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Ductal Carcinoma In Situ—Pathological Considerations

  • Non-Invasive Breast Cancer Diagnosis and Treatment (ES Hwang, Section Editor)
  • Published:
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Abstract

Purpose of Review

Mammographic screening and radiological surveillance for local management has led to an exponential increase in diagnosis of ductal carcinoma in situ (DCIS) with limited impact on breast cancer specific mortality. Since definitive diagnosis of DCIS requires histopathological examination increase in radiological surveillance has resulted in significant increase in breast biopsies. Pathological characteristics of DCIS include grade, necrosis, size, anatomy, margins of excision, estrogen, and progesterone receptor status, and these features are useful for both prognostication and prediction.

Recent Findings

Differential diagnosis of DCIS extends from atypical ductal hyperplasia to micro-invasive carcinoma and increasingly pathologists recognize intraductal lesions at the borderline between atypical ductal hyperplasia and ductal carcinoma in situ. Clinicopathological characteristics of DCIS continue to be significant in prospective trials and have been integrated with predictive molecular tools.

Summary

Since most cases of DCIS do not progress to invasive cancer multiple tools which include clinicopathologic and molecular signatures are in the process of development and validation for personalizing treatment strategies for patients. Ongoing clinical trials are testing whether DCIS with favorable clinicopathologic characteristics may avoid loco-regional therapy which typically includes breast conserving surgery and radiotherapy.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Schnitt SJ, Allred C, Britton P, Ellis IO, Lakhani SR, Morrow M, et al. WHO classification of tumors of the breast. In: Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, van de Vijr MJ, editors. . 4th ed. Lyon: International Agency for Research on Cancer; 2012.

    Google Scholar 

  2. Ernster VL, Barclay J, Kerlikowske K, Wilkie H, Ballard-Barbash R. Mortality among women with ductal carcinoma in situ of the breast in the population-based surveillance, epidemiology and end results program. Arch Intern Med. 2000;160(7):953–8.

    Article  CAS  PubMed  Google Scholar 

  3. Jemal ASR, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics. Cancer J Clin. 2009;59:277–300.

    Article  Google Scholar 

  4. [Available from: https://documents.cap.org/protocols/cp-breast-dcis-resection-19-4200.pdf. Accessed Feb 2019.

  5. Sanders ME, Schuyler PA, Dupont WD, Page DL. The natural history of low-grade ductal carcinoma in situ of the breast in women treated by biopsy only revealed over 30 years of long-term follow-up. Cancer. 2005;103(12):2481–4.

    Article  PubMed  Google Scholar 

  6. Collins LC, Tamimi RM, Baer HJ, Connolly JL, Colditz GA, Schnitt SJ. Outcome of patients with ductal carcinoma in situ untreated after diagnostic biopsy: results from the nurses' health study. Cancer. 2005;103(9):1778–84.

    Article  PubMed  Google Scholar 

  7. Groen EJ, Elshof LE, Visser LL, Rutgers EJT, Winter-Warnars HAO, Lips EH, et al. Finding the balance between over- and under-treatment of ductal carcinoma in situ (DCIS). Breast. 2017;31:274–83.

    Article  PubMed  Google Scholar 

  8. Wiechmann L, Kuerer HM. The molecular journey from ductal carcinoma in situ to invasive breast cancer. Cancer. 2008;112(10):2130–42.

    Article  PubMed  Google Scholar 

  9. Wapnir IL, Dignam JJ, Fisher B, Mamounas EP, Anderson SJ, Julian TB, et al. Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst. 2011;103(6):478–88.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Houghton J, George WD, Cuzick J, Duggan C, Fentiman IS, Spittle M, et al. Radiotherapy and tamoxifen in women with completely excised ductal carcinoma in situ of the breast in the UK, Australia, and New Zealand: randomised controlled trial. Lancet. 2003;362(9378):95–102.

    Article  PubMed  Google Scholar 

  11. Group EBCC, Group ER, Bijker N, Meijnen P, Peterse JL, Bogaerts J, et al. Breast-conserving treatment with or without radiotherapy in ductal carcinoma-in-situ: ten-year results of European Organisation for Research and Treatment of Cancer randomized phase III trial 10853--a study by the EORTC breast cancer cooperative group and EORTC radiotherapy group. J Clin Oncol. 2006;24(21):3381–7.

