Ductal Breast Cancer in Situ (DCIS)

Diagnosis

Written by :

Ductal Breast Cancer in Situ (DCIS) is an early form of breast cancer and accounts for about 12% of all breast cancers. It produces no symptoms. Although DCIS is non-invasive, it can develop into Invasive Ductal Cancer over time.

DCIS can be diagnosed by different methods - most often, it is diagnosed during a routine mammogram.

Other tests for diagnosis include ultrasounds and MRIs. A biopsy of the breast lump usually confirms the diagnosis.

Diagnostic Tests for DCIS:

  • Screening Mammography: Mammography is the most effective test in identifying DCIS. Mammograms can pick up microscopic breast changes that might be associated with DCIS although there may be no palpable lump, nipple discharge or any other symptom of breast cancer. Deposits of calcium called microcalcifications may be seen in the breast during a mammography which may raise suspicions of DCIS.

    All microcalcifications however, are not due to DCIS. Many women develop microcalcifications as they grow older and especially after menopause. So, it is recommended that all women above 40 years get a regular, yearly mammogram.

  • Diagnostic Mammography: If microcalcifications are seen on the screening mammogram, a more detailed study of the breast, called a diagnostic mammogram, which takes views at higher magnification and from more angles may be needed.

  • Ultrasound of the Breast: Ultrasound imaging, also known as ultrasonography or sonogram, produces a picture of the internal structures of the breast and can help identify a breast mass and its characteristics. A special type of ultrasound, known as Doppler ultrasound can evaluate blood flow or lack of flow in any breast mass. A malignant mass will have more blood flow than normal tissue.

  • MRI: If the mammogram and the ultrasound is not conclusive, then it may be necessary to get a breast MRI (magnetic resonance imaging) to assess the extent of the disease. An MRI can distinguish between normal and diseased tissue.

    DCIS with Microcalcifications-Mammography

    DCIS with Microcalcifications-Mammography

  • Breast Biopsy: If the areas identified by mammography and ultrasound need more evaluation, the next step is a breast biopsy. There are diffferent types of breast biopsies.

    • Fine Needle Aspiration Biopsy: This procedure uses a very thin needle and syringe to remove either fluid from a cyst or clusters of cells from a solid mass. Removal of tissue from a small mass with a fine needle requires a great deal of expertise.

    • Core Needle Biopsy: This procedure uses a somewhat larger needle with a sharp cutting edge. A core of tissue is cut from inside the mass. If the breast mass is quite large, as many as 15 samples, each about the size of a grain of rice, may be taken and sent to a lab for microscopic analysis.

    • Stereotactic Biopsy: This is a procedure in which tissue is removed from lumps which can be seen on a mammogram but cannot be felt on physical examination. It is done under the guidance of a mammogram or ultrasound. It helps in accurate localizing of the suspicious area.

    • Surgical Biopsy: In surgical biopsy, the suspicious area is first identified by mammogram. A needle is then inserted and fixed in the mass. Using this needle as a guide, the lump can be more accurately identified on the operating table and biopsied. If the lump is small, it may be completely removed - it is then called an excision biopsy.

  • Laboratory Tests: After the diagnosis of DCIS is confirmed, it may be necessary to do certain laboratory tests to determine if it is related to hormone receptors in the tissue. The two most common lab tests are the hormone receptor test and the HER2/neu test. Results from these tests can be helpful in determining of the patient needs specific hormone treatment after surgery or radiotherapy.

    Read More :

  • Symptoms and Grades of DCIS

  • Treatment of DCIS