Ductal Carcinoma in Situ: Quantitative Preoperative Breast MR Imaging Features Associated with Recurrence after Treatment

Abstract

Purpose To investigate whether specific imaging features on breast magnetic resonance (MR) images are associated with ductal carcinoma in situ (DCIS) recurrence risk after definitive treatment. Materials and Methods Patients with DCIS who underwent preoperative dynamic contrast material-enhanced (DCE) MR imaging between 2004 and 2014 with ipsilateral recurrence more than 6 months after definitive surgical treatment were retrospectively identified. For each patient, a control subject with DCIS that did not recur was identified and matched on the basis of clinical, histopathologic, and treatment features known to affect recurrence risk. On DCE MR images, lesion characteristics (longest diameter, functional tumor volume [FTV], peak percentage enhancement [PE], peak signal enhancement ratio [SER], and washout fraction) and normal tissue features (background parenchymal enhancement [BPE] volume, mean BPE) were quantitatively measured. MR imaging features were compared between patients and control subjects by using the Wilcoxon signed-rank test, with adjustment for multiple comparisons. Results Of 415 subjects with DCIS who underwent preoperative MR imaging, 14 experienced recurrence and 11 had an identifiable matching control subject (final cohort, 11 patients and 11 control subjects). Median time to recurrence was 14 months, and median follow-up for control subjects was 102 months. When compared with matched control subjects, patients with DCIS recurrence exhibited significantly greater FTV (median, 9.3 cm vs 1.3 cm, P = .01), lesion peak SER (median, 1.7 vs 1.2; P = .03), and mean BPE (median, 58.3% vs 41.1%; P = .02). Conclusion Quantitative lesion and normal breast tissue characteristics at preoperative MR imaging in women with newly diagnosed DCIS show promise for association with breast cancer recurrence after treatment. RSNA, 2017.

Combined application of pharamcokinetic DCE‐MRI and IVIM‐DWI could improve detection efficiency in early diagnosis of ductal carcinoma in situ

“…DCIS is defined as a malignant proliferation of ductal cells of the breast that does not invade through the basal membrane. However, some high‐grade DCIS lesions could lead to life‐threatening invasive breast cancers if it is left untreated . Because DCIS lesions are precancerous rather than malignant lesions, they lack the typical manifestations of invasive ductal carcinoma and then it is difficult to distinguish DCIS from benign lesions in morphology.…”

Background parenchymal enhancement on breast MRI: A comprehensive review

“…In support of precision therapy, BPE could be associated with other clinicopathologic factors that may help determine optimal treatment. In a retrospective case–control study of patients with unilateral DCIS, higher quantitative mean BPE on pretreatment breast MRI was associated with disease recurrence following treatment . These findings indicate that BPE could be helpful in determining which patients require adjuvant radiation or other therapies.…”

Application of Radiomics and Decision Support Systems for Breast MR Differential Diagnosis

“…The high gadolinium uptake by tumors helps the clinicians in the accurate differentiation of breast lesions compared to normal tissue. Furthermore, DCE-MRI signal time-series evaluation through empirical or pharmacokinetic models has presented robust results for tumor characterization [ 14 , 15 ], as well as monitoring response to therapy parameters [ 16 , 17 ]. For example, benign and malignant breast lesions differ in the characteristics of their microvessels, and hence in their behavior of gadolinium uptake in the lesion which can be measured with the pharmacokinetic parameters of vascular permeability, such as the transfer constant K trans , K trans measures the transit of contrast agent through the vascular bed at the capillary level and reflects qualitative changes of tumor vessels (i.e., increased porosity/permeability), a surrogate of neoangiogenesis.…”