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Rahul R. Parikh, MD 1 , Bruce G. Haffty, MD 1 , & Meena S. Moran, MD 2

Presentation No: 1083. Ductal Carcinoma in Situ with Microinvasion: Prognostic Implications, Long-term Outcomes, and Role of Axillary Evaluation. Rahul R. Parikh, MD 1 , Bruce G. Haffty, MD 1 , & Meena S. Moran, MD 2.

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Rahul R. Parikh, MD 1 , Bruce G. Haffty, MD 1 , & Meena S. Moran, MD 2

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  1. Presentation No: 1083 Ductal Carcinoma in Situ with Microinvasion: Prognostic Implications, Long-term Outcomes, and Role of Axillary Evaluation Rahul R. Parikh, MD1, Bruce G. Haffty, MD1, & Meena S. Moran, MD2 1Department of Radiation Oncology, The Cancer Institute of New Jersey, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ 2 Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT Yale School of Medicine

  2. Purpose/Methods • DCIS has a relatively good prognosis with breast conserving surgery and radiation (CS+RT). • Axillary evaluation is not routinely performed for pure DCIS lesions because of the low prevalence of nodal metastases (0-7%). • The role for surgical exploration of the axilla remains unclear for patients with DCIS with microinvasion (DCISM).    • We assessed the association of age, race, family history, margin status, histology, and receptor status, with DCIS or DCISM in a large cohort of patients treated with CS+RT (n=393).  • Long-term outcome was evaluated as a function pathology (DCIS vs. DCISM) and axillary evaluation for LRFS, DMFS, and OS. • Median patient age at diagnosis = 55.8 years • Median follow-up = 12.91 years 

  3. Extent of Axillary Evaluation * Note: All patients that had SLNBx went on to have Axillary dissection (standard clinical practice during this time interval)

  4. Patient/Tumor Characteristics • DCISM did NOT correlate with, young age, race, family history, margin status, histology, receptor status, use of hormonal therapy or chemotherapy. • (all p > 0.05)

  5. Univariate survival analysis In UVA, margin status, histology, pathology, and axillary evaluation were NOT independent predictors of LRFS, DMFS, or OS (p > 0.05).

  6. Survival Figure 2. 10-year DMFS for DCIS = 98.5% & DCISM = 97.9% (p = 0.77, log-rank test). Figure 1. 10 year LRFS for DCIS = 90.7% & DCISM = 89.0% (p = 0.36, log-rank test). Figure 3. 10-year OS for DCIS = 93.2% & DCISM = 95.7% (p = 0.93, log-rank test).

  7. Conclusions • DCISM did NOT correlate with local relapse, young age, race, family history, margin status, histology, or adjuvant therapy (all p> 0.05). • Similar to DCIS, the prevalence of nodal metastases in the DCISM cohort was low (1.38%) in this large dataset. • In UVA & survival analysis, pathology (DCIS vs. DCISM) was NOT an independent predictor of LRFS, DMFS, or OS (p > 0.05). • Surgical evaluation of the axilla was NOT an independent predictor of LRFS, DMFS, or OS in Cox proportional hazards analysis (p > 0.05). • Given the low incidence of loco-regional and distant failures in this large, retrospective dataset, the role for surgical evaluation of the axilla remains unclear. • TAKE HOME POINT: Patients with DCISM may be treated similarly to patients with DCIS. Yale School of Medicine

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