Extension of Ductal Carcinoma in Situ: Histopathological Association with MR Imaging and Mammography

Shiraishi, Akihiko; Kurosaki, Yoshihisa; Maehara, Tadayuki; Suzuki, Mitsuaki; Kurosumi, Masafumi

doi:10.2463/mrms.2.159

Cited by 40 publications

(27 citation statements)

References 22 publications

(14 reference statements)

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“…The limitation of mammography in the preoperative assessment of DCIS extent is well recognized since microcalcifications may coexist in the same DCIS lesion with uncalcified areas not associated with pathologic findings at mammography (17,18). Thus, in the era of breast-conserving surgery, there could be the risk that mammographically undetected areas would not be surgically removed, thus increasing the rate of surgical reoperation and local recurrences.…”

Section: Discussionmentioning

confidence: 99%

Breast Scintigraphy with Breast-Specific γ-Camera in the Detection of Ductal Carcinoma In Situ: A Correlation with Mammography and Histologic Subtype

et al. 2012

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Ductal carcinoma in situ (DCIS) is a subtype of breast cancer encountered increasingly in clinical practice because of the widespread use of screening mammography. In the present study, we evaluated the usefulness of breast-specific g-camera (BSGC) scintigraphy in DCIS identification, describing the scintigraphic findings and their correlation with mammography and histologic subtype. Methods: Thirty-three women, aged 41-81 y, with surgically proven DCIS were retrospectively reviewed. Before surgery, all patients underwent breast scintigraphy using a high-resolution semiconductor-based BSGC, starting 10 min after intravenous injection of 740 MBq of 99m Tc-tetrofosmin. All patients had previously undergone mammography. A definitive histologic diagnosis was obtained in all cases after scintigraphy, and the scintigraphic findings were correlated with mammography and histologic subtype. Results: Mammography was positive in 30 of 33 patients (sensitivity, 90.9%), showing calcifications in 22 of 30 (73.3%), masses in 3 of 30 (10%), and masses plus calcifications in the remaining 5 of 30 (16.7%). Scintigraphy was positive in 31 of 33 patients (sensitivity, 93.9%), showing patchy irregular uptake in patients with calcifications and focal uptake in masses; sensitivity was higher in low-to intermediate-grade DCIS than in intermediate/high-and high-grade DCIS (100% vs. 91.3%), but the difference was not statistically significant. Two comedo-type DCIS (one 20-mm intermediate/high-grade and one 15-mm high-grade) with heterogeneously or highly dense breasts at mammography and one papillary low/intermediate-grade DCIS associated with Paget disease were true positive only at scintigraphy. Moreover, scintigraphy better assessed disease extent than did mammography in 5 additional patients. Two comedo-type DCIS (one 6-mm intermediate/highgrade and one 15-mm high-grade) were true positive only at mammography. The difference in sensitivity between scintigraphy and mammography was not statistically significant. The combined use of mammography and scintigraphy achieved 100% sensitivity. Conclusion: BSGC scintigraphy proved to be a highly sensitive diagnostic tool in the detection of DCIS, irrespective of histologic subtype, and with a scintigraphic pattern of uptake that correlated well with mammography findings. In our series, BSGC scintigraphy demonstrated a slightly higher sensitivity than mammography and a better assessment of local disease extent. Thus, BSGC scintigraphy should represent a useful adjunctive tool in breast cancer diagnosis.Key Words: DCIS; breast-specific g-camera scintigraphy; mammography Duct al carcinoma in situ (DCIS) of the breast is a noninvasive subtype of primary breast cancer characterized by a malignant proliferation of ductal epithelium with no histologic evidence of invasion through the ductal basement membrane (1). The mortality associated with a pure DCIS without invasion is thus extremely low, generally lower than 1%-2% (2).However, different behaviors have been observed after the initial treatment; ...

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Section: Discussionmentioning

confidence: 99%

Breast Scintigraphy with Breast-Specific γ-Camera in the Detection of Ductal Carcinoma In Situ: A Correlation with Mammography and Histologic Subtype

et al. 2012

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“…DCIS is considered to be a nonobligate precursor of invasive cancer, and if treated has dramatically higher survival than invasive cancers. 18,19 Yet the sensitivity and specificity of DCEMRI for detection of DCIS needs improvement, 15,16,[20][21][22][23][24][25][26][27] particularly given recent American Cancer Society guidelines recommending breast MRI in the screening of women at high risk of developing breast cancer. 28 It is likely that mass-like and nonmass-like enhancement patterns reflect differences in the underlying physiology and vasculature of these lesions, which may in turn affect the kinetic characteristics.…”

Section: Introductionmentioning

confidence: 99%

DCEMRI of breast lesions: Is kinetic analysis equally effective for both mass and nonmass-like enhancement?

