Diagnosis of Ductal Carcinoma In Situ (DCIS)

  • Clinical Presentation:
    • Before the implementation of routine screening mammography:
      • Most patients with DCIS presented with a:
        • Palpable mass
        • Nipple thickening
        • Nipple discharge
        • Paget disease of the nipple
      • Occasionally, DCIS was an incidental finding:
        • In an otherwise benign breast biopsy specimen
      • In patients with palpable lesions:
        • Up to 25% demonstrated foci of invasive disease
    • Now that screening mammography is more prevalent:
      • The incidence of DCIS has increased dramatically and currently comprises:
        • Approximately 20% of all breast cancers
      • Most cases of DCIS are diagnosed:
        • When the tumor is still clinically occult
      • Patients with abnormalities detected by screening mammography:
        • Should always undergo diagnostic imaging of the contralateral breast:
          • Because 0.5% to 3.0% of patients have:
            • Synchronous occult abnormalities or
            • Cancers in the contralateral breast
        • Mammographic images should be compared with previous images, if available, to establish interval changes
  • Mammographic Features:
    • On a mammogram, DCIS can present as:
      • Microcalcifications:
        • 80% to 90% of mammographic manifestations
      • A soft-tissue density
      • Both
    • Microcalcifications are the most common (80% to 90%) mammographic manifestation of DCIS:
      • Which, in turn, accounts for 80% of all breast carcinomas:
        • Presenting with calcifications
    • Any interval change from a previous mammogram:
      • Is associated with malignancy in 15% to 20% of cases:
        • Most often indicates in situ disease
    • Holland et al. (1990):
      • Described two different classes of microcalcifications:
        • Linear branching-type microcalcifications:
          • Which are more often associated with:
            • High–nuclear-grade lesions
            • Comedo-type lesions
        • Fine, granular calcifications:
          • Which are primarily associated with:
            • Micropapillary or cribriform lesions:
              • Of lower nuclear grade and that do not show necrosis
      • Although the morphology of microcalcifications:
        • Suggests the architectural type of DCIS
          • It is not always reliable
    • Holland et al:
      • Also demonstrated that the mammographic findings:
        • Significantly underestimated the pathologic extent of disease:
          • Particularly in cases of:
            • Micropapillary DCIS:
              • Lesions were more than 2 cm larger by histologic examination than by mammographic estimation:
                • In 44% of cases of micropapillary lesions, compared with only 12% of cases of the pure comedo subtype
        • However, when magnification views were used in diagnostic mammographic examination:
          • The extent of disease was underestimated in only 14% of cases of micropapillary tumors
        • Hence, magnification views increase the image resolution and are better able to delineate the shape, number, and extent of microcalcifications when compared with mammography alone:
          • And should be used routinely in the evaluation of suspicious mammographic findings
Calcifications seen on diagnostic mammography associated with ductal carcinoma in situ (DCIS). Magnification view is shown to demonstrate calcifications spanning approximately 9 cm.

#Arrangoiz #CancerSurgeon #BreastSurgeon #SurgicalOncologist #BreastCancer #LCIS #DCIS #DuctalCarcinomaInsitu #LobularNeoplasia #LobularCarcinomaInsitu #Surgeon #Teacher #Miami #Mexico #MSMC #MountSinaiMedicalCenter

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