Open AccessACR Appropriateness Criteria ® Ductal Carcinoma in Situ
Author(s) -
Moran Meena S.,
Bai Harrison X.,
Harris Eleanor E. R.,
Arthur Douglas W.,
Bailey Lisa,
Bellon Jennifer R.,
Carey Lisa,
Goyal Sharad,
Halyard Michele Y.,
Horst Kathleen C.,
MacDonald Shan M.,
Haffty Bruce G.
Publication year - 2011
Publication title -
the breast journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.533
H-Index - 72
eISSN - 1524-4741
pISSN - 1075-122X
DOI - 10.1111/j.1524-4741.2011.01197.x
Subject(s) - medicine , ductal carcinoma , mastectomy , guideline , appropriate use criteria , tamoxifen , delphi method , medical physics , breast cancer , cancer , pathology , mathematics , statistics
Ductal carcinoma in situ (DCIS) describes a wide spectrum of non‐invasive tumors which carry a significant risk of invasive relapse, thus prevention of local recurrence is vital. For appropriate patients with limited disease, management with breast conserving surgery (BCS) followed by whole‐breast radiation (RT) is supported by multiple Phase III studies, but mastectomy may be appropriate in selected patients. Omission of RT may also be reasonable in some patients, though which criteria are to be utilized remain unclear, and the existing data are contradictory with limited follow‐up. Various RT techniques such as boost to the tumor bed, partial breast radiation or hypofractionated, whole‐breast RT are increasingly utilized but the data to support their use specifically in DCIS is limited. Tamoxifen also increases local control for ER + DCIS, adding to the complexity of the local treatment management. This article reviews the existing scientific evidence, the controversies surrounding local management, and clinical guidelines for DCIS based on the group consensus by the ACR Breast Expert Panel. The American College of Radiology Appropriateness Criteria are evidence‐based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer‐reviewed journals and the application of a well established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.