Original study| Volume 13, ISSUE 5, P385-391, October 2013

Download started.


Grade of Ductal Carcinoma In Situ Accompanying Infiltrating Ductal Carcinoma As an Independent Prognostic Factor



      Several studies about the relationship between IDC and DCIS have been reported, but no consensus has been reached regarding clinical characteristics and prognostic value.

      Patients and Methods

      We reviewed the medical records of patients who underwent surgery for IDC between 2006 and 2008. DCIS adjacent to IDC was pathologically classified as either high-grade DCIS or non–high-grade DCIS.


      Among 1751 IDC patients within the study period, 1384 patients (79.0%) had concomitant DCIS. There was no survival difference between patients with pure IDC and those with IDC and concomitant DCIS. However, patients with high-grade DCIS had worse survival than did patients with non–high-grade DCIS or pure IDC (5-year recurrence-free survival rates for IDC with non–high-grade DCIS, pure IDC without DCIS, and IDC with high-grade DCIS were 97%, 93%, and 86%, respectively; P = .001). This tendency was maintained regardless of estrogen receptor status or histologic grade of IDC. In a Cox regression model, patients with IDC and accompanying high-grade DCIS had a 2.5-fold higher probability of local or distant relapse than did those with IDC and low-grade DCIS (hazard ratio, 2.51; 95% confidence interval, 1.12–5.64).


