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Extensive Intraductal Component
Wendie A. Berg, MD, PhD, FACR, FSBI
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Definitions

                • Extensive intraductal component (EIC) = invasive ductal carcinoma (IDC) with associated DCIS where DCIS represents at least 25% of main tumor mass and satellite foci of DCIS beyond main tumor mass
                • Includes cases of DCIS with microinvasion (T1mic): ≤ 0.1-cm invasive carcinoma
                  • Multifocal invasive carcinomas each ≤ 0.1 cm still qualifies as microinvasive
                • Distinguish from IDC with only adjacent extensive DCIS

              IMAGING

              • General Features

                • Mammographic Findings

                  • Ultrasonographic Findings

                    • MR Findings

                      • Nuclear Medicine Findings

                        • Image-Guided Biopsy

                          • Imaging Recommendations

                            DIFFERENTIAL DIAGNOSIS

                              PATHOLOGY

                              • General Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              • Reporting Tips

                                                Selected References

                                                1. Janssen NNY et al: Breast conserving surgery for extensive DCIS using multiple radioactive seeds. Eur J Surg Oncol. 44(1):67-73, 2018
                                                2. 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
                                                3. Sopik V et al: Impact of microinvasion on breast cancer mortality in women with ductal carcinoma in situ. Breast Cancer Res Treat. 167(3):787-95, 2018
                                                4. Tirada N et al: Breast Cancer Tissue Markers, Genomic Profiling, and Other Prognostic Factors: A Primer for Radiologists. Radiographics. 38(7):1902-1920, 2018
                                                5. 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
                                                6. Qi X et al: Mammographic calcification can predict outcome in women with breast cancer treated with breast-conserving surgery. Oncol Lett. 14(1):79-88, 2017
                                                7. Choi EJ et al: Dynamic contrast-enhanced breast magnetic resonance imaging for the prediction of early and late recurrences in breast cancer. Medicine (Baltimore). 95(48):e5330, 2016
                                                8. Choi WJ et al: The Accuracy of Breast MR Imaging for Measuring the Size of a Breast Cancer: Analysis of the Histopathologic Factors. Clin Breast Cancer. 16(6):e145-e152, 2016
                                                9. Doebar SC et al: Extent of ductal carcinoma in situ according to breast cancer subtypes: a population-based cohort study. Breast Cancer Res Treat. 158(1):179-87, 2016
                                                10. Elsayed M et al: Analysis of loco-regional and distant recurrences in breast cancer after conservative surgery. World J Surg Oncol. 14:144, 2016
                                                11. Kim HR et al: Mammography, US, and MRI for Preoperative prediction of extensive intraductal component of invasive breast cancer: interobserver variability and performances. Clin Breast Cancer. 16(4):305-11, 2016
                                                12. Knuttel FM et al: Prediction Model For Extensive Ductal Carcinoma In Situ Around Early-Stage Invasive Breast Cancer. Invest Radiol. 51(7):462-8, 2016
                                                13. Lai SF et al: Locoregional Recurrence Risk for Postmastectomy Breast Cancer Patients With T1-2 and One to Three Positive Lymph Nodes Receiving Modern Systemic Treatment Without Radiotherapy. Ann Surg Oncol. 23(12):3860-3869, 2016
                                                14. Orzalesi L et al: Microinvasive breast cancer: pathological parameters, cancer subtypes distribution, and correlation with axillary lymph nodes invasion. Results of a large single-institution series. Breast Cancer. 23(4):640-8, 2016
                                                15. Szynglarewicz B et al: Breast segmentectomy with rotation mammoplasty as an oncoplastic approach to extensive ductal carcinoma in situ. World J Surg Oncol. 14:72, 2016
                                                16. Alrahbi S et al: Extent of margin involvement, lymphovascular invasion, and extensive intraductal component predict for residual disease after wide local excision for breast cancer. Clin Breast Cancer. 15(3):219-26, 2015
                                                17. Cedolini C et al: Impact of the presence and quantity of ductal carcinoma in situ component on the outcome of invasive breast cancer. Int J Clin Exp Pathol. 8(10):13304-13, 2015
                                                18. Kanumuri P et al: Characteristics of Multifocal and Multicentric Breast Cancers. Ann Surg Oncol. 22(8):2475-82, 2015
                                                19. Kaufman SA et al: ACR Appropriateness Criteria® Ductal Carcinoma in Situ. Oncology (Williston Park). 29(6):446-58, 460-1, 2015
                                                20. Nicholson S et al: Variations in the management of the axilla in screen-detected ductal carcinoma in situ: evidence from the UK NHS breast screening programme audit of screen detected DCIS. Eur J Surg Oncol. 41(1):86-93, 2015
                                                21. Park SY et al: Does background parenchymal enhancement on MRI affect the rate of positive resection margin in breast cancer patients? Br J Radiol. 88(1046):20140638, 2015
