Rosen's Breast Pathology, 4e

387

Ductal Carcinoma In Situ

A

B

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.

C

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

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.