Features of Occult Invasion in Biopsy-Proven DCIS at Breast MRI

Abstract

Purpose To determine if MRI BI-RADS criteria or radiologist perception correlate with presence of invasive cancer after initial core biopsy of ductal carcinoma in situ (DCIS). Materials and Methods Retrospective search spanning 2000-2007 identified all core-biopsy diagnoses of pure DCIS that coincided with preoperative MRI. Two radiologists fellowship-trained in breast imaging categorized lesions according to ACR MRI-BIRADS lexicon and estimated likelihood of occult invasion. Semi-quantitative signal enhancement ratio (SER) kinetic analysis was also performed. Results were compared to histopathology. Results 51 consecutive patients with primary core biopsy-proven DCIS and concurrent MRI were identified. Of these, 13 patients (25%) had invasion at excision. Invasion correlated significantly with presence of a mass for both readers (p=0.012, 0.001), rapid initial enhancement for Reader 1 (p=0.001), and washout kinetics for Reader 2 (p=0.012). Significant correlation between washout and invasion was confirmed by SER (p=0.006) when threshold percent enhancement was sufficiently high (130%), corresponding to rapidly enhancing portions of the lesion. Radiologist perception of occult invasion was strongly correlated to true presence of invasion. Conclusion These results provide evidence that certain BI-RADS MRI criteria, as well as radiologist perception, correlate with occult invasion after an initial core biopsy of DCIS.

Can algorithmically assessed MRI features predict which patients with a preoperative diagnosis of ductal carcinoma in situ are upstaged to invasive breast cancer?

“…Upstaging of DCIS to invasive carcinoma has implications for treatment planning. In this dataset, the rate of upstaging from DCIS to DCIS with an invasive component was within the ranges previously identified and similar to the average rate of upstaging found in Brennan et al and Lee et al Our study shows that semiautomatically assessed MRI features may have a role in predicting patients with a preoperative diagnosis of DCIS who are at increased risk for having an invasive component to their disease.…”

“…If an imaging marker predictive of DCIS upstaging to invasive carcinoma at surgery can be identified using routine imaging, clinicians may be able to better manage patients with underestimated invasive breast cancer. Previous work using radiologist‐identified features has shown that MRI has the potential to diagnose occult invasive disease in DCIS patients . The purpose of this study is to expand upon this previous work by assessing the ability of semiautomatically assessed MRI features to predict DCIS upstaging to invasive carcinoma at the time of surgery.…”

“…While a CNB is typically sufficient for a pathologist to make a diagnosis of DCIS, the small total volume of tumor sampled by CNB may miss adjacent invasive cancer. At the time of definitive surgery, upstaging to invasive disease occurs in 3.5–56% of cases . A meta‐analysis of DCIS upstaging rates by Brennan et al concluded an average upstaging rate of 25.9%, while Lee et al reviewed the literature to find an average rate of 20.9%.…”

“…At the time of definitive surgery, upstaging to invasive disease occurs in 3.5-56% of cases. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] A meta-analysis of DCIS upstaging rates by Brennan et al 7 concluded an average upstaging rate of 25.9%, while Lee et al 19 reviewed the literature to find an average rate of 20.9%. Because the prognostic and therapeutic implications of DCIS and invasive carcinoma differ, accurate detection of invasive cancer is clinically important.…”

“…Previous work using radiologist-identified features has shown that MRI has the potential to diagnose occult invasive disease in DCIS patients. 7,8,13,15,19 The purpose of this study is to expand upon this previous work by assessing the ability of semiautomatically assessed MRI features to predict DCIS upstaging to invasive carcinoma at the time of surgery.…”