Podcast
Questions and Answers
What classification system is proposed for understanding DCIS's relationship with lobular in situ neoplasia?
What classification system is proposed for understanding DCIS's relationship with lobular in situ neoplasia?
- Clinical symptoms classification system
- Genetic-based classification system (correct)
- Morphological classification system
- Histological classification system
Which of the following groupings represent the classification of DCIS by Silverstein and colleagues?
Which of the following groupings represent the classification of DCIS by Silverstein and colleagues?
- Non-high-grade with necrosis, high-grade, and low-grade
- All grades with and without necrosis
- High-grade, low-grade, and moderate
- High-grade, non-high-grade with necrosis, and non-high-grade without necrosis (correct)
What does the article suggest about the traditional separation of LCIS from DCIS?
What does the article suggest about the traditional separation of LCIS from DCIS?
- It is necessary for proper diagnosis.
- It is confirmed by all recent studies.
- It is well-founded and widely accepted.
- It may not be appropriate. (correct)
What aspect of DCIS classification is disputed based on recent research?
What aspect of DCIS classification is disputed based on recent research?
Which characteristic is associated with certain morphological subtypes of DCIS according to new research?
Which characteristic is associated with certain morphological subtypes of DCIS according to new research?
Which concept is highlighted as flawed regarding the nature of DCIS?
Which concept is highlighted as flawed regarding the nature of DCIS?
What does the existing system for the classification of intraductal epithelial proliferations range from?
What does the existing system for the classification of intraductal epithelial proliferations range from?
What is the primary distinction between usual epithelial hyperplasia and atypical ductal hyperplasia (ADH)?
What is the primary distinction between usual epithelial hyperplasia and atypical ductal hyperplasia (ADH)?
What is noted about current systems for typing DCIS in terms of clinical relevance?
What is noted about current systems for typing DCIS in terms of clinical relevance?
Which characteristic is correct about ductal carcinoma in situ (DCIS) and atypical ductal hyperplasia (ADH)?
Which characteristic is correct about ductal carcinoma in situ (DCIS) and atypical ductal hyperplasia (ADH)?
What is the established clinical distinction between atypical ductal hyperplasia (ADH) and low-grade ductal carcinoma in situ (DCIS)?
What is the established clinical distinction between atypical ductal hyperplasia (ADH) and low-grade ductal carcinoma in situ (DCIS)?
What is a major limitation of the current three-tier classification system in breast diseases?
What is a major limitation of the current three-tier classification system in breast diseases?
What percentage of symptomatic benign biopsies typically show atypical ductal hyperplasia (ADH)?
What percentage of symptomatic benign biopsies typically show atypical ductal hyperplasia (ADH)?
Which factor corresponds to the highest risk of invasive breast carcinoma associated with atypical ductal hyperplasia (ADH)?
Which factor corresponds to the highest risk of invasive breast carcinoma associated with atypical ductal hyperplasia (ADH)?
Why is clonality important in distinguishing between hyperplasia and neoplasia in breast conditions?
Why is clonality important in distinguishing between hyperplasia and neoplasia in breast conditions?
What kind of features differentiate atypical ductal hyperplasia from ductal carcinoma in situ?
What kind of features differentiate atypical ductal hyperplasia from ductal carcinoma in situ?
How is atypical ductal hyperplasia (ADH) diagnosed?
How is atypical ductal hyperplasia (ADH) diagnosed?
What role do cytokeratin and hormone receptor expression play in diagnosing breast lesions?
What role do cytokeratin and hormone receptor expression play in diagnosing breast lesions?
What has been indicated as a more appropriate boundary for distinguishing conditions related to ADH?
What has been indicated as a more appropriate boundary for distinguishing conditions related to ADH?
What is the risk of invasive breast carcinoma for women with atypical ductal hyperplasia (ADH)?
What is the risk of invasive breast carcinoma for women with atypical ductal hyperplasia (ADH)?
What significant finding has been revealed concerning low-grade DCIS and ADH in terms of genetic changes?
What significant finding has been revealed concerning low-grade DCIS and ADH in terms of genetic changes?
In which situation is atypical ductal hyperplasia (ADH) most commonly found?
In which situation is atypical ductal hyperplasia (ADH) most commonly found?
Which of the following statements about the current classification of breast diseases is NOT accurate?
Which of the following statements about the current classification of breast diseases is NOT accurate?
What is the primary basis for the diagnostic criteria used to define atypical ductal hyperplasia (ADH)?
What is the primary basis for the diagnostic criteria used to define atypical ductal hyperplasia (ADH)?
Which of the following papers discusses interobserver reproducibility in the diagnosis of ductal proliferative breast lesions?