    Article  Google Scholar 

  12. Fisher ER, Costantino J, Fisher B, Palekar AS, Redmond C, Mamounas E. Pathologic findings from the National Surgical Adjuvant Breast Project (NSABP) protocol B-17. Intraductal carcinoma (ductal carcinoma in situ). The National Surgical Adjuvant Breast and bowel project collaborating investigators. Cancer. 1995;75(6):1310–9.

    Article  CAS  PubMed  Google Scholar 

  13. Forbes JF, Sestak I, Howell A, Bonanni B, Bundred N, Levy C, et al. Anastrozole versus tamoxifen for the prevention of locoregional and contralateral breast cancer in postmenopausal women with locally excised ductal carcinoma in situ (IBIS-II DCIS): a double-blind, randomised controlled trial. Lancet. 2016;387(10021):866–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Margolese RG, Cecchini RS, Julian TB, Ganz PA, Costantino JP, Vallow LA, et al. Anastrozole versus tamoxifen in postmenopausal women with ductal carcinoma in situ undergoing lumpectomy plus radiotherapy (NSABP B-35): a randomised, double-blind, phase 3 clinical trial. Lancet. 2016;387(10021):849–56.

    Article  CAS  PubMed  Google Scholar 

  15. Gradishar WJ, Anderson BO, Balassanian R, Blair SL, Burstein HJ, Cyr A, et al. Breast cancer, version 4.2017, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw. 2018;16(3):310–20.

    Article  Google Scholar 

  16. Lyman GH, Somerfield MR, Bosserman LD, Perkins CL, Weaver DL, Giuliano AE. Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2017;35(5):561–4.

    Article  PubMed  Google Scholar 

  17. Ansari B, Ogston SA, Purdie CA, Adamson DJ, Brown DC, Thompson AM. Meta-analysis of sentinel node biopsy in ductal carcinoma in situ of the breast. Br J Surg. 2008;95(5):547–54.

    Article  CAS  PubMed  Google Scholar 

  18. Bleiweiss IJ, Nagi CS, Jaffer S. Axillary sentinel lymph nodes can be falsely positive due to iatrogenic displacement and transport of benign epithelial cells in patients with breast carcinoma. J Clin Oncol. 2006;24(13):2013–8.

    Article  PubMed  Google Scholar 

  19. Holland R, Hendriks JHCL, Verbeek ALM. Extent, distribution and mammographic /histological correlations of breast ductal carcinoma in situ. Lancet. 1990;335:519–22.

    Article  CAS  PubMed  Google Scholar 

  20. Hoda S, Brodi E, Koerner FC, Rosen PP. Rosen’s Breast Pathology. 4th Ed ed. Hoda S BE, Koerner FC, Rosen PP, editor: Walters Kluwer; 2014.

  21. Jackman RJ, Burbank F, Parker SH, et al. Stereotactic breast biopsy of nonpalpable lesions: determinants of ductal carcinoma in situ underestimation rates. Radiology. 2001;218:497–502.

    Article  CAS  PubMed  Google Scholar 

  22. Wang HH, Ducatman BS, Eick D. Comparative features of ductal carcinoma in situ and infiltrating ductal carcinoma of the breast on fine-needle aspiration biopsy. Am J Clin Pathol. 1989;92(6):736–40.

    Article  CAS  PubMed  Google Scholar 

  23. Willems SM, van Deurzen CH, van Diest PJ. Diagnosis of breast lesions: fine-needle aspiration cytology or core needle biopsy? A review. J Clin Pathol. 2012;65(4):287–92.

    Article  CAS  PubMed  Google Scholar 

  24. Castellano I, Metovic J, Balmativola D, Annaratone L, Rangel N, Vissio E, et al. The impact of malignant nipple discharge cytology (NDc) in surgical management of breast cancer patients. PLoS One. 2017;12(8):e0182073.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  25. Hammond ME, Hayes DF, Wolff AC, Mangu PB, Temin S. American society of clinical oncology/college of american pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Oncol Pract. 2010;6(4):195–7.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Bloodgood JC. Comedo carcinoma or comedo-adenoma of the female breast. Am J Cancer. 1934;22:842–53.

