RESUMO
BACKGROUND: Increasing incidence of ductal carcinoma in situ (DCIS) confronts patients and clinicians with optimal treatment decisions. This multidisciplinary study investigates therapeutic modalities of DCIS in daily practice and provides recommendations on how to increase quality of care. PATIENTS AND METHODS: All women (n = 116) with unilateral DCIS recorded in the Geneva Cancer Registry from 1995 to 1999 were considered. Information concerned patient and tumor characteristics, treatment and outcome. Factors linked to therapy were determined using a case-control approach. Cases were women with treatment of interest and controls other women on the study. RESULTS: Most DCIS cases (62%) were discovered by mammography screening. Ninety (78%) women had breast-conserving surgery (BCS), 18 (16%) mastectomy and seven (6%) bilateral mastectomy. Eight (7%) patients had tumor-positive margins, 18 (16%) lymph node dissection and two (1.7%) chemotherapy. Twenty-five per cent of women with BCS had no radiotherapy, three had radiotherapy after mastectomy. Less than 50% underwent breast reconstruction after mastectomy. Method of discovery, multifocality, tumor localization, size and differentiation were linked to the use of BCS or lymph node dissection. CONCLUSIONS: Because of important disparities in DCIS management, recommendations are made to increase quality of care, in particular to prevent axillary dissection or bilateral mastectomy and to increase the use of radiotherapy after BCS.
Assuntos
Neoplasias da Mama/terapia , Carcinoma Intraductal não Infiltrante/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/diagnóstico , Carcinoma Intraductal não Infiltrante/diagnóstico , Estudos de Casos e Controles , Diferenciação Celular , Terapia Combinada , Progressão da Doença , Feminino , Humanos , Excisão de Linfonodo , Mamografia , Mastectomia Segmentar , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Vigilância da População , Qualidade de Vida , Sistema de Registros , Fatores de Risco , Fatores SocioeconômicosRESUMO
Mucoepidermoid tumors of the lung are extremely uncommon. Like the considerably more common mucoepidermoid tumors of the salivary glands, their histology is characterized by two components: a glandular mucoid element and an epidermoid element. The degree of malignancy is still a subject of discussion, but as with mucoepidermoid tumors of the salivary glands, mucoepidermoid carcinomas of the bronchus may be of either high or low-grade malignancy. The three cases reported here were of high-grade malignancy and metastasized irrespective of the degree of cellular differenciation. We have concluded that mucoepidermoid lung tumors should be considered as malignant lesions and the treatment has to consist in radical resection.