Treatment of Ductal Carcinoma In Situ of Breast
Clinical Scenario
Ductal carcinoma in situ (DCIS) of the breast is a non-invasive breast malignancy confined to the ductal system. This protocol defines the primary local treatment strategy, with the guiding objective of achieving histologically clear surgical margins.
Treatment Approach
Management centres on a surgical intervention, with the specific procedure determined by factors including disease extent and the feasibility of adequate margin clearance. The complete protocol details the procedure options and the margin threshold required.
Treatment Goal
- Negative histological surgical margin of at least 2 mm
References
DOI: 10.1093/jjco/hyae122
- The standard local treatment for DCIS is breast-conserving surgery (BCS) or total mastectomy, the same as the treatment options for invasive carcinoma.
- The National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines recommend that patients with DCIS should undergo 'BCS without lymph node surgery' or 'total mastectomy with SLNB'.
- The Society of Surgical Oncology (SSO)—American Society for Radiation Oncology (ASTRO)—American Society of Clinical Oncology (ASCO) Consensus Guideline recommends a negative surgical margin of at least 2 mm based on this meta-analysis showing a reduced risk of ipsilateral breast tumor recurrence (IBTR).
- Achieving negative histological margins is crucial for patients undergoing BCS, as positive surgical margins are one of the important risk factors for local recurrence (LR).
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