ACR Appropriateness Criteria® Ductal Carcinoma in Situ
Identifieur interne : 004545 ( Istex/Corpus ); précédent : 004544; suivant : 004546ACR Appropriateness Criteria® Ductal Carcinoma in Situ
Auteurs : Meena S. Moran ; Harrison X. Bai ; Eleanor E. R. Harris ; Douglas W. Arthur ; Lisa Bailey ; Jennifer R. Bellon ; Lisa Carey ; Sharad Goyal ; Michele Y. Halyard ; Kathleen C. Horst ; Shannon M. Macdonald ; Bruce G. HafftySource :
- The Breast Journal [ 1075-122X ] ; 2012-01.
Abstract
Abstract: 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.
Url:
DOI: 10.1111/j.1524-4741.2011.01197.x
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ISTEX:932EA496305285B27F8AE75FE32F86D67C65161BLe document en format XML
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Halyard</name><affiliation><mods:affiliation>Mayo Clinic, Scottsdale, Arizona</mods:affiliation></affiliation></author><author><name sortKey="Horst, Kathleen C" sort="Horst, Kathleen C" uniqKey="Horst K" first="Kathleen C." last="Horst">Kathleen C. Horst</name><affiliation><mods:affiliation>Stanford University School of Medicine, Stanford, California</mods:affiliation></affiliation></author><author><name sortKey="Macdonald, Shannon M" sort="Macdonald, Shannon M" uniqKey="Macdonald S" first="Shannon M." last="Macdonald">Shannon M. Macdonald</name><affiliation><mods:affiliation>Massachusetts General Hospital, Boston, Massachusetts</mods:affiliation></affiliation></author><author><name sortKey="Haffty, Bruce G" sort="Haffty, Bruce G" uniqKey="Haffty B" first="Bruce G." last="Haffty">Bruce G. 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Moran</name><affiliation><mods:affiliation>Yale University School of Medicine, New Haven, Connecticut</mods:affiliation></affiliation></author><author><name sortKey="Bai, Harrison X" sort="Bai, Harrison X" uniqKey="Bai H" first="Harrison X." last="Bai">Harrison X. Bai</name><affiliation><mods:affiliation>Yale University School of Medicine, New Haven, Connecticut</mods:affiliation></affiliation></author><author><name sortKey="Harris, Eleanor E R" sort="Harris, Eleanor E R" uniqKey="Harris E" first="Eleanor E. R." last="Harris">Eleanor E. R. Harris</name><affiliation><mods:affiliation>Moffitt Cancer Center, Tampa, Florida</mods:affiliation></affiliation></author><author><name sortKey="Arthur, Douglas W" sort="Arthur, Douglas W" uniqKey="Arthur D" first="Douglas W." last="Arthur">Douglas W. Arthur</name><affiliation><mods:affiliation>Medical College of Virginia, Richmond, Virginia</mods:affiliation></affiliation></author><author><name sortKey="Bailey, Lisa" sort="Bailey, Lisa" uniqKey="Bailey L" first="Lisa" last="Bailey">Lisa Bailey</name><affiliation><mods:affiliation>Alta Bates Summit Medical Center, Oakland, California, American College of Surgeons</mods:affiliation></affiliation></author><author><name sortKey="Bellon, Jennifer R" sort="Bellon, Jennifer R" uniqKey="Bellon J" first="Jennifer R." last="Bellon">Jennifer R. Bellon</name><affiliation><mods:affiliation>Dana Farber Cancer Institute, Boston, Massachusetts</mods:affiliation></affiliation></author><author><name sortKey="Carey, Lisa" sort="Carey, Lisa" uniqKey="Carey L" first="Lisa" last="Carey">Lisa Carey</name><affiliation><mods:affiliation>University of North Carolina Health Care System, Chapel Hill, North Carolina, American Society of Clinical Oncology</mods:affiliation></affiliation></author><author><name sortKey="Goyal, Sharad" sort="Goyal, Sharad" uniqKey="Goyal S" first="Sharad" last="Goyal">Sharad Goyal</name><affiliation><mods:affiliation>UMDNJ‐Robert Wood Johnson Medical School, New Brunswick, New Jersey</mods:affiliation></affiliation></author><author><name sortKey="Halyard, Michele Y" sort="Halyard, Michele Y" uniqKey="Halyard M" first="Michele Y." last="Halyard">Michele Y. Halyard</name><affiliation><mods:affiliation>Mayo Clinic, Scottsdale, Arizona</mods:affiliation></affiliation></author><author><name sortKey="Horst, Kathleen C" sort="Horst, Kathleen C" uniqKey="Horst K" first="Kathleen C." last="Horst">Kathleen C. Horst</name><affiliation><mods:affiliation>Stanford University School of Medicine, Stanford, California</mods:affiliation></affiliation></author><author><name sortKey="Macdonald, Shannon M" sort="Macdonald, Shannon M" uniqKey="Macdonald S" first="Shannon M." last="Macdonald">Shannon M. Macdonald</name><affiliation><mods:affiliation>Massachusetts General Hospital, Boston, Massachusetts</mods:affiliation></affiliation></author><author><name sortKey="Haffty, Bruce G" sort="Haffty, Bruce G" uniqKey="Haffty