Which of the following papers discusses interobserver reproducibility in the diagnosis of ductal proliferative breast lesions?
What is discussed in the paper titled 'Duct carcinoma in situ: Pathology and treatment'?
What is discussed in the paper titled 'Duct carcinoma in situ: Pathology and treatment'?
What was the main focus of the EORTC consensus meeting regarding in situ breast cancer?
What was the main focus of the EORTC consensus meeting regarding in situ breast cancer?
Which study focuses on the clinical implications of three-dimensional imaging of mammary ductal carcinoma in situ?
Which study focuses on the clinical implications of three-dimensional imaging of mammary ductal carcinoma in situ?
What aspect of breast ductal carcinoma does the study by Holland et al. examine?
What aspect of breast ductal carcinoma does the study by Holland et al. examine?
Which author is associated with research on borderline epithelial lesions of the breast?
Which author is associated with research on borderline epithelial lesions of the breast?
In which year was the study on the consistency achieved by European pathologists published?
In which year was the study on the consistency achieved by European pathologists published?
What is a primary focus of the paper authored by Schnitt et al. in 1992?
What is a primary focus of the paper authored by Schnitt et al. in 1992?
What association is noted with atypical hyperplasia of lobular and ductal types?
What association is noted with atypical hyperplasia of lobular and ductal types?
Which reference proposes future methods of categorization for hyperplasia and neoplasia of the breast?
Which reference proposes future methods of categorization for hyperplasia and neoplasia of the breast?
What is the primary focus of the study by Marshall LM et al. regarding atypical hyperplasia?
What is the primary focus of the study by Marshall LM et al. regarding atypical hyperplasia?
What histological indicator is mentioned as a marker for increased breast cancer risk?
What histological indicator is mentioned as a marker for increased breast cancer risk?
Which study focuses on the frequency and relationships of atypical hyperplasia within breast biopsies?
Which study focuses on the frequency and relationships of atypical hyperplasia within breast biopsies?
The frequency of which type of breast lesions is analyzed in a forensic autopsy study by Bartow SA et al.?
The frequency of which type of breast lesions is analyzed in a forensic autopsy study by Bartow SA et al.?
Which of the following findings relates to the clinical and histologic aspects of benign breast disease as per Connolly JL et al.?
Which of the following findings relates to the clinical and histologic aspects of benign breast disease as per Connolly JL et al.?
What type of hyperplasia is associated with loss of heterozygosity on chromosomes 16q and 17p according to research?
What type of hyperplasia is associated with loss of heterozygosity on chromosomes 16q and 17p according to research?
What percentage of patients with microscopic foci of DCIS may develop invasive carcinoma?
What percentage of patients with microscopic foci of DCIS may develop invasive carcinoma?
Which type of DCIS is noted for progressing to invasive carcinoma more often and rapidly?
Which type of DCIS is noted for progressing to invasive carcinoma more often and rapidly?
What classification system does the National Coordinating Group for Breast Screening Pathology recommend for DCIS?
What classification system does the National Coordinating Group for Breast Screening Pathology recommend for DCIS?
What characterizes high-nuclear-grade DCIS?
What characterizes high-nuclear-grade DCIS?
Which feature is most commonly associated with low-nuclear-grade DCIS?
Which feature is most commonly associated with low-nuclear-grade DCIS?
What issue occurs with the traditional classification of DCIS?
What issue occurs with the traditional classification of DCIS?
What type of configuration is often seen in low-nuclear-grade DCIS?
What type of configuration is often seen in low-nuclear-grade DCIS?
What describes the nuclei in intermediate-grade DCIS?
What describes the nuclei in intermediate-grade DCIS?
Flashcards
Ductal Carcinoma in Situ (DCIS)
Ductal Carcinoma in Situ (DCIS)
A type of breast lesion characterized by abnormal cell growth within the milk ducts, but not spreading beyond the duct lining.
Atypical Ductal Hyperplasia (ADH)
Atypical Ductal Hyperplasia (ADH)
An abnormal cell growth within the milk ducts that is less severe than DCIS, but still considered a risk factor for breast cancer.
Usual Epithelial Hyperplasia
Usual Epithelial Hyperplasia
A common and benign breast condition characterized by an overgrowth of normal cells within the milk ducts.
Distinguishing Hyperplasia from Neoplasia
Distinguishing Hyperplasia from Neoplasia
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Classification of Breast Lesions
Classification of Breast Lesions
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Clonality in Breast Cancer
Clonality in Breast Cancer
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Immunohistochemistry in Breast Cancer
Immunohistochemistry in Breast Cancer
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Loss of Heterozygosity (LOH) in Breast Cancer
Loss of Heterozygosity (LOH) in Breast Cancer
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High-grade DCIS
High-grade DCIS
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Low-grade DCIS
Low-grade DCIS
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Intermediate-grade DCIS
Intermediate-grade DCIS
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Cribriform
Cribriform
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Micropapillary
Micropapillary
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Progression of DCIS
Progression of DCIS
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Comedo DCIS
Comedo DCIS
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What is Atypical Ductal Hyperplasia (ADH)?
