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Dr. Michael Lagios [pronounced Lay-os] is a pathologist in San Francisco who has for decades thoroughly and personally studied the breast cancers in his practice . His system is unusual in that the grades are in ascending Roman numerals from worst to best (almost all other cancer grading systems ascend from best to worst). The data in the table below are all relative to cases treated by CBS lumpectomy only and do not consider a margin parameter. Three parameters are noted: architectural features (histological subtype), Bloom-Richardson nuclear grade, and presence or absence of "comedo-type necrosis" [linear necrosis within central portions of neoplastic ducts].
| DCIS Histological subtype | Definition | local recurrence risk after CBS only recurrence per total of subtype | |
|---|---|---|---|
| grade I | comedo | high nuclear grade solid growth pattern +++ necrosis (comedo) | 7/31 (23%) |
| grade II | cribriform papillary with necrosis | high nuclear grade cribriform/papillary architecture +++ necrosis (comedo) | 2/5 (40%) |
| grade III | cribriform/ intermediate | intermediate nuclear grade cribriform architecture +/- necrosis (punctate) | 1/10 (10%) |
| grade IV | micropapillary (non-necrotic cribriform) | low nuclear grade micropapillary/cribriform architecture zero necrosis | 0/33 (0%) |
reference: Surg. Clinics N. A., 70 (4), August 1990.
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