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For Information OnlyBreast

Grade I:3 to 5 points

Grade II:6 to 7 points

Grade III:8 to 9 points

E.Ductal Carcinoma In Situ

The following histologic features of ductal carcinoma in situ (DCIS) should be included in the pathology report8:

Nuclear Grade

Grade 1:Monotonous nuclei, 1.5 to 2.0 RBC diameters, with finely dispersed chromatin and only occasional nucleoli.

Grade 2:Neither nuclear grade 1 nor nuclear grade 3.

Grade 3:Markedly pleomorphic nuclei, usually greater than 2.5 RBC diameters, with coarse chromatin and prominent or multiple nucleoli.

Presence or Absence of Necrosis

Architectural Pattern(s)






Although not required for pT classification and stage assignment, the extent (size) of DCIS is an important factor in patient management. Mammographic assessment of DCIS, usually based on distribution of calcifications, frequently underestimates the size of DCIS.9 While precise measurement may be impossible on nonpalpable, grossly inapparent lesions, the pathologist should estimate the size or extent of DCIS and include this in the report. Methods for estimating the extent of DCIS include directly measuring the lesion when confined to a single histologic slide, determining size by submitting the entire specimen in sequence and in sections of uniform thickness, and estimating the percentage of tissue involved in relation to the total specimen.10

In breast carcinomas with both invasive and in situ components, the pathology report should specify whether an extensive intraductal component (EIC) is present. EIC is identified when DCIS comprises a substantial portion of the main tumor mass (approximately 25%) and extends into the surrounding breast parenchyma. Cases in which the lesion is primarily DCIS with foci of invasion are also classified as EIC.11 This finding is associated with an increased risk of local recurrence when the surgical margins are not evaluated or focally involved.12 The finding appears to have less significance when DCIS does not extend close to any of the margins following careful histologic evaluation.


If the biopsy is done for microcalcifications, their presence in the specimen must be confirmed by specimen radiography and microscopy. Ultimately, the pathologist must be satisfied that the lesion responsible for the calcifications is present in the specimen and that it has been examined microscopically. For biopsies showing calcifications, the relationship of the calcifications to the tumor should be indicated.

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