Skip to main content

Advertisement

SpringerLink
Log in

Clinicopathologic, mammographic, and sonographic features in 1,187 patients with pure ductal carcinoma in situ of the breast by estrogen receptor status

  • Review
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

The clinicopathologic, mammographic, and sonographic findings in patients with pure ductal carcinoma in situ (DCIS) were assessed by estrogen receptor (ER) expression. After institutional review board approval, patients with pure DCIS evaluated from January 1996 to July 2009 with known ER status and available imaging were identified. Images were reviewed as per the ACR BI-RADS® lexicon (4th edition). Clinical, pathologic, and imaging characteristics were analyzed by ER status using t test, Chi square test, and Fisher’s exact test. Of 1,219 patients with pure DCIS and known ER status identified, 1,187 with complete data were included. Mammography was performed in all 1,187 patients and sonography in 519 (44 %). There were 972 (82 %) patients with ER-positive and 215 (18 %) with ER-negative disease. ER-negative DCIS was more likely to be high grade (93 vs 44 %, p < 0.0001), associated with comedonecrosis (64 vs 29 %, p < 0.0001), and multifocal (23 vs 15 %, p = 0.009). On sonography, ER-negative DCIS was more likely to be visible (61 vs 46 %, p = 0.004), larger (mean size, 2.3 vs 1.6 cm, p = 0.006), and show posterior shadowing (53 vs 28 %, p = 0.006). Mastectomy was more frequently performed for ER-negative DCIS (47 vs 37 %, p = 0.008). Palpable DCIS was visible on sonography in 55 % of cases and mammography in 81 %. Compared with ER-positive palpable DCIS, ER-negative palpable DCIS was larger and more likely to be visible on sonography. Compared with ER-positive noncalcified DCIS, ER-negative noncalcified DCIS was less likely to be visible on mammography. ER-positive and ER-negative pure DCIS have different clinicopathologic and imaging characteristics. ER-negative DCIS is associated with worse prognostic factors than ER-positive DCIS. On sonography, ER-negative DCIS is more frequently visible than ER-positive DCIS, tends to be larger, and more frequently demonstrates posterior shadowing.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kuerer HM, Albarracin CT, Yang WT, Cardiff RD, Brewster AM, Symmans WF, Hylton NM, Middleton LP, Krishnamurthy S, Perkins GH, Babiera G, Edgerton ME, Czerniecki BJ, Arun BK, Hortobagyi GN (2009) Ductal carcinoma in situ: state of the science and roadmap to advance the field. J Clin Oncol 27:279–288. doi:10.1200/JCO.2008.18.3103

    Article  PubMed  Google Scholar 

  2. Virnig BA, Tuttle TM, Shamliyan T, Kane RL (2010) Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes. J Natl Cancer Inst 102:170–178. doi:10.1093/jnci/djp482

    Article  PubMed  Google Scholar 

  3. Ernster VL, Ballard-Barbash R, Barlow WE, Zheng Y, Weaver DL, Cutter G, Yankaskas BC, Rosenberg R, Carney PA, Kerlikowske K, Taplin SH, Urban N, Geller BM (2002) Detection of ductal carcinoma in situ in women undergoing screening mammography. J Natl Cancer Inst 94:1546–1554

    Article  PubMed  Google Scholar 

  4. Jemal A, Murray T, Ward E, Samuels A, Tiwari RC, Ghafoor A, Feuer EJ, Thun MJ (2005) Cancer statistics. CA Cancer J Clin 55:10–30

    Article  PubMed  Google Scholar 

  5. Boughey JC, Gonzalez RJ, Bonner E, Kuerer HM (2007) Current treatment and clinical trial developments for ductal carcinoma in situ of the breast. Oncologist 12:1276–1287. doi:10.1634/theoncologist.12-11-1276

