Ductal carcinoma in situ: breast-conserving surgery without radiotherapy

Ductal carcinoma in situ (DCIS) is commonly managed with breast-conserving surgery (BCS) and adjuvant radiotherapy. Oncoplastic BCS allows wide excision without compromising the breast's natural shape. We use 'level one' techniques to excise a 'sector' of tissue (apex at the nipple) rather than traditional 'lumpectomy'. There are concerns that some DCIS is over-treated and radiotherapy administered unnecessarily incurring the associated cost, time and morbidity without added benefit. This study aims to determine if pure DCIS can be managed safely without relying upon adjuvant therapies with an acceptable breast conservation rate.

A retrospective clinical study of 96 patients who underwent BCS alone for pure DCIS between 1995 and 2009. Data were collected on patient's demographics, presentation, excision margins, re-excision and final margins, size, grade and nuclear architecture of DCIS, recurrent ipsilateral breast events, contralateral breast events, date of the last follow-up with mammography and patients' assessment of cosmetic outcome (scale 1-5: very dissatisfied, somewhat dissatisfied, somewhat satisfied, satisfied, very satisfied).

Twelve (12.5%) had an ipsilateral recurrence. Mean follow-up was 7.6 years (median 7.4); yearly recurrence rate was 1.67%. Of the 52 patients who gave an assessment of cosmetic outcome, 46 were satisfied.

Ipsilateral recurrence rates were favourable compared with previous trials where DCIS was treated with lumpectomy and radiotherapy. Oncoplastic techniques may be used to successfully treat pure DCIS with BCS alone without adjuvant therapies.