MBBS OSCE · General Surgery
OSCE — Ductal Carcinoma In Situ
Eight-minute OSCE station on Ductal Carcinoma In Situ: focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Ductal Carcinoma In Situ.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Ductal carcinoma in situ (DCIS) is a non-invasive breast neoplasm in which malignant epithelial cells proliferate within the ductal-lobular system but do not breach the basement membrane. It is a non-obligate precursor of invasive ductal carcinoma — untreated, about 30 to 50% progress over 10 to 20 years, but many lesions never become invasive. With screening mammography, DCIS now makes up about 20 to 25% of all new breast cancer diagnoses and is nearly always detected as microcalcifications. Treatment: breast-conserving surgery (wide local excision with at least 2 mm clear margins) plus whole-breast radiotherapy, or mastectomy for large or multicentric disease. Tamoxifen for ER-positive DCI
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | DCIS by definition CANNOT metastasise to nodes or distant sites — but 10 to 20% |
| Safety | Clustered pleomorphic microcalcifications in a ductal distribution on screening |
| Safety | Unilateral bloodstained nipple discharge or Paget disease of the nipple — underl |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.