The presence of an extensive intraductal component following a limited excision correlates with prominent residual disease in the remainder of the breast

Roland Holland*, James L. Connolly, Rebecca Gelman, Marcel Mravunac, Jan H C L Hendriks, Andre L M Verbeek, Stuart J. Schnitt, Barbara Silver, John Boyages, Jay R. Harris

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

400 Citations (Scopus)

Abstract

Previous studies of patients with infiltrating ductal breast cancer treated with conservative surgery (ie, limited excision) and radiotherapy have indicated that the presence of an extensive intraductal component (EIC) in the excision specimen is highly associated with subsequent breast recurrence. The reason for this association is not clear, but possible explanations include the presence of more extensive disease in the breast or increased radiation resistance among tumors with an EIC (EIC +) compared with those without (EIC -) tumors. To investigate this association further, we related the presence or absence of an EIC in the primary tumors of 214 women who underwent mastectomy to the likelihood of finding additional foci of cancer in their mastectomy specimens using a correlated pathologic-radiologic mapping technique. Primary tumors that were EIC+ were significantly more likely to have carcinoma in the remainder of the breast than those which were EIC-(74% v 42%; P = .00001). This difference was primarily due to the presence of residual intraductal carcinoma. Seventy-one percent of EIC+ patients had residual intraductal carcinoma compared with 28% of EIC-patients (P < .00001). In particular, 44% of EIC+ patients had "prominent" residual intraductal carcinoma compared with 3% of EIC-patients (P <.00001). We conclude that patients whose tumors contain an EIC more frequently have a large subclinical tumor burden in the remainder of the breast compared with patients whose tumors do not contain an EIC. This observation may explain the association between EIC and subsequent breast recurrence when patients are treated with a limited excision before radiotherapy.

Original languageEnglish
Pages (from-to)113-118
Number of pages6
JournalJournal of Clinical Oncology
Volume8
Issue number1
DOIs
Publication statusPublished - 1990

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