Surgical management of ductal carcinoma in situ of the breast: A large retrospective study from a single institution.
BACKGROUND
Management of breast ductal carcinoma in situ (DCIS) has various approaches with distinct institutional specific practice. Here, we review DCIS management in a single institution with emphasize on re-operation rates and outcome.


METHODS
Breast ductal carcinoma in situ cases diagnosed at the Nottingham Breast Institute between 1987 and 2017 were identified (n = 1249). Clinicopathological data were collected. Cases were histologically reviewed, and different factors associated with primary operation selection, re-excision, presence of residual tumor in the re-excision specimens, use of radiotherapy and ipsilateral recurrences were analyzed.


RESULTS
34% of DCIS patients were initially treated by mastectomy and were more frequently symptomatic, of high nuclear tumor grade, size >40 mm, and associated with comedo necrosis and Paget's disease of the nipple. Further surgery was due to involved or narrow surgical margins. Residual tumor tissue was detected in 53% of the re-excision specimens. Re-excision rates of patients treated with breast-conserving surgery (BCS) were reduced from approximately 70% to 23%, and the final mastectomy rates decreased from 60% to 20%. Changes in surgical practice with acceptance of smaller excision margins and more frequent use of local radiotherapy have led to a significant decrease not only in the re-excision rate but also in the final mastectomy rate together with non-significant reduction in 5- and 10-year local recurrence rates.


CONCLUSION
Although BCS is increasingly the preferred primary surgical option for DCIS management, a proportion of low-risk DCIS patients continue to undergo re-excision surgery or completion mastectomy. Despite acceptance of smaller margins, recurrence rate is decreasing.
['Miligy|Islam M|IM|', 'Toss|Michael S|MS|0000-0002-9077-3984', 'Khout|Hazem|H|', 'Whisker|Lisa|L|', 'Burrell|Helen C|HC|', 'Ellis|Ian O|IO|', 'Green|Andrew R|AR|', 'Macmillan|Douglas|D|', 'Rakha|Emad A|EA|0000-0002-5009-5525']
D000328:Adult D000368:Aged D001943:Breast Neoplasms D002285:Carcinoma, Intraductal, Noninfiltrating D005260:Female D006801:Humans D000072662:Margins of Excision D015412:Mastectomy, Segmental D008875:Middle Aged D012086:Reoperation D012189:Retrospective Studies
management ductal carcinoma in situ re-excision mastectomy breast-conserving surgery