Differentiation of ductal carcinoma in situ versus fibrocystic changes by magnetic resonance imaging: are there pathognomonic imaging features?

Abstract

Background

In breast magnetic resonance imaging (MRI), the diagnosis of ductal carcinoma in situ (DCIS) remains controversial; the most challenging cause of false-positive DCIS diagnosis is fibrocystic changes (FC).

Purpose

To search for typical and pathognomonic patterns of DCIS and FC using a standard clinical MRI protocol.

Material and Methods

Consecutive patients scheduled for breast MRI (standardized protocols @ 1.5T: dynamic-T1-GRE before/after Gd-DTPA [0.1 mmol/kg body weight (BW)]; T1-TSE), with subsequent pathological sampling, were investigated. Sixteen MRI descriptors were prospectively assessed by two experienced radiologists in consensus (blinded to pathology) and explored in patients with DCIS (n = 77) or FC (n = 219). Univariate and multivariate statistics were performed to identify the accuracy of descriptors (alone, combined). Furthermore, pathognomonic descriptor-combinations with an accuracy of 100% were explored (χ² statistics; decision trees).

Results

Six breast MRI descriptors significantly differentiated DCIS from FC (P_corrected < 0.05; odds ratio < 7.9). Pathognomonic imaging features were present in 33.8% (n = 100) of all cases allowing the identification of 42.9% of FC (n = 94).

Conclusion

Pathognomonic patterns of DCIS and FC were frequently observed in a standard clinical MRI protocol. Such imaging patterns could decrease the false-positive rate of breast MRI and hence might help to decrease the number of unnecessary biopsies in this clinically challenging subgroup.

Keywords

Magnetic resonance imaging ductal carcinoma in situ (DCIS)fibrocystic changes diagnostic accuracy breast cancer

Get full access to this article

View all access options for this article.

References

Narod

Iqbal

Giannakeas

et al.

Breast cancer mortality after a diagnosis of ductal carcinoma in situ. JAMA Oncol 2015; 1: 888–896.

Kuerer

Albarracin

Yang

et al.

Ductal carcinoma in situ: state of the science and roadmap to advance the field. J Clin Oncol Off J Am Soc Clin Oncol 2009; 27: 279–288.

Sardanelli

Boetes

Borisch

et al.

Magnetic resonance imaging of the breast: recommendations from the EUSOMA working group. Eur J Cancer Oxf Engl 1990 2010; 46: 1296–1316.

Mann

Kuhl

Kinkel

et al.

Breast MRI: guidelines from the European Society of Breast Imaging. Eur Radiol 2008; 18: 1307–1318.

Guidi

Schnitt

Fischer

et al.

Vascular permeability factor (vascular endothelial growth factor) expression and angiogenesis in patients with ductal carcinoma in situ of the breast. Cancer 1997; 80: 1945–1953.

Engels

Fox

Whitehouse

et al.

Distinct angiogenic patterns are associated with high-grade in situ ductal carcinomas of the breast. J Pathol 1997; 181: 207–212.

Jansen

Paunesku

Fan

et al.

Ductal carcinoma in situ: X-ray fluorescence microscopy and dynamic contrast-enhanced MR imaging reveals gadolinium uptake within neoplastic mammary ducts in a murine model. Radiology 2009; 253: 399–406.

Chen

Nalcioglu

. Fibrocystic change of the breast presenting as a focal lesion mimicking breast cancer in MR imaging. J Magn Reson Imaging 2008; 28: 1499–1505.

van den Bosch

MAAJ

Daniel

Mariano

et al.

Magnetic resonance imaging characteristics of fibrocystic change of the breast. Invest Radiol 2005; 40: 436–441.

10.

Kreienberg R, Albert S, Folkman M, et al. Interdisziplinäre S3-Leitlinie für die Diagnostik, Therapie und Nachsorge des Mammakarzinoms. Langversion 3.0. Berlin: Leitlinienprogramm Onkologie, 2012. Available at: http://www.awmf.org/uploads/tx_szleitlinien/032-045OL_k_S3__Brustkrebs_Mammakarzinom_Diagnostik_Therapie_Nachsorge_2012-07.pdf (20 January 2017).

