Analyzing the Risk of Recurrence after Mastectomy for DCIS: A New Use for the USC/Van Nuys Prognostic Index.
Summary of "Analyzing the Risk of Recurrence after Mastectomy for DCIS: A New Use for the USC/Van Nuys Prognostic Index."
Patients with ductal carcinoma in situ (DCIS) who are treated with mastectomy seldom recur locally or with metastatic disease. When patients with DCIS recur with invasive cancer, they are upstaged and their lives are threatened. We questioned whether histopathologic data could be used to predict these infrequent events.
We reviewed a prospective database of 1,472 patients with pure DCIS. All patients were scored from 4 to 12 using the USC Van Nuys Prognostic Index, an algorithm based on DCIS size, nuclear grade, necrosis, margin width, and patient age. Probabilities of recurrence and death were calculated using the Kaplan-Meier method.
A total of 496 patients with pure DCIS were treated with mastectomy. None received any form of postmastectomy adjuvant treatment. Average follow-up was 83 months. Eleven patients developed recurrences, all of whom scored 10-12 using the USC/VNPI. No patient who scored 4-9 recurred. All 11 patients who recurred had multifocal disease and comedo-type necrosis. The probability of disease recurrence after mastectomy for patients scoring 10-12 was 9.6% at 12 years, compared with 0% for those scoring 4-9. There was no difference in overall survival.
There were no recurrences among mastectomy patients who scored 4-9 using the USC/VNPI. Patients scoring 10-12 were significantly more likely to develop recurrence after mastectomy. At risk were young patients with large, high-grade, and multifocal or multicentric tumors. For every 100 patients with USC/VNPI scores of 10-12, 10 patients will recur by 12 years and 2-3 will develop metastatic disease.
Department of Surgical Oncology, University of Southern California, Los Angeles, USA, email@example.com.
This article was published in the following journal.
Name: Annals of surgical oncology
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20859695
- DOI: http://dx.doi.org/10.1245/s10434-010-1335-2
Abstract Diagnose of ductal carcinoma in situ (DCIS) requires, at least in a part of cases, assessment of auxiliary lymph nodes. The aim of the study was to analyze clinical value of Van Nuys Prognost...
The management of ductal carcinoma in situ (DCIS) can be controversial. Widespread adoption of mammographic screening has made DCIS a more frequent diagnosis, and increasingly smaller, lower-grade les...
Despite lack of survival benefit, an increasing number of women diagnosed with ductal carcinoma in situ (DCIS) opt for removal of the unaffected breast in addition to the breast with known pathology, ...
Low rates of locoregional recurrence (LRR) in patients with clinical stage IIB breast cancer (cT2N1 or cT3N0) who undergo neoadjuvant therapy (NAT) and mastectomy have been reported. We aimed to quant...
The introduction of mammographic screening has considerably increased the detection rate of ductal carcinoma in situ (DCIS), which has a high probability of recurrence. We carried out a meta-analysis ...
Primary Objectives: - To prospectively evaluate the feasibility of nipple-areolar complex (NAC) sparing mastectomy as an alternative procedure to skin-sparing mastectomy for patie...
This is a registry for patients who have a risk-reduction mastectomy ("prophylactic mastectomy") due to being at high risk for developing breast cancer, followed by breast reconstruction. ...
The purpose of this study is to determine whether adding an educational intervention, in the form of a decision board, which outlines the risks and benefits of treatment options for DCIS, ...
Aims: - To refine treatment selection for women with non-low risk DCIS to optimise disease control & minimize toxicity - Clinical: To evaluate outcomes after breast cons...
The purpose of this study is to observe the cosmetic outcomes, patient satisfaction, and complications after skin sparing mastectomy with preservation of the nipple areolar complex. These...
Medical and Biotech [MESH] Definitions
Total mastectomy with axillary node dissection, but with preservation of the pectoral muscles.
Radical mastectomy with removal of the ipsilateral half of the sternum and a portion of ribs two through five with the underlying pleura and the internal mammary lymph nodes.
The local recurrence of a neoplasm following treatment. It arises from microscopic cells of the original neoplasm that have escaped therapeutic intervention and later become clinically visible at the original site.
Reduction of high-risk choices and adoption of low-risk quantity and frequency alternatives.