COMPARISON OF CYTOMORPHOLOGICAL AND ARCHITECTURAL HETEROGENEITY IN MAMMOGRAPHICALLY-DETECTED DUCTAL CARCINOMA IN-SITU

Many classification schemes have been proposed for ductal carcinoma in situ. Architectural heterogeneity is widely recognized. Cytonuclear g rade appears to have greater prognostic significance than architectura l pattern. This study assesses heterogeneity using a classification ba sed on cytological grade and compares this to architectural heterogene ity in mammographically detected ductal carcinoma in situ. One hundred and twelve cases were classified according to architectural subtypes and the carcinoma nuclei were graded. Necrosis and microcalcification were assessed. Eighty-four percent of ductal carcinomas in situ had a single nuclear grade, whereas only 39% showed a single architectural p attern. High grade nuclei were present in 87% of cases. Necrosis was a ssociated with high nuclear grade. In contrast to architectural hetero geneity, this study shows little ductal carcinoma in situ heterogeneit y when classification is based on nuclear grade. Thus, a cytomorpholog ical classification should have the advantage of consistency and repro ducibility in comparison to architecture-based classification systems.