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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
- 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
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):246-255, 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):424-432, 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):1007-1014, 2017
- 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
- Tadros AB et al: Ductal carcinoma in situ and margins < 2 mm: Contemporary outcomes with breast conservation. Ann Surg. ePub, 2017
- 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
- 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):3801-3810, 2016
- Park TS et al: Current Trends in the Management of Ductal Carcinoma In Situ. Oncology (Williston Park). 30(9):823-31, 2016
- Elmore JG et al: Diagnostic concordance among pathologists interpreting breast biopsy specimens. JAMA. 313(11):1122-32, 2015
- Esserman L et al: Rethinking the Standard for Ductal Carcinoma In Situ Treatment. JAMA Oncol. 1(7):881-3, 2015
- Narod SA et al: Breast Cancer Mortality After a Diagnosis of Ductal Carcinoma In Situ. JAMA Oncol. 1(7):888-96, 2015
- 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
- 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
- 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
- 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
- D'Orsi CJ: Imaging for the diagnosis and management of ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010(41):214-7, 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
- Lehman CD: Magnetic resonance imaging in the evaluation of ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010(41):150-1, 2010
- Mossa-Basha M et al: Ductal carcinoma in situ of the breast: MR imaging findings with histopathologic correlation. Radiographics. 30:1673-87, 2010
- Pinder SE: Ductal carcinoma in situ (DCIS): pathological features, differential diagnosis, prognostic factors and specimen evaluation. Mod Pathol. 23 Suppl 2:S8-13, 2010
- Pisano ED: Mode of detection and secular time for ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010(41):142-4, 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
- Yamada T et al: Radiologic-pathologic correlation of ductal carcinoma in situ. Radiographics. 30(5):1183-98, 2010
- 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.
- Kuhl CK et al: MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational study. Lancet. 370(9586):485-92, 2007
- 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
- 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
- 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
- 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
- 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
- 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
- Khan A et al: Diagnosis and management of ductal carcinoma in situ. Curr Treat Options Oncol. 5(2):131-44, 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
- 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
- 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
- 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
- Berg WA et al: Biopsy of amorphous breast calcifications: pathologic outcome and yield at stereotactic biopsy. Radiology. 221(2):495-503, 2001
- 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
- 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
- Feig SA: Ductal carcinoma in situ. Implications for screening mammography. Radiol Clin North Am. 38(4):653-68, vii, 2000
- Holland R et al: Microcalcifications associated with ductal carcinoma in situ: mammographic-pathologic correlation. Semin Diagn Pathol. 11(3):181-92, 1994
- Lev-Toaff AS et al: Stability of malignant breast microcalcifications. Radiology. 192(1):153-6, 1994
- Bassett LW: Mammographic analysis of calcifications. Radiol Clin North Am. 30(1):93-105, 1992
- 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
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References
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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
- 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
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):246-255, 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):424-432, 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):1007-1014, 2017
- 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
- Tadros AB et al: Ductal carcinoma in situ and margins < 2 mm: Contemporary outcomes with breast conservation. Ann Surg. ePub, 2017
- 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
- 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):3801-3810, 2016
- Park TS et al: Current Trends in the Management of Ductal Carcinoma In Situ. Oncology (Williston Park). 30(9):823-31, 2016
- Elmore JG et al: Diagnostic concordance among pathologists interpreting breast biopsy specimens. JAMA. 313(11):1122-32, 2015
- Esserman L et al: Rethinking the Standard for Ductal Carcinoma In Situ Treatment. JAMA Oncol. 1(7):881-3, 2015
- Narod SA et al: Breast Cancer Mortality After a Diagnosis of Ductal Carcinoma In Situ. JAMA Oncol. 1(7):888-96, 2015
- 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
- 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
- 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
- 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
- D'Orsi CJ: Imaging for the diagnosis and management of ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010(41):214-7, 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
- Lehman CD: Magnetic resonance imaging in the evaluation of ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010(41):150-1, 2010
- Mossa-Basha M et al: Ductal carcinoma in situ of the breast: MR imaging findings with histopathologic correlation. Radiographics. 30:1673-87, 2010
- Pinder SE: Ductal carcinoma in situ (DCIS): pathological features, differential diagnosis, prognostic factors and specimen evaluation. Mod Pathol. 23 Suppl 2:S8-13, 2010
- Pisano ED: Mode of detection and secular time for ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010(41):142-4, 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
- Yamada T et al: Radiologic-pathologic correlation of ductal carcinoma in situ. Radiographics. 30(5):1183-98, 2010
- 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.
- Kuhl CK et al: MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational study. Lancet. 370(9586):485-92, 2007
- 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
- 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
- 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
- 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
- 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
- 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
- Khan A et al: Diagnosis and management of ductal carcinoma in situ. Curr Treat Options Oncol. 5(2):131-44, 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
- 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
- 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
- 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
- Berg WA et al: Biopsy of amorphous breast calcifications: pathologic outcome and yield at stereotactic biopsy. Radiology. 221(2):495-503, 2001
- 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
- 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
- Feig SA: Ductal carcinoma in situ. Implications for screening mammography. Radiol Clin North Am. 38(4):653-68, vii, 2000
- Holland R et al: Microcalcifications associated with ductal carcinoma in situ: mammographic-pathologic correlation. Semin Diagn Pathol. 11(3):181-92, 1994
- Lev-Toaff AS et al: Stability of malignant breast microcalcifications. Radiology. 192(1):153-6, 1994
- Bassett LW: Mammographic analysis of calcifications. Radiol Clin North Am. 30(1):93-105, 1992
- 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
