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DCIS, General
Regina J. Hooley, MD; Wei Tse Yang, MBBS
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Synonyms

              • Intraductal carcinoma; preinvasive or noninvasive cancer
            • Definitions

              • Clonal proliferation of malignant epithelial cells originating in terminal duct lobular unit (TDLU) without invasion of myoepithelial layer or basement membrane
              • Nonobligate precursor to IDC

            IMAGING

            • General Features

              • Mammographic Findings

                • Ultrasonographic Findings

                  • MR Findings

                    • Nuclear Medicine Findings

                      • Image-Guided Biopsy

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Staging, Grading, & Classification

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              • Prognostic Tools

                                                Selected References

                                                1. Parikh U et al: Ductal carcinoma in situ: the whole truth. AJR Am J Roentgenol. 210(2):246-55, 2018
                                                2. Podoll MB et al: Feasibility of the less is more approach in treating low-risk ductal carcinoma in situ diagnosed on core needle biopsy: ten-year review of ductal carcinoma in situ upgraded to invasion at surgery. Arch Pathol Lab Med. 142(9):1120-26, 2018
                                                3. Grimm LJ et al: Imaging features of patients undergoing active surveillance for ductal carcinoma in situ. Acad Radiol. 24(11):1364-71, 2017
                                                4. Grimm LJ et al: Surgical upstaging rates for vacuum assisted biopsy proven dcis: implications for active surveillance trials. Ann Surg Oncol. 24(12):3534-40, 2017
                                                5. Kuhl CK et al: Impact of preoperative breast MR imaging and MR-guided surgery on diagnosis and surgical outcome of women with invasive breast cancer with and without DCIS component. Radiology. 161449, 2017
                                                6. Elmore JG et al: Diagnostic concordance among pathologists interpreting breast biopsy specimens. JAMA. 313(11):1122-32, 2015
                                                7. Kim SY et al: Evaluation of malignancy risk stratification of microcalcifications detected on mammography: a study based on the 5th edition of BI-RADS. Ann Surg Oncol. 22(9):2895-901, 2015
                                                8. Solin LJ et al: Surgical excision without radiation for ductal carcinoma in situ of the breast: 12-year results from the ECOG-ACRIN E5194 study. J Clin Oncol. 33(33):3938-44, 2015
                                                9. Mun HS et al: Screening-detected calcified and non-calcified ductal carcinoma in situ: differences in the imaging and histopathological features. Clin Radiol. 68(1):e27-35, 2013
                                                10. Rauch GM et al: Clinicopathologic, mammographic, and sonographic features in 1,187 patients with pure ductal carcinoma in situ of the breast by estrogen receptor status. Breast Cancer Res Treat. 139(3):639-47, 2013
                                                11. Wang LC et al: US appearance of ductal carcinoma in situ. Radiographics. 33(1):213-28, 2013
                                                12. Davis KL et al: Use of MRI in preoperative planning for women with newly diagnosed DCIS: risk or benefit? Ann Surg Oncol. 19(10):3270-4, 2012
                                                13. Deurloo EE et al: MRI of the breast in patients with DCIS to exclude the presence of invasive disease. Eur Radiol. 22(7):1504-11, 2012
                                                14. Ferris-James DM et al: Imaging approaches to diagnosis and management of common ductal abnormalities. Radiographics. 32(4):1009-30, 2012
                                                15. Goto M et al: The role of breast MR imaging in pre-operative determination of invasive disease for ductal carcinoma in situ diagnosed by needle biopsy. Eur Radiol. 22(6):1255-64, 2012
                                                16. Pilewskie M et al: Effect of MRI on the Management of Ductal Carcinoma In Situ of the Breast. Ann Surg Oncol. Epub ahead of print, 2012
                                                17. Spanu A et al: Breast scintigraphy with breast-specific γ-camera in the detection of ductal carcinoma in situ: a correlation with mammography and histologic subtype. J Nucl Med. 53(10):1528-33, 2012
                                                18. Suh YJ et al: Comparison of the underestimation rate in cases with ductal carcinoma in situ at ultrasound-guided core biopsy: 14-gauge automated core-needle biopsy vs 8- or 11-gauge vacuum-assisted biopsy. Br J Radiol. 85(1016):e349-56, 2012
                                                19. Brennan ME et al: Ductal carcinoma in situ at core-needle biopsy: meta-analysis of underestimation and predictors of invasive breast cancer. Radiology. 260(1):119-28, 2011
                                                20. Cho N et al: Sonoelastographic lesion stiffness: preoperative predictor of the presence of an invasive focus in nonpalpable DCIS diagnosed at US-guided needle biopsy. Eur Radiol. 21(8):1618-27, 2011
                                                21. Gwak YJ et al: Ultrasonographic detection and characterization of asymptomatic ductal carcinoma in situ with histopathologic correlation. Acta Radiol. 52(4):364-71, 2011
                                                22. Hayward L et al: The influence of clinicopathological features on the predictive accuracy of conventional breast imaging in determining the extent of screen-detected high-grade pure ductal carcinoma in situ. Ann R Coll Surg Engl. 93(5):385-90, 2011
                                                23. Hofvind S et al: Mammographic morphology and distribution of calcifications in ductal carcinoma in situ diagnosed in organized screening. Acta Radiol. 52(5):481-7, 2011
                                                24. Houssami N et al: Accuracy of a preoperative model for predicting invasive breast cancer in women with ductal carcinoma-in-situ on vacuum-assisted core needle biopsy. Ann Surg Oncol. 18(5):1364-71, 2011
