Findings: The mammogram demonstrates multiple minute pleomorphic calcifications scattered throughout the left breast, predominantly in the central inferior aspect. The findings are highly suspicious for malignancy.

Diagnosis: Ductal carcinoma in-situ, predominantly micropapillary type, intermediate nuclear grade, with microcalcifications. No infiltrating carcinoma is identified.

Discussion: Ductal carcinoma in-situ (DCIS) refers to a breast carcinoma limited to the ducts with no extension beyond the basement membrane. It can be broadly divided into two types: comedo and noncomedo.

Comedo refers to the necrotic material that fills the ducts involved with DCIS. It is a more aggressive form of DCIS. Noncomedo has a low nuclear grade without significant necrosis. It has multiple patterns which often co-exist - cribiform, micropapillary, papillary and solid. Both forms of DCIS are associated with calcifications.

DCIS accounts for approximately 20% of all nonpalpable mammographically detected breast carcinoma. It often manifests as one or more clusters of pleomorphic calcifications. The calcifications of the comedo type are often branching, representing casts of the ducts, while noncomedo calcifications have a more rounded granular shape. However, there is considerable overlap between the two types.

The treatment of DCIS had traditionally been a mastectomy with a cure rate of almost 100%. Presently, there has been a trend towards breast conservation with mixed results. There is a 12-43% recurrence rate with local excision alone. The recurrence rate lowers to 2-17% when radiation therapy is added to the treatment regimen. The recurrences are equally divided between CSIS and invasive carcinoma.

References:
Rebner M, Raju V. Noninvasive Breast Cancer. Radiology 1994; 190:623-631.

Kopans DB. Breast Imaging. Philadelphia, JB Lippincott Company, 1989.

Return to Women's Diagnosic Imaging Page