Magnetic resonance imaging of the breast: role in the evaluation of ductal carcinoma in situ

Abstract

Ductal carcinoma in situ (DCIS) is a precursor mammary lesion whose malignant cells do not extend beyond the basement membrane and presents a risk of progression to malignant disease. Its early detection increased with screening mammography. The objective of this study was to review the literature on the main presentations of DCIS on magnetic resonance imaging (MRI), through searches of the Medline/PubMed, Latin-American and Caribbean Center on Health Sciences Information (Lilacs), and Scientific Electronic Library Online (SciELO) databases. DCIS can occur in its pure form or in conjunction with invasive disease, in the same lesion, in different foci, or in the contralateral breast. MRI has a high sensitivity for the detection of pure DCIS, being able to identify the non-calcified component, and its accuracy increases with the nuclear grade of the lesion. The most common pattern of presentation is non-nodular enhancement; heterogeneous internal structures; a kinetic curve showing washout or plateau enhancement; segmental distribution; and restricted diffusion. MRI plays an important role in the detection of DCIS, especially in the evaluation of its extent, contributing to more reliable surgical excision and reducing local recurrence.

Radiologic-pathologic correlation in breast cancer: do MRI biomarkers correlate with pathologic features and molecular subtypes?

“…The specific features of DCIS are calcifications at digital mammography (70-90% of cases [36]) and non-mass enhancement at MRI contrast-enhanced sequences (up to 81% of cases [34,[37][38][39]); our results (86.7% of DCIS presented as non-mass enhancements, p < 0.001) are in substantial agreement with those data. A second MRI feature significantly associated with DCIS was T2 isointensity (78.6%, p < 0.001) (Fig.…”

Preoperative breast magnetic resonance imaging in patients with ductal carcinoma in situ: a systematic review for the European Commission Initiative on Breast Cancer (ECIBC)

“…It has been proposed as an additional test after mammography, to improve the assessment of the extent of DCIS during the preoperative planning, providing better identification of candidates for BCS especially in the context of extensive microcalcifications [7]. Despite previous reviews suggesting MRI benefits [8][9][10], there is still uncertainty as some studies suggest it may overestimate the extent of disease, leading to an increase of unnecessary mastectomies or wider excisions [11,12].…”

The imaging appearances of non‐calcified ductal carcinoma in situ: A pictorial essay

“…The higher restriction of water movement in breast carcinoma manifests as high signal on diffusion restriction and lower apparent diffusion coefficient (ADC) values. Tajima et al 12 . reported that ADC values are typically higher in DCIS than in IDC.…”

“…Magnetic resonance imaging (MRI) is considered the gold standard in assessing local extent of disease in the breast 3 with sensitivities ranging from 60% to 100%, 12,13 and greater diagnostic accuracy of higher grade DCIS over conventional modalities (91.8% vs 36.7%) 14 . Dynamic contrast enhanced MRI of the breasts exploits carcinoma neovascularity, resulting in vascular hypertrophy and increased permeability which manifests as Gadolinium enhanced tissue (Fig.…”

“…Like CEDM, 3,10 DCIS of all grades, both calcified and non‐calcified, typically manifests as masses and non mass enhancement, 3,5 usually with peak contrast enhancement later than IDC 3 . Discrete enhancing foci or masses of variable distribution have also been described (usually lower histological grade), most commonly with plateau or washout enhancement kinetics 12 …”