title: Atypical presentations of screen-detected DCIS Implications for pre-operative assessment and surgical intervention.
abstract: Few series are published on DCIS that forms parenchymal lesions on screening mammograms. The implications of these unusual presentations for pre-operative assessment and surgical intervention are of interest. In the setting of a large, population-based breast cancer screening program, the diagnostic and management implications of DCIS presenting as parenchymal lesions on screening mammograms are investigated. A total of 125 lesions (20.1% of all DCIS) presented as a mass (n=99) or microcalcifications with an associated parenchymal lesion (n=26). Cytology was positive in 47.1% of cases. Core biopsy diagnosed DCIS in 68.4% of cases. Breast surgery after a definite preoperative diagnosis achieved negative initial margins in 69.4% case, versus 54.7% without a pre-operative malignant diagnosis. The mastectomy rate was 26.4%. Axillary surgery was carried out in 32.8% cases, including axillary clearance in 26.4% of cases. One in five cases of DCIS detected during mammographic screening has features other than pure microcalcifications. This has implications for pre-operative assessment and surgical management.
authors.affiliation: BreastScreen SA and Division of Tissue Pathology, Institute of Medical and Veterinary Science, Frome Road, Adelaide 5000, South Australia. gelareh.farshid@imvs.sa.gov.au
authors.forename: Gelareh
authors.initials: G
authors.lastname: Farshid
authors.forename: Peter
authors.initials: P
authors.lastname: Downey
authors.forename: P Grantley
authors.initials: PG
authors.lastname: Gill
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008327:Mammography; D015412:Mastectomy, Segmental; D008499:Medical Records; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012189:Retrospective Studies; D013021:South Australia / Q000453:epidemiology