007;370(9586):485-492. |
Observational-Dx |
7,319 patients |
To investigate the sensitivity with which DCIS is diagnosed by mammography and by breast MRI. |
Of the 89 high-grade DCIS, 43 (48%) were missed by mammography, but diagnosed by MRI alone. By contrast, MRI detected 87 (98%) of these lesions; the 2 cases missed by MRI were detected by mammography. Age, menopausal status, personal or family history of breast cancer or of benign breast disease, and breast density of women with MRI-only diagnosed DCIS did not differ significantly from those of women with mammography-diagnosed DCIS. MRI could help improve the ability to diagnose DCIS, especially DCIS with high nuclear grade. |
2 |
| 49. Avril N, Rose CA, Schelling M, et al. Breast imaging with positron emission tomography and fluorine-18 fluorodeoxyglucose: use and limitations. J Clin Oncol 2000;18:3495-502. |
Experimental-Dx |
144 patients |
To evaluate the diagnostic value of positron emission tomography (PET) using fluorine-18 fluorodeoxyglucose (FDG) for the diagnosis of primary breast cancer. |
Breast carcinomas were identified with an overall sensitivity of 64.4% (CIR) and 80.3% (SIR). The increase in sensitivity (SIR) resulted in a noticeable decrease in specificity, from 94.3% (CIR) to 75.5% (SIR). At stage pT1, only 30 (68.2%) of 44 breast carcinomas were detected, compared with 57 (91.9%) of 62 at stage pT2. A higher percentage of invasive lobular carcinomas were false-negative (65.2%) compared with invasive ductal carcinomas (23.7%). Nevertheless, positive PET scans provided a high positive-predictive value (96.6%) for breast cancer. |
2 |
| 50. Fujii T, Yanai K, Tokuda S, et al. Clinicopathological Features of Ductal Carcinoma In Situ from 18F-FDG-PET Findings. Anticancer Res. 37(9):5053-5056, 2017 09. |
Review/Other-Dx |
185 consecutive patients with primary breast cancer with DCIS or IDC and underwent FDG-PET preoperatively |
To retrospectively evaluate the clinicopathological features of DCIS by using FDG-PET findings, and we evaluated the possibility of using FDG-PET in DCIS cases as a biomarker of which lesions will go on to become invasive. |
We divided the cases into two groups on the basis of histology; DCIS vs. IDC (n=171). The DCIS cases were divided into two groups on the basis of FDG uptake in the primary tumor. Fourteen of the 185 patients (7.4%) were revealed to have a DCIS. The analysis revealed that the SUVmax and the number of cases not detected by FDG-PET were significantly different between the DICS and IDC groups. The extent of the primary tumor was not significantly different between the two groups. In six cases (42.9%) of the 14 DCIS cases, no FDG uptake was detected by FDG-PET. The extent of tumor did not significantly differ between the two groups. In addition, all six cases without FDG uptake were of the diffuse-spread type, without mass formation. All eight cases with mass formation had FDG uptake. |
4 |
| 51. Grana-Lopez L, Herranz M, Dominguez-Prado I, Argibay S, Villares A, Vazquez-Caruncho M. Can dedicated breast PET help to reduce overdiagnosis and overtreatment by differentiating between indolent and potentially aggressive ductal carcinoma in situ?. European Radiology. 30(1):514-522, 2020 Jan. |
Observational-Dx |
139 surgery-confirmed pure DCIS cases |
To analyze the utility of metabolic imaging, and specifically of dedicated breast positron emission tomography (dbPET) to differentiate between indolent and potentially aggressive ductal carcinoma in situ (DCIS). |
We enrolled 139 surgery-confirmed pure DCIS cases. Fifty were high-risk neoplasms and 89 low-risk DCIS. Only seven low-risk lesions were positive at dbPET and five of potentially aggressive neoplasms did not show FDG uptake, all included into the field of view (FOV). Sensitivity and specificity of dbPET to differentiate between indolent and potentially aggressive DCIS were 90% (95% CI, 77-96%) and 92% (95% CI, 84-97%), respectively. |
2 |
| 52. Berg WA, Gutierrez L, NessAiver MS, et al. Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology. 2004; 233(3):830-849. |
Observational-Dx |
111 consecutive women |
To prospectively assess the diagnostic accuracy of mammography, clinical examination, US, and MRI in the preoperative imaging of breast cancer. |
Mammographic sensitivity was highest for invasive ductal carcinoma (IDC) in 89 of 110 (81%) cases versus 10 of 29 (34%) cases of invasive lobular carcinoma (ILC) (P .001) and 21 of 38 (55%) cases of DCIS (P .01). US showed higher sensitivity than did mammography for IDC, depicting 104 of 110 (94%) cases, and for ILC, depicting 25 of 29 (86%) cases (P .01 for each). US showed higher sensitivity for invasive cancer than DCIS (18 of 38 [47%], P .001). MR showed higher sensitivity than did mammography for all tumor types (P .01) and higher sensitivity than did US for DCIS (P .001), depicting 105 of 110 (95%) cases of IDC, 28 of 29 (96%) cases of ILC, and 34 of 38 (89%) cases of DCIS. In anticipation of conservation or no surgery after mammography and clinical examination in 96 breasts, additional tumor (which altered surgical approach) was present in 30. Additional tumor was depicted in 17 of 96 (18%) breasts at US and in 29 of 96 (30%) at MR, though extent was now overestimated in 12 of 96 (12%) at US and 20 of 96 (21%) at MR imaging. After combined mammography, clinical examination, and US, MR depicted additional tumor in another 12 of 96 (12%) breasts and led to overestimation of extent in another six (6%); US showed no detection benefit after MR imaging. Bilateral cancer was present in 10 of 111 (9%) patients; contralateral tumor was depicted mammographically in six and with both US and MR in an additional three. One contralateral cancer was demonstrated only clinically. In non-fatty breasts, US and MRI were more sensitive than mammography for invasive cancer, but both overestimated tumor extent. US showed no detection benefit after MRI. Combined mammography, clinical examination, and MRI were more sensitive than any other individual test or combination of tests. |
3 |
| 53. Cheung YC, Chen K, Yu CC, Ueng SH, Li CW, Chen SC. Contrast-Enhanced Mammographic Features of In Situ and Invasive Ductal Carcinoma Manifesting Microcalcifications Only: Help to Predict Underestimation?. Cancers (Basel). 13(17), 2021 Aug 30. |
Observational-Dx |
49 patients |
To compare the enhanced features of biopsy-diagnosed breast cancers, including DCIS and IDC, manifesting mammographic microcalcifications only on conventional mammograms to analyze the feasibility of predicting IDC underestimation preoperatively. |
A total of 49 patients were included for analysis. Forty patients (81.6%) showed enhancement, including 18 (45%) DCIS and 22 (55%) IDC patients. All nine unenhanced cancers were pure DCIS. Pure DCIS showed 72.22% nonmass enhancement and 83.33% pure ground glass enhancement. IDC showed more mass (72.2% vs. 27.8%) and solid enhancements (83.33% vs. 16.67%). The cancer and texture of enhancement were significantly different between pure DCIS and IDC, with moderate diagnostic performance for the former (p-value < 0.01, AUC = 0.66, sensitivity = 93%, specificity = 39%) and the latter (p-value < 0.01, AUC = 0.74, sensitivity = 65%, specificity = 83%). Otherwise, pure DCIS showed a significant difference in enhanced texture compared with upgraded IDC and IDC (p = 0.0226 and 0.0018, respectively). |
3 |
| 54. Shetat OMM, Moustafa AFI, Zaitoon S, Fahim MII, Mohamed G, Gomaa MM. Added value of contrast-enhanced spectral mammogram in assessment of suspicious microcalcification and grading of DCIS. Egyptian Journal of Radiology and Nuclear Medicine 2021;52:186. |
Observational-Dx |
340 cases with suspicious microcalcification |
To assess the ability of contrast-enhanced spectral mammography in the assessment of suspicious microcalcification and in predicting the grade of DCIS. |
We excluded 160 cases associated with masses. Forty-five of 180 cases were benign, and 135/180 cases were malignant. Twentyfive of 135 cases were diagnosed as invasive breast carcinomas while 110/135 were ductal carcinoma in situ. From the latter, 110 patients with DCIS, 22/110 cases were low grade, 11/110 cases were intermediate grade, and 77/110 cases were high grade (44 with micro-invasion). A total of 25 invasive carcinomas showed pathological non-mass enhancement, 76/77 cases of high-grade DCIS, and 6/11 cases of intermediate-grade DCIS. No abnormal enhancement appeared with benign entities, low-grade DCIS, and 5/11 cases of intermediate DCIS. The diagnostic performance of CESM in anticipation of high grade in DCIS patients was sensitivity of 98%, specificity of 81.8%, and accuracy of 93.1%. CESM sensitivity, specificity, and accuracy in prediction of invasiveness or high-grade DCIS were 98.5%, 81.8%, and 87.5%, respectively. |
3 |
| 55. Cheung YC, Juan YH, Lin YC, et al. Dual-Energy Contrast-Enhanced Spectral Mammography: Enhancement Analysis on BI-RADS 4 Non-Mass Microcalcifications in Screened Women. PLoS ONE. 11(9):e0162740, 2016. |
Observational-Dx |
87 women with 94 biopsied lesions and 27 cancers |
To retrospectively evaluate the diagnosis and cancer probability of the non-mass screened microcalcifications by dual-energy contrast-enhanced spectral mammography (DE-CESM). |
A total of 94 biopsed lesions were available for analysis in our 87 women, yielding 27 cancers [19 ductal carcinoma in situ (DCIS), and 8 invasive ductal carcinoma (IDC)], 32 pre-malignant and 35 benign lesions. Of these 94 lesions, 33 showed associated enhancement in DE-CESM while the other 61 did not. All 8 IDC (100%) and 16 of 19 DCIS (84.21%) showed enhancement, but the other 3 DCIS (15.79%) did not. Overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 88.89%, 86.56%, 72.72%, 95.08% and 87.24%, respectively. The performances of DE-CESM on both amorphous and pleomorphic microcalcifications were satisfactory (AUC 0.8 and 0.92, respectively). The pleomorphous microcalcifications with enhancement showed higher positive predictive value (90.00% vs 46.15%, p = 0.013) and higher cancer probability than the amorphous microcalcifications (46.3% VS 15.1%). The Odds Ratio was 4.85 (95% CI: 1.84-12.82). |
3 |
| 56. Houben IP, Vanwetswinkel S, Kalia V, et al. Contrast-enhanced spectral mammography in the evaluation of breast suspicious calcifications: diagnostic accuracy and impact on surgical management. Acta Radiol 2019;60:1110-17. |
Observational-Dx |
147 women (82 were benign and 65 were pre-malignant) |
To evaluate the diagnostic accuracy of CESM in suspicious breast calcifications and its impact on surgical decision-making. |
In total, 147 women were included in this study (mean age = 61 years; age range = 49–75 years). Pathology showed 82 benign and 65 malignant lesions, of which 33 were ductal carcinomas in situ and 32 were invasive lesions. Diagnostic performances of CESM (differences compared to FFDM in brackets) were: sensitivity 93.8% (+3%), specificity 36.6% (-2.5%), PPV 54% (0%), and NPV 88.2% (+4%). Based on low-energy images, surgeons suggested BCT in 89% of the cases. Based on the CESM exam, no statistical changes in decisions were observed (86% BCT, P = 0.453). |
2 |
| 57. Tardivel AM, Balleyguier C, Dunant A, et al. Added Value of Contrast-Enhanced Spectral Mammography in Postscreening Assessment. Breast J. 22(5):520-8, 2016 Sep. |
Observational-Dx |
195 women with suspicious or undetermined findings on MG and/or US |
To assess the value on diagnostic and treatment management of contrast-enhanced spectral mammography (CESM), as adjunct to mammography (MG) and ultrasound (US) in postscreening in a breast cancer unit for patients with newly diagnosed breast cancer or with suspicious findings on conventional imaging. |
Two hundred and ninety-nine lesions were detected (221 malignant). CESM sensitivity, specificity, positive-predictive value and negative-predictive value were 94% (CI: 89-96%), 74% (CI: 63-83%), 91% (CI: 86-94%) and 81% (CI: 70-89%), respectively, with 18 false positive and 14 false negative. CESM changed diagnostic and treatment strategy in 41 (21%) patients either after detection of additional malignant lesions in 38 patients (19%)-with a more extensive surgery (n = 21) or neo-adjuvant chemotherapy (n = 1)-or avoiding further biopsy for 20 patients with negative CESM. |