      The prognosis of patients with invasive breast cancer differed according to the grade of concomitant adjacent DCIS. Accordingly, the grade of adjacent DCIS should be considered as a prognostic factor in the clinical management of patients with breast cancer. However, in our study, the follow-up periods were short to confirm prognostic effect. Further studies are needed.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Breast Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Buerger H.
        • Mommers E.C.
        • Littmann R.
        • et al.
        Ductal invasive G2 and G3 carcinomas of the breast are the end stages of at least two different lines of genetic evolution.
        J Pathol. 2001; 194: 165-170
        • Hwang E.S.
        • DeVries S.
        • Chew K.L.
        • et al.
        Patterns of chromosomal alterations in breast ductal carcinoma in situ.
        Clin Cancer Res. 2004; 10: 5160-5167
        • Carabias-Meseguer P.
        • Zapardiel I.
        • Cusido-Gimferrer M.
        • et al.
        Influence of the in situ component in 389 infiltrating ductal breast carcinomas.
        Breast Cancer. 2013; 20: 213-217
        • Leong A.S.
        • Sormunen R.T.
        • Vinyuvat S.
        • et al.
        Biologic markers in ductal carcinoma in situ and concurrent infiltrating carcinoma. A comparison of eight contemporary grading systems.
        Am J Clin Pathol. 2001; 115: 709-718
        • Wärnberg F.
        • Nordgren H.
        • Bergkvist L.
        • et al.
        Tumour markers in breast carcinoma correlate with grade rather than with invasiveness.
        Br J Cancer. 2001; 85: 869-874
        • Schorr M.C.
        • Pedrini J.L.
        • Savaris R.F.
        • et al.
        Are the pure in situ breast ductal carcinomas and those associated with invasive carcinoma the same?.
        Appl Immunohistochem Mol Morphol. 2010; 18: 51-54
        • Iakovlev V.V.
        • Arneson N.C.
        • Wong V.
        • et al.
        Genomic differences between pure ductal carcinoma in situ of the breast and that associated with invasive disease: a calibrated aCGH study.
        Clin Cancer Res. 2008; 14: 4446-4454
        • Aubele M.
        • Mattis A.
        • Zitzelsberger H.
        • et al.
        Extensive ductal carcinoma In situ with small foci of invasive ductal carcinoma: evidence of genetic resemblance by CGH.
        Int J Cancer. 2000; 85: 82-86
        • Castro N.P.
        • Osório C.A.
        • Torres C.
        • et al.
        Evidence that molecular changes in cells occur before morphological alterations during the progression of breast ductal carcinoma.
        Breast Cancer Res. 2008; 10: R87
        • Dillon M.F.
        • Maguire A.A.
        • McDermott E.W.
        • et al.
        Needle core biopsy characteristics identify patients at risk of compromised margins in breast conserving surgery.
        Mol Pathol. 2008; 21: 39-45
        • Dzierzanowski M.
        • Melville K.A.
        • Barnes P.J.
        • et al.
        Ductal carcinoma in situ in core biopsies containing invasive breast cancer: correlation with extensive intraductal carcinoma and lumpectomy margins.
        J Surg Oncol. 2005; 90: 71-76
        • Jimemez R.E.
        • Bongers S.
        • Bouwman D.
        • et al.
        Clinicopathologic significance of ductal carcinoma in situ in breast core needle biopsies with invasive cancer.
        Am J Surg Pathol. 2002; 24: 123-128
        • Jo B.H.
        • Chun Y.K.
        Heterogeneity of invasive ductal carcinoma: proposal for a hypothetical classification.
        J Korean Med Sci. 2006; 21: 460-468
        • Wong H.
        • Lau S.
        • Yau T.
        • et al.
        Presence of an in situ component is associated with reduced biological aggressiveness of size-matched invasive breast cancer.
        Br J Cancer. 2010; 102: 1391-1396
        • Chagpar A.B.
        • McMasters K.M.
        • Sahoo S.
        • et al.
        Does ductal carcinoma in situ accompanying invasive carcinoma affect prognosis?.
        Surgery. 2009; 146: 561-567
        • Wong H.
        • Lau S.
        • Leung R.
        • et al.
        Coexisting ductal carcinoma in situ independently predicts lower tumor aggressiveness in node-positive luminal breast cancer.
        Med Oncol. 2012; 29: 1536-1542
        • Silverstein M.J.
        • Poller D.N.
        • Waisman J.R.
        • et al.
        Prognostic classification of breast ductal carcinoma-in-situ.
        Lancet. 1995; 345: 1154-1157
        • Papantoniou V.
        • Sotiropoulou E.
        • Valsamaki P.
        • et al.
        Breast density, scintimammographic (99m)Tc(V)DMSA uptake, and calcitonin gene related peptide (CGRP) expression in mixed invasive ductal associated with extensive in situ ductal carcinoma (IDC + DCIS) and pure invasive ductal carcinoma (IDC): correlation with estrogen receptor (ER) status, proliferation index Ki-67, and histological grade.
        Breast Cancer. 2011; 18: 286-291
        • Pinder S.E.
        Ductal carinoma in situ(DCIS): pathological features, differential diagnosis, prognostic factors and specimen evaluation.
        Mod Pathol. 2010; 23: S8-13
        • Mylonas I.
        • Makovitzky J.
        • Jeschke U.
        • et al.
        Expression of Her2/neu, steroid receptors (ER and PR), Ki67 and p53 in invasive mammary ductal carcinoma associated with ductal carcinoma In Situ (DCIS) Versus invasive breast cancer alone.
        Anticancer Res. 2005; 25: 1719-1723
        • Bijker N.
        • Peterse J.L.
        • Duchateau L.
        • et al.
        Risk factors for recurrence and metastasis after breast-conserving therapy for ductal carcinoma-in-situ: analysis of European Organization for Research and Treatment of Cancer Trial 10853.
        J Clin Oncol. 2001; 15: 2263-2271
        • Solin L.J.
        • Kurtz J.
        • Fourquet A.
        • et al.
        Fifteen-year results of breast-conserving surgery and definitive breast irradiation for the treatment of ductal carcinoma in situ of the breast.
        J Clin Oncol. 1996; 14: 754-763
        • Wallis M.G.
        • Clements K.
        • Kearins O.
        • et al.
        The effect of DCIS grade on rate, type and time to recurrence after 15 years of follow-up of screen-detected DCIS.
        Br J Cancer. 2012; 106: 1611-1617
        • Johnson C.E.
        • Gorringe K.L.
        • Thompson E.R.
        • et al.
        Identification of copy number alterations associated with the progression of DCIS to invasive ductal carcinoma.
        Breast Cancer Res Treat. 2012; 133: 889-898