                                                25. Kim JA et al: MRI findings of pure ductal carcinoma in situ: kinetic characteristics compared according to lesion type and histopathologic factors. AJR Am J Roentgenol. 196(6):1450-6, 2011
                                                26. Lari SA et al: Biological markers in DCIS and risk of breast recurrence: a systematic review. J Cancer. 2:232-61, 2011
                                                27. Mossa-Basha M et al: Ductal carcinoma in situ of the breast: MR imaging findings with histopathologic correlation. Radiographics. 30(6):1673-87, 2010. Review. Erratum in: Radiographics. 31(1):316, 2011
                                                28. Rahbar H et al: Characterization of ductal carcinoma in situ on diffusion weighted breast MRI. Eur Radiol. 21(9):2011-9, 2011
                                                29. D'Orsi CJ: Imaging for the diagnosis and management of ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010(41):214-7, 2010
                                                30. Early Breast Cancer Trialists' Collaborative Group et al: Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast. J Natl Cancer Inst Monogr. 2010(41):162-77, 2010
                                                31. Habel LA et al: Mammographic density and risk of second breast cancer after ductal carcinoma in situ. Cancer Epidemiol Biomarkers Prev. 19(10):2488-95, 2010
                                                32. Lehman CD: Magnetic resonance imaging in the evaluation of ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010(41):150-1, 2010
                                                33. Pisano ED: Mode of detection and secular time for ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010(41):142-4, 2010
                                                34. Thomas J et al: Radiological and pathological size estimations of pure ductal carcinoma in situ of the breast, specimen handling and the influence on the success of breast conservation surgery: a review of 2564 cases from the Sloane Project. Br J Cancer. 102(2):285-93, 2010
                                                35. Virnig BA et al: Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes. J Natl Cancer Inst. 102(3):170-8, 2010
                                                36. Yamada T et al: Radiologic-pathologic correlation of ductal carcinoma in situ. Radiographics. 30(5):1183-98, 2010
                                                37. Shin HJ et al: Screening-detected and symptomatic ductal carcinoma in situ: differences in the sonographic and pathologic features. AJR Am J Roentgenol. 190(2):516-25, 2008
                                                38. Brem RF et al: Detection of ductal carcinoma in situ with mammography, breast specific gamma imaging, and magnetic resonance imaging: a comparative study. Acad Radiol. 14(8):945-50, 2007
                                                39. Kuhl CK et al: MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational study. Lancet. 370(9586):485-92, 2007
                                                40. Lehman CD et al: MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. N Engl J Med. 356(13):1295-303, 2007
                                                41. Al-Attar MA et al: The impact of image guided needle biopsy on the outcome of mammographically detected indeterminate microcalcification. Breast. 15(5):635-9, 2006
                                                42. Esserman LJ et al: Magnetic resonance imaging captures the biology of ductal carcinoma in situ. J Clin Oncol. 24(28):4603-10, 2006
                                                43. Weaver DL et al: Pathologic findings from the Breast Cancer Surveillance Consortium: population-based outcomes in women undergoing biopsy after screening mammography. Cancer. 106(4):732-42, 2006
                                                44. Barreau B et al: Mammography of ductal carcinoma in situ of the breast: review of 909 cases with radiographic-pathologic correlations. Eur J Radiol. 54(1):55-61, 2005
                                                45. Groves AM et al: Characterization of pure high-grade DCIS on magnetic resonance imaging using the evolving breast MR lexicon terminology: can it be differentiated from pure invasive disease? Magn Reson Imaging. 23(6):733-8, 2005
                                                46. Harms SE: The use of breast magnetic resonance imaging in ductal carcinoma in situ. Breast J. 11(6):379-81, 2005
                                                47. Menell JH et al: Determination of the presence and extent of pure ductal carcinoma in situ by mammography and magnetic resonance imaging. Breast J. 11(6):382-90, 2005
                                                48. Bluemke DA et al: Magnetic resonance imaging of the breast prior to biopsy. JAMA. 292(22):2735-42, 2004
                                                49. Harris JR et al: Diseases of the Breast. Philadelphia: Lippincott Williams & Wilkins. 521-38, 2004
                                                50. Moon WK et al: US of ductal carcinoma in situ. Radiographics. 22(2):269-80; discussion 280-1, 2002
                                                51. Ioffe OB: Local extent of disease: a pathology perspective. Semin Breast Dis. 4:179-90, 2001
                                                52. Stomper PC et al: Mammographic detection and staging of ductal carcinoma in situ: mammographic-pathological correlation. Semin Breast Dis. 3:26-41, 2000
                                                53. Fisher B et al: Tamoxifen in treatment of intraductal breast cancer: National Surgical Adjuvant Breast and Bowel Project B-24 randomised controlled trial. Lancet. 353(9169):1993-2000, 1999
                                                54. Rosen PP: Rosen's Breast Pathology. Philadelphia: Lippincott-Raven. 209-74, 1997
                                                55. Lev-Toaff AS et al: Stability of malignant breast microcalcifications. Radiology. 192(1):153-6, 1994
                                                Related Anatomy
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                                                Related Differential Diagnoses
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                                                References
                                                Tables

