What is the most common presentation of ductal carcinoma in situ (DCIS)?

Most Common Presentation of Ductal Carcinoma In Situ (DCIS)

The most common presentation of ductal carcinoma in situ (DCIS) is microcalcifications on mammography. This finding represents the primary way DCIS is detected in clinical practice.

Mammographic Presentations of DCIS

• Microcalcifications are the predominant presentation of DCIS, seen in approximately 75-98% of cases 1
• These calcifications typically appear pleomorphic (varying in size, form, and density) and are grouped in clusters, often with linear or segmental arrangements reflecting their presence within ducts 1
• The shape of calcification clusters is frequently irregular or triangular, suggesting a segmental or ductal distribution 1

Other Less Common Presentations

• Soft tissue changes without calcifications occur in approximately 22% of cases 1
• Mass lesions account for only about 8% of DCIS presentations 1
• Nodules or prominent ducts represent approximately 8% of presentations 1
• Other soft tissue changes account for roughly 6% of presentations 1
• Negative mammograms (no visible findings) occur in about 16% of DCIS cases 1

Ultrasound Findings in DCIS

• US can detect approximately 87% of DCIS lesions 1
• The most common ultrasound findings are nonmass abnormalities (64%), including hypoechoic areas (49%) and ductal abnormalities (10%) 1
• Masses account for about 36% of ultrasound-detected DCIS 1
• DCIS with microcalcifications on mammography shows ultrasound findings in 80% of cases 1

Clinical Presentations

• Palpable mass presentation is unusual for DCIS 1
• Breast pain is not a common presentation of DCIS
• Nipple discharge can occur but is not the primary presentation

Recurrence Patterns

• When DCIS recurs after treatment, 75% of recurrences present as microcalcifications 1
• 80% of patients whose initial DCIS presented with microcalcifications will have recurrences that also manifest as microcalcifications 1
• In 94% of cases, recurrent tumor calcifications have morphology similar to the initial DCIS 1

Clinical Implications

• The high prevalence of microcalcifications as the presenting sign of DCIS underscores the importance of thorough mammographic evaluation with magnification views 1
• Mammography may underestimate the extent of DCIS, particularly for low and intermediate-grade lesions, by up to 2 cm in as many as 50% of cases 1
• For accurate assessment, both mediolateral oblique and craniocaudal views should be obtained, along with magnification views 1

Based on the evidence presented, microcalcifications on mammography (option d) is clearly the most common presentation of ductal carcinoma in situ.