What is high grade DCIS with comedo necrosis?
High-grade DCIS has a higher risk of coming back than low- or moderate-grade DCIS. High-grade DCIS may be described as comedo or comedo necrosis, which means there are areas of dead cancer cells inside the DCIS.Feb 4, 2022
What is the treatment for DCIS with Microinvasion?
(See "Microinvasive breast carcinoma".) TREATMENT APPROACH Patients with DCIS undergo local treatment with breast-conserving therapy (BCT) or mastectomy. BCT consists of lumpectomy (also called breast-conserving surgery, wide excision, or partial mastectomy) followed in most cases by adjuvant radiation.Aug 23, 2021
What is comedo-type DCIS?
Comedo-DCIS is a histologic subtype of preinvasive breast neoplasia that is characterized by prominent apoptotic cell death and has greater malignant potential than other DCIS subtypes. We investigated the mechanisms of apoptosis in comedo-DCIS and its role in conversion of comedo-DCIS to invasive cancer.
Is DCIS with Microinvasion curable?
Patients with microinvasive breast cancer can typically expect a cure rate very close to 100%, with local treatment alone.May 7, 2019
How serious is DCIS with Microinvasion?
DCIS with microinvasion is a rare diagnosis with an excellent prognosis and a low rate of nodal involvement. This study attempts to identify factors associated with a positive sentinel lymph node biopsy and provides outcome data on these patients.Aug 5, 2014
What is best treatment for high grade DCIS?
Radiation therapy Treatment of DCIS has a high likelihood of success, in most instances removing the tumor and preventing any recurrence. In most people, treatment options for DCIS include: Breast-conserving surgery (lumpectomy) and radiation therapy. Breast-removing surgery (mastectomy)May 20, 2020
What is comedo type necrosis?
Answer: The term 'necrosis' refers to cells that are dying. When cells die, they often attract other chemicals in the body, and form something called 'comedo necrosis,' which is basically the residual, leftover dead cells.May 8, 2008
Why is comedo DCIS called comedo?
As these starved cells die off, a build up of dead cancer cells will begin to form inside the tumor. These groups of necrotic cells are often referred to as comedones, hence the classification of this type of high-grade DCIS as "comedo necrosis".
What is comedo necrosis of the breast?
(These small groups of dead cells are termed 'comedo necrosis'). It is a fast growing type of breast cancer with some risk of future invasive cancer status, but most of the time comedo breast carcinoma is considered to be 'intraductal', meaning, that it will be confined to the breast ducts.May 5, 2019
How long can you wait for DCIS surgery?
The researchers assessed overall survival using five time intervals representing delays to surgery: less than 30 days, 31-60 days, 61-90 days, 91-120 days, or 121-365 days. Overall survival was 95.8 percent, with a median delay from diagnosis to surgery of 38 days.Oct 21, 2019
How do you stop DCIS recurrence?
Lumpectomy with radiation. Typically, the remaining breast will then have radiation therapy to reduce the risk of local recurrence. Lumpectomy plus radiation is a good alternative to mastectomy for treatment of DCIS.
Is surgery necessary for DCIS?
Studies show that about 75% of DCIS cases may never become invasive breast cancer. Still, current guidelines for DCIS often recommend surgery, usually lumpectomy followed by radiation, to remove suspicious lesions.
What Is Ductal Carcinoma In-Situ (DCIS)?
For an in-depth look at Ductal Carcinoma visit our latest post.Basically, ductal carcinoma in-situ is a very early form of breast cancer, whereby c...
Factors at Diagnosis That Affect Prognosis For Ductal Carcinoma in Situ
Many people used to think that Ductal Carcinoma In-Situ was a precursor for invasive breast cancer or a ‘pre-cancerous’ condition. However, researc...
(I) Younger Age at Diagnosis of DCIS
A medical study published in 2015 set out to estimate the 10 and 20 year mortality rate after an initial diagnosis of ductal carcinoma in-situ.The...
(II) and (III) Tumor Grade and Necrosis at Diagnosis of DCIS
There are 3 grades of Ductal Carcinoma In-Situ (DCIS). If you have been diagnosed with DCIS you will be able to find the Grade on your Pathology Re...
(V)Tumor Size Or Clinical Features on Diagnosis
Tumor size, as a single prognostic factor in DCIS, has remained controversial amongst medical experts.Whilst many cases of DCIS are diagnosed by ma...
