Is it possible to predict underestimation in ductal carcinoma in situ of the breast? Yes, using a simple score!

BACKGROUND: Approximately 30% of patients with an initial diagnosis of ductal carcinoma ductal in situ (DCIS) present stromal invasion in the final surgical specimen. This study aimed to describe the prevalence of upstaging in women with an initial diagnosis of pure DCIS and identify predictive factors of invasion. METHODS: This is a cross-sectional study including patients with an initial unilateral DCIS diagnosed through needle core or vacuum-assisted biopsy. All patients were submitted to surgical excision. Clinical, radiological and histological variables were retrospectively collected from our medical records. RESULTS: A total of 169 biopsies diagnosed with DCIS were included in this study. 53 patients presented upstaging for invasive carcinoma (31.4%). In the univariate analysis the following variables were significantly associated with invasive breast carcinoma (IBC) at final diagnosis: age < 46 years, the presence of a palpable mass, type of biopsy, nuclear grade, and comedonecrosis. The frequency of upstaging did not vary according to the tumor size or menopausal status. In the multivariate analysis, only the type of biopsy and the presence of comedonecrosis remained as independent predictors of invasion. Our score attributed specific points according to the type of biopsy and the presence of comedonecrosis, ranging from 0 to 2.5, showing a very good predictive ability. CONCLUSIONS: We were able to identify that the type of biopsy and comedonecrosis are predictive factors of stromal invasion among women with DCIS. The proposed score has shown a good predictive ability and its utilization in the clinical practice can improve therapeutic planning.

The safe association of intraoperative evaluation of surgical margins and neoadjuvant chemotherapy in breast cancer larger than 3 centimeters.

OBJECTIVES AND BACKGROUND: The objective of the present study was to determine whether neoadjuvant chemotherapy in women with breast cancer larger than 3 cm associated with breast-conserving surgery plus intraoperative evaluation of surgical margins is safe. METHODS: A total of 164 patients with breast cancer larger than 3 cm in diameter were submitted to neoadjuvant chemotherapy between 1992 and 1998 and followed until 2003. We used neoadjuvant chemotherapy in pulses at 21-day intervals with 5-fluorouracil (500 mg/m2), epirubicin (50 mg/m2) and cyclophosphamide (500 mg/m2) (FEC). Initially, 3 cycles of chemotherapy were administered, followed by surgery and 6 additional chemotherhapy cycles. During surgery, an evaluation of the surgical margins was performed. RESULTS: Quadrantectomy was performed in 102 patients (62.2%) and mastectomy in 62 (37.8%). Local recurrence in 8 patients, metastasis in 37, and 21 deaths were observed. The curves of local recurrence for quadrantectomy and mastectomy were similar (P = 0.654 and P = 0.841, respectively), and so were the numbers of local recurrence (P = 0.4438). The curves of disease-free survival for quadrantectomy and mastectomy were different (P = 0.034 and P = 0.033, respectively). However, no statistically significant difference was observed in the number of events (P = 0.1283). A statistically significant difference was observed for the curves (P = 0.001 and P = 0.000) and the number (P = 0.0034) of deaths between patients undergoing quadrantectomy or mastectomy. CONCLUSIONS: Neoadjuvant chemotherapy can reduce surgery complexity and is safe when associated with intraoperative evaluation of the surgical margins, without changing the local recurrence rate, disease-free survival, and overall survival.