Skip to main content
NCBI home page
Journal of Clinical Pathology logoLink to Journal of Clinical Pathology
. 1997 Jul;50(7):596–599. doi: 10.1136/jcp.50.7.596

Cytological and architectural heterogeneity in ductal carcinoma in situ of the breast.

C M Quinn 1, J L Ostrowski 1
PMCID: PMC500068  PMID: 9306942

Abstract

AIM: The traditional architecture based classification system of ductal carcinoma in situ (DCIS) has been criticised on the grounds that individual lesions often show more than one pattern resulting in a large mixed category. New DCIS classification systems have emphasised the importance of cytological grade, which is reputed to be more uniformly expressed throughout a lesion. This study investigates the hypothesis that cytological heterogeneity is less common than architectural heterogeneity within DCIS lesions. METHODS: 121 cases of DCIS were graded as poorly, intermediately, or well differentiated according to a recently developed classification system that employs cytonuclear morphology as the major diagnostic criterion. Cases were categorised as pure when only one grade was present and as mixed if more than one grade was observed. Architecturally the cases were classified as solid, cribriform, micropapillary, or papillary and were described as pure if only one architectural pattern was present and as mixed if more than one pattern was seen. The incidence of cytological heterogeneity was compared with that of architectural heterogeneity. The presence of necrosis was assessed as an independent parameter and the relation to DCIS grade evaluated. RESULTS: Using the cytology based classification system 102 cases (84%) were classified as pure (65 poorly differentiated, 25 intermediately differentiated, and 12 well differentiated) and 19 cases (16%) as mixed. Extensive necrosis was observed in 61 (50%) cases and was closely correlated to DCIS grade. Architecturally 46 cases (38%) were classified as pure (38 solid, 5 cribriform, 2 micropapillary, and 1 papillary) and 75 (62%) as mixed. CONCLUSIONS: Cytological heterogeneity is much less common than architectural heterogeneity in DCIS lesions. The assessment of cytonuclear morphology is therefore likely to provide more consistent information about DCIS, particularly in small biopsy specimens where only part of the lesion may be available for examination.

