Carcinoma in situ and early breast carcinoma. Survey of the Portuguese Senology Society on the diagnostic tools used in Portugal and their evolution between 1985 and 2000

By means of a questionnaire, sent to the Portuguese hospitals which diagnose and treat most female patients with breast cancer, it was intended to assess the situation regarding the diagnosis of carcinoma in situ and early breast cancer (T1 or T2, N0 or N1), as well as their evolution between 1985 and 2000. The hospital participation rate was 65% and a sample of 865 patients was collected, distributed in the years 1985, 1990, 1995 and 2000. It was found that the presentation form of breast cancer in 1985 was of palpable tumour in 87% of the cases, whereas in 2000 this situation only corresponded to 54% of the patients, being most of the remaining patients diagnosed by imaging without palpable tumour. In 94% of the patients, the first diagnostic investigation was mammography, associated or not to echography, and the second most frequent investigation was fine-needle aspiration biopsy. The time evolution of the tumour size showed an increasingly earlier diagnosis. Invasive tumours not more than 1 cm represented 13.2% in 1985 and 20.3% in 2000. On the other hand, breast cancers more than 2 cm and not more than 5 cm decreased from 67.2% in 1985 to 40% in 2000. When oncology centres and some large university hospitals (Group A) were compared to the other hospitals (Group B), there were no significant differences between the diagnostic methods, although the sequence of diagnostic methods was different in the hospitals in Group A versus those in Group B. It was observed that in more differentiated hospitals the diagnosis was achieved increasingly earlier along the studied periods, and this situation did not occur in the other hospitals.     

The treatment of carcinoma in situ of the breast

In reference to a series of 36 in situ breast carcinomas, the current therapeutic possibilities are considered: 8 lobular carcinomas in situ (LCIS) and 28 ductal carcinomas in situ (DCIS) were diagnosed between January 1985 and July 1988. These are infraclinical forms in 80% of the cases, representing 20% of the breast carcinomas treated during the same period of time. The natural history of carcinomas in situ is presented; LCIS rarely evolve toward an invasive carcinoma and they should not be considered as risk factors. DCIS evolve, after biopsy, toward an infiltrating ductal carcinoma in 26 to 28% of the cases. Axillary node invasion is present in 3% of the cases. After diagnostic biopsy of a LCIS, a subcutaneous mastectomy with prosthetic reconstruction will be offered only if there are bilateral foci or diffuse microcalcifications. Supervision will be recommended in all other cases. The results of the mastectomy-node excision procedure are well known for the LCIS: less than 5% recurrence and a mortality under 1.5%. The current tendency goes toward a limited surgical act: axillary dissection is discussed for small LCIS; lumpectomy is more and more advocated with long-term results still not well known; in case of lumpectomy, two prospective trials are currently in progress in the world, in order to assess the efficacy of radiotherapy.     

The treatment of ductal carcinoma in situ of the breast

As screening mammography has become more frequently used to screen asvmptomatic women, the diagnosis of ductal carcrinoma in situ (DCIS) has become commonplace. Its treatment remains contentious, ranging from mastectomy to local excision alone. The goal of treatment for DCIS is breast conservation, however, as many as 25% of women with this diagnosis may require mastectomy. Although no clear selection criteria have been adopted to subdivide patients into groups best treated by either mastectomy or local excision with or without radiation therapy, many patients with DCIS are candidates for local excision alone, if the biology of the disease is favorable, the size is small, and the margins are negative. Radiation therapy added to local excision decreases the likelihood of recurrence; however, if there is recurrence when first radiation is employed, the patient's only remaining choice often is mastectomy.     

Lobular carcinoma in situ of the breast

Lobular carcinoma in situ of the breast is a well defined pathologic entity which is found in about 2.5 per cent of all specimens of the breast taken for biopsy and most commonly occurs in premenopausal females. Its diagnosis is virtually always incidental due to the absence of any clinical indication of its presence. This lesion carries a significant risk for development of subsequent invasive carcinoma which applies equally to both breasts and which appears to increase with time. The appropriate treatment of this disease remains a controversial issue. Various aspects of its epidemiology, pathology and natural history which have an important bearing on the therapeutic decision as well as the many treatment options available are analyzed herein. There is certainly a perception that lobular carcinoma in situ represent the early form of a malignant process which can be cured or prevented if appropriately treated at this stage. At the very least, an understanding of this lesion holds the potential for broadening our understanding of the physiologic basis of carcinoma of the breast as a whole.     

Lobular carcinoma in situ of the breast

The diagnosis of the lobular carcinoma in situ (LCIS), whose frequency is estimated to range from 0.8 to 3.8 p. cent of breast cancers on the whole, is exclusively anatomopathological since it does not have any specific clinical and/or radiological characteristics. After describing the two main differential diagnoses, the various possible treatments are studied, bearing in mind that the therapeutic strategy must take into account the three characteristics which are typical of LCIS: multicentricity, bilaterality and the possible occurrence of an invasive cancer.     