2 |
| 58. Patel BK, Garza SA, Eversman S, Lopez-Alvarez Y, Kosiorek H, Pockaj BA. Assessing tumor extent on contrast-enhanced spectral mammography versus full-field digital mammography and ultrasound. Clinical Imaging. 46:78-84, 2017 Nov - Dec. |
Observational-Dx |
88 women with newly diagnosed breast cancer who underwent FFDM and CEDM; 74 women who underwent US |
To compare breast cancer size measurements on full-field digital mammography (FFDM), contrast-enhanced spectral mammography (CEDM), and ultrasound (US), with histologic tumor size used as the reference standard. |
Pearson correlation coefficients for FFDM, US, and CEDM vs histopathology were 0.598, 0.639, and 0.859, respectively (P<0.001). The following correlation coefficients were calculated for dense breasts (n=48): histopathology vs FFDM (0.555), US (0.633), and CEDM (0.843) (P<0.001); for nondense breasts (n=40), they were FFDM (0.618), US (0.512), and CEDM (0.885) (P<0.001). For size difference, the mean (SD) for histopathology vs FFDM, US, and CEDM was -1.3 (11.9) mm, -2.8 (11.1) mm, and 2.9 (9.5) mm, respectively. Limits of agreement were -24.8 to 22.0mm, -24.5 to 18.8mm, and -15.6 to 21.4mm, respectively. |
2 |
| 59. Scott-Moncrieff A, Sullivan ME, Mendelson EB, Wang L. MR imaging appearance of noncalcified and calcified DCIS. Breast Journal. 24(3):343-349, 2018 05. |
Observational-Dx |
115 cases of MR biopsy-proven DCIS |
To evaluate the MR appearance of noncalcified ductal carcinoma in situ (DCIS), with comparison to calcified DCIS. |
115 cases of MR biopsy-proven DCIS were identified: 65 (56%) noncalcified and 50 (44%) calcified. For noncalcified DCIS, NME morphology was more common than mass or focus (60% vs 30.8% and 9.2%). There was a significant association between morphology and enhancement kinetics, with NME more likely demonstrating medium and persistent kinetics, and foci or masses demonstrating rapid and plateau or washout kinetics (P < .05). There was also a significant association between morphology and nuclear grade, with NME more likely seen with grade 3 DCIS (P = .024), and between size and initial enhancement, with lesions <1.5 cm more likely to have rapid initial enhancement (P = .0036). |
3 |
| 60. Greenwood HI, Heller SL, Kim S, Sigmund EE, Shaylor SD, Moy L. Ductal carcinoma in situ of the breasts: review of MR imaging features. [Review]. Radiographics. 33(6):1569-88, 2013 Oct. |
Review/Other-Dx |
N/A |
To discuss the use of MR imaging during detection of DCIS. |
Recent studies evaluating the detection of DCIS with magnetic resonance (MR) imaging have used high spatial resolution techniques and have increasingly been performed to screen a high-risk population as well as to evaluate the extent of disease. This work has shown that MR imaging is the most sensitive modality currently available for identifying DCIS and is more accurate than mammography in evaluating the extent of DCIS. MR imaging is particularly sensitive for identifying high-grade and intermediate-grade DCIS. DCIS may have variable morphologic features on MR images, with non-mass enhancement morphology being the most common manifestation. Less commonly, DCIS may also manifest as a mass on MR images, in which case it is most likely to be irregular. The kinetics of DCIS are also variable, with fast uptake and a plateau curve reported as the most common kinetic pattern. Additional MR imaging tools such as diffusion-weighted imaging and quantitative kinetic analysis combined with the benefit of high field strength, such as 3 T, may increase the sensitivity and specificity of breast MR imaging in the detection of DCIS. |
4 |
| 61. Orel SG, Mendonca MH, Reynolds C, Schnall MD, Solin LJ, Sullivan DC. MR imaging of ductal carcinoma in situ. Radiology 1997;202:413-20. |
Review/Other-Dx |
330 women underwent MR imaging before excisional biopsy |
To investigate the ability of magnetic resonance (MR) imaging to depict ductal carcinoma in situ (DCIS). |
Thirteen of 19 patients had pure DCIS. The mean lesion diameter was 10 mm (range, 2-22 mm). MR imaging enabled identification of DCIS in 10 (77%) of the 13 cases as ductal enhancement (n = 6), regional enhancement (n = 3), or a peripherally enhancing mass (n = 1). The three lesions not identified had a mean diameter of 3.7 mm. Six of 19 patients had both DCIS and an invasive cancer. In four of these patients, DCIS was identified only at MR imaging (mean diameter, 3 mm). In two of six patients, DCIS was not identified at MR imaging. |
4 |
| 62. Rosen EL, Smith-Foley SA, DeMartini WB, Eby PR, Peacock S, Lehman CD. BI-RADS MRI enhancement characteristics of ductal carcinoma in situ. Breast J 2007;13:545-50. |
Observational-Dx |
381 lesions in 361 patients with pathologic confirmation of either DCIS alone, invasive carcinoma alone, or mixed invasive and in-situ disease |
To identify the Breast Imaging Reporting and Data System magnetic resonance imaging (MRI) enhancement characteristics of ductal carcinoma in situ (DCIS). |
MRI features of the different malignancy types were compared utilizing Fisher's exact tests; 64/381 (16.8%) lesions had DCIS, 101/381 (26.5%) had invasive carcinoma, and 216/381 (56.7%) had mixed invasive/in situ carcinoma. A MRI lesion corresponding to the known cancer was identified in 55/64 (85.9%) cases of DCIS, 98/101 (97.0%) cases of invasive carcinoma, and 212/216 (98.1%) cases of mixed invasive and in-situ carcinoma. For pure DCIS lesions, 38/64 (59.4%) exhibited nonmass-like enhancement (NMLE), 9/64 (14.1%) were masses, and 8/64 (12.5%) were a focus. For pure invasive carcinomas 79/101(78.2%) were masses, 16/101 (15.8%) were NMLE, and 3/101 (3.0%) were a focus. For mixed lesions 163/216 (75.5%) were masses, 44/216 (20.4%) demonstrated NMLE, and 5/216 (2.3%) were a focus. |
3 |
| 63. Jansen SA, Newstead GM, Abe H, Shimauchi A, Schmidt RA, Karczmar GS. Pure ductal carcinoma in situ: kinetic and morphologic MR characteristics compared with mammographic appearance and nuclear grade. Radiology 2007;245:684-91. |
Observational-Dx |
78 patients with 79 histologically proved pure DCIS lesions |
To retrospectively compare the kinetic and morphologic characteristics of pure ductal carcinoma in situ (DCIS) lesions depicted on dynamic contrast material-enhanced magnetic resonance (MR) images with the nuclear grade and conventional mammographic appearance of these lesions. |
Of the 79 pure DCIS lesions, 20 (25%) exhibited enhancement plateau curves and 35 (44%) exhibited washout curves. The lesions with a masslike appearance on mammograms exhibited more suspicious kinetic characteristics (mean T(peak) approximately 2 minutes) than did the lesions with amorphous or indistinct calcifications (mean T(peak) = 4.4 minutes). There was no significant difference in enhancement kinetic properties across the nuclear grades. Lesion morphology was predominantly nonmass, with clumped or heterogeneous enhancement in a segmental or linear distribution. |
3 |
| 64. Boetes C, Strijk SP, Holland R, Barentsz JO, Van Der Sluis RF, Ruijs JH. False-negative MR imaging of malignant breast tumors. Eur Radiol 1997;7:1231-4. |
Review/Other-Dx |
208 lesions in 204 women |
To analyze MR-negative malignant lesions of the breast. |
A total of 208 lesions were evaluated; 145 turned out to be malignant and 63 proved to be benign. Six malignant lesions were misinterpreted as benign on MR imaging; thus, suspicious contrast enhancement was present in 96 % of the lesions detected by mammography, US, or clinical examination. Especially 4 of the 17 ductal carcinoma in situ (DCIS) lesions were misinterpreted (23.5 %). Despite optimal technique, 6 malignant lesions were not identified by MR imaging. The highest prevalence of these MR occult lesions was in the group of DCIS. |
4 |
| 65. Kuhl CK. Why do purely intraductal cancers enhance on breast MR images? Radiology 2009;253:281-3. |
Review/Other-Dx |
N/A |
To comment on the animal study performed by Jansen et al. |
On the basis of the results of the animal study performed by Jansen et al and clinical observations, there is compelling evidence to suggest that the imaging phenotype of a ductal carcinoma in situ (DCIS) lesion (its detectability at mammography and MR imaging, specifically the presence or absence of calcifications on mammograms and the presence or absence of calcifications and the degree of their enhancement on MR images) conveys important biologic information that will be useful when guiding DCIS treatment. |
4 |
| 66. Lehman CD.. Magnetic resonance imaging in the evaluation of ductal carcinoma in situ. [Review]. J Natl Cancer Inst Monogr. 2010(41):150-1, 2010. |
Review/Other-Dx |
N/A |
To discuss the role of magnetic resonance imaging (MRI) in the evaluation of ductal carcinoma in situ (DCIS) since future studies are needed to clarify how best to use this tool for improved patient outcomes. |
No results in abstract. |
4 |
| 67. Chou SS, Romanoff J, Lehman CD, et al. Preoperative Breast MRI for Newly Diagnosed Ductal Carcinoma in Situ: Imaging Features and Performance in a Multicenter Setting (ECOG-ACRIN E4112 Trial). Radiology. 301(1):66-77, 2021 10. |
Observational-Dx |
339 women |
To report qualitative MRI features of DCIS, MRI performance in the identification of additional disease, and associations of imaging features with pathologic, genomic, and surgical outcomes from the Eastern Cooperative Oncology Group-American College of Radiology Imaging Network (ECOG-ACRIN) E4112 trial. |
Among 339 women (median age, 60 years; interquartile range, 51-66 years), most DCIS cases showed nonmass enhancement (NME) (195 of 339 [58%]) on MRI scans with larger median size than on mammograms (19 mm vs 12 mm; P < .001). Positive predictive value of MRI-prompted CNBs was 32% (21 of 66) (95% CI: 22, 44), yielding an additional cancer detection rate of 6.2% (21 of 339) (95% CI: 4.1, 9.3). MRI false-positive rate was 14.2% (45 of 318) (95% CI: 10.7, 18.4). No imaging features were associated with invasive upgrade or DCIS score (P = .05 to P = .95). Smaller size and focal NME distribution at MRI were linked to single WLE success (P < .001). |
1 |
| 68. Hwang ES, Kinkel K, Esserman LJ, Lu Y, Weidner N, Hylton NM. Magnetic resonance imaging in patients diagnosed with ductal carcinoma-in-situ: value in the diagnosis of residual disease, occult invasion, and multicentricity. Ann Surg Oncol 2003;10:381-8. |
Observational-Dx |
51 patients with biopsy-proven DCIS |
To study the performance of MRI in patients with known DCIS for assessment of residual disease, occult invasion, and multicentricity to determine the clinical role of MRI in this setting. |
The accuracy of MRI was 88% in predicting residual disease, 82% in predicting invasive disease, and 90% in predicting multicentricity. The performance of MRI was equivalent in the core biopsy group when compared with the surgical biopsy group. For occult invasion only, MRI and mammography were equivalent. However, overall, MRI was more sensitive and had a higher negative predictive value than mammography. |
3 |
| 69. Rahbar H, Partridge SC, Demartini WB, et al. In vivo assessment of ductal carcinoma in situ grade: a model incorporating dynamic contrast-enhanced and diffusion-weighted breast MR imaging parameters. Radiology. 263(2):374-82, 2012 May. |
Observational-Dx |
55 pure DCIS lesions (19 HNG, 36 non-HNG) in 52 women |
To develop a model incorporating dynamic contrast material-enhanced (DCE) and diffusion-weighted (DW) magnetic resonance (MR) imaging features to differentiate high-nuclear-grade (HNG) from non-HNG ductal carcinoma in situ (DCIS) in vivo. |