B" first="Bruce G." last="Haffty">Bruce G. Haffty</name><affiliation><mods:affiliation>UMDNJ‐Robert Wood Johnson Medical School, New Brunswick, New Jersey</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j" type="main">The Breast Journal</title><title level="j" type="alt">BREAST JOURNAL</title><idno type="ISSN">1075-122X</idno><idno type="eISSN">1524-4741</idno><imprint><biblScope unit="vol">18</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="8">8</biblScope><biblScope unit="page" to="15">15</biblScope><biblScope unit="page-count">8</biblScope><publisher>Blackwell Publishing Ltd</publisher><pubPlace>Oxford, UK</pubPlace><date type="published" when="2012-01">2012-01</date></imprint><idno type="ISSN">1075-122X</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1075-122X</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract">Abstract: 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.</div></front></TEI><istex><corpusName>wiley</corpusName><keywords><teeft><json:string>dci</json:string><json:string>ductal</json:string><json:string>mastectomy</json:string><json:string>ductal carcinoma</json:string><json:string>tamoxifen</json:string><json:string>oncol</json:string><json:string>carcinoma</json:string><json:string>apbi</json:string><json:string>lumpectomy</json:string><json:string>relapse</json:string><json:string>mdcis</json:string><json:string>negative margins</json:string><json:string>randomized</json:string><json:string>slnb</json:string><json:string>invasive</json:string><json:string>adjuvant</json:string><json:string>microinvasion</json:string><json:string>cfwbrt</json:string><json:string>node</json:string><json:string>nsabp</json:string><json:string>radiotherapy</json:string><json:string>radiology</json:string><json:string>mammographically</json:string><json:string>surg</json:string><json:string>guideline</json:string><json:string>clin</json:string><json:string>moran</json:string><json:string>clin oncol</json:string><json:string>excision</json:string><json:string>awbrt</json:string><json:string>nodal</json:string><json:string>appropriateness criteria</json:string><json:string>axillary</json:string><json:string>axilla</json:string><json:string>local control</json:string><json:string>american college</json:string><json:string>american society</json:string><json:string>local relapse</json:string><json:string>pure dcis</json:string><json:string>recurrence</json:string><json:string>systemic therapy tamoxifen</json:string><json:string>sentinel lymph node biopsy</json:string><json:string>partial breast radiation</json:string><json:string>radiation oncologists</json:string><json:string>radiat oncol biol phys</json:string><json:string>adjuvant breast</json:string><json:string>local failure</json:string><json:string>breast cancer</json:string><json:string>supraclavicular fossa</json:string><json:string>regional nodal radiation</json:string><json:string>rating scale</json:string><json:string>daily fractions</json:string><json:string>treatment mastectomy</json:string><json:string>biopsy</json:string><json:string>breast</json:string><json:string>appropriateness</json:string><json:string>protocol</json:string></teeft></keywords><author><json:item><name>Meena S. Moran MD</name><affiliations><json:string>Yale University School of Medicine, New Haven, Connecticut</json:string></affiliations></json:item><json:item><name>Harrison X. Bai MSIII</name><affiliations><json:string>Yale University School of Medicine, New Haven, Connecticut</json:string></affiliations></json:item><json:item><name>Eleanor E. R. Harris MD</name><affiliations><json:string>Moffitt Cancer Center, Tampa, Florida</json:string></affiliations></json:item><json:item><name>Douglas W. Arthur MD</name><affiliations><json:string>Medical College of Virginia, Richmond, Virginia</json:string></affiliations></json:item><json:item><name>Lisa Bailey MD</name><affiliations><json:string>Alta Bates Summit Medical Center, Oakland, California, American College of Surgeons</json:string></affiliations></json:item><json:item><name>Jennifer R. Bellon MD</name><affiliations><json:string>Dana Farber Cancer Institute, Boston, Massachusetts</json:string></affiliations></json:item><json:item><name>Lisa Carey MD</name><affiliations><json:string>University of North Carolina Health Care System, Chapel Hill, North Carolina, American Society of Clinical Oncology</json:string></affiliations></json:item><json:item><name>Sharad Goyal MD</name><affiliations><json:string>UMDNJ‐Robert Wood Johnson Medical School, New Brunswick, New