Elsevier

Human Pathology

Volume 24, Issue 1, January 1993, Pages 16-23
Human Pathology

Original contribution
Noninvasive ductal carcinoma of the breast: The relevance of histologic categorization

https://doi.org/10.1016/0046-8177(93)90057-NGet rights and content

Abstract

A consecutive series of 130 review-confirmed cases of noninvasive ductal carcinoma of breast (DCIS) in women without previous breast carcinoma was analyzed. Histologic variables assessed included histologic pattern, nuclear grade, necrosis, and involved duct counts. These were correlated with presentation, extent of DCIS in the breast, completeness of excision, and outcome. Comedo DCIS had an occult presentation significantly more often than noncomedo DCIS. Micropapillary DCIS was significantly more likely than other patterns to involve multiple quadrants of breast, irrespective of nuclear grade or necrosis. Solid DCIS was significantly more often completely excised when compared with all other patterns, while high-grade DCIS was significantly more often incompletely excised compared with low-grade DCIS. Follow-up showed invasive recurrence in 16% of cases treated by primary local excision only and 3% cases treated by mastectomy or with re-excision. Of local excision cases with follow-up longer than 3 years, 22% had invasive recurrence. Invasive recurrence only followed high-grade DCIS and most often followed comedo DCIS. The need for strict definition of categories of DCIS is stressed.

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      Although necrosis is an important marker for high-risk lesions, this feature alone oversimplifies the categorization of DCIS lesions, signified by evidence of high-risk lesions with noncomedo architecture. Nuclear grade has emerged as a strong predictor of local recurrence (Fig. 2).100,106,111 As a result, the general consensus among experts is that nuclear grade is the most important feature governing histologic classification.108

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