Ductal carcinoma in situ of the breast has been accepted as being a distinct clinical and histopathologic entity since the 1940s. With increased use of screening mammopgraphy, there has been a dramatic increase in the detection of early breast
cancer.
Intraductal carcinoma is an increasingly common pathologic findings and its treatment is a dilemma for both patients and surgeons. The treatment of intraductal carcinoma is currently unsettled and quite controversal.
The clinical records were reviewed from 22 cases with ductal carcinoma in situ treated at the Department of Surgery, Korea University Hospital, between January 1985 and June 1994. If an area of invasion was found, the tumor was classified as an
infiltrating ductal carcinoma and excluded from this study. Multifocality was defined as additional intraductal cancers apart from the primary tumor in the same breast. Age, chief complaint, mammographic findings, tumor size, pathologic subtypes,
and
operative types were retrospectively analysed to find out adequate operative methods.
The incidence of intraductal carcinoma was 4.2% of all breast cancer. Age distribution was prevalent in second decade to seventh decade, and mean age was 44 years. Old. Chief complaints were palpable mass(68.2%) and positive in screening(32.8%).
The
most common mammographic finding was microcalcification, involving 11 cases (50%). All tumors were subclassified according to their predominant histologic subtype. Comedo carcinomas were the most common(68.6%). Micropapillary, cribriform, and
cribriform
with codemo subtypes were 2 cases respectively. Multifocality was 22.7%.
The median size of the cancers was 2.9cm. Four cases were 2cm or less. Nine cases were 2 to 5cm. Four cases were more than 5cm. The surgical procedures were breast conserving treatment with irradiation in 3 cases, simple mastectomy in 5 cases,
and
modified radical mastectomy in 14 cases(63.6%). Two of 17 cases had axillary metastase. Within a median follow-up of 32 months, a crude recurrence was not found.
As a results, this study has demonstated that mastectomy is the best choice for patients who get diffuse microcalcification on mammogrsphy, for those who have cancer lesions more than 5cm, and for those who have a phobia for breast recurrence.
Breast
consevation requires more detailed clinical followup than mastectomy.
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