HNG lesions exhibited larger mean maximum lesion size (P = .02) and lower mean CNR for images with b value of 600 sec/mm(2) (P = .004), allowing discrimination of HNG from non-HNG DCIS (AUC = 0.71 for maximum lesion size, AUC = 0.70 for CNR at b = 600 sec/mm(2)). Differences in CNR for images with b value of 0 sec/mm(2) (P = .025) without corresponding differences in ADC values were observed between HNG and non-HNG lesions. Peak initial enhancement was the only kinetic variable to approach significance (P = .05). No differences in lesion morphology (P = .11) or worst-curve delayed enhancement kinetics (P = .97) were observed. A multivariate model combining CNR for images with b value of 600 sec/mm(2) and maximum lesion size most significantly discriminated HNG from non-HNG (AUC = 0.81). |
3 |
| 70. Dillon MF, Mc Dermott EW, O'Doherty A, Quinn CM, Hill AD, O'Higgins N. Factors affecting successful breast conservation for ductal carcinoma in situ. Ann Surg Oncol 2007;14:1618-28. |
Observational-Dx |
135 patients with DCIS |
To determine if there were any pathological and radiological factors that identified patients at risk of compromised margins and of residual disease. To correlate precise DCIS-margin width with rates of residual disease on re-operation. |
One hundred and thirty-five patients underwent initial breast-conserving surgery for DCIS. The compromised margin rate was 72%, and the rate of residual disease on re-operation was 54%. On univariate analysis, underestimation of pathological size by mammography by >1 cm occurred in 40% of those with compromised margins undergoing a therapeutic operation compared to only 14% of those with clear margins (P = 0.02). However, on multivariate analysis only pathological size (P < 0.0001, OR = 1.0,95% CI 1.037-1.128) and lack of a preoperative diagnosis by core biopsy (P < 0.0001, OR = 5.3,95% CI 1.859-15.08) were predictive of compromised margins. The presence of residual disease on re-excision was associated with increasing pathological size (P < 0.0001, OR = 1.085,95% CI 1.038-1.134) and decreasing DCIS-margin distance (P = 0.03, OR = 6.694,95% CI 1.84-37.855). Twenty-nine percent (n = 13/45) of lesions < or =3 cm compared to 84% (n = 27/32) of lesions >3 cm had residual disease on re-operation (P < 0.0001). Residual disease was present in 62% (n = 34/55), 64% (n = 7/11) and 17% (n = 2/12) of patients with DCIS-margin distances < or =1, 1-2 and 2-5 mm, respectively. |
3 |
| 71. Fancellu A, Turner RM, Dixon JM, Pinna A, Cottu P, Houssami N. Meta-analysis of the effect of preoperative breast MRI on the surgical management of ductal carcinoma in situ. [Review]. Br J Surg. 102(8):883-93, 2015 Jul. |
Meta-analysis |
9 studies (1077 women with DCIS who had preoperative MRI and 2175 who did not) |
To examine the effects of MRI on surgical treatment of DCIS by analysing studies comparing preoperative MRI with conventional preoperative assessment. |
Nine eligible studies were identified that included 1077 women with DCIS who had preoperative MRI and 2175 who did not. MRI significantly increased the odds of having initial mastectomy (OR 1·72, P = 0·012; adjusted OR 1·76, P = 0·010). There were no significant differences in the proportion of women with positive margins following breast-conserving surgery (BCS) in the MRI and no-MRI groups (OR 0·80, P = 0·059; adjusted OR 1·10, P = 0·716), nor in the necessity of reoperation for positive margins after BCS (OR 1·06, P = 0·759; adjusted OR 1·04, P = 0·844). Overall mastectomy rates did not differ significantly according to whether or not MRI was performed (OR 1·23, P = 0·340; adjusted OR 0·97, P = 0·881). |
Good |
| 72. Schouten van der Velden AP, Schlooz-Vries MS, Boetes C, Wobbes T. Magnetic resonance imaging of ductal carcinoma in situ: what is its clinical application? A review. Am J Surg 2009;198:262-9. |
Review/Other-Dx |
11 studies |
To discuss the current knowledge and clinical application of MRI in the detection and treatment of DCIS and of invasive carcinoma with extensive intraductal component [EIC]. |
DCIS is accurately detected with magnetic resonance imaging (MRI), but the typical malignant features are inconsistently seen and most often in high-grade DCIS or in DCIS with a small invasive component. The histopathologic extent of DCIS is more accurately demonstrated with MRI. However, overestimation due to benign proliferative lesions does frequently occur. An improved depiction of DCIS could lead to improved preoperative staging. Conversely, the identification of more extensive disease on MRI could give rise to unnecessary interventions. Therefore, MRI should be used carefully and preferable in specialized and experienced centers. |
4 |
| 73. Allen LR, Lago-Toro CE, Hughes JH, et al. Is there a role for MRI in the preoperative assessment of patients with DCIS?. Ann Surg Oncol. 17(9):2395-400, 2010 Sep. |
Observational-Dx |
98 DCIS patients 63 underwent stereotactic biopsy and MRI and 35 underwent stereotactic biopsy alone) |
To assess the value of MRI in the preoperative evaluation of DCIS. |
There was no significant difference in mastectomy rates between the MRI and non-MRI group (20.3% vs 25.7%, P = .62). In patients undergoing breast-conserving surgery (BCS), there were fewer positive margins in the MRI versus the non-MRI group (21.2% vs 30.8%, P = .41). Of the 64 cases that underwent preoperative MRI, 43 (67.2%) were concordant. Also, 15 of 43 cases (34.8%) had MRI results that accurately predicted pathologic size. In 28 of 43 patients (65.2%), MRI overestimated disease in 20, by a mean of 1.97 cm. In patients with MRI tumor size >2 cm, MRI overestimated disease by a mean of 3.17 cm. Of the 64 cases, 21 (32.8%) were discordant. Also, 10 of 21 (47.6%) had a positive MRI and no residual disease on histopathology, and 11 of 21 (52.3%) had negative MRI and residual disease on pathology. |
3 |
| 74. Sun Y, Wei W, Yang HW, Liu JL. Clinical usefulness of breast-specific gamma imaging as an adjunct modality to mammography for diagnosis of breast cancer: a systemic review and meta-analysis. Eur J Nucl Med Mol Imaging 2013;40:450-63. |
Meta-analysis |
8 studies (2,183 lesions) |
To assess the diagnostic performance of breast-specific gamma imaging (BSGI) as an adjunct modality to mammography for detecting breast cancer. |
Analysis of the studies revealed that the overall validity estimates of BSGI in detecting breast cancer were as follows: sensitivity 95 % (95 % CI 93-96 %), specificity 80 % (95 % CI 78-82 %), positive likelihood ratio 4.63 (95 % CI 3.13-6.85), negative likelihood ratio 0.08 (95 % CI 0.05-0.14), and diagnostic odds ratio 56.67 (95 % CI 26.68-120.34). The area under the SROC was 0.9552 and the Q* point was 0.8977. The pooled sensitivities for detecting subcentimetre cancer and DCIS were 84 % (95 % CI 80-88 %) and 88 % (95 % CI 81-92 %), respectively. Among patients with normal mammography, 4 % were diagnosed with breast cancer by BSGI, and among those with mammography suggestive of malignancy or new biopsy-proven breast cancer, 6 % were diagnosed with additional cancers in the breast by BSGI. |
Good |
| 75. Spanu A, Sanna D, Chessa F, Cottu P, Manca A, Madeddu G. Breast scintigraphy with breast-specific gamma-camera in the detection of ductal carcinoma in situ: a correlation with mammography and histologic subtype. J Nucl Med 2012;53:1528-33. |
Observational-Dx |
33 women with DCIS |
To evaluate the usefulness of breast-specific ?-camera (BSGC) scintigraphy in DCIS identification, describing the scintigraphic findings and their correlation with mammography and histologic subtype. |
Mammography was positive in 30 of 33 patients (sensitivity, 90.9%), showing calcifications in 22 of 30 (73.3%), masses in 3 of 30 (10%), and masses plus calcifications in the remaining 5 of 30 (16.7%). Scintigraphy was positive in 31 of 33 patients (sensitivity, 93.9%), showing patchy irregular uptake in patients with calcifications and focal uptake in masses; sensitivity was higher in low- to intermediate-grade DCIS than in intermediate/high- and high-grade DCIS (100% vs. 91.3%), but the difference was not statistically significant. Two comedo-type DCIS (one 20-mm intermediate/high-grade and one 15-mm high-grade) with heterogeneously or highly dense breasts at mammography and one papillary low/intermediate-grade DCIS associated with Paget disease were true positive only at scintigraphy. Moreover, scintigraphy better assessed disease extent than did mammography in 5 additional patients. Two comedo-type DCIS (one 6-mm intermediate/high-grade and one 15-mm high-grade) were true positive only at mammography. The difference in sensitivity between scintigraphy and mammography was not statistically significant. The combined use of mammography and scintigraphy achieved 100% sensitivity. |
4 |
| 76. Hunt KN, Conners AL, Goetz MP, et al. Comparison of 99mTc-Sestamibi Molecular Breast Imaging and Breast MRI in Patients With Invasive Breast Cancer Receiving Neoadjuvant Chemotherapy. AJR Am J Roentgenol. 213(4):932-943, 2019 10. |
Observational-Dx |
34 patients |
To prospectively compare the size of invasive breast cancer before and after neoadjuvant chemotherapy (NAC) at breast MRI and molecular breast imaging (MBI) and to assess the accuracy of post-NAC MBI and MRI relative to pathologic analysis. |
The longest dimension at MRI was within 1.0 cm of that at MBI in 72.3% of cases before NAC and 70.1% of cases after NAC. The difference between the longest dimension at imaging after NAC and pathologic tumor size was within 1 cm for 58.7% of breast MRI cases and 59.6% of MBI cases. Ninety patients underwent both MRI and MBI after NAC. In the 56 patients with invasive residual disease, 10 (17.9%) cases were negative at MRI and 23 (41.1%) cases were negative at MBI. In the 34 patients with breast pathologic complete response, there was enhancement in 10 cases (29.4%) at MRI and uptake in six cases (17.6%) at MBI. Sensitivity, specificity, positive predictive value, and negative predictive value after NAC were 82.8%, 69.4%, 81.4%, and 71.4%, respectively, for MRI and 58.9%, 82.4%, 84.6%, and 54.9%, respectively, for MBI. |
3 |
| 77. Lee MH, Ko EY, Han BK, Shin JH, Ko ES, Hahn SY. Sonographic findings of pure ductal carcinoma in situ. J Clin Ultrasound. 41(8):465-71, 2013 Oct. |
Observational-Dx |
78 cases of pure DCIS with microcalcifications and 48 with no microcalcifications on mammography (MG) |
To investigate the characteristic sonographic (US) findings of pure ductal carcinoma in situ (DCIS) in a large series. |
Seventy-eight cases of pure DCIS had microcalcifications and 48 had no microcalcifications on mammography (MG). Overall, 109 cases (86.5%) of pure DCIS were demonstrated on US. DCIS with microcalcifications on MG showed positive US findings in 79.5% of cases. The most common US finding was heterogeneous hyper- or isoechoic parenchyma with intralesional microcalcifications and without posterior acoustic features. DCIS without microcalcifications on MG showed positive US findings in 97.9% of cases. The most common US findings were masses with round or oval shape, microlobulated margin, parallel orientation, heterogeneous mild hypoechogenicity, and without boundary echo or posterior acoustic features. Ductal dilatations and intralesional cystic foci were present in 17.5% (22/126) and 23.8% (30/126) of pure DCIS, respectively. |
3 |
| 78. Sickles E. Sonographic Detectability Of Breast Calcifications: SPIE; 1983. |
Review/Other-Dx |
300 consecutive patients with breast califications detected on mammography and using dedicated whole-breast US |
To examine the frequence with which calcifications are discovered when using ultrasonography. |
We found that sonographic detectability of these calcifications was highly dependent upon the size of the calcific particles. While large, typically benign calcifications were identified frequently, particles small enough to be considered mammographically suspicious for malignancy (less than 0.5 mm in greatest diameter) were found in fewer than 10% of cases, even in retrospect. For these smaller calcifications, sonography demonstrated low detection rates regardless of whether the particles were benign or malignant. Our series contains 25 nonpalpable cancers detected only by mammographic demonstration of clustered calcifications; only two (8%) of these lesions were imaged by sonography. The relatively poor resolution of current sonographic techniques (compared to mammography) appears to be the limiting factor in calcification detection. The inability of breast sonography to detect malignant breast calcifications will severely restrict its use as a screening tool for the diagnosis of breast cancer. |
