The Diagnosis and Treatment of Ductal Carcinoma In Situ of the Breast

Kim, Seong Hwan; Lee, Sang Dal; Lee, Hae Kyung; Nam, Suk Jin; Yang, Jung Hyun

Abstract

BACKGROUND: Ductal carcinoma in situ (DCIS) of the breast has been considered a relative rare form of breast cancer because its diagnosis was difficult, but the widespread use of screening mammography makes it easy to detect breast disease and there has been marked increase in the incidence of DCIS. But the exact diagnosis and treatment are controversial.
METHODS
We reviewed the clinical records of 55 cases with DCIS treated at the Department of Surgery, Samsung Medical Center, between September 1994 and December 1997. If microinvasion was noted, the case was excluded from this study.
RESULTS
The incidence of DCIS was 11.5% of all breast cancer (55 out of 477) with increasing tendency from 1995 to 1997. DCIS was most prevalent in women who were in their fifth decade, and the mean age was 47 years old. Chief complaints were palpable breast masses in 22 (40%) cases, mammographic abnormalities in 21 (38%), abnormal nipple discharge in 7 (13%), and others in 5 (9%). The most common mammographic finding was microcalcifications in 38 (78%) cases, but mass density and architectural distortion were also noted in a small percertage. Diagnostic methods for preoperative pathology were Fine Needle Aspiration (FNA) cytology in 15 (27%) cases, localization and excisional biopsy in 17 (31%), excisional biopsy in 12 (22%), incisional biopsy in 5 (9%), stereotactic core biopsy in 3 (5%), US guided biopsy in 2 (4%), and ABBI (Advanced Breast Biopsy Instrument) biopsy in 1 (2%). If the chief complaint was a palpable mass, FNA was the diagnostic choice. On the other hand, if the problem was mammographic abnormalities, localization and excisional biopsy was preferred. The surgical procedures were modified radical mastectomy in 17 (31%) cases, total mastectomy in 21 (38%), lumpectomy with axillary lymph node dissection in 7 (13%), and lumpectomy only in 10 (18%). If preoperative histology revealed the tumor of comedo type, mastectomy was preferred, but in case ofnon-comedo type, conservative surgery was preferred. Conservative surgery was followed by radiation therapy. Cancers were subclassified according to their histologic subtypes in 51 cases, and comedo type was most common (42%). Prevalent sizes of the masses were less than 2 cm, and the biggest one was 9 cm. There was one case (2%) of lymph node metastasis. It was comedo type and the size of the tumor was 9 cm.
CONCLUSIONS
The widespread use of screening mammography and various other diagnostic methods will increase the chance of detecting DCIS, and conservative surgery will be performed more frequently in selected groups of patients.