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Rahul R. Parikh, MD 1 , Bruce G. Haffty, MD 1 , & Meena S. Moran, MD 2 PowerPoint PPT Presentation


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Presentation No: 1083. Ductal Carcinoma in Situ with Microinvasion: Prognostic Implications, Long-term Outcomes, and Role of Axillary Evaluation. Rahul R. Parikh, MD 1 , Bruce G. Haffty, MD 1 , & Meena S. Moran, MD 2.

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Rahul R. Parikh, MD 1 , Bruce G. Haffty, MD 1 , & Meena S. Moran, MD 2

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Rahul r parikh md 1 bruce g haffty md 1 meena s moran md 2

Presentation No: 1083

Ductal Carcinoma in Situ with Microinvasion: Prognostic Implications, Long-term Outcomes, and Role of Axillary Evaluation

Rahul R. Parikh, MD1, Bruce G. Haffty, MD1,

& Meena S. Moran, MD2

1Department of Radiation Oncology, The Cancer Institute of New Jersey, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ

2 Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT

Yale School of Medicine


Purpose methods

Purpose/Methods

  • DCIS has a relatively good prognosis with breast conserving surgery and radiation (CS+RT).

  • Axillary evaluation is not routinely performed for pure DCIS lesions because of the low prevalence of nodal metastases (0-7%).

    • The role for surgical exploration of the axilla remains unclear for patients with DCIS with microinvasion (DCISM).   

  • We assessed the association of age, race, family history, margin status, histology, and receptor status, with DCIS or DCISM in a large cohort of patients treated with CS+RT (n=393). 

  • Long-term outcome was evaluated as a function pathology (DCIS vs. DCISM) and axillary evaluation for LRFS, DMFS, and OS.

  • Median patient age at diagnosis = 55.8 years

  • Median follow-up = 12.91 years 


Rahul r parikh md 1 bruce g haffty md 1 meena s moran md 2

Extent of Axillary Evaluation

* Note: All patients that had SLNBx went on to have Axillary dissection (standard clinical practice during this time interval)


Patient tumor characteristics

Patient/Tumor Characteristics

  • DCISM did NOT correlate with, young age, race, family history, margin status, histology, receptor status, use of hormonal therapy or chemotherapy.

  • (all p > 0.05)


Rahul r parikh md 1 bruce g haffty md 1 meena s moran md 2

Univariate survival analysis

In UVA, margin status, histology, pathology, and axillary evaluation were NOT independent predictors of LRFS, DMFS, or OS (p > 0.05).


Rahul r parikh md 1 bruce g haffty md 1 meena s moran md 2

Survival

Figure 2. 10-year DMFS for DCIS = 98.5% & DCISM = 97.9% (p = 0.77, log-rank test).

Figure 1. 10 year LRFS for DCIS = 90.7% & DCISM = 89.0% (p = 0.36, log-rank test).

Figure 3. 10-year OS for DCIS = 93.2% & DCISM = 95.7% (p = 0.93, log-rank test).


Conclusions

Conclusions

  • DCISM did NOT correlate with local relapse, young age, race, family history, margin status, histology, or adjuvant therapy (all p> 0.05).

  • Similar to DCIS, the prevalence of nodal metastases in the DCISM cohort was low (1.38%) in this large dataset.

  • In UVA & survival analysis, pathology (DCIS vs. DCISM) was NOT an independent predictor of LRFS, DMFS, or OS (p > 0.05).

  • Surgical evaluation of the axilla was NOT an independent predictor of LRFS, DMFS, or OS in Cox proportional hazards analysis (p > 0.05).

  • Given the low incidence of loco-regional and distant failures in this large, retrospective dataset, the role for surgical evaluation of the axilla remains unclear.

  • TAKE HOME POINT: Patients with DCISM may be treated similarly to patients with DCIS.

Yale School of Medicine


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