                                                Tables

                                                KEY FACTS

                                                • Terminology

                                                  • Imaging

                                                    • Top Differential Diagnoses

                                                      • Pathology

                                                        • Clinical Issues

                                                          TERMINOLOGY

                                                          • Synonyms

                                                            • Intraductal carcinoma; preinvasive or noninvasive cancer
                                                          • Definitions

                                                            • Clonal proliferation of malignant epithelial cells originating in terminal duct lobular unit (TDLU) without invasion of myoepithelial layer or basement membrane
                                                            • Nonobligate precursor to IDC

                                                          IMAGING

                                                          • General Features

                                                            • Mammographic Findings

                                                              • Ultrasonographic Findings

                                                                • MR Findings

                                                                  • Nuclear Medicine Findings

                                                                    • Image-Guided Biopsy

                                                                      • Imaging Recommendations

                                                                        DIFFERENTIAL DIAGNOSIS

                                                                          PATHOLOGY

                                                                          • General Features

                                                                            • Staging, Grading, & Classification

                                                                              • Microscopic Features

                                                                                CLINICAL ISSUES

                                                                                • Presentation

                                                                                  • Demographics

                                                                                    • Natural History & Prognosis

                                                                                      • Treatment

                                                                                        DIAGNOSTIC CHECKLIST

                                                                                        • Consider

                                                                                          • Image Interpretation Pearls

                                                                                            • Prognostic Tools

                                                                                              Selected References

                                                                                              1. Parikh U et al: Ductal carcinoma in situ: the whole truth. AJR Am J Roentgenol. 210(2):246-55, 2018
                                                                                              2. Podoll MB et al: Feasibility of the less is more approach in treating low-risk ductal carcinoma in situ diagnosed on core needle biopsy: ten-year review of ductal carcinoma in situ upgraded to invasion at surgery. Arch Pathol Lab Med. 142(9):1120-26, 2018
                                                                                              3. Grimm LJ et al: Imaging features of patients undergoing active surveillance for ductal carcinoma in situ. Acad Radiol. 24(11):1364-71, 2017
                                                                                              4. Grimm LJ et al: Surgical upstaging rates for vacuum assisted biopsy proven dcis: implications for active surveillance trials. Ann Surg Oncol. 24(12):3534-40, 2017
                                                                                              5. Kuhl CK et al: Impact of preoperative breast MR imaging and MR-guided surgery on diagnosis and surgical outcome of women with invasive breast cancer with and without DCIS component. Radiology. 161449, 2017
                                                                                              6. Elmore JG et al: Diagnostic concordance among pathologists interpreting breast biopsy specimens. JAMA. 313(11):1122-32, 2015
                                                                                              7. Kim SY et al: Evaluation of malignancy risk stratification of microcalcifications detected on mammography: a study based on the 5th edition of BI-RADS. Ann Surg Oncol. 22(9):2895-901, 2015
                                                                                              8. Solin LJ et al: Surgical excision without radiation for ductal carcinoma in situ of the breast: 12-year results from the ECOG-ACRIN E5194 study. J Clin Oncol. 33(33):3938-44, 2015
                                                                                              9. Mun HS et al: Screening-detected calcified and non-calcified ductal carcinoma in situ: differences in the imaging and histopathological features. Clin Radiol. 68(1):e27-35, 2013
