MRI of the Breast for the Detection and Assessment of the Size of Ductal Carcinoma in Situ

Kim, Do-Youn;Moon, Woo-Kyung;Cho, Na-Ri-Ya;Ko, Eun-Sook;Yang, Sang-Kyu;Park, Jeong-Seon;Kim, Sun-Mi;Park, In-Ae;Cha, Joo-Hee;Lee, Eun-Hye

  • Published : 20070200

Abstract

Objective: The aim of the study was to compare the accuracy of magnetic resonance imaging (MRI) and mammography for the detection and assessment of the size of ductal carcinoma in situ (DCIS). Materials and Methods: The preoperative contrast-enhanced MRI and mammography were analyzed in respect of the detection and assessment of the size DCIS in 72 patients (age range: 30 67 years, mean age: 47 years). The MRI and mammographic measurements were compared with the histopathologic size with using the Pearson's correlation coefficients and the Mann-Whitney u test. We evaluated whether the breast density, the tumor nuclear grade, the presence comedo necrosis and microinvasion influenced the MRI and mammographic size estimates by using the chi-square test. Results: Of the 72 DCIS lesions, 68 (94%) were detected by MRI and 62 86%) were detected by mammography. Overall, the Pearson's correlation of the size between MRI and histopathology was 0.786 versus 0.633 between mammography and histopathology (p < 0.001). MRI underestimated the size by more than 1 cm (including false negative examination) in 12 patients (17%), was accurate in 52 patients (72%) and overestimated the size by more than 1 cm in eight patients (11%) whereas mammography underestimated the size in 25 patients 35%), was accurate in 31 patients (43%) and overestimated the size in 16 patients (22%). The MRI, but not the mammography, showed significant correlation for the assessment of the size of tumor in noncomedo DCIS (p < 0.001 vs p 0.060). The assessment of tumor size by MRI was affected by the nuclear grade (p = 0.008) and the presence of comedo necrosis (p = 0.029), but not by the breast density (p = 0.747) or microinvasion (p = 0.093). Conclusion: MRI was more accurate for the detection and assessment of the size of DCIS than mammography.

Keywords

References

  1. Dershaw DD, Abramson A, Kinne DW. Ductal carcinoma in situ: mammographic findings and clinical implications. Radiology 1989;170:411-415 https://doi.org/10.1148/radiology.170.2.2536185
  2. Stomper PC, Connolly JL, Meyer JE, Harris JR. Clinically occult ductal carcinoma in situ detected with mammography: analysis of 100 cases with radiologic-pathologic correlation. Radiology 1989;172:235-241 https://doi.org/10.1148/radiology.172.1.2544922
  3. Ikeda DM, Andersson I. Ductal carcinoma in situ (DCIS): atypical mammographic appearances. Radiology 1989;172:661- 666 https://doi.org/10.1148/radiology.172.3.2549563
  4. Silverstein MJ. Ductal carcinoma in situ (DCIS) of the breast: diagnostic and therapeutic controversies. J Am Coll Surg 2001;192:196-214 https://doi.org/10.1016/S1072-7515(00)00791-2
  5. Orel SG, Schnall MD, LiVolsi VA, Troupin RH. Suspicious breast lesions: MR imaging with radiologic-pathologic correlation. Radiology 1994;190:485-493
  6. Soderstrom CE, Harms SE, Copit DS, Evans WP, Savino DA, Krakos PA, et al. Three-dimensional RODEO breast MR imaging of lesions containing ductal carcinoma in situ. Radiology 1996;201:427-432
  7. Kristoffersen Wiberg M, Aspelin P, Sylvan M, Bone B. Comparison of lesion size estimated by dynamic MR imaging, mammography and histopathology in breast neoplasms. Eur Radiol 2003;13:1207-1212
  8. Mumtaz H, Hall-Craggs MA, Davidson T, Walmsley K, Thurell W, Kissin MW, et al. Staging of symptomatic primary breast cancer with MR imaging. AJR Am J Roentgenol 1997;169:417- 424 https://doi.org/10.2214/ajr.169.2.9242745
  9. Morris EA, Liberman L, Ballon DJ, Robson M, Abramson AF, Heerdt A, et al. MRI of occult breast carcinoma in a high-risk population. AJR Am J Roentgenol 2003;181:619-626 https://doi.org/10.2214/ajr.181.3.1810619
  10. Hata T, Takahashi H, Watanabe K, Takahashi K, Taguchi K, Itoh T, et al. Magnetic resonance imaging for preoperative evaluation of breast cancer: a comparative study with mammography and ultrasonography. J Am Coll Surg 2004;198:190-197 https://doi.org/10.1016/j.jamcollsurg.2003.10.008
  11. Van Goethem M, Schelfout K, Dijckmans L, Van Der Auwera JC, Weyler J, Verslegers I, et al. MR mammography in the preoperative staging of breast cancer in patients with dense breast tissue: comparison with mammography and ultrasound. Eur Radiol 2004;14:809-816 https://doi.org/10.1007/s00330-003-2146-7
  12. Boetes C, Mus RD, Holland R, Barentsz JO, Strijk SP, Wobbes T, et al. Breast tumors: comparative accuracy of MR imaging relative to mammography and US for demonstrating extent. Radiology 1995;197:743-747 https://doi.org/10.1148/radiology.197.3.7480749
  13. Gilles R, Zafrani B, Guinebretiere JM, Meunier M, Lucidarme O, Tardivon AA, et al. Ductal carcinoma in situ: MR imaginghistopathologic correlation. Radiology 1995;196:415-419 https://doi.org/10.1148/radiology.196.2.7617854
  14. Heywang-Kobrunner SH. Contrast-enhanced magnetic resonance imaging of the breast. Invest Radiol 1994;29:94-104 https://doi.org/10.1097/00004424-199401000-00019
  15. American College of Radiology. Breast imaging reporting and data system (BI-RADS). Reston, Va: American College of Radiology, 2003
  16. Boetes C, Strijk SP, Holland R, Barentsz JO, Van Der Sluis RF, Ruijs JH. False-negative MR imaging of malignant breast tumors. Eur Radiol 1997;7:1231-1234 https://doi.org/10.1007/s003300050281
  17. Bluemke DA, Gatsonis CA, Chen MH, DeAngelis GA, DeBruhl N, Harms S, et al. Magnetic resonance imaging of the breast prior to biopsy. JAMA 2004;292:2735-2742 https://doi.org/10.1001/jama.292.22.2735
  18. Folkman J. What is the evidence that tumors are angiogenesis dependent? J Natl Cancer Inst 1990;82:4-6 https://doi.org/10.1093/jnci/82.1.4
  19. Guidi AJ, Fischer L, Harris JR, Schnitt SJ. Microvessel density and distribution in ductal carcinoma in situ of breast. J Natl Cancer Inst 1994;86:614-619 https://doi.org/10.1093/jnci/86.8.614
  20. Neubauer H, Li M, Kuehne-Heid R, Schneider A, Kaiser WA. High grade and non-high grade ductal carcinoma in situ on dynamic MR mammography: characteristic findings for signal increased and morphological pattern of enhancement. Br J Radiol 2003;76:3-12 https://doi.org/10.1259/bjr/14883856