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Patología Revista Latinoamericana

2010, Número 3

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Patol Rev Latinoam 2010; 48 (3)


Carcinoma ductal in situ: conceptos actuales

Acs G

Idioma: Ingles.
Referencias bibliográficas: 114
Paginas: 180-193
Archivo PDF: 660.87 Kb.


RESUMEN

El carcinoma ductal in situ incluye un grupo heterogéneo de lesiones con características, alteraciones genéticas, manifestación y comportamiento clínico diversos. Debido al mayor uso de la mastografía de vigilancia, la detección del carcinoma ductal in situ puro se ha incrementado de manera importante. Los criterios diagnósticos del carcinoma ductal in situ dependen del grado de atipia citológica, pero en general incluyen características citonucleares y arquitecturales, la clonalidad de la población celular y la extensión de la lesión. Se han propuesto diversos sistemas de clasificación del carcinoma ductal in situ a fin de predecir la recurrencia de la enfermedad después de la resección quirúrgica, y la mayor parte de los sistemas se basa principalmente en el grado nuclear y, en segundo lugar, en la polarización celular y en la ausencia o presencia de necrosis. Debido a que el estándar de atención actual es la remoción quirúrgica de la lesión, la evolución natural del carcinoma ductal in situ no puede observarse directamente y, en la actualidad, es escasamente entendida. Sin embargo, varias líneas de evidencia apoyan el punto de vista de que el carcinoma ductal in situ sirve como un precursor no obligado de carcinoma invasivo. Debido a su naturaleza típicamente localizada, se ha demostrado que el carcinoma ductal in situ es tratable, en la mayoría de los casos, con escisión sola, generalmente en conjunto con radioterapia coadyuvante, con tasas bajas de recurrencia local. El riesgo de recurrencia depende de las características de la paciente –como el antecedente familiar de cáncer de mama y la edad al momento del diagnóstico– y de los factores del tumor, que incluyen extensión de la enfermedad, el tipo histológico, el grado nuclear, la presencia de comedonecrosis, el patrón arquitectural y el estado de los márgenes de resección. La baja morbilidad de la biopsia del ganglio linfático centinela impulsó el interés de usar esta biopsia en el manejo de pacientes con carcinoma ductal in situ; sin embargo, su uso rutinario en este marco es en la actualidad motivo de intenso debate. Nuestra capacidad de predecir el comportamiento biológico del carcinoma ductal in situ mejorará con el uso de nuevas técnicas moleculares para identificar los biomarcadores específicos, lo que permitirá el manejo óptimo de pacientes con carcinoma ductal in situ.


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