Intermediate nuclear grade: Nuclei distinctly enlarged (1.5-2x normal); moderate variability in nuclear size, shape, and placement; pleomorphism intermediate between grade 1 (low grade) and grade 3 (high grade)
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
Selected References
Kim M et al: Microinvasive carcinoma versus ductal carcinoma in situ: a comparison of clinicopathological features and clinical outcomes. J Breast Cancer. 21(2):197-205, 2018
Scott-Moncrieff A et al: MR imaging appearance of noncalcified and calcified DCIS. Breast J. 24(3):343-349, 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
Chavez de Paz Villanueva C et al: Factors associated with underestimation of invasive cancer in patients with ductal carcinoma in situ: precautions for active surveillance. JAMA Surg. 152(11):1007-14, 2017
Kuerer HM et al: DCIS Margins and breast conservation: MD Anderson Cancer Center Multidisciplinary practice guidelines and outcomes. J Cancer. 8(14):2653-62, 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
Rudin AV et al: Flat epithelial atypia on core biopsy and upgrade to cancer: a systematic review and meta-analysis. Ann Surg Oncol. 24(12):3549-58, 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. Pract Radiat Oncol. 6(5):287-95, 2016
Park TS et al: Current trends in the management of ductal carcinoma in situ. Oncology (Williston Park). 30(9):823-31, 2016
Esserman L et al: Rethinking the standard for ductal carcinoma in situ treatment. JAMA Oncol. 1(7):881-3, 2015
Greenwood HI et al: Ductal carcinoma in situ of the breasts: review of MR imaging features. Radiographics. 33(6):1569-88, 2013
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
Wang LC et al: US appearance of ductal carcinoma in situ. Radiographics. 33(1):213-28, 2013
Alvarado R et al: Biology, treatment, and outcome in very young and older women with DCIS. Ann Surg Oncol. 19(12):3777-84, 2012
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
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
Wallis MG et al: The effect of DCIS grade on rate, type and time to recurrence after 15 years of follow-up of screen-detected DCIS. Br J Cancer. 106(10):1611-7, 2012
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
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
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
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
Tozaki M et al: Breast MRI using the VIBE sequence: clustered ring enhancement in the differential diagnosis of lesions showing non-masslike enhancement. AJR Am J Roentgenol. 2006;187:313-21
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
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
Hwang ES et al: Patterns of chromosomal alterations in breast ductal carcinoma in situ. Clin Cancer Res. 10(15):5160-7, 2004
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
Bonnett M et al: Histologic and radiographic analysis of ductal carcinoma in situ diagnosed using stereotactic incisional core breast biopsy. Mod Pathol. 15(2):95-101, 2002
Cserni G: Sentinel lymph node biopsy as a tool for the staging of ductal carcinoma in situ in patients with breast carcinoma. Surg Today. 32(2):99-103, 2002
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
Morrow M et al: Standard for the management of ductal carcinoma in situ of the breast (DCIS). CA Cancer J Clin. 52(5):256-76, 2002
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
Farshid G et al: Spindle cell ductal carcinoma in situ. An unusual variant of ductal intra-epithelial neoplasia that simulates ductal hyperplasia or a myoepithelial proliferation. Virchows Arch. 439(1):70-7, 2001
Leal C et al: Apocrine ductal carcinoma in situ of the breast: histologic classification and expression of biologic markers. Hum Pathol. 32(5):487-93, 2001
Renshaw AA et al: Atypical ductal hyperplasia in breast core needle biopsies. Correlation of size of the lesion, complete removal of the lesion, and the incidence of carcinoma in follow-up biopsies. Am J Clin Pathol. 116(1):92-6, 2001
Slanetz PJ et al: Mammographic appearance of ductal carcinoma in situ does not reliably predict histologic subtype. Breast J. 7(6):417-21, 2001
Wahedna Y et al: Mammographic size of ductal carcinoma in situ does not predict the presence of an invasive focus. Eur J Cancer. 37(4):459-62, 2001
Dinkel HP et al: Is the appearance of microcalcifications on mammography useful in predicting histological grade of malignancy in ductal cancer in situ? Br J Radiol. 73(873):938-44, 2000
Goldstein NS et al: Differences in the pathologic features of ductal carcinoma in situ of the breast based on patient age. Cancer. 88(11):2553-60, 2000
Stomper PC et al: Flow cytometric DNA analysis of specimen mammography-guided fine-needle aspirates of ductal carcinoma in situ. J Exp Clin Cancer Res. 19(3):309-15, 2000
Page DL et al: Continued local recurrence of carcinoma 15-25 years after a diagnosis of low grade ductal carcinoma in situ of the breast treated only by biopsy. Cancer. 76(7):1197-200, 1995
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
Abbreviations
Ductal carcinoma in situ (DCIS)
Synonyms
Nuclear grade 2 DCIS
Definitions
DCIS: Clonal proliferation of malignant epithelial cells within breast duct(s)
