Behaviour and characteristics of low‐grade ductal carcinoma in situ of the breast: literature review and single centre retrospective series

Abstract

Aims

Ductal carcinoma in situ (DCIS) of the breast is a heterogeneous disease that has risen to prominence and more recently controversy, with the advent of screening mammography. Debate about the true biological potential of low nuclear grade DCIS continues to challenge therapeutic considerations. In this study, we carried out a comprehensive literature review of the behaviour, outcomes and current management trials of low‐grade DCIS, as well as a retrospective study of a large single institutional series of low‐grade DCIS diagnosed at our hospital.

Methodology

The study cohort comprised 195 cases of low‐grade DCIS diagnosed at the Singapore General Hospital from 1994‐2010. Clinicopathological parameters and follow‐up data were retrieved and compared between screen‐detected and symptomatic low‐grade DCIS. Immunohistochemistry was performed for ER, PR, and HER2.

Results

Amongst 195 cases, 123 (63.1%) were screen‐detected, while 72 (36.9%) were symptomatic. Screen‐detected cases had frequent calcifications (p<0.001) and were smaller (p=0.018) than symptomatic cases. All cases were ER positive and rate of PR expression was high. No HER2 overexpression was observed. Mean and median follow‐up were 107.8 and 109.6 months respectively. Six patients recurred ipsilaterally, and 1 patient developed direct distant metastasis. One breast cancer‐related death was recorded. Positive surgical margins (p=0.023) were significantly associated with a higher risk of ipsilateral recurrences, as well as poorer disease‐free survivals (p=0.010).

Conclusion

Our data indicate that low‐grade DCIS may be followed by invasive recurrences and even metastatic disease, requiring more study before being regarded as innocuous and indolent.

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