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Patología Revista Latinoamericana

2010, Number 3

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Patol Rev Latinoam 2010; 48 (3)

carcinoma ductal in situ

Acs G

Language: English
References: 114
Page: 180-193
PDF size: 660.87 Kb.


ABSTRACT

Ductal carcinoma in situ (DCIS) includes a heterogeneous group of lesions with diverse morphologic features, genetic alterations, presentation and clinical behavior. Following the increased use of screening mammography the detection of pure DCIS has dramatically increased. Diagnostic criteria for DCIS depend on the degree of cytologic atypia, but in general include cytonuclear and architectural features, clonality of the cell population and extent of the lesion. Numerous classification systems have been proposed for DCIS in order to predict disease recurrence after surgical resection, and most systems are based primarily on nuclear grade and secondarily on cell polarization and the absence or presence of necrosis. Since the current standard of care is surgical removal of the lesion, the natural history of DCIS cannot be directly observed and is currently poorly understood. However, several lines of evidence support the view that DCIS serves as a nonobligate precursor to invasive carcinoma. Due to its typically localized nature, DCIS was shown to be treatable in most cases with excision alone, usually in conjunction with adjuvant radiotherapy, with low rates of local recurrence. The risk of recurrence depends on both patient characteristics, such as family history of breast cancer and age at diagnosis, as well as on tumor factors including extent of disease, histological type, nuclear grade, presence of comedo-type necrosis, architectural pattern and the status of the resection margins. The advent of sentinel lymph node biopsy with its low morbidity prompted interest in its use in the management of patients with DCIS, however its routine use in this setting is currently a matter of intense debate. Our ability to predict the biologic behavior of DCIS will improve with the identification of specific biomarkers using new molecular techniques and will enable optimal management of patients with DCIS.


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