Intermediate nuclear grade: Nuclei distinctly enlarged (1.5-2x normal); moderate variability in nuclear size, shape, and placement; pleomorphism intermediate between grade 1 (low grade) and grade 3 (high grade)
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
Selected References
Kim M et al: Microinvasive carcinoma versus ductal carcinoma in situ: a comparison of clinicopathological features and clinical outcomes. J Breast Cancer. 21(2):197-205, 2018
Scott-Moncrieff A et al: MR imaging appearance of noncalcified and calcified DCIS. Breast J. 24(3):343-349, 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
Chavez de Paz Villanueva C et al: Factors associated with underestimation of invasive cancer in patients with ductal carcinoma in situ: precautions for active surveillance. JAMA Surg. 152(11):1007-14, 2017
Kuerer HM et al: DCIS Margins and breast conservation: MD Anderson Cancer Center Multidisciplinary practice guidelines and outcomes. J Cancer. 8(14):2653-62, 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
Rudin AV et al: Flat epithelial atypia on core biopsy and upgrade to cancer: a systematic review and meta-analysis. Ann Surg Oncol. 24(12):3549-58, 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. Pract Radiat Oncol. 6(5):287-95, 2016
Park TS et al: Current trends in the management of ductal carcinoma in situ. Oncology (Williston Park). 30(9):823-31, 2016
Esserman L et al: Rethinking the standard for ductal carcinoma in situ treatment. JAMA Oncol. 1(7):881-3, 2015
Greenwood HI et al: Ductal carcinoma in situ of the breasts: review of MR imaging features. Radiographics. 33(6):1569-88, 2013
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
Wang LC et al: US appearance of ductal carcinoma in situ. Radiographics. 33(1):213-28, 2013
Alvarado R et al: Biology, treatment, and outcome in very young and older women with DCIS. Ann Surg Oncol. 19(12):3777-84, 2012
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
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
Wallis MG et al: The effect of DCIS grade on rate, type and time to recurrence after 15 years of follow-up of screen-detected DCIS. Br J Cancer. 106(10):1611-7, 2012
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
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
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
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
Tozaki M et al: Breast MRI using the VIBE sequence: clustered ring enhancement in the differential diagnosis of lesions showing non-masslike enhancement. AJR Am J Roentgenol. 2006;187:313-21
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
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
Hwang ES et al: Patterns of chromosomal alterations in breast ductal carcinoma in situ. Clin Cancer Res. 10(15):5160-7, 2004
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
Bonnett M et al: Histologic and radiographic analysis of ductal carcinoma in situ diagnosed using stereotactic incisional core breast biopsy. Mod Pathol. 15(2):95-101, 2002
Cserni G: Sentinel lymph node biopsy as a tool for the staging of ductal carcinoma in situ in patients with breast carcinoma. Surg Today. 32(2):99-103, 2002
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
Morrow M et al: Standard for the management of ductal carcinoma in situ of the breast (DCIS). CA Cancer J Clin. 52(5):256-76, 2002
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
Farshid G et al: Spindle cell ductal carcinoma in situ. An unusual variant of ductal intra-epithelial neoplasia that simulates ductal hyperplasia or a myoepithelial proliferation. Virchows Arch. 439(1):70-7, 2001
Leal C et al: Apocrine ductal carcinoma in situ of the breast: histologic classification and expression of biologic markers. Hum Pathol. 32(5):487-93, 2001
Renshaw AA et al: Atypical ductal hyperplasia in breast core needle biopsies. Correlation of size of the lesion, complete removal of the lesion, and the incidence of carcinoma in follow-up biopsies. Am J Clin Pathol. 116(1):92-6, 2001
Slanetz PJ et al: Mammographic appearance of ductal carcinoma in situ does not reliably predict histologic subtype. Breast J. 7(6):417-21, 2001
Wahedna Y et al: Mammographic size of ductal carcinoma in situ does not predict the presence of an invasive focus. Eur J Cancer. 37(4):459-62, 2001
Dinkel HP et al: Is the appearance of microcalcifications on mammography useful in predicting histological grade of malignancy in ductal cancer in situ? Br J Radiol. 73(873):938-44, 2000
Goldstein NS et al: Differences in the pathologic features of ductal carcinoma in situ of the breast based on patient age. Cancer. 88(11):2553-60, 2000
Stomper PC et al: Flow cytometric DNA analysis of specimen mammography-guided fine-needle aspirates of ductal carcinoma in situ. J Exp Clin Cancer Res. 19(3):309-15, 2000
Page DL et al: Continued local recurrence of carcinoma 15-25 years after a diagnosis of low grade ductal carcinoma in situ of the breast treated only by biopsy. Cancer. 76(7):1197-200, 1995
Rosen PP et al: The clinical significance of pre-invasive breast carcinoma. Cancer. 46(4 Suppl):919-25, 1980
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