DUCTAL CARCINOMA IN-SITU OF THE BREAST - CORRELATION BETWEEN MAMMOGRAPHIC AND PATHOLOGICAL FINDINGS

OBJECTIVE. Ductal carcinoma in situ shows heterogeneous clinical behav ior and response to treatment depending on its pathologic features. Th e aim of this study was to correlate the radiologic and pathologic fea tures of ductal carcinoma in situ of the breast. Differences, if prese nt, may allow refinement of diagnosis and selection of treatment optio ns. MATERIALS AND METHODS. The mammograms of 128 patients with ductal carcinoma in situ of the breast were analyzed by a radiologist who kne w that the patients had ductal carcinoma in situ but had no other path ologic information. The radiologic and pathologic features of subgroup s characterized according to cell size and presence of necrosis were t hen compared. Statistical comparisons were made by using the chi(2)- a nd Fisher's exact tests. RESULTS. Patients with small-cell ductal carc inoma in situ more commonly have a normal mammogram (28% vs 6%, respec tively, p < .001) or an abnormal mammogram without calcification (42% vs 5%, respectively, p < .001) than do patients with large-cell ductal carcinoma in situ. Among patients with abnormal mammographic findings , calcification is present in 58% of those with small-cell ductal carc inoma in situ, compared with 95% of those with large-cell ductal carci noma in situ (p < .001). No significant differences were found in the calcification morphology of small- and large-cell ductal carcinoma in situ. These features were seen more commonly in ductal carcinoma in si tu with necrosis than in ductal carcinoma in situ without necrosis, re spectively: abnormal mammographic findings (95% vs 73%, p < .001), cal cification (96% vs 61%, p < .001), calcification with a ductal distrib ution (80% vs 45%, p < .005), and rod-shaped calcification (83% vs 45% , p < .001). An abnormal mammogram without calcification (39% vs 4%, p < .001) or predominantly punctate calcification (36% vs 13%, p < .05) was seen more commonly in ductal carcinoma in situ without necrosis t han in ductal carcinoma in situ with necrosis, respectively. CONCLUSIO N. We have shown that the radiologic features of ductal carcinoma in s itu vary according to cell size and the presence of necrosis in partic ular. Necrosis has been found to be a feature of more biologically agg ressive in situ breast cancer, so these findings may be of practical v alue in deciding the management of indeterminate calcification cluster s and whether to offer breast conservation.