The presentation, management and outcome of patients with ductal carcinoma in situ (DCIS) with microinvasion (invasion ≤1 mm in size)-results from the UK Sloane Project.
Shaaban, Abeer M Hilton, Bridget Clements, Karen Dodwell, David Sharma, Nisha Kirwan, Cliona Sawyer, Elinor Maxwell, Anthony Wallis, Matthew Stobart, Hilary
Shaaban, Abeer M
Hilton, Bridget
Clements, Karen
Dodwell, David
Sharma, Nisha
Kirwan, Cliona
Sawyer, Elinor
Maxwell, Anthony
Wallis, Matthew
Stobart, Hilary
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2022-10-12
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Abstract
Background: The diagnosis, management and prognosis of microinvasive breast carcinoma remain controversial.
Methods: We analysed the outcomes of patients with DCIS with and without microinvasion diagnosed between 2003 and 2012 within the Sloane project.
Results: Microinvasion was recorded in 521 of 11,285 patients (4.6%), with considerable variation in reported incidence among screening units (0-25%). Microinvasion was associated with high-grade DCIS, larger DCIS size, comedo necrosis and solid, cribriform architecture (all P < 0.001). Microinvasion was more frequent in patients who underwent mastectomy compared with breast-conserving surgery (BCS) (6.9% vs 3.6%, P < 0.001), and in those undergoing axillary nodal surgery (60.4% vs 30.3%, P < 0.001) including the subset undergoing BCS (43.4% vs 8.5%, P < 0.001). Nodal metastasis rate was low and not statistically significant difference from the DCIS only group (P = 0.68). Following median follow-up of 110 months, 3% of patients had recurrent ipsilateral high-grade DCIS, and 4.2% developed invasive carcinoma. The subsequent ipsilateral invasion was of Grade 3 in 71.4% of patients with microinvasion vs 30.4% in DCIS without microinvasion (P = 0.02). Distant metastasis and breast cancer mortality were higher with microinvasion compared with DCIS only (1.2% vs 0.3%, P = 0.01 and 2.1% vs 0.8%; P = 0.005).
Conclusions: The higher breast cancer mortality with microinvasion indicates a more aggressive disease.
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Shaaban AM, Hilton B, Clements K, Dodwell D, Sharma N, Kirwan C, Sawyer E, Maxwell A, Wallis M, Stobart H, Mylvaganam S, Litherland J, Brace-McDonnell S, Dulson-Cox J, Kearins O, Provenzano E, Ellis IO, Pinder SE, Thompson AM. The presentation, management and outcome of patients with ductal carcinoma in situ (DCIS) with microinvasion (invasion ≤1 mm in size)-results from the UK Sloane Project. Br J Cancer. 2022 Dec;127(12):2125-2132. doi: 10.1038/s41416-022-01983-4. Epub 2022 Oct 12
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