Ductal carcinoma in situ (DCIS)

Definition

What DCIS is

• Definition: Ductal carcinoma in situ (DCIS) is an intraductal neoplasia in which the basement membrane is intact, thus making metastasis impossible.
• Radiological appearance: On mammography, DCIS almost always presents as clustered, pleomorphic microcalcifications in a ductal or segmental distribution.
• Sonographic appearance: On ultrasound, DCIS is usually not clearly identifiable — which is precisely why screening requires mammography.

Diagnosis

Benign vs. Malignant Calcification

• Criteria for malignancy: Features suggestive of malignancy are fine, pleomorphic or linear-branching calcifications in a clustered, segmental arrangement.
• Criteria for benignity: Considered benign are coarse 'popcorn' calcifications of a fibroadenoma, vascular calcifications with a 'tram-track' appearance, 'eggshell' and 'milk of calcium' calcifications.
• Further assessment: For further assessment of suspicious calcifications, magnification and compression views of the calcified area are used.

Work-up

• Biopsy: In cases of suspicious microcalcifications, the standard procedure is stereotactically guided vacuum-assisted biopsy.

Typical imaging findings

• Mammography: Within a circumscribed area numerous very fine calcific particles of differing size and shape lie densely together. They are arranged along an imaginary line towards the nipple; there is no palpable or visible mass.

Keep learning in the app

Further reading (selection)

1. StatPearls: Ductal Carcinoma In Situ (DCIS) of the Breast (NCBI Bookshelf)
2. DocCheck Flexikon, Duktales Carcinoma in situ

Cross-references