PDF(Pubmed)
Abstract：
Ductal carcinoma in situ (DCIS) accounts for approximately 30% of new breast cancer diagnoses. However, our understanding of how normal breast tissue evolves into DCIS and invasive cancers remains insufficient. Further, conclusions regarding the mechanisms of disease progression in terms of histopathology, genetics, and radiology are often conflicting and have implications for treatment planning. Moreover, the increase in DCIS diagnoses since the adoption of organized breast cancer screening programs has raised concerns about overdiagnosis and subsequent overtreatment. Active monitoring, a nonsurgical management strategy for DCIS, avoids surgery in favor of close imaging follow-up to de-escalate therapy and provides more treatment options. However, the two major challenges in active monitoring are identifying occult invasive cancer and patients at risk of invasive cancer progression. Subsequently, four prospective active monitoring trials are ongoing to determine the feasibility of active monitoring and refine the patient eligibility criteria and follow-up intervals. Radiologists play a major role in determining eligibility for active monitoring and reviewing surveillance images for disease progression. Trial results published over the next few years would support a new era of multidisciplinary DCIS care.
摘要：
导管原位癌（DCIS）约占新诊断乳腺癌的30％。然而,我们对正常乳腺组织如何演变为DCIS和浸润性癌症的理解仍然不足.Further,关于疾病进展机制在组织病理学方面的结论，遗传学,放射学和放射学往往相互矛盾，对治疗计划有影响。此外，自采用有组织的乳腺癌筛查计划以来,DCIS诊断的增加引发了对过度诊断和随后的过度治疗的担忧.主动监控,DCIS的非手术管理策略，避免手术而有利于密切的影像学随访以降低治疗的速度,并提供更多的治疗选择.然而,主动监测的两大挑战是识别隐匿性浸润性癌症和有浸润性癌症进展风险的患者.随后，正在进行四项前瞻性主动监测试验,以确定主动监测的可行性,并完善患者的入选标准和随访间隔.放射科医师在确定主动监测的资格和审查疾病进展的监测图像方面发挥着重要作用。未来几年公布的试验结果将支持多学科DCIS护理的新时代。