4 |
| 79. Watanabe T, Yamaguchi T, Tsunoda H, et al. Ultrasound Image Classification of Ductal Carcinoma In Situ (DCIS) of the Breast: Analysis of 705 DCIS Lesions. Ultrasound Med Biol. 43(5):918-925, 2017 05. |
Review/Other-Dx |
705 surgically treated DCIS lesions |
To confirm the utility of this system and to clarify the distribution of these findings in DCIS lesions. |
All 705 DCIS lesions could be classified according to the JABTS classification system. The most frequent findings were hypo-echoic areas in the mammary gland (48.6%), followed by solid masses (28.0%) and duct abnormalities (10.2%) or mixed masses (8.1%). Distortion (1.3%), clustered microcysts (1.4%) and echogenic foci without a hypo-echoic area (2.5%) were uncommon. |
4 |
| 80. Vourtsis A, Berg WA. Screening Breast Ultrasound Using Handheld or Automated Technique in Women with Dense Breasts. Journal of Breast Imaging 2019;1:283-96. |
Review/Other-Dx |
N/A |
To discuss the use of physician- and technologist-performed handheld ultrasound (HHUS) and automated ultrasound (AUS), and the ability of screening US to improve detection of node-negative invasive cancer in women with dense breasts on mammography. |
No results. |
4 |
| 81. Weinstein SP, Slanetz PJ, Lewin AA, et al. ACR Appropriateness Criteria® Supplemental Breast Cancer Screening Based on Breast Density. J Am Coll Radiol 2021;18:S456-S73. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for supplemental breast cancer screening based on breast density |
No results stated in abstract. |
4 |
| 82. Izumori A, Takebe K, Sato A. Ultrasound findings and histological features of ductal carcinoma in situ detected by ultrasound examination alone. Breast Cancer 2010;17:136-41. |
Observational-Dx |
150 cases with DCIS |
To summarize the features of DCISs detected by US alone based on US and clinicopathological findings. |
US findings of the echo group showed cystic or solid lesions in 37 cases (79%). The mean age of the echo group was significantly higher than that of the MMG/PE group (59.6 vs. 51.2 years; P < 0.01). Tumor sizes detected by US were 5.7 + 2.8 and 11.5 + 10.8 mm (P < 0.001), respectively. The tumor sizes of the echo group were, therefore, approximately half that of the MMG/PE group. Extensive intraductal components were significantly fewer in the echo group, and tumor grades of the echo group were significantly low (Van Nuys classification). In the echo group, all cases with a tumor size < 5 mm were grade 1 by Van Nuys classification. In addition, cases with > or = 5 mm tumor size had a significantly lower tumor grade in the echo group than in the MMG/PE group. |
4 |
| 83. Tagliafico AS, Calabrese M, Mariscotti G, et al. Adjunct Screening With Tomosynthesis or Ultrasound in Women With Mammography-Negative Dense Breasts: Interim Report of a Prospective Comparative Trial. J Clin Oncol 2016;34:1882-88. |
Observational-Dx |
3,231 mammography-negative screening participants with dense breasts |
To estimate the comparative incremental detection for these adjunct modalities using methods that allow independent test interpretation.To assess false recalls for each adjunct screening modality. |
Among 3,231 mammography-negative screening participants (median age, 51 years; interquartile range, 44 to 78 years) with dense breasts, 24 additional BCs were detected (23 invasive): 13 tomosynthesis-detected BCs (incremental CDR, 4.0 per 1,000 screens; 95% CI, 1.8 to 6.2) versus 23 ultrasound-detected BCs (incremental CDR, 7.1 per 1,000 screens; 95% CI, 4.2 to 10.0), P = .006. Incremental FP recall occurred in 107 participants (3.33%; 95% CI, 2.72% to 3.96%). FP recall (any testing) did not differ between tomosynthesis (FP = 53) and ultrasound (FP = 65), P = .26; FP recall (biopsy) also did not differ between tomosynthesis (FP = 22) and ultrasound (FP = 24), P = .86. |
1 |
| 84. Destounis S, Arieno A, Santacroce A. Comparison of Cancers Detected by Screening Breast Ultrasound and Digital Breast Tomosynthesis. Academic Radiology. 29(3):339-347, 2022 03. |
Observational-Dx |
115 breast cancers in patients having screening US and DBT |
To review outcomes of screening patients imaged with both digital breast tomosynthesis (DBT) and screening ultrasound (US) to compare the cancer detection rates and characteristics of cancers detected by the imaging modalities. |
Of the 115 cancers, 100 were invasive cancers and 15 were ductal carcinoma in situ: 64/115 were seen on DBT, 9 of which were seen only on DBT, and 106 were seen on US, with 51 seen only on US. The cancer detection rate of DBT only was 0.4/1000 (9/21,220) and 3.0/1000 (64/21,220) for those detected on DBT whether with or without additional US, with detection on US only having an incremental cancer detection rate of 2.4/1000 (51/21,220) above DBT detected malignancies. Differences in DBT-detected lesions and US only lesions when comparing median lesion size, lesion type, tumor type (invasive vs noninvasive) and tumor stage were statistically significant (p = 0.0045, p = 0.0113, p = 0.0003, and p = 0.0153, respectively). |
2 |
| 85. Byng D, Retel VP, Schaapveld M, Wesseling J, van Harten WH. Treating (low-risk) DCIS patients: What can we learn from real-world cancer registry evidence?. Breast Cancer Res Treat. 187(1):187-196, 2021 May. |
Observational-Tx |
85,982 women |
To identify a cohort of women with low-grade, small (< 2 cm), ER+ lesions to who did not receive localregional treatment to understand the potential impact of an active surveillance strategy compared to standard interventional treatment on health outcomes over a patient’s lifetime. |
Data on n = 85,982 women were used. Increased risk of iIBC = 5 years post-DCIS was demonstrated for ages 40-49 (Hazard ratio (HR) 1.86, 95% Confidence Interval (CI) 1.34-2.57 compared to age 50-69), grade 3 lesions (HR 1.42, 95%CI 1.05-1.91) compared to grade 2, lesion size = 2 cm (HR 1.66, 95%CI 1.23-2.25), and Black race (HR 2.52, 95%CI 1.83-3.48 compared to White). According to the multi-state model, propensity score-matched women with low-risk features who had not died or experienced any subsequent breast event by 10 years, had a predicted probability of iIBC as first event of 3.02% for no local treatment, 1.66% for BCS, and 0.42% for BCS+RT. |
3 |
| 86. Grimm LJ, Ghate SV, Hwang ES, Soo MS. Imaging Features of Patients Undergoing Active Surveillance for Ductal Carcinoma in Situ. Acad Radiol. 24(11):1364-1371, 2017 11. |
Review/Other-Dx |
Group 1: 22 patients with non-trial active surveillance and Group 2: 7 patients treated with letrozole |
To describe the imaging appearance of patients undergoing active surveillance for ductal carcinoma in situ (DCIS). |
In group 1, the median follow-up was 2.7 years (range: 0.6-13.9 years). Fifteen patients (68%) remained stable. Seven patients (32%) underwent additional biopsies with invasive ductal carcinoma diagnosed in two patients after 3.9 and 3.6 years who developed increasing calcifications and new masses. In group 2, one patient (14%) was upstaged to microinvasive ductal carcinoma at surgery. Among the patients in both groups with calcifications (n = 26), there was no progression to invasive disease among those with stable (50%, 13/26) or decreased (19%, 5/26) calcifications. |
4 |
| 87. U.S. National Library of Medicine. Letrozole in Treating Postmenopausal Women With Ductal Carcinoma in Situ. Available at: https://classic.clinicaltrials.gov/ct2/show/NCT01439711. |
Experimental-Tx |
108 patients with DCIS with microinvasion on diagnostic core biopsy |
To study how well letrozole works in treating women with ductal carcinoma in situ:To estimate the mean change in MRI tumor volume from pretreatment to completion of preoperative endocrine therapy in estrogen receptor-positive (ER+) ductal carcinoma in situ (DCIS), as well as to determine whether 3-month change in volume correlates with 6-month change.To assess radiographic-pathologic correlation between MRI findings and histopathology, including the prevalence of occult invasive cancer in patients undergoing neoadjuvant endocrine therapy for DCIS.To compare changes in MRI maximum lesion diameter and mammographic extent at baseline and following treatment. These are two additional radiographic parameters which may also biological response to therapy.To determine practice patterns of adjuvant hormonal and radiation therapy in patients who complete neoadjuvant letrozole therapy for DCIS.To determine whether Ki67 is reduced with neoadjuvant letrozole treatment for DCIS, and to compare the reduction in proliferation between radiographic responders and non-responders.To identify baseline IHC and expression biomarkers predictive of response to treatment, with response determined by extent of Ki67 reduction. Subsets showing the greatest reduction in Ki67 would be the most likely candidates for non-operative treatment in future studies.To examine whether germline polymorphisms are associated with clinical endpoints, including treatment-related toxicity or efficacy outcomes, or with expression of biomarkers in serum or tumor.To assess quality-of-life and musculoskeletal symptoms associated with neoadjuvant letrozole for ER positive DCIS. |
No results were described. |
2 |
| 88. Hwang ES, Hyslop T, Hendrix LH, et al. Phase II Single-Arm Study of Preoperative Letrozole for Estrogen Receptor-Positive Postmenopausal Ductal Carcinoma In Situ: CALGB 40903 (Alliance). Journal of Clinical Oncology. 38(12):1284-1292, 2020 04 20. |
Observational-Dx |
67 patients total (53 with lumpectomy, 6 with mastectomy, 8 with no surgery) |
To explore the feasibility of a short-term course of letrozole.To determine whether treatment results in measurable radiographic and biologic changes in estrogen receptor (ER)-positive DCIS. |
Overall, 79 patients were enrolled and 70 completed 6 months of letrozole. Of these, 67 patients had MRI data available for each timepoint. Baseline MRI volumes ranged from 0.004 to 26.3 cm3. Median reductions from baseline MRI volume (1.4 cm3) were 0.6 cm3 (61.0%) at 3 months (P < .001) and 0.8 cm3 (71.7%) at 6 months (P < .001). Consistent reductions were seen in median baseline ER H-score (228; median reduction, 15.0; P = .005), progesterone receptor H-score (15; median reduction, 85.0; P < .001), and Ki67 score (12%; median reduction, 6.3%; P = .007). Of the 59 patients who underwent surgery per study protocol, persistent DCIS remained in 50 patients (85%), invasive cancer was detected in six patients (10%), and no residual DCIS or invasive cancer was seen in nine patients (15%). |
3 |
| 89. Pinsky RW, Rebner M, Pierce LJ, et al. Recurrent cancer after breast-conserving surgery with radiation therapy for ductal carcinoma in situ: mammographic features, method of detection, and stage of recurrence. AJR Am J Roentgenol 2007;189:140-4. |
Observational-Dx |
32 women treated with breast-conserving surgery and radiation therapy for DCIS who developed an ipsilateral breast tumor recurrence |
To determine the mammographic appearance, detection method, and stage of ipsilateral breast tumor recurrence in women treated with breast-conserving surgery and whole-breast radiation therapy for ductal carcinoma in situ (DCIS). |
Of the 32 patients included in our study, 31 (97%) recurrences were mammographically apparent. Twenty-nine (91%) of 32 were diagnosed exclusively by mammography. Mammographic findings at recurrence were calcifications in 24 (75%) of 32, mass in six (19%) of 32, and distortion in one (3%) of 32. The mean time to recurrence was 4.5 years. Twelve (40%) of 30 had the recurrence in a remote quadrant from the original cancer. Recurrences were DCIS in 17 (53%) of 32, DCIS with microinvasion in six (19%) of 32, invasive ductal cancer in three (9%) of 32, invasive lobular cancer in two (6%) of 32, and mixed DCIS and invasive cancer in four (13%) of 32. Six (67%) of nine patients with invasive cancer (excluding microinvasion) had tumors smaller than 1 cm. Ninety-one percent of recurrences were minimal cancers. All recurrences were stage 0 or 1. |
