DCIS accounts for 25% of all diagnosed breast cancers. DCIS: heterogeneous group of neoplastic intraductal lesions; Subclassified into 8 subtypes (based on microscopic architecture, ex: comedo-type) and into 3 grades based on nuclear morphology (ex: ER-/PR- with p52 mutations and aneuploidy = high grade)  

Clinical presentation: No breast symptoms or physical exam findings; 90% present with suspicious microcalcifications on screening mammography

Diagnosis: Stereotactic core biopsy of microcalcifications

Imaging

–     Mammography: 90% present with microcalcifications: Linear branching or segmental pleomorphic – associated with high grade DCIS; Fine, granular  – associated with low grade DCIS

–     MRI: No better than mammography at differentiating DCIS from benign lesions; False positives common; ONLY consider if need to determine extent of DCIS, and to identify multicentric disease or synchronous disease in contralateral breast; Non mass enhancement in "clumped" distribution has 60% chance of being DCIS

Treatment: Goal is to prevent the progression of DCIS to invasive cancer and includes breast conserving surgery, radiation therapy, and tamoxifen

(Ikeda 2010, Georgian-Smith 2014, Bleiweiss 2013, Esserman 2016)

MALIGNANT BREAST DISORDERS:

DCIS