Cancer Letters

Cancer Letters

Volume 90, Issue 1, 23 March 1995, Pages 97-102
Cancer Letters

Heterogeneity of duct carcinoma in situ (DCIS): Relationship of grade and subtype analysis to local recurrence and risk of invasive transformation

https://doi.org/10.1016/0304-3835(94)03683-AGet rights and content

Abstract

Morphologic analysis of nuclear grade and extent of necrosis can provide reproducible classification of subclinical duct carcinoma in situ (DCIS) which strongly separates DCIS into three risk groups. For subclinical lesions of small size, risk is largely limited to local recurrences only, half of which, however, are invasive events. Local recurrences are seen much more frequently with high grade DCIS. Most local recurrences following breast conservation therapy represent residual disease in the immediate vicinity of the biopsy site. Stromal and cellular host reactions may provide additional prognostic information.

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      Pure DCIS accounts for about 20% of malignant screen-detected breast lesions (3,4). Fifty percent of DCIS are high grade and comprise the risk of harbouring or progressing to high grade invasive cancer (5,6). About 30–50% of DCIS progress into invasive cancer and half of the tumor recurrences are invasive cancers (7,8).

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      However, this may not fully represent the heterogeneity of DCIS. About 16% of low nuclear grade DCIS is mixed with either intermediate or high grade foci [54–56]. Reviewing 1059 cases of pure DCIS lesions diagnosed between 1990 and 2013 in Nottingham revealed that 13% of cases were pure low nuclear grade while 5.5% and 1.5% of low grade lesion were mixed with intermediate or intermediate and high grades respectively (unpublished data).

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      Progression from DCIS to iBC constitutes a complex biological phenomenon [16,25]. It has been hypothesised that breast cancer evolution can be classified into two groups: a low- and high-grade breast neoplasia family [16,26–30]. The low- and high-grade multistep model of breast cancer progression based on morphological, immunophenotypical and molecular features described by Lopez-Garcia et al. suggests that if low-grade DCIS progresses to invasive disease this will be low-grade iBC with favourable characteristics in most cases and survival rates after treatment of this invasive cancer will still be excellent.

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    1

    Clinical Associate Professor of Pathology, Stanford University, Stanford, California.

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