Palpable Ductal Carcinoma in Situ: Analysis of Radiological and Histological Features of a Large Series With 5-Year Follow-Up

摘要

Palpable (p) ductal carcinoma in situ (DCIS) is a rare entity that presents differently than screen-detected DCIS. pDCIS is often occult on conventional radilogical imaging and is generally associated with aggressive pathological features. Careful individualized surgical planning in a multi-disciplinary meeting is necessary for the management of patients presenting with pDCIS.Background: Palpable pure DCIS is a rare entity that presents differently than screen-detected DCIS. The aim of this study was to evaluate the clinical, radiological, and pathological characteristics and management of pDCIS in a retrospective cohort of patients. Patients and Methods: Patients diagnosed with pDCIS from January 1999 to December 2011 were identified from an electronic patient database and were included in this study. Results: During this period, 669 cases of DCIS were diagnosed and 62 (9.3%) were pDCIS (mean age, 56.9 ±15.1 years). The most common finding on ultrasound was mass in 43 patients (75%) and only 18 (33%) cases had calcification on mammography. The lesion was mammographically occult in 20 patients (37%). Ultrasound was more sensitive and delineated the pDCIS in 45 (80%) cases. Mean size of the pDCIS was 36.9 ± 30.4 mm and most were high grade (n = 42; 68%) and associated with comedo necrosis in 36 (59%). Most were oestrogen receptor (ER)-positive (n = 34; 62%), however 21 patients (38%) were ER-negative. Breast conservation was attempted in 30 patients (48%), however, because of involved margins further therapeutic surgery was needed in 10 patients (33%). Axillary surgery (sentinel lymph node biopsy or axillary nodal sampling) was performed in 34 patients (55%) and no lymph node metastasis was identified. During a medial follow-up of 60 months, 1 patient has developed a mastectomy scar recurrence and the rest remain disease-free. Conclusion: Palpable DCIS is often occult on conventional radiological imaging and is generally associated with aggressive pathological features. Hence, careful individualized surgical planning through a multidisciplinary meeting is necessary for their management.