Surgical treatment of ductal carcinoma in situ of the breast. 10- to 20-year follow-up
T. Simpson, R. C. Thirlby and D. H. Dail
Department of Surgery, Virginia Mason Medical Center, Seattle, Wash.
Between 1967 and 1977, 36 patients received treatment at the Virginia Mason
Medical Center in Seattle, Wash, for ductal carcinoma in situ of the
breast. Twenty-five patients had modified radical mastectomies, 10 had
radical mastectomies, and one had a simple mastectomy. Twenty-seven
patients have been followed up for at least 10 years and are without known
recurrence (mean follow-up, 17.7 years; range, 8 to 24 years), eight
patients died without known recurrence (mean follow-up, 10.6 years; range,
6 to 14 years), and one patient with a prior contralateral mastectomy for
infiltrating cancer of the breast had a recurrence in the scalene nodes on
the side of the infiltrating cancer and died of metastatic cancer. No
patients with ductal carcinoma in situ had local recurrences in the
ipsilateral breast or chest wall, and no patients developed cancers in the
contralateral breast; one patient had axillary metastasis. Twenty-eight
(78%) of 36 patients had multicentric ductal carcinoma in situ in their
mastectomy specimens. Twenty-three (88%) of 26 patients with
comedocarcinoma-type ductal carcinoma in situ had multicentric lesions.
Conversely, patients with low-grade nuclear papillary ductal carcinoma in
situ did not have multicentric lesions. Five (14%) of 36 patients had
incidental microinvasion discovered in the mastectomy specimens; all had
comedocarcinoma. In summary, our study of patients with ductal carcinoma in
situ revealed that (1) mastectomy provided excellent local and systemic
control; (2) cancer in the contralateral breast was infrequent; (3)
axillary metastasis was rare; and (4) histologic features of tumors
markedly affected the frequency of multicentricity and chance for
microinvasion.
