Top

Published in:

01-06-2013 | Review

Clinicopathologic, mammographic, and sonographic features in 1,187 patients with pure ductal carcinoma in situ of the breast by estrogen receptor status

Authors: Gaiane M. Rauch, Henry M. Kuerer, Marion E. Scoggins, Patricia S. Fox, Ana P. Benveniste, Young Mi Park, Sara A. Lari, Brian P. Hobbs, Beatriz E. Adrada, Savitri Krishnamurthy, Wei T. Yang

Published in: Breast Cancer Research and Treatment | Issue 3/2013

Abstract

The clinicopathologic, mammographic, and sonographic findings in patients with pure ductal carcinoma in situ (DCIS) were assessed by estrogen receptor (ER) expression. After institutional review board approval, patients with pure DCIS evaluated from January 1996 to July 2009 with known ER status and available imaging were identified. Images were reviewed as per the ACR BI-RADS^® lexicon (4th edition). Clinical, pathologic, and imaging characteristics were analyzed by ER status using t test, Chi square test, and Fisher’s exact test. Of 1,219 patients with pure DCIS and known ER status identified, 1,187 with complete data were included. Mammography was performed in all 1,187 patients and sonography in 519 (44 %). There were 972 (82 %) patients with ER-positive and 215 (18 %) with ER-negative disease. ER-negative DCIS was more likely to be high grade (93 vs 44 %, p < 0.0001), associated with comedonecrosis (64 vs 29 %, p < 0.0001), and multifocal (23 vs 15 %, p = 0.009). On sonography, ER-negative DCIS was more likely to be visible (61 vs 46 %, p = 0.004), larger (mean size, 2.3 vs 1.6 cm, p = 0.006), and show posterior shadowing (53 vs 28 %, p = 0.006). Mastectomy was more frequently performed for ER-negative DCIS (47 vs 37 %, p = 0.008). Palpable DCIS was visible on sonography in 55 % of cases and mammography in 81 %. Compared with ER-positive palpable DCIS, ER-negative palpable DCIS was larger and more likely to be visible on sonography. Compared with ER-positive noncalcified DCIS, ER-negative noncalcified DCIS was less likely to be visible on mammography. ER-positive and ER-negative pure DCIS have different clinicopathologic and imaging characteristics. ER-negative DCIS is associated with worse prognostic factors than ER-positive DCIS. On sonography, ER-negative DCIS is more frequently visible than ER-positive DCIS, tends to be larger, and more frequently demonstrates posterior shadowing.

Kuerer HM, Albarracin CT, Yang WT, Cardiff RD, Brewster AM, Symmans WF, Hylton NM, Middleton LP, Krishnamurthy S, Perkins GH, Babiera G, Edgerton ME, Czerniecki BJ, Arun BK, Hortobagyi GN (2009) Ductal carcinoma in situ: state of the science and roadmap to advance the field. J Clin Oncol 27:279–288. doi:10.1200/JCO.2008.18.3103 PubMedCrossRef

Virnig BA, Tuttle TM, Shamliyan T, Kane RL (2010) Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes. J Natl Cancer Inst 102:170–178. doi:10.1093/jnci/djp482 PubMedCrossRef

Ernster VL, Ballard-Barbash R, Barlow WE, Zheng Y, Weaver DL, Cutter G, Yankaskas BC, Rosenberg R, Carney PA, Kerlikowske K, Taplin SH, Urban N, Geller BM (2002) Detection of ductal carcinoma in situ in women undergoing screening mammography. J Natl Cancer Inst 94:1546–1554PubMedCrossRef

Jemal A, Murray T, Ward E, Samuels A, Tiwari RC, Ghafoor A, Feuer EJ, Thun MJ (2005) Cancer statistics. CA Cancer J Clin 55:10–30PubMedCrossRef

Boughey JC, Gonzalez RJ, Bonner E, Kuerer HM (2007) Current treatment and clinical trial developments for ductal carcinoma in situ of the breast. Oncologist 12:1276–1287. doi:10.1634/theoncologist.12-11-1276 PubMedCrossRef

Roses RE, Arun BK, Lari SA, Mittendorf EA, Lucci A, Hunt KK, Kuerer HM (2011) Ductal carcinoma-in situ of the breast with subsequent distant metastasis and death. Ann Surg Oncol 18:2873–2878. doi:10.1245/s10434-011-1707-2 PubMedCrossRef

MacDonald HR, Silverstein MJ, Mabry H, Moorthy B, Ye W, Epstein MS, Holmes D, Silberman H, Lagios M (2005) Local control in ductal carcinoma in situ treated by excision alone: incremental benefit of larger margins. Am J Surg 190:521–525. doi:10.1016/j.amjsurg.2005.06.005 PubMedCrossRef

