Screening mammography of a 55-year-old asymptomatic woman reveals a cluster of fine pleomorphic microcalcifications with no associated mass. Stereotactic core biopsy confirms high nuclear grade ductal carcinoma in situ with comedo necrosis. What is the standard surgical management?

• A Wide local excision alone
• B Wide local excision with adjuvant radiotherapy ✓
• C Simple mastectomy with sentinel node biopsy
• D Neoadjuvant chemotherapy followed by surgery

Explanation

Localised high-grade DCIS with comedo necrosis is treated with wide local excision to clear margins followed by whole breast radiotherapy, which roughly halves local recurrence risk. Excision alone is inadequate for high-grade disease with necrosis. Mastectomy is reserved for extensive, multicentric or diffuse microcalcification disease unsuitable for conservation. Sentinel node biopsy is not routine in pure DCIS because the risk of nodal metastasis is very low, and chemotherapy has no role in non-invasive disease.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.