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Ductal carcinoma in situ of breast

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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In ductal carcinoma in situ, the malignant cells are epithelial, confined to the ducts and do not invade the basement membrane. It is associated with an increased risk of invasive breast carcinoma. The risk of invasive carcinoma is increased in proportion to the extent of in situ disease.

In the general population, the incidence of ductal carcinoma in situ is about 5%. However, in populations screened mammographically, this increases up to 20% due to the tendency to produce conspicuous microcalcification

  • in situ lesions tend to exhibit micro-calcifications more frequently than invasive carcinoma, it is natural that the incidence of detecting pre-invasive lesions has dramatically increased (up to 20%) following the routine use of mammographic screening (2)

  • most lesions are detected on routine screening mammographs (1)
    • are seen most commonly as microcalcifications (in 76 % cases) or sometimes as masses/soft tissue densities (in 11-13 % of cases)
    • a number of markers related to proliferation, cell cycle regulation, apoptosis, angiogenesis, extracellular matrix proteins (CD10, SPARC) and inflammation including COX2 have been analysed in DCIS (2)

  • management of ductal carcinoma in situ is a team effort, comprising coordinated care provided by oncologists, surgeons, radiologists, and pathologists
    • the primary decision that needs to be made is whether the patient is a candidate for breast-conserving surgery (1)
      • simple mastectomy is curative for over 98 % of cases
      • recurrences may occur in 1-2 % of cases due to unrecognized invasive carcinoma, inadequate margins, or incomplete removal of breast tissue during the surgery
      • usually, the procedure is followed by immediate breast reconstruction.
  • studies suggest that between 14 and 53 % of DCIS may progress to invasive cancer over a period of ten or more years (1)

Reference:

  • Vaidya Y, Vaidya P, Vaidya T. Ductal Carcinoma In Situ of the Breast. Indian J Surg. 2015;77(2):141-146. doi:10.1007/s12262-013-0987-0
  • Badve SS, Gokmen-Polar Y. Ductal carcinoma in situ of breast: update 2019. Pathology. 2019;51(6):563-569. doi:10.1016/j.pathol.2019.07.005

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