Biological features of ductal carcinoma in situ: clinical role and basis for treatment individualization

Ductal carcinoma in situ (DCIS) is an extremely heterogeneous disease in terms of clinical manifestations, morphological changes, and expression of biomarkers, which determine the risk of subsequent development of an invasive breast cancer (BC). Diagnosis and treatment of DCIS prevents the developme...

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Autores principales:	Irina V. Kolyadina, Anastasia S. Butrimova, Irina V. Poddubnaya, Vlada V. Kоmetova, Valery V. Rodionov
Formato:	article
Lenguaje:	RU
Publicado:	IP Habib O.N. 2021
Materias:	ductal carcinoma in situ ductal carcinoma in situ low grade ductal carcinoma in situ high grade local treatment resection margins van nuys prognostic index adjuvant endocrine therapy Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/6e4ad4f21c5f4565a41b3d1f362f66f3
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spelling	oai:doaj.org-article:6e4ad4f21c5f4565a41b3d1f362f66f32021-11-30T16:55:01ZBiological features of ductal carcinoma in situ: clinical role and basis for treatment individualization1815-14341815-144210.26442/18151434.2021.2.200964https://doaj.org/article/6e4ad4f21c5f4565a41b3d1f362f66f32021-08-01T00:00:00Zhttps://modernonco.orscience.ru/1815-1434/article/viewFile/72310/pdfhttps://doaj.org/toc/1815-1434https://doaj.org/toc/1815-1442Ductal carcinoma in situ (DCIS) is an extremely heterogeneous disease in terms of clinical manifestations, morphological changes, and expression of biomarkers, which determine the risk of subsequent development of an invasive breast cancer (BC). Diagnosis and treatment of DCIS prevents the development of invasive tumors (which reduces the potential risk of death from BC); however, the prognostic value of local treatment depends on the biological characteristics of its. The tumor grade, presence of comedonecrosis and expression of estrogen receptors are the key prognostic factors in DCIS for the treatment tactics and prognosis. The clinical symptoms of DCIS are very scarce, the most of tumors is diagnosed by screening mammography; the typical sign of DCIS is malignant microcalcifications or changes of breast architectonic. The sensitivity of mammography, ultrasound and MRI directly depend on the biological characteristics of DCIS. Surgical treatment (breast-conserving surgery or mastectomy) significantly reduces the risk of BC death in women with DCIS G2/G3, and radiotherapy after breast-conserving surgery reduce the risk of local recurrence of non-invasive and invasive BC. The choice of the local treatment (breast-conserving surgery radiation therapy vs mastectomy) depend on such factors as: tumor size, localization, clear margins, and biological characteristics of DCIS. In contrast to invasive cancers, the negative margin in DCIS is more than 2 mm from the tumor. Regional lymph node involvement in DCIS occurs in less than 1% of cases; however, microinvasion is found in analyze the surgical specimen in 15% of patients, which raises the question about regional staging. Risk factors for microinvasion in DCIS are age less than 55 years, tumor lesion size more than 4.0 cm, DCIS grade G3, and tumor palpability. Adjuvant endocrine therapy with tamoxifen significantly reduces the 10-year risk of invasive recurrence by 51%, the risk of contralateral BC by 50% and the risk of death by 40%, but only for hormone-positive DCIS. HER2 overexpression is found in DCIS significantly often (up to 40% of cases) than in invasive BC, HER2+ status correlates with DCIS high grade G3, the presence of comedonecrosis and with increased risk of relapse (both non-invasive and invasive) but is not a reason for anti-HER2 therapy. DCIS low risk and DCIS high risk have not only different morphological characteristics, but also different models of biological behavior, which must be considered in the different choice of treatment tactics.Irina V. KolyadinaAnastasia S. ButrimovaIrina V. PoddubnayaVlada V. KоmetovaValery V. RodionovIP Habib O.N.articleductal carcinoma in situductal carcinoma in situ low gradeductal carcinoma in situ high gradelocal treatmentresection marginsvan nuys prognostic indexadjuvant endocrine therapyNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282RUСовременная онкология, Vol 23, Iss 2, Pp 263-268 (2021)
institution	DOAJ
collection	DOAJ
language	RU
