Ductal Carcinoma
In Situ
365
FIG. 11.44.
DCIS in a radial sclerosing lesion.
A:
DCIS of cribriform type (
arrows
) and ductal hyper-
plasia in a radial sclerosing lesion.
B:
Magnified view of DCIS shown in
(A)
.
A
B
FIG. 11.45.
DCIS, radial configuration.
A:
Stellate lesion with a scleroelastotic center.
B:
Cribriform
DCIS shown here is present throughout the tumor.
high- and low-grade components may coexist in a patient or
even in one duct (Figs. 11.10 and 11.53).
Some high-grade DCIS exhibit the basal-like immu-
nophenotype (no reactivity for ER and progesterone re-
ceptors [PRs] and for HER2). This form of DCIS is the
putative precursor to invasive basal-like ductal carcinoma.
Bryan et al.
152
found the basal-like immunophenotype in
4 (6%) of 66 DCIS with high nuclear grade. These DCIS
expressed basal cytokeratins and/or epidermal growth
factor receptor (EGFR) significantly more often than
did high-grade DCIS, which did not have the basal-like
immunophenotype.
Silverstein et al.
153
proposed a classification of DCIS
based on nuclear grade (high or nonhigh) and the presence
or absence of necrosis as part of a prognostic index. Three
prognostic categories resulting from consideration of these
variables were as follows: Group 1, nonhigh nuclear grade
without necrosis; Group 2, nonhigh nuclear grade with
necrosis; and Group 3, high nuclear grade with or without
necrosis. The Van Nuys Prognostic Index (VNPI, discussed
in greater detail below) includes margin status and tumor
size as well as these histologic groups.
154
Follow-up revealed
a significant correlation between the VNPI and the risk of
recurrence in the breast after conservation therapy. VNPI
should be used only if margin status and tumor size can be
reliably assessed.
Grading has been a component of other classification
schemes for assessing the effectiveness of breast conserva-
tion therapy in the treatment of DCIS. Including those cited
previously, at least six classifications have been proposed.
155
These have been based on some or all of the following fea-
tures: architecture, nuclear grade, presence or absence of