    Article  PubMed  CAS  Google Scholar 

  6. Roses RE, Arun BK, Lari SA, Mittendorf EA, Lucci A, Hunt KK, Kuerer HM (2011) Ductal carcinoma-in situ of the breast with subsequent distant metastasis and death. Ann Surg Oncol 18:2873–2878. doi:10.1245/s10434-011-1707-2

    Article  PubMed  Google Scholar 

  7. MacDonald HR, Silverstein MJ, Mabry H, Moorthy B, Ye W, Epstein MS, Holmes D, Silberman H, Lagios M (2005) Local control in ductal carcinoma in situ treated by excision alone: incremental benefit of larger margins. Am J Surg 190:521–525. doi:10.1016/j.amjsurg.2005.06.005

    Article  PubMed  Google Scholar 

  8. Tabar L, Tony Chen HH, Amy Yen MF, Tot T, Tung TH, Chen LS, Chiu YH, Duffy SW, Smith RA (2004) Mammographic tumor features can predict long-term outcomes reliably in women with 1–14-mm invasive breast carcinoma. Cancer 101:1745–1759. doi:10.1002/cncr.20582

    Article  PubMed  Google Scholar 

  9. Yi M, Krishnamurthy S, Kuerer HM, Meric-Bernstam F, Bedrosian I, Ross MI, Ames FC, Lucci A, Hwang RF, Hunt KK (2008) Role of primary tumor characteristics in predicting positive sentinel lymph nodes in patients with ductal carcinoma in situ or microinvasive breast cancer. Am J Surg 196:81–87. doi:10.1016/j.amjsurg.2007.08.057

    Article  PubMed  Google Scholar 

  10. Stomper PC, Margolin FR (1994) Ductal carcinoma in situ: the mammographer’s perspective. AJR Am J Roentgenol 162:585–591. doi:10.2214/ajr.162.3.8109501

    Article  PubMed  CAS  Google Scholar 

  11. Barreau B, de Mascarel I, Feuga C, MacGrogan G, Dilhuydy MH, Picot V, Dilhuydy JM, de Lara CT, Bussieres E, Schreer I (2005) Mammography of ductal carcinoma in situ of the breast: review of 909 cases with radiographic-pathologic correlations. Eur J Radiol 54:55–61. doi:10.1016/j.ejrad.2004.11.019

    Article  PubMed  Google Scholar 

  12. Zunzunegui RG, Chung MA, Oruwari J, Golding D, Marchant DJ, Cady B (2003) Casting-type calcifications with invasion and high-grade ductal carcinoma in situ: a more aggressive disease? Arch Surg 138:537–540. doi:10.1001/archsurg.138.5.537

    Article  PubMed  Google Scholar 

  13. Yang WT, Tse GM (2004) Sonographic, mammographic, and histopathologic correlation of symptomatic ductal carcinoma in situ. AJR Am J Roentgenol 182:101–110. doi:10.2214/ajr.182.1.1820101

    Article  PubMed  Google Scholar 

  14. Sorlie T, Tibshirani R, Parker J, Hastie T, Marron JS, Nobel A, Deng S, Johnsen H, Pesich R, Geisler S, Demeter J, Perou CM, Lonning PE, Brown PO, Borresen-Dale AL, Botstein D (2003) Repeated observation of breast tumor subtypes in independent gene expression data sets. Proc Natl Acad Sci USA 100:8418–8423. doi:10.1073/pnas.0932692100

    Article  PubMed  CAS  Google Scholar 

  15. Prat A, Perou CM (2011) Deconstructing the molecular portraits of breast cancer. Mol Oncol 5:5–23. doi:10.1016/j.molonc.2010.11.003

    Article  PubMed  CAS  Google Scholar 

  16. Lari SA, Kuerer HM (2011) Biological markers in DCIS and risk of breast recurrence: a systematic review. J Cancer 2:232–261

