Atypical presentations of screen-detected DCIS implications for pre-operative assessment and surgical intervention

Few series are published on DCIS that forms parenchymal lesions on screening mammograms. The implications of these unusual presentations for preoperative assessment and surgical intervention are of interest. In the setting of a Large, population-based breast cancer screening program, the diagnostic and management implications of DCIS presenting as parenchymal lesions on screening mammograms are investigated. A total of 125 lesions (20.1% of all DCIS) presented as a mass (n=99) or microcalcifications with an associated parenchymal Lesion (n = 26). Cytology was positive in 47.1% of cases. Core biopsy diagnosed DCIS in 68.4% of cases. Breast surgery after a definite preoperative diagnosis achieved negative initial margins in 69.4% case, versus 54.7% without a pre-operative malignant diagnosis. The mastectomy rate was 26.4%. Axillary surgery was carried out in 32.8% cases, including axillary clearance in 26.4% of cases. One in five cases of DCIS detected during mammographic screening has features other than pure microcalcifications. This has implications for pre-operative assessment and surgical management. Crown Copyright (C) 2006 Published by Elsevier Ltd. All rights reserved.