IV Ductal Carcinoma In Situ, Including its Histologic Subtypes and Grades

Abstract

Purpose of Review: Ductal carcinoma in situ (DCIS) of the breast is a heterogenous intraductal disease that exists within a spectrum of intraepithelial abnormalities ranging from atypia to invasive carcinoma. The vast majority of DCIS is diagnosed in asymptomatic women on screening mammography as suspicious calcifications, but can less commonly present as a palpable mass, suspicious nipple discharge, or as suspicious enhancement in high-risk women being screened with MRI. The distinction between atypia and low-grade DCIS is nuanced, and significant overlap in the imaging appearance of DCIS coupled with interobserver variability in diagnosing DCIS on pathology emphasizes the importance of collaboration between radiologist and pathologist when making a DCIS diagnosis. Under sampling or sampling error at core biopsy might lead to a diagnosis of atypia instead of DCIS or DCIS instead of invasive carcinoma, which has important management implications. Recent Findings: Classification of DCIS continues to evolve as it relates to likelihood of recurrence; currently, nuclear grade, presence or absence of necrosis, and margin status play key roles. Summary: While current treatment options for DCIS remain relatively aggressive and uniform for this non-lethal disease, on-going clinical trials, newer prognostic indices, and incorporation of genomics, proteomics, and radiomics aim to assist with optimizing DCIS management with the goal of decreasing overtreatment.