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
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
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
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
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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