    Article  Google Scholar 

  27. Yamada T, Mori N, Watanabe M, Kimijima I, Okumoto T, Seiji K, et al. Radiologic-pathologic correlation of ductal carcinoma in situ. Radiographics. 2010;30(5):1183–98.

    Article  PubMed  Google Scholar 

  28. Hardman PD, Worth A, Lee U, Baird RM. The risk of occult invasive breast cancer after excisional biopsy showing in-situ ductal carcinoma of comedo pattern. Can J Surg. 1989;32(1):56–60.

    CAS  PubMed  Google Scholar 

  29. Houssami N, Ciatto S, Macaskill P, Lord SJ, Warren RM, Dixon JM, et al. Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: systematic review and meta-analysis in detection of multifocal and multicentric cancer. J Clin Oncol. 2008;26(19):3248–58.

    Article  PubMed  Google Scholar 

  30. • Rauch GM, Hobbs BP, Kuerer HM, Scoggins ME, Benveniste AP, Park YM, et al. Microcalcifications in 1657. Patients with pure ductal carcinoma in situ of the breast: correlation with clinical, Histopathologic, biologic features, and local recurrence. Ann Surg Oncol. 2016;23(2):482–9. This retrospective study defines multicentricity and shows in multivariate analysis that dense breast tissue was a risk factor for multicentricity and positive margins in DCIS

  31. • Kuerer HM, Smith BD, Chavez-MacGregor M, Albarracin C, Barcenas CH, Santiago L, et al. DCIS margins and breast conservation: MD Anderson Cancer Center multidisciplinary practice guidelines and outcomes. J Cancer. 2017;8(14):2653–62. At MDACC a multi-disciplinary approach for intra-operative assessment of specimens has been used to personalize local and systemic therapeutic strategies.

  32. Molina MA, Snell S, Franceschi D, Jorda M, Gomez C, Moffat FL, et al. Breast specimen orientation. Ann Surg Oncol. 2009;16(2):285–8.

    Article  CAS  PubMed  Google Scholar 

  33. • Chagpar AB, Killelea BK, Tsangaris TN, Butler M, Stavris K, Li F, et al. A randomized, controlled trial of cavity shave margins in breast cancer. N Engl J Med. 2015;373(6):503–10. This randomized trial showed that surgical technique with cavity shaved margins halved the rate of reexcision among patients with partial mastectomy.

  34. Leonard GD, Swain SM. Ductal carcinoma in situ, complexities and challenges. J Natl Cancer Inst. 2004;96(12):906–20.

    Article  PubMed  Google Scholar 

  35. • Harrison BT, Hwang ES, Partridge AH, Thompson AM, Schnitt SJ. Variability in diagnostic threshold for comedo necrosis among breast pathologists: implications for patient eligibility for active surveillance trials of ductal carcinoma in situ. Mod Pathol. 2019;32(9):1257–62. This inter-observer study shows that pathologists use varying criteria to diagnose comedo necrosis.

  36. Simpson JF, Schnitt SJ, Visscher D, van de Vijr MJ, Ellis IO. WHO/IARC classification of tumors of the breast. In: Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, van de Vijr MJ, editors. . 4th ed. Lyon: International Agency for Research on Cancer; 2012.

    Google Scholar 

  37. Hartmann LC, Sellers TA, Frost MH, Lingle WL, Degnim AC, Ghosh K, et al. Benign breast disease and the risk of breast cancer. N Engl J Med. 2005;353(3):229–37.

  38. Page DL, Rogers LW. Combined histologic and cytologic criteria for the diagnosis of mammary atypical ductal hyperplasia. Hum Pathol. 1992;23(10):1095–7.

    Article  CAS  PubMed  Google Scholar 

  39. •• Onega T, Weaver DL, Frederick PD, Allison KH, Tosteson ANA, Carney PA, et al. The diagnostic challenge of low-grade ductal carcinoma in situ. Eur J Cancer. 2017;80:39–47. This study shows low inter-observer agreement between pathologists for low grade DCIS. These data support the observation that low grade DCIS is an interpretive challenge for the practicing pathologist.