    Article  PubMed  Google Scholar 

  17. Altintas S, Lambein K, Huizing MT, Braems G, Asjoe FT, Hellemans H, Van Marck E, Weyler J, Praet M, Van den Broecke R, Vermorken JB, Tjalma WA (2009) Prognostic significance of oncogenic markers in ductal carcinoma in situ of the breast: a clinicopathologic study. Breast J 15:120–132. doi:10.1111/j.1524-4741.2009.00686.x

    Article  PubMed  CAS  Google Scholar 

  18. Bijker N, Peterse JL, Duchateau L, Robanus-Maandag EC, Bosch CA, Duval C, Pilotti S, van de Vijver MJ (2001) Histological type and marker expression of the primary tumour compared with its local recurrence after breast-conserving therapy for ductal carcinoma in situ. Br J Cancer 84:539–544. doi:10.1054/bjoc.2000.1618

    Article  PubMed  CAS  Google Scholar 

  19. Claus EB, Chu P, Howe CL, Davison TL, Stern DF, Carter D, DiGiovanna MP (2001) Pathobiologic findings in DCIS of the breast: morphologic features, angiogenesis, HER-2/neu and hormone receptors. Exp Mol Pathol 70:303–316. doi:10.1006/exmp.2001.2366

    Article  PubMed  CAS  Google Scholar 

  20. Collins LC, Schnitt SJ (2005) HER2 protein overexpression in estrogen receptor-positive ductal carcinoma in situ of the breast: frequency and implications for tamoxifen therapy. Mod Pathol 18:615–620. doi:10.1038/modpathol.3800360

    Article  PubMed  CAS  Google Scholar 

  21. Hanley K, Wang J, Bourne P, Yang Q, Gao AC, Lyman G, Tang P (2008) Lack of expression of androgen receptor may play a critical role in transformation from in situ to invasive basal subtype of high-grade ductal carcinoma of the breast. Hum Pathol 39:386–392. doi:10.1016/j.humpath.2007.07.007

    Article  PubMed  CAS  Google Scholar 

  22. Lebeau A, Unholzer A, Amann G, Kronawitter M, Bauerfeind I, Sendelhofert A, Iff A, Lohrs U (2003) EGFR, HER-2/neu, cyclin D1, p21 and p53 in correlation to cell proliferation and steroid hormone receptor status in ductal carcinoma in situ of the breast. Breast Cancer Res Treat 79:187–198

    Article  PubMed  CAS  Google Scholar 

  23. Lebrecht A, Buchmann J, Hefler L, Lampe D, Koelbl H (2002) Histological category and expression of hormone receptors in ductal carcinoma in situ of the breast. Anticancer Res 22:1909–1911

    PubMed  CAS  Google Scholar 

  24. Meijnen P, Peterse JL, Antonini N, Rutgers EJ, van de Vijver MJ (2008) Immunohistochemical categorization of ductal carcinoma in situ of the breast. Br J Cancer 98:137–142. doi:10.1038/sj.bjc.6604112

    Article  PubMed  CAS  Google Scholar 

  25. Kerlikowske K, Molinaro AM, Gauthier ML, Berman HK, Waldman F, Bennington J, Sanchez H, Jimenez C, Stewart K, Chew K, Ljung BM, Tlsty TD (2010) Biomarker expression and risk of subsequent tumors after initial ductal carcinoma in situ diagnosis. J Natl Cancer Inst 102:627–637. doi:10.1093/jnci/djq101

    Article  PubMed  CAS  Google Scholar 

  26. Provenzano E, Hopper JL, Giles GG, Marr G, Venter DJ, Armes JE (2003) Biological markers that predict clinical recurrence in ductal carcinoma in situ of the breast. Eur J Cancer 39:622–630

    Article  PubMed  CAS  Google Scholar 

  27. Ringberg A, Anagnostaki L, Anderson H, Idvall I, Ferno M (2001) Cell biological factors in ductal carcinoma in situ (DCIS) of the breast-relationship to ipsilateral local recurrence and histopathological characteristics. Eur J Cancer 37:1514–1522

