J Korean Soc Radiol.  2019 Nov;80(6):1203-1213. 10.3348/jksr.2019.80.6.1203.

MRI Criteria for Predicting Invasive Lesions in Biopsy-Proven Ductal Carcinoma in Situ

• Lee J
• Park KW
• Ko EY
• Han BK
• Ko ES
• Choi JS
• Nam M
• Cho SY

• KMID: 2464917
• DOI: http://doi.org/10.3348/jksr.2019.80.6.1203

Abstract

PURPOSE
To evaluate the criteria for predicting invasive lesions with preoperative breast MRI in ductal carcinoma in situ (DCIS) histopathologically diagnosed with biopsy.
MATERIALS AND METHODS
We retrospectively analyzed the preoperative MRI findings of 80 percutaneous biopsy-proven DCIS. The morphological type, enhancement distribution and kinetics, and extent of the lesions were analyzed. We compared the results of pure DCIS and DCIS with invasive lesions. We evaluated the MRI criteria for predicting DCIS with invasive lesions and assessed its diagnostic performance.
RESULTS
Of the 80 DCIS lesions analyzed, 27 contained co-existing invasive lesions and 49 were pure DCIS. No residual lesions after biopsy were seen in 4 cases. DCIS with invasive lesions showed washout kinetics more frequently and to a larger extent than did pure DCIS (p = 0.030 and p = 0.048, respectively). Using enhancement kinetics and the lesion cut-off value of 4 cm yielded the highest diagnostic performance, with 92.6% sensitivity and 93.8% negative predictive value for predicting invasive lesions.
CONCLUSION
Washout kinetics and the lesion extent of at least 4 cm are useful criteria for the prediction of co-existing invasive lesions in patients with DCIS diagnosed with biopsy.

MeSH Terms

Biopsy
Breast
Carcinoma, Ductal*
Carcinoma, Intraductal, Noninfiltrating*
Humans
Kinetics
Magnetic Resonance Imaging*
Retrospective Studies

Figure

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  Fig. 1 A 43-year-old woman without any subjective symptoms showed 5 cm of pure ductal carcinoma in situ after the surgery. A. Preoperative spot-magnification mammography shows a segmental distribution of microcalcifications (arrows). B. Preoperative ultrasonography shows subtle parenchymal heterogeneity (arrows). C-E. Dynamic contrast-enhanced MRI (pre-contrast enhanced (C), 2 min (D) and 7 min (E) after contrast injection) show no evidence of abnormal enhancement around the post-biopsy change (arrows).

• 

  Fig. 2 A 56-year-old woman with a palpable mass in her left breast showed ductal carcinoma in situ with three invasive ductal carcinomas (2, 0.2, and 0.1 cm) after the surgery. A, B. Mammography (A) and ultrasonography show ill-defined mass-like lesions with microcalcifications (B, arrows). C. Dynamic contrast-enhanced MRI (pre-contrast enhanced image, post-contrast 2 min and 7 min images) show 8 cm heterogeneous nonmass enhancement with early enhancement and washout (arrows).

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  Fig. 3 A 62-year-old woman without any subjective symptoms showed 2 cm of pure ductal carcinoma in situ after the surgery. A. Mammography shows a segmental distribution of fine linear and coarse heterogeneous microcalcifications (arrow). B. Preoperative ultrasonography shows parenchymal heterogeneity with internal echogenic dots (arrows). C. Dynamic contrast-enhanced MRI (pre-contrast enhanced image, post-contrast 2 min and 7 min images) show 5 cm mass with gradual enhancement (arrows).

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