The new pathological classification of DCIS (ductal carcinoma in situ) is based on cytonuclear atypia, degree of necrosis, size, and distance from margin/architecture. Low and intermediate grades DCIS require cytologic, architectural and size criteria to be met but high-grade DCIS requires only cytologic criteria; this is as follows:
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low grade
round, regular to mildly irregular nuclei up to 2-3 times the size of a red blood cell
no comedo necrosis
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intermediate grade
round, regular to mildly irregular nuclei up to 2-3 times the size of a red blood cell
substantial comedo necrosis
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high grade
pleomorphic nuclei more than 3 times the size of a red blood cell
substantial comedo necrosis usually present, but not required for the diagnosis
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