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Breast pathology: rationale for adopting the ductal intraepithelial neoplasia (DIN) classification

Nature Clinical Practice Oncology volume 2, pages 116–117 (2005)Cite this article

The widespread use of screening mammography has resulted in a significant increase in detection of clinically occult invasive and non-invasive breast carcinomas. The impact of screening has also extended to the presentation and morphologic subtypes of ductal carcinoma in situ (DCIS), as well as the treatment and survival of women with DCIS. Most importantly, advanced imaging techniques have led to detection of a variety of intraductal proliferations/alterations of unknown or poorly understood clinical and biologic significance, thereby unmasking the deficiencies of the current classification system.

Traditionally, highly heterogeneous intraductal proliferative lesions have been subdivided into non-cancer—intraductal hyperplasia (IDH) and atypical intraductal hyperplasia (AIDH)—and cancer—DCIS, grades 1, 2 and 3. This classification implies a multistep model of carcinogenesis, with a transition from normal to invasive carcinoma via IDH, AIDH, and grades 1 to 3 DCIS. Some invasive breast carcinomas may go through this stepwise progression, but molecular alterations observed in grade 1 DCIS are significantly different from those observed in high-grade DCIS, suggesting independent pathways. Grade 1 DCIS progresses to a well-differentiated invasive carcinoma; both the in situ and invasive carcinomas show loss of 16q. Grade 3 DCIS generally progresses to a high-grade invasive carcinoma, but the chromosomal alterations are most frequently at 13q, 17q and 20q in both the in situ and the invasive lesions.

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  1. Professor of Pathology and Director of the Women's Health Program/Gynecology and Breast Pathology at Yale University School of Medicine,

    Fattaneh A Tavassoli

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  1. Fattaneh A Tavassoli
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Tavassoli, F. Breast pathology: rationale for adopting the ductal intraepithelial neoplasia (DIN) classification. Nat Rev Clin Oncol 2, 116–117 (2005). https://doi.org/10.1038/ncponc0109

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