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Is there a low-grade precursor pathway in breast cancer?
Ann Surg Oncol. 2012 Apr; 19(4):1115-21.AS

Abstract

BACKGROUND

Newly proposed models of breast tumorigenesis suggest that low- and high-grade lesions have distinct tumor progression pathways. Our objective was to examine the relationship between histologic grade and molecular subtype in women with lobular carcinoma in situ (LCIS) and ductal carcinoma in situ (DCIS) who developed subsequent ipsilateral invasive breast cancers.

METHODS

Patients who underwent surveillance for classical LCIS (1994-2007) and those followed after lumpectomy±radiation for DCIS (1991-2004) who developed subsequent ipsilateral invasive cancers and had available tissue blocks were included. ER/PR/HER2 surrogates were used for molecular subtype.

RESULTS

Material was available for 27 patients with classical LCIS who developed ipsilateral invasive cancer (12 invasive ductal cancer [IDC], 14 invasive lobular, 1 mixed), and 26 patients with DCIS (12 low-grade [LG], 14 high-grade [HG]) who developed ipsilateral IDC. No difference in age at diagnosis or median time to invasive cancer existed between groups with LCIS and DCIS. When stratified by grade, 0 of 12 LG-DCIS developed LG-IDC (3 grade II; 9 grade III), and only 1 of 12 LCIS patients who developed IDC had LG-IDC. Thirteen (93%) patients with HG-DCIS developed HG-IDC. In contrast, molecular subtype was maintained in 23 of 27 (85%) cases of LCIS and in 18 of 26 (69%) cases of DCIS.

CONCLUSIONS

These data do not support a low-grade precursor pathway characterized by LCIS and LG-DCIS. ER/PR and HER2 status have a high rate of concordance between in situ and subsequent invasive lesions. Additional studies of metachronous in situ and invasive lesions are needed to better understand pathways of breast tumorigenesis.

Authors+Show Affiliations

Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, USA. kingt@mskcc.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21935747

Citation

King, Tari A., et al. "Is There a Low-grade Precursor Pathway in Breast Cancer?" Annals of Surgical Oncology, vol. 19, no. 4, 2012, pp. 1115-21.
King TA, Sakr RA, Muhsen S, et al. Is there a low-grade precursor pathway in breast cancer? Ann Surg Oncol. 2012;19(4):1115-21.
King, T. A., Sakr, R. A., Muhsen, S., Andrade, V. P., Giri, D., Van Zee, K. J., & Morrow, M. (2012). Is there a low-grade precursor pathway in breast cancer? Annals of Surgical Oncology, 19(4), 1115-21. https://doi.org/10.1245/s10434-011-2053-0
King TA, et al. Is There a Low-grade Precursor Pathway in Breast Cancer. Ann Surg Oncol. 2012;19(4):1115-21. PubMed PMID: 21935747.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is there a low-grade precursor pathway in breast cancer? AU - King,Tari A, AU - Sakr,Rita A, AU - Muhsen,Shirin, AU - Andrade,Victor P, AU - Giri,Dilip, AU - Van Zee,Kimberly J, AU - Morrow,Monica, Y1 - 2011/09/21/ PY - 2011/03/07/received PY - 2011/9/22/entrez PY - 2011/9/22/pubmed PY - 2012/7/24/medline SP - 1115 EP - 21 JF - Annals of surgical oncology JO - Ann Surg Oncol VL - 19 IS - 4 N2 - BACKGROUND: Newly proposed models of breast tumorigenesis suggest that low- and high-grade lesions have distinct tumor progression pathways. Our objective was to examine the relationship between histologic grade and molecular subtype in women with lobular carcinoma in situ (LCIS) and ductal carcinoma in situ (DCIS) who developed subsequent ipsilateral invasive breast cancers. METHODS: Patients who underwent surveillance for classical LCIS (1994-2007) and those followed after lumpectomy±radiation for DCIS (1991-2004) who developed subsequent ipsilateral invasive cancers and had available tissue blocks were included. ER/PR/HER2 surrogates were used for molecular subtype. RESULTS: Material was available for 27 patients with classical LCIS who developed ipsilateral invasive cancer (12 invasive ductal cancer [IDC], 14 invasive lobular, 1 mixed), and 26 patients with DCIS (12 low-grade [LG], 14 high-grade [HG]) who developed ipsilateral IDC. No difference in age at diagnosis or median time to invasive cancer existed between groups with LCIS and DCIS. When stratified by grade, 0 of 12 LG-DCIS developed LG-IDC (3 grade II; 9 grade III), and only 1 of 12 LCIS patients who developed IDC had LG-IDC. Thirteen (93%) patients with HG-DCIS developed HG-IDC. In contrast, molecular subtype was maintained in 23 of 27 (85%) cases of LCIS and in 18 of 26 (69%) cases of DCIS. CONCLUSIONS: These data do not support a low-grade precursor pathway characterized by LCIS and LG-DCIS. ER/PR and HER2 status have a high rate of concordance between in situ and subsequent invasive lesions. Additional studies of metachronous in situ and invasive lesions are needed to better understand pathways of breast tumorigenesis. SN - 1534-4681 UR - https://www.unboundmedicine.com/medline/citation/21935747/Is_there_a_low_grade_precursor_pathway_in_breast_cancer L2 - https://dx.doi.org/10.1245/s10434-011-2053-0 DB - PRIME DP - Unbound Medicine ER -