scholarly journals Clumped vs non-clumped internal enhancement patterns in linear non-mass enhancement on breast MRI

2020 ◽  
pp. 20201166
Author(s):  
Shu Tian Chen ◽  
James Covelli ◽  
Satoko Okamoto ◽  
Bruce L Daniel ◽  
Wendy B DeMartini ◽  
...  
Keyword(s):  
Breast Biopsy ◽  
Ductal Carcinoma ◽  
Univariate Analysis ◽  
Breast Mri ◽  
Lesion Size ◽  
Predictive Values ◽  
Institutional Review ◽  
Average Size ◽  
Mass Enhancement

Objective: To compare positive predictive values (PPVs) of clumped vs non-clumped (homogenous and heterogeneous) internal enhancement on MRI detected linear non-mass enhancement (NME) on MRI-guided vacuum-assisted breast biopsy (MRI-VABB). Methods: With IRB (Institutional Review Board) approval, we retrospectively reviewed 598 lesions undergoing MRI-VABB from January 2015 to April 2018 that showed linear NME. We reviewed the electronic medical records for MRI-VABB pathology, any subsequent surgery and clinical follow-up. The X2 test was performed for univariate analysis. Results: There were 120/598 (20%) linear NME MRI-VABB lesions with clumped (52/120, 43%) vs non-clumped (68/120, 57%) internal enhancement, average size 1.8 cm (range 0.6–7.6 cm). On MRI-VABB, cancer was identified in 22/120 (18%) lesions, ductal carcinoma in situ (DCIS) was found in 18/22 (82%) and invasive cancer in 4 (18%). 3/31 (10%) high-risk lesions upgraded to DCIS at surgery, for a total of 25/120 (21%) malignancies. Malignancy was found in 12/52 (23%) clumped lesions and in 13/68 (19%) of non-clumped lesions that showed heterogeneous (5/13, 38%) or homogenous (8/13, 62%) internal enhancement. The PPV of linear NME with clumped internal enhancement (23.1%) was not significantly different from the PPV of non-clumped linear NME (19.1%) (p = 0.597). The PPV of linear NME lesions <1 cm (33.3%) was not significantly different from the PPV of lesions ≥1 cm (18.6%) (p = 0.157). Conclusions: Linear NME showed malignancy in 21% of our series. Linear NME with clumped or non-clumped internal enhancement patterns, regardless of lesion size, might need to undergo MRI-VABB in appropriate populations. Advances in knowledge: Evaluation of linear NME lesions on breast MRI focuses especially on internal enhancement pattern.

scholarly journals Intraductal Papilloma Without Atypia on Image- Guided Breast Biopsy: Upgrade Rates to Carcinoma at Surgical Excision

Breast Care ◽  
2018 ◽  
Vol 13 (5) ◽  
pp. 364-368 ◽  
Author(s):  
Doris Leithner ◽  
Benjamin Kaltenbach ◽  
Petra Hödl ◽  
Volker Möbus ◽  
Volker Brandenbusch ◽  
...  
Keyword(s):  
Needle Biopsy ◽  
Breast Biopsy ◽  
Ductal Carcinoma ◽  
Statistical Tests ◽  
Menopausal Status ◽  
Surgical Excision ◽  
Lesion Size ◽  
Intraductal Papilloma ◽  
Image Guided ◽  
Institutional Review

Background: The management of intraductal papilloma without atypia (IDP) in breast needle biopsy remains controversial. This study investigates the upgrade rate of IDP to carcinoma and clinical and radiologic features predictive of an upgrade. Methods: Patients with a diagnosis of IDP on image-guided (mammography, ultrasound, magnetic resonance imaging) core needle or vacuum-assisted biopsy and surgical excision of this lesion at a certified breast center between 2007 and 2017 were included in this institutional review board-approved retrospective study. Appropriate statistical tests were performed to assess clinical and radiologic characteristics associated with an upgrade to malignancy at excision. Results: For 60 women with 62 surgically removed IDPs, the upgrade rate to malignancy was 16.1% (10 upgrades, 4 invasive ductal carcinoma, 6 ductal carcinoma in situ). IDPs with upgrade to carcinoma showed a significantly greater distance to the nipple (63.5 vs. 36.8 mm; p = 0.012). No significant associations were found between upgrade to carcinoma and age, menopausal status, lesion size, microcalcifications, BI-RADS descriptors, initial BI-RADS category, and biopsy modality. Conclusion: The upgrade rate at excision for IDPs diagnosed with needle biopsy was higher than expected according to some guideline recommendations. Observation only might not be appropriate for all patients with IDP, particularly for those with peripheral IDP.

