Department of Radiation Oncology, Academic Medical Center, P.O. Box 22700, 1100DE, Amsterdam, The Netherlands.
Curr Treat Options Oncol. 2013 Mar;14(1):75-87. doi: 10.1007/s11864-012-0217-1.
Ductal carcinoma in situ (DCIS) is a pre-invasive stage of breast cancer with a heterogeneous clinical behaviour. Since the introduction of mammographic screening programmes, the incidence of DCIS has shown a dramatic increase. Treatment should focus on the prevention of progression to invasive disease. If progression occurs, poorly differentiated DCIS frequently gives rise to grade III invasive breast cancer, whereas well differentiated DCIS more often recurs as grade I invasive disease. However, at present, validated diagnostic test are lacking to predict progression accurately. The majority of women with DCIS are suitable for breast conserving therapy. Obtaining clear surgical margins is the most important goal of a local excision. Radiotherapy is effective in reducing the risk of local recurrence with about 50 % in all subgroups of patients with DCIS. (Breast cancer specific) survival of women with DCIS is excellent, and radiotherapy does not further improve this. Future research should be directed in enabling to select women who have a high risk of--invasive--recurrence, so in which radiotherapy should be standard part of the breast conserving approach, and those women with a more indolent lesion, in which after surgery a watchful waiting approach can be followed.
导管原位癌（DCIS）是乳腺癌的一种具有异质性临床表现的早期浸润性癌。自从引入乳房 X 线筛查项目以来，DCIS 的发病率呈显著上升趋势。治疗应侧重于预防向浸润性疾病进展。如果发生进展，低分化 DCIS 常导致 III 级浸润性乳腺癌，而高分化 DCIS 更常复发为 I 级浸润性疾病。然而，目前缺乏准确预测进展的验证性诊断检测。大多数 DCIS 患者适合保乳治疗。获得明确的手术切缘是局部切除的最重要目标。放疗在降低所有 DCIS 患者亚组的局部复发风险方面非常有效，约为 50%。DCIS 妇女的乳腺癌特异性生存率极好，放疗并不能进一步提高这一生存率。未来的研究应着眼于能够选择具有高侵袭性复发风险的女性，因此放疗应成为保乳治疗方法的标准部分，而对于那些具有更惰性病变的女性，手术后可以采取观察等待的方法。
