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ASBS: Ductal Carcinoma in Situ Margins Present Three-Dimensional Challenge By Norra MacReady LOS ANGELES, CA -- March 24, 2005 -- Properly excised margins are critical in the analysis of ductal carcinoma in situ (DCIS) specimens, according to a presentation at the 6th annual meeting of the American Society of Breast Surgeons. Margin status is a "3-dimensional puzzle that has been aided greatly by mammographic and other imaging correlations, although those methods still aren't perfect," said Dr. Page, professor of pathology and epidemiology, Vanderbilt University Hospital, Nashville, Tennessee, United States. Every lesion is different and demands a different approach to sampling, he explained here on March 20th. The sample must be oriented properly and labeled so the pathologist knows what to look for. The tumor's growth pattern, size, and 3-dimensional margin status are other factors essential to obtaining a good specimen. A long, irregular tumor that involves more than one duct system demands a different approach than a tumor that is shaped more regularly and confined to a single duct. Knowing the segmental anatomy of the breast is also important. In general, "margins trump, but are very dependent on the type and extent of the DCIS," Dr. Page said. Most DCIS seen today are relatively small, ranging from 5 to 15 mm, with 7-8 mm being the most common size, and limited to one duct. In those cases, the pathologist takes 12 blocks of tissue that completely encompass the lesion and the relevant duct system. If the margins and the first and last cut are completely free of malignant cells, the tumor is usually excised completely and no further treatment is necessary. Long-term studies have shown that local excision usually is sufficient for most small tumors 3 mm to 1 cm in size, depending on their grade and pattern of spread. Local recurrences usually appear at the site of the original lesion, suggesting that the excision was inadequate. Larger tumors present more of a problem, Dr. Page said. "Many large DCIS have extensive, irregular, and sometimes a pagetoid pattern," which make them more challenging to excise, he explained. However, cases like that are uncommon today. The differential diagnosis of DCIS is another critical element in margin assessment. It should include atypical ductal hyperplasia (ADH), and complex ADH with enlarged lobular units. Papillomas and sclerosing lesions should also be considered, as should high-grade and micropapilloma patterns of DCIS, especially if the tumor is large, Dr. Page concluded. [Presentation title: "Margins and SLN Processing in 15 Minutes."] E-mail this page to a friend or colleague! To print, use this version