et al. 2008

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To perform a pilot study investigating whether the sensitivity and specificity of kinetic parameters can be improved by considering mass and nonmass breast lesions separately. The contrast media uptake and washout kinetics in benign and malignant breast lesions were analyzed using an empirical mathematical model ͑EMM͒, and model parameters were compared in lesions with masslike and nonmass-like enhancement characteristics. 34 benign and 78 malignant breast lesions were selected for review. Dynamic MR protocol: 1 pre and 5 postcontrast images acquired in the coronal plane using a 3D T1-weighted SPGR with 68 s timing resolution. An experienced radiologist classified the type of enhancement as mass, nonmass, or focus, according to the BI-RADS® lexicon. The kinetic curve obtained from a radiologist-drawn region within the lesion was analyzed quantitatively using a three parameter EMM. Several kinetic parameters were then derived from the EMM parameters: the initial slope ͑Slope ini ͒, curvature at the peak ͑ peak ͒, time to peak ͑T peak ͒, initial area under the curve at 30 s ͑iAUC 30 ͒, and the signal enhancement ratio ͑SER͒. The BI-RADS classification of the lesions yielded: 70 mass lesions, 38 nonmass, 4 focus. For mass lesions, the contrast uptake rate ͑␣͒, contrast washout rate ͑␤͒, iAUC 30 , SER, Slope ini , T peak and peak differed substantially between benign and malignant lesions, and after correcting for multiple tests of significance SER and T peak demonstrated significance ͑p Ͻ 0.007͒. For nonmass lesions, we did not find statistically significant differences in any of the parameters for benign vs. malignant lesions ͑p Ͼ 0.5͒. Kinetic parameters could distinguish benign and malignant mass lesions effectively, but were not quite as useful in discriminating benign from malignant nonmass lesions. If the results of this pilot study are validated in a larger trial, we expect that to maximize diagnostic utility, it will be better to classify lesion morphology as mass or nonmass-like enhancement prior to kinetic analysis.

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“…In one study (13), the difference may have existed because five of the 12 low-grade lesions studied did not enhance at all; in our study, we only considered DCIS lesions that enhanced at MR imaging. In other studies (22,23), the numbers of lesions consid- …”

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confidence: 83%

Detection and Evaluation of Early Breast Cancer via Magnetic Resonance Imaging: Studies of Mouse Models and Clinical Implementation

Jansen¹

2009

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Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing this collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. (From -To) REPORT DATE (DD-MM-YYYY) 01-03-2008 REPORT TYPE Annual Summary DATES COVERED PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) 8. PERFORMING ORGANIZATION REPORT NUMBERUniversity of Chicago Chicago, IL 60637 SPONSORING / MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR'S ACRONYM(S) U.S. Army Medical Research and Materiel Command Fort Detrick, Maryland 21702-5012 SPONSOR/MONITOR'S REPORT NUMBER(S) DISTRIBUTION / AVAILABILITY STATEMENTApproved for Public Release; Distribution Unlimited SUPPLEMENTARY NOTES ABSTRACTThe general goals of this research are to (i) improve the specificity of MRI to early cancer, particularly ductal carcinoma in situ (DCIS), by studying the MR presentation of early cancers compared with other malignant and benign lesions in women, (ii) to develop techniques for imaging DCIS and early invasive cancer in mice via MR imaging, and (iii) to use these techniques to study the progression of murine mammary cancer. The pre-clinical animal research proposed here can directly lead to clinical improvements in both early breast cancer detection, as well as effective breast cancer therapy. To date, we have performed a comprehensive evaluation of the MR kinetic and morphologic characteristics of DCIS and early invasive cancers compared with other lesions. We have also developed techniques to image early murine mammary cancer, including DCIS, using in vivo MRI. To our knowledge, this is the first report of the in vivo detection of murine DCIS with histopathologic correlation. We have also performed a longitudinal imaging experiment in 12 transgenic mice, following the development and progression of murine DCIS into invasive carcinoma. In this study we have found that some DCIS lesions have remained stable and did not progress to invasive cancer during the study window. These represent the first steps towards probing in vivo the radiologic and biologic changes that occur during the transition from in situ to invasive cancer. SUBJECT TERMSEarly detection, MRI, mouse models, DCIS References……………………………………………………………………………. 20Appendices…………………………………………………………………………… 21 INTRODUCTIONThe ea...

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Extension of Ductal Carcinoma in Situ: Histopathological Association with MR Imaging and Mammography

Cited by 40 publications

References 22 publications

Breast Scintigraphy with Breast-Specific γ-Camera in the Detection of Ductal Carcinoma In Situ: A Correlation with Mammography and Histologic Subtype

Breast Scintigraphy with Breast-Specific γ-Camera in the Detection of Ductal Carcinoma In Situ: A Correlation with Mammography and Histologic Subtype

DCEMRI of breast lesions: Is kinetic analysis equally effective for both mass and nonmass-like enhancement?

Detection and Evaluation of Early Breast Cancer via Magnetic Resonance Imaging: Studies of Mouse Models and Clinical Implementation

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