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Tests and diagnosis
By Mayo Clinic staff
Mammography is the most beneficial tool in identifying DCIS. Because DCIS may be present in your breast even though you can't feel it, getting regular mammograms can help identify microscopic breast changes that might be associated with DCIS. Ask your doctor when you should begin regular mammograms.
If suspicious areas such as shadows or bright white specks (microcalcifications) are identified on your mammogram, your radiologist likely will recommend additional breast imaging. You may have a diagnostic mammogram, which takes views at higher magnification from more angles, or ultrasound. If the area of concern needs further evaluation, the next step will be a breast biopsy.
You may undergo one of these biopsy procedures:
- Core needle biopsy. A radiologist or surgeon uses a hollow needle to remove tissue samples from the suspicious area. As many as 15 samples, each about the size of a grain of rice, may be taken and sent to a lab for analysis.
- Stereotactic biopsy. This type of biopsy also involves removing tissue samples with a hollow needle, but with the help of stereo images — mammogram images of the same area obtained from different angles — in finding (localizing) the area of concern.
- Surgical biopsy (wide local excision or lumpectomy). If results from a core needle biopsy or stereotactic biopsy show areas of DCIS, you'll likely need to meet with a surgeon to discuss your options for surgically removing a wider area of breast tissue for analysis.
A pathologist will analyze the breast tissue from your biopsy to also determine:
- Grade. In DCIS, grade refers to the appearance of the control centers (nuclei) of the cells. If, when examined under a microscope, the nuclei appear fairly similar to the nuclei of normal cells and very few cells are dividing, the tumor is low grade. If the nuclei are markedly different from the nuclei of normal cells, or if they're dividing rapidly, or both, the tumor is high grade and more likely to become invasive.
- Cell structure. Two major subtypes of DCIS are distinguished by the structure of their cells. One type is characterized by large, atypical cells with a central area of dead or degenerating cells (comedo necrosis). The other type is characterized by the lack of these qualities. The presence of comedo necrosis generally signifies a more aggressive lesion.
- What is breast cancer? American Cancer Society. http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_is_breast_cancer_5.asp?sitearea=. Accessed May 7, 2009.
- Lagios MD. Breast ductal carcinoma in situ and microinvasive carcinoma. http://www.uptodate.com/home/index.html. Accessed May 7, 2009.
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- The basics of DCIS. Breastcancer.org. http://www.breastcancer.org/symptoms/types/dcis/basics.jsp. Accessed May 7, 2009.
- Can breast cancer be found early? American Cancer Society. http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_Can_breast_cancer_be_found_early_5.asp?rnav=cri. Accessed May 7, 2009.
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- How is breast cancer treated? American Cancer Society. http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Treatment_of_stage_0_breast_cancer.asp?rnav=cri. Accessed May 7, 2009.
- The emotional impact of a cancer diagnosis. American Cancer Society. http://www.cancer.org/docroot/MBC/content/MBC_4_1X_The_Emotional_Impact_of_A_Cancer_Diagnosis.asp?sitearea=MBC. Accessed May 7, 2009.
- What are the risk factors for breast cancer? American Cancer Society. http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_the_risk_factors_for_breast_cancer_5.asp?rnav=cri. Accessed May 7, 2009.
