Md. Lagios, CLASSIFICATION OF DUCT CARCINOMA IN-SITU (DCIS) WITH A CHARACTERIZATION OF HIGH-GRADE LESIONS - DEFINING COHORTS FOR CHEMOPREVENTION TRIALS, Journal of cellular biochemistry, 1996, pp. 108-111
In the last 6 years a number of non-randomized, predominantly single i
nstitutional trials of breast conservation therapy (BCT) with DCIS, ha
ve demonstrated that it constitutes a very heterogeneous group of dise
ases with markedly different risks of local recurrence and invasive tr
ansformation. There has been a consensus that DCIS, which exhibits a '
'comedo'' morphology, generally defines a high risk group. Most studie
s, moreover, have identified the same two features, nuclear grade and
necrosis, as contributing most significantly to prognosis [4-6]. Nucle
ar grade and necrosis have been identified as independent prognostic v
ariables in several studies [5,6]. High nuclear grade DCIS which exhib
its comedo necrosis defines the majority of all DCIS which will result
in local recurrence and invasive transformation after BCT. Studies ut
ilizing image cytometry, to determine ploidy and S-phase fraction and
immunohistochemical studies of proliferation and oncogene distribution
have shown a significant association with morphologically identified
high nuclear grade and aneuploidy, high S-phase fraction or proliferat
ion rate, presence of HER-2/neu and P53 oncogenes and absence of estro
gen receptors. Generally the inverse of this association is seen with
low nuclear grade DCIS. However, initial hopes that these adjunctive s
tudies would identify subsets within the high nuclear grade group whic
h might be more likely to recur have not been fulfilled. (C) 1997 Wile
y-Liss, Inc.