Tabar L, Tony Chen HH, Amy Yen MF, Tot T, Tung TH, Chen LS, Chiu YH, Duffy SW, Smith RA (2004) Mammographic tumor features can predict long-term outcomes reliably in women with 1–14-mm invasive breast carcinoma. Cancer 101:1745–1759. doi:10.1002/cncr.20582 PubMedCrossRef

Yi M, Krishnamurthy S, Kuerer HM, Meric-Bernstam F, Bedrosian I, Ross MI, Ames FC, Lucci A, Hwang RF, Hunt KK (2008) Role of primary tumor characteristics in predicting positive sentinel lymph nodes in patients with ductal carcinoma in situ or microinvasive breast cancer. Am J Surg 196:81–87. doi:10.1016/j.amjsurg.2007.08.057 PubMedCrossRef

10.

Stomper PC, Margolin FR (1994) Ductal carcinoma in situ: the mammographer’s perspective. AJR Am J Roentgenol 162:585–591. doi:10.2214/ajr.162.3.8109501 PubMedCrossRef

11.

Barreau B, de Mascarel I, Feuga C, MacGrogan G, Dilhuydy MH, Picot V, Dilhuydy JM, de Lara CT, Bussieres E, Schreer I (2005) Mammography of ductal carcinoma in situ of the breast: review of 909 cases with radiographic-pathologic correlations. Eur J Radiol 54:55–61. doi:10.1016/j.ejrad.2004.11.019 PubMedCrossRef

12.

Zunzunegui RG, Chung MA, Oruwari J, Golding D, Marchant DJ, Cady B (2003) Casting-type calcifications with invasion and high-grade ductal carcinoma in situ: a more aggressive disease? Arch Surg 138:537–540. doi:10.1001/archsurg.138.5.537 PubMedCrossRef

13.

Yang WT, Tse GM (2004) Sonographic, mammographic, and histopathologic correlation of symptomatic ductal carcinoma in situ. AJR Am J Roentgenol 182:101–110. doi:10.2214/ajr.182.1.1820101 PubMedCrossRef

14.

Sorlie T, Tibshirani R, Parker J, Hastie T, Marron JS, Nobel A, Deng S, Johnsen H, Pesich R, Geisler S, Demeter J, Perou CM, Lonning PE, Brown PO, Borresen-Dale AL, Botstein D (2003) Repeated observation of breast tumor subtypes in independent gene expression data sets. Proc Natl Acad Sci USA 100:8418–8423. doi:10.1073/pnas.0932692100 PubMedCrossRef

15.

Prat A, Perou CM (2011) Deconstructing the molecular portraits of breast cancer. Mol Oncol 5:5–23. doi:10.1016/j.molonc.2010.11.003 PubMedCrossRef

16.

Lari SA, Kuerer HM (2011) Biological markers in DCIS and risk of breast recurrence: a systematic review. J Cancer 2:232–261PubMedCrossRef

17.

Altintas S, Lambein K, Huizing MT, Braems G, Asjoe FT, Hellemans H, Van Marck E, Weyler J, Praet M, Van den Broecke R, Vermorken JB, Tjalma WA (2009) Prognostic significance of oncogenic markers in ductal carcinoma in situ of the breast: a clinicopathologic study. Breast J 15:120–132. doi:10.1111/j.1524-4741.2009.00686.x PubMedCrossRef

18.

Bijker N, Peterse JL, Duchateau L, Robanus-Maandag EC, Bosch CA, Duval C, Pilotti S, van de Vijver MJ (2001) Histological type and marker expression of the primary tumour compared with its local recurrence after breast-conserving therapy for ductal carcinoma in situ. Br J Cancer 84:539–544. doi:10.1054/bjoc.2000.1618 PubMedCrossRef

19.

Claus EB, Chu P, Howe CL, Davison TL, Stern DF, Carter D, DiGiovanna MP (2001) Pathobiologic findings in DCIS of the breast: morphologic features, angiogenesis, HER-2/neu and hormone receptors. Exp Mol Pathol 70:303–316. doi:10.1006/exmp.2001.2366 PubMedCrossRef

20.

Collins LC, Schnitt SJ (2005) HER2 protein overexpression in estrogen receptor-positive ductal carcinoma in situ of the breast: frequency and implications for tamoxifen therapy. Mod Pathol 18:615–620. doi:10.1038/modpathol.3800360 PubMedCrossRef

21.

Hanley K, Wang J, Bourne P, Yang Q, Gao AC, Lyman G, Tang P (2008) Lack of expression of androgen receptor may play a critical role in transformation from in situ to invasive basal subtype of high-grade ductal carcinoma of the breast. Hum Pathol 39:386–392. doi:10.1016/j.humpath.2007.07.007 PubMedCrossRef

22.

