Clinics in diagnostic imaging (180). Ductal carcinoma in situ (DCIS)

A 26-year-old woman presented with a slow-growing right breast lump. Excision biopsy of the lump showed invasive ductal carcinoma with adjacent ductal carcinoma in situ (DCIS). Preoperative imaging was performed to assess the extent of disease. Magnetic resonance (MR) imaging of the breasts showed an area of clustered ring enhancement deep to the biopsy site, which was representative of residual DCIS. DCIS is a common noninvasive malignancy that manifests as a primary breast tumour or in association with other lesions. The radiological features of DCIS are discussed herein, with special attention to the clustered ring enhancement pattern on MR imaging.

Diagnosis of Ductal Carcinoma in situ: Role of Additional Breast Sonography

PURPOSE: To verify the role of additional sonography on routine mammograms in the diagnosis of ductal carcinoma in situ (DCIS). MATERIALS AND METHODS: Between 2005 and 2008, a total of 105 breasts belonging to 102 patients were diagnosed with DCIS by surgery. Preoperative ultrasound and mammographic findings and reports using BI-RADS were retrospectively reviewed and analyzed. In both mammogram and ultrasound, BI-RADS categories 1, 2, and 3 were regarded as negative results and categories 4 and 5 as positive results. We analyzed the frequency in which additional ultrasound examinations aided in the diagnosis in each mammographic finding. RESULTS: Out of the 105 cases, 96 showed positive results on a mammogram and 9 cases showed negative results. Clustered microcalcifications, positive mammographic findings, were found most often (64/96, 66.67%). In those cases, ultrasound examinations gave no additional information, but did enablesonographically-guided biopsies in 38. In the 32 cases with other positive mammographic findings, ultrasound examinations were helpful in 15 cases. Of the 9 cases showing negative results on a mammogram, 8 cases were correctly diagnosed with DCIS because of the additionally-performed ultrasound examination, but 1 case returned a false negative on both the mammogram and ultrasound examination. CONCLUSION: Additional sonography contributes to a diagnosis of DCIS in patients with negative mammographic findings, nonspecific mammographic findings, or multifocal lesions.

Clinical Features and Pathological Characteristics of Ductal Carcinoma in Situ of the Breast in Mastectomy and Breast Conservative Surgery

PURPOSE: Breast conservative surgery (BCS) with adjuvant radiation has recently shown similarly good treatment results in patients with early invasive breast cancer, as a mastectomy. However, a mastectomy is performed in some patients with ductal carcinoma in situ (DCIS) for many reasons. In order to compare a mastectomy with breast conservative surgery, the relationship between the clinical and pathological features, the prognoses, and factors affecting the choice of surgical method were evaluated. METHODS: A total 217 patients who underwent an operation for DCIS at Samsung Medical Center, between November 1994 and February 2002, were enrolled for this study. The patients' medical records were retrospectively reviewed for the clinical, radiological and pathological findings. RESULTS: The mean age of the mastectomy and conservative surgery groups were 47.5 and 45.0 years, respectively. A mastectomy was performed in 124 patients (57.1%), and breast conservative surgery was received by 93. The major causes for a mastectomy were a subareolar mass or calcification and multiple masses or calcifications. The median tumor size in the mastectomy group was 2.41cm, which was larger than the 1.05 cm in the BCS group (P<0.05). Recurrence was found in four patients during the follow up period (at a median of 34.0 months), but no additional recurrence was found after local excision or mastectomy for the recurred tumors. CONCLUSION: The patients in the mastectomy group were older, and their tumor size larger than the conservative surgery group. 57.1% of the patients, with nipple-areolar complex invasion, had a subareolar mass or calcification as the cause for their mastectomy, therefore, it is suggested that the patients with a subareolar mass or calcification should undergo a mastectomy for the complete excision of the tumor.

Ductal Carcinoma In Situ (DCIS) of the Breast; Clinico-pathological Analysis, Expression of Molecular Markers, and Correlations between Known Prognostic Factors

PURPOSE: The improved availability of breast cancer screening, including mammography, has dramatically increased the detection rate of DCIS (ductal carcinoma in situ). However, there has been controversy regarding the clinico-pathological characteristics and optimal management of DCIS. This analysis was conducted in order to evaluate the clinico- pathological findings of DCIS, and any possible correlations between the known prognostic factors. METHODS: We analyzed 58 consecutive cases of DCIS, from 1990 to 1995, including data on the annual proportion of DCIS to total breast cancer cases, the clinico-pathological characteristics and the expressions of ER, PR, c-erbB-2 and p53. The median length of follow-up was 98.5 months. RESULTS: The proportion of DCIS was 8.8%, with progressive increases from 1990 to 1995. The mean age at diagnosis was 47.1 years, with the peak of prevalence seen in women aged 40~49 years. The most common presentation was a palpable breast mass in 28 (48.3%) cases, but 18 (31%) patients were asymptomatic. The mammographic findings demonstrated calcification in 75% and mass density in 59.6%. There was only 1 (1.8%) case of a bilateral lesion, and 5 (8.6%) of multifocal or multicentric lesions. Axillary lymph nodes were positive in 5.5% of the patients who underwent an axillary dissection. Breast conserving operations were performed in 8 (13.8%) cases. The frequencies of ER, PR, c-erbB-2 and p53, positivity, by immunohistochemistry were 52, 50, 55.1 and 30.6%, respectively. c-erbB- 2 immunoreactivity was found more often in DCIS with larger size, higher nuclear grade and negative ER and PR (P= 0.011, P=0.001, P=0.002, and P=0.006, respectively). There was a significant association between higher nuclear grade and negative ER and PR, and comedotype (P=0.001, P= 0.000, and 0.008, respectively). Although an invasive ductal carcinoma had developed in 5.4% of the contralateral breasts, there were no cases of systemic relapse, or disease-specific mortality, at the last follow-up.

