Objective. Ductal carcinoma in situ (DCIS) of the breast is
becoming more and more frequent in women after the introduction
of breast screening programmes. Once the diagnosis
is confirmed on the surgical specimen, its prognosis is excellent,
but still some tumours recur as in situ or even invasive
neoplasms in the same or contralateral breast.
Neoductgenesis (NGD), defined by László Tabár and Tibor
Tot as the presence of “casting type” calcifications on mammography,
an abnormal number of ducts, periductal desmoplastic
reaction and lymphocytic infiltrate, has been proposed
as a marker of aggressiveness in “early” breast carcinoma
(1 2). We analysed this phenomenon in pure DCIS by correlating
its presence with clinical and instrumental findings,
morphological and immunohistochemical features, and with
patients’ prognosis.
Materials and Methods. We selected 199 cases of breast
DCIS undergone surgery between 2004 and 2016, available
at the Unit of Pathology of the Academic Hospital of Trieste,
and performed a re-evaluation of the histological slides in
order to define the presence or absence of NDG, based on the
morphological features previously described2. Furthermore,
a subgroup of 64 cases underwent radiological review by
two expert radiologists (AF, MT) in order to re-classify the
mammographic findings according to specific types of calcifications1.
The correlation between morphological NDG,
casting type calcifications and prognostic markers of breast
DCIS, such as extension, grade and expression of hormonal
receptors and HER2-neu, as well as with disease recurrence,
was evaluated through Chi-Square independence test or Fisher
test as appropriate.
Results. NDG was identified in 33 cases (16.6%) and was
found to be positively associated with the larger size of lesions
on mammography (p=0.008), histological high grade
(p<0.001), presence of necrosis (p<0.001), low expression
of hormonal receptors (p<0.001), HER2-neu overexpression
(p=0.005) and high proliferative index (p<0.001). Casting
type calcifications were present in 54% of DCIS with NDG
and 44% of DCIS without NDG (p=0.70). They were also
found in 63% of DCIS with comedo type necrosis versus 35%
of DCIS without comedo necrosis (p=0.07). Nine patients
(4.64%) developed disease recurrences during the follow-up
and among them 5 had tumours with the morphological features
of NDG.
Conclusions. Consistent with literature, the morphological
features of NDG were able to identify lesions with an “aggressive”
biological phenotype. Interestingly, NDG was found to
positively correlate with disease recurrences in patients with
pure DCIS.
