Department of Radiology, Duke University, Durham, NC, USA.
Department of Mathematics, Duke University, Durham, NC, USA.
Ann Surg Oncol. 2017 Nov;24(12):3534-3540. doi: 10.1245/s10434-017-6018-9. Epub 2017 Aug 9.
This study was designed to determine invasive cancer upstaging rates at surgical excision following vacuum-assisted biopsy of ductal carcinoma in situ (DCIS) among women meeting eligibility for active surveillance trials.
Patients with vacuum-assisted, biopsy-proven DCIS at a single center from 2008 to 2015 were retrospectively reviewed. Imaging and pathology reports were interrogated for the imaging appearance, tumor grade, hormone receptor status, and presence of comedonecrosis. Subsequent surgical reports were reviewed for upstaging to invasive disease. Cases were classified by eligibility criteria for the COMET, LORIS, and LORD DCIS active surveillance trials.
Of 307 DCIS diagnoses, 15 (5%) were low, 95 (31%) intermediate, and 197 (64%) high nuclear grade. The overall upstage rate to invasive disease was 17% (53/307). Eighty-one patients were eligible for the COMET Trial, 74 for the LORIS trial, and 10 for the LORD Trial, although LORIS trial eligibility also included real-time, multiple central pathology review, including elements not routinely reported. The upstaging rates to invasive disease were 6% (5/81), 7% (5/74), and 10% (1/10) for the COMET, LORIS, and LORD trials, respectively. Among upstaged cancers (n = 5), four tumors were Stage IA invasive ductal carcinoma and one was Stage IIA invasive lobular carcinoma; all were node-negative.
DCIS upstaging rates in women eligible for active surveillance trials are low (6-10%), and in this series, all those with invasive disease were early-stage, node-negative. The careful patient selection for DCIS active surveillance trials has a low risk of missing occult invasive cancer and additional studies will determine clinical outcomes.
本研究旨在确定符合主动监测试验入选标准的导管原位癌（DCIS）患者行真空辅助活检（VAB）后行手术切除的浸润性癌升级率。
回顾性分析 2008 年至 2015 年期间于单一中心行 VAB 证实为 DCIS 的患者。对影像学和病理学报告进行了调查，以评估影像学表现、肿瘤分级、激素受体状态和有无粉刺样坏死。对后续手术报告进行了审查，以确定是否升级为浸润性疾病。根据 COMET、LORIS 和 LORD DCIS 主动监测试验的入选标准对病例进行分类。
307 例 DCIS 诊断中，低级别 15 例（5%），中级别 95 例（31%），高级别 197 例（64%）。总体而言，浸润性疾病升级率为 17%（53/307）。81 例患者符合 COMET 试验入选标准，74 例符合 LORIS 试验入选标准，10 例符合 LORD 试验入选标准，但 LORIS 试验入选标准还包括实时、多中心病理复查，包括常规不报告的内容。COMET、LORIS 和 LORD 试验的浸润性疾病升级率分别为 6%（5/81）、7%（5/74）和 10%（1/10）。在升级的癌症（n=5）中，4 例为 IA 期浸润性导管癌，1 例为 IIA 期浸润性小叶癌；所有患者均无淋巴结转移。
符合主动监测试验入选标准的 DCIS 升级率较低（6-10%），在本系列中，所有浸润性疾病均为早期、无淋巴结转移的疾病。对 DCIS 主动监测试验进行了严格的患者选择，其漏诊隐匿性浸润性癌的风险较低，还需要进一步的研究来确定临床结局。