Assessment of MIB1 (Ki-67) Labeling Index and Correlation with Other Well Established Prognostic Factors in Breast Cancer

PURPOSE: The MIB1 labeling index is new method utilizing a monoclonal antibody against Ki-67 antigen and useful for evaluating the proliferation rate in breast cancer due to its ease of use and reliability. We compared the MIB1 labeling index to other, well established prognostic factors and assessed the prognostic value of MIB1 in 564 breast cancers. METHODS: The MIB1 (Ki-67 equivalent monoclonal antibody) proliferation rate, MIB1 labeling index, was determined in formalin-fixed, paraffin-embedded tissue specimens of 564 primary breast cancer patients who underwent surgery between March 1998 and February 2000 at Seoul National University Hospital. The clinicopathologic characteristics of the primary tumor such as age, tumor size, histologic type, nuclear grade, histologic grade, hormone receptor status and various tumor markers (p53, c-erbB-2, bcl-2) were compared with the value of the MIB1 labeling Index. RESULTS: The mean value of MIB1 labeling index was 6.9. MIB1 labeling index was correlated to younger age (p= 0.011), histologic types, low nuclear grade (p=0.0001), high histologic grade (p=0.0001), p53 positive (IDC) (p=0.0001), c-erbB-2 positive (DCIS) (p=0.01), comedo type (DCIS) (p= 0.001) and inversely correlated to hormone receptor positivity (p=0.0001), bcl-2 positive (IDC) (p=0.001). No correlation was found in tumor size, lymph node status and c-erbB-2 positive (IDC). CONCLUSION: The MIB1 labeling index correlated well with well-established poor prognostic factors. The MIB1 labeling index may be an important prognostic determinant in breast cancer.

Clinicopathological Analysis of Ductal Carcinoma in situ (DCIS) and Ductal Carcinoma in situ with Microinvasion

PURPOSE: The natural history of patients with ductal carcinoma in situ (DCIS) with microinvasion is poorly defined, and the clinical management of these patients, with particular reference to management of the axilla, has been controversial. Previous studies of this lesion have used arbitrary criteria for the evaluation of microinvasion. METHODS: In order to compare the clinicopathologic features and treatment outcomes between DCIS and DCIS with microinvasion, the medical records of 101 patients of DCIS with or without microinvasion who had been treated at Yongdong Severance hospital from April 1991, to October 1998, were reviewed retrospectively. RESULTS: The mean age of the DCIS with microinvasion group was 44.8 years-old and that of the DCIS group was 47.4 years-old. The peak age group within both study groups was the 5th decade. The primary tumors of the DCIS-MI group were larger (2.16 vs 1.93 cm) and more easily palpated (66.3% vs 36.6%) upon the physical examination than that of the DCIS group. The rate of axillary lymph node metastasis was higher in the DCIS-MI group (10% vs 1.3%). In terms of nuclear grade, comedo type, hormone receptor status, and c-erbB2 immunohistochemical positivity, there were no statistically significant differences between the DCIS and DCIS-MI groups. The recurrence rate within the DCIS-MI group was higher than that of DCIS group (10% vs 1.4%). The 5-year disease free survival rate of the DCIS and DCIS-MI groups were 98% and 89% respectively. CONCLUSION: Ductal carcinoma in situ with microinvasion is thought to be a transitional disease entity between ductal carcinoma in situ and invasive ductal carcinoma. However, the treatment options for ductal carcinoma in situ with microinvasion have been similar to that of the invasive carcinoma. More long-term follow-up and a multicenter study seem to be necessary to identify differences in the clinical features and to determine the optimal methods of treatment.

Clinicopathological analysis of ductal carcinoma in situ(DCIS) and ductal carcinoma in situ with microinvasion / 한국유방암학회지

BACKGROUND: The natural history of the patients of ductal carcinoma in situ(DCIS) with microinvasion is poorly defined, and the clinical management of these patients, with particular reference to management of the axilla, has been controversial. Previous studies of this lesion have used and/or arbitrary criteria for the evaluation of microinvasion. METHODS: To compare the clinicopathologic features and the outcomes of treatment between DCIS and DCIS with microinvasion, the medical records of 101 patients of DCIS with/without microinvasion who had been treated at Yongdong Severance hospital from Apr. 1991, to Oct 1998, were reviewed retrospectively. RESULTS: The mean age of the patients of DCIS with microinvasion group was 44.8 years and that of the patients of DCIS group was 47.4 years. The peak age group of both was 5th decade. The primary tumors of DCIS-MI group were larger(2.16 vs 1.93cm) and more easily palpated(66.3% vs 36.6%) on the physical examination than that of DCIS group. The rate of the axillary lymph node metastasis was higher in DCIS-MI group.(10% vs 1.3%) In terms of nuclear grade, comedo type, hormone receptor status, and c-erbB2 immunohistochemical positivity, there were no statistical significances between DCIS group and DCIS-MI group. The recurrence rate of DCIS-MI group was higher than that of DCIS group.(10% vs 1.4%) The 5-year disease free survival rate of the DCIS group and DCIS-MI group were 98% and 89% respectively. CONCLUSIONS: Ductal carcinoma in situ with microinvasion is thought to be transitional disease entity between ductal carcinoma in situ and invasive ductal carcinoma. But the treatment options of ductal carcinoma in situ with microinvasion were similar to that of the invasive carcinoma. More long-term follow-up and multicenter studies seem to be necessary to identify differences in clinical features and to determine the optimal methods of treatment.