Evaluation of predictive factors, particularly the Van Nuys index, of local recurrence in ductal carcinoma in situ of the breast: study of 166 cases with conservative treatment and review of the literature

Ductal carcinoma in situ (DCIS), a non metastazing lesion of the breast is more frequently observed due to the improvement of mammography and widespre ad use of screening. The most important risk of this disease is local recur rence. In about half of cases, it occurs as an infiltrating carcinoma. In a series of 166 DCIS treated by lumpectomy plus radiotherapy, we have studie d clinico-pathological factors for the prognosis of local recurrences and p artictularly the Van Nuys Index criteria (nuclear grade, necrosis, rite, ma rgin width). After median follow up of 75 months, 21 recurrences were obser ved with IO corresponding to an infiltrating carcinoma and one of them died . The size of DCIS evaluated on pathological documents (histological slides and thames), the Van Nuys Prognostic Index (VNPI) and the mitotic index we re the main prognostic factors of local recurrence We discuss these results and confront them to a review of the literature focalised on the delicate problem of the decision of conservative treatment A multidisciplinary appro ach (Breast : Surgeon, Radiologist, Pathologist and Radiotherapist), a stan dardisation of pathological criteria (size, margin width) and the continuat ion of randomised trials are necessary to fine the best attitude of conserv ative therapy.