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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
TERMINOLOGY
Synonyms
- Poorly differentiated DCIS
- Nuclear grade 3 DCIS
Definitions
- DCIS: Clonal proliferation of malignant epithelial cells within breast duct(s)
- Myoepithelial cell layer remains intact around periphery of malignant cells
- High nuclear grade: Enlarged, pleomorphic nuclei, 2.5-3.0x size of red blood cell (> 15 μm)
- Central necrosis in duct lumen (comedonecrosis) almost always present; when present, termed comedocarcinoma or comedo DCIS
- DCIS: Clonal proliferation of malignant epithelial cells within breast duct(s)
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
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
- Parikh U et al: Ductal carcinoma in situ: the whole truth. AJR Am J Roentgenol. 210(2):246-55, 2018
- Scott-Moncrieff A et al: MR imaging appearance of noncalcified and calcified DCIS. Breast J. 24(3):343-49, 2018
- Weigel S et al: Detection rates of ductal carcinoma in situ with biennial digital mammography screening: radiologic findings support pathologic model of tumor progression. Radiology. 286(2):424-32, 2018
- 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
- Luiten JD et al: Trends in incidence and tumour grade in screen-detected ductal carcinoma in situ and invasive breast cancer. Breast Cancer Res Treat. 166(1):307-14, 2017
- Duffy SW et al: Screen detection of ductal carcinoma in situ and subsequent incidence of invasive interval breast cancers: a retrospective population-based study. Lancet Oncol. 17(1):109-14, 2016
- Morrow M et al: Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology Consensus Guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ. Ann Surg Oncol. 23(12):3801-10, 2016
- Raj SD et al: Stereotactic biopsy of segmental breast calcifications: is sampling of anterior and posterior components necessary? Acad Radiol. 23(6):682-6, 2016
- Szynglarewicz B et al: Screen-detected ductal carcinoma in situ found on stereotactic vacuum-assisted biopsy of suspicious microcalcifications without mass: radiological-histological correlation. Radiol Oncol. 50(2):145-52, 2016
- van Roozendaal LM et al: Sentinel lymph node biopsy can be omitted in DCIS patients treated with breast conserving therapy. Breast Cancer Res Treat. 156(3):517-525, 2016
- Silverstein MJ et al: Treatment selection for patients with ductal carcinoma in situ (DCIS) of the breast using the University of Southern California/Van Nuys (USC/VNPI) prognostic index. Breast J. 21(2):127-32, 2015
- Chin-Lenn L et al: Predictors of treatment with mastectomy, use of sentinel lymph node biopsy and upstaging to invasive cancer in patients diagnosed with breast ductal carcinoma in situ (DCIS) on core biopsy. Ann Surg Oncol. 21(1):66-73, 2014
- Pilewskie M et al: Effect of MRI on the management of ductal carcinoma in situ of the breast. Ann Surg Oncol. 20(5):1522-9, 2013
- 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
- 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
- Gwak YJ et al: Ultrasonographic detection and characterization of asymptomatic ductal carcinoma in situ with histopathologic correlation. Acta Radiol. 52(4):364-71, 2011
- 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
- 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
- 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
- Lari SA et al: Biological markers in DCIS and risk of breast recurrence: a systematic review. J Cancer. 2:232-61, 2011
- Early Breast Cancer Trialists' Collaborative Group (EBCTCG) 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
- Kurniawan ED et al: Risk factors for invasive breast cancer when core needle biopsy shows ductal carcinoma in situ. Arch Surg. 145(11):1098-104, 2010
- Park JS et al: Sonographic findings of high-grade and non-high-grade ductal carcinoma in situ of the breast. J Ultrasound Med. 29(12):1687-97, 2010
- 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
- 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
