Focal areas of increased opacity in ductal carcinoma in situ of the comedo type: mammographic-pathologic correlation.

Abstract

To determine a histopathologic explanation for focal areas of increased opacity on mammograms of ductal carcinoma in situ of the comedo type (comedocarcinoma). From January 1991 to January 1993, mammograms from 36 patients with comedocarcinomas were reviewed. Each mammogram was screened for microcalcifications and/or any focal area of increased opacity. The presence or absence of infiltrating components was confirmed at pathologic examination, with particular emphasis placed on the search for any stromal reaction. The clinical examination revealed a palpable tumor in five patients (14%) and a bloody discharge from the nipple in two (5%). Isolated clusters of microcalcifications were seen at mammography in 24 patients (67%). Nine patients (25%) had clusters associated with focal areas of increased opacity; three patients (8%) had no microcalcifications. Histologic analysis demonstrated an intense, periductal, inflammatory reaction in all 12 patients with focal areas of increased opacity. Focal areas of increased opacity are not always indicative of an infiltrating component and may merely represent intense stromal reaction.