DCIS and LCIS

Question 1

Malignant cell proliferation of DCIS and LCIS is confined to what area of the breast structure?

Answer 1

Basement memebrane

Question 2

What are the two types of DCIS

Answer 2

Comedo and noncomedo

Question 3

Nuclear grade of DCIS is determined by

Answer 3

Nuclear morphology and mitotic index

Question 4

What is the survival of DCIS?

Answer 4

Excellent regardless of nuclear grade. 10-year survival is >95%

Question 5

DCIS accounts for what % of screening mammogram detected breast CA?

Answer 5

20%

Question 6

What are the mammographic findings of DCIS?

Answer 6

Suspiciously grouped, pleomorphic, or fine linear microcalcifications

Question 7

T/F: The local recurrence rate is greater for breast conservation therapy than mastectomy when treating DCIS?

Answer 7

True. However, regardless of approach or additional XRT, the survival is the same in all treated groups.

Question 8

When is a mastectomy indicated for DCIS?

Answer 8

Centrally located, large lesion, multifocal, or repeated excisions for inadequate margins

Question 9

What is the recommended margin for DCIS?

Answer 9

No standard. But, a study showed that a margin <1mm had local recurrence with adjuvet tx (30%) and without (58%). Cameron recommends a 2-3 mm margin.

Question 10

Should XRT be yes when a patient has breast conservation therapy for DCIS?

Answer 10

Yes. A US study demonstrated a 58% decrease in tumor recurrence with the addition of XRT. But no clear survival advantage is seen.

Question 11

With a USC-Van Nuys Prognostic Index score of 4, 5, or 6 what therapy is recommended?

Answer 11

Lumpectomy alone

Question 12

With a USC-Van Nuys Prognostic Index score of 7, 8, or 9 what therapy is recommended?

Answer 12

Lumpectomy with XRT

Question 13

With a USC-Van Nuys Prognostic Index score of 10, 11, or 12 what therapy is recommended?

Answer 13

Mastectomy

Question 14

What is the surveillance for DCIS following resection?

Answer 14

q6 mo x 5 years, then annually thereafter with diagnostic, not screening mammograms

Question 15

What are the two histologic subtypes of LCIS?

Answer 15

Classic and pleomorphic

Question 16

Although LCIS is thought to increase the risk of breast CA in both breasts, is one side favored over the other?

Answer 16

Yes. CA is 3 times more likely to develop in the ipsilateral rather than the contralateral breast

Question 17

LCIS is more likely to increase the risk of invasive lobular or ductal CA?

Answer 17

Recent review of the SEER database showed that pts w/ LCIS are 5.3, and 0.8 times more likely to develop invasive lobular and ductal CA respectively.

Question 18

Compared to DCIS, is LCIS more multifocal and bilateral?

Answer 18

Yes

Question 19

What % of pts with LCIS will have multifocal disease?

Answer 19

> 50%

Question 20

What % of pts with LCIS will have dz in the contralateral breast?

Answer 20

30%

Question 21

Why is LCIS difficult to manage?

Answer 21

Because it often presents with multifocal disease and bilaterally

Question 22

Is finding LCIS at resected margins a risk factor for recurrence?

Answer 22

No. This is why LCIS is still treated as a risk indicator rather than a precursor lesion

Question 23

What is the risk for invasive breast CA in a pt with LCIS?

Answer 23

0.5-1% per year

Question 24

Does tamoxifen or raloxifene reduce th risk of invasive breast CA in pts with LCIS?

Answer 24

Yes

Question 25

What is the recommended NCCN management for women with LCIS?

Answer 25

Observation. Clinical exams q 6-12 mo with annual diagnostic mammograms. Consider tamoxifen/raloxifene.

Question 26

The NCCN guidelines recommend prophylactic mastectomy in what pt group with LCIS ?

Answer 26

Women with BRCA1 or BRCA2 or have a strong family history