                                                                                              10. Rauch GM et al: Clinicopathologic, mammographic, and sonographic features in 1,187 patients with pure ductal carcinoma in situ of the breast by estrogen receptor status. Breast Cancer Res Treat. 139(3):639-47, 2013
                                                                                              11. Wang LC et al: US appearance of ductal carcinoma in situ. Radiographics. 33(1):213-28, 2013
                                                                                              12. Davis KL et al: Use of MRI in preoperative planning for women with newly diagnosed DCIS: risk or benefit? Ann Surg Oncol. 19(10):3270-4, 2012
                                                                                              13. Deurloo EE et al: MRI of the breast in patients with DCIS to exclude the presence of invasive disease. Eur Radiol. 22(7):1504-11, 2012
                                                                                              14. Ferris-James DM et al: Imaging approaches to diagnosis and management of common ductal abnormalities. Radiographics. 32(4):1009-30, 2012
                                                                                              15. Goto M et al: The role of breast MR imaging in pre-operative determination of invasive disease for ductal carcinoma in situ diagnosed by needle biopsy. Eur Radiol. 22(6):1255-64, 2012
                                                                                              16. Pilewskie M et al: Effect of MRI on the Management of Ductal Carcinoma In Situ of the Breast. Ann Surg Oncol. Epub ahead of print, 2012
                                                                                              17. Spanu A et al: Breast scintigraphy with breast-specific γ-camera in the detection of ductal carcinoma in situ: a correlation with mammography and histologic subtype. J Nucl Med. 53(10):1528-33, 2012
                                                                                              18. Suh YJ et al: Comparison of the underestimation rate in cases with ductal carcinoma in situ at ultrasound-guided core biopsy: 14-gauge automated core-needle biopsy vs 8- or 11-gauge vacuum-assisted biopsy. Br J Radiol. 85(1016):e349-56, 2012
                                                                                              19. Brennan ME et al: Ductal carcinoma in situ at core-needle biopsy: meta-analysis of underestimation and predictors of invasive breast cancer. Radiology. 260(1):119-28, 2011
                                                                                              20. Cho N et al: Sonoelastographic lesion stiffness: preoperative predictor of the presence of an invasive focus in nonpalpable DCIS diagnosed at US-guided needle biopsy. Eur Radiol. 21(8):1618-27, 2011
                                                                                              21. Gwak YJ et al: Ultrasonographic detection and characterization of asymptomatic ductal carcinoma in situ with histopathologic correlation. Acta Radiol. 52(4):364-71, 2011
                                                                                              22. Hayward L et al: The influence of clinicopathological features on the predictive accuracy of conventional breast imaging in determining the extent of screen-detected high-grade pure ductal carcinoma in situ. Ann R Coll Surg Engl. 93(5):385-90, 2011
                                                                                              23. Hofvind S et al: Mammographic morphology and distribution of calcifications in ductal carcinoma in situ diagnosed in organized screening. Acta Radiol. 52(5):481-7, 2011
                                                                                              24. Houssami N et al: Accuracy of a preoperative model for predicting invasive breast cancer in women with ductal carcinoma-in-situ on vacuum-assisted core needle biopsy. Ann Surg Oncol. 18(5):1364-71, 2011
                                                                                              25. Kim JA et al: MRI findings of pure ductal carcinoma in situ: kinetic characteristics compared according to lesion type and histopathologic factors. AJR Am J Roentgenol. 196(6):1450-6, 2011
                                                                                              26. Lari SA et al: Biological markers in DCIS and risk of breast recurrence: a systematic review. J Cancer. 2:232-61, 2011
                                                                                              27. Mossa-Basha M et al: Ductal carcinoma in situ of the breast: MR imaging findings with histopathologic correlation. Radiographics. 30(6):1673-87, 2010. Review. Erratum in: Radiographics. 31(1):316, 2011
                                                                                              28. Rahbar H et al: Characterization of ductal carcinoma in situ on diffusion weighted breast MRI. Eur Radiol. 21(9):2011-9, 2011
                                                                                              29. D'Orsi CJ: Imaging for the diagnosis and management of ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010(41):214-7, 2010
                                                                                              30. Early Breast Cancer Trialists' Collaborative Group et al: Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast. J Natl Cancer Inst Monogr. 2010(41):162-77, 2010
                                                                                              31. Habel LA et al: Mammographic density and risk of second breast cancer after ductal carcinoma in situ. Cancer Epidemiol Biomarkers Prev. 19(10):2488-95, 2010
