scholarly journals The role of breast magnetic resonance imaging in the diagnosis of ductal carcinoma in situ

2013 ◽  
Vol 141 (5-6) ◽  
pp. 402-408 ◽  
Author(s):  
Mirjan Nadrljanski ◽  
Zorica Milosevic ◽  
Vesna Plesinac­Karapandzic ◽  
Branislav Goldner
Keyword(s):  
Contrast Enhancement ◽  
Signal Intensity ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Breast Magnetic Resonance Imaging ◽  
Intensity Increase ◽  
Resonance Imaging ◽  
Breast Magnetic Resonance

Ductal carcinoma in situ (DCIS), the noninvasive breast malignant tumor originates from the terminal ductal?lobular units (TDLU). The typical feature of DCSI is the formation of calcifications. Up to 90% of DCIS are diagnosed on mammographic examinations, as clinically asymptomatic. Between 10% and 20% of DCIS remain mammographically occult due to the lack of calcifications and/ or small tumor dimensions. Contrast?enhanced breast magnetic resonance imaging (MRI) detects mammographically occult breast lesions, thus defining morphologic features of the lesion and the dynamics of signal intensity changes due to contrast enhancement. Distribution of contrast enhancement - signal intensity increase in DCIS most frequently includes segmental, ductal and linear patterns, followed by regional enhancement pattern, while the intralesional contrast uptake most frequently includes the nodular pattern with the areas of confluence. Post? contrast signal intensity increase in DCIS is most frequently fast in the initial phase (wash?in), while the whole dynamic of contrast?enhancement includes either of the three possible time?intensity curve (TIC) types (persistent, plateau or washout), although the plateau TIC is considered to be more frequent. Breast MRI has high sensitivity in the diagnosis of invasive breast cancer, varying from 90% to 100%; the sensitivity in the diagnosis of DCIS is lower (77?96%). For the time being, the primary role of MRI in DCIS is planning of breast?conserving surgery (BCS) for the evaluation of lesion extension. Further development of MRI in the diagnosis of DCIS includes the implementation of the principles of functional and molecular imaging.

Preoperative Breast Magnetic Resonance Imaging in Women With Local Ductal Carcinoma in Situ to Optimize Surgical Outcomes: Results From the Randomized Phase III Trial IRCIS

2019 ◽  
Vol 37 (11) ◽  
pp. 885-892 ◽  
Author(s):  
Corinne Balleyguier ◽  
Ariane Dunant ◽  
Luc Ceugnart ◽  
Marguerite Kandel ◽  
Marie-Pierre Chauvet ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Odds Ratio ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Breast Magnetic Resonance Imaging ◽  
Resonance Imaging ◽  
End Point ◽  
Breast Magnetic Resonance

PURPOSE We evaluated the addition of breast magnetic resonance imaging (MRI) to standard radiologic evaluation on the re-intervention rate in women with ductal carcinoma in situ (DCIS) undergoing breast-conserving surgery. PATIENTS AND METHODS Women with biopsy-proven DCIS corresponding to a unifocal microcalcification cluster or a mass less than 30 mm were randomly assigned to undergo MRI or standard evaluation. The primary end point was the re-intervention rate for positive or close margins (< 2 mm) in the 6 months after randomization ( ClinicalTrials.gov identifier: NCT01112254). RESULTS A total of 360 patients from 10 hospitals in France were included in the study. Of the 352 analyzable patients, 178 were randomly assigned to the MRI arm, and 174 were assigned to the control arm. In the intent-to-treat analysis, 82 of 345 patients with the assessable end point were reoperated for positive or close margins within 6 months, resulting in a re-intervention rate of 20% (35 of 173) in the MRI arm and 27% (47 of 172) in the control arm. The absolute difference of 7% (95% CI, −2% to 16%) corresponded to a relative reduction of 26% (stratified odds ratio, 0.68; 95% CI, 0.41 to 1.1; P = .13). When considering only the per-protocol population with an assessable end point, the difference was 9% (stratified odds ratio, 0.59; 95% CI, 0.35 to 1.0; P = .05). Total mastectomy rates were 18% (31 of 176) in the MRI arm and 17% (30 of 173) in the control arm (stratified P = .93). For 100 lesions seen on MRI, nonmass-like enhancement was more predominant (82%) than mass enhancement (20%). Nevertheless, no specific morphologic and kinetic parameters for DCIS were identified. CONCLUSION The study did not show sufficient surgical improvement with the use of preoperative MRI to be clinically relevant in DCIS staging. However, this could be reconsidered with the improvement of new MRI sequences and new modalities in magnetic resonance techniques.

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