  40. • Elmore JG, Longton GM, Carney PA, Geller BM, Onega T, Tosteson AN, et al. Diagnostic concordance among pathologists interpreting breast biopsy specimens. JAMA. 2015;313(11):1122–32. Inter-observer agreement amongst pathologists while interpreting breast biopsies is highfor diagnosis of invasive carcinoma and low for DCIS.

  41. Canas-Marques R, Schnitt SJ. E-cadherin immunohistochemistry in breast pathology: uses and pitfalls. Histopathology. 2016;68(1):57–69.

    Article  PubMed  Google Scholar 

  42. •• Tozbikian G, Brogi E, Vallejo CE, Giri D, Murray M, Catalano J, et al. Atypical ductal hyperplasia bordering on ductal carcinoma in situ. Int J Surg Pathol. 2017;25(2):100–7. This study reports that some intraductal proliferations are at the borderline between ADH and DCIS. Interobserver variability is high for these lesions they can not be reproducibly be categorized as either ADH or DCIS.

  43. Rosai J. Borderline epithelial lesions of the breast. Am J Surg Pathol. 1991;15(3):209–21.

    Article  CAS  PubMed  Google Scholar 

  44. Curigliano G, Burstein HJ, Winer EP, Gnant M, Dubsky P, Loibl S, et al. De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen international expert consensus conference on the primary therapy of early breast cancer 2017. Ann Oncol. 2017;28(8):1700–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. •• Morrow M, Van Zee KJ, Solin LJ, Houssami N, Chavez-MacGregor M, Harris JR, et al. Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ. Pract Radiat Oncol. 2016;6(5):287–95. SSO/ASTRO guidelines have reviewed the published literature and defined 2mm as adequate margin in DCIS treated with WBRT with low rate of recurrence.

  46. • Marinovich ML, Azizi L, Macaskill P, Irwig L, Morrow M, Solin LJ, et al. The Association of Surgical Margins and Local Recurrence in women with ductal carcinoma in situ treated with breast-conserving therapy: a meta-analysis. Ann Surg Oncol. 2016;23(12):3811–21. This meta-analysis forms an important evidentiary basis for SSO/ASTRO guidelines. This analysis shows that 2mm margin for DCIS is adequate.

  47. Havel L, Naik H, Ramirez L, Morrow M, Landercasper J. Impact of the SSO-ASTRO margin guideline on rates of re-excision after lumpectomy for breast cancer: a meta-analysis. Ann Surg Oncol. 2019;26(5):1238–44.

    Article  PubMed  Google Scholar 

  48. Paget J. On disease of the mammary areola preceding cancer of the mammary gland. St Bartholowmew Hospital Reports. 1874;10:87–9.

    Google Scholar 

  49. Shouba S, Eusebi V, Lester S. Paget disease of the nipple. Lakhani S, Ellis I, Schnitt S, tan PH, van de Vijr MJ, editors. Lyon: IARC; 2012.

  50. Caliskan M, Gatti G, Sosnovskikh I, Rotmensz N, Botteri E, Musmeci S, et al. Paget's disease of the breast: the experience of the European Institute of Oncology and review of the literature. Breast Cancer Res Treat. 2008;112(3):513–21.

  51. Chen CY, Sun LM, Anderson BO. Paget disease of the breast: changing patterns of incidence, clinical presentation, and treatment in the U.S. Cancer. 2006;107(7):1448–58.

    Article  PubMed  Google Scholar 

  52. Sek P, Zawrocki A, Biernat W, Piekarski JH. HER2 molecular subtype is a dominant subtype of mammary Paget's cells. An immunohistochemical study. Histopathology. 2010;57(4):564–71.

    Article  PubMed  Google Scholar 

  53. Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, et al. The eighth edition AJCC cancer staging manual: continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging. CA Cancer J Clin. 2017;67(2):93–9.

    Article  PubMed  Google Scholar 

  54. • Champion CD, Ren Y, Thomas SM, Fayanju OM, Rosenberger LH, Greenup RA, et al. DCIS with microinvasion: is it in situ or invasive disease? Ann Surg Oncol. 2019;26(10):3124–32. This study shows that patients with micro-invasion have outcomes similar to T1a invasivecarcinoma.

