Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Active Surveillance in the Management of Ductal Carcinoma in Situ: The Radiologist’s Point of View

Version 1 : Received: 30 December 2020 / Approved: 31 December 2020 / Online: 31 December 2020 (12:52:08 CET)

A peer-reviewed article of this Preprint also exists.

Nicosia, L.; Giulio, G.; Bozzini, A.C.; Fanizza, M.; Ballati, F.; Rotili, A.; Lazzeroni, M.; Latronico, A.; Abbate, F.; Renne, G.; Addante, F.; Lucioni, M.; Cassano, E.; Mastropasqua, M.G. Complete Removal of the Lesion as A Guidance in the Management of Patients with Breast Ductal Carcinoma in Situ. Cancers 2021, 13, 868. Nicosia, L.; Giulio, G.; Bozzini, A.C.; Fanizza, M.; Ballati, F.; Rotili, A.; Lazzeroni, M.; Latronico, A.; Abbate, F.; Renne, G.; Addante, F.; Lucioni, M.; Cassano, E.; Mastropasqua, M.G. Complete Removal of the Lesion as A Guidance in the Management of Patients with Breast Ductal Carcinoma in Situ. Cancers 2021, 13, 868.

Journal reference: Cancers 2021, 13, 868
DOI: 10.3390/cancers13040868

Abstract

(1) Background: Considering highly selected patients with ductal carcinoma in situ (DCIS), active surveillance is a valid alternative to surgery. Our study is aimed at showing the reliability of post-biopsy complete lesion removal, documented by mammogram, as additional criterion to select these patients. (2) Methods: 2173 Vacuum Assisted Breast Biopsies (VABB) documented as DCIS have been reviewed. Surgery has been performed in all cases. We retrospectively collected the reports of post-VABB complete lesion removal and the histological results of the biopsy and surgery. We calculated the rate of upgrade of DCIS identified on VABB upon excision for patients with post-biopsy complete lesion removal and for those showing residual lesion. (3) Results: We observed 2173 cases of DCIS: 408 classified as low grade; 1262 as intermediate grade; 503 as high grade. The overall upgrading rate to invasive carcinoma was 15.2% (330/2173). The upgrade rate was significantly lower (8.2%) when considering patients showing mammographically documented complete removal of the lesion. (4) Conclusion: The absence of mammographically documented residual lesion following VABB is associated to a lower upgrading rate of DCIS to invasive carcinoma on surgical excision and should be considered when deciding the proper management DCIS diagnosis.

Keywords

Ductal carcinoma in situ (DCIS); Invasive Breast Carcinoma; Underestimation; Upgrade Rate; Vacuum assisted breast biopsy (VABB); Breast Microcalcifications; Active Surveillance.

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