3 |
| 90. Liberman L, Van Zee KJ, Dershaw DD, Morris EA, Abramson AF, Samli B. Mammographic features of local recurrence in women who have undergone breast-conserving therapy for ductal carcinoma in situ. AJR Am J Roentgenol 1997;168:489-93. |
Review/Other-Dx |
162 women with DCIS treated with breast-conserving therapy |
To evaluate the mammographic features of local recurrence in women who have undergone breast-conserving therapy for ductal carcinoma in situ (DCIS). |
The median interval from diagnosis of the original DCIS to local recurrence was 26 months (range, 6-168 months). Recurrences were detected solely by mammography in 17 (85%) of 20 patients, by mammography and physical examination in two (10%), and solely by physical examination in one (5%). Eighteen (90%) local recurrence contained calcifications and eighteen (90%) involved the tumorectomy quadrant. When we compared available mammographic findings of the original DCIS and the local recurrence we found the mammographic pattern and calcification morphology to be the same in 11 (79%) of 14 DCIS and nine (82%) of 11 DCIS, respectively. Histopathologic analysis of recurrences found DCIS in 13 (65%) of 20 patients and DCIS and infiltrating carcinoma in the remaining seven (35%) patients. Of 13 pure DCIS recurrences, 12 (92%) were detected solely by mammography. |
4 |
| 91. Shaaban AM, Hilton B, Clements K, et al. Pathological features of 11,337 patients with primary ductal carcinoma in situ (DCIS) and subsequent events: results from the UK Sloane Project. Br J Cancer. 124(5):1009-1017, 2021 03. |
Observational-Dx |
11,337 women with primary DCIS |
To analyse the pathological features of a large prospective cohort of well-characterised screen-detected DCIS patients and associated atypical epithelial lesions within the Sloane Project.To assess changes in pathological features over time (2003–2012) and the development of subsequent ipsilateral, contralateral and distant metastasis events. |
Among 11,337 patients, 7204 (64%) had high-grade DCIS. Over time, the proportion of high-grade disease increased (from 60 to 65%), low-grade DCIS decreased (from 10 to 6%) and mean size increased (from 21.4 to 24.1 mm). Mastectomy was more common for high-grade (36%) than for low-grade DCIS (15%). Few (6%) patients treated with breast-conserving surgery (BCS) had a surgical margin <1 mm. Of the 9191 women diagnosed in England (median follow-up 9.4 years), 7% developed DCIS or invasive malignancy in the ipsilateral and 5% in the contralateral breast. The commonest ipsilateral event was invasive carcinoma (n = 413), median time 62 months, followed by DCIS (n = 225), at median 37 months. Radiotherapy (RT) was most protective against recurrence for high-grade DCIS (3.2% for high-grade DCIS with RT compared to 6.9% without, compared with 2.3 and 3.0%, respectively, for low/intermediate-grade DCIS). Ipsilateral DCIS events lessened after 5 years, while the risk of ipsilateral invasive cancer remained consistent to beyond 10 years. |
3 |
| 92. Cheung S, Booth ME, Kearins O, Dodwell D. Risk of subsequent invasive breast cancer after a diagnosis of ductal carcinoma in situ (DCIS). BREAST. 23(6):807-11, 2014 Dec. |
Observational-Dx |
3930 patients diagnosed with DCIS in the West Midlands |
To evaluate the risk of invasive recurrence following surgical treatment of DCIS. |
Patients whose DCIS was detected outside of the NHS Breast Screening Programme have a higher risk of subsequent ipsilateral invasive breast cancer than those whose DCIS is detected through screening. There is no significant difference in risk of subsequent contralateral invasive recurrence according to mode of detection. |
4 |
| 93. Sprague BL, McLaughlin V, Hampton JM, Newcomb PA, Trentham-Dietz A. Disease-free survival by treatment after a DCIS diagnosis in a population-based cohort study. Breast Cancer Res Treat 2013;141:145-54. |
Observational-Dx |
143 second breast cancer events |
To describe the risk of second breast cancer events among women diagnosed with DCIS between 1995–2006.To examine the relative frequency of ipsilateral and contralateral second events, and evaluated disease-free survival among the various treatment groups. |
After an average of 7.1 years of follow-up, 143 second breast cancer events occurred. Overall 5-year DFS was similar among women treated with ipsilateral mastectomy (95.6 %; 95 % CI 93.5-97.0) compared to women treated with BCS and radiation (94.8 %; 95 % CI 92.8-96.1), though women receiving BCS without radiation experienced poorer overall DFS (87.0 %; 95 % CI 80.6-91.5). Women treated with tamoxifen in addition to BCS and radiation had a similar risk of a second breast event, although the hazard ratio (HR) suggested a potential benefit (0.70, 95% CI 0.41-1.19). Women treated with BCS, radiation, and tamoxifen had comparable risk of a second event as those treated with ipsilateral mastectomy (HR = 1.20; 95 % CI 0.71-2.02). |
1 |
| 94. Correa C, McGale P, Taylor C, et al. Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast. J Natl Cancer Inst Monogr. 2010;2010(41):162-177. |
Review/Other-Tx |
3,729 women |
To report an overview of the randomized trials of RT in DCIS of the breast. |
RT reduced the absolute 10-year risk of any IBE (ie, either recurrent DCIS or invasive cancer) by 15.2% (SE 1.6%, 12.9% vs 28.1% 2P<.00001), and it was effective regardless of the age at diagnosis, extent of BCS, use of tamoxifen, method of DCIS detection, margin status, focality, grade, comedonecrosis, architecture, or tumor size. The proportional reduction in IBEs was greater in older than in younger women (2P<.0004 for difference between proportional reductions; 10-year absolute risks: 18.5% vs 29.1% at ages <50 years, 10.8% vs 27.8% at ages =50 years) but did not differ significantly according to any other available factor. Even for women with negative margins and small low-grade tumors, the absolute reduction in the 10-year risk of IBEs was 18.0% (SE 5.5, 12.1% vs 30.1%, 2P=.002). After 10 years of follow-up, there was, however, no significant effect on breast cancer mortality, mortality from causes other than breast cancer, or all-cause mortality. |
4 |
| 95. Fitzpatrick SE, Eaton M, McLeay W, Dean NR. Outcomes of DCIS treated with breast conserving surgery without radiotherapy on recurrence, survival, and health-related quality of life. ANZ J Surg 2023:[E-pub ahead of print]. |
Observational-Tx |
138 patients were treated for pure DCIS |
To investigate whether women with DCIS managed with sector resection without radiotherapy had acceptable rates of recurrence and health-related quality of life outcomes. |
One hundred and thirty-eight patients were treated for pure DCIS by two surgeons from 1992 to 2018. One hundred and sixteen patients underwent sector resection, 22 had mastectomy. Average age 61 years. Mean follow up 9.14 years. Recurrence rate after sector resection was 18.97%. 55% were DCIS. Annualized recurrence rate was 2.07%. There were no cancer-related deaths. BREAST-Q completion rate was 44%. Satisfaction with breasts, physical, psychosocial, and sexual well-being scores were significantly higher than normative Australian values and a mixed cohort of women who underwent breast conserving surgery with radiotherapy. |
2 |
| 96. Rakovitch E, Pignol JP, Hanna W, et al. Significance of multifocality in ductal carcinoma in situ: outcomes of women treated with breast-conserving therapy. J Clin Oncol. 25(35):5591-6, 2007 Dec 10. |
Observational-Tx |
615 cases of DCIS |
To evaluate the significance of multifocality and the outcomes of women with multifocal DCIS treated with breast-conserving therapy. |
Of 615 cases of DCIS reviewed, 310 (41%) received breast-conserving surgery and 305 (40%) received breast-conserving surgery plus radiation (n = 260 with multifocality, n = 314 without multifocality, and n = 31 focality unreported). On multivariate analysis, multifocality (hazard ratio [HR] = 1.80; 95% CI, 1.15 to 2.80; P = .01), radiation treatment (HR = 0.46; 95% CI, 0.29 to 0.74; P = .001), margin width 4 mm or smaller (HR = 1.74; 95% CI, 1.03 to 2.92; P = .04), and high nuclear grade (HR = 1.65; 95% CI, 1.02 to 2.65; P = .04) were associated with risk of local recurrence. The detrimental effect of multifocality was limited to women who did not receive radiotherapy; the local recurrence-free survival rate at 10 years was 59% for women with multifocal disease and 80% for women without multifocality (P = .02). Among women treated with breast-conserving surgery plus radiation, there was no difference in 10-year local recurrence-free survival (80% v 87%; P = .35). There was no association between multifocality and the development of invasive recurrence. |
2 |
| 97. Rudloff U, Jacks LM, Goldberg JI, et al. Nomogram for predicting the risk of local recurrence after breast-conserving surgery for ductal carcinoma in situ. J Clin Oncol 2010;28:3762-9. |
Observational-Tx |
1,868 consecutive patients treated with BCS for DCIS |
To develop a nomogram, using continuous risk estimation modeling, to predict the probability of ipsilateral breast tumor recurrence (IBTR) at 5 and 10 years in women with DCIS treated with BCS. |
The DCIS nomogram for prediction of 5- and 10-year IBTR probabilities demonstrated good calibration and discrimination, with a concordance index of 0.704 (bootstrap corrected, 0.688) and a concordance probability estimate of 0.686. Factors with the greatest influence on risk of IBTR in the model included adjuvant RT or endocrine therapy, age, margin status, number of excisions, and treatment time period. |
2 |
| 98. Flowers CI, Mooney BP, Drukteinis JS. Clinical and imaging surveillance following breast cancer diagnosis. Am Soc Clin Oncol Educ Book 2012:59-64. |
Review/Other-Dx |
N/A |
To present a review of major academic institutions' imaging protocols and discuss the advantages of including MRI in traditional mammographic and clinical exams. |
No results in abstract. |
4 |
| 99. Mehta TS, Lourenco AP, Niell BL, et al. ACR Appropriateness Criteria® Imaging After Breast Surgery. J Am Coll Radiol 2022;19:S341-S56. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for imaging after breast surgery. |
No results stated in abstract. |
4 |
| 100. Khatcheressian JL, Hurley P, Bantug E, et al. Breast cancer follow-up and management after primary treatment: American Society of Clinical Oncology clinical practice guideline update. [Review]. J Clin Oncol. 31(7):961-5, 2013 Mar 01. |
Review/Other-Tx |
N/A |
To provide recommendations on the follow-up and management of patients with breast cancer who have completed primary therapy with curative intent. |
There were 14 new publications that met inclusion criteria: nine systematic reviews (three included meta-analyses) and five randomized controlled trials. After its review and analysis of the evidence, the Update Committee concluded that no revisions to the existing ASCO recommendations were warranted.Regular history, physical examination, and mammography are recommended for breast cancer follow-up. Physical examinations should be performed every 3 to 6 months for the first 3 years, every 6 to 12 months for years 4 and 5, and annually thereafter. For women who have undergone breast-conserving surgery, a post-treatment mammogram should be obtained 1 year after the initial mammogram and at least 6 months after completion of radiation therapy. Thereafter, unless otherwise indicated, a yearly mammographic evaluation should be performed. The use of complete blood counts, chemistry panels, bone scans, chest radiographs, liver ultrasounds, pelvic ultrasounds, computed tomography scans, [(18)F]fluorodeoxyglucose-positron emission tomography scans, magnetic resonance imaging, and/or tumor markers (carcinoembryonic antigen, CA 15-3, and CA 27.29) is not recommended for routine follow-up in an otherwise asymptomatic patient with no specific findings on clinical examination. |
4 |
