Breast Cancer

, Volume 18, Issue 3, pp 213–220 | Cite as

Radiographic features for triple negative ductal carcinoma in situ of the breast

  • Yasuyuki KojimaEmail author
  • Hiroko Tsunoda
  • Satoshi Honda
  • Mari Kikuchi
  • Nobue Kawauchi
  • Atsushi Yoshida
  • Hiroshi Yagata
  • Hideko Yamauchi
  • Koyu Suzuki
Original Article



Triple negative (TN) breast cancer is characterized as having a high malignancy potential and a poor prognosis. An understanding of the radiological features of TN DCIS will enable the early detection of intractable TN invasive breast cancer.


Our cohort of 494 DCIS patients, including 18 TN DCIS cases (3.6%), was diagnosed and treated between January 2006 and November 2009. We reviewed the TN DCIS cases in order to assess mammogram (MMG), ultrasound (US), magnetic resonance imaging (MRI), and pathology findings. Routine diagnostic MMG, US, and MRI were performed before surgery in our institution.


The average age of TN DCIS patients was 54.2 years (40–73). MMG findings were as follows: no abnormal findings (n = 4), masses (n = 3), focal asymmetric density (n = 2), architectural distortion (n = 5), and calcifications (n = 4). US findings included low echoic masses (n = 17) and architectural distortion (n = 4). MRI findings (two patients did not undergo this examination) included mass (n = 6) and non-mass-like enhancements (n = 10). The average lesion measured 3.3 cm in diameter (0.5–8.5 cm). The histological findings were non-comedo type (n = 9) and mixed type including some comedo components (n = 9).

Notably, our study revealed that only 22% of TN DCIS cases were detected via mammographic abnormal calcifications. This percentage was less than in non-TN DCIS cases. TN DCIS cases were detected mainly because of masses or asymmetry. US and MRI findings of TN DCIS revealed the same features considered to be common DCIS findings.


We diagnosed TN DCIS in 3.6% of our cohort including 494 DCIS patients. Incidences of TN DCIS with mammographic abnormal calcifications were fewer than those of non-TN DCIS cases.