- Virnig BA et al: Ductal carcinoma in situ: risk factors and impact of screening. J Natl Cancer Inst Monogr. 2010(41):113-6, 2010
- 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
- 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
- Kuhl CK et al: MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational study. Lancet. 370(9586):485-92, 2007
- 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
- Esserman LJ et al: Magnetic resonance imaging captures the biology of ductal carcinoma in situ. J Clin Oncol. 24(28):4603-10, 2006
- Collins LC et al: HER2 protein overexpression in estrogen receptor-positive ductal carcinoma in situ of the breast: frequency and implications for tamoxifen therapy. Mod Pathol. 18(5):615-20, 2005
- Collins LC et al: Outcome of patients with ductal carcinoma in situ untreated after diagnostic biopsy: results from the Nurses' Health Study. Cancer. 103(9):1778-84, 2005
- 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
- Bluemke DA et al: Magnetic resonance imaging of the breast prior to biopsy. JAMA. 292(22):2735-42, 2004
- Burstein HJ et al: Ductal carcinoma in situ of the breast. N Engl J Med. 350(14):1430-41, 2004
- De Roos MA et al: Correlation between imaging and pathology in ductal carcinoma in situ of the breast. World J Surg Oncol. 2(1):4, 2004
- Kricker A et al: Ductal carcinoma in situ of the breast, a population-based study of epidemiology and pathology. Br J Cancer. 90(7):1382-5, 2004
- Yang WT et al: Sonographic, mammographic, and histopathologic correlation of symptomatic ductal carcinoma in situ. AJR Am J Roentgenol. 182(1):101-10, 2004
- Neubauer H et al: High grade and non-high grade ductal carcinoma in situ on dynamic MR mammography: characteristic findings for signal increase and morphological pattern of enhancement. Br J Radiol. 76(901):3-12, 2003
- Silverstein MJ et al: Ductal carcinoma in situ: USC/Van Nuys Prognostic Index and the impact of margin status. Breast. 12(6):457-71, 2003
- Jaffer S et al: Histologic classification of ductal carcinoma in situ. Microsc Res Tech. 59(2):92-101, 2002
- Kessar P et al: How significant is detection of ductal carcinoma in situ in a breast screening programme? Clin Radiol. 57(9):807-14, 2002
- Kothari AS et al: Paget disease of the nipple: a multifocal manifestation of higher-risk disease. Cancer. 95(1):1-7, 2002
- Moon WK et al: Multifocal, multicentric, and contralateral breast cancers: bilateral whole-breast US in the preoperative evaluation of patients. Radiology. 224(2):569-76, 2002
- Moon WK et al: US of ductal carcinoma in situ. Radiographics. 22(2):269-80; discussion 280-1, 2002
- Bijker N et al: Histological type and marker expression of the primary tumour compared with its local recurrence after breast-conserving therapy for ductal carcinoma in situ. Br J Cancer. 84(4):539-44, 2001
- Evans AJ et al: Screen detected ductal carcinoma in situ (DCIS): overdiagnosis or an obligate precursor of invasive disease? J Med Screen. 8(3):149-51, 2001
- Viehweg P et al: In situ and minimally invasive breast cancer: morphologic and kinetic features on contrast-enhanced MR imaging. MAGMA. 11(3):129-37, 2000
- Hetelekidis S et al: Predictors of local recurrence following excision alone for ductal carcinoma in situ. Cancer. 85(2):427-31, 1999
- Lagios MD et al: Ductal carcinoma in situ. The success of breast conservation therapy: a shared experience of two single institutional nonrandomized prospective studies. Surg Oncol Clin N Am. 6(2):385-92, 1997
- Evans A et al: Ductal carcinoma in situ of the breast: correlation between mammographic and pathologic findings. AJR Am J Roentgenol. 162(6):1307-11, 1994
- Stomper PC et al: Ductal carcinoma in situ of the breast: correlation between mammographic calcification and tumor subtype. AJR. 159:483-5, 1992
- Holland R et al: Extent, distribution, and mammographic/histological correlations of breast ductal carcinoma in situ. Lancet. 335(8688):519-22, 1990
- Rosen PP et al: The clinical significance of pre-invasive breast carcinoma. Cancer. 46(4 Suppl):919-25, 1980
