Duktal Karsinoma İn Situ(DKİS) Tedavisi
Synopsis
DKİS, meme koruyucu cerrahi (MKC) veya mastektomi ile lokal olarak tedavi edilebilen bir hastalıktır. Mastektomi bazı vakalarda bir seçenek olsa da, genellikle lokal tedavi olarak MKC tercih edilir. MKC, lumpektomi olarak da adlandırılır. Bu tedavilerin ardından çoğu vakada adjuvan radyoterapi (RT) de verilir. Düşük riskli hastalığı olan bazı hastalarda radyoterapi makul ölçüde ihmal edilebilir. Çoğu vakada sentinel lenf nodu biyopsisi (SLNB) gereksinimi olmaz. Ancak, rezeksiyonun (mastektomi veya MKC) ileride yapılabilecek SLNB’nin doğruluğunu veya kullanılabilirliğini azaltabileceği yüksek riskli özelliklere sahip hastalarda SLNB yapılmalıdır (24). Sonraki kanser riskini azaltmak için hormon tedavisi uygulama kararı, lokal tedavi seçimine ve tümörün hormon reseptörü durumuna bağlıdır. Östrojen ve progesteron reseptörü pozitif olan, MKC planlanan hastada, tedaviyi desteklemek ve nüks riskini azaltmak için beş yıllık hormon tedavisi önerilir. Tedavi seçimi hastanın menopoz durumuna göre belirlenir. Menopoz öncesi hastalarda tamoksifen kullanılır. Menopoz sonrası hastalarda ise tamoksifen veya aromataz inhibitörleri kabul edilebilir seçeneklerdir. Östrojen ve progesteron reseptörü pozitif olan ve mastektomi planlanan hastada, karşı taraf meme kanserinin önlenmesi için hormon tedavisi düşünülmelidir (54-55). MKC veya tek taraflı mastektomi yapılmış östrojen reseptörü (ÖR) / progesteron reseptörü (PR) negatif olan hastalarda yeni bir ÖR/PR pozitif hastalığı önlemek için tamoksifen kullanımı önerilebilir; ancak bu durumun rutin tedavide yeri yoktur. Seçilmiş hastalarda, hasta bilgilendirilmesi ve onamı alınarak yapılabilir. Bilateral mastektomi yapılan hastalarda endokrin tedavinin bir rolü yoktur Hormon reseptörü pozitif, 1. veya 2. derece DKİS'li ve invaziv kanseri olmayan 40 yaş ve üzeri 995 hastada yapılan randomize bir çalışmada, aktif izlemeye (altı ayda bir meme görüntüleme ve fizik muayene ile takip) atananlarda ipsilateral meme kanseri oranlarının, kılavuza uygun bakıma atananlarla benzer olduğu gösterilmiştir (79). Hormon reseptörü pozitif, 1. Veya 2. Derece DKİS'li ve invaziv kanseri olmayan 40 yaş ve üzeri hastalarda yapılan bir çalışmada, altı ayda bir meme görüntüleme ve fizik muayene ile takip edilip aktif izlemeye atananlarda ipsilateral meme kanseri oranlarının, kılavuza uygun izlenen hastalarla benzer olduğu gösterilmiştir (75). MKC yapılan DKİS’li hastalarda tedavi sonrası takip; düzenli öykü, fizik muayene ve mamografiden oluşur; laboratuvar testleri, tümör belirteçleri veya diğer ileri görüntüleme yöntemleri rutin olarak kullanılmaz.
References
Ernster VL, Ballard-Barbash R, Barlow WE, et al. Detection of ductal carcinoma in situ in women undergoing screening mammography. J Natl Cancer Inst. 2002;94(20):1546-1554. doi:10.1093/jnci/94.20.1546.
Elshof LE, Tryfonidis K, Slaets L, et al. Feasibility of a prospective, randomised, open-label, international multicentre, phase III, non-inferiority trial to assess the safety of active surveillance for low risk ductal carcinoma in situ - The LORD study. Eur J Cancer. 2015;51(12):1497-1510. doi:10.1016/j.ejca.2015.05.008
Ryser MD, Thomas SM, Li Y, et al. Cancer outcomes in women without upfront surgery for ductal carcinoma in situ: observational cohort study. BMJ 2025; 390:e083542.
