Ductal Carcinoma
In Situ
387
FIG. 11.70.
DCIS with microinvasive carcinoma and ax-
illary nodal metastasis.
A:
DCIS with microinvasion
.
B:
A minute subcapsular metastatic deposit (<0.2 cm) was
present in one of two sentinel nodes excised in this case.
C:
The cytokeratin AE1/3 immunostain identified one “iso-
lated tumor cell” in the other SLN.
A
B
C
FIG. 11.71.
DCIS, displaced epithelium.
Fragment of car-
cinoma in a fibrin clot (
arrow
) next to DCIS. The site of
duct disruption is evident on the
right
. The patient had an
FNA biopsy before the surgical excision that yielded this
specimen.
deposits, is indicative of traumatic displacement. The pres-
ence of carcinoma cells in vascular or lymphatic channels
after a needle biopsy of DCIS can be associated with carci-
noma cells in ALNs even when intrinsic invasion has not
been detected (Fig. 11.72).
If DCIS is found in a needle core biopsy sample, it will
require histologic examination of the excised lesional site
to rule out coexisting invasive carcinoma. There have been
several studies that have identified features of DCIS in core
biopsy specimens that were predictive of detecting invasive
carcinoma in the subsequent lumpectomy.
254,255
Renshaw
251
reported that invasive carcinoma in the excisional biopsy
specimen was significantly associated with cribriform/pap-
illary architecture and necrosis in the DCIS and more than
4 mm of lobular extension. Huo et al.
297
also found lobu-
lar extension to be predictive of invasion. Other features of
DCIS in a needle core biopsy sample that have been cited as
predictive of invasion include the presence of a mass lesion
on the imaging study,
254,297–298
high nuclear grade,
299–301
ex-
tensive calcifications,
299,300
and a palpable lesion.
300
The histologic diagnosis of microinvasion is confounded
in some instances by the capacity of invasive carcinoma to
