Ductal Carcinoma
In Situ
371
assessment of ER and PR status in all DCIS cases
176
; how-
ever, since DCIS is often a lesion of microscopic dimension,
little information was available about hormone receptor ex-
pression until immunohistochemical methods became avail-
able. Biochemical analysis employing homogenized tissue
samples contained a substantial proportion of nonneoplastic
tissue, and as a consequence, the majority of specimens of
DCIS were reportedly receptor negative. In one study, the
median level of ER in DCIS was 5 fmol/mg cytosol protein,
significantly less than the median of 11 fmol/mg for infiltrat-
ing duct carcinoma.
177
Barnes and Masood
178
described an immunohistochemi-
cal study of ER in DCIS in 1990. Nuclear reactivity, usually
heterogeneously distributed when present, was found in
75% of pure DCIS, in 73% of DCIS associated with invasive
duct carcinoma, and in 100% of 36 examples of atypical duct
hyperplasia. Nuclear ER reactivity was less frequent in com-
edo DCIS than in other variants (Fig. 11.55). The same pat-
tern of ER expression was usually found in the intraductal
and in the infiltrating portions of carcinomas with both
components. ER positivity was more frequent in tumors
Biomarkers in DCIS
A variety of biologic markers have been studied in DCIS.
Lari and Kuerer
175
performed a comprehensive review of 622
major studies that had reported on 25 traditional and emerg-
ing biologic markers of DCIS and their associated recurrence
risk. These studies appeared over a 10-year period beginning
late 2000 and included 6,252 patients. The study included
hormone receptors, proliferation markers, cell cycle regula-
tion markers, among others. No prospective validation study
was identified, and the various studies included in the review
suffered from the usual limitations of variations in surgery,
radiation, and endocrine therapy. Nonetheless, the review
provides considerable information. For the three most com-
mon biomarkers, the mean expression rates in DCIS were
68.7 for ER, 59.6% for PR, and 40.1% for HER2.
Estrogen Receptor and Progesterone Receptor
American Society of Clinical Oncology (ASCO) and College
of American Pathology (CAP) currently endorse the routine
Ta b l e 1 1 . 1
Consensus Committee Recommendation for Nuclear Grading of DCIS
Low Nuclear Grade (NG1)
• Monomorphic (monotonous) appearance
• Size of duct epithelial nuclei or 1.5–2.0 normal red blood cell
• Chromatin diffuse, finely dispersed
• “Occasional nucleoli and mitoses”
• Cells usually polarized
High Nuclear Grade (NG3)
• “Markedly pleomorphic”
• Size usually more than 2.5 duct epithelial nuclei
• Chromatin vesicular with irregular distribution
• “Prominent, often multiple nucleoli”
• “Mitoses may be conspicuous”
Intermediate Nuclear Grade (NG2)
• “Nuclei that are neither NG1 nor NG3”
Based on The Consensus Conference Committee. Consensus Conference on the classification of ductal carcinoma in situ.
Cancer
1997;80:1798–1802.
Based on The Consensus Conference Committee. Consensus Conference on the classification of ductal carcinoma in situ.
Cancer
1997;80:1798–1802.
Comedonecrosis
“Central zone necrosis within a duct, usually exhibiting a linear pattern within ducts if sectioned longitudinally”
Punctate
“Nonzonal type necrosis (foci of necrosis that do not exhibit a linear pattern if longitudinally sectioned)”
Ta b l e 1 1 . 2
Consensus Committee Recommendation for Reporting Necrosis in DCIS
