Investigational Paradigms in Downscoring and Upscoring DCIS: Surgical Management ReviewReportar como inadecuado

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International Journal of Surgical OncologyVolume 2012 2012, Article ID 560493, 10 pages

Review ArticleDivision of Surgical Oncology, Department of Surgery, Tor Vergata University Hospital, 00133 Rome, Italy

Received 12 January 2012; Accepted 14 March 2012

Academic Editor: Kimberly Van Zee

Copyright © 2012 P. Orsaria et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Counseling patients with DCIS in a rational manner can be extremely difficult when the range of treatment criteria results in diverse and confusing clinical recommendations. Surgeons need tools that quantify measurable prognostic factors to be used in conjunction with clinical experience for the complex decision-making process. Combination of statistically significant tumor recurrence predictors and lesion parameters obtained after initial excision suggests that patients with DCIS can be stratified into specific subsets allowing a scientifically based discussion. The goal is to choose the treatment regimen that will significantly benefit each patient group without subjecting the patients to unnecessary risks. Exploring the effectiveness of complete excision may offer a starting place in a new way of reasoning and conceiving surgical modalities in terms of “downscoring” or “upscoring” patient risk, perhaps changing clinical approach. Reexcison may lower the specific subsets- score and improve local recurrence-free survival also by revealing a larger tumor size, a higher nuclear grade, or an involved margin and so suggesting the best management. It seems, that the key could be identifying significant relapse predictive factors, according to validated risk investigation models, whose value is modifiable by the surgical approach which avails of different diagnostic and therapeutic potentials to be optimal. Certainly DCIS clinical question cannot have a single curative mode due to heterogeneity of pathological lesions and histologic classification.

Autor: P. Orsaria, A. V. Granai, D. Venditti, G. Petrella, and O. Buonomo



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