Benign, preinvasive and invasive ductal breast lesions. A comparative study with quantitative techniques: morphometry, image- and flow cytometry.

The histological distinction between ductal hyperplasia of the breast, atypical ductal hyperplasia and ductal carcinoma in situ is difficult and subjective. To gain a better understanding of these lesions, we performed a comparative study comprising 20 cases of ductal hyperplasia without atypia, 20 cases of ductal hyperplasia with atypia, and 30 cases of ductal carcinoma in situ (well-, moderately- and poorly-differentiated), using quantitative techniques: image cytometry analysis, morphometry and DNA analysis, and DNA flow cytometry. Our results confirm that the mean nuclear area and volume progressively decreased from ductal carcinoma in situ to ductal hyperplasia without atypia. The difference was significant (p < 0.05) when comparing hyperplasia without atypia with hyperplasia with atypia and hyperplasia with atypia with poorly differentiated ductal carcinoma in situ. Atypical ductal hyperplasia values were comparable to those of well-differentiated ductal carcinoma in situ. DNA image cytometry proved significant (p < 0.05) when comparing hyperplasia without atypia with hyperplasia with atypia and hyperplasia with atypia with moderately- and poorly-differentiated ductal carcinoma in situ. DNA flow cytometry revealed significant differences only in the distribution of the DNA ploidy patterns (p < 0.05) when comparing hyperplasia without atypia with moderately- and poorly-differentiated DCIS. A comparison of the results obtained by image and flow cytometry showed that in 90% of the cases the IC and FC values were coincident, whereas in the remaining cases the DNA index was aneuploid by IC and diploid by FC.