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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
TERMINOLOGY
Synonyms
- Poorly differentiated DCIS
- Nuclear grade 3 DCIS
Definitions
- DCIS: Clonal proliferation of malignant epithelial cells within breast duct(s)
- Myoepithelial cell layer remains intact around periphery of malignant cells
- High nuclear grade: Enlarged, pleomorphic nuclei, 2.5-3.0x size of red blood cell (> 15 μm)
- Central necrosis in duct lumen (comedonecrosis) almost always present; when present, termed comedocarcinoma or comedo DCIS
- DCIS: Clonal proliferation of malignant epithelial cells within breast duct(s)
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
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
- Parikh U et al: Ductal carcinoma in situ: the whole truth. AJR Am J Roentgenol. 210(2):246-55, 2018
- Scott-Moncrieff A et al: MR imaging appearance of noncalcified and calcified DCIS. Breast J. 24(3):343-49, 2018
- Weigel S et al: Detection rates of ductal carcinoma in situ with biennial digital mammography screening: radiologic findings support pathologic model of tumor progression. Radiology. 286(2):424-32, 2018
- 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
- Luiten JD et al: Trends in incidence and tumour grade in screen-detected ductal carcinoma in situ and invasive breast cancer. Breast Cancer Res Treat. 166(1):307-14, 2017
- Duffy SW et al: Screen detection of ductal carcinoma in situ and subsequent incidence of invasive interval breast cancers: a retrospective population-based study. Lancet Oncol. 17(1):109-14, 2016
- Morrow M et al: Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology Consensus Guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ. Ann Surg Oncol. 23(12):3801-10, 2016
- Raj SD et al: Stereotactic biopsy of segmental breast calcifications: is sampling of anterior and posterior components necessary? Acad Radiol. 23(6):682-6, 2016
- Szynglarewicz B et al: Screen-detected ductal carcinoma in situ found on stereotactic vacuum-assisted biopsy of suspicious microcalcifications without mass: radiological-histological correlation. Radiol Oncol. 50(2):145-52, 2016
- van Roozendaal LM et al: Sentinel lymph node biopsy can be omitted in DCIS patients treated with breast conserving therapy. Breast Cancer Res Treat. 156(3):517-525, 2016
- Silverstein MJ et al: Treatment selection for patients with ductal carcinoma in situ (DCIS) of the breast using the University of Southern California/Van Nuys (USC/VNPI) prognostic index. Breast J. 21(2):127-32, 2015
- Chin-Lenn L et al: Predictors of treatment with mastectomy, use of sentinel lymph node biopsy and upstaging to invasive cancer in patients diagnosed with breast ductal carcinoma in situ (DCIS) on core biopsy. Ann Surg Oncol. 21(1):66-73, 2014
- Pilewskie M et al: Effect of MRI on the management of ductal carcinoma in situ of the breast. Ann Surg Oncol. 20(5):1522-9, 2013
- 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
- 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
- Gwak YJ et al: Ultrasonographic detection and characterization of asymptomatic ductal carcinoma in situ with histopathologic correlation. Acta Radiol. 52(4):364-71, 2011
- 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
- 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
- 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
- Lari SA et al: Biological markers in DCIS and risk of breast recurrence: a systematic review. J Cancer. 2:232-61, 2011
- Early Breast Cancer Trialists' Collaborative Group (EBCTCG) 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
- Kurniawan ED et al: Risk factors for invasive breast cancer when core needle biopsy shows ductal carcinoma in situ. Arch Surg. 145(11):1098-104, 2010
- Park JS et al: Sonographic findings of high-grade and non-high-grade ductal carcinoma in situ of the breast. J Ultrasound Med. 29(12):1687-97, 2010
- 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
- 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