Hanson SE, Lei X, Roubaud MS, et al. Long-term Quality of Life in Patients With Breast Cancer After Breast Conservation vs Mastectomy and Reconstruction. JAMA Surg 2022; 157:e220631.
Meijnen P, Oldenburg HS, Peterse JL, et al. Clinical outcome after selective treatment of patients diagnosed with ductal carcinoma in situ of the breast. Ann Surg Oncol 2008; 15:235.
Narod SA, Iqbal J, Giannakeas V, et al. Breast Cancer Mortality After a Diagnosis of Ductal Carcinoma In Situ. JAMA Oncol 2015; 1:888.
Fisher B, Land S, Mamounas E, et al. Prevention of invasive breast cancer in women with ductal carcinoma in situ: an update of the National Surgical Adjuvant Breast and Bowel Project experience. Semin Oncol 2001; 28:400.
LJ, Fourquet A, Vicini FA, et al. Long-term outcome after breast-conservation treatment with radiation for mammographically detected ductal carcinoma in situ of the breast. Cancer 2005; 103:1137.
Vargas C, Kestin L, Go N, et al. Factors associated with local recurrence and cause-specific survival in patients with ductal carcinoma in situ of the breast treated with breast-conserving therapy or mastectomy. Int J Radiat Oncol Biol Phys 2005; 63:1514.
Cutuli B, Cohen-Solal-le Nir C, de Lafontan B, et al. Breast-conserving therapy for ductal carcinoma in situ of the breast: the French Cancer Centers' experience. Int J Radiat Oncol Biol Phys 2002; 53:868.
Wapnir IL, Dignam JJ, Fisher B, et al. Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst 2011; 103:478.
Bleicher RJ. Ductal carcinoma in situ. Surg Clin North Am 2013; 93:393.
Chatterjee A, Pyfer B, Czerniecki B, et al. Early postoperative outcomes in lumpectomy versus simple mastectomy. J Surg Res 2015; 198:143.
Rakovitch E, Pignol JP, Hanna W, et al. Significance of multifocality in ductal carcinoma in situ: outcomes of women treated with breast-conserving therapy. J Clin Oncol 2007; 25:5591.
Morrow M, Van Zee KJ, Solin LJ, et al. Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology Consensus Guideline on Margins for Breast-Conserving Surgery with Whole-Breast Irradiation in Ductal Carcinoma In Situ. Ann Surg Oncol 2016; 23:3801.
Boland GP, Chan KC, Knox WF, et al. Value of the Van Nuys Prognostic Index in prediction of recurrence of ductal carcinoma in situ after breast-conserving surgery. Br J Surg 2003; 90:426.
Silverstein MJ, Lagios MD, Groshen S, et al. The influence of margin width on local control of ductal carcinoma in situ of the breast. N Engl J Med 1999; 340:1455.
Kinne DW, Petrek JA, Osborne MP, et al. Breast carcinoma in situ. Arch Surg 1989; 124:33.
Silverstein MJ. An argument against routine use of radiotherapy for ductal carcinoma in situ. Oncology (Williston Park) 2003; 17:1511.
Gao X, Fisher SG, Emami B. Risk of second primary cancer in the contralateral breast in women treated for early-stage breast cancer: a population-based study. Int J Radiat Oncol Biol Phys 2003; 56:1038.
Tuttle TM, Jarosek S, Habermann EB, et al. Increasing rates of contralateral prophylactic mastectomy among patients with ductal carcinoma in situ. J Clin Oncol 2009; 27:1362.
Hwang ES. The impact of surgery on ductal carcinoma in situ outcomes: the use of mastectomy. J Natl Cancer Inst Monogr 2010; 2010:197.
Giardiello D, Kramer I, Hooning MJ, et al. Contralateral breast cancer risk in patients with ductal carcinoma in situ and invasive breast cancer. NPJ Breast Cancer 2020; 6:60.
Virnig BA, Tuttle TM, Shamliyan T, Kane RL. Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes. J Natl Cancer Inst 2010; 102:170.
White RR, Halperin TJ, Olson JA Jr, et al. Impact of core-needle breast biopsy on the surgical management of mammographic abnormalities. Ann Surg 2001; 233:769.
