DCIS


More than 90% of the cases entered into the Sloane Project are of DCIS. This page gives relevant extracts from the Sloane Pathology Form, examples of the main patterns seen in your practice and also some side-by-side images to act as an aide memoire for grading. There will always be an element of subjectivity at the grade 'boundaries' but it is hoped that we can help reduce the inter-observer variability by providing guidance notes and high quality images to illustrate the points.


Growth Pattern

Grading

Paget's Disease of the Nipple

Microinvasion

Assessing receptor status in DCIS



The Sloane Project Steering Group has also arranged for a number of good examples of DCIS cases to be rendered as whole slide scans so that you can explore the range of features present. These are avilable on..... Link to Digital Slide Box - via Sloane Project website.



Growth Pattern


Page 2 part 3 of the Pathology Form

Solid DCIS (example 1)
Solid DCIS Solid DCIS


Cribriform DCIS (example 1)
Cribriform DCIS Cribriform DCIS


Cribriform DCIS (example 2)
Cribriform DCIS - example 2 Cribriform DCIS - example 2

Cribriform DCIS (example 2)
Cribriform DCIS - example 2

Micropapillary DCIS (example 1)
Micropapillary DCIS Micropapillary DCIS


Papillary DCIS (intracystic papillary carcinoma) (example 1 - macro)
Intracystic papillary DCIS - macro

Papillary DCIS (intracystic papillary carcinoma) (example 1)
Intracystic papillary DCIS Intracystic pillary DCIS


Apocrine DCIS (example 1)
Apocrine DCIS Apocrine DCIS


Apocrine DCIS (example 2)
Apocrine DCIS Apocrine DCIS
Apocrine DCIS

Clinging DCIS (example 1)
Apocrine DCIS Apocrine DCIS

Clinging/Flat DCIS (example 2)
Clinging/Flat DCIS Clinging/Flat DCIS

Grading


Page 2 part 2a of the Pathology Form


College of American Pathologists Guidelines for grading DCIS:



In the following series of six combination photos all the images have been photographed using a x40 objective on the same microscope. Every effort has been made to ensure that during the assembly of the images the magnifications remain comparable and unaltered.


Grading DCIS - Combination photo showing three separate examples of low grade DCIS
Low grade DCIS - three examples


Grading DCIS - Combination photo showing three separate examples of intermediate grade DCIS
Intermediate grade DCIS - three examples


Grading DCIS - Combination photo showing three separate examples of high grade DCIS
High grade DCIS - three examples

Grading DCIS - Low grade left hand panel, high grade right hand panel
Grading DCIS (1)


Grading DCIS (Micropapillary DCIS) - Low grade left hand panel, high grade right hand panel
Grading (micropapillary) DCIS


Grading DCIS - Low grade left hand panel, high grade right hand panel
Grading DCIS

Paget's Disease


Page 2 part 3bi of the Pathology Form

Paget's disease of the nipple
Paget's disease of the nipple


Microinvasion


Page 2 part 3bii of the Pathology Form



High grade comedo DCIS and microinvasion - 'Mouse over' for high power view
DCIS with adjacent foci of microinvasion


High grade DCIS and microinvasion (example 2)
DCIS with adjacent foci of microinvasion


High grade DCIS and microinvasion (example 2) CK 5/6 immunostain
Note the foci of microinvasive carcinoma (labels A & B) and the apparent breach of the basal layer with protruding carcinoma into specialised stroma (arrow)
DCIS with adjacent foci of microinvasion

Assessing receptor status in DCIS



Section of Sloane pathology form dealing with receptor status


Comparison between negative (<5% of cells staining) and strongly positive staining for ER in two cases of DCIS
Comedo DCIS - negative staining for ER Comedo DCIS - strong positive staining for ER

References:


1. Vogel VG, Constantino JP, Wickeham DL & Cronin WM. National surgical adjuvant breast and bowel project update: prevention trials and endocrine therapy of ductal carcinoma in situ. Clinical Cancer Research, 2003, Vol 9: 495S-501S


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