| 101. Wallace AS, Nelson JP, Wang Z, Dale PS, Biedermann GB. In support of the Choosing Wisely campaign: Perceived higher risk leads to unnecessary imaging in accelerated partial breast irradiation?. Breast J. 24(1):12-15, 2018 01. |
Review/Other-Dx |
169 patients |
To determine clinical significance of frequent surveillance in this perceived higher risk population. |
Stage was 0, I, and II in 27%, 64%, and 9%, respectively. Most patients had pure invasive ductal cancer. Ninety-two percent and 99% of patients had imaging performed by 6 and 12 months (+/- 3 months) respectively. Median interval between end of radiation and first image, and subsequent 3 images were 6, 6, 9, and 12 months, respectively. Median follow-up was 49 months for all patients (range 7-106). Six patients experienced local recurrence: 4 invasive, all clinically detected, and none within the first 2 years. One patient had mammographically detected recurrent ductal carcinoma in situ. No mammographic images within the first year lead to diagnosis of recurrent cancer. APBI via balloon base brachytherapy offered women excellent locoregional control rates. Frequent mammographic surveillance did not result in increased detection of early recurrent disease. The result of our study are in line with the Choosing Wisely campaign recommendations to perform no more than annual follow-up for women who have completed radiation as part of BCT, with first imaging done at 6-12 months. |
4 |
| 102. Buist DS, Bosco JL, Silliman RA, et al. Long-term surveillance mammography and mortality in older women with a history of early stage invasive breast cancer. Breast Cancer Res Treat. 142(1):153-63, 2013 Nov. |
Observational-Dx |
1,235 patients |
To examine the association between surveillance mammography beyond 5 years after diagnosis on breast cancer-specific mortality in a cohort of women aged >/= 65 years diagnosed 1990-1994 with early stage breast cancer. |
The majority (85 %) of the 1,235 5-year breast cancer survivors received >/= 1 surveillance mammogram in years 5-9 (yearly proportions ranged from 48 to 58 %); 82 % of women received >/= 1 surveillance mammogram in years 10-14. A total of 120 women died of breast cancer and 393 women died from other causes (average follow-up 7.3 years). Multivariable models and lasagna plots suggested a modest reduction in breast cancer-specific mortality with surveillance mammogram receipt in the preceding year (IRR 0.82, 95 % CI 0.56-1.19, p = 0.29); the association with other-cause mortality was 0.95 (95 % CI 0.78-1.17, p = 0.64). |
3 |
| 103. Smith-Gagen J, Carrillo JE, Ang A, Perez-Stable EJ. Practices that reduce the Latina survival disparity after breast cancer. J Womens Health (Larchmt). 22(11):938-46, 2013 Nov. |
Observational-Dx |
44,999 patients |
To study which utilization factors drive the shorter survival in Latina women compared with white women. |
Of the four utilization factors potentially driving this disparity, a lack of consistent post-diagnosis mammograms was the strongest driver of the Latina breast cancer survival disparity. Consistent mammograms attenuated the hazard of death from 23% [hazard ratio, HR, (95% confidence interval, 95%CI)=1.23 (1.1,1.4)] to a nonsignificant 12% [HR (95%CI)=1.12 (0.7,1.3)] and reduced the excess hazard of death in Latina women by 55%. Effect modification identified that visits to primary care providers have a greater protective impact on the survival of Latina compared to white women [HR (95%CI)=0.9 (0.9,0.9)]. |
3 |
| 104. Lee JM, Buist DS, Houssami N, et al. Five-year risk of interval-invasive second breast cancer. J Natl Cancer Inst. 107(7), 2015 Jul. |
Observational-Dx |
15,114 patients |
To examine women presenting clinically with second breast cancers after negative surveillance mammography (interval cancers), and to estimate the five-year risk of interval-invasive second cancers for women with varying risk profiles. |
The cumulative incidence of second breast cancers after five years was 54.4 per 1000 women, with 325 surveillance-detected and 138 interval-invasive second breast cancers. The five-year risk of interval-invasive second cancer for women with referent category characteristics was 0.60%. For women with the most and least favorable profiles, the five-year risk ranged from 0.07% to 6.11%. Multivariable modeling identified grade II PBC (odds ratio [OR] = 1.95, 95% confidence interval [CI] = 1.15 to 3.31), treatment with lumpectomy without radiation (OR = 3.27, 95% CI = 1.91 to 5.62), interval PBC presentation (OR = 2.01, 95% CI 1.28 to 3.16), and heterogeneously dense breasts on mammography (OR = 1.54, 95% CI = 1.01 to 2.36) as independent predictors of interval-invasive second breast cancers. |
3 |
| 105. Lowry KP, Braunstein LZ, Economopoulos KP, et al. Predictors of surveillance mammography outcomes in women with a personal history of breast cancer. Breast Cancer Research & Treatment. 171(1):209-215, 2018 Aug. |
Observational-Dx |
164 patients |
To identify predictors of poor mammography surveillance outcomes based on clinico-pathologic features. |
164 women met inclusion criteria (65 with IBTR, 99 with CBC); 124 had screen-detected second cancers. On univariate analysis, poor surveillance outcome (n = 40) was associated with age at primary cancer diagnosis < 50 years (p < 0.0001), AJCC stage II primary cancers (p = 0.007), and heterogeneously or extremely dense breasts (p = 0.04). On multivariate analysis, age < 50 years at primary breast cancer diagnosis remained a significant predictor of poor surveillance outcome (p = 0.001). |
3 |
| 106. Solin LJ.. The impact of adding radiation treatment after breast conservation surgery for ductal carcinoma in situ of the breast. [Review]. J Natl Cancer Inst Monogr. 2010(41):187-92, 2010. |
Review/Other-Tx |
N/A |
To review impact of adding radiation treatment after breast conservation surgery for ductal carcinoma in situ of the breast. |
No results stated in abstract. |
4 |
| 107. American College of Radiology. ACR Practice Parameter for the Performance of Screening and Diagnostic Mammography. Available at: https://gravitas.acr.org/PPTS/GetDocumentView?docId=8+&releaseId=2 |
Review/Other-Dx |
N/A |
Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. |
No abstract available. |
4 |
| 108. Patel BK, Lee CS, Kosiorek HE, Newell MS, Pizzitola VJ, D'Orsi CJ. Variability of Postsurgical Imaging Surveillance of Breast Cancer Patients: A Nationwide Survey Study. AJR. American Journal of Roentgenology. 210(1):222-227, 2018 Jan. |
Review/Other-Dx |
849 patients |
To conduct a survey to explore whether broad discrepancy exists in imaging protocols used for postsurgical surveillance. |
Seventy-nine percent of respondents recommended initial diagnostic mammography after lumpectomy (65% at 6 months, 14% at 12 months); 49% recommended diagnostic surveillance for up to 2 years before a return to screening mammography; and 33% continued diagnostic surveillance for 2-5 years before returning to screening. For imaging after mastectomy, 57% of respondents recommended diagnostic mammography of the unaffected breast. Among the 57%, however, 37% recommended diagnostic screening for only the first postmastectomy follow-up evaluation, and the other 20% permanently designated patients for diagnostic mammography after mastectomy. |
4 |
| 109. Hasan S, Gresswell S, Colosimo B, et al. Surveillance Mammography After Breast Conservation Therapy: Is Tomosynthesis Worth It?. Am J Clin Oncol. 42(8):682-686, 2019 08. |
Observational-Dx |
450 patients |
To investigate the downstream workup and costs associated with digital breast tomosynthesis (DBT) compared with 2-dimensional full field digital mammogram (FFDM) when employed as initial follow-up imaging in breast conservation therapy. |
The first posttreatment mammogram was received within 3 (20%), 3 to 6 (32%), or after 6 months (48%) following radiation. Younger patients and those undergoing hypofractionated radiation were more likely to get DBT. There were no differences in stage, receptor status, or mammogram timing between those in the FFDM and DBT groups.The following downstream workup ensued for DBT compared with FFDM imaging: 18% versus 29% short-interval (6-mo) mammogram (odds ratio=1.83, P=0.01), 6% versus 11% breast magnetic resonance imaging (odds ratio=1.90, P=0.08), 4% ultrasound for each, and 3% biopsy for each (1 positive in the FFDM group). Including downstream workup, the estimated cost per patient in the DBT group was $216.14 compared with $237.83 in the FFDM group. Independent predictors for reduced downstream workup per multivariable analysis were the use of DBT and first follow-up mammogram at least 6 months after radiation (P<0.05). |
3 |
| 110. Sia J, Moodie K, Bressel M, et al. A prospective study comparing digital breast tomosynthesis with digital mammography in surveillance after breast cancer treatment. Eur J Cancer. 61:122-7, 2016 07. |
Observational-Dx |
618 patients |
To evaluate whether the addition of DBT to digital mammography (DM) reduced the rate of indeterminate findings compared to DM alone in patients after breast cancer treatment. |
The rates of indeterminate findings for DM+DBT versus DM alone were 10.5% and 13.1%, respectively (p=0.018). In breasts treated with surgery and radiotherapy (n=558), the corresponding rates of indeterminate findings were 4.9% and 6.9%, respectively (p=0.039). The rate of indeterminate findings for DM+DBT increased with increasing breast density (p=0.019). There was no significant difference in the rates of indeterminate findings between DM and SM (13.1% versus 11.5%, p=0.1). |
3 |
| 111. Yoon JH, Kim EK, Kim GR, et al. Comparing recall rates following implementation of digital breast tomosynthesis to synthetic 2D images and digital mammography on women with breast-conserving surgery. European Radiology. 30(11):6072-6079, 2020 Nov. |
Observational-Dx |
229 patients |
To evaluate the recall rates of digital mammography (DM) and synthetic images after adding digital breast tomosynthesis (DBT) in patients with breast-conserving surgery. |
Of the 229 patients included, 230 mammography images were reviewed. One patient (0.4%) developed locoregional recurrences during follow-up (mean duration, 25.8 +/- 4.5 months). Recall rates for synthetic 2D+DBT were significantly lower than for DM alone (4.1% (2.6-6.2) vs. 11.6% (9.2-14.5), respectively; p < 0.001). Recall rates did not differ between synthetic 2D+DBT and DM+DBT (4.1% (2.6-6.2) vs. 2.9% (1.9-4.5), respectively; p = 0.234). Recall rates of synthetic 2D+DBT and DM+DBT were significantly lower than those of DM alone, regardless of mammographic breast density (all p < 0.05, respectively). |
3 |
| 112. Orel SG, Fowble BL, Solin LJ, Schultz DJ, Conant EF, Troupin RH. Breast cancer recurrence after lumpectomy and radiation therapy for early-stage disease: prognostic significance of detection method. Radiology 1993;188:189-94. |
Observational-Tx |
72 women treated with lumpectomy and irradiation |
To evaluate whether there was prognostic significance ot the method by which local recurrence was detected. |
There was a statistically significant association between detection with mammography alone and lower T stage (P = .05), and there was a nonstatistically significant trend toward noninvasive histologic findings. No significant association was noted between detection method and site of recurrent current cancer in the breast, interval to recurrence, or patient age. There were nonstatistically significant trends toward improved relapse-free survival and overall survival for patients with recurrences detected solely with mammography. |
2 |
| 113. Arasu VA, Joe BN, Lvoff NM, et al. Benefit of semiannual ipsilateral mammographic surveillance following breast conservation therapy. Radiology. 264(2):371-7, 2012 Aug. |
Observational-Dx |
2329 patients |
To compare cancer recurrence outcomes on the basis of compliant semiannual versus noncompliant annual ipsilateral mammographic surveillance following breast conservation therapy (BCT). |
