Ofri Adam, Melanie Tam Sze Ki, Gill Suki, Spillane Andrew J
Breast and Endocrine Department, Mater Hospital, Wollstonecraft, 2065, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Surgery, University of Notre Dame, NSW, Australia.
Department of Surgery, Westmead Hospital, Sydney, NSW, Australia.
Breast. 2025 Aug;82:104482. doi: 10.1016/j.breast.2025.104482. Epub 2025 Apr 23.
Ductal carcinoma in-situ (DCIS) is a non-obligate precursor breast lesion with variable tendency to become invasive malignancy. Multiple studies have attempted to identify patient groups that could avoid radiation therapy (RT). We investigated the recent surgical management of DCIS in Australia and New Zealand (ANZ) and evaluated the likely rates of RT delivery dependent on differing low risk predictive criteria compared to actual practice.
The BreastSurgANZ Quality Audit identified patients with DCIS from 2018 to 2022. Data were analysed on multiple DCIS characteristics as well as postoperative RT recommendations. Existing potential RT avoidance characteristics, low risk classification criteria (LRCC) and RTOG 9804, were tested against the cohort.
7790 cases were analysed with 5323 (68.33 %) undergoing breast conservation surgery (BCS). There was higher median age, lower tumour grade and smaller size in the BCS group compared to mastectomy (p < 0.001). According to the BQA, 25.38 % of patients had RT omitted. Using LRCC, 1659 patients (31.17 %) could omit RT but only 760 (45.81 %) of those patients did. When using RTOG 9804 criterion, 1287 patients (24.18 %) could omit RT but only 447 (34.73 %) did. Of 3477 patients with neither low risk classifying characteristics, 553 (15.9 %) had no RT.
BCS is the preferred surgical management of DCIS in ANZ. Currently RT is omitted following BCS in 25 % of cases. Using LRCC and RTOG 9804 low risk classifiers there was inconsistent avoidance of RT, whereas RT was avoided in 15.9 % of higher risk patients. More consistent and transparent selection methods are desirable and currently genomic testing and clinico-molecular tools appears promising.
导管原位癌（DCIS）是一种非必然发展为浸润性恶性肿瘤的乳腺前驱病变，其发展为浸润性恶性肿瘤的倾向各异。多项研究试图确定可避免放疗（RT）的患者群体。我们调查了澳大利亚和新西兰（ANZ）近期对DCIS的手术治疗情况，并根据不同的低风险预测标准与实际治疗情况评估了可能接受放疗的比例。
“BreastSurgANZ质量审计”确定了2018年至2022年期间患有DCIS的患者。对多个DCIS特征以及术后放疗建议进行了数据分析。针对该队列，对现有的潜在放疗避免特征、低风险分类标准（LRCC）和RTOG 9804进行了测试。
分析了7790例病例，其中5323例（68.33%）接受了保乳手术（BCS）。与乳房切除术组相比，BCS组患者的年龄中位数更高，肿瘤分级更低，肿瘤尺寸更小（p < 0.001）。根据乳房质量审计，25.38%的患者未接受放疗。采用LRCC标准，1659例患者（31.17%）可免予放疗，但其中只有760例（45.81%）实际未接受放疗。采用RTOG 9804标准时，1287例患者（24.18%）可免予放疗，但实际只有447例（34.73%）未接受放疗。在3477例既无低风险分类特征的患者中，553例（15.9%）未接受放疗。
在ANZ，BCS是DCIS首选的手术治疗方式。目前，25%的BCS病例术后未接受放疗。采用LRCC和RTOG 9804低风险分类标准时，放疗的避免情况并不一致，而在15.9%的高风险患者中避免了放疗。需要更一致、透明的选择方法，目前基因检测和临床分子工具似乎很有前景。