Lebeau A, Unholzer A, Amann G, Kronawitter M, Bauerfeind I, Sendelhofert A, Iff A, Lohrs U (2003) EGFR, HER-2/neu, cyclin D1, p21 and p53 in correlation to cell proliferation and steroid hormone receptor status in ductal carcinoma in situ of the breast. Breast Cancer Res Treat 79:187–198PubMedCrossRef

23.

Lebrecht A, Buchmann J, Hefler L, Lampe D, Koelbl H (2002) Histological category and expression of hormone receptors in ductal carcinoma in situ of the breast. Anticancer Res 22:1909–1911PubMed

24.

Meijnen P, Peterse JL, Antonini N, Rutgers EJ, van de Vijver MJ (2008) Immunohistochemical categorization of ductal carcinoma in situ of the breast. Br J Cancer 98:137–142. doi:10.1038/sj.bjc.6604112 PubMedCrossRef

25.

Kerlikowske K, Molinaro AM, Gauthier ML, Berman HK, Waldman F, Bennington J, Sanchez H, Jimenez C, Stewart K, Chew K, Ljung BM, Tlsty TD (2010) Biomarker expression and risk of subsequent tumors after initial ductal carcinoma in situ diagnosis. J Natl Cancer Inst 102:627–637. doi:10.1093/jnci/djq101 PubMedCrossRef

26.

Provenzano E, Hopper JL, Giles GG, Marr G, Venter DJ, Armes JE (2003) Biological markers that predict clinical recurrence in ductal carcinoma in situ of the breast. Eur J Cancer 39:622–630PubMedCrossRef

27.

Ringberg A, Anagnostaki L, Anderson H, Idvall I, Ferno M (2001) Cell biological factors in ductal carcinoma in situ (DCIS) of the breast-relationship to ipsilateral local recurrence and histopathological characteristics. Eur J Cancer 37:1514–1522PubMedCrossRef

28.

Roka S, Rudas M, Taucher S, Dubsky P, Bachleitner-Hofmann T, Kandioler D, Gnant M, Jakesz R (2004) High nuclear grade and negative estrogen receptor are significant risk factors for recurrence in DCIS. Eur J Surg Oncol 30:243–247. doi:10.1016/j.ejso.2003.11.004 PubMedCrossRef

29.

Kojima Y, Tsunoda H, Honda S, Kikuchi M, Kawauchi N, Yoshida A, Yagata H, Yamauchi H, Suzuki K (2011) Radiographic features for triple negative ductal carcinoma in situ of the breast. Breast Cancer 18:213–220. doi:10.1007/s12282-011-0261-x PubMedCrossRef

30.

D’Orsi C, Mendelson EB, Ikeda D (2003) Breast imaging reporting and data system: ACR BI-RADS - Breast Imaging Atlas. American College of Radiology, Reston

31.

Mendelson EB, Baum J, Berg W (2003) BI-RADS: Ultrasound, 1st edition. In: D’Orsi CJ, Mendelson EB, Ikeda DM et al (eds) Breast imaging reporting and data system: ACR BI-RADS-Breast Imaging Atlas. American College of Radiology, Reston

32.

Samardar P, de Paredes ES, Grimes MM, Wilson JD (2002) Focal asymmetric densities seen at mammography: US and pathologic correlation. Radiographics 22:19–33PubMed

33.

Takei J, Tsunoda-Shimizu H, Kikuchi M, Kawasaki T, Yagata H, Tsugawa K, Suzuki K, Nakamura S, Saida Y (2009) Clinical implications of architectural distortion visualized by breast ultrasonography. Breast Cancer 16:132–135. doi:10.1007/s12282-008-0085-5 PubMedCrossRef

34.

Allegra CJ, Aberle DR, Ganschow P, Hahn SM, Lee CN, Millon-Underwood S, Pike MC, Reed SD, Saftlas AF, Scarvalone SA, Schwartz AM, Slomski C, Yothers G, Zon R (2010) National Institutes of Health State-of-the-Science Conference statement: diagnosis and management of ductal carcinoma in situ. September 22–24, 2009. J Natl Cancer Inst 102:161–169. doi:10.1093/jnci/djp485 PubMedCrossRef

35.

Chen YY, DeVries S, Anderson J, Lessing J, Swain R, Chin K, Shim V, Esserman LJ, Waldman FM, Hwang ES (2009) Pathologic and biologic response to preoperative endocrine therapy in patients with ER-positive ductal carcinoma in situ. BMC Cancer 9:285. doi:10.1186/1471-2407-9-285 PubMedCrossRef

36.

