title: Palpable ductal carcinoma in situ: analysis of radiological and histological features of a large series with 5-year follow-up.
abstract: BACKGROUND
  Palpable pure DCIS is a rare entity that presents differently than screen-detected DCIS. The aim of this study was to evaluate the clinical, radiological, and pathological characteristics and management of pDCIS in a retrospective cohort of patients.
  
  
  METHODS
  Patients diagnosed with pDCIS from January 1999 to December 2011 were identified from an electronic patient database and were included in this study.
  
  
  RESULTS
  During this period, 669 cases of DCIS were diagnosed and 62 (9.3%) were pDCIS (mean age, 56.9 ± 15.1 years). The most common finding on ultrasound was mass in 43 patients (75%) and only 18 (33%) cases had calcification on mammography. The lesion was mammographically occult in 20 patients (37%). Ultrasound was more sensitive and delineated the pDCIS in 45 (80%) cases. Mean size of the pDCIS was 36.9 ± 30.4 mm and most were high grade (n = 42; 68%) and associated with comedo necrosis in 36 (59%). Most were oestrogen receptor (ER)-positive (n = 34; 62%), however 21 patients (38%) were ER-negative. Breast conservation was attempted in 30 patients (48%), however, because of involved margins further therapeutic surgery was needed in 10 patients (33%). Axillary surgery (sentinel lymph node biopsy or axillary nodal sampling) was performed in 34 patients (55%) and no lymph node metastasis was identified. During a medial follow-up of 60 months, 1 patient has developed a mastectomy scar recurrence and the rest remain disease-free.
  
  
  CONCLUSIONS
  Palpable DCIS is often occult on conventional radiological imaging and is generally associated with aggressive pathological features. Hence, careful individualized surgical planning through a multidisciplinary meeting is necessary for their management.
authors.affiliation: Department of Breast Surgery, St. James University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom. Electronic address: drsreek_79@yahoo.co.in.
authors.forename: Sreekumar
authors.initials: S
authors.lastname: Sundara Rajan
authors.forename: Rashmi
authors.initials: R
authors.lastname: Verma
authors.forename: Abeer M
authors.initials: AM
authors.lastname: Shaaban
authors.forename: Nisha
authors.initials: N
authors.lastname: Sharma
authors.forename: Barbara
authors.initials: B
authors.lastname: Dall
authors.forename: Mark
authors.initials: M
authors.lastname: Lansdown
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D002291:Carcinoma, Papillary / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008327:Mammography; D008408:Mastectomy; D008875:Middle Aged; D060787:Neoplasm Grading; D011379:Prognosis; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D013997:Time Factors; D016217:Ultrasonography, Mammary
keywords: Histology; Intraductal; Noninfiltrating; Radiology; Therapeutic agents