Breast Cancer Working Conference, 3–6 September 1991, Leuven

Ductal carcinoma in-situ of the breast; second EORTC consensus meeting*

Breast ductal carcinoma in situ (DCIS) is a preinvasive lesion that is considered to be a precursor to invasive breast cancer. Nevertheless, not all DCIS will progress to invasion. Current histopathological classification systems are unable to predict which cases will or will not progress, and therefore many women with DCIS may be overtreated. Artificial intelligence (AI) image-based analysis methods have potential to identify and analyze novel features that may facilitate tumor identification, prediction of disease outcome and response to treatment. Indeed, these methods prove promising for accurately identifying DCIS lesions, and show potential clinical utility in the therapeutic stratification of DCIS patients. Here, we review how AI techniques in histopathology may aid diagnosis and clinical decisions in regards to DCIS, and how such techniques could be incorporated into clinical practice.

Male breast cancer (MaleBC) is a rare disease, accounting for <1% of all male tumors. During the last few years, there has been an increase in the incidence of this disease, along with the increase in female breast cancer (FBC). Little is known about the etiology of MaleBC: hormonal, environmental and genetic factors have been reported to be involved in its pathogenesis. Major risk factors include clinical disorders carrying hormonal imbalances, radiation exposure and, in particular, a positive family history (FH) for BC, the latter suggestive of genetic susceptibility. Rare mutations in high-penetrance genes (BRCA1 and BRCA2) confer a high risk of BC development; low-penetrance gene mutations (i.e. CHEK-2) are more common but involve a lower risk increase.

About 90% of all male breast tumors have proved to be invasive ductal carcinomas, expressing high levels of hormone receptors with evident therapeutic returns.

The most common clinical sign of BC onset in men is a painless palpable retroareolar lump, which should be evaluated by means of mammography, ultrasonography and core biopsy or fine needle aspiration (FNA).

To date, there are no published data from prospective randomized trials supporting a specific therapeutic approach in MaleBC. Tumor size together with the number of axillary nodes involved are the main prognostic factors and should guide the treatment choice. Locoregional approaches include surgery and radiotherapy (RT), depending upon the initial clinical presentation. When systemic treatment (adjuvant, neoadjuvant and metastatic) is delivered, the choice between hormonal and or chemotherapy (CT) should depend upon the clinical and biological features, according to the FBC management guidelines. However great caution is required because of high rates of age-related comorbidities.

Analizar la incidencia y las formas de presentación clínica del carcinoma intraductal de mama, las características patológicas de las lesiones, las formas de tratamiento utilizadas y la evolución de la enfermedad.

Estudio descriptivo retrospectivo de 83 casos con diagnóstico anatomopatológico de carcinoma ductal in situ (CDIS), recogidos entre el 1 de enero de 1990 y el 31 de diciembre de 2004 en el Hospital Universitario Son Dureta (HUSD).

El CDIS representa el 3,5% del total de los cánceres de mama diagnosticados en el HUSD en los últimos 15 años. La edad más frecuente en el diagnóstico es de 50-64 años. El 72% de las lesiones se detectó mamográficamente. Se realizó una mastectomía simple en el 57% de los casos, y una cirugía conservadora en el 37%. La tasa de recidiva es del 4% y la de supervivencia, a día de hoy, del 100%.

Gracias a la mamografía como método de cribado, diagnosticamos tumores de tamaños muy reducidos. La afección de los márgenes quirúrgicos es un factor importante para la valoración de la cirugía conservadora y la determinación del riesgo de recidiva. La mastectomía simple consigue una curación de casiel 100%, aunque el tratamiento conservador es de elección en el CDIS.

To determine the incidence rates and clinical presentation of ductal carcinoma in situ of the breast, as well as its pathologic characteristics, the forms of treatment used, and outcomes.

We performed a retrospective study with review of 83 consecutive patients with a histopathological diagnosis of ductal carcinoma in situ (DCIS) of the breast from January 1st, 1990 to December 31st, 2004 in the Son Dureta University Hospital in Palma, Majorca.

Breast DCIS accounted for 3.5% of all breast carcinomas identified in our hospital in the previous 15 years. The most frequent age at diagnosis ranged from 50 to 64 years. Seventy-two percent of the lesions were detected by mammography. Total mastectomy was performed in 57% of the patients, and treatment with breast preservation was carried out in 37%. The recurrence rate was 4%, with an overall survival rate of 100%.

Screening mammography identifies very small cancers. Involvement of the surgical margins is a determining factor for local treatment of breast cancer and is an accurate predictor of risk of recurrence. Disease-free survival is almost 100% in patients undergoing mastectomy, although the preferred therapy in cases of DCIS is local treatment with breast conservation.

PC-cell-derived growth factor (PCDGF, progranulin) is a novel autocrine growth factor that is overexpressed in human breast cancer cell lines. We have examined immunohistochemical PCDGF expression in 206 paraffin-embedded human breast lesions and investigated its association with clinicopathological variables. PCDGF staining was observed in breast carcinoma, whereas it was almost always negative in benign breast epithelium. PCDGF expression was more common in invasive ductal carcinoma (80% cases positive) than in invasive lobular carcinoma (53% positive). PCDGF staining was almost never observed in lobular carcinoma in situ. Ductal carcinoma in situ expressed PCDGF in 66% of the cases, and this expression correlated strongly with nuclear grade. Similar correlation was observed between PCDGF expression and histologic grade of invasive ductal carcinoma. Average Ki-67 index of PCDGF-negative/weakly positive invasive carcinomas (30.3) was significantly lower than that of strongly PCDGF-positive tumors (48.8, P = 0.01). A larger percentage of tumors that expressed PCDGF with a staining intensity of 2+ or 3+ were p53 positive (44%) than were PCDGF-negative tumors (25%), P = 0.02. PCDGF expression was independent of c-erbB-2 overexpression and of ER and PR status. Our study provides the first evidence of high incidence of PCDGF expression in human breast cancer in which it correlates with clinicopathological variables such as tumor grade, proliferation index, and p53 expression. These characteristics, as well as the virtual absence of expression in benign breast tissue, suggest an important role of PCDGF in breast cancer pathogenesis and make it a potential novel target for the treatment of breast cancer.