Breast Ductal Carcinoma In Situ with Microinvasion: Clinicopathological Characteristics, Prognosis and Role of Surgery in Treatment

Background: Advances in screening have led to almost half of the reduction in breast cancer mortality. Precocious diagnosis increasingly needs clinicians to better treat early breast diseases, such as DCIS, or DCIS with microinvasion (DCIS-Mi). Due to the increasing prevalence of DCIS-Mi. In this review, we will focus on study this entity and define current treatment options, especially the role of surgical approach in the overall treatment of DCIS-Mi to explore the current and future optimal management of DCIS-Mi. Methods: A PubMed search for relevant articles was performed using the following keywords by MeSH and free-word: breast cancer, DCIS, DCIS‐Mi, microinvasion, invasive ductal carcinoma (IDC), clinicopathological characteristics, prognosis and treatment. Results: Until 1997, the American Joint Committee on Cancer (AJCC) defined DCIS-Mi as a tumor with an area of invasion less than or equal to 1 mm as T1mic in the TNM staging system. Histologically, two distinct types of DCIS-MI was classified. Comedocarcinoma subtype of DCIS, the larger the size of a tumor’s DCIS component and multicentric foci of DCIS are more commonly associated with microinvasion. The roles of surgery in treatment of DCIS-Mi includes breast-conserving surgery, mastectomy, and surgical evaluation of the axilla. Current guidelines from the National Comprehensive Cancer Network (NCCN) recommend treating DCIS-Mi following surgery guidelines for DCIS. The overall prognosis of DCIS-Mi is excellent with survival at 5 years. Conclusions: An supposition of current available data indicates no survival benefit to an individual undergoing mastectomy versus lumpectomy and radiation (breast-conserving surgery). Whenever possible, breast-conserving therapy is the treatment of the first choice of DCIS-Mi. Among those unfavorable factors, the key factor is the ability to achieve negative final pathologic margins. Surgical assessment of the axilla, such as sentinel lymph node biopsy on all DCIS-Mi is recommended.