Other Factors That May Affect Survival Rates For Ductal Carcinoma in Situ
There has been extensive research in the past regarding the connection between women taking hormone replacement therapy (HRT) after menopause and i...
Treatment Options For DCIS: Lumpectomy Or Mastectomy
In most cases the first line of treatment when DCIS is diagnosed is some form of breast surgery.There are two basic surgical approaches for DCIS tr...
The Use of Triple Therapy (Lumpectomy, Radiation, Tamoxifen) Does It Have A Role in DCIS.
It has been suggested, in the past, that triple therapy (lumpectomy, radiation and Tamoxifen) for DCIS reduces the risk of local recurrence of inva...
What happens when you have comedo carcinoma?
What typically happens in a breast comedo carcinoma is that some of the cells die off and form small groups. ( These small groups of dead cells are termed ‘comedo necrosis‘ ). It is a fast growing type of breast cancer with some risk of future invasive cancer status, but most of the time comedo breast carcinoma is considered to be ‘ intraductal ‘, meaning, that it will be confined to the breast ducts. DCIS-comedo is generally diagnosed when at least one duct in the breast is filled and expanded by large, markedly atypical cells, and which also has abundant central luminal necrosis.
What is non-comedo ductal carcinoma in situ?
What is NON-comedo ductal carcinoma in situ? This is a subgroup of DCIS. This group comprises of relatively less aggressive types with low nuclear grade. It also can have multiple patterns which often co-exist, these types include: cribriform, micropapillary, papillary, and solid.
Is breast cancer a single disease?
Breast DCIS is really not considered a single disease, but rather a ‘ heterogenous ‘ collection of diseases. The different types and grades of ductal carcinoma in situ have different tendencies regarding their potential to become invasive breast cancer. There are various factors that influence the type of grade associated with DCIS, ...
Is comedo carcinoma a type of carcinoma?
Comedo carcinoma of the breast is actually a type of ductal carcinoma in situ. It is considered to be an early stage of breast cancer, and it is characterized by the presence of central necrosis, or evidence of cell death and decay. A diagnosis of this particular kind of breast cancer is somewhat fortuitous as it is confined to the breast ducts and usually does not spread beyond. However, in terms of the various kinds of DCIS, comedo carcinoma is considered to be of a higher grade and a little more aggressive than the others, and may be treated a little more aggressively.
What is the gold standard for DCIS?
The gold standard of treatment for DCIS at the moment is wide local excision (lumpectomy) with radiotherapy . According to one 2012 medical study, surgery and radiation therapy is superior to just surgery regarding recurrence rates. However, neither of these approaches affect overall survival rates.
What is ductal carcinoma in situ?
Basically, ductal carcinoma in-situ is a very early form of breast cancer, whereby cancer cells, of various grades, are present in the milk ducts of the breasts. The reason ductal cancer is named ‘ in-situ ’ at this early phase, is that the abnormal cells have not yet spread outside of the milk ducts. This explains the reason for the very good ...
Is DCIS good for breast cancer?
The prognosis for DCIS is always very, very good, regardless of the exact nature of the type of breast cancer and the treatment method used. There will always be ongoing research and speculation as to the most risky types of DCIS, or those most likely to either progress or recur as something worrisome.
Can DCIS recur?
However, some cases of DCIS will not recur or progress to invasive ductal cancer. This poses a dilemma for the surgeon with small, positive margins being associated with recurrence on one hand. However, on the other hand, DCIS patients may also be having unnecessary large resections with poor cosmetic outcomes.
Is tumor size a prognostic factor?
Tumor size, as a single prognostic factor in DCIS, has remained controversial amongst medical experts. Whilst many cases of DCIS are diagnosed by mammography and are not palpable on diagnosis some present as a clinical, palpable mass (or breast lump). Narod, following a 2014 medical study, asserts that:-.
Does breast conserving surgery affect survival?
However, the increased local recurrence risk following breast conservation surgery did NOT affect breast cancer-specific survival when compared with patients who underwent mastectomy for DCIS.
Does tamoxifen reduce breast cancer?
A 2014 review of the use of Tamoxifen, as opposed to no additional treatment in DCIS patients, showed a reduction in the risk of new DCIS events in the same and opposite breast. There was also a signigicant reduction in breast cancers in the opposite breast.
What percentage of DCIS are microcalcified?