Jersey</json:string></affiliations></json:item><json:item><name>Michele Y. Halyard MD</name><affiliations><json:string>Mayo Clinic, Scottsdale, Arizona</json:string></affiliations></json:item><json:item><name>Kathleen C. Horst MD</name><affiliations><json:string>Stanford University School of Medicine, Stanford, California</json:string></affiliations></json:item><json:item><name>Shannon M. MacDonald MD</name><affiliations><json:string>Massachusetts General Hospital, Boston, Massachusetts</json:string></affiliations></json:item><json:item><name>Bruce G. Haffty MD</name><affiliations><json:string>UMDNJ‐Robert Wood Johnson Medical School, New Brunswick, New Jersey</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>ACR appropriateness criteria</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>breast conservation therapy</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>ductal carcinoma in situ</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>guidelines</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>radiation therapy</value></json:item></subject><articleId><json:string>TBJ1197</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>article</json:string></originalGenre><abstract>Abstract: 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. 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R.</forename><surname>Harris</surname><roleName type="degree">MD</roleName></persName><affiliation>Moffitt Cancer Center, Tampa, Florida<address><country key="US"></country></address></affiliation></author><author xml:id="author-0003"><persName><forename type="first">Douglas W.</forename><surname>Arthur</surname><roleName type="degree">MD</roleName></persName><affiliation>Medical College of Virginia, Richmond, Virginia<address><country key="US"></country></address></affiliation></author><author xml:id="author-0004"><persName><forename type="first">Lisa</forename><surname>Bailey</surname><roleName type="degree">MD</roleName></persName><affiliation>Alta Bates Summit Medical Center, Oakland, California, American College of Surgeons<address><country key="US"></country></address></affiliation></author><author xml:id="author-0005"><persName><forename type="first">Jennifer R.</forename><surname>Bellon</surname><roleName type="degree">MD</roleName></persName><affiliation>Dana Farber Cancer Institute, Boston, Massachusetts<address><country key="US"></country></address></affiliation></author><author xml:id="author-0006"><persName><forename type="first">Lisa</forename><surname>Carey</surname><roleName type="degree">MD</roleName></persName><affiliation>University of North Carolina Health Care System, Chapel Hill, North Carolina, American Society of Clinical Oncology<address><country key="US"></country></address></affiliation></author><author xml:id="author-0007"><persName><forename type="first">Sharad</forename><surname>Goyal</surname><roleName type="degree">MD</roleName></persName><affiliation>UMDNJ‐Robert Wood Johnson Medical School, New Brunswick, New Jersey<address><country key="US"></country></address></affiliation></author><author xml:id="author-0008"><persName><forename type="first">Michele Y.</forename><surname>Halyard</surname><roleName type="degree">MD</roleName></persName><affiliation>Mayo Clinic, Scottsdale, Arizona<address><country key="US"></country></address></affiliation></author><author xml:id="author-0009"><persName><forename type="first">Kathleen C.</forename><surname>Horst</surname><roleName type="degree">MD</roleName></persName><affiliation>Stanford University School of Medicine, Stanford, California<address><country key="US"></country></address></affiliation></author><author xml:id="author-0010"><persName><forename type="first">Shannon M.</forename><surname>MacDonald</surname><roleName type="degree">MD</roleName></persName><affiliation>Massachusetts General Hospital, Boston, Massachusetts<address><country key="US"></country></address></affiliation></author><author xml:id="author-0011"><persName><forename type="first">Bruce G.