Empfehlungen der Österreichischen Gesellschaft für Senologie zur Diagnostik und Therapie des duktalen Karzinoms in situ (= DCIS)

Bildgebende Diagnostik

1. Bestimmung der Ausdehnung der Läsion durch digitale Mammografieverfahren

2. Ultraschall nur bei assoziierter Herdläsion und/oder Architekturstörung

3. Präoperative MRT: a) bei bioptisch verifiziertem DCIS G2, 3 bei dichter Brust (ACR 3 und 4)

   • bei Verdacht auf Multizentrizität und Multifokalität [1].

4. Clipmarkierung nach jeder Biopsie obligat!
   Vakuumbiopsie oder Corebiopsie (nur bei soliden Läsionen) [2] [3]

5. Präoperative, bildgesteuerte Hakenmarkierung. Bei großen Läsionen (≥ 4 cm) und quardrantenüberragenden Läsionen Markierung der Tumorränder mit Haken an bis zu 3 Stellen empfohlen. Bildgebende Dokumentation der Lage der Haken

6. Präparatradiografie zum Nachweis der kompletten Exzision von Mikroverkalkungen [4] – unmittelbare Nachexzision bei sehr knappem oder involviertem Schnittrand eventuell in Zusammenschau mit einem möglichen Gefrierschnitt vom verdächtigen Schnittrand

7. Postoperative Kontrollmammografie bei Schnittrand ≤ 2 mm und ausgedehntem Mikrokalk – Verdacht auf Residualkalk (4 bis 6 Wochen postoperativ, Kompression der Brust bereits möglich) [5] [6].
   Postoperative MRT bei Schnittrand ≤ 2 mm und ausgedehntem non-mass enhancement im Rahmen eines präoperativen MRT (Verdacht auf Residualläsion)

8. Jährliche Kontrollmammografie zum Ausschluss von Rezidiven und kontralateralem Karzinom.

Publikationsverlauf

Artikel online veröffentlicht:
01. Juni 2021

• Literatur

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