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The role of breast MR imaging in pre-operative determination of invasive disease for ductal carcinoma in situ diagnosed by needle biopsy

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Abstract

Objectives

To evaluate whether magnetic resonance (MR) imaging features can predict the presence of occult invasion in cases of biopsy-proven pure ductal carcinoma in situ (DCIS).

Methods

We retrospectively reviewed 92 biopsy-proven pure DCIS in 92 women who underwent MR imaging. The following MR imaging findings were compared between confirmed DCIS and invasive breast cancer (IBC): lesion size, type, morphological and kinetic assessments by ACR BI-RADS MRI, and findings of fat-suppressed T2-weighted (FS-T2W) imaging.

Results

Sixty-eight of 92 (74%) were non-mass-like enhancements (NMLE) and 24 were mass lesions on MR imaging. Twenty-one of 68 (31%) NMLE and 13 of 24 (54%) mass lesions were confirmed as IBC. In NMLE lesions, large lesions (P = 0.007) and higher signal intensities (SI) on FS-T2W images (P = 0.032) were significantly associated with IBC. Lesion size remained a significant independent predictor of invasion in multivariate analysis (P = 0.032), and combined with FS-T2W SIs showed slightly higher observer performances (area under the curve, AUC, 0.71) than lesion size alone (AUC 0.68). There were no useful findings that enabled the differentiation of mass-type lesions.

Conclusions

Breast MR imaging is potentially useful to predict the presence of occult invasion in biopsy-proven DCIS with NMLE.

Key Points

  • MR mammography permits more precise lesion assessment including ductal carcinoma in situ

  • A correct diagnosis of occult invasion before treatment is important for clinicians

  • This study showed the potential of MR mammography to diagnose occult invasion

  • Treatment and/or aggressive biopsy can be given with greater confidence

  • MR mammography can lead to more appropriate management of patients

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Authors and Affiliations

  1. Departments of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi Hirokoji, Kamigyoku, 602-8566, Kyoto, Japan

    Mariko Goto, Sachiko Yuen, Kentaro Akazawa, Kaori Nishida & Kei Yamada

  2. Departments of Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Eiichi Konishi

  3. Departments of Radiology, Kyoto Breast Center Sawai Memorial Clinic, Kyoto, Japan

    Mariko Kajihara

  4. Departments of Surgery, Kyoto Breast Center Sawai Memorial Clinic, Kyoto, Japan

    Nobuhiko Shinkura

Authors
  1. Mariko Goto
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  2. Sachiko Yuen
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  3. Kentaro Akazawa
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  4. Kaori Nishida
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  5. Eiichi Konishi
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  6. Mariko Kajihara
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  7. Nobuhiko Shinkura
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  8. Kei Yamada
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Correspondence to Mariko Goto.

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Goto, M., Yuen, S., Akazawa, K. et al. The role of breast MR imaging in pre-operative determination of invasive disease for ductal carcinoma in situ diagnosed by needle biopsy. Eur Radiol 22, 1255–1264 (2012). https://doi.org/10.1007/s00330-011-2357-2

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  • DOI: https://doi.org/10.1007/s00330-011-2357-2

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