Full text

PDF
596

Images in this article

597Image
on p.597
597Image
on p.597
597Image
on p.597
598Image
on p.598

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barnes D. M., Meyer J. S., Gonzalez J. G., Gullick W. J., Millis R. R. Relationship between c-erbB-2 immunoreactivity and thymidine labelling index in breast carcinoma in situ. Breast Cancer Res Treat. 1991 Mar;18(1):11–17. doi: 10.1007/BF01975438. [DOI] [PubMed] [Google Scholar]
  2. Bellamy C. O., McDonald C., Salter D. M., Chetty U., Anderson T. J. Noninvasive ductal carcinoma of the breast: the relevance of histologic categorization. Hum Pathol. 1993 Jan;24(1):16–23. doi: 10.1016/0046-8177(93)90057-n. [DOI] [PubMed] [Google Scholar]
  3. Bobrow L. G., Happerfield L. C., Gregory W. M., Millis R. R. Ductal carcinoma in situ: assessment of necrosis and nuclear morphology and their association with biological markers. J Pathol. 1995 Aug;176(4):333–341. doi: 10.1002/path.1711760404. [DOI] [PubMed] [Google Scholar]
  4. Bobrow L. G., Happerfield L. C., Gregory W. M., Springall R. D., Millis R. R. The classification of ductal carcinoma in situ and its association with biological markers. Semin Diagn Pathol. 1994 Aug;11(3):199–207. [PubMed] [Google Scholar]
  5. Bur M. E., Zimarowski M. J., Schnitt S. J., Baker S., Lew R. Estrogen receptor immunohistochemistry in carcinoma in situ of the breast. Cancer. 1992 Mar 1;69(5):1174–1181. doi: 10.1002/cncr.2820690518. [DOI] [PubMed] [Google Scholar]
  6. Harrison M., Coyne J. D., Gorey T., Dervan P. A. Comparison of cytomorphological and architectural heterogeneity in mammographically-detected ductal carcinoma in situ. Histopathology. 1996 May;28(5):445–450. doi: 10.1046/j.1365-2559.1996.322365.x. [DOI] [PubMed] [Google Scholar]
  7. Holland R., Peterse J. L., Millis R. R., Eusebi V., Faverly D., van de Vijver M. J., Zafrani B. Ductal carcinoma in situ: a proposal for a new classification. Semin Diagn Pathol. 1994 Aug;11(3):167–180. [PubMed] [Google Scholar]
  8. Killeen J. L., Namiki H. DNA analysis of ductal carcinoma in situ of the breast. A comparison with histologic features. Cancer. 1991 Dec 15;68(12):2602–2607. doi: 10.1002/1097-0142(19911215)68:12<2602::aid-cncr2820681214>3.0.co;2-i. [DOI] [PubMed] [Google Scholar]
  9. Lagios M. D. Duct carcinoma in situ. Pathology and treatment. Surg Clin North Am. 1990 Aug;70(4):853–871. doi: 10.1016/s0039-6109(16)45185-6. [DOI] [PubMed] [Google Scholar]
  10. Lagios M. D., Margolin F. R., Westdahl P. R., Rose M. R. Mammographically detected duct carcinoma in situ. Frequency of local recurrence following tylectomy and prognostic effect of nuclear grade on local recurrence. Cancer. 1989 Feb 15;63(4):618–624. doi: 10.1002/1097-0142(19890215)63:4<618::aid-cncr2820630403>3.0.co;2-j. [DOI] [PubMed] [Google Scholar]
  11. Lampejo O. T., Barnes D. M., Smith P., Millis R. R. Evaluation of infiltrating ductal carcinomas with a DCIS component: correlation of the histologic type of the in situ component with grade of the infiltrating component. Semin Diagn Pathol. 1994 Aug;11(3):215–222. [PubMed] [Google Scholar]
  12. Leal C. B., Schmitt F. C., Bento M. J., Maia N. C., Lopes C. S. Ductal carcinoma in situ of the breast. Histologic categorization and its relationship to ploidy and immunohistochemical expression of hormone receptors, p53, and c-erbB-2 protein. Cancer. 1995 Apr 15;75(8):2123–2131. doi: 10.1002/1097-0142(19950415)75:8<2123::aid-cncr2820750815>3.0.co;2-v. [DOI] [PubMed] [Google Scholar]
  13. Lennington W. J., Jensen R. A., Dalton L. W., Page D. L. Ductal carcinoma in situ of the breast. Heterogeneity of individual lesions. Cancer. 1994 Jan 1;73(1):118–124. doi: 10.1002/1097-0142(19940101)73:1<118::aid-cncr2820730121>3.0.co;2-r. [DOI] [PubMed] [Google Scholar]
  14. Locker A. P., Horrocks C., Gilmour A. S., Ellis I. O., Dowle C. S., Elston C. W., Blamey R. W. Flow cytometric and histological analysis of ductal carcinoma in situ of the breast. Br J Surg. 1990 May;77(5):564–567. doi: 10.1002/bjs.1800770533. [DOI] [PubMed] [Google Scholar]
  15. Ottesen G. L., Graversen H. P., Blichert-Toft M., Zedeler K., Andersen J. A. Ductal carcinoma in situ of the female breast. Short-term results of a prospective nationwide study. The Danish Breast Cancer Cooperative Group. Am J Surg Pathol. 1992 Dec;16(12):1183–1196. doi: 10.1097/00000478-199212000-00005. [DOI] [PubMed] [Google Scholar]
  16. Poller D. N., Roberts E. C., Bell J. A., Elston C. W., Blamey R. W., Ellis I. O. p53 protein expression in mammary ductal carcinoma in situ: relationship to immunohistochemical expression of estrogen receptor and c-erbB-2 protein. Hum Pathol. 1993 May;24(5):463–468. doi: 10.1016/0046-8177(93)90157-c. [DOI] [PubMed] [Google Scholar]
  17. Poller D. N., Silverstein M. J., Galea M., Locker A. P., Elston C. W., Blamey R. W., Ellis I. O. Ideas in pathology. Ductal carcinoma in situ of the breast: a proposal for a new simplified histological classification association between cellular proliferation and c-erbB-2 protein expression. Mod Pathol. 1994 Feb;7(2):257–262. [PubMed] [Google Scholar]
  18. Silverstein M. J., Poller D. N., Waisman J. R., Colburn W. J., Barth A., Gierson E. D., Lewinsky B., Gamagami P., Slamon D. J. Prognostic classification of breast ductal carcinoma-in-situ. Lancet. 1995 May 6;345(8958):1154–1157. doi: 10.1016/s0140-6736(95)90982-6. [DOI] [PubMed] [Google Scholar]
  19. Solin L. J., Yeh I. T., Kurtz J., Fourquet A., Recht A., Kuske R., McCormick B., Cross M. A., Schultz D. J., Amalric R. Ductal carcinoma in situ (intraductal carcinoma) of the breast treated with breast-conserving surgery and definitive irradiation. Correlation of pathologic parameters with outcome of treatment. Cancer. 1993 Apr 15;71(8):2532–2542. doi: 10.1002/1097-0142(19930415)71:8<2532::aid-cncr2820710817>3.0.co;2-0. [DOI] [PubMed] [Google Scholar]
  20. van Dongen J. A., Holland R., Peterse J. L., Fentiman I. S., Lagios M. D., Millis R. R., Recht A. Ductal carcinoma in-situ of the breast; second EORTC consensus meeting. Eur J Cancer. 1992;28(2-3):626–629. doi: 10.1016/s0959-8049(05)80113-3. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Clinical Pathology are provided here courtesy of BMJ Publishing Group

RESOURCES