Breast biopsy and the surgical treatment of early carcinoma of the breast

Biopsy techniques include aspiration for fluid, for cytology, or for histology. The indications for each method depend on the physical and/or mammographic findings. If a breast cancer is diagnosed, then treatment will depend on the size and location of the lesion and the patient's wishes. The surgical technique for lumpectomy and axillary node dissection is described.     

Lobular carcinoma in situ and invasive lobular cancer of the breast

PURPOSE OF REVIEW: The incidence of lobular carcinoma in situ and invasive lobular carcinoma of the breast is increasing. Recent data suggest that lobular carcinoma in situ is an indolent precursor for breast cancer, rather than a pure risk factor. This could imply free surgical margins become important. The risk of contralateral carcinoma and of multifocality of invasive lobular carcinoma is higher than for invasive ductal carcinoma. Therefore, the need for mastectomy, or even for preventative contralateral mastectomy is questioned. Conventional mammography or ultrasonography cannot always give useful preoperative information about the extent of lobular cancers. The value of dynamic contrast-enhanced magnetic resonance imaging needs to be established for these patients. RECENT FINDINGS: The risk of invasive carcinoma after lobular carcinoma in situ is increased. Invasive carcinoma is usually located at the index point of lobular carcinoma in situ and is of lobular histology. Dynamic contrast-enhanced magnetic resonance imaging can be useful in the detection and preoperative staging of invasive lobular carcinoma. The risk of local recurrence is high in patients with invasive lobular carcinoma. Mastectomy and breast reconstruction could be an option in selected patients. The response to preoperative chemotherapy is worse for invasive lobular carcinoma compared with invasive ductal carcinoma, with a greater need for rescue mastectomy. SUMMARY: Lobular carcinoma in situ and invasive lobular carcinoma are different entities from ductal carcinoma in situ and invasive lobular carcinoma. Their biological profile should be studied further in order to make the fine tuning of treatment possible.     

Actual management of ductal carcinoma in situ of the breast

Ductal carcinoma in situ (DCIS) represents a premalignant, non-invasive intraductal carcinoma of the breast. About 30% of all mammographically detected breast cancers contain DCIS. Due to the increased use of mammography during the last 20 years the incidence of DCIS has dramatically risen. Histologically it represents a heterogenous group of potentially malignant lesions. The prognosis of DCIS is excellent, but the optimal management of the disease still remains controversial. This review summarizes the results of the latest randomized trials and retrospective analyses investigating the optimal therapeutic strategies in the treatment of DCIS. In addition, it presents a range of treatment options on the basis of the guidelines of the German gynecological oncology group (AGO) 2008.     

子宫颈原位癌的诊断及处理

子宫颈原位癌（cervical carcinoma in situ，ccis）首先由Broder于1953年提出，1967年Richart认为子宫颈上皮非典型增生和子宫颈原位癌同属一种上皮变化谱，有连续关系，是子宫颈浸润癌的癌前病变，统称为宫颈上皮内瘤变（cervical intraepithelial neoplasia，CIN）。CINⅢ级是指子宫颈重度非典型增生和（或）子宫颈原位癌。子宫颈原位癌上皮全层极性消失，     

Carcinoma in situ of the vagina following treatment for carcinoma of the cervix: a distinctive clinical entity.

A series of 10 patients who presented with carcinoma in situ of the vagina following treatment for carcinoma of the cervix were seen in a 3 year period and their clinical and histologic features reviewed. Vaginal lesions developed 1 to 22 years after diagnosis of carcinoma of the cervix was made. In three patients the vaginal lesions progressed to invasion. In the remaining patients repeated biopsies have revealed persistent carcinoma in situ. From this series of 10 patients we conclude that the biologic behavior of vaginal carcinoma in situ following carcinoma of the cervix resembles that of carcinoma in situ of the cervix and that carcinoma of the vagina following carcinoma of the cervix should be considered a separate clinical entity distinctive from primary invasive carcinoma of the vagina.     

Involvement of the nipple in early carcinoma of the breast

Cancerous involvement of the nipple and subareolar tissue (nipple and areolar complex, NAC) was confirmed histopathologically in 24 of 65 patients with gross tumors measuring 2.5 centimeters or less. Erosion of the nipple as a clinical manifestation of involvement of NAC was seen in only two patients. The other 22 were all subclinical. The histologic form of involvement of NAC included intraductal-1 in 19 patients, stromal in one patient, lymphatic in two patients and intraductal-1 as well as stromal in two. Stepcut and serial observation of the whole breast suggested that both intraductal spread and stromal invasion of carcinoma were continuous processes from the underlying tumor. Involvement of NAC was more frequent if the patient was aged 50 years or less and if the proximity of the tumor to the nipple was less than 4 centimeters, regardless of the size of the tumor.     

Lobular carcinoma in situ of the breast. Apropos of 3 cases

The authors explain the particular nature of these multifocal tumors: absence of node involvement, difficulties of diagnosis, relatively favorable prognosis and a therapeutic dilemma: limited procedure with strict surveillance, subcutaneous bilateral mastectomy.