                                                                                              32. Lehman CD: Magnetic resonance imaging in the evaluation of ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010(41):150-1, 2010
                                                                                              33. Pisano ED: Mode of detection and secular time for ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010(41):142-4, 2010
                                                                                              34. Thomas J et al: Radiological and pathological size estimations of pure ductal carcinoma in situ of the breast, specimen handling and the influence on the success of breast conservation surgery: a review of 2564 cases from the Sloane Project. Br J Cancer. 102(2):285-93, 2010
                                                                                              35. Virnig BA et al: Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes. J Natl Cancer Inst. 102(3):170-8, 2010
                                                                                              36. Yamada T et al: Radiologic-pathologic correlation of ductal carcinoma in situ. Radiographics. 30(5):1183-98, 2010
                                                                                              37. Shin HJ et al: Screening-detected and symptomatic ductal carcinoma in situ: differences in the sonographic and pathologic features. AJR Am J Roentgenol. 190(2):516-25, 2008
                                                                                              38. Brem RF et al: Detection of ductal carcinoma in situ with mammography, breast specific gamma imaging, and magnetic resonance imaging: a comparative study. Acad Radiol. 14(8):945-50, 2007
                                                                                              39. Kuhl CK et al: MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational study. Lancet. 370(9586):485-92, 2007
                                                                                              40. Lehman CD et al: MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. N Engl J Med. 356(13):1295-303, 2007
                                                                                              41. Al-Attar MA et al: The impact of image guided needle biopsy on the outcome of mammographically detected indeterminate microcalcification. Breast. 15(5):635-9, 2006
                                                                                              42. Esserman LJ et al: Magnetic resonance imaging captures the biology of ductal carcinoma in situ. J Clin Oncol. 24(28):4603-10, 2006
                                                                                              43. Weaver DL et al: Pathologic findings from the Breast Cancer Surveillance Consortium: population-based outcomes in women undergoing biopsy after screening mammography. Cancer. 106(4):732-42, 2006
                                                                                              44. Barreau B et al: Mammography of ductal carcinoma in situ of the breast: review of 909 cases with radiographic-pathologic correlations. Eur J Radiol. 54(1):55-61, 2005
                                                                                              45. Groves AM et al: Characterization of pure high-grade DCIS on magnetic resonance imaging using the evolving breast MR lexicon terminology: can it be differentiated from pure invasive disease? Magn Reson Imaging. 23(6):733-8, 2005
                                                                                              46. Harms SE: The use of breast magnetic resonance imaging in ductal carcinoma in situ. Breast J. 11(6):379-81, 2005
                                                                                              47. Menell JH et al: Determination of the presence and extent of pure ductal carcinoma in situ by mammography and magnetic resonance imaging. Breast J. 11(6):382-90, 2005
                                                                                              48. Bluemke DA et al: Magnetic resonance imaging of the breast prior to biopsy. JAMA. 292(22):2735-42, 2004
                                                                                              49. Harris JR et al: Diseases of the Breast. Philadelphia: Lippincott Williams & Wilkins. 521-38, 2004
                                                                                              50. Moon WK et al: US of ductal carcinoma in situ. Radiographics. 22(2):269-80; discussion 280-1, 2002
                                                                                              51. Ioffe OB: Local extent of disease: a pathology perspective. Semin Breast Dis. 4:179-90, 2001
                                                                                              52. Stomper PC et al: Mammographic detection and staging of ductal carcinoma in situ: mammographic-pathological correlation. Semin Breast Dis. 3:26-41, 2000
                                                                                              53. Fisher B et al: Tamoxifen in treatment of intraductal breast cancer: National Surgical Adjuvant Breast and Bowel Project B-24 randomised controlled trial. Lancet. 353(9169):1993-2000, 1999
                                                                                              54. Rosen PP: Rosen's Breast Pathology. Philadelphia: Lippincott-Raven. 209-74, 1997
                                                                                              55. Lev-Toaff AS et al: Stability of malignant breast microcalcifications. Radiology. 192(1):153-6, 1994