DCIS and LCIS Flashcards
Malignant cell proliferation of DCIS and LCIS is confined to what area of the breast structure?
Basement memebrane
What are the two types of DCIS
Comedo and noncomedo
Nuclear grade of DCIS is determined by
Nuclear morphology and mitotic index
What is the survival of DCIS?
Excellent regardless of nuclear grade. 10-year survival is >95%
DCIS accounts for what % of screening mammogram detected breast CA?
20%
What are the mammographic findings of DCIS?
Suspiciously grouped, pleomorphic, or fine linear microcalcifications
T/F: The local recurrence rate is greater for breast conservation therapy than mastectomy when treating DCIS?
True. However, regardless of approach or additional XRT, the survival is the same in all treated groups.
When is a mastectomy indicated for DCIS?
Centrally located, large lesion, multifocal, or repeated excisions for inadequate margins
What is the recommended margin for DCIS?
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.
Should XRT be yes when a patient has breast conservation therapy for DCIS?
Yes. A US study demonstrated a 58% decrease in tumor recurrence with the addition of XRT. But no clear survival advantage is seen.
With a USC-Van Nuys Prognostic Index score of 4, 5, or 6 what therapy is recommended?
Lumpectomy alone
With a USC-Van Nuys Prognostic Index score of 7, 8, or 9 what therapy is recommended?
Lumpectomy with XRT
With a USC-Van Nuys Prognostic Index score of 10, 11, or 12 what therapy is recommended?
Mastectomy
What is the surveillance for DCIS following resection?
q6 mo x 5 years, then annually thereafter with diagnostic, not screening mammograms
What are the two histologic subtypes of LCIS?
Classic and pleomorphic
Although LCIS is thought to increase the risk of breast CA in both breasts, is one side favored over the other?
Yes. CA is 3 times more likely to develop in the ipsilateral rather than the contralateral breast
LCIS is more likely to increase the risk of invasive lobular or ductal CA?
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.
Compared to DCIS, is LCIS more multifocal and bilateral?
Yes
What % of pts with LCIS will have multifocal disease?
> 50%
What % of pts with LCIS will have dz in the contralateral breast?
30%
Why is LCIS difficult to manage?
Because it often presents with multifocal disease and bilaterally
Is finding LCIS at resected margins a risk factor for recurrence?
No. This is why LCIS is still treated as a risk indicator rather than a precursor lesion
What is the risk for invasive breast CA in a pt with LCIS?
0.5-1% per year
Does tamoxifen or raloxifene reduce th risk of invasive breast CA in pts with LCIS?
Yes
What is the recommended NCCN management for women with LCIS?
Observation. Clinical exams q 6-12 mo with annual diagnostic mammograms. Consider tamoxifen/raloxifene.
The NCCN guidelines recommend prophylactic mastectomy in what pt group with LCIS ?
Women with BRCA1 or BRCA2 or have a strong family history
