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Breast carcinoma in situ (CIS) (Diagnosis Screening (Examination Breast…
Breast carcinoma
in situ (CIS)
Pathophysiology
Ductal (DCIS)
Malignancy of ductal tissue
Contained within basement membrane (not invasive)
20-30% will become invasive
Lobular (LCIS)
Malignancy of the secretory lobules
Contained within basement membrane (not invasive)
High risk of developing invasive disease
Clinical
presentation
Asymptomatic
Diagnosis
Screening
Examination
Breast: often nil
Investigations
USS: LCIS may be seen
Mammography: microcalcification (DCIS),
LCIS often not seen
Biopsy: histology shows DICS/LCIS
History
PC/HPC: often asymptomatic
PMH: smoking, menses, menopause, parity
DH: OCP/HRT
FH: breast/ovarian ca
SH: smoking, alcohol. diet
Differentials
Neoplastic
Benign: lipoma, fibroadenoma, duct ectasia
Malignant: DCIS/LCIS, breast carcinoma
Infection
Mastitis
Breast abscess
Screening
Breast Screening Programme
Management
Surgical
Complete WLE
indication: DCIS
MOA: excision of cancer and wide boundary,
ensuring negative margins
Complete ipsilateral masectomy
Indication: widespread/multifocal DCIS
MOA: complete removal of breast
Bilateral prophylactic masectomy
Indication: BRCA1/2
Conservative
Monitoring
Indication: low grade LCIS
Definition
Malignancy of the breast contained
within the basement membrane
Epidemiology
DCIS commonest type,
20% of all breast cancers
LCIS commonest in pre-menopausal women