                                                22. Tunon-de-Lara C et al: The Role of Sentinel Lymph Node Biopsy and Factors Associated with Invasion in Extensive DCIS of the Breast Treated by Mastectomy: The Cinnamome Prospective Multicenter Study. Ann Surg Oncol. 22(12):3853-60, 2015
                                                23. Guillot E et al: Extensive pure ductal carcinoma in situ of the breast: identification of predictors of associated infiltrating carcinoma and lymph node metastasis before immediate reconstructive surgery. Breast. 23(2):97-103, 2014
                                                24. Sung JS et al: Preoperative breast MRI for early-stage breast cancer: effect on surgical and long-term outcomes. AJR Am J Roentgenol. 202(6):1376-82, 2014
                                                25. Berg WA et al: Breast cancer: comparative effectiveness of positron emission mammography and MR imaging in presurgical planning for the ipsilateral breast. Radiology. 258(1):59-72, 2011
                                                26. Shin HJ et al: Correlation between mammographic and sonographic findings and prognostic factors in patients with node-negative invasive breast cancer. Br J Radiol. 84(997):19-30, 2011
                                                27. Izumori A et al: Ultrasound findings and histological features of ductal carcinoma in situ detected by ultrasound examination alone. Breast Cancer. 17(2):136-41, 2010
                                                28. Sanchez C et al: Factors associated with re-excision in patients with early-stage breast cancer treated with breast conservation therapy. Am Surg. 76(3):331-4, 2010
                                                29. Schouten van der Velden AP et al: Magnetic resonance imaging in size assessment of invasive breast carcinoma with an extensive intraductal component. BMC Med Imaging. 9:5, 2009
                                                30. Wiechmann L et al: Presenting features of breast cancer differ by molecular subtype. Ann Surg Oncol. 16(10):2705-10, 2009
                                                31. Sahin FI et al: Clinical findings and HER-2/neu gene amplification status of breast carcinoma patients. Pathol Oncol Res. 12(4):211-5, 2006
                                                32. Dzierzanowski M et al: Ductal carcinoma in situ in core biopsies containing invasive breast cancer: correlation with extensive intraductal component and lumpectomy margins. J Surg Oncol. 90(2):71-6, 2005
                                                33. Berg WA et al: Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology. 233(3):830-49, 2004
                                                34. Ikeda O et al: Magnetic resonance evaluation of the presence of an extensive intraductal component in breast cancer. Acta Radiol. 45(7):721-5, 2004
                                                35. Ishida T et al: Pathological assessment of intraductal spread of carcinoma in relation to surgical margin state in breast-conserving surgery. Jpn J Clin Oncol. 33(4):161-6, 2003
                                                36. Smitt MC et al: Predictors of reexcision findings and recurrence after breast conservation. Int J Radiat Oncol Biol Phys. 57(4):979-85, 2003
                                                37. Nishimura R et al: An evaluation of predictive factors involved in clinical or pathological response to primary chemotherapy in advanced breast cancer. Breast Cancer. 9(2):145-52, 2002
                                                38. Ferranti C et al: Relationships between age, mammographic features and pathological tumour characteristics in non-palpable breast cancer. Br J Radiol. 73(871):698-705, 2000
                                                39. Mai KT et al: Predictive value of extent and grade of ductal carcinoma in situ in radiologically guided core biopsy for the status of margins in lumpectomy specimens. Eur J Surg Oncol. 26(7):646-51, 2000
                                                40. Wazer DE et al: The influence of age and extensive intraductal component histology upon breast lumpectomy margin assessment as a predictor of residual tumor. Int J Radiat Oncol Biol Phys. 45(4):885-91, 1999
                                                41. Hurd TC et al: Impact of extensive intraductal component on recurrence and survival in patients with stage I or II breast cancer treated with breast conservation therapy. Ann Surg Oncol. 4(2):119-24, 1997
                                                42. Holland R et al: The presence of an extensive intraductal component following a limited excision correlates with prominent residual disease in the remainder of the breast. J Clin Oncol. 8(1):113-8, 1990
                                                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

                                                          • Diagnostic Checklist

                                                            TERMINOLOGY

                                                            • Definitions

                                                              • Extensive intraductal component (EIC) = invasive ductal carcinoma (IDC) with associated DCIS where DCIS represents at least 25% of main tumor mass and satellite foci of DCIS beyond main tumor mass
                                                              • Includes cases of DCIS with microinvasion (T1mic): ≤ 0.1-cm invasive carcinoma
                                                                • Multifocal invasive carcinomas each ≤ 0.1 cm still qualifies as microinvasive
                                                              • Distinguish from IDC with only adjacent extensive DCIS