scholarly journals Predictive factors for the presence of invasive components in patients diagnosed with ductal carcinoma in situ based on preoperative biopsy

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Kwan Ho Lee ◽  
Jeong Woo Han ◽  
Eun Young Kim ◽  
Ji Sup Yun ◽  
Yong Lai Park ◽  
...  
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Preoperative Diagnosis ◽  
Ductal Carcinoma ◽  
Univariate Analysis ◽  
Breast Mri ◽  
Nuclear Grade ◽  
Preoperative Biopsy ◽  
Areolar Complex

Abstract Background In patients diagnosed with ductal carcinoma in situ (DCIS) with needle biopsy before surgery, invasive component (IC) is often found in the postoperative tissue, which results in altered post-surgical care. However, there are no clinically available factors to predict IC, and few MRI studies are available for the detection of IC in DCIS patients. The purpose of this study was to evaluate which risk factors can predict IC preoperatively. Methods Patients with a DCIS diagnosis based on preoperative biopsy, who underwent breast surgery Kangbuk Samsung Hospital between Jan 2005 and June 2018, were retrospectively evaluated. Clinico-pathological and breast MRI factors were compared between DCIS and DCIS with IC in postsurgical specimens. Results Of the 431 patients with a preoperative diagnosis of DCIS, 34 (7.9%) showed IC during the postoperative pathological investigations, and 217 (50.3%) underwent breast MRI. Among MRI-related factors, Mass-like enhancement on MRI was the sole but significant predictor of IC (HR = 0.26, C.I. = 0.07–0.93, p = 0.038), while nipple-areolar complex invasion, enhancement peak and pattern were not statistically significant. Nuclear grade was the only significant predictor of IC in the analysis of other clinico-pathological factors (HR = 2.39, C.I. = 1.05–5.42, p = 0.038 in univariate analysis, HR = 2.86, C.I. = 1.14–7.14, p = 0.025 in multivariate analysis). Conclusions Mass-like enhancement on MRI and high nuclear grade were associated with IC in patients with preoperative diagnosis of DCIS. Considering the high sensitivity of breast MRI for IC, further evaluation of the predictive value of MRI in preoperative DCIS patients is desirable.

scholarly journals Atypical Ductal Hyperplasia after Vacuum-Assisted Breast Biopsy: Can We Reduce the Upgrade to Breast Cancer to an Acceptable Rate?

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1120
Author(s):  
Luca Nicosia ◽  
Antuono Latronico ◽  
Francesca Addante ◽  
Rossella De Santis ◽  
Anna Carla Bozzini ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Invasive Carcinoma ◽  
Breast Biopsy ◽  
Ductal Carcinoma ◽  
Atypical Ductal Hyperplasia ◽  
Univariate Analysis ◽  
Surgical Excision ◽  
P Value ◽  
Ductal Hyperplasia

(1) Background: to evaluate which factors can reduce the upgrade rate of atypical ductal hyperplasia (ADH) to in situ or invasive carcinoma in patients who underwent vacuum-assisted breast biopsy (VABB) and subsequent surgical excision. (2) Methods: 2955 VABBs were reviewed; 141 patients with a diagnosis of ADH were selected for subsequent surgical excision. The association between patients’ characteristics and the upgrade rate to breast cancer was evaluated in both univariate and multivariate analyses. (3) Results: the upgrade rates to ductal carcinoma in situ (DCIS) and invasive carcinoma (IC) were, respectively, 29.1% and 7.8%. The pooled upgrade rate to DCIS or IC was statistically lower at univariate analysis, considering the following parameters: complete removal of the lesion (p-value < 0.001); BIRADS ≤ 4a (p-value < 0.001); size of the lesion ≤15 mm (p-value: 0.002); age of the patients <50 years (p-value: 0.035). (4) Conclusions: the overall upgrade rate of ADH to DCIS or IC is high and, as already known, surgery should be recommended. However, ADH cases should always be discussed in multidisciplinary meetings: some parameters appear to be related to a lower upgrade rate. Patients presenting these parameters could be strictly followed up to avoid overtreatment.