Silverstein MJ, Larsen L, Soni R, et al. Breast biopsy and oncoplastic surgery for the patient with ductal carcinoma in situ: Surgical, pathologic, and radiologic issues. In: Ductal Carcinoma in Situ of the Breast, Silverstein MJ (Ed), Lippincortt Williams and Wilkins, Philadelphia 2002. p.185.
Gluck BS, Dershaw DD, Liberman L, Deutch BM. Microcalcifications on postoperative mammograms as an indicator of adequacy of tumor excision. Radiology 1993; 188:469.
Aref A, Youssef E, Washington T, et al. The value of postlumpectomy mammogram in the management of breast cancer patients presenting with suspicious microcalcifications. Cancer J Sci Am 2000; 6:25.
Grann A, Abdou JC, Dragman N, Goodman R. The value of postexcision preradiation mammography in patients with early-stage breast cancer. Am J Clin Oncol 2004; 27:285.
Giannakeas V, Sopik V, Narod SA. Association of Radiotherapy With Survival in Women Treated for Ductal Carcinoma In Situ With Lumpectomy or Mastectomy. JAMA Netw Open 2018; 1:e181100.
Lyman GH, Giuliano AE, Somerfield MR, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol 2005; 23:7703.
Weaver DL. Occult "micrometastases" in ductal carcinoma in situ: investigative implications for sentinel lymph node biopsy. Cancer 2003; 98:2083.
Lara JF, Young SM, Velilla RE, et al. The relevance of occult axillary micrometastasis in ductal carcinoma in situ: a clinicopathologic study with long-term follow-up. Cancer 2003; 98:2105.
Silverstein MJ, Waisman JR, Gamagami P, et al. Intraductal carcinoma of the breast (208 cases). Clinical factors influencing treatment choice. Cancer 1990; 66:102.
Intra M, Veronesi P, Mazzarol G, et al. Axillary sentinel lymph node biopsy in patients with pure ductal carcinoma in situ of the breast. Arch Surg 2003; 138:309.
Julian TB, Land SR, Fourchotte V, et al. Is sentinel node biopsy necessary in conservatively treated DCIS? Ann Surg Oncol 2007; 14:2202.
Diaz Casas SE, Serrano Muñoz WA, Buelvas Gómez NA, et al. When is Sentinel Lymph Node Biopsy Useful in Ductal Carcinoma In Situ? The Experience at a Latin American Cancer Center. Cureus. 2021;13(7):e16134. Published 2021 Jul 3. doi:10.7759/cureus.16134
Intra M, Rotmensz N, Veronesi P, et al. Sentinel node biopsy is not a standard procedure in ductal carcinoma in situ of the breast: the experience of the European institute of oncology on 854 patients in 10 years. Ann Surg 2008; 247:315.
Schwartz GF, Giuliano AE, Veronesi U, Consensus Conference Committee. Proceedings of the consensus conference on the role of sentinel lymph node biopsy in carcinoma of the breast, April 19-22, 2001, Philadelphia, Pennsylvania. Cancer 2002; 94:2542.
Lagios MD, Westdahl PR, Margolin FR, Rose MR. Duct carcinoma in situ. Relationship of extent of noninvasive disease to the frequency of occult invasion, multicentricity, lymph node metastases, and short-term treatment failures. Cancer 1982; 50:1309.
Brennan ME, Turner RM, Ciatto S, et al. Ductal carcinoma in situ at core-needle biopsy: meta-analysis of underestimation and predictors of invasive breast cancer. Radiology 2011; 260:119.
Silverstein MJ, Lagios MD. Should all patients undergoing breast conserving therapy for DCIS receive radiation therapy? No. One size does not fit all: an argument against the routine use of radiation therapy for all patients with ductal carcinoma in situ of the breast who elect breast conservation. J Surg Oncol 2007; 95:605.
Buchholz TA, Haffty BG, Harris JR. Should all patients undergoing breast conserving therapy for DCIS receive radiation therapy? Yes. Radiation therapy, an important component of breast conserving treatment for patients with ductal carcinoma in situ of the breast. J Surg Oncol 2007; 95:610.
