Pathologic variables predictive of breast events in patients with ductal carcinoma in situ

Central pathology review of ductal carcinoma in situ from 1,456patients enrolled in National Surgical Adjuvant Breast and Bowel Project (NSABP) protocol B-24 was performed to determine predictors for ipsilateral breast tumor recurrences and contralateral breast cancers. Findings after a median follow-up time of 10.5 years revealed ductal comedo necrosis, micropapillary histologic tumor type, and multifocality to be independent high riskjactorsfor ipsilateral breast tumor recurrence. Risk increasedfor slight comedo necrosis vs absent andfor moderate to marked comedo necrosis vs slight. The presence of a micropapillary tumor type and gross tumor size (2TO cm) were independently found as riskfactorsfor contralateral breast cancers. Although 4 7% of ipsilateral and 66% of contralateral events were invasive carcinomas, overall mortality was only 2.3%, a conundrum possibly related to the small size of the latter The similar predictive role of comedo necrosis in this study and that reported previouslyfrom NSABP B-1 7 (total of 2,079 patients) strongly supports its role as a simple high- risk predictor for ipsilateral breast tumor recurrences.