New Test May Reduce Unnecessary Surgery for DCIS

Research Overview

Scientists at the University of California San Diego (UCSD) have developed a new test that could help patients avoid unnecessary surgery for ductal carcinoma in situ (DCIS). Their findings, published in the journal Cell Reports, indicate that the stickiness of tumor cells can predict whether a tumor is likely to progress to invasive cancer.

The DCIS Dilemma

Ductal carcinoma in situ (DCIS) is classified as a “precancerous” condition often detected during routine breast cancer screenings. Estimates suggest that DCIS accounts for approximately 20% of new breast cancer diagnoses. However, most cases do not progress to invasive cancer. As of 2010, mortality rates for women diagnosed with DCIS ranged from 1% to 2.6%. Some experts have argued that labeling DCIS as cancer may lead to unnecessary surgeries, causing financial and emotional burdens on patients and their families. Conversely, some studies indicate that over 25% of DCIS cases could eventually develop into invasive cancer.

Current Testing Methods

Currently, pathologists evaluate DCIS biopsies under a microscope and assign a grade based on cellular characteristics that indicate the potential for invasiveness. This grading informs decisions regarding surgical removal. However, many patients are uncomfortable with the uncertainty of leaving potentially dangerous growths untreated. As UCSD professor Dr. Adam J. Engler noted, “There’s no good universal marker for metastasis.”

Developing a Reliable DCIS Test

Innovative Approach by UCSD Team

Dr. Engler and his team from UCSD’s Chien-Lay Department of Bioengineering are exploring a solution to the challenges posed by DCIS. Their research, published in March 2025, details a method for assessing whether DCIS tumors are likely to metastasize. They have developed a device that measures the adhesion properties of tumor cells to predict metastatic potential.

Significance of Cell Stickiness

The researchers posited that by analyzing how sticky the cells in a biopsy are, they could infer the likelihood of the tumor becoming invasive. Dr. Engler expressed hope that this technology could eventually provide patients with personalized risk assessments for metastasis, allowing for tailored treatment plans.

Understanding Cancer Metastasis

Mechanics of Metastasis

Cancer metastasis occurs when groups of tumor cells break away and establish secondary growths elsewhere in the body. Cancer cells often lose their original characteristics after numerous divisions and genetic mutations, leading to a lack of cohesive connection with neighboring cells. This loss of attachment enables them to migrate to new locations, where they can proliferate and form secondary tumors.

Role of Epithelial Cells

DCIS forms from epithelial cells that line the milk ducts of the breast. These cells typically maintain strong connections that prevent the entry of foreign substances. The UCSD team aimed to measure how readily these cells could detach from each other, hypothesizing that this would correlate with their potential to become invasive.

Research Findings

Cell Adhesion Studies

The research team began by investigating the relationship between cell stickiness and markers of metastasis. They utilized a virus to label human breast cancer cells with fluorescent proteins and studied their migration on a collagen-coated surface. Results showed that cells with stronger adhesive properties were less likely to migrate.

Animal Model Experiments

In a subsequent experiment, the researchers injected glowing human breast cancer cells into mice. They found that cells that escaped the primary tumor were less adhesive than those that remained. Adhesion studies revealed that cells remaining in the tumor were 60% stickier than those that metastasized.

Gene Expression Correlation

The team sorted cancer cells based on their adhesion strength and found that the less sticky cells expressed more genes associated with movement and migration. This indicated that increased stickiness is associated with a reduced likelihood of metastasis.

Translating Findings into Practice

Evaluating Metastatic Potential

The researchers sought to establish whether stickiness could serve as a reliable marker for metastatic potential. They assessed various human breast cancer cell cultures and employed a modified parallel-plate flow chamber to evaluate cell adhesion under realistic conditions.

Real-World Application

The team successfully distinguished between samples with high and low metastatic potential based on cell stickiness. They tested this method using biopsy samples from women diagnosed with DCIS, confirming that stickiness could predict the likelihood of metastasis.

Future Directions

Implications for DCIS Management

The findings from UCSD’s research offer a promising approach to objectively assess the metastatic potential of DCIS tumors. While this method is still in its early stages, it highlights a new pathway for improving the management of DCIS, ultimately leading to more informed treatment decisions.

Need for Further Research

More extensive testing and validation will be necessary before this method can gain FDA approval for widespread use. However, the encouraging results pave the way for advancements in the understanding and treatment of DCIS, addressing the ongoing debate about its classification and management.

Bibliography

Deep learning for predicting invasive recurrence of ductal carcinoma in situ: leveraging histopathology images and clinical features – eBioMedicine. Accessed June 5, 2025. https://www.thelancet.com/journals/ebiom/article/PIIS2352-3964(25)00194-X/fulltext
Kane MA, Birmingham KG, Yeoman B, et al. Adhesion strength of tumor cells predicts metastatic disease in vivo. Cell Reports. 2025;44(3):115359. doi:10.1016/j.celrep.2025.115359
Kerlikowske K. Epidemiology of Ductal Carcinoma In Situ. J Natl Cancer Inst Monogr. 2010;2010(41):139-141. doi:10.1093/jncimonographs/lgq027
Morrow M, Barrio AV. Is It Time to Abandon Surgery for Low-Risk DCIS? JAMA. 2025;333(11):946-947. doi:10.1001/jama.2024.26723
Partridge AH, Hyslop T, Rosenberg SM, et al. Patient-Reported Outcomes for Low-Risk Ductal Carcinoma In Situ: A Secondary Analysis of the COMET Randomized Clinical Trial. JAMA Oncology. 2025;11(3):300-309. doi:10.1001/jamaoncol.2024.6556
Rubin R. Experts Are Debating Whether Some Cancers Shouldn’t Be Called That. JAMA. 2025;333(7):556-558. doi:10.1001/jama.2024.27250