Goodwin A, Parker S, Ghersi D, Wilcken N. Post-operative radiotherapy for ductal carcinoma in situ of the breast--a systematic review of the randomised trials. Breast 2009; 18:143.
van Seijen M, Lips EH, Fu L, et al. Long-term risk of subsequent ipsilateral lesions after surgery with or without radiotherapy for ductal carcinoma in situ of the breast. Br J Cancer 2021; 125:1443.
Sagara Y, Freedman RA, Vaz-Luis I, et al. Patient Prognostic Score and Associations With Survival Improvement Offered by Radiotherapy After Breast-Conserving Surgery for Ductal Carcinoma In Situ: A Population-Based Longitudinal Cohort Study. J Clin Oncol 2016; 34:1190.
Shurell E, Olcese C, Patil S, et al. Delay in radiotherapy is associated with an increased risk of disease recurrence in women with ductal carcinoma in situ. Cancer 2018; 124:46.
Shah C, McGee M, Wilkinson JB, et al. Clinical outcomes using accelerated partial breast irradiation in patients with ductal carcinoma in situ. Clin Breast Cancer 2012; 12:259.
Ciervide R, Dhage S, Guth A, et al. Five year outcome of 145 patients with ductal carcinoma in situ (DCIS) after accelerated breast radiotherapy. Int J Radiat Oncol Biol Phys 2012; 83:e159.
Shah C, Vicini F, Wazer DE, et al. The American Brachytherapy Society consensus statement for accelerated partial breast irradiation. Brachytherapy 2013; 12:267.
Offersen BV, Alsner J, Nielsen HM, et al. Hypofractionated Versus Standard Fractionated Radiotherapy in Patients With Early Breast Cancer or Ductal Carcinoma In Situ in a Randomized Phase III Trial: The DBCG HYPO Trial. J Clin Oncol 2020; 38:3615.
Fisher B, Costantino J, Redmond C, et al. Lumpectomy compared with lumpectomy and radiation therapy for the treatment of intraductal breast cancer. N Engl J Med 1993; 328:1581.
Chua BH, Link EK, Kunkler IH, et al. Radiation doses and fractionation schedules in non-low-risk ductal carcinoma in situ in the breast (BIG 3-07/TROG 07.01): a randomised, factorial, multicentre, open-label, phase 3 study. Lancet 2022; 400:431.
Gradishar WJ, Moran MS, Abraham J, et al. Breast Cancer, Version 3.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2022; 20:691.
Cuzick J, Sestak I, Pinder SE, et al. Effect of tamoxifen and radiotherapy in women with locally excised ductal carcinoma in situ: long-term results from the UK/ANZ DCIS trial. Lancet Oncol 2011; 12:21.
Allred DC, Anderson SJ, Paik S, et al. Adjuvant tamoxifen reduces subsequent breast cancer in women with estrogen receptor-positive ductal carcinoma in situ: a study based on NSABP protocol B-24. J Clin Oncol 2012; 30:1268.
Donker M, Litière S, Werutsky G, et al. Breast-conserving treatment with or without radiotherapy in ductal carcinoma In Situ: 15-year recurrence rates and outcome after a recurrence, from the EORTC 10853 randomized phase III trial. J Clin Oncol 2013; 31:4054.
Hughes LL, Wang M, Page DL, et al. Local excision alone without irradiation for ductal carcinoma in situ of the breast: a trial of the Eastern Cooperative Oncology Group. J Clin Oncol 2009; 27:5319.
Solin LJ, Gray R, Hughes LL, et al. Surgical Excision Without Radiation for Ductal Carcinoma in Situ of the Breast: 12-Year Results From the ECOG-ACRIN E5194 Study. J Clin Oncol 2015; 33:3938.
McCormick B, Winter K, Hudis C, et al. RTOG 9804: a prospective randomized trial for good-risk ductal carcinoma in situ comparing radiotherapy with observation. J Clin Oncol 2015; 33:709.
McCormick B, Winter KA, Woodward W, et al. Randomized Phase III Trial Evaluating Radiation Following Surgical Excision for Good-Risk Ductal Carcinoma In Situ: Long-Term Report From NRG Oncology/RTOG 9804. J Clin Oncol 2021; 39:3574.