What is Atypical Ductal Hyperplasia (ADH)?
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Where is ADH commonly observed?
Where is ADH commonly observed?
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How is ADH diagnosed?
How is ADH diagnosed?
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What is the risk of developing invasive breast cancer with ADH?
What is the risk of developing invasive breast cancer with ADH?
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How is ADH also diagnosed?
How is ADH also diagnosed?
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How is ADH diagnosed in the real world?
How is ADH diagnosed in the real world?
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What is the debate about the boundary of ADH?
What is the debate about the boundary of ADH?
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What is the current system used to classify breast tissue?
What is the current system used to classify breast tissue?
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Lobular Carcinoma In Situ (LCIS)
Lobular Carcinoma In Situ (LCIS)
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Classification of DCIS
Classification of DCIS
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Silverstein Classification
Silverstein Classification
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DCIS as a Spectrum
DCIS as a Spectrum
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Comparative Genomic Hybridization (CGH)
Comparative Genomic Hybridization (CGH)
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Future of DCIS Classification
Future of DCIS Classification
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Usual Epithelial Hyperplasia (UEH)
Usual Epithelial Hyperplasia (UEH)
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Immunohistochemistry (IHC) in Breast Cancer
Immunohistochemistry (IHC) in Breast Cancer
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Study Notes
Pre-invasive Breast Disease: DCIS and ADH
- Intraductal epithelial proliferations in the breast are categorized histologically and clinically into three groups: usual epithelial hyperplasia, atypical ductal hyperplasia (ADH), and ductal carcinoma in situ (DCIS).
- While a three-tier system is currently used, evidence suggests boundaries aren't ideal morphologically, immunohistochemically, or genetically.
- ADH and DCIS definitions, histological features, and classification systems are described in the text.
Atypical Ductal Hyperplasia (ADH)
- ADH is a rare condition, found in 4% of symptomatic benign biopsies and often detected incidentally during screening, being more frequent in relation to microcalcifications.
- ADH is associated with a significant risk of invasive breast cancer, approximately four to five times higher than the general population, and potentially higher risk for premenopausal women.
- Risk is further elevated if a first-degree relative has breast cancer (10-fold increase).
- Diagnostic criteria for ADH are imperfect, originally based on excluding features of DCIS and usual epithelial hyperplasia, though now include supplementary criteria.Cellular characteristics of ADH include uniform, small or medium-sized, round, cuboidal or polygonal hyperchromatic cells, nuclei arranged evenly, presence of a rosette-like pattern, single nucleoli, rare mitoses, geometric spaces, and possible cribriform or micropapillary patterns. Small foci of necrosis are sometimes observed and do not indicate DCIS.
- Lesions less than 2mm in maximum dimension are classified as ADH. Larger lesions are considered DCIS if combined with radial scar or papilloma.
Ductal Carcinoma In Situ (DCIS)
- DCIS is defined by malignant epithelial cell proliferation within breast tissue, lacking evidence of invasion across basement membranes.
- Immunohistochemical confirmation of myoepithelial cells/basement membrane is usually conducted.
- DCIS accounts for 15-20% of breast cancers and is more prevalent than in prior studies.
- DCIS is typically a unicentric, disease process often confined to a single area of the breast.
- The natural history of DCIS is not completely understood because of relying on extrapolation of historical data and reassessment of previously misdiagnosed lesions, often of low-grade nature.
Classification of DCIS
- Classification systems for DCIS have been described, but traditional systems based on architectural and cytological features often have poor reproducibility (up to 30%).
- A recommended system, derived from Holland and colleagues, classifies DCIS as high, low, or intermediate grade based on cytonuclear features.
- High-grade DCIS involves pleomorphic large cells with abundant mitoses; low-grade DCIS involves uniform cells and less mitoses.
Additional details
- The difficulty in consistently diagnosing ADH is a significant issue.
- Methods like criteria revisions, enhanced recognition, and standardized systems can improve consistency.
- The possibility of a hypothetical model for DCIS pathogenesis based on genetic lesions and morphological subtypes is suggested.
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Description
This quiz explores the classification systems related to Ductal Carcinoma In Situ (DCIS) and its relationship with Lobular Carcinoma In Situ (LCIS). It discusses the traditional separation of these neoplasias, recent research findings, and the primary distinctions in their classifications. Test your knowledge on key concepts and characteristics associated with these conditions.