</forename><surname>Haffty</surname><roleName type="degree">MD</roleName></persName><affiliation>UMDNJ‐Robert Wood Johnson Medical School, New Brunswick, New Jersey<address><country key="US"></country></address></affiliation></author><idno type="istex">932EA496305285B27F8AE75FE32F86D67C65161B</idno><idno type="DOI">10.1111/j.1524-4741.2011.01197.x</idno><idno type="unit">TBJ1197</idno><idno type="toTypesetVersion">file:TBJ.TBJ1197.pdf</idno></analytic><monogr><title level="j" type="main">The Breast Journal</title><title level="j" type="alt">BREAST JOURNAL</title><idno type="pISSN">1075-122X</idno><idno type="eISSN">1524-4741</idno><idno type="book-DOI">10.1111/(ISSN)1524-4741</idno><idno type="book-part-DOI">10.1111/tbj.2011.18.issue-1</idno><idno type="product">TBJ</idno><idno type="publisherDivision">ST</idno><imprint><biblScope unit="vol">18</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="8">8</biblScope><biblScope unit="page" to="15">15</biblScope><biblScope unit="page-count">8</biblScope><publisher>Blackwell Publishing Ltd</publisher><pubPlace>Oxford, UK</pubPlace><date type="published" when="2012-01"></date></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><abstract xml:lang="en" style="main"><p><hi rend="bold">Abstract: </hi> 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.</p></abstract><textClass><keywords xml:lang="en"><term xml:id="k1">ACR appropriateness criteria</term><term xml:id="k2">breast conservation therapy</term><term xml:id="k3">ductal carcinoma in situ</term><term xml:id="k4">guidelines</term><term xml:id="k5">radiation therapy</term></keywords><classCode scheme="tocHeading1">ORIGINAL ARTICLES</classCode><classCode scheme="articleCategory">ORIGINAL ARTICLE</classCode></textClass><langUsage><language ident="EN"></language></langUsage></profileDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/932EA496305285B27F8AE75FE32F86D67C65161B/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Blackwell Publishing Ltd</publisherName><publisherLoc>Oxford, UK</publisherLoc></publisherInfo><doi origin="wiley" registered="yes">10.1111/(ISSN)1524-4741</doi><issn type="print">1075-122X</issn><issn type="electronic">1524-4741</issn><idGroup><id type="product" value="TBJ"></id><id type="publisherDivision" value="ST"></id></idGroup><titleGroup><title type="main" sort="BREAST JOURNAL">The Breast Journal</title></titleGroup></publicationMeta><publicationMeta level="part" position="01101"><doi origin="wiley">10.1111/tbj.2011.18.issue-1</doi><numberingGroup><numbering type="journalVolume" number="18">18</numbering><numbering type="journalIssue" number="1">1</numbering></numberingGroup><coverDate startDate="2012-01">January/February 2012</coverDate></publicationMeta><publicationMeta level="unit" type="article" position="3" status="forIssue"><doi origin="wiley">10.1111/j.1524-4741.2011.01197.x</doi><idGroup><id type="unit" value="TBJ1197"></id></idGroup><countGroup><count type="pageTotal" number="8"></count></countGroup><titleGroup><title type="tocHeading1">ORIGINAL ARTICLES</title><title type="articleCategory">ORIGINAL ARTICLE</title></titleGroup><copyright>© 2011 American College of Radiology</copyright><eventGroup><event type="xmlConverted" agent="Converter:BPG_TO_WML3G version:3.0.1 mode:FullText" date="2012-01-09"></event><event type="publishedOnlineEarlyUnpaginated" date="2011-11-23"></event><event type="firstOnline" date="2011-11-23"></event><event type="publishedOnlineFinalForm" date="2012-01-09"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:3.8.8" date="2014-02-10"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.3.4 mode:FullText" date="2015-02-25"></event></eventGroup><numberingGroup><numbering type="pageFirst" number="8">8</numbering><numbering type="pageLast" number="15">15</numbering></numberingGroup><correspondenceTo>Address correspondence and reprint requests to: Meena S. Moran, MD, American College of Radiology, 1891 Preston White Dr., Reston, VA 20191, or e‐mail: <email>meena.moran@yale.edu</email></correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:TBJ.TBJ1197.pdf"></link></linkGroup></publicationMeta><contentMeta><countGroup><count type="figureTotal" number="0"></count><count type="tableTotal" number="5"></count></countGroup><titleGroup><title type="main">ACR Appropriateness Criteria<sup>®</sup> Ductal Carcinoma <i>in Situ</i></title><title type="shortAuthors">MORAN ET AL.</title><title type="short"><i>ACR Appropriateness Criteria® DCIS</i></title></titleGroup><creators><creator creatorRole="author" xml:id="cr1" affiliationRef="#a1"><personName><givenNames>Meena S.</givenNames><familyName>Moran</familyName><degrees>MD</degrees></personName></creator><creator creatorRole="author" xml:id="cr2" affiliationRef="#a1"><personName><givenNames>Harrison X.</givenNames><familyName>Bai</familyName><degrees>MSIII</degrees></personName></creator><creator creatorRole="author" xml:id="cr3" affiliationRef="#a2"><personName><givenNames>Eleanor E. R.</givenNames><familyName>Harris</familyName><degrees>MD</degrees></personName></creator><creator creatorRole="author" xml:id="cr4" affiliationRef="#a3"><personName><givenNames>Douglas W.