Solin LJ, Gray R, Baehner FL, et al. A multigene expression assay to predict local recurrence risk for ductal carcinoma in situ of the breast. J Natl Cancer Inst 2013; 105:701.
Rakovitch E, Nofech-Mozes S, Hanna W, et al. A large prospectively designed study of the DCIS score: Recurrence risk after local excision for ductal carcinoma in situ patients with and without irradiation. Cancer Res 2015; 75S: SABCS #S5-04.
Rakovitch E, Sutradhar R, Nofech-Mozes S, et al. 21-Gene Assay and Breast Cancer Mortality in Ductal Carcinoma In Situ. J Natl Cancer Inst 2021; 113:572.
Shah C, Bremer T, Cox C, et al. Correction to: The Clinical Utility of DCISionRT® on Radiation Therapy Decision Making in Patients with Ductal Carcinoma In Situ Following Breast-Conserving Surgery. Ann Surg Oncol 2021; 28:878.
Woodward WA, Mitchell MP. The Elusive Prize of Radiation Therapy Predictive Assays in Breast Cancer. Int J Radiat Oncol Biol Phys 2023; 115:103.
de Mascarel I, MacGrogan G, Mathoulin-Pélissier S, et al. Breast ductal carcinoma in situ with microinvasion: a definition supported by a long-term study of 1248 serially sectioned ductal carcinomas. Cancer 2002; 94:2134.
Lagios MD. Practical pathology of duct carcinoma in situ: How to derive optimal data from the pathologic examination. In: Ductal Carcinoma of the Breast, Silverstein MJ (Ed), Lippincott Williams and Wilkins, Philadelphia 2002. p.207.
Gilcrease MZ, Sahin AA. Detection of ductal carcinoma in situ by screening mammography: Pathologic features important for clinical management. Breast Diseases: A Year Book Quarterly 2003; 13:316.
Consensus Conference on the classification of ductal carcinoma in situ. The Consensus Conference Committee. Cancer 1997; 80:1798.
International Breast Cancer Consensus Conference. Image-detected breast cancer: state of the art diagnosis and treatment. International Breast Cancer Consensus Conference. J Am Coll Surg 2001; 193:297.
Harris L, Fritsche H, Mennel R, et al. American Society of Clinical Oncology 2007 update of recommendations for the use of tumor markers in breast cancer. J Clin Oncol 2007; 25:5287.
Hammond ME, Hayes DF, Dowsett M, et al. American Society of Clinical Oncology/College Of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Clin Oncol 2010; 28:2784.
Wolff AC, Hammond ME, Schwartz JN, et al. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for human epidermal growth factor receptor 2 testing in breast cancer. Arch Pathol Lab Med 2007; 131:18.
Hwang ES, Hyslop T, Lynch T, et al. Active Monitoring With or Without Endocrine Therapy for Low-Risk Ductal Carcinoma In Situ: The COMET Randomized Clinical Trial. JAMA 2025; 333:972.
Claus EB, Chu P, Howe CL, et al. Pathobiologic findings in DCIS of the breast: morphologic features, angiogenesis, HER-2/neu and hormone receptors. Exp Mol Pathol 2001; 70:303.
Selim AG, El-Ayat G, Wells CA. Androgen receptor expression in ductal carcinoma in situ of the breast: relation to oestrogen and progesterone receptors. J Clin Pathol 2002; 55:14.
Hird RB, Chang A, Cimmino V, et al. Impact of estrogen receptor expression and other clinicopathologic features on tamoxifen use in ductal carcinoma in situ. Cancer 2006; 106:2113.
Allison KH, Hammond MEH, Dowsett M, et al. Estrogen and Progesterone Receptor Testing in Breast Cancer: ASCO/CAP Guideline Update. J Clin Oncol 2020; 38:1346.
Fisher B, Dignam J, Wolmark N, et al. Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-17. J Clin Oncol 1998; 16:441.
Fisher B, Dignam J, Wolmark N, et al. Tamoxifen in treatment of intraductal breast cancer: National Surgical Adjuvant Breast and Bowel Project B-24 randomised controlled trial. Lancet 1999; 353:1993.
Staley H, McCallum I, Bruce J. Postoperative tamoxifen for ductal carcinoma in situ. Cochrane Database Syst Rev 2012; 10:CD007847.