    Article  PubMed  CAS  Google Scholar 

  28. Roka S, Rudas M, Taucher S, Dubsky P, Bachleitner-Hofmann T, Kandioler D, Gnant M, Jakesz R (2004) High nuclear grade and negative estrogen receptor are significant risk factors for recurrence in DCIS. Eur J Surg Oncol 30:243–247. doi:10.1016/j.ejso.2003.11.004

    Article  PubMed  CAS  Google Scholar 

  29. Kojima Y, Tsunoda H, Honda S, Kikuchi M, Kawauchi N, Yoshida A, Yagata H, Yamauchi H, Suzuki K (2011) Radiographic features for triple negative ductal carcinoma in situ of the breast. Breast Cancer 18:213–220. doi:10.1007/s12282-011-0261-x

    Article  PubMed  Google Scholar 

  30. D’Orsi C, Mendelson EB, Ikeda D (2003) Breast imaging reporting and data system: ACR BI-RADS - Breast Imaging Atlas. American College of Radiology, Reston

    Google Scholar 

  31. Mendelson EB, Baum J, Berg W (2003) BI-RADS: Ultrasound, 1st edition. In: D’Orsi CJ, Mendelson EB, Ikeda DM et al (eds) Breast imaging reporting and data system: ACR BI-RADS-Breast Imaging Atlas. American College of Radiology, Reston

    Google Scholar 

  32. Samardar P, de Paredes ES, Grimes MM, Wilson JD (2002) Focal asymmetric densities seen at mammography: US and pathologic correlation. Radiographics 22:19–33

    PubMed  Google Scholar 

  33. Takei J, Tsunoda-Shimizu H, Kikuchi M, Kawasaki T, Yagata H, Tsugawa K, Suzuki K, Nakamura S, Saida Y (2009) Clinical implications of architectural distortion visualized by breast ultrasonography. Breast Cancer 16:132–135. doi:10.1007/s12282-008-0085-5

    Article  PubMed  Google Scholar 

  34. Allegra CJ, Aberle DR, Ganschow P, Hahn SM, Lee CN, Millon-Underwood S, Pike MC, Reed SD, Saftlas AF, Scarvalone SA, Schwartz AM, Slomski C, Yothers G, Zon R (2010) National Institutes of Health State-of-the-Science Conference statement: diagnosis and management of ductal carcinoma in situ. September 22–24, 2009. J Natl Cancer Inst 102:161–169. doi:10.1093/jnci/djp485

    Article  PubMed  Google Scholar 

  35. Chen YY, DeVries S, Anderson J, Lessing J, Swain R, Chin K, Shim V, Esserman LJ, Waldman FM, Hwang ES (2009) Pathologic and biologic response to preoperative endocrine therapy in patients with ER-positive ductal carcinoma in situ. BMC Cancer 9:285. doi:10.1186/1471-2407-9-285

    Article  PubMed  Google Scholar 

  36. Cuzick J, Sestak I, Pinder SE, Ellis IO, Forsyth S, Bundred NJ, Forbes JF, Bishop H, Fentiman IS, George WD (2011) Effect of tamoxifen and radiotherapy in women with locally excised ductal carcinoma in situ: long-term results from the UK/ANZ DCIS trial. Lancet Oncol 12:21–29. doi:10.1016/S1470-2045(10)70266-7

    Article  PubMed  CAS  Google Scholar 

  37. Eng-Wong J, Costantino JP, Swain SM (2010) The impact of systemic therapy following ductal carcinoma in situ. J Natl Cancer Inst Monogr 41:200–203. doi:10.1093/jncimonographs/lgq021

    Article  Google Scholar 

  38. Kuerer HM (2011) Rational individualised selection of adjuvant therapy for ductal carcinoma in situ. Lancet Oncol 12:2–3. doi:10.1016/S1470-2045(10)70277-1

