Questioning the Value of Evaluating Estrogen and Progesterone Receptors on Core Biopsy Specimens of Patients with Ductal Carcinoma in Situ (DCIS)

Abstract

Purpose: To evaluate the value of estrogen and progesterone receptors on core biopsy specimens of patients with ductal carcinoma in situ. Introduction: The immunohistochemical determination of the estrogen receptor (ER) and progesterone receptor (PR) status is predictive of the response of patients with invasive cancer to hormonal therapy. The value of the receptor status prior to definitive surgery with either breast conservation or mastectomy for patients with ductal carcinoma in situ (DCIS) and no invasive component is less clear. Methods: We identified through the tumor registry 344 patients with breast cancer diagnosed from 2014 through 2015. Two hundred seventy-seven patients had invasive cancer at diagnosis. Results: Of the remaining 67 patients with DCIS or atypical hyperplasia alone on core biopsy, 15 (22%) patients were found to have invasive cancer at the time of definitive surgery. Forty-six patients without an invasive component had definitive surgery at the study institution, of which three had a component of higher grade DCIS than on the core biopsy. Fourteen patients (30%) underwent a mastectomy. Conclusion: A significant proportion (29%) of patients with DCIS alone on core biopsy had either an invasive component at the time of definitive surgery or a higher grade DCIS component. An additional 14/46 (30%) of patients chose mastectomy, for whom consideration of adjuvant endocrine therapy for contralateral risk reduction did not depend on the receptor status of the index DCIS. Cost savings could be realized if the determination of ER is deferred until after definitive surgery. Determination of PR on DCIS specimens can be omitted entirely.