Vila Jose, Farante Gabriel, Ripoll-Orts Francisco, Lissidini Germana, Nicosia Luca, Lazzeroni Matteo, Frassoni Samuele, Bagnardi Vincenzo, Rodríguez Del Busto Belén, Bonanni Bernardo, Cassano Enrico, Veronesi Paolo
Division of Breast Surgery, European Institute of Oncology, IRCCS, Milan, Italy; Breast Surgery Department, La Fe University Hospital, Valencia, Spain.
Division of Breast Surgery, European Institute of Oncology, IRCCS, Milan, Italy.
Eur J Surg Oncol. 2025 Jul;51(7):109716. doi: 10.1016/j.ejso.2025.109716. Epub 2025 Feb 26.
The management of small low-to-medium grade ductal carcinoma in situ (DCIS) on core biopsy remains controversial. Four international studies are currently recruiting highly selected low-risk DCIS patients to compare active surveillance ( ± hormonal treatment) versus conventional treatment. In this study, we aim to determine the upstaging rate at a tertiary center among low-risk DCIS patients meeting eligibility criteria for active surveillance trials.
A retrospective study was undertaken of all patients diagnosed with small (<2 cm) low-medium grade DCIS patients at the European Institute of Oncology, Milan, from 2009 to 2019. All cases were classified as eligible based on the COMET, LORIS, LORD and LORETTA DCIS studies, according to their respective inclusion criteria.
We identified 351 patients from a prospectively maintained database who were diagnosed with G1-G2 DCIS on core biopsy, with a median age of 55 years (range 45-82). The overall upstage/upgrade rate was 23.6 %. Of the 351 patients, sixty-four (18.2 %) were upstaged to invasive disease and nine-teen (5.4 %) were upgraded to grade 3 DCIS. It is worth noting a rate of 7.9 % of patients with >pT1c and 2.3 % of patients with nodal involvement at the time of surgery. On both univariable and multivariable analysis, no specific variable was found to be a statistically significant predictor for upstaging.
Over 23 % of patients with low-risk DCIS may be upgraded or upstaged at resection, especially towards invasive carcinoma (18.2 % of cases were staged to invasive cancer at surgical resection). These data suggest that active surveillance is not warranted in this highly selected group of low-risk DCIS patients. Stricter selection criteria must be considered to ensure appropriate treatment of such patients.
在粗针活检时，小的低至中等级别导管原位癌（DCIS）的管理仍存在争议。目前有四项国际研究正在招募经过高度筛选的低风险DCIS患者，以比较主动监测（±激素治疗）与传统治疗。在本研究中，我们旨在确定在一家三级中心，符合主动监测试验资格标准的低风险DCIS患者的分期上调率。
对2009年至2019年在米兰欧洲肿瘤研究所诊断为小（<2 cm）低至中等级别DCIS的所有患者进行回顾性研究。根据COMET、LORIS、LORD和LORETTA DCIS研究的各自纳入标准，所有病例均被分类为符合条件。
我们从一个前瞻性维护的数据库中识别出351例在粗针活检时被诊断为G1-G2 DCIS的患者，中位年龄为55岁（范围45-82岁）。总体分期上调/分级上调率为23.6%。在351例患者中，64例（18.2%）分期上调为浸润性疾病，19例（5.4%）分级上调为3级DCIS。值得注意的是，手术时>pT1c的患者比例为7.9%，淋巴结受累的患者比例为2.3%。在单变量和多变量分析中，均未发现特定变量是分期上调的统计学显著预测因素。
超过23%的低风险DCIS患者在切除时可能会分级上调或分期上调，尤其是向浸润性癌（18.2%的病例在手术切除时分期为浸润性癌）。这些数据表明，在这一经过高度筛选的低风险DCIS患者群体中，主动监测是不必要的。必须考虑更严格的选择标准，以确保对此类患者进行适当的治疗。
