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DCIS, Low Grade
Vilert Loving, MD; Wei Tse Yang, MBBS
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Synonyms

              • Nuclear grade 1 DCIS
            • Definitions

              • DCIS: Clonal proliferation of malignant epithelial cells within breast duct(s)
                • Myoepithelial cell layer remains intact around periphery of malignant cells
              • Low-grade DCIS refers to low nuclear grade
                • Monomorphic, small nuclei, no or very few mitoses
                • No or few apoptotic bodies; nuclei usually diploid
                • Central comedonecrosis extremely rare

            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

                                              1. Parikh U et al: Ductal carcinoma in situ: The whole truth. AJR Am J Roentgenol. 210(2):246-255, 2018
                                              2. Scott-Moncrieff A et al: MR imaging appearance of noncalcified and calcified DCIS. Breast J. 24(3):343-349, 2018
                                              3. 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):424-432, 2018
                                              4. 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):1007-1014, 2017
                                              5. Kuerer HM et al: DCIS margins and breast conservation: MD Anderson Cancer Center Multidisciplinary Practice Guidelines and Outcomes. J Cancer. 8(14):2653-2662, 2017
                                              6. Tadros AB et al: Ductal carcinoma in situ and margins < 2 mm: Contemporary outcomes with breast conservation. Ann Surg. ePub, 2017
                                              7. Allison KH et al: Histological features associated with diagnostic agreement in atypical ductal hyperplasia of the breast: illustrative cases from the B-Path study. Histopathology. 69(6):1028-1046, 2016
                                              8. 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
                                              9. 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):3801-3810, 2016
                                              10. Park TS et al: Current Trends in the Management of Ductal Carcinoma In Situ. Oncology (Williston Park). 30(9):823-31, 2016
                                              11. Elmore JG et al: Diagnostic concordance among pathologists interpreting breast biopsy specimens. JAMA. 313(11):1122-32, 2015
                                              12. Esserman L et al: Rethinking the Standard for Ductal Carcinoma In Situ Treatment. JAMA Oncol. 1(7):881-3, 2015
                                              13. Narod SA et al: Breast Cancer Mortality After a Diagnosis of Ductal Carcinoma In Situ. JAMA Oncol. 1(7):888-96, 2015
                                              14. 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
                                              15. Wang LC et al: US appearance of ductal carcinoma in situ. Radiographics. 33(1):213-28, 2013
                                              16. 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
                                              17. Gwak YJ et al: Ultrasonographic detection and characterization of asymptomatic ductal carcinoma in situ with histopathologic correlation. Acta Radiol. 52(4):364-71, 2011
                                              18. 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
                                              19. Chang CB, Lvoff NM, Leung JW, et al. Solitary dilated duct identified at mammography: outcomes analysis. AJR Am J Roentgenol. 2010;194(2):378-82
                                              20. D'Orsi CJ: Imaging for the diagnosis and management of ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010(41):214-7, 2010
                                              21. 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
                                              22. Lehman CD: Magnetic resonance imaging in the evaluation of ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010(41):150-1, 2010
                                              23. Mossa-Basha M et al: Ductal carcinoma in situ of the breast: MR imaging findings with histopathologic correlation. Radiographics. 30:1673-87, 2010
                                              24. Pinder SE: Ductal carcinoma in situ (DCIS): pathological features, differential diagnosis, prognostic factors and specimen evaluation. Mod Pathol. 23 Suppl 2:S8-13, 2010
                                              25. Pisano ED: Mode of detection and secular time for ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010(41):142-4, 2010
                                              26. Virnig BA et al: Ductal carcinoma in situ: risk factors and impact of screening. J Natl Cancer Inst Monogr. 2010(41):113-6, 2010
                                              27. Yamada T et al: Radiologic-pathologic correlation of ductal carcinoma in situ. Radiographics. 30(5):1183-98, 2010
                                              28. Shin HJ et al: Screening-detected and symptomatic ductal carcinoma in situ: differences in the sonographic and pathologic features. AJR Am J Roentgenol. 2008 Feb;190(2):516-25.
                                              29. Kuhl CK et al: MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational study. Lancet. 370(9586):485-92, 2007
                                              30. Hird RB et al: Impact of estrogen receptor expression and other clinicopathologic features on tamoxifen use in ductal carcinoma in situ. Cancer. 106(10):2113-8, 2006
                                              31. 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
                                              32. Wong JS et al: Prospective study of wide excision alone for ductal carcinoma in situ of the breast. J Clin Oncol. 24(7):1031-6, 2006
                                              33. 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
                                              34. 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
                                              35. Sanders ME et al: The natural history of low-grade ductal carcinoma in situ of the breast in women treated by biopsy only revealed over 30 years of long-term follow-up. Cancer. 103(12):2481-4, 2005
                                              36. Khan A et al: Diagnosis and management of ductal carcinoma in situ. Curr Treat Options Oncol. 5(2):131-44, 2004
                                              37. 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
                                              38. Yang WT et al: Sonographic, mammographic, and histopathologic correlation of symptomatic ductal carcinoma in situ. AJR Am J Roentgenol. 182(1):101-10, 2004
                                              39. 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
                                              40. Rodrigues NA et al: Differences in the pathologic and molecular features of intraductal breast carcinoma between younger and older women. Cancer. 97(6):1393-403, 2003
                                              41. Jaffer S et al: Histologic classification of ductal carcinoma in situ. Microsc Res Tech. 59(2):92-101, 2002
                                              42. 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
                                              43. 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
                                              44. Berg WA et al: Biopsy of amorphous breast calcifications: pathologic outcome and yield at stereotactic biopsy. Radiology. 221(2):495-503, 2001
                                              45. Claus EB et al: Pathobiologic findings in DCIS of the breast: morphologic features, angiogenesis, HER-2/neu and hormone receptors. Exp Mol Pathol. 70(3):303-16, 2001
                                              46. 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
                                              47. Feig SA: Ductal carcinoma in situ. Implications for screening mammography. Radiol Clin North Am. 38(4):653-68, vii, 2000
                                              48. Holland R et al: Microcalcifications associated with ductal carcinoma in situ: mammographic-pathologic correlation. Semin Diagn Pathol. 11(3):181-92, 1994
                                              49. Lev-Toaff AS et al: Stability of malignant breast microcalcifications. Radiology. 192(1):153-6, 1994
                                              50. Bassett LW: Mammographic analysis of calcifications. Radiol Clin North Am. 30(1):93-105, 1992
                                              51. Stomper PC et al: Ductal carcinoma in situ of the breast: correlation between mammographic calcification and tumor subtype. AJR Am J Roentgenol. 159(3):483-5, 1992
                                              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

