Carcinoma intraduttale della mammella: state dell'arte ed orientamenti futuri

Ductal Carcinoma In Situ (DCIS) has become one of the most controversial topics in breast disease. During the last few years the clinical picture at diagnosis is changed and the knowledge concerning the natural history of pathologic variants, prognostic factors and correlated guidelines for management has evolved. DCIS is defined as a malignancy of the epithelial cells that line the lactiferous ducts in which the malignant cells remain confined within the duct. Penetration of the basement membrane must be excluded by light microscopy. The recognition of DCIS as a distinct entity from invasive breast cancer has led to the current consensus that the treatment of patients with DCIS must be tailored specifically to this disease process. Before the advent of mammography, patients with DCIS became at diagnosis with symptoms and/or a palpable mass. Actually smaller and smaller lesions are detected and DCIS is recognized with much greater frequency. Mastectomy has proved to be a very effective treatment for patients with DCIS, but the early acceptance of breast conserving surgery plus radiation therapy for invasive cancer led to a reexamination of the effective role of such ablative treatment in this less severe disease. The adjuvant radiation treatment has recently observed to produce no benefit in local disease free survival in selected patients so that it would be an over-treatment if applied systematically with breast conserving surgery. Actually, clinical, pathologic and treatment related factors permit to stratify DCIS into specific subset in order to identify the more appropriate therapy for such lesions and in future other factors, as molecular markers, may be integrated into selection of the best treatment in order to improve the outcome.