376
Chapter 11
Ploidy and Proliferative Rate
When studied by flow cytometry, the frequency of aneuploidy
in DCIS ranges from 21% to 71%.
215–220
The clinical relevance,
and need, for this information has diminished over the years.
Aneuploidy has been found in 55% tomore than 90% of come-
docarcinomas
215,216,218,219
and in 65%of DCIS with high nuclear
grade.
217
Image analysis of Feulgen-stained tissue sections re-
vealed aneuploidy in 77.5% of DCIS, predominantly in lesions
with high (100%) and intermediate (80%) nuclear grade.
207
Thymidine labeling and flow cytometry studies demon-
strated a significantly higher proliferative rate in comedo-
carcinoma than in cribriform–micropapillary DCIS.
189,221
All papillary DCIS examined in one series were diploid.
219
Cribriform DCIS tend to be diploid with a low S-phase frac-
tion (SPF).
218,220
Sataloff et al.
220
reported that micropapillary
DCIS was typically diploid with a low SPF.
Numerical alterations in individual chromosomes have
been studied by fluorescence
in situ
hybridization (FISH) us-
ing specific probes. Using this method in paraffin sections of
archival tissue samples, Visscher et al.
222
detected chromo-
somal aneuploidy in 7 to 10 specimens of DCIS. Aneuploidy
was more frequent in specimens from patients with concur-
rent invasive carcinoma. Patterns of aneuploidy consisted of
gains only, losses only, or gains and losses involving different
chromosomes. Aneuploidy was most frequent for chromo-
somes 16 and 17. HER2-positive and triple-negative types of
DCIS, to a greater degree than the “luminal” types of DCIS,
show DNA aneuploidy, as assessed by image analysis.
223
The proliferative activity in DCIS is now usually analyzed
by IHC (Fig. 11.59). Albonico et al.
195
reported the highest
PI in lesions of the comedo type. Other types of DCIS had
much lower PIs: solid 14.4%, papillary 13.4%, cribriform
4.5%, and micropapillary 0%. DCIS can be graded using
FIG. 11.59.
DCIS, Ki67 proliferation marker.
A:
Nuclear immunoreactivity for Ki67 is present in very
few neoplastic cells in the basal region of cribriform DCIS with low-grade nuclei.
B:
Ki67 reactiv-
ity observed in less than 10% of cells in this micropapillary DCIS with intermediate-grade nuclei.
Nuclear reactivity is mostly localized to the basal region in this example also.
C:
Approximately
10% of the neoplastic cells are Ki67 reactive in this solid DCIS.
D:
Approximately one-third of the
neoplastic cells are reactive for Ki67 in this solid high-grade DCIS with necrosis (
left
).
A
C
D
B
