Ductal Carcinoma In Situ of the Breast: A Comparative Analysis of Histology, Nuclear Area, Ploidy, and Neovascularization Provides Differentiation Between Low- and High-Grade Tumors

Abstract

Ductal carcinoma in situ (DCIS) is a heterogeneous group of lesions that has been subdivided into three types: well differentiated (grade I), moderately differentiated (grade II), and poorly differentiated (grade III). Forty-five cases of DCIS were analyzed for image analysis: nuclear area, DNA ploidy, and vascularization in order to establish a more precise correlation between the histologic grade and these morphometric parameters. Our results confirm that the mean nuclear area, DNA ploidy, and microvessel density (MVD) progressively increased from DCIS grade I to DCIS grade III. The analysis of the nuclear area in relationship to DCIS grading demonstrated a progressive increase of values between grades I/II to grade III, but these data have no statistical significance. An analysis of DNA ploidy demonstrated significant differences between grades I/III (p < 0.05), but there was no statistical significance between grades I/II, grades II/III, or both (p > 0.005). The analysis of MVD was extremely significant between grades I/III (p < 0.001) and grades II/III (p < 0.001), but between grades I/II, these values showed no significant differences (p > 0.05). Based on this study, it can be concluded that image analysis techniques confirm how DCIS presents morphometric values that increase from DCIS grade I to DCIS grade III and that within this spectrum, DCIS grade III can be identified as a group of tumors presenting a large nuclear area, aneuploid DNA, and abundant vascular neogenesis, confirming that this neoplasm displays more aggressive patterns than the other two types. These criteria should justify a higher rate of tumor progression to DCIS grade III.

Significance of Periductal Lymphatic and Blood Vascular Densities in Intraductal Carcinoma of the Breast

“…In concordance with our study, Guidi et al found, using factor VIII-related antigen, significantly increased MD in IDC with comedonecrosis compared to those without comedonecrosis (33). Similarly, more recent studies supported the same conclusion (37)(38)(39).…”

“…Compared to IC, the studies for MD in IDC are relatively limited in the literature and have generally focused on blood vessel density (33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43). Only two relatively recent studies (dedicated mainly to investigate lymphangiogenesis in breast cancer) commented on lymphatic vascular density in IDC of the breast in comparison with other breast lesions and without correlating it with the different prognostic parameters within the IDC (10,11).…”

Sensitivity and Specificity of Unilateral Edema on T2w-TSE Sequences in MR-Mammography Considering 974 Histologically Verified Lesions

“…Regarding nuclear grading, there was a significant higher prevalence of edema in poorly differentiated carcinomas (G3) compared with well‐ and intermediate‐differentiated tumors (G1 and G2). Higher nuclear grading is associated with a more aggressive growth pattern, increased neoangiogenesis, and higher levels of proteolytic enzymes (23,28,31,32). According to the cited experimental literature and the statements above, a higher level of neoangiogenesis and proteolysis may be assumed in these cases.…”

Magnetic resonance imaging of breast lesions—a pathologic correlation

“…These findings indicate a lower MRI detection rate for DCIS compared to invasive ductal carcinoma. Pathologically it has been demonstrated that microvessel density differs with different grades of DCIS, with a higher microvessel density in the higher-grade lesions with comedo necrosis [59,60], and this is related to VEGF expression [61]. It would thus be reasonable to postulate that for low-grade DCIS, it is likely that absent contrast enhancement on MRI may be due to the lower angiogenetic activity.…”