Understanding DCIS and LCIS Neoplasia Classification

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Questions and Answers

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?

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?

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?

The distinction between ADH and low-grade DCIS. Signup and view all the answers

Which characteristic is associated with certain morphological subtypes of DCIS according to new research?

Genetic lesions Signup and view all the answers

Which concept is highlighted as flawed regarding the nature of DCIS?

DCIS being a spectrum of the same disease. Signup and view all the answers

What does the existing system for the classification of intraductal epithelial proliferations range from?

Usual epithelial hyperplasia to high-grade DCIS Signup and view all the answers

What is the primary distinction between usual epithelial hyperplasia and atypical ductal hyperplasia (ADH)?

Uniformity of morphology and phenotype Signup and view all the answers

What is noted about current systems for typing DCIS in terms of clinical relevance?

They show reasonable reproducibility. Signup and view all the answers

Which characteristic is correct about ductal carcinoma in situ (DCIS) and atypical ductal hyperplasia (ADH)?

Both are recognized as clonal processes Signup and view all the answers

What is the established clinical distinction between atypical ductal hyperplasia (ADH) and low-grade ductal carcinoma in situ (DCIS)?

At the boundary of benign neoplasia and DCIS Signup and view all the answers

What is a major limitation of the current three-tier classification system in breast diseases?

It has poor reproducibility in diagnosis Signup and view all the answers

What percentage of symptomatic benign biopsies typically show atypical ductal hyperplasia (ADH)?

4% Signup and view all the answers

Which factor corresponds to the highest risk of invasive breast carcinoma associated with atypical ductal hyperplasia (ADH)?

Having a first-degree relative with breast cancer Signup and view all the answers

Why is clonality important in distinguishing between hyperplasia and neoplasia in breast conditions?

It suggests a uniformity in morphology and phenotype Signup and view all the answers

What kind of features differentiate atypical ductal hyperplasia from ductal carcinoma in situ?

Histological features and genetic markers Signup and view all the answers

How is atypical ductal hyperplasia (ADH) diagnosed?

Based on exclusion of some features of DCIS Signup and view all the answers

What role do cytokeratin and hormone receptor expression play in diagnosing breast lesions?

They are used to identify clonal cell processes Signup and view all the answers

What has been indicated as a more appropriate boundary for distinguishing conditions related to ADH?

Between usual epithelial hyperplasia and ADH Signup and view all the answers

What is the risk of invasive breast carcinoma for women with atypical ductal hyperplasia (ADH)?

Four to five times the general population Signup and view all the answers

What significant finding has been revealed concerning low-grade DCIS and ADH in terms of genetic changes?

They exhibit similar genetic changes Signup and view all the answers

In which situation is atypical ductal hyperplasia (ADH) most commonly found?

As an incidental finding Signup and view all the answers

Which of the following statements about the current classification of breast diseases is NOT accurate?

It differentiates purely based on clinical presentation Signup and view all the answers

What is the primary basis for the diagnostic criteria used to define atypical ductal hyperplasia (ADH)?

The absence of all features of DCIS Signup and view all the answers

Which of the following papers discusses interobserver reproducibility in the diagnosis of ductal proliferative breast lesions?

Interobserver reproducibility in the diagnosis of ductal proliferative breast lesions using standardised criteria Signup and view all the answers

What is discussed in the paper titled 'Duct carcinoma in situ: Pathology and treatment'?

Pathological features and treatment approaches for duct carcinoma in situ Signup and view all the answers

What was the main focus of the EORTC consensus meeting regarding in situ breast cancer?

Prognostic features of carcinoma Signup and view all the answers

Which study focuses on the clinical implications of three-dimensional imaging of mammary ductal carcinoma in situ?

Three dimensional imaging of mammary ductal carcinoma in situ: clinical implications Signup and view all the answers

What aspect of breast ductal carcinoma does the study by Holland et al. examine?

Distribution and correlations of ductal carcinoma in situ Signup and view all the answers

Which author is associated with research on borderline epithelial lesions of the breast?

Rosai J Signup and view all the answers

In which year was the study on the consistency achieved by European pathologists published?

1999 Signup and view all the answers

What is a primary focus of the paper authored by Schnitt et al. in 1992?

Standardized criteria for diagnosing ductal proliferative lesions Signup and view all the answers

What association is noted with atypical hyperplasia of lobular and ductal types?

Increased risk of breast cancer Signup and view all the answers

Which reference proposes future methods of categorization for hyperplasia and neoplasia of the breast?

Ellis IO et al. Signup and view all the answers

What is the primary focus of the study by Marshall LM et al. regarding atypical hyperplasia?

Assessing the risk of breast cancer associated with atypical hyperplasia Signup and view all the answers

What histological indicator is mentioned as a marker for increased breast cancer risk?

Atypical ductal hyperplasia Signup and view all the answers

Which study focuses on the frequency and relationships of atypical hyperplasia within breast biopsies?

Stomper PC et al. Signup and view all the answers

The frequency of which type of breast lesions is analyzed in a forensic autopsy study by Bartow SA et al.?

Benign, atypical, and malignant lesions Signup and view all the answers

Which of the following findings relates to the clinical and histologic aspects of benign breast disease as per Connolly JL et al.?

Both proliferative and non-proliferative benign breast diseases are clinically relevant Signup and view all the answers

What type of hyperplasia is associated with loss of heterozygosity on chromosomes 16q and 17p according to research?

Atypical ductal hyperplasia Signup and view all the answers

What percentage of patients with microscopic foci of DCIS may develop invasive carcinoma?

50% Signup and view all the answers

Which type of DCIS is noted for progressing to invasive carcinoma more often and rapidly?

Comedo DCIS Signup and view all the answers

What classification system does the National Coordinating Group for Breast Screening Pathology recommend for DCIS?

Cytonuclear features classification Signup and view all the answers

What characterizes high-nuclear-grade DCIS?

Pleomorphic large cells with abnormal mitoses Signup and view all the answers

Which feature is most commonly associated with low-nuclear-grade DCIS?

Small, uniform cells with a cribriform configuration Signup and view all the answers

What issue occurs with the traditional classification of DCIS?

It requires reclassification for up to 30% of cases. Signup and view all the answers

What type of configuration is often seen in low-nuclear-grade DCIS?

Cribriform or micropapillary Signup and view all the answers

What describes the nuclei in intermediate-grade DCIS?

High nuclear-to-cytoplasmic ratio Signup and view all the answers

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.