The presentation, management and outcome of patients with ductal carcinoma in situ (DCIS) with microinvasion (invasion ≤1 mm in size)-results from the UK Sloane Project

Abeer M Shaaban; Bridget Hilton; Karen Clements; David Dodwell; Nisha Sharma; Cliona Kirwan; Elinor Sawyer; Anthony Maxwell; Matthew Wallis; Hilary Stobart; Senthurun Mylvaganam; Janet Litherland; Samantha Brace-McDonnell; Joanne Dulson-Cox; Olive Kearins; Elena Provenzano; Ian O Ellis; Sarah E Pinder; Alastair M Thompson

doi:10.1038/s41416-022-01983-4

The presentation, management and outcome of patients with ductal carcinoma in situ (DCIS) with microinvasion (invasion ≤1 mm in size)-results from the UK Sloane Project

Abeer M Shaaban^*, Bridget Hilton, Karen Clements, David Dodwell, Nisha Sharma, Cliona Kirwan, Elinor Sawyer, Anthony Maxwell, Matthew Wallis, Hilary Stobart, Senthurun Mylvaganam, Janet Litherland, Samantha Brace-McDonnell, Joanne Dulson-Cox, Olive Kearins, Elena Provenzano, Ian O Ellis, Sarah E Pinder, Alastair M Thompson

^*Corresponding author for this work

The Centre for Computational Biology

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Abstract

BACKGROUND: The diagnosis, management and prognosis of microinvasive breast carcinoma remain controversial.

METHODS: We analysed the outcomes of patients with DCIS with and without microinvasion diagnosed between 2003 and 2012 within the Sloane project.

RESULTS: Microinvasion was recorded in 521 of 11,285 patients (4.6%), with considerable variation in reported incidence among screening units (0-25%). Microinvasion was associated with high-grade DCIS, larger DCIS size, comedo necrosis and solid, cribriform architecture (all P < 0.001). Microinvasion was more frequent in patients who underwent mastectomy compared with breast-conserving surgery (BCS) (6.9% vs 3.6%, P < 0.001), and in those undergoing axillary nodal surgery (60.4% vs 30.3%, P < 0.001) including the subset undergoing BCS (43.4% vs 8.5%, P < 0.001). Nodal metastasis rate was low and not statistically significant difference from the DCIS only group (P = 0.68). Following median follow-up of 110 months, 3% of patients had recurrent ipsilateral high-grade DCIS, and 4.2% developed invasive carcinoma. The subsequent ipsilateral invasion was of Grade 3 in 71.4% of patients with microinvasion vs 30.4% in DCIS without microinvasion (P = 0.02). Distant metastasis and breast cancer mortality were higher with microinvasion compared with DCIS only (1.2% vs 0.3%, P = 0.01 and 2.1% vs 0.8%; P = 0.005).

CONCLUSIONS: The higher breast cancer mortality with microinvasion indicates a more aggressive disease.

Original language	English
Journal	British Journal of Cancer
Early online date	12 Oct 2022
DOIs	https://doi.org/10.1038/s41416-022-01983-4
Publication status	E-pub ahead of print - 12 Oct 2022

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Cite this

Shaaban, A. M., Hilton, B., Clements, K., Dodwell, D., Sharma, N., Kirwan, C., Sawyer, E., Maxwell, A., Wallis, M., Stobart, H., Mylvaganam, S., Litherland, J., Brace-McDonnell, S., Dulson-Cox, J., Kearins, O., Provenzano, E., Ellis, I. O., Pinder, S. E., & Thompson, A. M. (2022). The presentation, management and outcome of patients with ductal carcinoma in situ (DCIS) with microinvasion (invasion ≤1 mm in size)-results from the UK Sloane Project. British Journal of Cancer. Advance online publication. https://doi.org/10.1038/s41416-022-01983-4

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title = "The presentation, management and outcome of patients with ductal carcinoma in situ (DCIS) with microinvasion (invasion ≤1 mm in size)-results from the UK Sloane Project",

abstract = "BACKGROUND: The diagnosis, management and prognosis of microinvasive breast carcinoma remain controversial.METHODS: We analysed the outcomes of patients with DCIS with and without microinvasion diagnosed between 2003 and 2012 within the Sloane project.RESULTS: Microinvasion was recorded in 521 of 11,285 patients (4.6%), with considerable variation in reported incidence among screening units (0-25%). Microinvasion was associated with high-grade DCIS, larger DCIS size, comedo necrosis and solid, cribriform architecture (all P < 0.001). Microinvasion was more frequent in patients who underwent mastectomy compared with breast-conserving surgery (BCS) (6.9% vs 3.6%, P < 0.001), and in those undergoing axillary nodal surgery (60.4% vs 30.3%, P < 0.001) including the subset undergoing BCS (43.4% vs 8.5%, P < 0.001). Nodal metastasis rate was low and not statistically significant difference from the DCIS only group (P = 0.68). Following median follow-up of 110 months, 3% of patients had recurrent ipsilateral high-grade DCIS, and 4.2% developed invasive carcinoma. The subsequent ipsilateral invasion was of Grade 3 in 71.4% of patients with microinvasion vs 30.4% in DCIS without microinvasion (P = 0.02). Distant metastasis and breast cancer mortality were higher with microinvasion compared with DCIS only (1.2% vs 0.3%, P = 0.01 and 2.1% vs 0.8%; P = 0.005).CONCLUSIONS: The higher breast cancer mortality with microinvasion indicates a more aggressive disease.",

author = "Shaaban, {Abeer M} and Bridget Hilton and Karen Clements and David Dodwell and Nisha Sharma and Cliona Kirwan and Elinor Sawyer and Anthony Maxwell and Matthew Wallis and Hilary Stobart and Senthurun Mylvaganam and Janet Litherland and Samantha Brace-McDonnell and Joanne Dulson-Cox and Olive Kearins and Elena Provenzano and Ellis, {Ian O} and Pinder, {Sarah E} and Thompson, {Alastair M}",