11.

Morris

Comstock

Lee

et al.

ACR BI-RADS® Magnetic Resonance Imaging. In: Creech

Priscilla

Wiegmann

et al. (eds). ACR BI-RADS® Atlas Breast Imaging Report Data Syst, 5th ed. Reston, VA: American College of Radiology, 2013, pp. 372–558.

12.

Marino

Clauser

Woitek

et al.

A simple scoring system for breast MRI interpretation: does it compensate for reader experience?

Eur Radiol 2016; 26: 2529–2537.

13.

Dietzel

Baltzer

Vag

et al.

Magnetic resonance mammography in small vs. advanced breast lesions - systematic comparison reveals significant impact of lesion size on diagnostic accuracy in 936 histologically verified breast lesions. RoFo 2011; 183: 126–135.

14.

Baltzer

PAT

Dietzel

Kaiser

. A simple and robust classification tree for differentiation between benign and malignant lesions in MR-mammography. Eur Radiol 2013; 23: 2051–2060.

15.

Guillaume

Taieb

Ceugnart

et al.

BIRADS 3 MRI lesions: Was the initial score appropriate and what is the value of the blooming sign as an additional parameter to better characterize these lesions?

Eur J Radiol 2016; 85: 337–345.

16.

Dietzel

Baltzer

Vag

et al.

Magnetic resonance mammography of invasive lobular versus ductal carcinoma: systematic comparison of 811 patients reveals high diagnostic accuracy irrespective of typing. J Comput Assist Tomogr 2010; 34: 587–595.

17.

Dietzel

Baltzer

PAT

Vag

et al.

Application of breast MRI for prediction of lymph node metastases–systematic approach using 17 individual descriptors and a dedicated decision tree. Acta Radiol 2010; 51: 885–894.

18.

Dietzel

Kaiser

Baltzer

PAT

. Magnetic resonance imaging of intraductal papillomas: typical findings and differential diagnosis. J Comput Assist Tomogr 2015; 39: 176–184.

19.

Kuhl

Schrading

Bieling

et al.

MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational study. Lancet 2007; 370: 485–492.

20.

Doyle

Prakash

Wang

et al.

DCIS of the breast: The value of preoperative MRI. J Med Imaging Radiat Oncol 2016; 60: 194–198.

21.

Proulx

Correa

Ferré

et al.

Value of pre-operative breast MRI for the size assessment of ductal carcinoma in situ. Br J Radiol 2016; 89: 20150543–20150543.

22.

Fancellu

Turner

Dixon

et al.

Meta-analysis of the effect of preoperative breast MRI on the surgical management of ductal carcinoma in situ. Br J Surg 2015; 102: 883–893.

23.

Gutierrez

DeMartini

Eby

et al.

BI-RADS lesion characteristics predict likelihood of malignancy in breast MRI for masses but not for nonmasslike enhancement. Am J Roentgenol 2009; 193: 994–1000.

24.

Baltzer

PAT

Benndorf

Dietzel

et al.

False-positive findings at contrast-enhanced breast MRI: a BI-RADS descriptor study. Am J Roentgenol 2010; 194: 1658–1663.

25.

Rahbar

Partridge

Eby

et al.

Characterization of ductal carcinoma in situ on diffusion weighted breast MRI. Eur Radiol 2011; 21: 2011–2019.

26.

Baltzer

Dietzel

Kaiser

et al.

Combined reading of Contrast Enhanced and Diffusion Weighted Magnetic Resonance Imaging by using a simple sum score. Eur Radiol 2015; 26: 884–891.

27.

Elshof

Tryfonidis

Slaets

et al.

Feasibility of a prospective, randomised, open-label, international multicentre, phase III, non-inferiority trial to assess the safety of active surveillance for low risk ductal carcinoma in situ – The LORD study. Eur J Cancer Oxf Engl 1990 2015; 51: 1497–1510.

28.

Dietzel

Baltzer

Vag

et al.

Potential of MR mammography to predict tumor grading of invasive breast cancer. RoFo 2011; 183: 826–833.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.45 MB