Cuzick J, Sestak I, Pinder SE, Ellis IO, Forsyth S, Bundred NJ, Forbes JF, Bishop H, Fentiman IS, George WD (2011) Effect of tamoxifen and radiotherapy in women with locally excised ductal carcinoma in situ: long-term results from the UK/ANZ DCIS trial. Lancet Oncol 12:21–29. doi:10.1016/S1470-2045(10)70266-7 PubMedCrossRef

37.

Eng-Wong J, Costantino JP, Swain SM (2010) The impact of systemic therapy following ductal carcinoma in situ. J Natl Cancer Inst Monogr 41:200–203. doi:10.1093/jncimonographs/lgq021 CrossRef

38.

Kuerer HM (2011) Rational individualised selection of adjuvant therapy for ductal carcinoma in situ. Lancet Oncol 12:2–3. doi:10.1016/S1470-2045(10)70277-1 PubMedCrossRef

39.

Hayward L, Oeppen RS, Grima AV, Royle GT, Rubin CM, Cutress RI (2011) The influence of clinicopathological features on the predictive accuracy of conventional breast imaging in determining the extent of screen-detected high-grade pure ductal carcinoma in situ. Ann R Coll Surg Engl 93:385–390. doi:10.1308/003588411X579829 PubMedCrossRef

40.

Hofvind S, Iversen BF, Eriksen L, Styr BM, Kjellevold K, Kurz KD (2011) Mammographic morphology and distribution of calcifications in ductal carcinoma in situ diagnosed in organized screening. Acta Radiol 52:481–487. doi:10.1258/ar.2011.100357 PubMedCrossRef

41.

Mansson E, Bergkvist L, Christenson G, Persson C, Warnberg F (2009) Mammographic casting-type calcifications is not a prognostic factor in unifocal small invasive breast cancer: a population-based retrospective cohort study. J Surg Oncol 100:670–674. doi:10.1002/jso.21405 PubMedCrossRef

42.

Burnside ES, Ochsner JE, Fowler KJ, Fine JP, Salkowski LR, Rubin DL, Sisney GA (2007) Use of microcalcification descriptors in BI-RADS 4th edition to stratify risk of malignancy. Radiology 242:388–395. doi:10.1148/radiol.2422052130 PubMedCrossRef

43.

Holland R, Hendriks JH (1994) Microcalcifications associated with ductal carcinoma in situ: mammographic-pathologic correlation. Semin Diagn Pathol 11:181–192PubMed

44.

Poplack SP, Wells WA (1998) Ductal carcinoma in situ of the breast: mammographic-pathologic correlation. AJR Am J Roentgenol 170:1543–1549. doi:10.2214/ajr.170.6.9609171 PubMedCrossRef

45.

Albonico G, Querzoli P, Ferretti S, Rinaldi R, Nenci I (1998) Biological profile of in situ breast cancer investigated by immunohistochemical technique. Cancer Detect Prev 22:313–318PubMedCrossRef

46.

Moon WK, Myung JS, Lee YJ, Park IA, Noh DY, Im JG (2002) US of ductal carcinoma in situ. Radiographics 22:269–280PubMed

47.

Mesurolle B, El-Khoury M, Khetani K, Abdullah N, Joseph L, Kao E (2009) Mammographically non-calcified ductal carcinoma in situ: sonographic features with pathological correlation in 35 patients. Clin Radiol 64:628–636. doi:10.1016/j.crad.2008.12.013 PubMedCrossRef

Title: Clinicopathologic, mammographic, and sonographic features in 1,187 patients with pure ductal carcinoma in situ of the breast by estrogen receptor status
Authors: Gaiane M. Rauch
Henry M. Kuerer
Marion E. Scoggins
Patricia S. Fox
Ana P. Benveniste
Young Mi Park
Sara A. Lari
Brian P. Hobbs
Beatriz E. Adrada
Savitri Krishnamurthy
Wei T. Yang
Publication date: 01-06-2013
Publisher: Springer US
Published in: Breast Cancer Research and Treatment / Issue 3/2013
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-013-2598-7

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2013

Unjustified prescribing of CYP2D6 inhibiting SSRIs in women treated with tamoxifen

Plasma enterolactone and breast cancer risk in the Nurses’ Health Study II

Androgen metabolite-dependent growth of hormone receptor-positive breast cancer as a possible aromatase inhibitor-resistance mechanism

Serum thymidine kinase activity compared with CA 15-3 in locally advanced and metastatic breast cancer within a randomized trial

Differential characteristics of heart, liver, and brain metastatic subsets of murine breast carcinoma

CYP2C19*2 predicts substantial tamoxifen benefit in postmenopausal breast cancer patients randomized between adjuvant tamoxifen and no systemic treatment

Keynote webinar | Spotlight on antibody–drug conjugates in cancer