The London Breast Institute, The Princess Grace Hospital, London, UK.
Surg Oncol. 2011 Mar;20(1):e23-31. doi: 10.1016/j.suronc.2010.08.007. Epub 2010 Nov 24.
Ductal carcinoma in-situ (DCIS) is a heterogeneous entity with an elusive natural history. The objective of radiological, histological and molecular characterisation remains to reliably predict the biological behaviour and optimise clinical management strategies. Increases in diagnostic frequency have followed the introduction of mammographic screening and increased utility of magnetic resonance imaging. However, progress remains limited in distinguishing non-progressive incidental lesions from their progressive and clinically relevant counterparts. This article reviews current management strategies for DCIS in the context of recent randomized trials, including the role of sentinel lymph node biopsy (SLNB), adjuvant radiotherapy (RT) and endocrine treatment.
Literature review facilitated by Medline, PubMed, Embase and Cochrane databases.
DCIS should be managed in the context of a multidisciplinary team. Local control depends upon adequate surgical clearance with margins of at least 2 mm. SLNB is not routinely indicated and should be reserved for those with concurrent or recurrent invasive disease. SLNB can be considered in patients undergoing mastectomy (MX) and those with risk factors for invasion such as palpability, comedo morphology, necrosis or recurrent disease. RT following BCS significantly reduces local recurrence (LR), particularly in those at high-risk. There remains a lack of level-1 evidence supporting the omission of adjuvant RT in selected low-risk cases. Large, multi-centric or recurrent lesions (particularly in cases of prior RT) should be treated by MX with the opportunity for immediate reconstruction. Adjuvant Tamoxifen may reduce the risk of LR in selected cases with hormone sensitive disease.
Further research is required to determine the role of contemporary RT regimes and endocrine therapies. Biological profiling and molecular analysis represent an opportunity to improve our understanding of the tumour biology of this condition and rationalise its treatment. Reliable identification of low-risk lesions could allow treatment to be less radical or safely omitted.
导管原位癌（DCIS）是一种异质性实体，其自然病史难以捉摸。放射学、组织学和分子特征的目标仍然是可靠地预测生物学行为并优化临床管理策略。随着乳腺 X 线筛查的引入和磁共振成像的广泛应用，诊断频率不断增加。然而，在区分非进展性偶发病变与进展性和临床相关病变方面，进展仍然有限。本文综述了最近随机试验中 DCIS 的当前管理策略，包括前哨淋巴结活检（SLNB）、辅助放疗（RT）和内分泌治疗的作用。
通过 Medline、PubMed、Embase 和 Cochrane 数据库进行文献回顾。
DCIS 应在多学科团队的背景下进行管理。局部控制取决于充分的手术清除，切缘至少 2mm。SLNB 通常不适用，应保留给同时或复发浸润性疾病的患者。SLNB 可考虑用于接受乳房切除术（MX）的患者和有浸润风险因素的患者，如可触及性、粉刺样形态、坏死或复发性疾病。BCS 后 RT 显著降低局部复发（LR）的风险，尤其是在高危患者中。缺乏支持在选定的低危病例中省略辅助 RT 的 1 级证据。大型、多中心或复发性病变（尤其是在先前接受 RT 的情况下）应通过 MX 治疗，并有机会立即重建。在选择的激素敏感疾病病例中，辅助他莫昔芬可能降低 LR 的风险。
需要进一步研究来确定当代 RT 方案和内分泌治疗的作用。生物特征分析和分子分析为更好地了解这种疾病的肿瘤生物学并合理治疗提供了机会。可靠地识别低危病变可以使治疗不那么激进或安全地省略。