Wright J, et al. GS2-02: Impact of Tamoxifen Only after Breast Conservation Surgery for "Good Risk" Duct Carcinoma in Situ: Results from the NRG Oncology/RTOG 9804 and ECOG-ACRIN E5194 Trial. SABCS 2024; SESS-3482.
DeCensi A, Puntoni M, Guerrieri-Gonzaga A, et al. Randomized Placebo Controlled Trial of Low-Dose Tamoxifen to Prevent Local and Contralateral Recurrence in Breast Intraepithelial Neoplasia. J Clin Oncol 2019; 37:1629.
Lazzeroni M, Puntoni M, Guerrieri-Gonzaga A, et al. Randomized Placebo Controlled Trial of Low-Dose Tamoxifen to Prevent Recurrence in Breast Noninvasive Neoplasia: A 10-Year Follow-Up of TAM-01 Study. J Clin Oncol 2023; 41:3116.
Hammarström M, Gabrielson M, Crippa A, et al. Side effects of low-dose tamoxifen: results from a six-armed randomised controlled trial in healthy women. Br J Cancer 2023; 129:61.
Margolese RG, Cecchini RS, Julian TB, et al. Anastrozole versus tamoxifen in postmenopausal women with ductal carcinoma in situ undergoing lumpectomy plus radiotherapy (NSABP B-35): a randomised, double-blind, phase 3 clinical trial. Lancet 2016; 387:849.
Gradishar WJ, Moran MS, Abraham J, et al. Breast Cancer, J Natl Compr Canc Netw 2024;22(5):331–357
doi:10.6004/jnccn.2024.0035
Allred DC, Clark GM, Molina R, et al. Overexpression of HER-2/neu and its relationship with other prognostic factors change during the progression of in situ to invasive breast cancer. Hum Pathol 1992; 23:974.
Kuerer HM, Buzdar AU, Mittendorf EA, et al. Biologic and immunologic effects of preoperative trastuzumab for ductal carcinoma in situ of the breast. Cancer 2011; 117:39.
Kerlikowske K, Molinaro A, Cha I, et al. Characteristics associated with recurrence among women with ductal carcinoma in situ treated by lumpectomy. J Natl Cancer Inst 2003; 95:1692.
Allred DC. Ductal carcinoma in situ: terminology, classification, and natural history. J Natl Cancer Inst Monogr 2010; 2010:134.
Subhedar P, Olcese C, Patil S, et al. Decreasing Recurrence Rates for Ductal Carcinoma In Situ: Analysis of 2996 Women Treated with Breast-Conserving Surgery Over 30 Years. Ann Surg Oncol 2015; 22:3273.
Cronin PA, Olcese C, Patil S, et al. Impact of Age on Risk of Recurrence of Ductal Carcinoma In Situ: Outcomes of 2996 Women Treated with Breast-Conserving Surgery Over 30 Years. Ann Surg Oncol 2016; 23:2816.
Schmitz RSJM, van den Belt-Dusebout AW, Clements K, et al. Association of DCIS size and margin status with risk of developing breast cancer post-treatment: multinational, pooled cohort study. BMJ 2023; 383:e076022.
Schwartz GF, Patchefsky AS, Finklestein SD, et al. Nonpalpable in situ ductal carcinoma of the breast. Predictors of multicentricity and microinvasion and implications for treatment. Arch Surg 1989; 124:29.
Silverstein MJ, Waisman JR, Gamagami P, et al. Intraductal carcinoma of the breast (208 cases). Clinical factors influencing treatment choice. Cancer 1990; 66:102.
Fisher ER, Dignam J, Tan-Chiu E, et al. Pathologic findings from the National Surgical Adjuvant Breast Project (NSABP) eight-year update of Protocol B-17: intraductal carcinoma. Cancer 1999; 86:429.
Grabowski J, Salzstein SL, Sadler GR, Blair S. Intracystic papillary carcinoma: a review of 917 cases. Cancer 2008; 113:916.
Solin LJ, Fourquet A, Vicini FA, et al. Salvage treatment for local or local-regional recurrence after initial breast conservation treatment with radiation for ductal carcinoma in situ. Eur J Cancer. 2005;41(12):1715-1723. doi:10.1016/j.ejca.2005.03.028
