Queen Elizabeth Hospital Birmingham and University of Birmingham, Birmingham, UK.
Screening Quality Assurance Service, Public Health England, Birmingham, UK.
Br J Cancer. 2021 Mar;124(5):1009-1017. doi: 10.1038/s41416-020-01152-5. Epub 2020 Nov 17.
The Sloane audit compares screen-detected ductal carcinoma in situ (DCIS) pathology with subsequent management and outcomes.
This was a national, prospective cohort study of DCIS diagnosed during 2003-2012.
Among 11,337 patients, 7204 (64%) had high-grade DCIS. Over time, the proportion of high-grade disease increased (from 60 to 65%), low-grade DCIS decreased (from 10 to 6%) and mean size increased (from 21.4 to 24.1 mm). Mastectomy was more common for high-grade (36%) than for low-grade DCIS (15%). Few (6%) patients treated with breast-conserving surgery (BCS) had a surgical margin <1 mm. Of the 9191 women diagnosed in England (median follow-up 9.4 years), 7% developed DCIS or invasive malignancy in the ipsilateral and 5% in the contralateral breast. The commonest ipsilateral event was invasive carcinoma (n = 413), median time 62 months, followed by DCIS (n = 225), at median 37 months. Radiotherapy (RT) was most protective against recurrence for high-grade DCIS (3.2% for high-grade DCIS with RT compared to 6.9% without, compared with 2.3 and 3.0%, respectively, for low/intermediate-grade DCIS). Ipsilateral DCIS events lessened after 5 years, while the risk of ipsilateral invasive cancer remained consistent to beyond 10 years.
DCIS pathology informs patient management and highlights the need for prolonged follow-up of screen-detected DCIS.
Sloane 审计将筛查出的乳腺导管原位癌 (DCIS) 的病理与后续的管理和结果进行了比较。
这是一项针对 2003 年至 2012 年期间诊断为 DCIS 的全国性前瞻性队列研究。
在 11337 名患者中，7204 名（64%）患有高级别 DCIS。随着时间的推移，高级别疾病的比例增加（从 60%增加到 65%），低级别 DCIS 减少（从 10%减少到 6%），平均大小增加（从 21.4 毫米增加到 24.1 毫米）。高级别 DCIS （36%）比低级别 DCIS（15%）更常行乳房切除术。接受保乳手术（BCS）治疗的少数（6%）患者的手术切缘<1mm。在英格兰诊断的 9191 名女性中（中位随访 9.4 年），7%在同侧发生 DCIS 或浸润性恶性肿瘤，5%在对侧发生。同侧最常见的事件是浸润性癌（n=413），中位时间为 62 个月，其次是 DCIS（n=225），中位时间为 37 个月。对于高级别 DCIS，放疗（RT）对复发最具保护作用（高级别 DCIS 有 RT 者为 3.2%，无 RT 者为 6.9%，而低/中级别 DCIS 者分别为 2.3%和 3.0%）。同侧 DCIS 事件在 5 年后减少，而同侧浸润性癌的风险在 10 年后仍保持一致。
DCIS 病理为患者管理提供了信息，并强调了对筛查出的 DCIS 进行长期随访的必要性。