                                                            IMAGING

                                                            • General Features

                                                              • Mammographic Findings

                                                                • Ultrasonographic Findings

                                                                  • MR Findings

                                                                    • Nuclear Medicine Findings

                                                                      • Image-Guided Biopsy

                                                                        • Imaging Recommendations

                                                                          DIFFERENTIAL DIAGNOSIS

                                                                            PATHOLOGY

                                                                            • General Features

                                                                              • Microscopic Features

                                                                                CLINICAL ISSUES

                                                                                • Presentation

                                                                                  • Demographics

                                                                                    • Natural History & Prognosis

                                                                                      • Treatment

                                                                                        DIAGNOSTIC CHECKLIST

                                                                                        • Consider

                                                                                          • Image Interpretation Pearls

                                                                                            • Reporting Tips

                                                                                              Selected References

                                                                                              1. Janssen NNY et al: Breast conserving surgery for extensive DCIS using multiple radioactive seeds. Eur J Surg Oncol. 44(1):67-73, 2018
                                                                                              2. 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
                                                                                              3. Sopik V et al: Impact of microinvasion on breast cancer mortality in women with ductal carcinoma in situ. Breast Cancer Res Treat. 167(3):787-95, 2018
                                                                                              4. Tirada N et al: Breast Cancer Tissue Markers, Genomic Profiling, and Other Prognostic Factors: A Primer for Radiologists. Radiographics. 38(7):1902-1920, 2018
                                                                                              5. 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
                                                                                              6. Qi X et al: Mammographic calcification can predict outcome in women with breast cancer treated with breast-conserving surgery. Oncol Lett. 14(1):79-88, 2017
                                                                                              7. Choi EJ et al: Dynamic contrast-enhanced breast magnetic resonance imaging for the prediction of early and late recurrences in breast cancer. Medicine (Baltimore). 95(48):e5330, 2016
                                                                                              8. Choi WJ et al: The Accuracy of Breast MR Imaging for Measuring the Size of a Breast Cancer: Analysis of the Histopathologic Factors. Clin Breast Cancer. 16(6):e145-e152, 2016
                                                                                              9. Doebar SC et al: Extent of ductal carcinoma in situ according to breast cancer subtypes: a population-based cohort study. Breast Cancer Res Treat. 158(1):179-87, 2016
                                                                                              10. Elsayed M et al: Analysis of loco-regional and distant recurrences in breast cancer after conservative surgery. World J Surg Oncol. 14:144, 2016
                                                                                              11. Kim HR et al: Mammography, US, and MRI for Preoperative prediction of extensive intraductal component of invasive breast cancer: interobserver variability and performances. Clin Breast Cancer. 16(4):305-11, 2016
                                                                                              12. Knuttel FM et al: Prediction Model For Extensive Ductal Carcinoma In Situ Around Early-Stage Invasive Breast Cancer. Invest Radiol. 51(7):462-8, 2016
                                                                                              13. Lai SF et al: Locoregional Recurrence Risk for Postmastectomy Breast Cancer Patients With T1-2 and One to Three Positive Lymph Nodes Receiving Modern Systemic Treatment Without Radiotherapy. Ann Surg Oncol. 23(12):3860-3869, 2016
                                                                                              14. Orzalesi L et al: Microinvasive breast cancer: pathological parameters, cancer subtypes distribution, and correlation with axillary lymph nodes invasion. Results of a large single-institution series. Breast Cancer. 23(4):640-8, 2016
                                                                                              15. Szynglarewicz B et al: Breast segmentectomy with rotation mammoplasty as an oncoplastic approach to extensive ductal carcinoma in situ. World J Surg Oncol. 14:72, 2016
                                                                                              16. Alrahbi S et al: Extent of margin involvement, lymphovascular invasion, and extensive intraductal component predict for residual disease after wide local excision for breast cancer. Clin Breast Cancer. 15(3):219-26, 2015
                                                                                              17. Cedolini C et al: Impact of the presence and quantity of ductal carcinoma in situ component on the outcome of invasive breast cancer. Int J Clin Exp Pathol. 8(10):13304-13, 2015
                                                                                              18. Kanumuri P et al: Characteristics of Multifocal and Multicentric Breast Cancers. Ann Surg Oncol. 22(8):2475-82, 2015