Initially, a total of 10 750 post-BCT examinations among 2329 asymptomatic patients were identified. Excluding initial mammographic follow-up, there were 8234 examinations. Of these, 7169 examinations were semiannual with 94 recurrences detected and 1065 examinations were annual with 15 recurrences detected. There were no differences in demographic risk factors or biopsy rates. Recurrences identified at semiannual intervals were significantly less advanced than those identified at annual intervals (stage I vs stage II, P = .04; stage 0 + stage I vs stage II, P = .03). Nonsignificant findings associated with semiannual versus annual intervals included smaller tumor size (mean, 11.7 vs 15.3 mm; P = .15) and node negativity (98% vs 91%, P = .28). |
3 |
| 114. American College of Radiology. ACR Practice Parameter for the Performance of Contrast-Enhanced Magnetic Resonance Imaging (MRI) of the Breast. Available at: https://gravitas.acr.org/PPTS/GetDocumentView?docId=6+&releaseId=2 |
Review/Other-Dx |
N/A |
Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. |
No abstract available. |
4 |
| 115. Giannotti DG, Hanna SA, Cerri GG, Barbosa Bevilacqua JL. Analysis of Skin Flap Thickness and Residual Breast Tissue After Mastectomy. Int J Radiat Oncol Biol Phys. 102(1):82-91, 2018 09 01. |
Observational-Dx |
367 women who underwent therapeutic or prophylactic mastectomy with reconstruction |
To evaluate the frequency of residual breast tissue (RBT) and provide average thickness skin flap measurements in patients with total mastectomy, skin-sparing mastectomy, and nipple-sparing mastectomy (NSM) followed by breast reconstruction. |
At 9 of the 11 points of measure, the median thickness of the flap exceeded 5.5 mm. Excluding the areolar region, RBT was identified in 29.9% of the cases: 21.3% of the therapeutic mastectomy cases and 51% of the NSM cases. The variables independently associated with the presence of RBT were flap thickness (P < .001), patient height (P < .03), mastectomy indication (P < .001), mastectomy type (P < .012 for skin-sparing mastectomy and P < .001 for NSM and total mastectomy), and breast reconstruction with flap (P < .019). |
4 |
| 116. Papassotiropoulos B, Guth U, Chiesa F, et al. Prospective Evaluation of Residual Breast Tissue After Skin- or Nipple-Sparing Mastectomy: Results of the SKINI-Trial. Ann Surg Oncol 2019;26:1254-62. |
Observational-Dx |
82 mastectomies |
To investigate the presence of residual breast tissue (RBT) after skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) and to analyse patient- and therapy-related factors associated with RBT. |
Residual breast tissue was detected in 82 (51.3%) mastectomies. The median RBT percentage per breast was 7.1%. Of all factors considered, only type of surgery (40.4% for SSM vs. 68.9% for NSM; P < 0.001) and surgeon (P < 0.001) were significantly associated with RBT. None of the remaining factors, e.g., skin flap necrosis, was associated significantly with RBT. Residual disease was detected in three biopsies. |
3 |
| 117. Carlson GW, Page A, Johnson E, Nicholson K, Styblo TM, Wood WC. Local recurrence of ductal carcinoma in situ after skin-sparing mastectomy. J Am Coll Surg 2007;204:1074-8; discussion 78-80. |
Observational-Tx |
223 consecutive patients with DCIS treated by skin-sparing mastectomy (SSM) and immediate reconstruction |
To evaluate the oncologic safety of SSM in patients with DCIS.To examine potential risk factors for LR after SSM for DCIS. |
Mean followup was 82.3 months (range 4.9 to 123.2 months). Recurrences developed in 11 patients (5.1%), including: local (n = 7; 3.3%), regional (n = 2; 0.9%), and distant (n = 2; 0.9%). All seven local recurrences were detected by physical examination. No patients received adjuvant radiation therapy. Two of 19 patients with surgical margins < 1 mm developed LR (10.5%). Univariate analysis showed high tumor grade (p = .019) to influence LR. |
2 |
| 118. Chan LW, Rabban J, Hwang ES, et al. Is radiation indicated in patients with ductal carcinoma in situ and close or positive mastectomy margins? Int J Radiat Oncol Biol Phys 2011;80:25-30. |
Review/Other-Tx |
22 patients with DCIS of >5 cm or diffuse diseas |
To determine chest wall recurrence rates in women with DCIS and close (<5 mm) or positive mastectomy margins in order to evaluate the potential role of radiation therapy. |
Median pathologic size of the DCIS in the mastectomy specimen was 4.5 cm. Twenty-two patients had DCIS of >5 cm or diffuse disease. Median width of the close final margin was 2 mm. Nineteen patients had margins of <1 mm. One of these 59 patients experienced a chest wall recurrence with regional adenopathy, followed by distant metastases 2 years following skin-sparing mastectomy. The DCIS was high-grade, 4 cm, with a 5-mm deep margin. A second patient developed an invasive cancer in the chest wall 20 years after her mastectomy for DCIS. This cancer was considered a new primary site arising in residual breast tissue. |
4 |
| 119. Hwang ES. The impact of surgery on ductal carcinoma in situ outcomes: the use of mastectomy. J Natl Cancer Inst Monogr 2010;2010:197-9. |
Review/Other-Tx |
N/A |
To discuss the impact and use of mastectomy on ductal carcinoma in situ, which will continue to be an important and acceptable treatment option. |
No results in abstract. |
4 |
| 120. Pawloski KR, Tadros AB, Sevilimedu V, et al. Patterns of invasive recurrence among patients originally treated for ductal carcinoma in situ by breast-conserving surgery versus mastectomy. [Review]. Breast Cancer Res Treat. 186(3):617-624, 2021 Apr. |
Observational-Tx |
452 patients with an invasive recurrence after surgery for DCIS |
To compare patterns of first recurrence between those originally treated with BCS vs. mastectomy. |
367 patients (81%) had initially undergone BCS and 85 patients (19%) mastectomy. Patients originally treated with mastectomy were younger and were more likely to have had high grade, necrosis, and multifocal or multicentric DCIS (p < 0.001) compared with the BCS group. A higher proportion of invasive recurrences were local after BCS (93%; 343/367), whereas 88% (75/85) of recurrences after mastectomy were regional or distant (p < 0.001). The median time to first invasive recurrence was not different between surgical groups (BCS: 6.4 years vs. mastectomy: 5.5 years; p = 0.12). |
2 |
| 121. NCCN Clinical Practice Guidelines in Oncology. Breast Cancer. NCCN Evidence Blocks™. Version 4.2023. Available at: https://www.nccn.org/professionals/physician_gls/pdf/breast_blocks.pdf. |
Review/Other-Dx |
N/A |
To provide the health care provider and the patient information to make informed choices when selecting systemic therapies based upon measures related to treatment, supporting data, and cost. |
No results available. |
4 |
| 122. ESMO. Breast Cancer Pocket Guideline 2022. Available at: https://interactiveguidelines.esmo.org/esmo-web-app/toc/index.php?subjectAreaID=8&loadPdf=1. |
Review/Other-Dx |
N/A |
To provide you with the most important content of the ESMO Clinical Practice Guidelines (CPGs) on the management of breast cancer (including metastatic breast cancer, hereditary breast cancer syndromes and early breast cancer). |
No results. |
4 |
| 123. Chapman MC, Hayward JH, Woodard GA, Joe BN, Lee AY. The Role of Breast MRI in Detecting Asymptomatic Recurrence After Therapeutic Mastectomy. AJR Am J Roentgenol. 215(1):254-261, 2020 07. |
Observational-Dx |
191 women (402 breast MRI studies) |
To determine the utility of breast MRI in detecting asymptomatic locoregional recurrence after therapeutic mastectomy. |
In all, 395 MR images (98.3%) were assessed as showing benign findings on the mastectomy side. Seven (1.7%) were interpreted as showing positive findings on the mastectomy side (BI-RADS category 4, suspicious for malignancy). Biopsy was performed in four of the seven positive interpretations. All four biopsies yielded malignancy for a positive predictive value of biopsy of 100%. The three remaining positive cases did not include biopsy; however, in each case, follow-up imaging showed improvement or resolution of the finding, yielding a positive predictive value of an abnormal examination of 57.1%. Two MRI studies were false-negative, with local recurrence within 12 months after MRI deemed to show benign findings, yielding a negative predictive value of 99.5%. Sensitivity and specificity were 66.7% and 99.2%, respectively. The cancer detection rate in the asymptomatic mastectomy side for all MRI examinations was 10 cancers per 1000 examinations. |
4 |
| 124. Lee JH, Kim EK, Oh JY, et al. US screening for detection of nonpalpable locoregional recurrence after mastectomy. Eur J Radiol. 82(3):485-9, 2013 Mar. |
Observational-Dx |
468 patients |
To assess the value of screening ultrasonography (US) in the detection of nonpalpable locoregional recurrence following mastectomy for breast cancer and to describe the US appearances of occult recurrent cancers. |
Of the 468 patients assessed, 19 (4.1%) showed "suspicious for malignant nodules"; of these lesions, 10 were malignant. One false-negative case was identified. The sensitivity and specificity were 90.9% and 98.0%, respectively. A biopsy positive predictive value of 52.6% was observed. Cancer detection rates were 2.1% with US screenings of mastectomy sites and ipsilateral axillary fossae. The common US features of occult recurrences at the mastectomy sites were irregular shaped, not-circumscribed marginated, and hypoechoic masses with intratumoral vascularities. The most common location was within the deep muscle layer. |
3 |
| 125. Moy L, Heller SL, Bailey L, et al. ACR Appropriateness Criteria® Palpable Breast Masses. J Am Coll Radiol 2017;14:S203-S24. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for palpable breast masses. |
No results stated in abstract. |
4 |
| 126. Holbrook AI, Moy L, Akin EA, et al. ACR Appropriateness Criteria® Breast Pain. J Am Coll Radiol 2018;15:S276-S82. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for breast pain. |
No results stated in abstract. |
4 |
| 127. Willems SM, van Deurzen CH, van Diest PJ. Diagnosis of breast lesions: fine-needle aspiration cytology or core needle biopsy? A review. J Clin Pathol 2012;65:287-92. |
Review/Other-Dx |
N/A |
To review fine-needle aspiration cytology (FNAC) and core needle biopsy (CNB) for breast lesion diagnosis, comparing methodological issues, diagnostic performance indices, possibilities for additional prognostic and predictive tests and cost effectiveness. |
No results in abstract. |
4 |
| 128. Robertson C, Ragupathy SK, Boachie C, et al. Surveillance mammography for detecting ipsilateral breast tumour recurrence and metachronous contralateral breast cancer: a systematic review. [Review]. Eur Radiol. 21(12):2484-91, 2011 Dec. |
Review/Other-Dx |
9 studies |
To determine the diagnostic accuracy of surveillance mammography for detecting ipsilateral breast tumour recurrence and metachronous contralateral breast cancer in women previously treated for primary breast cancer. |
Nine studies met our inclusion criteria. Variations in study comparisons precluded meta-analysis. For routine ipsilateral breast tumour detection, surveillance mammography sensitivity ranged from 64-67% and specificity ranged from 85-97%. For MRI, sensitivity ranged from 86-100% and specificity was 93%. For non-routine ipsilateral breast tumour detection, sensitivity and specificity for surveillance mammography ranged from 50-83% and 57-75% and for MRI 93-100% and 88-96%. For routine metachronous contralateral breast cancer detection, one study reported sensitivity of 67% and specificity of 50% for both surveillance mammography and MRI. |
4 |
| 129. Amitai Y, Menes TS, Weinstein I, Filyavich A, Yakobson I, Golan O. What is the yield of breast MRI in the assessment of palpable breast findings?. Clin Radiol. 72(11):930-935, 2017 Nov. |
Observational-Dx |
7,782 patients |
To examine the contribution of magnetic resonance imaging (MRI) to characterise palpable breast masses after conventional imaging was found to be non-contributory. |
