Editing DCIS (section)

== Classification ==

* Grade
** Classify by highest grade present
** Key factors
*** nuclear pleomorphism
*** Nuclear size
*** Nuclear polarity
*** mitotic rate
*** presence of necrosis/calcification
*** solid architecture
** Not as simple as for IDC - can use the NHS Breast Screening Programme (NHS BSP)
*** Low: monomorphic cells, small nuclei, few mitoses, rare necrosis, retained polarity, cribriform or micropapillary architecture
*** Intermediate: moderate pleomorphism, mildly enlarged muclei, polarity largely maintained, solid, cribriform or micropapillary
*** High (60%): nuclear pleomorphism, large nuclei, frequent mitoses, comedo-type necrosis, loss of polarity, frequently solid
* Morphology
** Solid - malignant cells fill extended duct spaces
** Micropapillary - tufts of cells project into the duct lumen perpendicular to the basement membrane
** Papillary - projecting tufts are larger than the microvascular type and contain a fibrovascular core
** Cribriform - the arrangement of malignant cells takes on a fenestrated/sieve-like appearance
** 'Clinging' - single-layered, atypical epithelial cells lining the duct
** Rarer subtypes also exist
* Comedo necrosis presence or absence
** Central necrosis associated with DCIS, although exact definitions vary
** This leads to the microcalcifications
** Central necrosis has a tendency to appear as the cells inside the ductal membrane grow, which coagulates and eventually calcifies, causing the tiny, pleomorphic and frequently linear forms of microcalcifications seen on mammograms