    Article  PubMed  Google Scholar 

  39. Hayward L, Oeppen RS, Grima AV, Royle GT, Rubin CM, Cutress RI (2011) The influence of clinicopathological features on the predictive accuracy of conventional breast imaging in determining the extent of screen-detected high-grade pure ductal carcinoma in situ. Ann R Coll Surg Engl 93:385–390. doi:10.1308/003588411X579829

    Article  PubMed  CAS  Google Scholar 

  40. Hofvind S, Iversen BF, Eriksen L, Styr BM, Kjellevold K, Kurz KD (2011) Mammographic morphology and distribution of calcifications in ductal carcinoma in situ diagnosed in organized screening. Acta Radiol 52:481–487. doi:10.1258/ar.2011.100357

    Article  PubMed  Google Scholar 

  41. Mansson E, Bergkvist L, Christenson G, Persson C, Warnberg F (2009) Mammographic casting-type calcifications is not a prognostic factor in unifocal small invasive breast cancer: a population-based retrospective cohort study. J Surg Oncol 100:670–674. doi:10.1002/jso.21405

    Article  PubMed  Google Scholar 

  42. Burnside ES, Ochsner JE, Fowler KJ, Fine JP, Salkowski LR, Rubin DL, Sisney GA (2007) Use of microcalcification descriptors in BI-RADS 4th edition to stratify risk of malignancy. Radiology 242:388–395. doi:10.1148/radiol.2422052130

    Article  PubMed  Google Scholar 

  43. Holland R, Hendriks JH (1994) Microcalcifications associated with ductal carcinoma in situ: mammographic-pathologic correlation. Semin Diagn Pathol 11:181–192

    PubMed  CAS  Google Scholar 

  44. Poplack SP, Wells WA (1998) Ductal carcinoma in situ of the breast: mammographic-pathologic correlation. AJR Am J Roentgenol 170:1543–1549. doi:10.2214/ajr.170.6.9609171

    Article  PubMed  CAS  Google Scholar 

  45. Albonico G, Querzoli P, Ferretti S, Rinaldi R, Nenci I (1998) Biological profile of in situ breast cancer investigated by immunohistochemical technique. Cancer Detect Prev 22:313–318

    Article  PubMed  CAS  Google Scholar 

  46. Moon WK, Myung JS, Lee YJ, Park IA, Noh DY, Im JG (2002) US of ductal carcinoma in situ. Radiographics 22:269–280

    PubMed  Google Scholar 

  47. Mesurolle B, El-Khoury M, Khetani K, Abdullah N, Joseph L, Kao E (2009) Mammographically non-calcified ductal carcinoma in situ: sonographic features with pathological correlation in 35 patients. Clin Radiol 64:628–636. doi:10.1016/j.crad.2008.12.013

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We thank Stephanie Deming for assistance in editing of this manuscript.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Unit 1473, 1515 Holcombe Blvd., Houston, TX, 77030, USA

    Gaiane M. Rauch, Marion E. Scoggins, Ana P. Benveniste, Young Mi Park, Beatriz E. Adrada & Wei T. Yang

  2. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA

    Henry M. Kuerer & Sara A. Lari

  3. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA

    Patricia S. Fox & Brian P. Hobbs

  4. Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA

    Savitri Krishnamurthy

  5. Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea

    Young Mi Park

Authors
  1. Gaiane M. Rauch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Henry M. Kuerer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marion E. Scoggins
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Patricia S. Fox
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ana P. Benveniste
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Young Mi Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sara A. Lari
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Brian P. Hobbs
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Beatriz E. Adrada
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Savitri Krishnamurthy
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Wei T. Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gaiane M. Rauch.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rauch, G.M., Kuerer, H.M., Scoggins, M.E. et al. Clinicopathologic, mammographic, and sonographic features in 1,187 patients with pure ductal carcinoma in situ of the breast by estrogen receptor status. Breast Cancer Res Treat 139, 639–647 (2013). https://doi.org/10.1007/s10549-013-2598-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-013-2598-7

Keywords

Search

Navigation