Duktales Carcinoma in situ der Mamma: Mythos Resektionsränder

The DCIS is a non-invasive cancer type but it can progress to an invasive cancer in up to 50% of the cases. It accounts for 8-30% of the total rate of breast cancer with an increasing tendency. The main part of DCIS is diagnosed by the mammographic typical pleomorphic micro-calcifications. There are three gradings of core malignancy. A part of the DCIS contains comedo necrosis. Therapeutical options are the surgical resection and a marking by wire before. A radiological control of the resected tissue should be performed during the operation. In cases of a larger size of the DCIS, the resection could be combined with an axillary sentinel node biopsy. Nonsurgical options are the radiation and the endocrine therapy with tamoxifen. The main prognostic factors are the size and the architecture of the DCIS, histological grading, comedo necrosis, age of the patient, calcification-residuals of the DCIS and the resection margin. SILVERSTEIN published the VNPI (= Van Nuys Prog-nosting Index) to determine the risk of local recurrence. This index was modificated in progress. The classification of the DCIS in different stages leads to diverse therapeutical options. Beside the DCIS size and the histological classification the third parameter of the index is the resection margin. There is special interest in this parameter because it is the only one which can be influenced actively after the diagnosis. Based on the evaluation from DUNNE et al. who analysed more the 20 studies, the current german recommendation of a resection margin of more than 2 mm has been established.