                                                          • Nuclear grade 1 DCIS
                                                        • Definitions

                                                          • DCIS: Clonal proliferation of malignant epithelial cells within breast duct(s)
                                                            • Myoepithelial cell layer remains intact around periphery of malignant cells
                                                          • Low-grade DCIS refers to low nuclear grade
                                                            • Monomorphic, small nuclei, no or very few mitoses
                                                            • No or few apoptotic bodies; nuclei usually diploid
                                                            • Central comedonecrosis extremely rare

                                                        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

                                                                                          1. Parikh U et al: Ductal carcinoma in situ: The whole truth. AJR Am J Roentgenol. 210(2):246-255, 2018
                                                                                          2. Scott-Moncrieff A et al: MR imaging appearance of noncalcified and calcified DCIS. Breast J. 24(3):343-349, 2018
                                                                                          3. 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):424-432, 2018
                                                                                          4. 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):1007-1014, 2017
                                                                                          5. Kuerer HM et al: DCIS margins and breast conservation: MD Anderson Cancer Center Multidisciplinary Practice Guidelines and Outcomes. J Cancer. 8(14):2653-2662, 2017
                                                                                          6. Tadros AB et al: Ductal carcinoma in situ and margins < 2 mm: Contemporary outcomes with breast conservation. Ann Surg. ePub, 2017
                                                                                          7. Allison KH et al: Histological features associated with diagnostic agreement in atypical ductal hyperplasia of the breast: illustrative cases from the B-Path study. Histopathology. 69(6):1028-1046, 2016
                                                                                          8. 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
                                                                                          9. 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):3801-3810, 2016
                                                                                          10. Park TS et al: Current Trends in the Management of Ductal Carcinoma In Situ. Oncology (Williston Park). 30(9):823-31, 2016
                                                                                          11. Elmore JG et al: Diagnostic concordance among pathologists interpreting breast biopsy specimens. JAMA. 313(11):1122-32, 2015
                                                                                          12. Esserman L et al: Rethinking the Standard for Ductal Carcinoma In Situ Treatment. JAMA Oncol. 1(7):881-3, 2015
                                                                                          13. Narod SA et al: Breast Cancer Mortality After a Diagnosis of Ductal Carcinoma In Situ. JAMA Oncol. 1(7):888-96, 2015
                                                                                          14. 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
                                                                                          15. Wang LC et al: US appearance of ductal carcinoma in situ. Radiographics. 33(1):213-28, 2013
                                                                                          16. 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
                                                                                          17. Gwak YJ et al: Ultrasonographic detection and characterization of asymptomatic ductal carcinoma in situ with histopathologic correlation. Acta Radiol. 52(4):364-71, 2011
                                                                                          18. 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
                                                                                          19. Chang CB, Lvoff NM, Leung JW, et al. Solitary dilated duct identified at mammography: outcomes analysis. AJR Am J Roentgenol. 2010;194(2):378-82
                                                                                          20. D'Orsi CJ: Imaging for the diagnosis and management of ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010(41):214-7, 2010
                                                                                          21. 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
                                                                                          22. Lehman CD: Magnetic resonance imaging in the evaluation of ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010(41):150-1, 2010
                                                                                          23. Mossa-Basha M et al: Ductal carcinoma in situ of the breast: MR imaging findings with histopathologic correlation. Radiographics. 30:1673-87, 2010
                                                                                          24. Pinder SE: Ductal carcinoma in situ (DCIS): pathological features, differential diagnosis, prognostic factors and specimen evaluation. Mod Pathol. 23 Suppl 2:S8-13, 2010