                                                                                              19. Kaufman SA et al: ACR Appropriateness Criteria® Ductal Carcinoma in Situ. Oncology (Williston Park). 29(6):446-58, 460-1, 2015
                                                                                              20. Nicholson S et al: Variations in the management of the axilla in screen-detected ductal carcinoma in situ: evidence from the UK NHS breast screening programme audit of screen detected DCIS. Eur J Surg Oncol. 41(1):86-93, 2015
                                                                                              21. Park SY et al: Does background parenchymal enhancement on MRI affect the rate of positive resection margin in breast cancer patients? Br J Radiol. 88(1046):20140638, 2015
                                                                                              22. Tunon-de-Lara C et al: The Role of Sentinel Lymph Node Biopsy and Factors Associated with Invasion in Extensive DCIS of the Breast Treated by Mastectomy: The Cinnamome Prospective Multicenter Study. Ann Surg Oncol. 22(12):3853-60, 2015
                                                                                              23. Guillot E et al: Extensive pure ductal carcinoma in situ of the breast: identification of predictors of associated infiltrating carcinoma and lymph node metastasis before immediate reconstructive surgery. Breast. 23(2):97-103, 2014
                                                                                              24. Sung JS et al: Preoperative breast MRI for early-stage breast cancer: effect on surgical and long-term outcomes. AJR Am J Roentgenol. 202(6):1376-82, 2014
                                                                                              25. Berg WA et al: Breast cancer: comparative effectiveness of positron emission mammography and MR imaging in presurgical planning for the ipsilateral breast. Radiology. 258(1):59-72, 2011
                                                                                              26. Shin HJ et al: Correlation between mammographic and sonographic findings and prognostic factors in patients with node-negative invasive breast cancer. Br J Radiol. 84(997):19-30, 2011
                                                                                              27. Izumori A et al: Ultrasound findings and histological features of ductal carcinoma in situ detected by ultrasound examination alone. Breast Cancer. 17(2):136-41, 2010
                                                                                              28. Sanchez C et al: Factors associated with re-excision in patients with early-stage breast cancer treated with breast conservation therapy. Am Surg. 76(3):331-4, 2010
                                                                                              29. Schouten van der Velden AP et al: Magnetic resonance imaging in size assessment of invasive breast carcinoma with an extensive intraductal component. BMC Med Imaging. 9:5, 2009
                                                                                              30. Wiechmann L et al: Presenting features of breast cancer differ by molecular subtype. Ann Surg Oncol. 16(10):2705-10, 2009
                                                                                              31. Sahin FI et al: Clinical findings and HER-2/neu gene amplification status of breast carcinoma patients. Pathol Oncol Res. 12(4):211-5, 2006
                                                                                              32. Dzierzanowski M et al: Ductal carcinoma in situ in core biopsies containing invasive breast cancer: correlation with extensive intraductal component and lumpectomy margins. J Surg Oncol. 90(2):71-6, 2005
                                                                                              33. Berg WA et al: Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology. 233(3):830-49, 2004
                                                                                              34. Ikeda O et al: Magnetic resonance evaluation of the presence of an extensive intraductal component in breast cancer. Acta Radiol. 45(7):721-5, 2004
                                                                                              35. Ishida T et al: Pathological assessment of intraductal spread of carcinoma in relation to surgical margin state in breast-conserving surgery. Jpn J Clin Oncol. 33(4):161-6, 2003
                                                                                              36. Smitt MC et al: Predictors of reexcision findings and recurrence after breast conservation. Int J Radiat Oncol Biol Phys. 57(4):979-85, 2003
                                                                                              37. Nishimura R et al: An evaluation of predictive factors involved in clinical or pathological response to primary chemotherapy in advanced breast cancer. Breast Cancer. 9(2):145-52, 2002
                                                                                              38. Ferranti C et al: Relationships between age, mammographic features and pathological tumour characteristics in non-palpable breast cancer. Br J Radiol. 73(871):698-705, 2000
                                                                                              39. Mai KT et al: Predictive value of extent and grade of ductal carcinoma in situ in radiologically guided core biopsy for the status of margins in lumpectomy specimens. Eur J Surg Oncol. 26(7):646-51, 2000
                                                                                              40. Wazer DE et al: The influence of age and extensive intraductal component histology upon breast lumpectomy margin assessment as a predictor of residual tumor. Int J Radiat Oncol Biol Phys. 45(4):885-91, 1999
                                                                                              41. Hurd TC et al: Impact of extensive intraductal component on recurrence and survival in patients with stage I or II breast cancer treated with breast conservation therapy. Ann Surg Oncol. 4(2):119-24, 1997
                                                                                              42. Holland R et al: The presence of an extensive intraductal component following a limited excision correlates with prominent residual disease in the remainder of the breast. J Clin Oncol. 8(1):113-8, 1990