Investigation of palpable breast finding was the clinical indication for 167 of 7,782 (2%) examinations. Thirty-two (19%) women in the study had positive MRI findings. Most (20, 63%) findings corresponded to the palpable area, resulting in three carcinomas being diagnosed. Only one carcinoma required MRI-guided biopsy for diagnosis. Eighteen women with negative MRI underwent ultrasound-guided biopsy from the palpable area, which resulted in a diagnosis of one carcinoma. One carcinoma was incidentally detected in another location. Within the present population, the sensitivity for detecting malignancy was 80%, specificity 78%, negative predictive value 99%, and positive predictive value 13%. |
3 |
| 130. Olsen ML, Morton MJ, Stan DL, Pruthi S. Is there a role for magnetic resonance imaging in diagnosing palpable breast masses when mammogram and ultrasound are negative? J Womens Health (Larchmt) 2012;21:1149-54. |
Observational-Dx |
77 studies |
To examine the use and utility of breast MRI in evaluating palpable breast masses with negative diagnostic mammogram and ultrasound studies. |
Seventy-seven studies were included, comprising 1.3% of all breast MRI studies performed at our institution during the study period (2005-2011). Twenty-two patients underwent biopsy, and 55 were followed clinically without biopsy. Approximately half (27 of 55) of the patients without biopsy were lost to follow-up after negative MRI, and the rest had no evidence of cancer on imaging or clinical examination at 1 year. Of the 22 patients who underwent biopsy, 2 were diagnosed with cancer, both with positive MRI studies. Sensitivity of MRI when compared to tissue diagnosis was 100%, and specificity was 70%. Positive and negative predictive values were 25% and 100%, respectively. |
3 |
| 131. Yalniz C, Campbell D, Le-Petross C, et al. The role of magnetic resonance imaging in patients with palpable breast abnormalities and negative mammographic and sonographic findings. Breast J 2020;26:1289-95. |
Observational-Dx |
22,004 women with palpable abnormalities |
To determine the frequency of positive findings on breast magnetic resonance imaging (MRI) in patients with palpable breast abnormalities in the setting of negative mammographic and sonographic evaluations. |
22 004 women presented with palpable abnormalities at one breast imaging center between January 1, 2005 and December 31, 2015. Nine thousand and three hundred and thirty-four patients had negative or benign findings on mammography, ultrasound, or mammography plus ultrasound. Thirty-one patients underwent MRI with the complaint of palpable abnormalities despite negative or benign mammographic and/or sonographic findings. Their age range was between 32 and 74 years, and their mean age was 49 years. Of those who had MRI, twenty-one patients had negative MRI findings. Six patients had negative concordant results for the palpable abnormalities and benign incidental findings. Three patients had benign concordant results for the palpable abnormalities, and one patient had incidental atypia. Twenty-eight patients had negative MRI results in the area of the palpable abnormality, and none of these patients underwent biopsy. Of the 31 cases, four patients (13%) underwent additional examinations (three second-look ultrasounds and one bone scan) after MRI. Five patients (16%) underwent MRI-guided biopsies, two patients (6%) underwent ultrasound-guided biopsies, and one patient (3%) had an excision. All biopsies showed benign results. The Gail risk score was calculated for 22 of them and the mean 5-year risk was 1.64 and the mean lifetime risk was 12.51. |
4 |
| 132. Wang M, He X, Chang Y, Sun G, Thabane L. A sensitivity and specificity comparison of fine needle aspiration cytology and core needle biopsy in evaluation of suspicious breast lesions: A systematic review and meta-analysis. [Review]. BREAST. 31:157-166, 2017 Feb. |
Meta-analysis |
12 articles (1802 patients) |
To compare the sensitivity and specificity of core needle biopsy (CNB) and fine needle aspiration cytology (FNAC)in this setting. |
Ultimately, 12 articles (1802 patients) were included in the final analysis. The pooled analysis shows that the sensitivity of CNB is better than that of FNAC [87% (95% CI, 84%-88%, I2 = 88.5%) versus 74% (95% CI, 72%-77%, I2 = 88.3%)] and the specificity of CNB is similar to that of FNAC [98% (95% CI, 96%-99%, I2 = 76.2%) versus 96% (95% CI, 94%-98%, I2 = 39.0%)]. For subgroup analysis, the sensitivities of both tests are better for palpable lesions than that of non-palpable lesions. Sensitivity analysis shows the robustness of the primary analysis. |
Good |
| 133. Brancato B, Crocetti E, Bianchi S, et al. Accuracy of needle biopsy of breast lesions visible on ultrasound: audit of fine needle versus core needle biopsy in 3233 consecutive samplings with ascertained outcomes. Breast 2012;21:449-54. |
Observational-Dx |
3233 consecutive needle biopsies (1950 FNAC and 1283 CNB) |
To examine the outcomes of core needle biopsy (CNB) and fine needle aspiration cytology (FNAC) in a large series ascertained with surgical histology or clinical-imaging follow-up. |
The probability of CNB as a first test instead of FNAC increased significantly over time, when there was a pre-test higher level of suspicion, in younger (relative to older) women, with increasing lesion size on imaging, and for palpable (relative to impalpable) lesions. Inadequacy rate was lower for CNB (B1 = 6.9%) than for FNAC (C1 = 17.7%), p < 0.001, and specifically in malignant lesions (B1 = 0.9% vs. C1 = 4.5%; p < 0.001). False negative rate was equally low for both CNB and FNAC (1.7% each test). CNB performed significantly better than FNAC for absolute sensitivity (93.1% vs. 74.4%; p < 0.001) and complete sensitivity (97.4% vs. 93.8%; p = 0.001), however specificity was lower for CNB than FNAC (88.3% vs. 96.4%; p < 0.001). Absolute diagnostic accuracy was higher for CNB than FNAC (84.5% vs. 71.9; p < 0.001) while FNAC performed better than CNB for complete diagnostic accuracy (95.4% vs. 93.2; p < 0.008). In the small subgroup assessed with CNB after an inconclusive initial FNAC (231 cases) there was improved complete sensitivity (from 93.8% to 97.0%) however this also increased costs. |
3 |
| 134. Bianchi S, Vezzosi V. Microinvasive carcinoma of the breast. Pathol Oncol Res 2008;14:105-11. |
Review/Other-Dx |
N/A |
To discuss the definitions and diagnostic criteria of microinvasive carcinoma (MC). |
No results in abstract. |
4 |
| 135. Shiino S, Quinn C, Ball G, et al. Prognostic significance of microinvasion with ductal carcinoma in situ of the breast: a meta-analysis. [Review]. Breast Cancer Res Treat. 197(2):245-254, 2023 Jan. |
Meta-analysis |
26 studies |
To investigate the survival differences between patients with DCIS/microinvasion and those with pure DCIS. |
This study identified 26 studies that described the clinicopathological characteristics of patients in both the DCIS and DCIS/microinvasion groups. Survival differences were evaluated in 10 of 26 studies. Disease-free survival and loco-regional recurrence-free survival were significantly shorter in patients with DCIS/microinvasion than in those with DCIS (Hazard ratio, 1.52; 95% confidence interval, 1.11-2.08; p = 0.01 and hazard ratio, 2.53; 95% confidence interval, 1.45-4.41; p = 0.001, respectively). Both overall survival and distant metastasis-free survival tended to be shorter in patients with DCIS/microinvasion than in patients with DCIS (Hazard ratio, 1.63; 95% CI, 0.63-4.23; p = 0.31 and hazard ratio, 1.85; 95% confidence interval, 0.74-4.66; p = 0.19, respectively) but the difference was not statistically significant. |
Good |
| 136. Amin MB, Edge S, Greene F, et al. AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017. |
Review/Other-Dx |
N/A |
To classify patients with cancer, define prognosis, and determine the best treatment approaches. |
No abstract available. |
4 |
| 137. Yu KD, Wu LM, Liu GY, et al. Different distribution of breast cancer subtypes in breast ductal carcinoma in situ (DCIS), DCIS with microinvasion, and DCIS with invasion component. Ann Surg Oncol 2011;18:1342-8. |
Observational-Dx |
550 consecutive DCIS patients |
To study the differences of clinicopathological features and immunohistochemical-based subtypes among DCIS, DCIS-Mi, and DCIS-I. |
DCIS-Mi and DCIS-I patients tended to have larger tumors with highly graded nuclear (P = 0.011 for size; P < 0.0001 for nuclear grade). The proportion of luminal-like tumors decreased, whereas ERBB2+ and basal-like tumors increased in DCIS-I/DCIS-Mi compared with pure-DCIS (P = 0.039). Although the HER2-positive tumors displayed a stable proportion among DCIS subgroups, the essences of them were varying. In pure-DCIS, luminal-B was the major subtype of HER2-positive tumors (luminal-B vs. ERBB2+, 19% vs. 14.6%), whereas in DCIS-I, the proportion of luminal-B decreased vastly (luminal-B vs. ERBB2+, 12.8% vs. 23.5%). DCIS-I had a worse relapse-free survival outcome compared with pure-DCIS. |
3 |
| 138. Lyman GH, Temin S, Edge SB, et al. Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 32(13):1365-83, 2014 May 01. |
Review/Other-Dx |
N/A |
To provide evidence-based recommendations to practicing oncologists, surgeons, and radiation therapy clinicians to update the 2005 clinical practice guideline on the use of sentinel node biopsy (SNB) for patients with early-stage breast cancer. |
This guideline update reflects changes in practice since the 2005 guideline. Nine randomized clinical trials (RCTs) met systematic review criteria for clinical questions 1 and 2; 13 cohort studies informed clinical question 3. |
4 |
| 139. Lai HW, Chang YL, Chen ST, et al. Revisit the practice of lymph node biopsy in patients diagnosed as ductal carcinoma in situ before operation: a retrospective analysis of 682 cases and evaluation of the role of breast MRI. World Journal of Surgical Oncology. 19(1):263, 2021 Sep 01. |
Observational-Dx |
682 cases with pre-operative diagnosis of DCIS |
To evaluate the role of axillary lymph node (ALN) surgery in pre-OP biopsy diagnosed DCIS patients, and investigate the accuracy of breast MRI to predict ALN metastasis.To analyze and discuss the rate and predictors of upgrade from preOP DCIS to DCIS-IC, ALN metastasis, and potential of breast MRI to replace SLNB in pre-OP biopsy diagnosed DCIS patients |
The rate of upgrade to invasive cancer were found in 34.2% of specimen, and this upgrade rate is 23% for patients who received breast conserving surgery and 40.7% for mastectomy (p < 0.01). Large pre-operative imaging tumor size and post-operative invasive component were risk factors to ALN metastasis. Breast MRI had 53.8% sensitivity, 77.8% specificity, 14.9% positive predictive value, 95.9% negative predictive value (NPV), and 76.2% accuracy to predict ALN metastasis in pre-OP DCIS patients. In MRI node-negative breast cancer patients with MRI tumor size < 3 cm, the NPV was 96.4%, and all these false-negative cases were N1. Pre-OP diagnosed DCIS patients with MRI tumor size < 3 cm and node negative suitable for BCS could safely omit SLNB if whole breast radiotherapy is to be performed. |
3 |
| 140. National Academies of Sciences, Engineering, and Medicine; Division of Behavioral and Social Sciences and Education; Committee on National Statistics; Committee on Measuring Sex, Gender Identity, and Sexual Orientation. Measuring Sex, Gender Identity, and Sexual Orientation. In: Becker T, Chin M, Bates N, eds. Measuring Sex, Gender Identity, and Sexual Orientation. Washington (DC): National Academies Press (US) Copyright 2022 by the National Academy of Sciences. All rights reserved.; 2022. |
Review/Other-Dx |
N/A |
Sex and gender are often conflated under the assumptions that they are mutually determined and do not differ from each other; however, the growing visibility of transgender and intersex populations, as well as efforts to improve the measurement of sex and gender across many scientific fields, has demonstrated the need to reconsider how sex, gender, and the relationship between them are conceptualized. |
No abstract available. |
4 |
| 141. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