topic	ductal carcinoma in situ ductal carcinoma in situ low grade ductal carcinoma in situ high grade local treatment resection margins van nuys prognostic index adjuvant endocrine therapy Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	ductal carcinoma in situ ductal carcinoma in situ low grade ductal carcinoma in situ high grade local treatment resection margins van nuys prognostic index adjuvant endocrine therapy Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Irina V. Kolyadina Anastasia S. Butrimova Irina V. Poddubnaya Vlada V. Kоmetova Valery V. Rodionov Biological features of ductal carcinoma in situ: clinical role and basis for treatment individualization
description	Ductal carcinoma in situ (DCIS) is an extremely heterogeneous disease in terms of clinical manifestations, morphological changes, and expression of biomarkers, which determine the risk of subsequent development of an invasive breast cancer (BC). Diagnosis and treatment of DCIS prevents the development of invasive tumors (which reduces the potential risk of death from BC); however, the prognostic value of local treatment depends on the biological characteristics of its. The tumor grade, presence of comedonecrosis and expression of estrogen receptors are the key prognostic factors in DCIS for the treatment tactics and prognosis. The clinical symptoms of DCIS are very scarce, the most of tumors is diagnosed by screening mammography; the typical sign of DCIS is malignant microcalcifications or changes of breast architectonic. The sensitivity of mammography, ultrasound and MRI directly depend on the biological characteristics of DCIS. Surgical treatment (breast-conserving surgery or mastectomy) significantly reduces the risk of BC death in women with DCIS G2/G3, and radiotherapy after breast-conserving surgery reduce the risk of local recurrence of non-invasive and invasive BC. The choice of the local treatment (breast-conserving surgery radiation therapy vs mastectomy) depend on such factors as: tumor size, localization, clear margins, and biological characteristics of DCIS. In contrast to invasive cancers, the negative margin in DCIS is more than 2 mm from the tumor. Regional lymph node involvement in DCIS occurs in less than 1% of cases; however, microinvasion is found in analyze the surgical specimen in 15% of patients, which raises the question about regional staging. Risk factors for microinvasion in DCIS are age less than 55 years, tumor lesion size more than 4.0 cm, DCIS grade G3, and tumor palpability. Adjuvant endocrine therapy with tamoxifen significantly reduces the 10-year risk of invasive recurrence by 51%, the risk of contralateral BC by 50% and the risk of death by 40%, but only for hormone-positive DCIS. HER2 overexpression is found in DCIS significantly often (up to 40% of cases) than in invasive BC, HER2+ status correlates with DCIS high grade G3, the presence of comedonecrosis and with increased risk of relapse (both non-invasive and invasive) but is not a reason for anti-HER2 therapy. DCIS low risk and DCIS high risk have not only different morphological characteristics, but also different models of biological behavior, which must be considered in the different choice of treatment tactics.
format	article
author	Irina V. Kolyadina Anastasia S. Butrimova Irina V. Poddubnaya Vlada V. Kоmetova Valery V. Rodionov
author_facet	Irina V. Kolyadina Anastasia S. Butrimova Irina V. Poddubnaya Vlada V. Kоmetova Valery V. Rodionov
author_sort	Irina V. Kolyadina
title	Biological features of ductal carcinoma in situ: clinical role and basis for treatment individualization
title_short	Biological features of ductal carcinoma in situ: clinical role and basis for treatment individualization
title_full	Biological features of ductal carcinoma in situ: clinical role and basis for treatment individualization
title_fullStr	Biological features of ductal carcinoma in situ: clinical role and basis for treatment individualization
title_full_unstemmed	Biological features of ductal carcinoma in situ: clinical role and basis for treatment individualization
title_sort	biological features of ductal carcinoma in situ: clinical role and basis for treatment individualization
publisher	IP Habib O.N.
publishDate	2021
url	https://doaj.org/article/6e4ad4f21c5f4565a41b3d1f362f66f3
work_keys_str_mv	AT irinavkolyadina biologicalfeaturesofductalcarcinomainsituclinicalroleandbasisfortreatmentindividualization AT anastasiasbutrimova biologicalfeaturesofductalcarcinomainsituclinicalroleandbasisfortreatmentindividualization AT irinavpoddubnaya biologicalfeaturesofductalcarcinomainsituclinicalroleandbasisfortreatmentindividualization AT vladavkometova biologicalfeaturesofductalcarcinomainsituclinicalroleandbasisfortreatmentindividualization AT valeryvrodionov biologicalfeaturesofductalcarcinomainsituclinicalroleandbasisfortreatmentindividualization
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Biological features of ductal carcinoma in situ: clinical role and basis for treatment individualization

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