                                                                                          25. Pisano ED: Mode of detection and secular time for ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010(41):142-4, 2010
                                                                                          26. Virnig BA et al: Ductal carcinoma in situ: risk factors and impact of screening. J Natl Cancer Inst Monogr. 2010(41):113-6, 2010
                                                                                          27. Yamada T et al: Radiologic-pathologic correlation of ductal carcinoma in situ. Radiographics. 30(5):1183-98, 2010
                                                                                          28. Shin HJ et al: Screening-detected and symptomatic ductal carcinoma in situ: differences in the sonographic and pathologic features. AJR Am J Roentgenol. 2008 Feb;190(2):516-25.
                                                                                          29. Kuhl CK et al: MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational study. Lancet. 370(9586):485-92, 2007
                                                                                          30. Hird RB et al: Impact of estrogen receptor expression and other clinicopathologic features on tamoxifen use in ductal carcinoma in situ. Cancer. 106(10):2113-8, 2006
                                                                                          31. 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
                                                                                          32. Wong JS et al: Prospective study of wide excision alone for ductal carcinoma in situ of the breast. J Clin Oncol. 24(7):1031-6, 2006
                                                                                          33. 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
                                                                                          34. 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
                                                                                          35. Sanders ME et al: The natural history of low-grade ductal carcinoma in situ of the breast in women treated by biopsy only revealed over 30 years of long-term follow-up. Cancer. 103(12):2481-4, 2005
                                                                                          36. Khan A et al: Diagnosis and management of ductal carcinoma in situ. Curr Treat Options Oncol. 5(2):131-44, 2004
                                                                                          37. 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
                                                                                          38. Yang WT et al: Sonographic, mammographic, and histopathologic correlation of symptomatic ductal carcinoma in situ. AJR Am J Roentgenol. 182(1):101-10, 2004
                                                                                          39. 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
                                                                                          40. Rodrigues NA et al: Differences in the pathologic and molecular features of intraductal breast carcinoma between younger and older women. Cancer. 97(6):1393-403, 2003
                                                                                          41. Jaffer S et al: Histologic classification of ductal carcinoma in situ. Microsc Res Tech. 59(2):92-101, 2002
                                                                                          42. 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
                                                                                          43. 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
                                                                                          44. Berg WA et al: Biopsy of amorphous breast calcifications: pathologic outcome and yield at stereotactic biopsy. Radiology. 221(2):495-503, 2001
                                                                                          45. Claus EB et al: Pathobiologic findings in DCIS of the breast: morphologic features, angiogenesis, HER-2/neu and hormone receptors. Exp Mol Pathol. 70(3):303-16, 2001
                                                                                          46. 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
                                                                                          47. Feig SA: Ductal carcinoma in situ. Implications for screening mammography. Radiol Clin North Am. 38(4):653-68, vii, 2000
                                                                                          48. Holland R et al: Microcalcifications associated with ductal carcinoma in situ: mammographic-pathologic correlation. Semin Diagn Pathol. 11(3):181-92, 1994
                                                                                          49. Lev-Toaff AS et al: Stability of malignant breast microcalcifications. Radiology. 192(1):153-6, 1994
                                                                                          50. Bassett LW: Mammographic analysis of calcifications. Radiol Clin North Am. 30(1):93-105, 1992
                                                                                          51. Stomper PC et al: Ductal carcinoma in situ of the breast: correlation between mammographic calcification and tumor subtype. AJR Am J Roentgenol. 159(3):483-5, 1992