Management of ductal carcinoma in situ with nipple discharge. Intraductal spreading of carcinoma is an unfavorable pathologic factor for breast-conserving surgery.

BACKGROUND

Surgical management of ductal carcinoma in situ (DCIS) has been a controversial issue in the selection of breast-conserving surgery as a method of treatment. The definition of intraductal spreading of carcinoma becomes an important factor in the decision making process, but little is known about how much intraductal extension influences the spreading of tumor in the whole breast. To define any unfavorable pathologic factors existing in limited surgery for patients with DCIS, the authors investigated histopathologic characteristics using a sequential slicing of tissues.

METHODS

Duct-lobular segmentectomy, a limited surgery, was performed on 110 patients with a bloody nipple discharge. Six patients with invasive carcinoma and 17 patients with DCIS subsequently received a total mastectomy. The specimens obtained by segmentectomy and mastectomy were histopathologically examined. Using subserial sections, the authors examined the relationship between intraductal spreading of carcinoma in the segmentectomy specimens and carcinoma residue in the mastectomy specimens.

RESULTS

Among 16 mastectomy specimens, the authors found residual DCIS in 6, and atypical ductal hyperplasia in 4. Intraductal spreading of carcinoma was detected in 8 of 16 segmentectomy specimens. Six of eight patients with intraductal spreading had residual DCIS. The other two patients had atypical hyperplasia in breasts. No residual DCIS was detected in the other eight patients without intraductal spreading. Among 12 patients under observation who did not have a mastectomy, invasive carcinoma subsequently developed in 3. Two of three patients had intraductal spreading in segmentectomy specimens. Only 1 of 10 patients without intraductal spreading, however, developed carcinoma.

CONCLUSIONS

Intraductal spreading of carcinoma is an unfavorable pathologic factor in breast-conserving surgery for patients with ductal carcinoma in situ with nipple discharge.