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BackgroundWe aimed to analyse the morphokinetic features of breast fibrocystic changes (nonproliferative lesions, proliferative lesions without atypia and proliferative lesions with atypia) presenting as a non-mass enhancement (NME)in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) examination.Patients and methodsForty-six patients with histologically proven fibrocystic changes (FCCs) were retrospectively reviewed, according to Breast Imaging Reporting and Data System (BI-RADS) lexicon. Prior to DCE-MRI examination, a unilateral breast lesion suspicious of malignancy was detected clinically, on mammography or breast ultrasonography.ResultsThe predominant features of FCCs presenting as NME in DCE-MRI examination were: unilateral regional or diffuse distribution (in 35 patients or 76.1%), heterogeneous or clumped internal pattern of enhancement (in 36 patients or 78.3%), plateau time-intensity curve (in 25 patients or 54.3%), moderate or fast wash-in (in 31 patients or 67.4%).Nonproliferative lesions were found in 11 patients (24%), proliferative lesions without atypia in 29 patients (63%) and lesions with atypia in six patients (13%), without statistically significant difference of morphokinetic features, except of the association of clustered microcysts with proliferative dysplasia without atypia.ConclusionsFCCs presenting as NME in DCE-MRI examination have several morphokinetic features suspicious of malignancy, therefore requiring biopsy (BI-RADS 4). Nonproliferative lesions, proliferative lesions without atypia and proliferative lesions with atypia predominantly share the same predefined DCE-MRI morphokinetic features.

BackgroundAdequate diagnosis of ductal carcinoma in situ (DCIS) could lead to efficacious treatment. Due to the fact that DCIS lesions can progress to invasive carcinomas and that the sensitivity of the standard examination – mammography – is between 70 and 80%, use of a more sensitive diagnostic tool was needed. In detection of DCIS, contrast-enhanced magnetic resonance imaging (CE-MRI) has the sensitivity up to 96%.ObjectivesMorphological features and kinetic parameters were evaluated to define the most regular morphological, kinetic and morpho-kinetic patterns on MRI assessment of breast ductal carcinoma in situ (DCIS).Patients and MethodsWe retrospectively assessed eighteen patients with 23 histologically confirmed lesions (mean age, 52.4 ± 10.5 years). All patients were clinically and mammographically examined prior to MRI examination.ResultsDCIS appeared most frequently as non-mass-like lesions (12 lesions, 52.17%). The differences in the frequency of lesion types were statistically significant (P<0.05). The following morphological patterns were detected: A: no specific morphologic features, B: linear/branching enhancement, C: focal mass-like enhancement, D: segmental enhancement, E: segmental enhancement in triangular shape, F: diffuse enhancement, G: regional heterogeneous enhancement in one quadrant not conforming to duct distribution and H: dotted or granular type of enhancement with patchy distribution. The difference in the frequency of the proposed patterns was statistically significant (P<0.05). There were eight lesions with mass enhancement, and six with segmental lesions: regional and triangular. There was no statistically significant difference in the frequency of enhancement curve types (P>0.05). There was no significant difference in the frequency of morpho-kinetic patterns.ConclusionNon-mass-like lesions, lesions with focal or segmental distribution, with a “plateau” enhancement curve type were the most frequent findings of DCIS lesions on MRI.

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Introduction: Microcalcifications represent a significant and reliable sign of the presence of the malignant breast lesion. Aim: The aim of the paper is to radiologically evaluate the type and distribution of suspicious microcalcifications, in patients with invasive ductal carcinoma (IDC) and ductal carcinoma in situ (DCIS). Material and Methods: Retrospective analysis includes the evaluation of the type and distribution of suspicious microcalcifications, in patients with histologically verified malignant lesions: invasive ductal carcinoma (N1=40 pts.) and ductal carcinoma in situ (N2=40 pts.). Standardised mediolateral oblique and cranicaudal views were selected for the evaluation of the images, taken on the full-field digital mammograph (FFDM «Selenia», Institute of Oncology and Radiology of Serbia, Belgrade), on the dedicated workstation of the mammography unit, with the aid of the software for lesion evaluation. Results: Eight patients with invasive ductal carcinoma (20%) had no suspicious microcalcifications, as opposed to the patients with ductal in situ carcinoma, where all patients had suspicious microcalcifications (p<0.05). In the subgroup of patients with invasive ductal carcinoma, the most frequent type of microcalcifications included the fine pleomorphic calcifications (75%). In patients with ductal carcinoma in situ, amorphous (57.5%) and linear/ branching microcalcifications were more frequent than other types (55%). Conclusion:The results of this study show that the amorphous microcalcifications segmental distribution usually detected in the subgroup with DCIS, which coincides with published results. With acceptable sensitivity and specificity, amorphous microcalcifications and linear distribution segment represents a specific mammographic findings in the detection of DCIS.

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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. Postcontrast 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.