Evaluation of clinical and pathological features associated with relapse in breast ductal carcinoma insitu patients

Objective: It was aimed to evaluate the clinical and pathological features recorded in the archive files of patients who are being followed up with the diagnosis of breast ductal carcinoma in situ in our medical oncology clinic and to determine the relationship of these features with recurrence. Method: In our study, the system files of approximately 6000 patients diagnosed with breast cancer were scanned and ductal carcinoma insitu (DCIS) patients who were followed up for at least 2 years were included. These 6000 files were scanned in the system with 21 different diagnosis codes. Ultimately, 44 patients were found to have DCIS. From the pathology reports and files of these patients, estrogen and progesterone receptor status, Ki-67 percentage, CerBB2 status, lesion size and grade, presence of necrosis, pathological variant of the lesion, presence and type of calcification, operation type, sentinel lymph node biopsy status, whether they received radiotherapy or not. Whether the patient received hormonal therapy, time to recurrence during follow-up, and clinical and pathological characteristics of the patients who developed recurrence that may be related to recurrence were examined. Results: It was determined that 56.8% (n=25) of the patients diagnosed with breast ductal carcinoma in situ underwent mastectomy and 43.2% (n=19) underwent breast-conserving surgery. It was noted that 65.9% (n=29) of these cases were not given radiotherapy, and 34.1% (n=15) were given radiotherapy. It was determined that 38.6% (n=17) of the cases were not given any hormone therapy, 40.9% (n=18) were given tamoxifen, 9.1% (n=4) were given aromatase inhibitors, 11.4% were given no hormone therapy. It was determined that (n=5) tamoxifen and aromatase inhibitor were given sequentially. The average duration of hormonal therapy for 27 patients given hormone therapy was recorded as 3.65 ± 1.76 years. While sentinel lymph node biopsy could not be performed in 50.0% (n=22) of the cases, sentinel lymph node biopsy was performed in 45.0% (n=20). The biopsy results of 20 patients who underwent sentinel lymph node biopsy were interpreted as negative. It was determined that 52.3% (n=23) of the patients did not undergo axillary lymph node dissection, and 38.6% (n=17) underwent axillary lymph node dissection. No positivity was detected in the lymph nodes of patients who underwent axillary dissection. While recurrence was detected in 4.5% (n=2) of the patients, it was noted that one of these patients had a recurrence within 2 years and the other within 8 years. In the patient with early recurrence, the tumor size was 5.5 cm and mastectomy was performed. The patient did not receive RT or hormonotherapy after this operation. Estrogen and progesterone receptors were negative. Cerbb2 was reported as (+++). The patient relapsed 2 years after the operation. In our other patient, who had a recurrence in 8 years, the tumor size was 1 cm and the lesion was grade 3. After the BCS operation, the patient received RT and tamoxifen for 5 years, and then was monitored without medication, and he relapsed during this period. In 2 patients with recurrence, the type of recurrence was determined as invasive cancer. The site of recurrence was locally in the breast in both cases. Conclusion: In our study, we found that the number of recurrences was only 2 in patients diagnosed with ductal carcinoma in situ. Since our number of patients with relapse was low, we did not conduct additional analysis on factors that may be associated with relapse. Studies involving larger numbers of patients are needed to analyze relaps-related conditions. Keywords: Breast cancer, ductal carcinoma in situ, radiotherapy, mastectomy, hormonotherapy