Updated: 5/31/2020

Ductal Carcinoma In Situ (DCIS)

0%
Topic
Review Topic
0
0
N/A
N/A
Questions
1
0
0
Topic
https://upload.medbullets.com/topic/120425/images/dcis.jpg
https://upload.medbullets.com/topic/120425/images/dcis.jpg
https://upload.medbullets.com/topic/120425/images/dcis_mammo..jpg
Snapshot
  • A 58-year-old woman presented to her primary care physician after a screening mammogram revealed calcifications in the left breast. Physical exam revealed no palpable breast lumps or axillary lymphadenopathy. 
Introduction
  • Overview
    • a neoplastic lesion confined to the breast duct
    • a true premalignancy
      • 50% develop into invasive ductal carcinoma if untreated
        • risk is for both the ipsilateral and contralateral breast
  • Epidemiology
    • incidence
      • 32.5 in 100,000 women
      • represents ~20% of breast cancer diagnoses in the U.S.
    • risk factors
      • increasing age
      • nulliparity
      • family history of breast cancer
      • age ≥ 30 or older at birth of first child
      • obesity
  • Genetics
    • inheritance
      • increased risk with BRCA1 and BRCA2 mutations
    • mutations
      • 75% of DCIS is estrogen (ER)/progesterone (PR) receptor-positive
  • Associated conditions
    • Paget disease of the breast 
      • overlying breast skin changes that may occur in association with DCIS
        • skin crusting and itching
  • Prognosis
    • excellent
      • ~1.7-3% mortality in treated patients
Presentation
  • Symptoms
    • asymptomatic
  • Presentation
    • typically no palpable mass on exam
    • +/- nipple discharge
    • +/- overlying breast skin crusting
Imaging
  • Mammography 
    • indications
      • screening
        • DCIS often detected on screening mammogram
    • findings
      • calcifications
        • in 90% of DCIS
        • linear calcifications associated with more aggressive DCIS
        • granular calcifications associated with less aggresive DCIS
      • breast mass
        • uncommon but occassionally found on mammography (~8% of cases)
  • Ultrasound
    • indications
      • to guide biopsy if lesion is visible on US
    • findings
      • microlobulated mild hypoechoic mass with ductal extension 
  • Core or excisional biopsy 
    • indications
      • diagnosis following detection of calcifications on mammogram
        • using stereotactic guidance
    • findings
      • proliferation of neoplastic cells within the mammary ductal system 
      • 11% will have findings of microinvasion
Differential
  • Lobular carcinoma in situ (LCIS) 
    • key distinguishing factor
      • e-cadherin expression on histology
        • positive in DCIS and negative in LCIS 
  • Invasive carcinoma
    • key distinguishing factor
      • evidence of invasion on biopsy
Treatment
  • Medical
    • radiation
      • indications
        • postoperative following lumpectomy
    • endocrine therapy
      • indications
        • ER/PR-positive DCIS to reduce chance of developing invasive cancer
          • especially in patients who did not undergo bilateral mastectomy
      • modalities
        • tamoxifen
    • close follow-up and screening mammography
      • indications
        • all DCIS patients to detect future development of invasive carcinoma
  • Surgical
    • lumpectomy
      • indications
        • relatively smaller masses compared to size of breast
        • ability to get negative margins
          • multicentric disease involving more than one quadrant is a relative contraindication
      • followed by radiation
        • can skip radiation if low-grade DCIS that is < 1-2 cm
    • mastectomy (typically bilateral)
      • indications
        • invasive components on biopsy
        • multicentric disease
        • relatively large masses compared to size of breast
        • patients who prefer bilateral mastectomy in order to reduce risk of future invasive carcinoma
Complications
  • Development of invasive carcinoma 
    • ~6% risk of recurrence of invasive carcinoma after DCIS treatment in both contralateral and ipsilateral breast
  • Death

Please rate topic.

Average 5.0 of 1 Ratings

Questions (1)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
EXPERT COMMENTS (2)
Private Note