</givenNames><familyName>Arthur</familyName><degrees>MD</degrees></personName></creator><creator creatorRole="author" xml:id="cr5" affiliationRef="#a4"><personName><givenNames>Lisa</givenNames><familyName>Bailey</familyName><degrees>MD</degrees></personName></creator><creator creatorRole="author" xml:id="cr6" affiliationRef="#a5"><personName><givenNames>Jennifer R.</givenNames><familyName>Bellon</familyName><degrees>MD</degrees></personName></creator><creator creatorRole="author" xml:id="cr7" affiliationRef="#a6"><personName><givenNames>Lisa</givenNames><familyName>Carey</familyName><degrees>MD</degrees></personName></creator><creator creatorRole="author" xml:id="cr8" affiliationRef="#a7"><personName><givenNames>Sharad</givenNames><familyName>Goyal</familyName><degrees>MD</degrees></personName></creator><creator creatorRole="author" xml:id="cr9" affiliationRef="#a8"><personName><givenNames>Michele Y.</givenNames><familyName>Halyard</familyName><degrees>MD</degrees></personName></creator><creator creatorRole="author" xml:id="cr10" affiliationRef="#a9"><personName><givenNames>Kathleen C.</givenNames><familyName>Horst</familyName><degrees>MD</degrees></personName></creator><creator creatorRole="author" xml:id="cr11" affiliationRef="#a10"><personName><givenNames>Shannon M.</givenNames><familyName>MacDonald</familyName><degrees>MD</degrees></personName></creator><creator creatorRole="author" xml:id="cr12" affiliationRef="#a7"><personName><givenNames>Bruce G.</givenNames><familyName>Haffty</familyName><degrees>MD</degrees></personName></creator></creators><affiliationGroup><affiliation xml:id="a1" countryCode="US"><unparsedAffiliation>Yale University School of Medicine, New Haven, Connecticut</unparsedAffiliation></affiliation><affiliation xml:id="a2" countryCode="US"><unparsedAffiliation>Moffitt Cancer Center, Tampa, Florida</unparsedAffiliation></affiliation><affiliation xml:id="a3" countryCode="US"><unparsedAffiliation>Medical College of Virginia, Richmond, Virginia</unparsedAffiliation></affiliation><affiliation xml:id="a4" countryCode="US"><unparsedAffiliation>Alta Bates Summit Medical Center, Oakland, California, American College of Surgeons</unparsedAffiliation></affiliation><affiliation xml:id="a5" countryCode="US"><unparsedAffiliation>Dana Farber Cancer Institute, Boston, Massachusetts</unparsedAffiliation></affiliation><affiliation xml:id="a6" countryCode="US"><unparsedAffiliation>University of North Carolina Health Care System, Chapel Hill, North Carolina, American Society of Clinical Oncology</unparsedAffiliation></affiliation><affiliation xml:id="a7" countryCode="US"><unparsedAffiliation>UMDNJ‐Robert Wood Johnson Medical School, New Brunswick, New Jersey</unparsedAffiliation></affiliation><affiliation xml:id="a8" countryCode="US"><unparsedAffiliation>Mayo Clinic, Scottsdale, Arizona</unparsedAffiliation></affiliation><affiliation xml:id="a9" countryCode="US"><unparsedAffiliation>Stanford University School of Medicine, Stanford, California</unparsedAffiliation></affiliation><affiliation xml:id="a10" countryCode="US"><unparsedAffiliation>Massachusetts General Hospital, Boston, Massachusetts</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en"><keyword xml:id="k1">ACR appropriateness criteria</keyword><keyword xml:id="k2">breast conservation therapy</keyword><keyword xml:id="k3">ductal carcinoma in situ</keyword><keyword xml:id="k4">guidelines</keyword><keyword xml:id="k5">radiation therapy</keyword></keywordGroup><abstractGroup><abstract type="main" xml:lang="en"><p><b>Abstract: </b> 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.</p></abstract></abstractGroup></contentMeta><noteGroup><note xml:id="fn1"><p>The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria<sup><b>®</b></sup> through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply society endorsement of the final document.</p></note><note xml:id="fn2"><p>This article is a revised version of the American College of Radiology Appropriateness Criteria Ductal Carcinoma in Situ, excerpts of which are reprinted here with permission. Practitioners are encouraged to refer to the complete version at <url href="http://www.acr.org/ac">http://www.acr.org/ac</url>.</p></note></noteGroup></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>ACR Appropriateness Criteria® Ductal Carcinoma in Situ</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>ACR Appropriateness Criteria® DCIS</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>ACR Appropriateness Criteria® Ductal Carcinoma in Situ</title></titleInfo><name type="personal"><namePart type="given">Meena S.