J Breast Cancer.  2018 Jun;21(2):197-205. 10.4048/jbc.2018.21.2.197.

Microinvasive Carcinoma versus Ductal Carcinoma In Situ: A Comparison of Clinicopathological Features and Clinical Outcomes

Affiliations
  • 1Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea. sypmd@snu.ac.kr
  • 2Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
  • 3Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
  • 4Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

Abstract

PURPOSE
Although microinvasive carcinoma is distinct from ductal carcinoma in situ (DCIS), the clinical significance of microinvasion in DCIS remains elusive. The purpose of this study is to evaluate the clinicopathological features and clinical outcomes of microinvasive carcinoma compared with pure DCIS.
METHODS
We assessed 613 cases of DCIS and microinvasive carcinoma that were consecutively resected from 2003 to 2014 and analyzed clinicopathological variables, expression of standard biomarkers such as the estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), p53, and Ki-67, and tumor recurrence.
RESULTS
Among the 613 cases, 136 (22.2%) were classified as microinvasive carcinoma. Microinvasive carcinoma was significantly associated with DCIS with a large extent, high nuclear grade, necrosis, and comedotype architectural pattern. ER and PR expressions were dominantly observed in pure DCIS, whereas positive HER2 status, p53 overexpression, and high Ki-67 proliferation indices were more frequently observed in microinvasive carcinoma. Lymph node metastasis was found in only four cases of microinvasive carcinoma with multifocal microinvasion. In the multivariate analysis, DCIS with a large extent, comedo-type architectural pattern, and negative ER status were found to be independent predictors of microinvasion. During follow-up, 12 patients had ipsilateral breast recurrence, and no differences in recurrence rates were observed between patients with DCIS and those with microinvasive carcinoma. The triple-negative subtype was the only factor that was associated with tumor recurrence.
CONCLUSION
Microinvasive carcinomas are distinct from DCIS in terms of clinicopathological features and biomarker expressions but are similar to DCIS in terms of clinical outcomes. Our results suggest that microinvasive carcinoma can be treated and followed up as pure DCIS.

Keyword

Breast neoplasms; Noninfiltrating intraductal carcinoma; Recurrence; Triple negative breast neoplasms

MeSH Terms

Biomarkers
Breast
Breast Neoplasms
Carcinoma, Ductal*
Carcinoma, Intraductal, Noninfiltrating*
Estrogens
Follow-Up Studies
Humans
Lymph Nodes
Multivariate Analysis
Necrosis
Neoplasm Metastasis
Receptor, Epidermal Growth Factor
Receptors, Progesterone
Recurrence
Triple Negative Breast Neoplasms
Biomarkers
Estrogens
Receptor, Epidermal Growth Factor
Receptors, Progesterone

Figure

  • Figure 1 Histologic features and biomarker expression of microinvasive carcinoma. (A) In a representative case of microinvasive carcinoma, microinvasive foci appear as small clusters of tumor cells with inflammatory cell infiltrates in the stroma (H&E stain, ×200). (B) Surrounding ductal carcinoma in situ (DCIS) exhibits high nuclear grade and comedo-type necrosis with dystrophic calcification (H&E stain, ×200). Immunohistochemically, the tumor cells show estrogen receptor negativity (C), human epidermal growth factor receptor 2 overexpression (3+/3) (D), p53 overexpression (E), and high Ki-67 index (F) (C-F, immunohistochemistry, ×200). Immunohistochemical features of microinvasive carcinoma are identical to those of the adjacent DCIS.

  • Figure 2 A representative example of node metastasis in microinvasive carcinoma. (A) Microinvasive focus is seen as a large tumor cell nest and a few small clusters accompanied by lymphoid cell infiltration in the lower portion (arrow) (H&E stain, ×200). (B) An axillary lymph node reveals macrometastasis (arrow), measuring 0.3 cm in diameter (H&E stain, ×40).

  • Figure 3 Kaplan-Meier survival curves for recurrence-free survival stratified by subtypes. Tumors of triple-negative subtype show decreased recurrence-free survival compared to those with non-triple-negative subtype for all types of recurrence including ductal carcinoma in situ, microinvasive carcinoma and invasive carcinoma (A), and invasive recurrence (B).


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