Triple negative DCIS Radiology findings Mammography Ultrasound 


  1. 1.
    Page DL, Dupont WD, Rogers LW, Jensen RA, Schuyler PA. Continued local recurrence of carcinoma 15–25 years after a diagnosis of low grade ductal carcinoma in situ of the breast treated only by biopsy. Cancer. 1995;76:1197–200.PubMedCrossRefGoogle Scholar
  2. 2.
    Page DL, Dupont WD, Rogers LW, Landenberger M. Intraductal carcinoma of the breast: follow up after biopsy alone. Cancer. 1982;49:751–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Betsill WLJ, Rosen PP, Lieberman PH, Robbins GF. Intraductal carcinoma. Long-term follow-up after treatment by biopsy alone. JAMA. 1978;239:1863–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Pinder SE, Ellis IO. The diagnosis and management of pre-invasive breast disease: ductal carcinoma in situ (DCIS) and atypical ductal hyperplasia (ADH)—current definitions and classification. Breast Cancer Res. 2003;5:254–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Simpson JF. Update on atypical epithelial hyperplasia and ductal carcinoma in situ. Pathology. 2009;41:36–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Bradley BB, Stuart JS, Laura CC. Ductal carcinoma in situ with basal-like phenotype: a possible precursor to invasive basal-like breast cancer. Mod Pathol. 2006;19:617–21.CrossRefGoogle Scholar
  7. 7.
    Livasy CA, Perou CM, Karaca G, Cowan DW, Maia D, Jackson S, et al. Identification of a basal-like subtype of breast ductal carcinoma in situ. Hum Pathol. 2007;38:197–204.PubMedCrossRefGoogle Scholar
  8. 8.
    Flora Z, Theodoros NS, George CZ. Precursors and preinvasive lesions of the breast: the role of molecular prognostic markers in the diagnostic and therapeutic dilemma. World J Surg Oncol. 2007;5:57–68.CrossRefGoogle Scholar
  9. 9.
    Japan Radiological Society, Japanese Society of Radiological Technology. The Committee of Mammography guidelineMammography guidelines. 2nd ed. Tokyo: Igaku Syoin; 2004 (in Japanese).Google Scholar
  10. 10.
    Itoh A, Ueno E, Tohno E, Kamma H, Takashi H, Shiina T, et al. Breast disease: clinical application of US elastography for diagnosis. Radiology. 2006;239:341–50.PubMedCrossRefGoogle Scholar
  11. 11.
    Ernster VL, Barclay J, Kerlikowske K, Wilkie H, Ballard-Barbash R. Mortality among women with ductal carcinoma in situ of the breast in the population-based surveillance, epidemiology and end results program. Arch Intern Med. 2000;160:953–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Frykberg ER. An overview of the history and epidemiology of ductal carcinoma in situ of the breast. Breast J. 1997;3:227–31.CrossRefGoogle Scholar
  13. 13.
    Schnitt SJ, Silen W, Sadowsky NL, Connolly JL. Ductal carcinoma in situ (intraductal carcinoma) of the breast. N Engl J Med. 1988;318:898–903.PubMedCrossRefGoogle Scholar
  14. 14.
    Dershaw DD. Ductal carcinoma in situ: mammographic finings and clinical implications. Radiology. 1989;170:411–5.PubMedGoogle Scholar
  15. 15.
    Stomper PC. Clinically occult ductal carcinoma in situ detected with mammography: analysis of 100 cases with radiologic-pathologic correlation. Radiology. 1989;172:235–41.PubMedGoogle Scholar
  16. 16.
    Ikeda DM, Anderson I. Ductal carcinoma in situ: atypical mammographic appearances. Radiology. 1989;172:661–6.PubMedGoogle Scholar
  17. 17.
    Kopans DB. Breast imaging, 2nd ed. Philadelphia: Lippincott-Raven; 1998.Google Scholar
  18. 18.
    Ketcham AS, Moffat FL. Vexed surgeons, perplexed patients, and breast cancers which may not be cancer. Cancer. 1990;65:387–93.PubMedCrossRefGoogle Scholar
  19. 19.
    Wiechmann L, Kuerer HM. The molecular journey from ductal carcinoma in situ to invasive breast cancer. Cancer. 2008;112:2130–42.PubMedCrossRefGoogle Scholar
  20. 20.
    Wendie AB. Tailored supplemental screening for breast cancer: what now and what next? Am J Roentgenol. 2009;192:390–9.CrossRefGoogle Scholar
  21. 21.
    Schrading S, Kuhl CK. Mammographic, US and MR imaging phenotypes of familial breast cancer. Radiology. 2008;246:58–70.PubMedGoogle Scholar
  22. 22.
    Noguchi S, Kasugai T, Miki Y, Fukutomi T, Emi M, Nomizu T. Clinicopathologic analysis of BRCA1- or BRCA2-associated hereditary breast carcinoma in Japanese women. Cancer. 1999;85:2200–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Johannsson OT, Idvall I, Anderson C, Borg A, Barkardottir RB, Egilsson V, et al. Tumor biological features of BRCA1-induced breast and ovarian cancer. Eur J Cancer. 1997;33:362–71.PubMedCrossRefGoogle Scholar
  24. 24.
    Crook T, Crossland S, Crompton MR, Osin P, Gusterson BA. P53 mutations in BRCA1-associated familial breast cancer. Lancet. 1997;350:638–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Lakhani SR, Jacquemier J, Sloane JP, Gusterson BA, Anderson TJ, van de Vijver MJ, et al. Multifactorial analysis of differences between sporadic breast cancers and cancers involving BRCA1 and BRCA2 mutations. J Natl Cancer Inst. 1998;90:1138–45.PubMedCrossRefGoogle Scholar
  26. 26.
    Jacquemier J, Eisinger F, Guinebretiere JM, Stoppa-Lyonnet D, Sobol H. Intraductal component and BRCA1-associated breast cancer. Lancet. 1996;348:1098.CrossRefGoogle Scholar
  27. 27.
    Sun CC, Lenoir G, Lynch H, Narod SA. In situ breast cancer and BRCA1. Lancet. 1996;348:408.PubMedCrossRefGoogle Scholar
  28. 28.
    Claus EB, Petruzella S, Matloff E, Carter D. Prevalence of BRCA1 and BRCA2 mutations in women diagnosed with ductal carcinoma in situ. JAMA. 2005;293:964–9.PubMedCrossRefGoogle Scholar

Copyright information

© The Japanese Breast Cancer Society 2011

Authors and Affiliations

  • Yasuyuki Kojima
    • 1
    Email author
  • Hiroko Tsunoda
    • 2
  • Satoshi Honda
    • 2
  • Mari Kikuchi
    • 2
  • Nobue Kawauchi
    • 2
  • Atsushi Yoshida
    • 1
  • Hiroshi Yagata
    • 1
  • Hideko Yamauchi
    • 1
  • Koyu Suzuki
    • 3
  1. 1.Department of Breast SurgerySt. Luke’s International HospitalTokyoJapan
  2. 2.Department of RadiologySt. Luke’s International HospitalTokyoJapan
  3. 3.Department of PathologySt. Luke’s International HospitalTokyoJapan

Personalised recommendations