It is important to note that the authors are not recommending hormone receptor testing be completely abandoned for ductal carcinoma in situ. They are simply suggesting that the testing should be deferred to being performed on the surgical resection specimen rather than the diagnostic core needle biopsy tissue.
The sample size used (58 cases) is clearly extremely small and cannot be used as the basis for sweeping recommendations for the many thousands of DCIS cases that are diagnosed in the United States annually. This study is from a major academic program; other programs may run the risk of patients not having the ER testing done at all if it is no longer a routine component of pathology testing on DCIS tissue.
The case is probably stronger for abandoning PR testing in DCIS, since this value is very unlikely to influence management decisions on its own.
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Dr. Lisa Newman |
Other institutions should be encouraged to perform their own analyses to monitor the cost-effectiveness of ER/PR testing on core needle biopsies revealing DCIS. A study of this type should also be considered for large, multisite data sets, such as the American College of Surgeons’ National Cancer Database.
Lisa Newman, MD, FACS, is director of the breast oncology program for the Henry Ford Health System, and medical director for the Henry Ford International Center for the Study of Breast Cancer Subtypes, both in Detroit. She also serves as adjunct professor of health management and policy at the University of Michigan School of Public Health, Detroit. She has no relevant financial disclosures.
FROM THE AMERICAN JOURNAL OF SURGICAL PATHOLOGY
