Breast Carcinoma In Situ - Podcast Version 0:00 / 0:00 1x 0.25x 0.5x 0.75x 1x 1.25x 1.5x 1.75x 2x Breast Carcinoma In Situ are neoplasms that are contained within the breast ducts and have not spread into the surrounding breast tissue. These carcinoma types represent a precursor to invasive breast cancer, they are typically identified solely on imaging, and are rarely symptomatic at presentation. The two main types of in situ breast carcinoma types are Ductal Carcinoma In Situ (DCIS) and Lobular Carcinoma In Situ (LCIS). Ductal Carcinoma in Situ Ductal carcinoma in situ (DCIS) is the most common type of non-invasive breast malignancy and currently comprises around 20% of all breast cancers diagnosed. It is a malignancy of the ductal tissue of the breast that is contained within the basement membrane (Fig. 1). DCIS is is categorised into five major types based upon histological features; these subtypes are comedo, cribriform, micropapillary, papillary, and solid types, however most lesions are mixed. Adobe Stock, Licensed to TeachMeSeries Ltd Figure 1Illustration demonstrating difference between ductal carcinoma in situ and invasive breast carcinoma Investigations DCIS is often detected during screening. Around 90% of patients with DCIS will have suspicious microcalcifications seen on mammography, with the diagnosis then subsequently confirmed via biopsy (Fig. 2). Adobe Stock, Licensed to TeachMeSeries Ltd Figure 2Histology showing ductal carcinoma in-situ (DCIS), demonstrating the malignant cells confined to the mammary ducts Management Any detected DCIS should be treated with surgical excision. This is done with breast conserving surgery (wide local excision) or (in cases of widespread or multifocal DCIS) with mastectomy. Lobular Carcinoma In Situ Lobular Carcinoma in Situ (LCIS) is a non-invasive lesion of the secretory lobules of the breast that is contained within the basement membrane (Fig. 3). They are much rarer than DCIS however individuals with LCIS are at greater risk of developing an invasive breast malignancy. LCIS is usually diagnosed before menopause, with only 10-20% of women diagnosed being post-menopausal. Adobe Stock, Licensed to TeachMeSeries Ltd Figure 3Illustration demonstrating lobular carcinoma in situ Investigations LCIS is usually asymptomatic, much like DCIS, however LCIS is not associated with microcalcifications; LCIS is usually diagnosed as an incidental finding during biopsy of the breast (Fig. 4) Adobe Stock, Licensed to TeachMeSeries Ltd Figure 4Histology showing lobular carcinoma in-situ (LCIS), demonstrating the malignant cells confined to the lobules Management Management of LCIS is dependent on extent of disease. Low grade LCIS is usually treated by monitoring rather than excision. When an invasive component is identified, it is less likely to be associated with axillary nodal metastasis than with DCIS. Bilateral prophylactic mastectomy can be potentially indicated if individuals possess the BRCA1 or BRCA2 genes. Key Points Carcinoma-in-situ are premalignant conditions Typically found on imaging and are rarely symptomatic at presentation Two main subtypes are Ductal Carcinoma In Situ (DCIS) and Lobular Carcinoma In Situ (LCIS) Management depends on subtype and extent of the disease Do you think you’re ready? Take the quiz below Pro Feature - Quiz Breast Carcinoma In Situ Question 1 of 2 Submitting... Skip Next Rate question: You scored 0% Skipped: 0/2 Keep your streak going Unlock the full question bank You’ve made a great start. Continue with over 1,200 MRCS-style MCQs, two full mock papers, and ad-free revision with TeachMeSurgery Pro. Continue with Pro Frequent questions What is Breast Carcinoma In Situ? Breast Carcinoma In Situ refers to neoplasms that remain confined within the breast ducts and have not invaded surrounding tissue. These conditions are considered precursors to invasive breast cancer and are typically detected through imaging rather than presenting with symptoms. What are the main types of Breast Carcinoma In Situ? The two primary types of Breast Carcinoma In Situ are Ductal Carcinoma In Situ (DCIS) and Lobular Carcinoma In Situ (LCIS). DCIS is the more common type, while LCIS is rarer but indicates a higher risk for developing invasive breast cancer. How is Ductal Carcinoma In Situ diagnosed? Ductal Carcinoma In Situ is often diagnosed during routine screening, with approximately 90% of cases showing suspicious microcalcifications on mammography. A biopsy is then performed to confirm the diagnosis. What is the management approach for Lobular Carcinoma In Situ? Management of Lobular Carcinoma In Situ typically involves monitoring, especially for low-grade cases, rather than surgical excision. However, if invasive components are detected or if the patient carries BRCA1 or BRCA2 genes, more aggressive options like bilateral prophylactic mastectomy may be considered. Why is early detection of Breast Carcinoma In Situ important? Early detection of Breast Carcinoma In Situ is crucial as these conditions are premalignant and indicate a risk for developing invasive breast cancer. Identifying and managing these lesions promptly can significantly impact patient outcomes and treatment options. Rate This Article