  55. Sopik V, Sun P, Narod SA. Impact of microinvasion on breast cancer mortality in women with ductal carcinoma in situ. Breast Cancer Res Treat. 2018;167(3):787–95.

    Article  PubMed  Google Scholar 

  56. Moran MS, Schnitt SJ, Giuliano AE, Harris JR, Khan SA, Horton J, et al. Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. Int J Radiat Oncol Biol Phys. 2014;88(3):553–64.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Shamliyan T, Wang SY, Virnig BA, Tuttle TM, Kane RL. Association between patient and tumor characteristics with clinical outcomes in women with ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010;2010(41):121–9.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Wang SY, Shamliyan T, Virnig BA, Kane R. Tumor characteristics as predictors of local recurrence after treatment of ductal carcinoma in situ: a meta-analysis. Breast Cancer Res Treat. 2011;127(1):1–14.

    Article  CAS  PubMed  Google Scholar 

  59. Silverstein MJ, Lagios MD. Choosing treatment for patients with ductal carcinoma in situ: fine tuning the University of Southern California/Van Nuys prognostic index. J Natl Cancer Inst Monogr. 2010;2010(41):193–6.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Kelley L, Silverstein M, Guerra L. Analyzing the risk of recurrence after mastectomy for DCIS: a new use for the USC/Van Nuys prognostic index. Ann Surg Oncol. 2011;18(2):459–62.

    Article  PubMed  Google Scholar 

  61. Di Saverio S, Catena F, Santini D, Ansaloni L, Fogacci T, Mignani S, et al. 259 patients with DCIS of the breast applying USC/Van Nuys prognostic index: a retrospective review with long term follow up. Breast Cancer Res Treat. 2008;109(3):405–16.

    Article  PubMed  Google Scholar 

  62. Rudloff U, Jacks LM, Goldberg JI, Wynveen CA, Brogi E, Patil S, et al. Nomogram for predicting the risk of local recurrence after breast-conserving surgery for ductal carcinoma in situ. J Clin Oncol. 2010;28(23):3762–9.

    Article  PubMed  Google Scholar 

  63. Sweldens C, Peeters S, van Limbergen E, Janssen H, Laenen A, Patil S, et al. Local relapse after breast-conserving therapy for ductal carcinoma in situ: a European single-center experience and external validation of the Memorial Sloan-Kettering Cancer Center DCIS nomogram. Cancer J. 2014;20(1):1–7.

    Article  CAS  PubMed  Google Scholar 

  64. Fisher B, Dignam J, Wolmark N, Wickerham DL, Fisher ER, Mamounas E, et al. Tamoxifen in treatment of intraductal breast cancer: National Surgical Adjuvant Breast and bowel project B-24 randomised controlled trial. Lancet. 1999;353(9169):1993–2000.

    Article  CAS  PubMed  Google Scholar 

  65. Allred DC, Wu Y, Mao S, Nagtegaal ID, Lee S, Perou CM, et al. Ductal carcinoma in situ and the emergence of diversity during breast cancer evolution. Clin Cancer Res. 2008;14(2):370–8.

    Article  CAS  PubMed  Google Scholar 

  66. Lari SA, Kuerer HM. Biological markers in DCIS and risk of breast recurrence: a systematic review. J Cancer. 2011;2:232–61.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Hanna WM, Parra-Herran C, Lu FI, Slodkowska E, Rakovitch E, Nofech-Mozes S. Ductal carcinoma in situ of the breast: an update for the pathologist in the era of individualized risk assessment and tailored therapies. Mod Pathol. 2019;32(7):896–915.

    Article  CAS  PubMed  Google Scholar 

  68. Punglia RS, Jiang W, Lipsitz SR, Hughes ME, Schnitt SJ, Hassett MJ, et al. Clinical risk score to predict likelihood of recurrence after ductal carcinoma in situ treated with breast-conserving surgery. Breast Cancer Res Treat. 2018;167(3):751–9.

    Article  CAS  PubMed  Google Scholar 

  69. Tumedei MM, Silvestrini R, Ravaioli S, Massa I, Maltoni R, Rocca A, et al. Role of androgen and estrogen receptors as prognostic and potential predictive markers of ductal carcinoma in situ of the breast. Int J Biol Markers. 2015;30(4):e425–8.

