Pathological Appraisal of Low Nuclear Grade Ductal Carcinoma In Situ of the Breast
Puay Hoon Tan, Aye Aye Thike, Jill Su-Lin Wong, Gay Hui Ho, Shyamala Thilagaratnam. Singapore General Hospital, Singapore, Singapore; National Cancer Centre, Singapore, Singapore; Health Promotion Board, Singapore, Singapore
Background: Ductal carcinoma in situ (DCIS) of the breast is increasingly diagnosed as a result of mammographic screening. Debate regarding the true biological potential of low grade DCIS continues to challenge therapeutic considerations. In this study, we review the clinicopathological characteristics of a series of low nuclear grade DCIS and correlate with clinical outcome.
Design: Cases of DCIS of low nuclear grade were retrieved from the files of the Department of Pathology, Singapore General Hospital, between 1994 and 2010. Clinical presentation was correlated with histological parameters. Associated microscopic changes were documented. Follow-up was obtained from patient casenotes. Statistical associations with a p value of <0.05 were deemed significant.
Results: Of 237 cases of low grade DCIS in our files, 36 had to be excluded due to presence of invasive disease in 3 cases, 2 cases were lobular carcinoma in situ and not DCIS on histological review, 10 cases contained intermediate grade foci, and no material was available in 21 cases. From the final 201 cases, 128 (63.7%) were screen detected and 73 (36.3%) were symptomatic. Median age of affected women was 50 years and median DCIS size was 9 mm. The commonest architectural pattern was cribriform with 78 (39%) cases, followed by combined cribriform and micropapillary with 24 (12%) cases. Presence of solid papillary carcinoma elements was noted in 28 (14%) cases. There was statistically significant association of presence of calcifications with screen detected DCIS (p < 0.001). Flat epithelial atypia (FEA) was observed in 18 (9%) cases. Recurrent disease occurred in 10 (5%) women during a median follow-up of 69 months. Deaths were reported in 3 women, with one being breast cancer related, while the other 2 died from carcinoma of the vagina and larynx respectively.
Conclusions: Low nuclear grade DCIS has a small risk of recurrence, though there can be breast cancer specific mortality related to subsequent diagnosis of invasive breast cancer. Longer follow-up is needed to understand the true biological nature of these lesions.
Monday, March 4, 2013 1:00 PM
Poster Session II # 55, Monday Afternoon