Ductal Carcinoma
In Situ
379
FIG. 11.62.
DCIS, needle core biopsy with scar.
Concen-
tric layers of collagen probably represent the scar formed
at the site of “healed” DCIS. A dilated duct with a thin layer
of DCIS is shown on the
left
.
FIG. 11.63.
DCIS, apocrine type in sclerosing adenosis,
needle core biopsy.
A:
Apocrine DCIS occupying SA re-
sembles invasive carcinoma.
B:
A section parallel to
(A)
prepared with the immunostain for SMA demonstrating
myoepithelial cells around all glandular structures.
reported that patients with a preoperative diagnosis of DCIS
rendered on needle core biopsy had a reoperative rate of
36% compared with 65% for those patients who did not
(
p
=
0.0007). Furthermore, it has been suggested that find-
ings in needle core biopsies can help in the achievement of
negative margins in lumpectomies through the assessment
of relative proportion of DCIS in cases of invasive ductal
carcinoma. A high proportion of DCIS in the core biopsy
specimen have been shown to identify patients at risk of
compromised margins in the subsequently performed
lumpectomy.
255
Cytologic Diagnosis
Fine-needle aspiration (FNA) specimens from DCIS tend
to be less cellular than aspirates from invasive carcinomas,
and they are more likely to yield insufficient material for
diagnosis.
256
These circumstances are especially prone to
occur when FNA is performed on a nonpalpable abnor-
mality detected by mammography. Failure to obtain diag-
nostic material by FNA in this setting is an indication for
excisional biopsy. FNA cytologic evaluation is not recom-
mended for assessment of mammographically detected
microcalcifications.
257
When the FNA specimen is diagnostic of carcinoma,
the distinction between intraductal and infiltrating ductal
carcinoma cannot be made with confidence.
256,258
Corre-
lation with the mammogram is useful, but limitations of
sampling make it impossible to exclude the presence of in-
vasive carcinoma in a region outside the site of the FNA
procedure or to exclude microinvasion in the region of
the FNA. Findings more likely to be associated with in-
traductal than with invasive carcinoma are admixed cy-
tologically benign epithelial cells and histiocytes. Invasive
carcinoma is more likely to be present if carcinoma cells
singly or in groups are intimately mingled with adipose tis-
sue, fibrous stroma, or fat cells.
FIG. 11.61.
DCIS, needle core biopsy with displaced epi-
thelium.
A fragment of papillary carcinoma is lodged in
fat. This is not invasive carcinoma.