- Virnig BA et al: Ductal carcinoma in situ: risk factors and impact of screening. J Natl Cancer Inst Monogr. 2010(41):113-6, 2010
- 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
- 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
- Kuhl CK et al: MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational study. Lancet. 370(9586):485-92, 2007
- 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
- Esserman LJ et al: Magnetic resonance imaging captures the biology of ductal carcinoma in situ. J Clin Oncol. 24(28):4603-10, 2006
- Collins LC et al: HER2 protein overexpression in estrogen receptor-positive ductal carcinoma in situ of the breast: frequency and implications for tamoxifen therapy. Mod Pathol. 18(5):615-20, 2005
- Collins LC et al: Outcome of patients with ductal carcinoma in situ untreated after diagnostic biopsy: results from the Nurses' Health Study. Cancer. 103(9):1778-84, 2005
- 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
- Bluemke DA et al: Magnetic resonance imaging of the breast prior to biopsy. JAMA. 292(22):2735-42, 2004
- Burstein HJ et al: Ductal carcinoma in situ of the breast. N Engl J Med. 350(14):1430-41, 2004
- De Roos MA et al: Correlation between imaging and pathology in ductal carcinoma in situ of the breast. World J Surg Oncol. 2(1):4, 2004
- Kricker A et al: Ductal carcinoma in situ of the breast, a population-based study of epidemiology and pathology. Br J Cancer. 90(7):1382-5, 2004
- Yang WT et al: Sonographic, mammographic, and histopathologic correlation of symptomatic ductal carcinoma in situ. AJR Am J Roentgenol. 182(1):101-10, 2004
- Neubauer H et al: High grade and non-high grade ductal carcinoma in situ on dynamic MR mammography: characteristic findings for signal increase and morphological pattern of enhancement. Br J Radiol. 76(901):3-12, 2003
- Silverstein MJ et al: Ductal carcinoma in situ: USC/Van Nuys Prognostic Index and the impact of margin status. Breast. 12(6):457-71, 2003
- Jaffer S et al: Histologic classification of ductal carcinoma in situ. Microsc Res Tech. 59(2):92-101, 2002
- Kessar P et al: How significant is detection of ductal carcinoma in situ in a breast screening programme? Clin Radiol. 57(9):807-14, 2002
- Kothari AS et al: Paget disease of the nipple: a multifocal manifestation of higher-risk disease. Cancer. 95(1):1-7, 2002
- Moon WK et al: Multifocal, multicentric, and contralateral breast cancers: bilateral whole-breast US in the preoperative evaluation of patients. Radiology. 224(2):569-76, 2002
- Moon WK et al: US of ductal carcinoma in situ. Radiographics. 22(2):269-80; discussion 280-1, 2002
- Bijker N et al: Histological type and marker expression of the primary tumour compared with its local recurrence after breast-conserving therapy for ductal carcinoma in situ. Br J Cancer. 84(4):539-44, 2001
- Evans AJ et al: Screen detected ductal carcinoma in situ (DCIS): overdiagnosis or an obligate precursor of invasive disease? J Med Screen. 8(3):149-51, 2001
- Viehweg P et al: In situ and minimally invasive breast cancer: morphologic and kinetic features on contrast-enhanced MR imaging. MAGMA. 11(3):129-37, 2000
- Hetelekidis S et al: Predictors of local recurrence following excision alone for ductal carcinoma in situ. Cancer. 85(2):427-31, 1999
- Lagios MD et al: Ductal carcinoma in situ. The success of breast conservation therapy: a shared experience of two single institutional nonrandomized prospective studies. Surg Oncol Clin N Am. 6(2):385-92, 1997
- Evans A et al: Ductal carcinoma in situ of the breast: correlation between mammographic and pathologic findings. AJR Am J Roentgenol. 162(6):1307-11, 1994
- Stomper PC et al: Ductal carcinoma in situ of the breast: correlation between mammographic calcification and tumor subtype. AJR. 159:483-5, 1992
- Holland R et al: Extent, distribution, and mammographic/histological correlations of breast ductal carcinoma in situ. Lancet. 335(8688):519-22, 1990
- Rosen PP et al: The clinical significance of pre-invasive breast carcinoma. Cancer. 46(4 Suppl):919-25, 1980