scholarly journals A Model to Predict Upstaging to Invasive Carcinoma in Patients Preoperatively Diagnosed with Low-grade Ductal Carcinoma In Situ of the Breast

2021 ◽  
Author(s):  
Luca Nicosia ◽  
Anna Carla Bozzini ◽  
Silvia Penco ◽  
Chiara Trentin ◽  
Maria Pizzamiglio ◽  
...  
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Invasive Carcinoma ◽  
Breast Biopsy ◽  
Ductal Carcinoma ◽  
Univariate Analysis ◽  
Surgical Excision ◽  
Low Grade ◽  
Multivariable Model

Background: We aimed to create a model of radiological and pathological criteria able to predict the upgrade rate of low-grade ductal carcinoma in situ (DCIS) to invasive carcinoma, in patients undergoing vacuum-assisted breast biopsy (VABB) and subsequent surgical excision. Methods: 3100 VABBs were retrospectively reviewed among which we reported 295 low-grade DCIS who subsequently underwent surgery. The association between patients&rsquo; features and the upgrade rate to invasive breast cancer (IBC) was evaluated by univariate analysis. Finally, we developed a predictive multivariable model based on the features which were significantly associated with the univariate analysis outcome. Results: the upgrade rate to invasive carcinoma was 10.8 %. At univariate analysis, the risk of upgrade was significantly lower in the absence of post- biopsy residual lesion (p&lt;0.001), age &gt; 50 (p=0.029), and in presence of low-grade DCIS only in specimens with microcalcifications (p=0.002). According to the final multivariable model, the predicted probability of diagnostic underestimation for a patient with all the three favourable features selected at univariate analysis was 1% (95% CI: 0.3%-4%). Conclusions: An easy to use predictive model of radiological and pathological criteria is able to identify patients with low-grade carcinoma in situ with low risk of upstaging to infiltrating carcinomas.

scholarly journals Predictive factors for the presence of invasive components in patients diagnosed with ductal carcinoma in situ based on preoperative biopsy

2019 ◽  
Author(s):  
Kwan Ho Lee ◽  
Jeong Woo Han ◽  
Eun Young Kim ◽  
Ji Sup Yun ◽  
Yong Lai Park ◽  
...  
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Preoperative Diagnosis ◽  
Ductal Carcinoma ◽  
Univariate Analysis ◽  
Breast Mri ◽  
Nuclear Grade ◽  
Preoperative Biopsy ◽  
Areolar Complex

Abstract Background In patients diagnosed with ductal carcinoma in situ (DCIS) with needle biopsy before surgery, invasive component (IC) is often found in the postoperative tissue, which results in altered post-surgical care. However, there are no clinically available factors to predict IC, and few MRI studies are available for the detection of IC in DCIS patients. The purpose of this study was to evaluate which risk factors can predict IC preoperatively.Methods Patients with a DCIS diagnosis based on preoperative biopsy, who underwent breast surgery Kangbuk Samsung Hospital between Jan 2005 and June 2018, were retrospectively evaluated. Clinico-pathological and breast MRI factors were compared between DCIS and DCIS with IC in postsurgical specimens.Results Of the 431 patients with a preoperative diagnosis of DCIS, 34 (7.9%) showed IC during the postoperative pathological investigations, and 217 (50.3%) underwent breast MRI. Among MRI-related factors, Mass-like enhancement on MRI was the sole but significant predictor of IC (HR=0.26, C.I.=0.07-0.93, p=0.038), while nipple-areolar complex invasion, enhancement peak and pattern were not statistically significant. Nuclear grade was the only significant predictor of IC in the analysis of other clinico-pathological factors (HR=2.39, C.I.=1.05-5.42, p=0.038 in univariate analysis, HR=2.86, C.I.=1.14-7.14, p=0.025 in multivariate analysis).Conclusions Mass-like enhancement on MRI and high nuclear grade were associated with IC in patients with preoperative diagnosis of DCIS. Considering the high sensitivity of breast MRI for IC, further evaluation of the predictive value of MRI in preoperative DCIS patients is desirable.

scholarly journals A Model to Predict Upstaging to Invasive Carcinoma in Patients Preoperatively Diagnosed with Low-Grade Ductal Carcinoma In Situ of the Breast