</namePart><namePart type="family">Moran</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Yale University School of Medicine, New Haven, Connecticut</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Harrison X.</namePart><namePart type="family">Bai</namePart><namePart type="termsOfAddress">MSIII</namePart><affiliation>Yale University School of Medicine, New Haven, Connecticut</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Eleanor E. R.</namePart><namePart type="family">Harris</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Moffitt Cancer Center, Tampa, Florida</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Douglas W.</namePart><namePart type="family">Arthur</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Medical College of Virginia, Richmond, Virginia</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Lisa</namePart><namePart type="family">Bailey</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Alta Bates Summit Medical Center, Oakland, California, American College of Surgeons</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Jennifer R.</namePart><namePart type="family">Bellon</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Dana Farber Cancer Institute, Boston, Massachusetts</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Lisa</namePart><namePart type="family">Carey</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>University of North Carolina Health Care System, Chapel Hill, North Carolina, American Society of Clinical Oncology</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Sharad</namePart><namePart type="family">Goyal</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>UMDNJ‐Robert Wood Johnson Medical School, New Brunswick, New Jersey</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Michele Y.</namePart><namePart type="family">Halyard</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Mayo Clinic, Scottsdale, Arizona</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Kathleen C.</namePart><namePart type="family">Horst</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Stanford University School of Medicine, Stanford, California</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Shannon M.</namePart><namePart type="family">MacDonald</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Massachusetts General Hospital, Boston, Massachusetts</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Bruce G.</namePart><namePart type="family">Haffty</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>UMDNJ‐Robert Wood Johnson Medical School, New Brunswick, New Jersey</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article"></genre><originInfo><publisher>Blackwell Publishing Ltd</publisher><place><placeTerm type="text">Oxford, UK</placeTerm></place><dateIssued encoding="w3cdtf">2012-01</dateIssued><copyrightDate encoding="w3cdtf">2012</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="tables">5</extent></physicalDescription><abstract>Abstract: 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.</abstract><subject lang="en"><genre>keywords</genre><topic>ACR appropriateness criteria</topic><topic>breast conservation therapy</topic><topic>ductal carcinoma in situ</topic><topic>guidelines</topic><topic>radiation therapy</topic></subject><relatedItem type="host"><titleInfo><title>The Breast Journal</title></titleInfo><genre type="journal">journal</genre><subject><genre>article-category</genre><topic>ORIGINAL ARTICLE</topic></subject><identifier type="ISSN">1075-122X</identifier><identifier type="eISSN">1524-4741</identifier><identifier type="DOI">10.1111/(ISSN)1524-4741</identifier><identifier type="PublisherID">TBJ</identifier><part><date>2012</date><detail type="volume"><caption>vol.</caption><number>18</number></detail><detail type="issue"><caption>no.</caption><number>1</number></detail><extent unit="pages"><start>8</start><end>15</end><total>8</total></extent></part></relatedItem><identifier type="istex">932EA496305285B27F8AE75FE32F86D67C65161B</identifier><identifier type="DOI">10.1111/j.1524-4741.2011.01197.x</identifier><identifier type="ArticleID">TBJ1197</identifier><accessCondition type="use and reproduction" contentType="copyright">© 2011 American College of Radiology</accessCondition><recordInfo><recordContentSource>WILEY</recordContentSource><recordOrigin>Blackwell Publishing Ltd</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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