Microcalcifications are found in an estimated 50-75% of all DCIS diagnosed on mammography and in approximately 90% of clinically occult DCIS. 30-34 Radiologic-pathologic correlation has shown that these calcifications develop as a consequence of calcified intraluminal cellular debris secondary to a high concentration of calcium in adjacent necrotic cells and from ductal secretions, such as mucin or other calcific product. 31,35
What is ductal carcinoma in situ?
Ductal carcinoma in situ (DCIS) is a common pre-invasive malignancy of the breast, representing approximately 20% of all breast cancer diagnoses. 12 It is widely believed that DCIS is a precursor lesion to invasive ductal carcinoma, but the exact biologic nature is not completely understood and debated by some. 3-5 DCIS is unarguably a heterogeneous disease with variable malignant potential. Evidence shows that high-grade DCIS is an aggressive subtype with an overall poorer prognosis than non-high-grade disease. There have been many studies evaluating the role of the radiologist in the diagnosis of high-grade DCIS with emphasis on radiologic-pathologic correlation using standard mammography and magnetic resonance imaging. Our current understanding of the clinical importance of high-grade DCIS from the perspective of a radiologist and characteristic imaging features are discussed in detail.
How sensitive is breast MRI?
The overalI sensitivity of breast MRI for the detection of all grades of DCIS was previously considered to be relatively low with authors reporting various sensitivity data for DC IS as low as 77%. 44 However, with improved MRI techniques and high spatial resolution, as many as 98% of DCIS cases are now detectable by MRI with an additional 6-23% of mammographically occult DCIS lesions detectable only by MRl. 44,45 This is largely attributed to the enhancement of non-calcified DCIS which cannot be identified with a mammogram. 45
Is DCIS a high grade disease?
Overall, pure DCIS has an excellent prognosis ; however, high-grade DCIS is an aggressive subtype with significantly greater morbidity and risk of mortality with recurrent invasive disease. Appropriate use of mammography and MRI affords radiologists an opportunity to identify this population and guide the most appropriate surgical and oncologic management based upon our current understanding of the disease. Research has extensively evaluated mammographic and MRI features of high-grade DCIS, and its appearances are well documented. Unfortunately, imaging currently shows little prospective value in cases of pure high-grade DCIS beyond the ability to make the initial diagnosis. Future research is necessary to determine the full impact of imaging patients with high-grade disease and to further define the best clinical treatment strategies.
What is a DCIS with microinvasion?
DCIS with microinvasion has an elevated risk of progression to invasive breast cancer. Microinvasion refers to DCIS with an invasive component (beyond the ducts) of less than 1 or 2 mm. Microinvasion is found in 5 to 10% of DCIS cases. The incidence of microinvasion increases with the size and aggressiveness of the DCIS.
What is DCIS in breast cancer?
DCIS that is found together with lobular carcinoma in situ ( LCIS ), the other type of noninvasive breast cancer, is associated with increased risk of progression to invasive breast cancer.
What is the prognosis for ductal carcinoma in situ?
Ductal carcinoma in situ (DCIS) prognosis. Ductal carcinoma in situ ( DCIS) represents approximately 20% of new breast cancer diagnoses. DCIS is classified as non-invasive because the cancer cells are confined to milk ducts and have not spread beyond the duct walls to invade the surrounding tissue.
What are the characteristics of DCIS?
Other characteristics of DCIS associated with increased risk of progression to invasive breast cancer are heightened Ki-67 antigen, over expression of cyclooxygenase-2 (COX-2), and cancerization of lobules. Atypical ductal hyperplasia, which is not considered cancer, is a risk factor for both DCIS and invasive breast cancer.
How long does it take for DCIS to recur?
The negative impact of DCIS recurrence has been underestimated because it takes as many as 15 years of follow up for the impact on survival to become apparent. This may have led to a tendency to de-emphasize the importance of radiation after breast conserving surgery in some cases.
Does alcohol cause breast cancer?
Alcohol consumption is associated with increased risk of both DCIS and invasive breast cancer. The risk of DCIS recurrence or progression to invasive cancer continues for decades and requires active follow up that is likely to include additional diagnostic procedures.
What age is considered a good age to get diagnosed with DCIS?
Young age (under 45) at diagnosis of DCIS is associated with increased risk of progression to invasive breast cancer. On the other hand, old age (over 70) is associated with reduced risk.