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day = "12",

doi = "10.1038/s41416-022-01983-4",

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Shaaban, AM, Hilton, B, Clements, K, Dodwell, D, Sharma, N, Kirwan, C, Sawyer, E, Maxwell, A, Wallis, M, Stobart, H, Mylvaganam, S, Litherland, J, Brace-McDonnell, S, Dulson-Cox, J, Kearins, O, Provenzano, E, Ellis, IO, Pinder, SE & Thompson, AM 2022, 'The presentation, management and outcome of patients with ductal carcinoma in situ (DCIS) with microinvasion (invasion ≤1 mm in size)-results from the UK Sloane Project', British Journal of Cancer. https://doi.org/10.1038/s41416-022-01983-4

TY - JOUR

T1 - The presentation, management and outcome of patients with ductal carcinoma in situ (DCIS) with microinvasion (invasion ≤1 mm in size)-results from the UK Sloane Project

AU - Shaaban, Abeer M

AU - Hilton, Bridget

AU - Clements, Karen

AU - Dodwell, David

AU - Sharma, Nisha

AU - Kirwan, Cliona

AU - Sawyer, Elinor

AU - Maxwell, Anthony

AU - Wallis, Matthew

AU - Stobart, Hilary

AU - Mylvaganam, Senthurun

AU - Litherland, Janet

AU - Brace-McDonnell, Samantha

AU - Dulson-Cox, Joanne

AU - Kearins, Olive

AU - Provenzano, Elena

AU - Ellis, Ian O

AU - Pinder, Sarah E

AU - Thompson, Alastair M

PY - 2022/10/12

Y1 - 2022/10/12

N2 - BACKGROUND: The diagnosis, management and prognosis of microinvasive breast carcinoma remain controversial.METHODS: We analysed the outcomes of patients with DCIS with and without microinvasion diagnosed between 2003 and 2012 within the Sloane project.RESULTS: Microinvasion was recorded in 521 of 11,285 patients (4.6%), with considerable variation in reported incidence among screening units (0-25%). Microinvasion was associated with high-grade DCIS, larger DCIS size, comedo necrosis and solid, cribriform architecture (all P < 0.001). Microinvasion was more frequent in patients who underwent mastectomy compared with breast-conserving surgery (BCS) (6.9% vs 3.6%, P < 0.001), and in those undergoing axillary nodal surgery (60.4% vs 30.3%, P < 0.001) including the subset undergoing BCS (43.4% vs 8.5%, P < 0.001). Nodal metastasis rate was low and not statistically significant difference from the DCIS only group (P = 0.68). Following median follow-up of 110 months, 3% of patients had recurrent ipsilateral high-grade DCIS, and 4.2% developed invasive carcinoma. The subsequent ipsilateral invasion was of Grade 3 in 71.4% of patients with microinvasion vs 30.4% in DCIS without microinvasion (P = 0.02). Distant metastasis and breast cancer mortality were higher with microinvasion compared with DCIS only (1.2% vs 0.3%, P = 0.01 and 2.1% vs 0.8%; P = 0.005).CONCLUSIONS: The higher breast cancer mortality with microinvasion indicates a more aggressive disease.

AB - BACKGROUND: The diagnosis, management and prognosis of microinvasive breast carcinoma remain controversial.METHODS: We analysed the outcomes of patients with DCIS with and without microinvasion diagnosed between 2003 and 2012 within the Sloane project.RESULTS: Microinvasion was recorded in 521 of 11,285 patients (4.6%), with considerable variation in reported incidence among screening units (0-25%). Microinvasion was associated with high-grade DCIS, larger DCIS size, comedo necrosis and solid, cribriform architecture (all P < 0.001). Microinvasion was more frequent in patients who underwent mastectomy compared with breast-conserving surgery (BCS) (6.9% vs 3.6%, P < 0.001), and in those undergoing axillary nodal surgery (60.4% vs 30.3%, P < 0.001) including the subset undergoing BCS (43.4% vs 8.5%, P < 0.001). Nodal metastasis rate was low and not statistically significant difference from the DCIS only group (P = 0.68). Following median follow-up of 110 months, 3% of patients had recurrent ipsilateral high-grade DCIS, and 4.2% developed invasive carcinoma. The subsequent ipsilateral invasion was of Grade 3 in 71.4% of patients with microinvasion vs 30.4% in DCIS without microinvasion (P = 0.02). Distant metastasis and breast cancer mortality were higher with microinvasion compared with DCIS only (1.2% vs 0.3%, P = 0.01 and 2.1% vs 0.8%; P = 0.005).CONCLUSIONS: The higher breast cancer mortality with microinvasion indicates a more aggressive disease.

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U2 - 10.1038/s41416-022-01983-4

DO - 10.1038/s41416-022-01983-4

M3 - Article

C2 - 36224403

SN - 0007-0920

JO - British Journal of Cancer

JF - British Journal of Cancer

ER -