    Article  CAS  PubMed  Google Scholar 

  70. • Rakovitch E, Nofech-Mozes S, Hanna W, Baehner FL, Saskin R, Butler SM, et al. A population-based validation study of the DCIS score predicting recurrence risk in individuals treated by breast-conserving surgery alone. Breast Cancer Res Treat. 2015;152(2):389–98. This population based study Oncotype DX DCIS Score provided information on local recurrence independent of traditional clinico-pathological features.

  71. Han K, Nofech-Mozes S, Narod S, Hanna W, Vesprini D, Saskin R, et al. Expression of HER2neu in ductal carcinoma in situ is associated with local recurrence. Clin Oncol (R Coll Radiol). 2012;24(3):183–9.

    Article  CAS  Google Scholar 

  72. Generali D, Buffa FM, Deb S, Cummings M, Reid LE, Taylor M, et al. COX-2 expression is predictive for early relapse and aromatase inhibitor resistance in patients with ductal carcinoma in situ of the breast, and is a target for treatment. Br J Cancer. 2014;111(1):46–54.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  73. Lopez-Garcia MA, Geyer FC, Lacroix-Triki M, Marchio C, Reis-Filho JS. Breast cancer precursors revisited: molecular features and progression pathways. Histopathology. 2010;57(2):171–92.

    Article  PubMed  Google Scholar 

  74. Polyak K. Molecular markers for the diagnosis and management of ductal carcinoma in situ. J Natl Cancer Inst Monogr. 2010;2010(41):210–3.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Solin LJ, Gray R, Baehner FL, Butler SM, Hughes LL, Yoshizawa C, et al. A multigene expression assay to predict local recurrence risk for ductal carcinoma in situ of the breast. J Natl Cancer Inst. 2013;105(10):701–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. • Bremer T, Whitworth PW, Patel R, Savala J, Barry T, Lyle S, et al. A biological signature for breast ductal carcinoma in situ to predict radiotherapy benefit and assess recurrence risk. Clin Cancer Res. 2018;24(23):5895–901. This study reports a new DCIS signature based on immunohistochemical markers and clinico-pathological factors which can stratify DCIS patients into low risk and elevated risk groups.

  77. Hendry S, Salgado R, Gevaert T, Russell PA, John T, Thapa B, et al. Assessing Tumor-Infiltrating Lymphocytes in Solid Tumors: A Practical Review for Pathologists and Proposal for a Standardized Method from the International Immuno-Oncology Biomarkers Working Group: Part 2: TILs in Melanoma, Gastrointestinal Tract Carcinomas, Non-Small Cell Lung Carcinoma and Mesothelioma, Endometrial and Ovarian Carcinomas, Squamous Cell Carcinoma of the Head and Neck, Genitourinary Carcinomas, and Primary Brain Tumors. Adv Anat Pathol. 2017;24(6):311–35.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Pruneri G, Lazzeroni M, Bagnardi V, Tiburzio GB, Rotmensz N, DeCensi A, et al. The prevalence and clinical relevance of tumor-infiltrating lymphocytes (TILs) in ductal carcinoma in situ of the breast. Ann Oncol. 2017;28(2):321–8.

    Article  CAS  PubMed  Google Scholar 

  79. Campbell MJ, Baehner F, O'Meara T, Ojukwu E, Han B, Mukhtar R, et al. Characterizing the immune microenvironment in high-risk ductal carcinoma in situ of the breast. Breast Cancer Res Treat. 2017;161(1):17–28.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

I am grateful to Dr. Caren Greenstein MD, White Plains Hospital, NY; Minetta C. Liu, MD, Mayo Clinic, Rochester, MN; and Charis Warchal, New York for reviewing the manuscript.

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  1. Pathology and Laboratory Medicine, White Plains Hospital, 41 E Post Road, White Plains, NY, 10601, USA

    Baljit Singh

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Singh, B. Ductal Carcinoma In Situ—Pathological Considerations. Curr Breast Cancer Rep 12, 107–117 (2020). https://doi.org/10.1007/s12609-020-00359-y

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