There has been a recent increase in the diagnosis of in situ duct
carcinoma of the breast (
DCIS) as a result of mammographic screening.
DCIS is heterogeneous in appearance and likely in prognosis. There is no generally accepted model to predict progression to invasive
carcinoma. We investigated the prognostic effect of clinical presentation and pathologic factors for women diagnosed with primary
DCIS. A cohort of 124 patients was accrued between 1979 and 1994 and was followed to 1997; 78 had
DCIS detected mammographically, and 88 underwent
lumpectomy alone. In this article, we provide details about characteristics affecting the choice of primary therapeutic modality, and we examine the effects of factors on progression for the two patient subgroups. Presentation with bloody nipple discharge was associated with a significant increase in
DCIS recurrence (p=0.07). The pattern of duct distribution was important:
DCIS in which the involved ducts were more widely separated had a significantly greater recurrence of
DCIS than when the involved ducts were more concentrated (p=0.08 for mammographically detected
DCIS, p=0.07 for patients who underwent
lumpectomy alone). For mammographically detected
DCIS, younger patients had more
DCIS recurrence (p=0.07). We found considerable heterogeneity in nuclear grade; 50% of patients exhibited more than one grade. Nuclear grade,
necrosis, and architecture were not significantly associated with either recurrence of
DCIS or development of invasive
carcinoma. Longer follow-up will allow further evaluation of the prognostic relevance of the factors assessed.