Cancers ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 370
Author(s):  
Luca Nicosia ◽  
Anna Carla Bozzini ◽  
Silvia Penco ◽  
Chiara Trentin ◽  
Maria Pizzamiglio ◽  
...  
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Invasive Carcinoma ◽  
Breast Biopsy ◽  
Ductal Carcinoma ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Model ◽  
Low Grade ◽  
Residual Lesion

Background: We aimed to create a model of radiological and pathological criteria able to predict the upgrade rate of low-grade ductal carcinoma in situ (DCIS) to invasive carcinoma, in patients undergoing vacuum-assisted breast biopsy (VABB) and subsequent surgical excision. Methods: A total of 3100 VABBs were retrospectively reviewed, among which we reported 295 low-grade DCIS who subsequently underwent surgery. The association between patients’ features and the upgrade rate to invasive breast cancer (IBC) was evaluated by univariate and multivariate analysis. Finally, we developed a nomogram for predicting the upstage at surgery, according to the multivariate logistic regression model. Results: The overall upgrade rate to invasive carcinoma was 10.8%. At univariate analysis, the risk of upgrade was significantly lower in patients with greater age (p = 0.018), without post-biopsy residual lesion (p < 0.001), with a smaller post-biopsy residual lesion size (p < 0.001), and in the presence of low-grade DCIS only in specimens with microcalcifications (p = 0.002). According to the final multivariable model, the predicted probability of upstage at surgery was lower than 2% in 58 patients; among these 58 patients, only one (1.7%) upstage was observed, showing a good calibration of the model. Conclusions: An easy-to-use nomogram for predicting the upstage at surgery based on radiological and pathological criteria is able to identify patients with low-grade carcinoma in situ with low risk of upstaging to infiltrating carcinomas.

scholarly journals Predictive factors for the presence of invasive components in patients diagnosed with ductal carcinoma in situ based on preoperative biopsy

2019 ◽  
Author(s):  
Kwan Ho Lee ◽  
Jeong Woo Han ◽  
Eun Young Kim ◽  
Ji Sup Yun ◽  
Yong Lai Park ◽  
...  
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Preoperative Diagnosis ◽  
Ductal Carcinoma ◽  
Univariate Analysis ◽  
Breast Mri ◽  
Nuclear Grade ◽  
Preoperative Biopsy ◽  
Areolar Complex

Abstract Background In patients diagnosed with ductal carcinoma in situ (DCIS) with needle biopsy before surgery, invasive component (IC) is often found in the postoperative tissue, which results in altered post-surgical care. However, there are no clinically available factors to predict IC, and few MRI studies are available for the detection of IC in DCIS patients. The purpose of this study was to evaluate which risk factors can predict IC preoperatively.Methods Patients with a DCIS diagnosis based on preoperative biopsy, who underwent breast surgery Kangbuk Samsung Hospital between Jan 2005 and June 2018, were retrospectively evaluated. Clinico-pathological and breast MRI factors were compared between DCIS and DCIS with IC in postsurgical specimens.Results Of the 431 patients with a preoperative diagnosis of DCIS, 34 (7.9%) showed IC during the postoperative pathological investigations, and 217 (50.3%) underwent breast MRI. Among MRI-related factors, Mass-like enhancement on MRI was the sole but significant predictor of IC (HR=0.26, C.I.=0.07-0.93, p=0.038), while nipple-areolar complex invasion, enhancement peak and pattern were not statistically significant. Nuclear grade was the only significant predictor of IC in the analysis of other clinico-pathological factors (HR=2.39, C.I.=1.05-5.42, p=0.038 in univariate analysis, HR=2.86, C.I.=1.14-7.14, p=0.025 in multivariate analysis).Conclusions Mass-like enhancement on MRI and high nuclear grade were associated with IC in patients with preoperative diagnosis of DCIS. Considering the high sensitivity of breast MRI for IC, further evaluation of the predictive value of MRI in preoperative DCIS patients is desirable.

scholarly journals Predictive factors for the presence of invasive components in patients diagnosed with ductal carcinoma in situ based on preoperative biopsy

2019 ◽  
Author(s):  
Kwan Ho Lee ◽  
Jung Woo Han ◽  
Eun Young Kim ◽  
Ji Sup Yun ◽  
Yong Lai Park ◽  
...  
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Preoperative Diagnosis ◽  
Ductal Carcinoma ◽  
Univariate Analysis ◽  
Breast Mri ◽  
Nuclear Grade ◽  
Preoperative Biopsy ◽  
Areolar Complex

