Magnoni Francesca, Bianchi Beatrice, Corso Giovanni, Alloggio Erica Anna, Di Silvestre Susanna, Abruzzese Giuliarianna, Sacchini Virgilio, Galimberti Viviana, Veronesi Paolo
Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, 20141 Milan, Italy.
European Cancer Prevention Organization (ECP), 20141 Milan, Italy.
Healthcare (Basel). 2023 May 5;11(9):1324. doi: 10.3390/healthcare11091324.
Advances in treatments, screening, and awareness have led to continually decreasing breast cancer-related mortality rates in the past decades. This achievement is coupled with early breast cancer diagnosis. Ductal carcinoma in situ (DCIS) and microinvasive breast cancer have increasingly been diagnosed in the context of mammographic screening. Clinical management of DCIS is heterogenous, and the clinical significance of microinvasion in DCIS remains elusive, although microinvasive DCIS (DCIS-Mi) is distinct from "pure" DCIS. Upfront surgery has a fundamental role in the overall treatment of these breast diseases. The growing number of screen-detected DCIS diagnoses with clinicopathological features of low risk for local recurrence (LR) allows more conservative surgical options, followed by personalised adjuvant radiotherapy plans. Furthermore, studies are underway to evaluate the validity of surgery omission in selected low-risk categories. Nevertheless, the management, the priority of axillary surgical staging, and the prognosis of DCIS-Mi remain the subject of debate, demonstrating how the paucity of data still necessitates adequate studies to provide conclusive guidelines. The current scientific scenario for DCIS and DCIS-Mi surgical approach consists of highly controversial and diversified sources, which this narrative review will delineate and clarify.
在过去几十年中，治疗、筛查及认知方面的进展使得乳腺癌相关死亡率持续下降。这一成就与早期乳腺癌诊断密切相关。在乳腺钼靶筛查中，导管原位癌（DCIS）和微浸润性乳腺癌的诊断越来越多。DCIS的临床管理存在异质性，尽管微浸润性DCIS（DCIS-Mi）与“纯”DCIS不同，但其在DCIS中的临床意义仍不明确。 upfront手术在这些乳腺疾病的整体治疗中起着基础性作用。越来越多经筛查发现的DCIS病例，其具有局部复发（LR）低风险的临床病理特征，这使得更保守的手术选择成为可能，随后是个性化的辅助放疗计划。此外，正在进行研究以评估在选定的低风险类别中省略手术的有效性。然而，DCIS-Mi的管理、腋窝手术分期的优先级以及预后仍然是争论的焦点，这表明数据的匮乏仍需要充分的研究来提供确凿的指导方针。目前关于DCIS和DCIS-Mi手术方法的科学情况包括高度有争议和多样化的来源，本叙述性综述将对此进行描述和澄清。
