导管原位癌的病理学国际社会调查:现在和未来。

Carole Mathelin, Massimo Lodi, Khalid Alghamdi, Bolivar Arboleda-Osorio, Eli Avisar, Stanley Anyanwu, Mohcen Boubnider, Mauricio Maghales Costa, Elisabeth Elder, Tony Elonge, Luiz Gebrim, Xishan Hao, Shigeru Imoto, Esther Meka, Michel Mouelle, Alexander Mundinger, Valerijus Ostapenko, Serdar Özbaş, Tolga Özmen, Vahit Özmen, Tadeusz Pienkowski, Gustavo Sarria, Ashraf Selim, Vladimir Semiglazov, Schlomo Schneebaum
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引用次数: 2

摘要

目的:导管原位癌(DCIS)的治疗管理在世界各国存在差异,一些治疗指征仍存在争议。探讨不同国家DCIS的管理情况;确定双方同意的做法和有争议的话题;以及对DCIS未来管理的调查意见。材料和方法:Senologic International Society网络成员在2021年11月至2022年2月期间使用问卷参与了一项在线调查。结果:来自20个不同国家的22份回复显示,87%的参与者参与了有组织的乳腺癌筛查项目,DCIS病例占所有乳腺癌的13.7%。大多数参与者使用分级分类(100%)、形态分类(78%)和免疫组织化学分析(73%)。在保守治疗的情况下,平均再切除率为10.3%,平均2.5 mm的边缘清晰被认为是健康的。乳房根治率为35.5%,乳房重建率为53%。肿瘤床增强适应症是不一致的,73%的参与者表示激素阳性DCIS需要激素治疗。73%的参与者认为对一些低风险DCIS不进行手术和放疗。43%的参与者使用了多基因检测。关于DCIS管理的未来变化,参与者大多回答手术降级(48%),放疗降级(35%)和/或主动监测(22%)。结论:本调查提供了目前全球DCIS管理实践的概述。研究表明,有些领域是双方同意的:发病率随着时间的推移而增加,年轻妇女的治疗,病理分类,健康边缘的定义,保留皮肤的乳房切除术和立即乳房重建。然而,一些话题仍然存在争议,并导致了不同的实践,例如诊断年龄的演变,老年妇女低风险DCIS降级的益处,激素治疗的适应症,放疗遗漏或多基因检测。在这些问题上达成共识需要进一步的证据,创新方法仍在临床试验中进行评估。国际老年医学会(International Senologic Society)鼓励对DCIS进行精准医疗和个性化治疗,避免过度治疗和过度诊断,为患有DCIS的女性提供更好的医疗服务。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Senologic International Society Survey on Ductal Carcinoma In Situ: Present and Future.

Objective: Therapeutic management of ductal carcinoma in situ (DCIS) is heterogeneous among countries worldwide, and some treatment indications are still controversial. To investigate DCIS management in different countries; identify both consensual practices and controversial topics; and survey opinions about the future management of DCIS.

Materials and methods: The Senologic International Society network members participated to an online survey using a questionnaire, between November 2021 and February 2022.

Results: Twenty-two responses from 20 different countries showed that organized breast cancer screening programs were present for 87% participants, and DCIS cases represented 13.7% of all breast cancers. Most participants used the grade classification (100%), the morphological classification (78%) and performed immunohistochemistry assays (73%). In case of conservative treatment, the mean re-excision rate was 10.3% and clear margins of mean 2.5 mm were considered healthy. Radical mastectomy rate was 35.5% with a breast reconstruction rate of 53%. Tumor bed boost indications were heterogeneous, and 73% of participants indicated hormone therapy for hormone-positive DCIS. Surgery and radiotherapy omission for some low-risk DCIS were considered by 73% of participants. Multigene assays were used by 43% of participants. Concerning future changes in DCIS management, participants mostly answered surgical de-escalation (48%), radiotherapy de-escalation (35) and/or active surveillance for some cases (22%).

Conclusion: This survey provided an overview of the current practices of DCIS management worldwide. It showed that some areas are rather consensual: incidence increases over time, treatment in young women, pathological classifications, definition of healthy margins, the skin-sparing mastectomy and immediate breast reconstruction. However, some topics are still debated and result in heterogeneous practices, such as evolution in the age of diagnosis, the benefit of de-escalation in low-risk DCIS among elderly women, indications for hormone therapy, radiotherapy omission, or multigene assays. Further evidence is needed to reach consensus on these points, and innovative approaches are still under evaluation in clinical trials. The International Senologic Society, by its members, encourages precision medicine and personalized treatments for DCIS, to avoid overtreatment and overdiagnosis, and provide better healthcare to women with DCIS.

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