Abstract Background In patients diagnosed with ductal carcinoma in situ (DCIS) with needle biopsy before surgery, invasive component (IC) is often found in the postoperative tissue, which results in altered post-surgical care. However, there are no clinically available factors to predict IC, and few MRI studies are available for the detection of IC in DCIS patients.Methods Patients with a DCIS diagnosis based on preoperative biopsy, who underwent breast surgery Kangbuk Samsung Hospital between Jan 2005 and June 2018, were retrospectively evaluated. Clinico-pathological and breast MRI factors were compared between DCIS and DCIS with IC in postsurgical specimens.Results Of the 431 patients with a preoperative diagnosis of DCIS, 34 (7.9%) showed IC during the postoperative pathological investigations, and 217 (50.3%) underwent breast MRI. Among MRI-related factors, Mass-like enhancement on MRI was the sole but significant predictor of IC (HR=0.26, C.I.=0.07-0.93, p=0.038), while nipple-areolar complex invasion, enhancement peak and pattern were not statistically significant. Nuclear grade was the only significant predictor of IC in the analysis of other clinico-pathological factors (HR=2.39, C.I.=1.05-5.42, p=0.038 in univariate analysis, HR=2.86, C.I.=1.14-7.14, p=0.025 in multivariate analysis).Conclusions Mass-like enhancement on MRI and high nuclear grade were associated with IC in patients with preoperative diagnosis of DCIS. Considering the high sensitivity of breast MRI for IC, further evaluation of the predictive value of MRI in preoperative DCIS patients is desirable.

Patterns of malignant non-mass enhancement on 3-T breast MRI help predict invasiveness: using the BI-RADS lexicon fifth edition

2018 ◽  
Vol 59 (11) ◽  
pp. 1292-1299 ◽  
Author(s):  
Seung Min Lee ◽  
Kyung Jin Nam ◽  
Ki Seok Choo ◽  
Jin You Kim ◽  
Dong Wook Jeong ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Imaging ◽  
Ductal Carcinoma ◽  
Breast Mri ◽  
Ki 67 ◽  
Factors Associated ◽  
Assessment And Treatment ◽  
Magnetic Resonance Imaging Mri ◽  
Mass Enhancement

Background Non-mass enhancements (NME) with invasive components account for 10–42% of total malignant NMEs. The factors associated with invasiveness on magnetic resonance imaging (MRI) could be useful for clinical assessment and treatment. Purpose To evaluate the clinical significances of the distributions and internal enhancement patterns (IEP) of malignant NMEs on 3-T breast MRI. Material and Methods A total of 448 consecutive women with newly diagnosed breast cancer that had undergone preoperative MRI and surgery between February 2013 and March 2016 were identified. After exclusions, 72 malignant NMEs without a mass in 72 women (mean age = 51.5 years) were included. Two readers independently assessed distributions and IEPs of NME, according to the Breast Imaging Reporting and Data System lexicon fifth edition. Collected data included the presence of invasion and histopathologic factors. Results A clustered ring IEP was significantly associated with invasive cancer (75.0%, P = 0.001, Reader1; 72.9%, P < 0.001, Reader 2), absence of necrosis (79.0%, P < 0.001; 72.1%, P < 0.001, respectively), and high Ki-67 expression (74.2%, P = 0.048; 74.2%, P = 0.003, respectively). A clumped IEP was related to ductal carcinoma in situ (33.3%, P = 0.025; 50.0%, P = 0.001, respectively), absence of lymph node metastasis (24.1%, P = 0.029; 31.5%, P = 0.030, respectively), and presence of necrosis (34.5%, P = 0.003; 44.8%, P = 0.001, respectively). Conclusion The presence of a clustered ring IEP in patients with breast cancer was found to be significantly associated with invasive breast cancer and high Ki-67 expression.

Lesion size is a major determinant of the mammographic features of ductal carcinoma in situ: findings from the Sloane project

2010 ◽  
Vol 65 (3) ◽  
pp. 181-184 ◽  
Author(s):  
A. Evans ◽  
K. Clements ◽  
A. Maxwell ◽  
H. Bishop ◽  
A. Hanby ◽  
...  
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Lesion Size ◽  
Major Determinant
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